Chiropractors might ask me why I have any interest in the integrative medicine movement. The answer is simply to improve patient access to chiropractic services. Early in my career as a chiropractic physician, one of my patients asked me a question I never forgot.
If we examine the medical literature, the evidence demonstrates that patients are in need of chiropractic care and they are seeking/demanding the services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.1 More than one in three respondents used CAM during 1997, representing about 72 million adults.2 Almost one-third (192 million) of the 629 million visits to CAM providers in the same year were to chiropractors.3 In 1991, Lovelace Medical Center developed the first chiropractic service within a health care system due to the demand of their patients.4 The patients were pleased with the availability of chiropractic services and the biomedical physicians were willing to work side by side with a chiropractor.5 Trends indicate that yes, patients are seeking chiropractic services but are chiropractors providing services within integrative medicine centers?
The Osher Clinical Center for Complementary and Integrative Medical Therapies brought together a team of the region's top clinicians to serve a common mission; enhance the body's natural ability to heal and to maintain good health. The Brigham and Women's Hospital staff, in Chestnut Hill, Mass., works with primary care physicians and medical specialists to help resolve patients' health problems with numerous non-allopathic services, including chiropractic care.6
The University of New Mexico Center for Life, an integrative and inter-cultural center for prevention and wellness recently hired a full-time chiropractic physician to serve as a clinical assistant professor. According to Dr. Arti Prasad of the Center for Life, "Integrative medicine is healing-oriented medicine that takes account of the whole person (mind, body, and spirit), including all aspects of lifestyle."7
Unfortunately, the majority of integrative medicine centers does not offer chiropractic services. Most often, the rationale for not hiring chiropractors has nothing to do with patient demand but the prejudices expressed by certain medical faculty members. In spite of patient demand, administrators and integrative medicine providers, intimidated by threats from ancient members of the faculty and staff to eliminate the integrative medicine center, choose to delay hiring chiropractors. This conundrum reduces the availability of chiropractic services. One solution would be the founding of integrative medicine centers of excellence by chiropractic colleges. This strategy is one approach for chiropractic medicine to gain higher cultural authority in an effective manner, in a relatively short time and enhance availability of chiropractic services.8
In 1997, David Eisenberg, MD, spoke on the subject of alternative medicine and its implications to the practice of medical doctors. In beginning his talk, Dr. Eisenberg asked for a show of hands from the group of 700-800 doctors and clinicians with the question, "How many of you, or a close friend or family member, have used chiropractic or acupuncture in the last year?" About 80 percent of the audience raised their hands.9 This experience should make chiropractors wonder why their services are not readily available to all patients seeking integrative care.
Of course, we could blame the AMA. After all, the organization is once again attempting to eliminate the chiropractic profession.10 Yet, only 10 percent of biomedical physicians belong to the AMA. Possibly, we should attempt to integrate the medical system and become partners on the medical team. As demonstrated at Lovelace Medical Center, medical physicians are willing to work with chiropractors.
If you are interested in participating within an integrative medicine model, I would like to offer you some advice that might benefit your endeavors. Initiate a fact-finding process that will provide information regarding the availability of integrative medicine services in your community. Clarify the definition of integrative medicine. Determine if the local integrative medicine center(s) offer chiropractic services. If not, is there a potential for chiropractors to participate as providers?
The journey for the chiropractor interested in forming or joining an integrative medicine organization starts with the first step. This involves developing a strategy with the creation of a business plan. Then implementation will require you to meet providers of all fields, but most importantly, medical doctors. Most chiropractors choose the orthopedist as the first specialist in the medical field. It is my opinion that your first contact should be the primary care physician. They are overwhelmed with musculoskeletal patients in need of chiropractic services. How would you accomplish this feat?
If you want to join an integrative medicine team, you will need to do some research and create a plan that complements your self-marketing efforts. Most importantly, you will have to master the act of successfully introducing your services to the medical doctor by shaking hands and creating trust. Ask the doctor if they refer certain musculoskeletal conditions to other providers. Prepare to explain your educational background, evaluation and management protocols for those conditions. The possibilities for integration of bio-medical and chiropractic medicine services are endless, based upon the needs of the involved parties.
References
- Eisenberg DM, Davis RB, Ettner SL. Trends in alternative medicine use in the United States, 1990-1997 results of a follow-up national survey. JAMA 1998; 280:1569-75.
- Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med 2005 Jan-Feb;11(1):42-9.
- Meeker WC. Public demand and the integration of complementary and alternative medicine in the US health care system. J Manipulative Physiol Ther 2000 Feb;23(2):123-6.
- Kelly S. New Mexico's Leading HMO to Open Chiropractic Facility. Dynamic Chiropractic May 10, 1991;9(10).
- Pasternak DP, Lehman JJ, Smith HL, Piland NF. Can medicine and chiropractic practice side-by-side? Implications for healthcare delivery. Hosp Top 1999;77:8-17.
- www.brighamandwomens.org/medicine/oshercenter/default.aspx
- http://hsc.unm.edu/som/cfl/about.shtml
- Lehman JJ, Suozzi PJ. Founding integrative medicine centers of excellence: one strategy for chiropractic medicine to build higher cultural authority. J Chiropr Educ 2008 Spring;22(1):29-33.
- Chamberlain N. Dr. Eisenberg Addresses Implications of Alternative Medicine. Dynamic Chiropractic Nov 3, 1997;15(23).
- Sportelli L. An Old War in a Modern Era: AMA's "Contain and Eliminate" Tactics Alive and Well. Dynamic Chiropractic July 15, 2010;28(15).
Click here for previous articles by James Lehman, DC, MBA, DIANM.