Strategic Alliance

Atrategic Alliance

San Francisco’s Chiro-Medical Group leverages the power of its multidisciplinary approach to achieve excellence in chiropractic care.

By Amy Stankiewicz

When Scott Calzaretta, DC, got the idea of providing a multidisciplinary approach to chiropractic care in the heart of San Francisco, he didn’t start close to home. It was during the World Championships of Athletics in Rome in 1987 when he realized how important a team approach to treating athletes can be.

“We were the doctors at the host medical facility, and the three of us (Calzaretta, David Pierson, DC, and Don Oyoa, DC) had the longest line of athletes from all over the world waiting to get adjusted,” Calzaretta says. At the time, he was traveling with the Fédération Internationale de Chiropratique du Sport (FICS), a group that organizes teams of doctors and other healthcare providers to treat professional athletes at international sporting events. Calzaretta is also a founding board member of FICS; the federation began in 1987.

The federation “always had multidisciplinary teams,” says Calzaretta, who graduated from Life Chiropractic College East (now Life University) in 1985. He says he was impressed at these teams’ ability to address many athletes’ needs quickly and with seamless communication across specialties.

Calzaretta also cites his experience with the team-based approach used at the 24th Olympic Games in 1988. At that time, he and Pierson had befriended the Korean Olympic team doctor, a renowned neurosurgeon who had invited them to join him in treating some of his patients.

“What happened then was incredible,” Calzaretta says. “In those days, they did CT myelograms to evaluate low-back-injured patients. So in the mornings before the Games, we would go to the hospital where (the Korean neurosurgeon) was the head of the neurosurgical department and treat patients. David Pierson and I started treating the patients who were scheduled for surgery, and over the next two weeks we cleared out his (the neurosurgeon’s) entire low-back-patient surgical schedule.

“I wish this was always the case, but during those two weeks, as demonstrated by pre- and post-CT myelograms (they did post-treatment to see what effect we had on the patients’ disc injuries), we reduced multiple disc herniations/protrusions and the patients were no longer candidates for surgery,” he adds. “It was at that moment that we all realized that we should be a team and manage patients together. As an aside, he (the Korean doctor) sent neurosurgeons to our clinic for the next five years to watch what we did, and eventually he added a chiropractor to his staff.”

Calzaretta says he also gained an appreciation for the benefits of a multidisciplinary approach after serving as a consultant at St. Francis Memorial Hospital’s San Francisco Spine Center. That center didn’t practice multidisciplinary medicine, he explains, and after seeing the advantages of such care working with the FICS, “We thought we could have more success with this approach working in a private clinic. At that time, it was easier to set up a multidisciplinary approach in a private clinic.”

Thus was born Chiro-Medical Group. Today, Calzaretta and Taylor Rabbetz, DC, his partner since 2000, treat nearly 1,000 patients a week by providing access to a variety of therapies and treatments designed to optimize their health and well-being. The practice incorporated in 1994.

“The multidisciplinary approach gives patients the best opportunity to have a successful outcome in their care,” Calzaretta says. He has also served as an Olympic team doctor at past Olympic events and was one of the first chiropractors to complete the American College of Sports Medicine Team Physician program.

The multidisciplinary mindset

Chiro-Medical Group’s multidisciplinary team includes professionals from a wide range of specialties. Its primary medical care team includes in-house medical doctors who focus on pain management and rehabilitation as well as family practice.

The practice goes beyond traditional chiropractic care by providing access to basic primary care services such as treatment for colds, rashes, infections, bronchitis, and digestive disorders. The group also offers access to general physical exams and women’s health services such as gynecological exams.

Regarding sports medicine, Chiro-Medical Group provides such services as video running-gait analysis, functional movement analysis (to identify and treat recurrent athletic injuries), and orthotics casting and prescription. The group has independent personal trainers on hand to help patients improve their speed, agility, and strength.

In the area of physical therapy, the group offers exercise and rehabilitation services provided by board-certified physical therapists and certified athletic trainers. Among the physical therapy offerings are sports injury treatment, computerized muscle testing and assessment, computerized range of motion evaluation, and more. Exercise rehabilitation offerings include neuromuscular reeducation, cardiovascular exercise, and strengthening and conditioning.

Chiro-Medical Group has also entered into less traditional areas of medicine to offer more alternative healthcare options to the residents of San Francisco. The group provides biopuncture treatments, platelet-rich plasma therapy and prolotherapy to treat both sporting and other injuries.

According to Rabbetz, at least half of the group’s patients are seeking less invasive medical treatments that can help them avoid traditional surgery. “People who were destined to go to surgery are getting results” with prolotherapy and biopuncture, he explains.

And for those individuals who simply want to take their golf game to the next level, Calzaretta himself runs a golf program in which individuals can perfect their swing. Calzaretta is golf injury certified through the Blanchard Golf Academy and is medical professional level-3-certified through the Titleist Performance Institute.

