Health care is facing tremendous challenges in the near future, particularly from a financial perspective, and was a significant element of the 2008 political debate. If you are a cash-only practitioner and enjoy being one, this may not matter much to you. But to the majority of chiropractors and chiropractic institutions who want to be a part of the future of health care as it develops, you need to be on board with the message that follows.
Too many chiropractors are so entrenched in the past history and dogma of the profession that they fail to perceive market forces that will cause the profession to become extinct if change does not occur. No, survival is not mandatory, but the only alternative is an altogether unpleasant one: extinction.
Several years ago, chiropractic was removed from Ontario, Canada as a covered service. Optometry and physical therapy were also eliminated, but exemptions were eventually made for both of these service and coverage was reinstated. Only chiropractic was eliminated in total without exemption.3 At the time, Ontario Finance Minister Greg Sorbara said the reason for eliminating chiropractic was because it was considered to be in a category described as "less critical services."
Let me ask you a question: Would any insurance program, whether national or private, delete coverage of primary care? You and I know the answer to this question: It would never happen. To do so would result in no health insurance at all. Health care that enjoys cultural acceptance as primary care will never be eliminated.
Now let me digress for a moment. Clearly, early on, chiropractic and medicine sought separation from each other. Real change did not occur until 1987 when the Wilk suit against the AMA was brought to a favorable conclusion. It was after this that chiropractic began to be accepted by the public as part of mainstream health care, and chiropractors were able to order imaging and testing just like their medical counterparts.
The concept of being integrated into mainstream health care and achieving cultural authority in that capacity requires some in-depth thinking and soul searching. Why? Because chiropractic needs to decide in what manner it is truly going to be accepted into mainstream health care. We are at a crossroads and any decision that pigeonholes chiropractic in national health care will likely have lasting effects.
Chiropractic has traditionally been nondrug and nonsurgical in its approach to health care. However, chiropractors currently need to know the indications, contraindications and drug/drug interactions associated with medications their patients are taking. Why does the chiropractor, who is trained to be a primary care practitioner, only see 7 percent to 10 percent of the population, and the majority of those patients only for neuromusculoskeletal problems?" The obvious answer, and I think we would all agree, is that the chiropractor is not perceived as a personal primary-care practitioner for most Americans.
Now, why is this? The answer is really quite simple. It has to do with the public's perception of the chiropractor's privilege and practice. For example, when you go to a primary care practitioner and you have elevated blood pressure, you expect the PCP, in addition to discussing exercise, weight loss, etc., to prescribe medication to control the blood pressure. Other disorders and maladies have medicinal approaches to treatment.
Therefore, it is the perceived scope of practice to diagnose and manage conditions that culturally identifies a group as being primary care providers. If the practice of chiropractic were understood to be the diagnosis and treatment of human ailments without the use of surgery, we would essentially be perceived as primary care providers by the public.
Chiropractors do not exist in a vacuum. We have been and will continue to be affected by our political surroundings. This concept of chiropractic being considered optional or unnecessary by a government is potentially lethal to the long-term survival of the chiropractic profession.
President Obama says he will make available a new national health plan to all Americans.4 The plan would cover all essential medical services. The Obama plan would create a watchdog group and help reform the insurance market by creating rules and standards. If you read between the lines, health care insurance in America will cover health care services, but only those determined to be essential by the government. Do you not see the parallel between what happened in Canada and what could happen in the United States?
According to the Council on Chiropractic Education, "A doctor of chiropractic is a primary care physician whose purpose, as a practitioner of the healing arts, is to help meet the health needs of individual patients and of the public, giving particular attention to the structural and neurological aspects of the body."5 We simply need to get out of our own way and decide, as chiropractic institutions and as chiropractors, to accept the cultural role of the primary care physician.
The patient needs to know that when they come to the chiropractor, they will be consulting a doctor who has the ability to diagnose and treat conditions, as would any primary care provider. The fact that they may also receive chiropractic adjustment to correct neuromusculoskeletal dynamics and promote health is simply part of care and is an added bonus for any patient who selects a DC as their primary care provider.
To those in the profession who resist this logic because the concept seems "non-chiropractic," think of it as a compromise to ensure longevity of the chiropractic profession. In the future, we need to provide services that keep us as desired essential members of the health care community. Otherwise, we are destined to be relegated to some other nebulous position.
References
- Meeker W, Haldeman S. Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Ann Intern Med 2002;136:216-227.
- www.chiro.org/Plus/History/Persons/NewYorkState/nys_chronology.pdf., page 103.
- Devitt M. "Ontario Removes Chiropractic From Provincial Health Plan." Dynamic Chiropractic, July 1, 2004.
- http://change.gov/agenda/health_care_agenda
- Council on Chiropractic Education. Frequently Asked Questions. www.cce-usa.org/faq.php
Dr. Geoffrey Gerow, a graduate of National College of Chiropractic, has been in private practice in Buffalo, N.Y., since 1989. From 2004-2007, he served as director of the chiropractic program at D’Youville College, helping to develop the program and gain CCE accreditation. He also served in numerous capacities for 15 years at his alma mater, including instructor in biomechanics and chiropractic technique and supervisor of the orthopedic residency program.