Someone once said to me, "I think that person must be a 'flat-worlder.'" He meant just what you think he meant.
I use this analogy because I think we are perilously close to being flat-worlders as a profession. As a group, we continue to ignore the obvious and go our merry way hoping or praying or wishing or expecting that "everything will be fine because chiropractic gets results."
The signs seem abundantly clear that in health care delivery we are about to meet Columbus, and I believe that when we do he will tell us he world is round and then relegate us to some remote place where we can continue to delude ourselves to our heart's content.
How can we continue to ignore the need to plan strategically as a profession? The best thing that has happened in this regard has been the Mercy Center Conference. At those tables, I sat with the president of SCASA, Dr. Ralph Boone. Dr. John Triano sat across from Dr. Arlan Fuhr and Dr. Jim Gregg, and I found ourselves thinking along the same lines often enough that we probably worried about what was in the food; but, in the end, we forged a document that just might signal some awareness on our part of the urgency of the moment.
It is true that the medical profession, in some arenas, is behind us. That makes no difference. They are in the catbird seat while we are still hoping to be able to dangle from the edge. It makes no difference to the government nor to society as a whole that the medical profession has not completed research on every aspect of medical practice. Medicine is not behind the eight ball, we are.
There are those colleagues of mine who have said that I am for acceptance at any cost. That I would give anything to be part of the medical system. Well, if the word "medical" is used in the generic sense, and if all of you who are my practicing fellow colleagues wish to continue to be paid for your services, then maybe we could all begin to see that on the edges of the horizon there is a slight curve after all.
In his article in this paper recently, Dr. Cassata referred once again to "clinical purpose" for the chiropractic profession. As if to reinforce this concern, the recently released document from FCER "An Evaluation of Federal Funding Policies and Programs and the Relationship of the Chiropractic Profession," prepared by the Corporate Health Policies Group, December 1991, should bring us all up short. It says, among other things, that not only does the public not know what we are, but, even worse, neither do we. When a group of individual chiropractors was asked to define what chiropractic is, there were 20 different responses. I know that is not new, but it is also part of the flat-world reaction. Today, we can no longer afford to be indecisive about ourselves. The inevitable crush of managed health care is upon us. What are we? Are we primary care? Then we must be ready to demonstrate our ability to care for "the majority of the health care needs of members of society." That is part of the government definition of primary care. No it doesn't just mean portal of entry, it doesn't mean just low backs, it doesn't just mean "analyze and adjust," it means much more.
If we are not primary care, then what are we? Are we limited specialty? What are the limits? Neuromusculoskeletal? What does that mean? Does it mean that we specialize in the treatment of muscular dystrophy or does it mean that we specialize in the treatment of Arnold Chiari syndrome, or do we just specialize in a subspecialty called "simple low back pain without neurological signs?" Perhaps we are headache, neck, and back doctors. Is that specialty alternative or duplicative?
Obviously, we could go on and on with these questions, and, in fact, we must! You are out there facing the difficulties of third-party reimbursement, and I keep asking myself what the prospects are for my students. We can plan and we can face the realities. Each of us must take the initiative to contact our leaders and encourage such efforts. Each of us must join a national chiropractic organization so that we can participate in mounting a strong campaign toward this end. For me, this is the American Chiropractic Association, and I recommend it for you too. Speaking of national chiropractic organizations, let's face the fact that we very much need one strong clear voice for our profession. We must set this nonsense aside in which we perpetuate confusion by speaking through multiple mouths. This just reassures everyone that we are, in fact, not a real profession. We are just a bunch of people who can't agree on anything. That must stop.
I call upon the leaders of the ICA, the ACA, the FCLB, and upon my colleagues in the CCE and the ACC to set aside conflict and try another consensus for the express purpose of examining who and what we are and setting in motion a plan for our future. The question remains, will we do it or will we sail serenely along until we fall off the edge of the earth and die?
James F. Winterstein, D.C., President
The National College of Chiropractic
Lombard, Illinois
Dr. James Winterstein, president of National University of Health Sciences since 1986, graduated from then-National Chiropractic College in 1968. Among his varied professional accomplishments, he is a former president and board chair of the Council on Chiropractic Education, and a former president of the American Chiropractic College of Radiology.