Chiropractor at University of Maryland School of Medicine | An Interview with Brian Morrison By Noah Volz

What's the origin story behind your involvement with the Center for Integrative Medicine?
Dr. Morrison: The center has been with University of Maryland for well over 20 years. One of the first centers and Brian Barman is a medical doctor who was director there. He was able to get some grant money together and some supporters so they started an integrated medicine center which was placed on the second floor of a satellite hospital for the University of Maryland.
They had a medical doctor who did integrated medicine, an acupuncturist.  The two things that was Dr. Berman's real interest was acupuncture and one of the directors of the clinic came to my office for care and she said, “We could probably use what you do, would you be interested in coming down?” I said yes. ​

Their offer was why don’t you go ahead and rent a small space from us as many days a week as you want and we'll refer patients in. It was a foot in the door and I took it. I had been down there for several years and then the clinic changed its whole complexion and I stopped seeing patients down there.
In the meantime they'd asked me to start teaching an elective for fourth-year med students that they wanted to expose to manual medicine. It was a one or two hour program. In the first year we had four students. A new educational coordinator increased the educational component and now there's two sections and it’s a full house. It’s still an elective. Then they expand the clinical side with a new clinical director and they staffed it with two chiropractors, two acupuncturists, massage therapists and a bunch of other things. We developed a chronic pain pathway that involved all of the players in integrative medicine including a cognitive behavioral therapy psychologist and we started working more closely with the physical medicine rehabilitation department in the hospital. It was all funded independent party and that funding ended in 2018 so right now the clinic is in hiatus.
Noah: Thank you for the work that you've done creating this curriculum and the protocol and everything. As a pilot is it easily replicated or transferred to other medical schools or is it pretty specific to your location?
Dr. Morrison: No, it's very general. We were fortunate enough to have a preventive medicine resident who helped us write the program. She wrote it from a community health aspect and there is basically a tree to follow, an algorithm to follow, including the triage portion of it. I also teach this at Maryland University of integrative health not to be confused with the University of Maryland center for Integrative medicine. They have a doctoral program in acupuncture and I exposed them to this program at that institution. I think this could be replicated, I think a lot of people are also working on this project. The big thing everybody that was trying to figure out with this model is how do we make it profitable? How do we make it pay for itself? That is the unknown right now in integrative medicine centers. Most do not generate profit, the only one I know of that does is Vanderbilt.
Noah: I know a lot of students want to get involved in integrative medicine. I've talked to a lot of people who are doing the University of Pittsburgh program in primary spine care, they are pushing a multidisciplinary collaborative care model. What do you do at our own clinic and how does it differ from an integrative care environment and how is it similar?
Dr. Morrison: We've evolved quite bit because the when the center was closed there were two medical doctors who had nowhere to go and I had some extra space in my office. We’ve set them up doing integrative care in my office so I have an MD, a cognitive behavioral therapist, a massage therapist, an acupuncturist and a few other integrative disciplines. From an economic standpoint they’re completely separate from us. They are just our tenants and I’ve worked with these doctors for a long time. 
My practice functions as a chiropractic practice. Patients come in for neck pain, back pain, headaches, and chronic pain.  I've taken the pain science model into my office wholeheartedly. For patients that have chronic pain we use Carlo Ammendolia Spinal stenosis boot camp model and the Dr. McGill model for spinal stabilization and the McKenzie mechanical diagnosis.
I'm starting to develop some of our practice based on what they cover in the book “World of Hurt” so we have a lot of back and forth. It’s great to have the integrated medicine doctors if we need medication, if we need nutritional supplements, or an anti-inflammatory diet. Or systemic issues like gut biome stuff. If they need it they receive chiropractic care, dry needling, Rehab or manipulation. That’s what were there to provide.
Noah: This clarifies a lot of questions that students who want to open an integrative center. I would assume that this is a really profitable model that you've developed and how does it compare to straight chiropractic clinic?
Dr. Morrison: I’m not a straight chiropractor. So, I'm not sure, but it’s still a completely chiropractic clinic. Like any clinic it has its ups and downs. There’s things you have to figure out. We’ve got it pretty good as one of the only integrative medicine centers and even though these allied health professionals have only been with me for a year they say their doing better than they did at the University. I know it can be done. The problem we find in integrative medicine, especially integrated pain care, like the primary spine care model is that health insurance is not set up to pay us. A lot of the pain management that we do doesn’t get reimbursed. We figure out how to drop-in a lot of pain education while I’m doing manual therapy or while I'm doing movement exercises so that offsets the cost. But we are paid to check the box not to actually do something or get a good outcome at this point.
Noah: Are you primarily an insurance based practice or a cash practice?
Dr. Morrison: Its insurance based. There are barriers to care for people if you don't take insurance. Having been in practice for 30 years a lot of my patients have grown old with me so I have a lot of Medicare patients and as you know Medicare is pretty bad payer as far as it goes. There’s a lot of hoops to jump through, but if I dropped out of Medicare I would shut these patients out of care and these patients have been extremely loyal to me for many years and I'm not willing to do that to them.
Noah: What do you feel is the most important thing a student can do to create more opportunities to work in an integrative care center and be a part of the medical pain management landscape?

Dr. Morrison: They need to read a lot. There’s a lot of great material out there such as the chiropractic science podcast with Dean Smith or the Forward Thinking Chiropractic Alliance. I think that the biggest hole in chiropractic education and professional development is lack of residency programs. I think any student who wants to get into an integrative setting where he can be toe-to-toe and eye-to-eye with his medical colleagues needs to do a fellowship or a residency and that’s just not there. I wanted to get that stared in the Maryland program but it hasn’t got any traction 
Noah: The VA is doing a great job with their residency program. What are five things that chiropractors who want to get in an integrative care model need to read or expose themselves to?
Dr. Morrison: You'd need to read anything by Dr. Craig Liebenson. He's a fantastic integrator and get’s straight to the key points. He integrates a biopsychosocial component into his manual therapy, rehab exercise component, and coaching component. I would read Rehabilitation of the Spine by Dr. Stuart McGill. Read World of Hurt. Then read Lorimer Moseley’s work. Adrian Louw doesn't get a lot of traction in our profession but he's the therapeutic neuroscience educator who was with Moseley and Butlers group in Australia, but he's come to America and he’s in Chicago with the International Spine and Pain Institute. I think those would be some good places to get started and there's a ton more.
Noah: I mean there's always more to learn. Thanks for coming on the show. 
Links
https://www.spinemobility.com/start-here
https://bodyinmind.org/who-are-we/
https://www.ispinstitute.com