|Prescription for Chiropractic
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By Alexander J. Rinehart, MS, DC, CCN
The viability of Chiropractic's future is as vulnerable today as it was back in 1895.
The Chiropractic profession has been in a bit of a legislative upheaval over the last few months. Most of the uproar has been initiated by the push for prescription rights in New Mexico.
To put the upheaval in perspective, Chiropractic has had a long history of a losing battle with "cultural authority". Cultural authority is best explained with an example that you are likely already familiar with:When a patient has a bad experience with a medical doctor they simply find another medical doctor - Medical Doctors are viewed as a cultural authority; while a poor experience with a Chiropractor would have that same patient vowing never to try Chiropractic again.
With this said, I am seeing patients increasingly fed up with conventional healthcare, and more patients are seeking Chiropractic and other natural therapies as first-line of treatment rather than a last resort.
The medical-industrial complex is really starting to shoot itself in the foot.
• To market drugs, pharmaceutical companies must now offer antibiotics for free, offer discount cards, and tell patients "not to kid themselves" on seeking other remedies.
• Pharmacies can no longer be standalone entities but must be integrated in grocery stores, convenience markets, and low-cost department stores that a large percentage of the public is already visiting.
• Medical industries must also push for mandates of interventions once widely accepted but now receiving questions (ahem, vaccines).
• They are also starting to offer "pharmaceutical-grade" supplements, caving in to the push for natural, lifestyle based treatment approaches.
• You are hearing more stories of doctors kicking patients out of their offices when they ask for something different than conventional medicine. I also have seen information "experts" censoring comments on their blogs or responding angrily to alternative opinionsDoes anyone else get as excited as me about this? Docs, you should be SALIVATING at the opportunities before us.
Given the above observations, you would think that Chiropractic would be gaining steam in the cultural authority department. Not so fast...
You see, Chiropractic also shoots itself in the foot in four main ways:
1. There is a long-standing philosophical divide between the "straights" and the "mixers", or "condition-based care" vs. "subluxation-based care". Personally, I welcome the diversity in our profession. In theory, it increases who we can serve.
What I strongly disagree with is the fact that we make the debate so embarrassingly public. We confuse the public, policymakers, and prospective Chiropractors alike.
I love subluxations, and you know what, I love condition-based care too. Why? Because, when cases are managed correctly, both styles help patients - isn't that why we're here?
2. We refuse to increase academic and admission standards of our institutions - in my opinion, out of fear.
Whether you want to acknowledge it or not, Chiropractors are perceived by the public as medical students who could not make it. Our educational institutions are largely tuition-dependent - translating to admissions departments going through the motions of taking applications, charging fees, and setting up interviews. In all reality, if you have a 2.5-3.0 GPA and the right prerequisites, you are most likely to get in to your school of choice.
How many eyebrow-raising conversations have you had with individuals from the public about the education required to become a Chiropractor?
Now, maybe I am exaggerating, but there's a perception in the public that we take weekend courses, or a "less rigorous" two-year education, and suddenly call ourselves "doctors".
Might you begin to understand how certain segments of public can be so convinced that we hurt our patients or cause strokes? Might you also understand how Chiropractors may enter the healthcare marketplace with a second-class citizen mindset?
I think this is part and parcel of the lack of cultural authority and Chiropractic's sieve-like educational standards.
(Recently, National University of Health Sciences did raise their requirements... perhaps more interesting, however, is that they are also center stage in the big push for prescription rights!)
Do I even need to bring up the CCE? During my educational experience at NYCC, I witnessed some great professors being pushed out and some great students becoming disillusioned because of our institutional addiction to CCE guidelines. Former ACA chairmen and American Chiropractic Foundation President, Dr. James Edwards describes the guidelines as incestuous - and recently claimed that the recent CCE proposals vastly misrepresent the profession.
3. We are still holding on to old battles against the medical profession.
Yes, we've won two crucial court cases against the American Medical Association.
Yes, we should appreciate our history and show a little respect for the diverse history of DD and BJ Palmer.
Yes, we had to fight for our existence in the early goings as Chiropractors were literally imprisoned for practicing their art.
But what was the charge against Chiropractic at the beginning of the "battle"? "Practicing Medicine Without a License".
