The other day, I was talking to a banker friend of mine who asked me a very pointed but unusual question: "Would you consider chiropractic to be a subprime profession?" I must confess it took me by surprise for a few moments, and I must also admit I had difficulty in responding to that very simple question.
"Being powerful," the iconic former House Speaker Sam Rayburn once observed, "is like being a lady. If you have to say you are, you ain't." Such is the case, I'm afraid, with some in our profession. There are those who make egotistical pronouncements about the necessity of chiropractic just to maintain life, while others articulate eloquent recitations about lofty principles as primary health care providers. Regardless, few in the world seem ready to accept chiropractic as we would like them to, and for the most part we have ourselves to thank for that.
Defining Ourselves by Inaction
Our transgression? We have failed to define ourselves through actions, hoping instead that our rhetorical bombast would suffice. Unfortunately, that is nothing more than a wishful delusion. There are many villains in this drama, far too many to name, and it would be counterproductive to embark on the blame game. Each of us shares a measure of irresponsibility for standing and watching the train wreck that has become chiropractic's march away from the standards and rigors imposed by modern science and medicine. Yes, I said medicine. It is what it is, and no amount of wordsmithing will change medicine's influential position.
Like a bunch of grizzled war veterans recounting stories of past glories and fights against "the great conspiracy," we have essentially become prisoners of our own history, not makers of it. We seem content, in fact even eager, to fight the "Great AMA War" all over again, not realizing that time and circumstances have moved on. We keep doing the same thing over and over and expecting a different result, and you know what the definition of that action is.
The histories of the healing arts - ours and that of traditional medicine - could not be more different. There are reasons for that, both good and bad. Our need to not rely on drugs or invasive procedures is a positive differentiator. But political medicine's war on quackery, and its subsequent program to "contain and eliminate" chiropractic, demonstrated the power of how actions combined with words define great professions and individuals.
Whereas medicine preached standards and clinical consensus, chiropractic rejoiced in its isolation by advancing the misguided axiom that the emerging body of rules and regulations did not apply to us. The profession then bequeathed that ridiculous supposition to new generations of practitioners by remaining silent, while the guru's of practice building and management foisted their "clinical economics" on those who attended their seminars to learn secret voodoo methods in order to prosper in practice. We lost that powerful but important patient-centric focus that was the core of chiropractic's success.
If we simply look at the financial crisis consuming America and the rest of the world, it is soon obvious to even the casual onlooker that these giant financial institutions did not fail for lack of regulation, but rather for lack of enforcement! These institutions, like chiropractors, must step up to the plate and recognize that they are in effect an image campaign for their entire industry.
Health care cannot be compared to widget production. You simply cannot get away with long-term exposure to bad quality, lack of professionalism and shoddy enforcement of standards and expect to escape unscathed. Those truly bad subprime lenders were a minority within their profession, and yet the entire financial profession was tarred and feathered just the same as their minority brothers. Chiropractors are judged collectively by the most egregious actions of a single individual, and unfortunately, in today's modern world of instant communication, the most sensational stories, offensive and/or scandalous, are the ones usually reported and remembered.
The bright light of transparency (after the fact) now focuses on and exposes the near-daily financial scandals. This will, in turn, lead to scrutiny of every facet of public activity and operations by government agencies. With the next big issue undoubtedly being health care reform, the debate for dominance has already begun. This time, reform will be unlike anything we have seen as a nation, not unlike the far-reaching near-nationalization of our banks.
Participation: A Prerequisite to Progress
Those providers who are called to the health care table for input will, by necessity, have to demonstrate the ability to self-govern and that the interest of the public is greater than the interest of their profession. Patient-centered care backed by valid outcome measures will be a prerequisite to having a place at the negotiating table.
All groups may have an opportunity to demonstrate their ability to self-govern, self-direct, self-regulate and self-police, as well as to demonstrate their ability to continually evolve as new research and information become available. Those groups with tarnished images, little research and little evidence to support self-regulation will be significantly hampered and will not enjoy the privilege of participation and inclusion.
The question we all must ask is simply this: "In what direction is the profession headed?" If you are not convinced your national, state and/or local association is responding to the challenge the profession is facing tomorrow, then you have only one choice: participate and change it! It is not too difficult to participate because the evidence is strong that only a small percentage of the profession is actually members, and even fewer of those members take part in the actual governance process. If you are not happy, do something about it because the window of opportunity for self-determination is rapidly closing. The forces challenging all the health care professions in this new area of reform, accountability and cost-containment are enormous and never before mandated by those making the decisions (paying the bills).
Time to Bail Ourselves Out
If we do not want to be subprime and do not want to be viewed as a profession in foreclosure or bankruptcy with respect to our values and worth, there is only one kind of bailout we have available, and that is bailing ourselves out. It is time to clean up the garbage and eliminate the toxic waste from every aspect of our profession. Those who are in positions of authority, national, state and local associations, state boards of examiners, educational institutions, research organizations and individuals in practice who hold the most power must simply draw a deep line in the sand and say no. No to every scheme, scam and scandal in our glass house we call chiropractic.
The difference between 2009 and any other time in our history is simply this - more than ever, we now have those who would gladly take our profession and claim it as their own. The evidence is clear and compelling that the forces at work to marginalize chiropractic are overwhelming. The difference is that the reforms mandated by the government and policy-making groups are more all-encompassing this time. Just witness the regulations imposed on the banks and auto industry since the bailout. View the controls and restrictions put in place and consider what similar regulations can do to our profession with one sweep of a pen, if any such regulatory mandates were imposed.
"Subprime" is not necessarily a bad place to be. It can afford the chiropractic profession the opportunity to advance by redefining whom we are, how we will participate, and what values we want to be known by. It could be the equivalent of restructuring and being given a new chance to succeed after removing unnecessary and detrimental past practices. This is a new chance for chiropractic to remortgage, get rid of the old baggage that has not served us well, and begin a new era of accountability and transparency. It will not happen, however, until each of us is willing to share in the responsibility.
Click here for previous articles by Louis Sportelli, DC.