It is hard to imagine, but the first-hand history of the majority of chiropractors in the United States is the decade of the '90s. It is equally hard to conceive that those of us in the greater-than-25-years-in-chiropractic club are a distinct minority as 2000 dawns.
The decade of the '90s was an exciting and tumultuous one. A line from Neil Diamond's "Surviving the Life" comes to mind: "Got some highs, got some lows but the wise man he knows what it's really about ... surviving the life." The next decade will be equally as exciting, if not more so. However, before we go there, let's look at where we have been.
The decade began with a rude comment from the Bush administration about our profession "not being worthy of the public trust." This delightful proclamation came from a Bush budget proposal that sought to remove chiropractic students (along with our podiatric colleagues) from participation in the HEAL loan program. Thankfully, the Bush crowd did not prevail and we continued to be included in the HEAL program. Chiropractic education was able to make a strategic move out of the program and replace the funding need with a private- sector loan program known as ChiroLoan, developed by Mr. Steve Galvin of the Education Finance Group (then called the Education Funding Service).
Soon after the election of Mr. Clinton, we heard of grand and glorious plans for the revolutionizing of health care in America. Names once foreign to us became the focus of everyday discussions: Alan Einthoven, Ira Magaziner, and the Jackson Hole Group. Hillary Clinton dominated the conversations of health care providers, planners and consumers alike. We also picked up some new terms: managed care; health maintenance organizations; preferred provider organizations; capitated plans; staff model plans; vertically integrated delivery systems and the like, that quickly became the language of the profession in the '90s. Organizational and delivery concepts (primary care provider or gatekeeper) seemed to hold the keys to our tomorrow and its relative degree of rosiness.
How did we act when exposed to these emerging ideas and designs? For the most part, we've acted like a deer caught in the headlights of an oncoming car - frozen with fear, gripped by denial and stunned with what appeared to be imminent changes for chiropractic. That was the routine behavior of the day. Examples of these behaviors can be found in the following:
• the full-page, apology-oriented advertisements placed by the ACA in response to a critical article in the Wall Street Journal;
• the modifications of the CCE's educational standards to reflect the "primary care" nature of chiropractic education and the primary care role of the chiropractic provider -absent any definition of the concept;
• the rush to develop "practice guidelines" to define and refine who we are and what we do, lest "they" do it for us;
• the strengthening of the musculoskeletal role of chiropractic and the rejection of the greater role regarding visceral conditions and wellness;
• the development of practice alliances by individual practitioners that resulted in suspect MD-DC practices;
• the sale of practices to large management groups;
• the abdication from participation in the health care system by opting out as "cash practitioners."
So what has become of the demons that drove us in the early years of the decade?
• The HEAL program is all but defunct, not of its own weight but of its own lack of flexibility.
• The role of the gatekeeper was advanced, embellished, studied and abolished.
• Dozens of definitions of primary care were advanced, with none having surfaced as the wisdom of the decade.
• The lowback, once the clear domain of the chiropractor, is now being shared with the osteopath, the physical therapist and the $1.00 low back information packet.
• The public has embraced "alternative care" with such force and magnitude that they have demanded the revamping of the systems and presentation of practices that make chiropractic care look wholly mainstream.
• The leading edge of the baby boom has begun its encounter in earnest with health care consumption, and they are demanding chiropractic care more commonly than any other form of care.
There are many lessons to be learned from the decade just passed. Some of these are unique to health care; some are common to all. The lessons have included the following:
• In general, things are not always as they seem. What appears to be rock solid one day can vaporize the next.
• The public will be heard, regardless of what the pundits think or do.
• Great political power does not necessarily ensure success.
• Yesterday's decisions in light of today's reality can look wise or foolish. The variable appears to be how deep the thought and reflection that lead to the decision.
• Knee-jerk reactions can sometimes, perhaps oftentimes, be the wrong decisions.
In this age of internet millionaires and billionaires, it is hard not to react impulsively to a changing environment. Fortunes of all kinds, financial and other, seem to swing wildly on the moment. The wisdom of the day appears to call for the ability to turn on a dime, to remodel, to adapt and redress a situation overnight. In the process, we have the opportunity to make what psychologists would refer to as "premature cognitive commitments" - that is, long-term decisions and commitments based upon a temporary set of facts and data.
The elephant tethered by a rope and a stake in the ground has made such a premature cognitive commitment. Conditioned as a baby, it believes in the limiting capacity of the stake and rope. The elite runners who never broke a four-minute mile before Roger Bannister made a similar commitment to the edict that a human simply could not run that fast. Similarly, many among us have made such commitments in other terms: political; educational; consumer demand; practice model; style; and the magnitude of chiropractic itself.
Consider the following:
• Political organizations assert a mantra of 'size is might' while we enter an era of profound personal empowerment and great potential for the little guy to be heard.
• Educational institutions dilute their objectives as they modify their missions and goals from a position of fear and weakness, as opposed to evolving from a position of opportunity and demand.
• Practitioners seek alliances in the short term that, while momentarily profitable, hold the seeds of great harm personally and professionally, rather than approaching alliances from a position of strength and consumer demand.
• Chiropractors, consultants, organizations and institutions call for the abandonment of our language and ideas that are unique, because we can't afford to be identified in any way other than with the mainstream of the day.
Each item is in its own way a form of premature cognitive commitment: each a limitation, a compromise that appears logical at first blush, but the utility of each evaporates with the fullness of time.
We have the right to (and deserve to) enter this new decade, century and millennium proclaiming what it is that makes us unique and what we bring to the marketplace in terms of services, ideas, understanding and perspectives.
We are poised to burst into this new era with an unprecedented explosion of public interest in what we do and why we do it. Because of its clinical utility, its financial viability, its minimal incidence of iatrogenesis, its nontoxic nature, its evolutionarily supportive contribution to the species, and for its plain and simple common sense, chiropractic is poised for a grand tomorrow.
The cognitive commitments that we need to make speak to the expansion of these ideas, not to their erosion; to their distinction, not to their commonality; and to their boldness and potential, not to their "more of the same" thinking.
Chiropractic has an answer for many of the health care world's concerns as we turn this page in history. Our realization of the public's preparedness and thirst for the diversity we bring to health care is a key to seeing the 21st century dawn more brightly and healthier than we ever imagined possible.
Happy New Year! May God fulfill your heart's truest and deepest desires.
Dr. Gerry Clum served as president of Life Chiropractic College West for 30 years. He also is a former founding board member and president of the Association of Chiropractic Colleges and World Federation of Chiropractic. Currently, he is a member of the executive committee of the Foundation for Chiropractic Progress.