The main question addressed by the CCE panel was what course the chiropractic profession should take: remain a somewhat isolated, independent health care profession, or seek integration as a member of a broader health care team? Each member of the "distinguished dozen" was allotted 20 minutes to address the issue: "Isolation or integration: chiropractic's role in the evolving health delivery system."
The presenters then answered a variety of questions from the audience, a group almost as notable as the panel: chiropractic college presidents, association leadership, and other well-known personalities.
Below is a sampling of what each presenter had to say:
John Allenburg, DC, president of Northwestern College of Chiropractic presented, "Some Implications of Health Reform for College Programs in Education and Research: a Case Study."
Dr. Allenburg remarked:
"In summary, to achieve our ideals for the profession, the colleges and the public, we need to seek integration and participation on all fronts:Attorney Chapman-Smith's comments included:
- between the colleges and profession;
- with other health care providers within all health care environments while maintaining our profession's identity and autonomy;
- become positioned within the managed care industry in order to more ideally shape our profession's role;
- become positioned to participate in shaping health care policy;
- become positioned within the community health structure;
- carry out interdisciplinary health research."
David A. Chapman-Smith, LLB FICC(Hon) secretary general of the World Federation of Chiropractic warned: "Ignore the Marketplace and Kiss Yourself Goodbye."
"During the next l5 years most nurse practitioners and family physicians throughout the Western world are going to want to refer many patients with back and neck pain and tension headache to someone trustworthy and skilled in spinal manipulation. Will that be chiropractors or someone else on average? Are you available (integrated)? Whoever gets these referrals will end up top dog in spinal manipulation for the rest of the history of this world."Arnold Cianciulli, DC, president of National Chiropractic Mutual Insurance Company (NCMIC) discussed, "Chiropractic in the Information Age":
Dr. Cianciulli stated:
"The future of chiropractic requires a replacement of antiquated data with an awareness that chiropractic's future will be evidence-based with guidelines and options for the practicing DC. We must end the mindless practice gurus who presently dot the chiropractic landscape and portray chiropractic as a weird nonprofession.Gerard Clum, DC, president of Life Chiropractic College West."The integration of the chiropractic profession within the health delivery system will be enhanced by the expansion of our "domain specific competency," which will convince the lords of business and industry that our profession is a valuable asset for their employees."
Dr. Clum proclaimed:
"Our day is dawning! Every popular health author in the United States from Chopra to Siegel and back are talking our talk. The import of the chiropractic model of altered function as a result of structural abnormality of the spine is a view that is gaining significant momentum.William Dallas, DC, president of Western States Chiropractic College, explained how chiropractic could move "From Isolation to Integration.""Integration of the chiropractor into American culture has occurred. The monolith of health authority once represented by medicine is crumbling. The present day society is learned, savvy and cautious. The value of minimally invasive health care is being more widely recognized on a daily basis. The views and perspectives of the chiropractic profession are being widely recognized, even if they are not directly associated with the chiropractor. The society is aligning with our thoughts and our approach.
"The goal of integration within the health care arena will be best served by maintaining our orientation to a vitalistic perspective rooted in the tradition of the chiropractic profession as a non-drug, non-surgical discipline whose focus remains the maximization of the ability of the body to marshal its own healing resources."
Dr. William Dallas concluded:
"Our primary concern has always been quality health-care for chiropractic patients. Providing chiropractors who wish to assume an expanded role with the authority in primary care provision appears to be in the best interest of our patients. The need for isolation, so necessary in our first century, is being replaced with opportunities for integration. Through research, high educational standards, and an understanding of chiropractic's potential role in the health-care delivery system, chiropractic has the opportunity to grow stronger and to serve more patients. As chiropractic begins its second century, let quality health care for our patients, through integration and an element of primary care provision, be our goal."Mark Goodin, the lobbyist for the American Chiropractic Association.
Mr. Goodin warned the profession:
"Like it or not, integration, and by that I mean chiropractic's involvement with organized medicine and the beast known as managed care, is where it's at: not just because it is politically correct, but because it's the way of the world in which we live. And so, I have to chuckle a little at your topic today. Isolation or integration? It's a question that is posed as if you really had a choice. The simple truth is that you do not."
Ian Grassam, DC, the southern regional director for the International Chiropractors Association.
