We Are Primary Care Doctors
Dear Editor:
They say to write what you know. I know this: This isn't working. There was a time when chiropractors could expect to make a decent living treating their patients.
Managed care took from the providers and gave to the shareholders. Health insurance companies have been consistently the most reliably profitable publicly traded entities on Wall Street. Many of these, including one of the largest, Empire BlueCross BlueShield, were at one time in the not-so-distant past not-for-profit operations. This blight affects all providers and subscribers. There are not enough primary care providers and too many specialists, which is an economic response to managed care.
If you can't reproduce it, then it didn't happen; a truism that most of us in the profession have acknowledged long ago. While I can't prove that what I do will help with ADHD, cancer or a plethora of other things, I can prove that what I do will successfully treat, most of the time, neuromusculoskeletal pain and dysfunction. What I can prove is that I was prepared to be a primary care doctor by sitting in classrooms, labs, and examining rooms for close to 5,000 hours and by passing the five sections of the national boards. I can prove that I was trained to administer a ludicrously complete general, neurological and orthopedic examination.
I was trained in phlebotomy and blood analysis. I was trained to administer an ECG and read and comprehend the results of said test. I was trained to take X-rays and interpret the results. I was trained to read CT, MRI, and tomography (God rest its fuzzy soul). I was trained in differential diagnosis, and this has benefited every other health care provider in town but me. Compare our 525 hours of diagnosis training with an NP, PA, DO, OD or MD.
I get paid $12 to administer a full-spine CMT (adjustment) and can barely keep the lights on. I don't get paid for exams, referrals (even though I saw the patient, examined the patient and recognized that the problem was beyond my very thin scope of practice.) or reviewing imaging. My X-ray unit wound up in a dumpster a few years ago when the insurance companies started paying me $1 for a series. Now I order diagnostic imaging. Oh, wait; the largest health insurer, Medicare, won't let me do that.
Here's the proof of how bad things are for us: A recent NYCC (my alma mater) publication had an advertisement for its Master of Science in Clinical Anatomy. Wow, only two years to get my masters in something that I essentially already have a doctorate in. If you haven't noticed, most of the droves of chiropractors who are leaving the profession wind up teaching college anatomy and physiology, or high-school chemistry and biology. Or how about a Master in Applied Clinical Nutrition, 'cause they got that, too. You won't be able to get a job as a dietician with that degree, but hey, it can make your credentials longer.
The last page of the latest NYCC magazine has an imploration to contact your member of Congress and even the president to "express your personal wishes regarding chiropractic inclusion in any reform proposal" as it pertains to national reform legislation. Why would anyone want to include our current condition in anything? Meanwhile, physical therapists (they are doctors now, you know) are achieving direct access and taking over manipulation with MD approval. Look at any physical therapy publication and you will find a veritable plethora of advertisements for evidence-based spinal manipulation. (Evidence based? When we do it, it could kill you and doesn't do anything, but when they do it, suddenly it becomes evidence based?) Hence, they have the Spinal Manipulation Institute and we have the ICA and the ACA bickering over minutia.
A recent advertisement in Dynamic Chiropractic begins with, "Imagine your healthcare practice in three years. You are an in-demand member of the nationwide healthcare community. You work together with medical physicians. You are treating a wider range of illnesses. You are a true primary healthcare provider." Hey, only three more years of education and I can be a nurse.
We are primary care doctors who are watching our profession founder and we continue to fiddle. We were trained as primary care physicians and have almost no role now in health care. It is time to split the profession. Those who wish to continue in their current role can do so by remaining a DC. The rest of us, those who wish to fulfill our role as true PCPs, can become doctors of chiropractic medicine. Additional education would be required for this DCM degree, mostly in pharmacology, but at least it would be something built upon our already sturdy background.
The idea of going back to school to become a nurse, physical trainer, or anything else that we are already overqualified for is entirely unacceptable. If the national and state organizations don't want to lead, then we need to take on this responsibility ourselves.
Robert Merrihew, DC
Water Mill, N.Y.