As The American Chiropractor celebrates its 30 Year Anniversary, our panel of leaders look back on just how far the chiropractic profession has come and what lies ahead.
Dr. Louis Sportelli
President of NCMIC
Dr. Sportelli has served in many capacities throughout his 47-year career in chiropractic. He is currently serving as President of NCMIC Group Inc., which provides malpractice insurance and financial services to doctors of chiropractic. Another area of interest has been patient education, and he has written a book, Introduction to Chiropractic™, which is widely used by doctors of chiropractic across the world and is now in its 12th edition.
TAC: The past thirty years have been controversial for chiropractic. What would you say have been the milestones that have occurred and how have they impacted chiropractic?
There have been several that have happened in the past 30 years. A few years earlier than 1979, the most significant achievement occurred and that was the recognition of CCE by the United States Department of Education. That single event changed the entire educational process for the profession, established one standard, provided loans for prospective students and removed a stigma from the profession that chiropractic education was inferior. Following that event, the long awaited success of the Wilk v AMA litigation, which essentially provided information from the legal discovery process which enabled the profession to fully understand the events of the past and pave the way for future advancement based on the AMA conspiracy. Then, the starting of the World Federation of Chiropractic (WFC) in 1988, the AHCPR recognition of spinal manipulation and the most current accomplishment with the publication of the proceedings of the Bone and Joint Decade–Neck Pain Task Force, which was the most comprehensive research consortium ever assembled from around the world. The significance of that research and scientific collaboration has yet to be fully realized. These events have continued and will continue to change the public, private and professional view of chiropractic.
TAC: What is the most pressing issue of the moment for the profession?
Without question, The Health Care Reform, and whether or not chiropractic will be included and in what fashion. This new health care model will change the direction of chiropractic availability for decades. This issue is far more difficult to expound upon because no one knows precisely where the debate will take us and upon what the reform will focus. Without a doubt, however, the health care debate will provide the most significant challenge to the profession ever.
Dr. James Winterstein
President of National University Health Sciences
Dr. James Winterstein is a 1968 graduate of National University of Health Sciences. He completed his residency in diagnostic imaging in 1970 and became a diplomate of the American Chiropractic Board of Radiology in May of 1970. Dr. Winterstein has been a member of the Board of Directors of the Federation of Illinois Independent Colleges and Universities for the past 18 years and also serves as a board member for Alternative Medicine Integrated Inc.
TAC: What would you say was the largest missed opportunity for Chiropractic?
During the past 30 years, the chiropractic profession, which prior to 1970, saw itself and practiced as a diagnostically, therapeutically conservative primary care profession, had the opportunity to demonstrate its potential as a source of conservative primary care providers–the necessity for which has become very clear in the past several years, as the deficiency of primary care providers becomes ever more evident. Unfortunately, the chiropractic profession chose to restrict itself almost completely to musculoskeletal disorders, primarily because of reimbursement opportunities provided by the insurance industry during the 80’s and 90’s. It sold its true value for the sake of increased income. As this took place, the third party payer industry took note through its actuaries and, gradually but consistently, contained and further restrained the chiropractic profession, by virtue of its own profile of practice to limited musculoskeletal therapeutics. The missed opportunity has resulted in a boxed in profession and, except for some small future opportunities, it might well never recover from this error of professional judgment.
TAC: What, in your opinion, was the most significant event that unfolded in the past 30 years?
The most significant event to have unfolded in the past 30 years was the development of the Journal of Manipulative and Physiological Therapeutics, which, until recently, was the only peer reviewed and fully indexed scientific journal of the profession. Prior to this, the development of educational accreditation by the Council of Chiropractic Education as a true watershed event. Also of true significance for the profession has been the development and federal funding of basic and clinical research at a high level of scientific attainment. These three accomplishments, which actually cover the period from 1974 to the present, are, in my estimation of greatest significance to the development and recognition of the chiropractic profession.
Dr. Joseph Brimhall
President of Western States Chiropractic College
Joseph Brimhall, D.C., President of Western States Chiropractic College in Portland, Oregon, since 2003, was in private practice for twenty-two years. He has extensive experience in regulation, professional testing, chiropractic accreditation (national and international), and regional accreditation. Dr. Brimhall was CCE President, CCE-COA Chairman, and is President-Elect of CCEI.
TAC: What has been the single biggest deterrent to unity within the profession?
