I would first like to thank you for the work Dynamic Chiropractic has done in bringing important issues to all our attention. This letter is about another important issue.
In the year 2000, a newspaper headline will read "Competition In Manual Back Care Therapy Takes It Toll -- Chiropractic Profession Suffers a Decline." Sound farfetched? Just another doomsday prediction? Something that chiropractors have heard many years before? Maybe, but let's examine this closer.
Manipulation is becoming more accepted. Medical journals are publishing research on it. It is just a matter of time before manipulation is adopted by the mainstream health care system. The new kids on the block in this game are the physical therapists. Physical therapy schools are now offering an intensive program of manipulation and some diagnosis as part of their ever-expanding curriculum. I hear that the "novice" physical therapy adjustors are excited by what they are doing. They are also encouraged by the acceptance manipulation is getting and are looking forward to gaining a bigger role in the health care field. Hold on, you say! These physical therapists won't be able to adjust like we can! Come on, do you really think so? How long was it before most of your patients were getting better from your adjustments.
As manipulation becomes more scientifically accepted, it will become more publicly accepted and trendy. This means that besides the physical therapists, osteopath will be doing more manipulation. Likewise, massage therapists, naturopaths, and even some MDs will do it. (You don't have to have a license to manipulate.) According to an article in the California Chiropractic Journal, there are even MDs (Lewit and Greenman) who are "leading the international medical think-tank that is establishing full-time postgraduate courses in musculoskeletal medicine to prepare MDs for a full-time career in manipulative medicine."
Don't even think we can claim sole rights to manipulation. These professions will not permit it. The medical establishment will be particularly pleased, because they will now have somebody under their control (the physical therapist, massage therapist) who can perform manual therapy. In this way, it will be easy for your local neighborhood MD to prescribe several adjustments for patients.
Conglomerate health care centers like Kaiser will employ multiple therapists. Especially once these health care centers see how much money they can save by using manual therapy while still raising their rates. Other health care insurance companies will not have to add chiropractic benefits. There will not be a direct demand for chiropractic treatment as people can get their manual therapy through mainstream traditional sources. With this in mind, we can forget about the Medicare patient. People will not pay large deductibles, x-rays, and copayments for only a few treatments a year when they can get cheaper, more convenient care elsewhere. For example, a person may get their periodic adjustment while they pick up a prescription. If physical therapists are also allowed to practice solo in a particular state, it is just a matter of time before they compete directly with many chiropractors. At the very least, chiropractors will be much more dependent on the trend of mainstream health care in America.
If these things take place, it will almost certainly signal a decline in the chiropractic profession. What can we do? There are two ways to direct our efforts against this:
- Change the existing laws to favor chiropractors. At the rate current changes are being made, this does not appear likely, especially if the larger, better-organized professions are to have even more top gain from our losses.
- What is more feasible is that chiropractors offer more to the public so that they make themselves such a valuable part of health care there is just no way to replace them. This requires chiropractors to address their attention to the following:
a. Unite the profession. It may be necessary for the main body of the profession to establish a separate identity. In this way it will be easier for the public and other professions to differentiate between high and low standards of practitioners.
b. Become a major player in the mainstream health care system. The initial move in this direction would be to obtain access to most hospitals. We have to establish our "turf."
c. Initiate more research projects with prestigious educational institutions.
d. Develop the scope of the average practice to include more than just manipulation and use of a few physical therapy devices. Manipulation will always be the main form of treatment, but the majority of chiropractors will have to offer other specialists like acupuncture (electrical or non-electrical), homeopathy, nutrition, rehabilitation facilities, to be qualified in sports medicine and have excellent diagnostic capabilities, etc.
If we, as a profession, do not expand our expertise, it will be too easy to substitute our services. Even if manual health care services must be shared, it will be easier to negotiate our place from a position of strength rather than weakness. These things must be started soon as time is running out. Our situation reminds me of feuding, immature boys in an adult professional environment. Our profession must realize the fragility of our place in the health care system and work towards stabilizing this.
Brian W. Balbon, D.C.
San Francisco, California