"It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care.
The authors (co-authors of the paper in addition to Dr. Murphy include Drs. Brian Justice, Ian Paskowski, Stephen Perle and Michael Schneider) discuss what they consider the necessary skill set of the primary spine care practitioner, including but not limited to a wide-ranging understanding of spine pain; the ability to identify psychological factors contributing to a spine condition; "understanding of the methods, techniques and indications of intensive rehabilitation, interventional treatments and surgical procedures;" and the ability to coordinate care involving a variety of health care providers. As might be expected, DCs could serve as one of the sources (albeit not the only source) of this specialty:
"Institutions of chiropractic medicine, for example, provide training that is focused primarily on the spine. Many of the skills required of the primary spine care practitioner are already taught at these schools. By instituting some specific changes ... these institutions can become at least one source of appropriately trained primary spine care practitioners."
The authors add: "It is likely that the best candidates to be groomed to become primary spine care providers may not come from the allopathic medical profession. ... The institution of new models of health care in general, including primary spine care, will require non-traditional ways of thinking about which provider will become the 'team captain' for any particular medical condition."
So, in terms of overall practice scope, what would a primary spine care provider look like? In the eyes of Murphy, et al.: "The primary spine care practitioner would function as the first contact for patients with SRDs [spine-related disorders], i.e., the first practitioner that a patient consults when he or she develops a spine problem. The primary spine care practitioner could also function as a resource for traditional PCPs (family practice physicians, general internal medicine physicians, pediatric, obstetrical / gynecological physicians, primary care nurse practitioners or physician's assistants) to refer patients who present with SRDs."
Among the many potential benefits of a primary care spine specialty, according to the authors, are faster patient recovery; cost savings; avoidance of iatrogenic disability; care coordination; unburdening of traditional primary care providers; and standardization of care. Among the potential obstacles, the authors note educational changes that would need to take place ("Currently, none of the major health care educational institutions are consistently graduating providers who meet all the criteria necessary to be successful primary spine care practitioners"); prejudice / resistance to such a specialty within the traditional allopathic medical model; and even "resistance from within the profession(s) that could potentially be the source of primary spine care practitioners." Also noted as an obstacle is "the detrimental effect on those invested in the 'supermarket approach' ... if a system in which value rather than volume is rewarded, some practitioners may be negatively impacted and some may even go out of business."
While the immediate and long-term shape of health care – and chiropractic care – in the U.S. remains speculative at best, cost-containment and patient-centric care appear destined to be overriding priorities. Murphy, et al., address this in their conclusion, emphasizing the potential value of the primary spine care physician model:
"It is our view that the addition of a primary spine care provider who is responsible for front-line diagnosis, management and triage [would bring] greater value in the care of patients with SRDs. Moreover, the addition of this practitioner would be aligned with developing models of health care such as the patient-centered medical home and the accountable care organization."
Full text of the Murphy, et al., commentary is available on the Chiropractic & Manual Therapies Web site.
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