The question, itself, reveals the restraint—the perception that the profession lacks unity may actually be the principal dilemma. Second to that quandary is the illusory notion that somehow "unity" is a necessary or desirable attribute for the profession.
The chiropractic profession is unified where it counts, with recognized educational requirements, dependable evaluation processes, professional licensure and regulation in jurisdictions around the world, and strong ethical values. Yes, we disagree about practice scope and philosophy and techniques and many other things. We have a variable mixture of attitudes and a broad dissimilarity of professional philosophies. Is that a bad thing, or is the diversity of thought a strength?
My view is that the range and assortment of clinical and philosophical approaches is an asset—that we benefit from having multiple views and opinions, because it forces us to persistently assess and evaluate our direction and our values. I’m not talking about those that use the profession for unethical purposes—we need to continue to weed those elements out in order to protect our patients and our professional integrity. However, I believe that honest disagreements provide grist for the mill in advancing the profession. Otherwise, we become a profession of homogenous zombies that are unable to make new discoveries or adapt to changing environments.
Our disagreements need to continue as great debates. As changes occur and health care evolves, we can discover our direction and our identity only through open dialogue, mindful deliberation, and decisive action.
It is not the lack of unity that binds us; it is the failure to engage. A critical majority of the profession is willing to simply sit on the side-line and observe, too lazy or too afraid to take a stand and work for the greater good. If we expect the profession to develop and thrive, we need to be willing to ask the difficult questions, to fight for what we believe in, and to grapple with our differences until we find accord. This is a continuous and necessary pattern. If we expect to grow, the process must repeat itself over and over. There is no easy path to success, and advancement of the profession cannot be accomplished by spectators.
Dr. Gerry Clum
President of Life Chiropractic College West
Gerard W. Clum, D.C., is president of Life Chiropractic College West in Hayward, California, and is the most senior chiropractic college president in the world today. He will begin his 30th year as president of Life West in January 2010. He has served in the leadership of the ICA, ACC, WFC and the Foundation for Chiropractic Progress.
TAC: What is the Most Pressing Issue of the Moment for the Profession?
Perspective. We are in a moment of great fluidity in our culture. Further, we are in a moment where the focus of this fluidity has the potential to greatly impact our circumstances.
I am not naïve. I understand there is a great deal at stake in the current discussions regarding health reform. But I also understand that this focus on health reform has brought conversations forward that would have been hard for us to imagine months ago. When the President of the United States predicates a dialogue about health care reform with the premise that we do NOT have a health care system, we have a sickness care system, something we have longed for has arrived. When policy makers and pundits alike agree that health care reform will not reform health, something we have longed for has arrived. When the great "answer" for health reform is not big pharma, but clean living, something we have longed for has arrived.
If we can gain a perspective on how the thinking of large and powerful portions of society is aligning with our viewpoints and understandings, we can begin to further appreciate how the firmament is being prepared for a transition that will be far more welcoming to our practices than we ever dreamed possible.
Joseph Campbell was fond of remarking that, to change a culture, one must first change the metaphor of the culture. The metaphors of health and health care have changed and the culture is changing accordingly. The culture wants and needs a new model of health care—and we are in remarkable alignment with what they are seeking.
Our task today is to gain a broader view of our world and its directions and express our views in language and metaphors that are consistent and synchronous with their view, so that we may be more easily heard and more fully appreciated for our contribution. We are on target. We do not need to change our path. Rather, we need to appreciate the alignment of the hearts and minds of our society with our thoughts and practices. Dr. Sid Williams often quoted Columbus’ log, "Today, we sailed due West, because it was our course." Stay the course, but do so in the language and with the cultural understandings of the day.
Dr. Scott Haldeman
Chairman of the Research Council of the World Federation
Scott Haldeman, D.C., M.D., Ph.D., is a Clinical Professor of the Department of Neurology, UC, Irvine; Adjunct Professor of the Department of Epidemiology, UCLA; and Past President of the North American Spine Society and the American Back Society. He is chairman of the Research Council of the World Federation of Chiropractic. He has published over 185 articles or book chapters and has authored or edited 7 books.
TAC: What are the challenges that face the chiropractic profession in the 21st century, in the next decade, and beyond? How could the growth and progress of chiropractic be advanced or stymied during this time period?
The past 20 years has seen a marked increase in the amount of research into the epidemiology, diagnosis, and treatment of disorders associated with the spine, especially back and neck pain. The therapeutic benefit of spinal manipulation for back and neck pain is no longer seriously questioned and there are growing research efforts to look into the impact of this treatment approach on other conditions.