Dr. Grassam presented these thoughts:
"In today's health care marketplace, there can be no question of the urgent need for the chiropractic profession to fully integrate the unique and powerful contribution we are capable of making into the mainstream of health care service delivery. The question is, what will the nature of that integration be? There are some in our profession who believe that the key to success in this integration process is to change chiropractic to take on enough of the trappings of orthodox medicine to give the appearance of acceptability, within the conventions of the medical model. They believe that the addition of a few medical procedures will, through some mutation process, establish a new class of medically acceptable practitioners who will bring chiropractic into the "mainstream" of health care. These people could not be more wrong."Scott Haldeman, MD, PhD, DC, chair of the research council for the World Federation of Chiropractic discussed, "The Role of Chiropractic in an Integrated Health Care System."
Dr. Haldeman advised:
"It is clear that the chiropractic profession must accelerate the training of representatives with the scientific and intellectual skills to serve as warriors in the turf war. The colleges must provide increasing resources and energy to research and establishing national standards. The associations must dedicate more political emphasis and funds to finance research which can be used as weapons. Chiropractic must participate in the managed care industry as businessmen, consultants and advisors to provide forums for presentation of research.Russell Sawyer, DC, president of the American Chiropractic Association (ACA) presented "Back Pain or Primary Care?""It would be a pity if chiropractic was relegated to treating acute low back pain in adults because that was the only place where a turf war could be won. No one here knows the true potential of chiropractic integration into the health care delivery system. Only with dedication to research, intellectual honesty, high education standards and service to the public can chiropractic's full potential be realized."
Dr. Sawyer stated:
"The remaining requirement is for the profession to urge the establishment of a proper ethic of interprofessional referral so that a referral by a chiropractor to a medical physician no longer implies the transfer of that patient.Louis Sportelli, DC, past chairman of the ACA Board of Governors posed the question: "Is There Really a Choice?""The referred patient never ceases to be the chiropractor's patient and must be sent back to the chiropractor after the medical doctor has considered the patient's needs from his or her perspective. This is the process at work when the medical physician initiates a 'referral.'"
Dr. Sportelli's thoughts included:
"Chiropractic will undergo significant changes and overcome major hurdles in its quest for recognition and acceptance. We must not forsake our heritage, nor must we allow dogma to stifle progress. Our political and educational bodies must endure the challenge of being labelled as fringes, for they are the vestiges of our traditionalism. After all has been said, it should be clear that change lies ahead: change that offers a multiplicity of opportunities for those prepared to step forward. Change never happens without discord and we shall not be immune, nor shall change come without added responsibilities."Sid Williams, DC, founder and president of Life Chiropractic College presented "Chiropractic: The Road Less Traveled."
Dr. Williams encouraged the profession with these remarks:
"My colleagues, we have the world's most effective drugless and knifeless health care method in the world, and we ought not to be adding failing elements to our profession's outreach.James Winterstein, DC, president, of National College of Chiropractic offered, "Suggested Principles of Integration.""Just as sure as the earth revolves around the sun, unless we bravely face this issue here and now and resolve that chiropractic will protect its unique niche in the business and profession of health care, the legislative justification for our existence will be gone. Professionals who do broad-body diagnoses with broad-body treatments are fully qualified MDs with proper education."
Dr. Winterstein proposed:
"The chiropractic profession agrees to adopt and teach the standard medical lexicon while, at the same time, we preserve that which is meaningful to us.After the convocation, CCE President Carl S. Cleveland III, DC, made these comments:"The chiropractic profession accepts the need to practice standard diagnostic procedures.
"The members of the chiropractic profession accept the method of scientific investigation.
"Within the integrated health delivery system, chiropractic physicians will participate in the triage system with other physicians and will manage principally those patients who present with neuromusculoskeletal syndromes.
"Chiropractic physicians will, as part of the integrated health delivery system, support those measures of disease prevention and human wellness which are generally accepted by other clinicians within the system.
The chiropractic colleges will vigorously pursue educational programs which provide graduates with clear perspectives on the nature of the managed care delivery system."
"This convocation has served to reinforce the acute awareness that chiropractic education must prepare its graduates to function and to compete in a multidisciplinary health care setting. Strategies must be developed to communicate a uniform message to the marketplace presenting the chiropractic profession through education and research rather than patient support and politics.The CCE is making audio cassette recordings of the event available at a very low cost. To order your set of five tapes please send $48 plus $5 for shipping and handling to:"The opportunities in chiropractic have never been greater. However, the critical need for coordination proactive responsible action has never been more clear and urgent. Through cooperation and group action our best days are yet to come."
The Council on Chiropractic Education
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