Most chiropractors agree that medical referrals are valuable. But how many new patients should a chiropractic clinic realistically expect to receive from primary care providers (PCPs)? We were curious about that (and about the broader patterns behind how clinics do or don’t get referrals), so we surveyed the ChiroUp provider network. According to the results, chiropractors report that, on average, approximately 14% of their new patients come from PCP referrals.

This average masks a significant divide. Nearly two-thirds of all surveyed clinics receive only 0–10% of their new patients from PCPs. However, the top third enjoyed a significantly more robust referral rate, including a top tier of respondents who reported receiving over 50% of their new patients from medical providers. The takeaway? High referral numbers are achievable, but as you will see, they require intentional effort.

1. What Are the Barriers to PCP Referrals?

When asked about the biggest obstacles to PCP referrals, chiropractors in our survey pointed to several consistent themes. Together, these responses illustrate that while some barriers are systemic, others reflect missed opportunities to communicate value or initiate outreach.

Why Would a PCP Not Refer?

Considering that multiple authoritative clinical practice guidelines endorse spinal manipulation and chiropractic care for a variety of musculoskeletal conditions (1) —and that prior studies have found that approximately four out of five physicians (76-84%) agree chiropractors provide effective treatment for some musculoskeletal complaints (2,3)—it raises an important question: Why wouldn’t a PCP refer?

Prior authors have identified several common reasons for this hesitation:

Uncertainty about what chiropractic care entails
Lack of familiarity with evidence
Concerns about over-treatment or fringe practices
Perceived lack of communication from DCs
Insurance or safety concerns

Want to hear directly from PCPs? Our prior blog on 4 Reasons Why MDs Don’t Refer breaks down why some PCPs remain on the bench, based on dozens of structured interviews. It’s a candid look at what medical providers are thinking, and what chiropractors can do to change the narrative.

2. Mindsets That Shape Referral Outcomes

Our survey highlighted that a DC's attitude and effort toward PCP outreach clearly impact outcomes. Chiropractors who deprioritize these relationships tend to remain stuck in the lowest referral brackets. In contrast, those who treat PCP collaboration as a top priority consistently outperform.

Lesson: The Proactive Engagement Imperative

Survey results show that chiropractors who avoid PCP outreach tend to receive few (if any) referrals. Active, ongoing communication was almost always a prerequisite for higher referral volumes.

3. How Many PCP Referral Sources Do Most Clinics Have?

Most chiropractors reported receiving referrals from a modest but meaningful number of PCPs. The majority (around 51%) said 3–5 different PCPs referred to them in the past six months. About 25% reported 1–2 PCPs, while another 25% received referrals from 6–10 or even 11+ providers.

Lesson: The Power of a Broad Network

A higher number of PCPs referring to a clinic strongly correlated with a higher percentage of their new patients coming from PCPs. Clinics with 11+ active referral sources also tended to employ more consistent outreach and communication strategies. This suggests that growing the number of referral sources (and subsequent referrals) is possible but is nearly always tied to deliberate relationship-building.

4. Top Strategies That Drive Referrals

We wanted to know what top-performing clinics do to earn more PCP referrals. The answer was clear: they use deliberate strategies that build trust and demonstrate value. Here’s what they told us:

Deliver a Worthy Product

A consistent theme that emerged from our respondents was this: the first step to increasing referrals is earning them. Being referral-worthy is the foundation. Before any outreach or marketing, your clinical reputation needs to speak for itself. That means:

Performing thorough exams
Delivering individualized, evidence-based treatment
Communicating clearly and consistently
Presenting yourself as a collaborative provider, not a competitor

Referrals begin with trust. These fundamentals inspire confidence in PCPs and make them more likely to refer patients your way.

Lunch Meetings

Face-to-face meetings with PCPs were cited as a top tactic. Many chiropractors reported that lunch visits helped demystify chiropractic care and position the chiropractor as a credible, collaborative resource. Our survey found that the frequency of outreach efforts via face-to-face meetings directly correlated with the percentage of new patients coming from PCP referrals.

Pro Tip: Many respondents noted that bringing along evidence-based materials (like printed ChiroUp condition references or your clinical outcome statistics) made the visit more impactful and often sparked meaningful clinical conversations. These tools were repeatedly mentioned as a way to supercharge outreach and leave a lasting impression. And remember, outreach doesn’t have to be aimed solely at the PCP; a well-informed staff often drives referral behavior and patient routing.