Growing the multidisciplinary approach

Calzaretta knew early on that he wanted to create a multidisciplinary approach to chiropractic care, but it didn’t happen overnight. It took time to decide exactly what specialties he wanted to incorporate into his practice. To answer this question, he looked to his patients for inspiration.

“You need to set up your multidisciplinary practice based on what you think your patients need,” he explains. “It depends on what you think works best for your patients.”

Because Chiro-Medical Group is in a large city, one of the main things the practice’s patients wanted was convenience. So Calzaretta and Rabbetz used that information to build their multi-specialty practice, and they did it around the specialty they both do best — chiropractic medicine.

“Our original approach has gone through different phases,” Rabbetz says. “Our original problem was trying to formulate who should see (the patients). The thing that worked the best and that is now working very well is that the practice is centered on chiropractic care. We see those patients and gain their trust, and they trust us to guide their health. We are at the point where the practice is driving itself, telling us where to go.”

One of the places the practice has gone is into San Francisco’s financial district. In an effort to meet patients’ desire for convenience, Chiro-Medical Group now operates an express clinic called Chiro-Medical Express, which focuses on the needs of busy people working in the city’s financial district.

Chiro-Medical Express is designed for people “who want treatment on an almost walk-in basis,” Calzaretta says. “This is a niche market in which patients want that quick approach.” Any patients who need more advanced care than the express center can provide are referred to the main practice location in the South of Market (SOMA) district.

Calzaretta and Rabbetz have seen impressive results from their efforts to meet patient needs in an easily accessible, multidisciplinary environment. Rabbetz cites a recent example of streamlined communication:

“We set up a physical therapy program for a few patients after they were done with their chiropractic treatment,” he says. “After a couple of visits, the patients weren’t getting the results they wanted, so we went down the hall to talk to the MD and determined that injections might work better. We want outcomes quickly for the patients, and catching it sooner rather than later is a really good model.

“Within our model, we can talk amongst ourselves and ultimately get a better result for our patients,” Rabbetz adds. “Healthcare costs are spiraling out of control, and the major reason is that everyone has a different opinion. When we can communicate and share expertise and be on the same page, we can get some really good results.”

Calzaretta agrees that having multiple specialists in one location improves communication and speeds results. “The multidisciplinary approach gives patients the best opportunity to have a successful outcome in their care,” he says. “When I walk into the physical therapy department and talk to the physical therapists right in front of the patients, the patients love it.”

Expert advice

Benefits may abound from a multidisciplinary approach, but the efforts involved do present challenges. After all, says Calzaretta, “I love treating and managing patients’ care — managing your employees is much more of a challenge unless you have a great team, so focus on building and training your team. Our other partner, Lauren Wheaton, is an MBA and is brilliant. We would not be here today, helping so many people live better lives, if it were not for her combination of compassion and business acuity.”

Knowing what your patients want and growing your practice based on their needs is only one of the requirements in multidisciplinary chiropractic care, Calzaretta says, adding that “you need to hire people who are motivated to help others.”

Rabbetz suggests that if you are looking to grow a multidisciplinary approach, you should work on fostering solid relationships with local medical doctors.

“People are looking for alternative healthcare options, and when you start to develop relationships with local doctors, those doctors put you in touch with other doctors who may refer to you,” he says. “But more importantly, many of them are looking for something like this (a multidisciplinary approach to healthcare).”

Another challenge that presents itself in a multidisciplinary practice is technology. Because a tremendous amount of paperwork and regulations are involved when operating this type of practice, Calzaretta recommends you consider carefully the type of electronic health record (EHR) system you choose to implement.

“One of the biggest challenges I had was finding software that works for a multidisciplinary approach,” he says. “There’s great software out there for a straight chiropractic office, but it is a little harder to find what you need to support a multidisciplinary practice.”

Ultimately, Calzaretta found an EHR system that offered sufficient flexibility and customization to fit his practice’s needs. Currently, both Chiro-Medical Group locations are moving toward complete implementation of the software.

Marketing minute

For all its advances in multidisciplinary care, surprisingly, Chiro-Medical Group does not have a sophisticated marketing program. Calzaretta did, however, recently hire an Internet marketer to manage the practice’s social media and website. “Living in the Bay Area, which is at the heart of technology, Internet marketing is an important component of our success,” he says.

His advice for developing and maintaining a thriving practice? “Just do a great job with your patients,” he says. “Our marketing is not sophisticated, but it is based on common sense; do a great job with your patients.” That way they will keep coming back as well as refer their family and friends to you, he explains.

Calzaretta and Rabbetz also do a great job staying involved in the local community. They and the other healthcare professionals in their practice volunteer their time to treat not only area athletes but also musicians, Broadway actors, and others who travel to the San Francisco area to give performances.

“It’s all about giving back — we’re big on that,” Rabbetz says. Perhaps that genuine desire to contribute to their community is the most powerful tool the chiropractors have in their marketing arsenal.

Amy Stankiewicz is a freelance writer based in Cleveland, Ohio. She has written for trade publications for more than 15 years. She can be contacted at