The meeting was initiated by the National Chiropractic Mutual Insurance Company (NCMIC) in response to the concerns of their policyholders that the profession needed to, among other issues, consolidate its resources and leadership in a common direction, as opposed to the independent programs and initiatives of the national associations. Instead, the ACA and ICA have opted to convene their own leadership conference this November. The Council on Chiropractic Education, and the Foundation for the Advancement of Chiropractic Tenets and Science (FACTS) also declined to send representatives to the NCMIC conference.
The NCMIC meeting did however included representatives from a wide variety of chiropractic organizations concerned with chiropractic practice, research, education and policy:
American Spinal Research Foundation (formally the Consortium for Chiropractic Research) Patricia Brennan, PhD William Meeker, DC, MPH
Association of Chiropractic Colleges (ACC)
Reed Phillips, DC, DACBR, PhD
George Goodman, DC
Association for the History of Chiropractic
Carl Cleveland, III, DC
Congress of Chiropractic State Associations (COCSA) Mario Spoto, DC Rick McMichael, DC
Federation of Chiropractic Licensing Boards (FCLB) Robert Vaughn, DC Peter Ferguson, DC
Foundation for Chiropractic Education and Research (FCER) Vince Lucido, DC Stephen Seater, CAE
National Association of Chiropractic Attorneys (NACA) Paul Watson Lambert, Esq.
National Institute of Chiropractic Research
Daniel Hansen, DC
Individual Participants
John Allenburg, DC
President, Northwestern College of Chiropractic
Eugene Cianciulli, DC
Delegate, American Chiropractic Association
Kirt Josefik, DC
Delegate, American Chiropractic Association
George "Mac" McClelland, DC
Delegate, American Chiropractic Association
Malcolm McDonald, DC
Delegate, American Chiropractic Association
James Winterstein, DC
President, National College of Chiropractic
Frank Zolli, DC President, University of Bridgeport College of Chiropractic
Observers
National Board of Chiropractic Examiners (NBCE)
Frank Hideg, DC
Paul Tulio, DC
NCMIC Directors
Phil Aiken, DC
Jerilynn Kaibel, DC
Jerome McAndrews, DC
Steve Owens, DC
Michael Pedigo, DC
Invitees had been asked prior to their attendance to consider from their organizations' standpoint: the most compelling problems facing the profession today, and the programs or solutions their organizations had considered or undertaken to resolve them. Input from individual chiropractors was also solicited and presented.
The meeting was a first step to open debate on chiropractic's future. The format of the first day had participants identifying their key concerns, with lively discussion and debate ensuing.
During the second day, participants heard presentations from two research organizations engaged in chiropractic-related social research projects.
- Atul Dighe (Institute for Alternative Futures) asked the participants to provide some feedback on some possible future health care scenarios developed by the Institute.
- Gerald Celente (Trends Institute) presented his organization's initial findings of the trends in health care and social policy they believe will have an impact on chiropractic.
The participants made no attempt to arrive at a consensus on any given point, feeling it was important to spend the two days carefully talking and listening to all sides and opinions.
The common areas of concern fell into three broad categories:
- survival of chiropractic in the health care marketplace;
- issues of professional stature, including: consistency within the profession; public relations; focus and leadership; greater morale; dedication and enthusiasm; resources, particularly those of education and research.
At the conclusion of the two days, participants agreed that they had, like the Paul Williams lyrics to the old Carpenters' song, "only just begun," and that the "dialogue must continue."
There was no agreement on how the common areas of concern should be addressed. A variety of models were proposed, including a task force and a think tank. The participants were however somewhat tentative and guarded in their comments, a result of the two national chiropractic associations not being represented. Some of the leaders were hesitant to make suggestions, not wanting to tread on the mandates of the national organization to which they are members. Ironically, it was recognized that for the NCMIC leadership conference to succeed it would need to reach beyond political affiliations and build alliances across the profession.
Many participants expressed their hope that future initiatives to advance this dialogue (such as the ICA/ACA joint session scheduled for November, and the continuing retreats of the Association of Chiropractic Colleges), would continue to build upon the goodwill and understanding generated thus far. There was also a plea for the leadership conference to be an open and explicit one, with full disclosure.
This is a summary of the issues raised and some of the points made:
Market Position
Enhancing our Image It was acknowledged that historically, the public perception of chiropractic was to a large extent set by advocates of medicine, whose significant resources were brought to bear on discrediting chiropractic. Some participants suggested that chiropractic has contributed to the misperception by not mounting a direct and clear campaign of what chiropractic is (and is not). Again, internal rivalries coupled with our inability to communicate our diversity as a positive attitude, seem to have prevented us from effectively rebutting the rumors and allegations of medicine.
Communicating our Message
It was acknowledged that managed care had turned the health care world into more of a marketplace, with chiropractors, like all health care providers, competing to "sell" their products and services. Although the profession would like to see a level playing field, it was recognized that this was unlikely to happen. Instead, the profession must find effective ways to tell its story, and promote its services. Participants suggested that our message should include that chiropractic care is safe, cost-effective, and that chiropractors are ethical and learned.
Participation in Development of Public Policy
The narrow role of chiropractic in HMOs was seen as yet another example of the way in which the profession is treated as a token health care provider. Why was chiropractic so absent from the policy development of HMOs? A variety of reasons were cited for the absence of chiropractors in public health care policy development at the local, state and federal levels, including exclusionary tactics by the medical profession.
Ensuring Accessibility
In many jurisdictions, managed care is making chiropractic inaccessible to those who need it, contributing to the frustration and discouragement within the profession.
Professional Stature
Consistency and Focus within the Profession
One of the main contributors to ensuring a certain level of consistency within the profession is chiropractic education. The general sense is that the chiropractic education is academically sound, but students lack clinical experience, largely because of lack of access to clinical settings in which to gain that experience. This has a tremendous impact on the graduating student, who in addition to lacking confidence as a practitioner, has had a limited exposure (if any) to models of practice.
Leadership
Participants agreed that the profession is facing a time of tremendous external pressure. What is driving the future of chiropractic: the market, legislation, expectations of managed care organizations? And how able is the profession to respond to these pressures? Have we become a profession that is acted upon, that is reactive?
Professional Morale and Valued
Several meeting participants expressed dismay about the overall mood in the profession, attributed largely to managed care, leading to early retirements, tremendous drops in chiropractic incomes, and deflated spirits. Chiropractors in the field are tired of the struggles within the profession, and continue to experience professional prejudice from other health care providers.
Resources
Education
Lack of resources was initially identified as a concern to the colleges. Eighty-percent of the costs of educating future chiropractors is derived from tuition. This compares to other professional disciplines like medicine and nursing, where the figure is believed to be less than five percent.
Research
Chiropractic has not been tremendously successful in obtaining federal or state funds to conduct research. One participant suggested that she was not aware of there having ever been an award from the National Institutes of Health, which as the largest funder of health-related research has an annual research budget of between $11-$13 billion, to chiropractic research. (Editor's note: Partap Singh Khalsa, MS, DC, was the first DC to received a fellowship from the NIH in 1992, as reported in the Sept. 11, 1992 issue of DC. However, grants from the NIH to chiroprctors have been rare indeed.
It was noted that less than three percent of the chiropractic college operating budgets are spent on research. A telling statistic is that the profession spends about three times more on yellow pages advertising than it does on research.
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