Call or Text PCPs

Multiple providers indicated calling or texting PCPs is a primary strategy for building referral relationships. These direct communications are often used to provide patient updates, coordinate imaging or procedures, or establish a more personal connection. This approach is valuable because it makes collaboration easier for the PCP, reinforces continuity of care, and positions you as a proactive clinical partner.

Ask Patients to Share

Nearly two-thirds of DCs (61%) relayed that one of their most effective referral strategies was simply asking patients to tell their PCP about their positive experience. While it may seem small, this approach helps close a communication gap that often leaves PCPs unaware of successful chiropractic outcomes. You could say something like:

“I’d like to ask you a quick favor. If you’ve had a good experience here, would you be willing to tell your PCP about it? You’ve got a great doctor who’s open to different care options, and when they hear real stories like yours, it makes them even more likely to refer other patients who could benefit. Would you do that for me?”

Encouraging patients to share their progress reinforces your professionalism and builds trust between you and the referring provider. It’s an easy win, especially when combined with the following written communication strategies, to ensure the PCP hears the good news directly from both patient and provider.

Initial & Release Reports

Prior studies have suggested that one of a PCP's biggest complaints is “not hearing back about what happened to their patient”. This communication gap is one of the most common reasons cited for avoiding future referrals.

Our survey reaffirmed that consistent communication is critical. Chiropractors who sent initial visit and release reports to PCPs saw 3–4x more referrals than those who didn’t. Conversely, chiropractors who reported never sending these reports were approximately five times more likely to be in the group receiving 0% of their new patients from PCP referrals compared to their colleagues who do send reports.

Clarifying the Reports PCPs Actually Read

An initial report is a half-page summary sent to the patient’s PCP after their first visit. It succinctly outlines the patient’s complaints, your objective findings, and a clear plan for treatment and goals. Think of it as a professional heads-up that shows you're engaged, competent, and collaborative, without asking the busy PCP to read your complete SOAP note (which they probably won’t).
A release report, or discharge summary, is sent when care concludes. It gives the PCP a concise update on the patient's progress and clinical outcomes. Release reports are crucial because patients rarely return to their PCP just to say they’re better. Without your update, the only chiropractic stories the PCP hears may be the negative ones.

Of course, you can create these by filling out a template, but efficient DCs recognize the value of their time and do it with 2 clicks. Click here to see how!

5. Key Takeaways from Top-Performing Clinics

Do Something: Passive strategies don’t work. Initiate contact.
Communicate Consistently: Initial contact is just the start. Follow up with consistent written summaries, texts, or calls.
Use Multiple Tactics: Clinics that layered multiple coordinated strategies consistently outperformed others. The combination of face-to-face meetings and release reports drives the highest referral rates.*
Be patient: Don’t expect one meeting or a couple of reports to open the referral floodgates. Building familiarity and a trustworthy reputation takes time.
Overcome Health System Barriers: Persistence and professionalism matter more than access alone.

Subscriber Bonus: ChiroUp subscribers can explore the updated PCP Marketing Guide in the Marketing Campaigns Library. It’s packed with additional proven strategies to boost referrals, plus all the templates and resources needed to implement them quickly and easily.

As health systems increasingly embrace non-pharmacological care, especially for back and neck pain, chiropractors who position themselves as evidence-based, collaborative, and communicative will be best positioned to capitalize on growing PCP openness. Integration is no longer a future goal; it’s happening now in VA systems, FQHCs, and countless progressive medical clinics. Your outreach matters more than ever.

If you're ready to turn referral theory into action, don’t miss our upcoming webinar on June 16th, "The PCP Playbook: How to Earn More PCP Referrals This Year." We’ll walk you through exactly how top clinics are using tools like PCP reports, newsletters, in-person meetings, and follow-up workflows to build strong referral relationships. This session is packed with real-world examples, implementation tips, and a live walkthrough of how to apply these strategies in your own practice.

Ready to Earn More Referrals?

The best time to build medical referral relationships was yesterday. The second-best time? Today. ChiroUp gives you the tools to do it with confidence—without adding to your workload. Start now for free!

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PCP Referrals to Chiropractors: What the Top Clinics Are Doing Differently