The research support for spinal manipulation has resulted in the situation where chiropractors are generally accepted as valuable members of the health care team. The acceptance of chiropractic has resulted in a debate within the profession concerning the future role it wishes to play within this team. The potential future roles for chiropractors include 1) a limited practice to that of a skilled practitioner of spinal manipulation; 2) a wellness/holistic clinician focusing on preventative health care therapies; or 3) the primary spine care clinician.
Recent publication of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders and a special issue of The Spine Journal on Evidence Informed Management of Chronic Low Back Pain emphasized the fact that many of the treatments that have been demonstrated to be effective in the management of back and neck pain, such as exercise, education, mobilization, manipulation and NSAID’s, are neither high tech nor expensive and could easily be offered by chiropractors.
The position that offers the greatest opportunity for chiropractors is that of primary spine care clinician. This position assumes that the chiropractor will become the most knowledgeable clinician in the field. A decision to strive for this role in the health care system will require a change in the culture of the profession. Practicing chiropractors will be expected to attend the major chiropractic research meetings, such as the World Federation of Chiropractic and the RAC conferences. They will have to participate in greater numbers in the inter-professional spine research meetings, such as the North American Spine Society Congress. They will also be required to subscribe to and read the major spine journals in order to achieve the knowledge necessary to become the authority on the spine. Chiropractic colleges will have to change the curriculum to train students to accept this role. Graduate continuing education programs will have to include a strong scientific component.
It is not yet clear whether individual chiropractors, the colleges or the state and national associations have made the decision as to which of these roles would serve the profession the best. It will be very interesting to see what role the chiropractic profession will decide to assume in this very exciting evolution of health care.
David Chapman-Smith, LL.B, F.I.C.C.
Secretary-General of the World Federation of Chiropractic
Mr. Chapman-Smith, a Toronto attorney, is Secretary-General of the World Federation of Chiropractic and editor/publisher of The Chiropractic Report. His introduction to chiropractic was as legal counsel for the New Zealand Chiropractors' Association before the famous New Zealand Commission of Inquiry into Chiropractic in 1977/78.
TAC: If you could have your wish to change the profession, what would be the thing you would change?
Nothing fundamental to the profession should change–such as its philosophy of health and its central focus on skilled assessment and treatment, by hand, of subluxation/dysfunction in the spine and the neuromusculoskeletal system.
The profession that so many of us admire, and to which I have devoted my last 30 years, will have lost its way, if new generations of chiropractors are not skilled and confident in joint adjustment–spine, pelvis and extremities.
Two of the major issues for the profession today, related to each other, are its relative isolation within health care and the lack of public funding for education, research and practice that it needs and deserves. On isolation, a chiropractic friend of mine who holds qualifications in both chiropractic and medicine is an executive in a large Canadian health services corporation. This employs many MD’s, DC’s, PT’s and others. It seeks contracts with large employers, insurers and others for the health plans it offers. He sees much more of the health care world as it actually is than you or me. His conclusion, after watching all the above professions at work with NMS patients, and seeing which services are most in demand and how they are priced–"chiropractic is the best kept secret in the world. DC’s offer such a superior service but nobody knows."
What would I change in the profession? It would be something key to bring about more rapid knowledge, acceptance and, therefore, use, funding and support of chiropractic services within mainstream healthcare. I would like to see all chiropractic students having at least part of their clinical training in a multidisciplinary setting that includes medical services and, ideally, medical students.
This is already happening in many chiropractic schools internationally. In Denmark, chiropractic students complete most of their clinical training in a major spine care hospital. In Mexico, all graduates complete a first clinical year in state hospitals.
In the US, eleven chiropractic colleges now have some students doing rotations in VA and DOD hospitals, but this exposure to broader clinical training and other professions and healthcare students should be available for all.
This will strengthen clinical training. However, my point here is that it will continuously educate others influential in health care about chiropractic—and this will lead to the greatly increased community acceptance and funding that the profession and its patients need and deserve.
Dr. Vernon Temple
President of the National Board of Chiropractic Examiners
Dr. Vernon R. Temple is the president of the National Board of Chiropractic Examiners. A 1977 graduate of Palmer College of Chiropractic, he is past president of the Vermont Board of Chiropractic and past chair of the Federation of Chiropractic Licensing Boards. Dr. Temple is a diplomate of the American Board of Chiropractic Orthopedists.He continues to practice in Bellows Falls, Vermont.
TAC: If you had one piece of advice for new graduates starting into practice in 2010, what would it be?
The most important piece of advice I can provide to the new practitioner is to develop a Patient-Centered (PC) practice. This means that the full intent of doctor and staff regarding all patient contact is always to be focused on the best interest of the patient.
Some of the key areas where the practitioner can incorporate PC include:
1. Patient Education
Patients come into your office with the same four basic questions: "What’s wrong with me?" "Can you help?" "How long will it take?" "How much will it cost?"
To meet patient’s needs, the doctor will completely answer these questions; but, to truly have a PC practice, the doctor should also educate the patient about their role as a partner in their health care. The PC doctor ensures patients understand how chiropractic will relieve their current condition and contribute to long-term health.
2. Patient Services
As the new practitioner develops office procedures, both the doctor and staff must put patients’ needs first. From the initial phone call, to the first time a patient comes in to fill out forms, to the initial consultation, to the report of findings, through the final staff encounter, all processes must be convenient for the patient and must make the patient feel cared for.
Having a doctor and staff who demonstrate a sincere and genuine passion for the patient’s well being will build a lifelong successful practice. Empathy for the patient’s suffering gives the patients confidence that their health is in the hands of caring people. Not only will these patients return, but they will refer their family, friends and loved ones to receive that quality of care.
4. Financial arrangements
Payment for services will always be a consideration, but should never take priority over patient needs. A PC practice dictates that patient contact and care always remain in the best interest of the patient. Ensure that all financial arrangements are based upon the needs of the patient and then billed appropriately. The fruits of an ethical practice are a waiting room full of patients appreciative of a doctor they know is working in their best interest.
5. Continuing Education for the Doctor and Staff
Doctors of Chiropractic should always continue to learn, to expand their knowledge, to continue to invest their time in order to enhance their abilities to meet their patients needs. Ongoing staff training regarding procedures and patient interactions represents another avenue to meet the goals of a PC practice.
If all doctors incorporate the philosophy of patient-centered care, they will be rewarded with a comfortable living, an enjoyable career and, most important of all, the satisfaction of helping thousands of patients in their community live healthier lives.
Dr. William Morgan
Champion for Chiropractic Integration
Dr. William Morgan, a champion for chiropractic integration, has been credentialed in four hospitals, including Bethesda and Walter Reed. He is the resident chiropractic consultant to the government clinics that care for our nation’s leaders in Washington, D.C., and is on faculty of three chiropractic colleges and one medical school.
TAC: Where do you see the next great challenge to face chiropractic?
Cultural Relevance. Contrary to what other futurists may predict, I do not see chiropractic’s next big challenge to be attacks on our market share by competing professions or insurance companies, nor do I see it as exclusion from Congress’ health care bill. I do, however, see chiropractic’s next big challenge to be more fundamental: the loss of cultural relevance. Cultural relevance is maintained by being embedded in the popular culture; to speak the same language, to understand the culture, and to have a position in the culture that is valued. In the current congressional healthcare debate, no adversary is seeking to confine us, because we aren’t even mentioned. Have we lost our impact on the debate? Is society becoming indifferent towards chiropractic? If these are indicators of a trend, chiropractic will gradually ebb. The danger of this type of challenge is in its insidious nature, slowly eroding our niche; so slowly, that it is hardly recognized.
The vertebral subluxation is neither the cause nor the solution to our problems. Certainly, I can use this term when engaged in discussions in chiropractic circles, or I can speak with more standardized neurological/biomechanical terminology when engaged with medical specialists. To most of our culture, whose goals are pain relief and health, the word subluxation is simply jargon. To establish our relevance, we need to move past jargon, beyond practice management schemes, past intra-professional disagreements, and emerge with a higher degree of professionalism and maturity.
If chiropractic attains cultural relevance (some would say cultural authority), then our other concerns should take care of themselves. With relevance, chiropractic will be in demand and, whether or not we are included in government health care plans or covered by insurance, will not matter. Patients will seek us regardless of coverage or competition. Think of dentists or optometrists. Whether covered by third party payers or not, our culture will continue to utilize dentistry and optometry. These professions have cultural relevance.
What will it take to attain strategic cultural relevance? We need to align our profession with the needs of the culture. We need to develop a realistic sense of self-awareness and, instead of trying to bring the culture around to our way of thinking, we need to listen to the culture, learn what the culture values, strive to fill a niche that is valued by the culture, and communicate to the culture in the predominant forums of the day.