The solution required for Chiropractors to maintain professional existence? Chiropractic was re-branded strategically as a "belief", (and quite bluntly a "religion"), to prove to the courts that Chiropractic was a separate and distinct profession from medicine.
This strategic distinction haunts us to this day.
Today, our passion for our message turns policymakers away even when we have a legitimate message! The result... other professions are systematically taking our holistic philosophy and repackaging it to show that holistic medicine can indeed be evidence-based and cost-effective.
The result? Policymakers (and more importantly, consumers) are finally starting to turn their heads and take notice. The message was never wrong, it was the emotionally-driven packaging.
Dr. Mehmet Oz, Dr. Mark Hyman, and Dr. Andrew Weil can talk to Congress about integrative medicine and "Innate Intelligence" and be welcomed as geniuses. Meanwhile, Chiropractors have only been sitting back quietly arguing and advocating for this type of healthcare since 1895.
4. We ignore aspects of our scope of practice that we already have!
Chiropractors receive just as many credit hours as medical students, and arguably more when you factor in Chiropractic technique lab hours.
As a general rule, we also receive more credit hours of training in musculoskeletal diagnosis, anatomy, nutrition, physiology, neurology and radiology than medical students, while receiving less in medical diagnosis, in-office medical procedures, and pathology.
Why not reorganize our schools and our CCE guidelines and most importantly, quit arguing amongst ourselves. Instead, why not push for holistic research, and create and execute a campaign to prove our clinical utility and cost-effectiveness in the subjects we already have competitive advantage?
Remember, the big issue behind New Mexico's move to allow prescription rights is cultural authority. Yet, at the historical moment that we have been waiting for where momentum is finally shifting in our favor - we disavow our most differentiating characteristic as a drug-less profession.
Could it be that we're scared of the impending responsibility?
So How Do We Stop Shooting Ourselves in the Foot?
It's been documented, by study of successful professions like podiatry and dentistry, that cultural authority is gained when professions speak with one voice, evolve to enlist specialties, cross refer amongst one another, and prove themselves as useful and cost-effective counterparts in the overall system.
I know that to get into hospital rotations we need to be more marketable in terms of our skill-sets - hence the short-sighted push for prescription rights (Psst... Hospitals make money off of residents and would like the flexibility of shifting you around multiple departments).
The key players behind these short-sighted movements believe wholeheartedly that they are acting in our best interests, but, in my opinion they are led with a misguided perception as to how.
Behaving like Medicine and other established fields is easy. Pushing for prescription rights will be more easily accepted by gatekeepers, but it doesn't make it right! In my opinion, gaining prescription rights will do little to address the core issues of cultural authority over the long-term.
I personally feel that prescription rights would be a fatal blow to our competitive edge in holism. We would be doing medicine and insurance companies a favor, and will have no one but ourselves to blame when we spiral downward with the rest of healthcare.
Chiros, what we need is to set up a bipartisan summit and outline a Blue Ocean Strategy for our profession that emphasizes are current strengths in musculoskeletal care, neurology, nutrition, radiology, and physiology.
We are dilly-dallying around arguing amongst ourselves, while other professions are gaining adjusting rights, and borrowing our century-old philosophy from right under our noses.
Our response? Borrow prescription rights under a failed model, while jettisoning some of the basic tenets of our philosophy that others are beginning to adopt and find valuable.
But beyond emotional discourse, the push in New Mexico is really about capturing cultural authority.
Cultural authority is gained when professions gain access into the university systems, expand into specialties, and cross-refer amongst one another. Lastly, cultural authority is about increasing admission standards, supporting our own holistic research, and educating the public about our unique lens and its merits for stemming the 21st century tide of chronic disease.
I know this is exactly what the push for prescription rights is trying to accomplish, but can we agree that we already have all the tools we need, exemplified by the number of Chiropractors venturing into Functional Neurology, Clinical Nutrition and Functional Medicine?
Ultimately, does the New Mexico failure really just show that it's time to go back to the drawing board?
Dr. Alex Rinehart is a Board Certified Clinical Nutritionist with the International and American Associations of Clinical Nutrition (IAACN). He obtained a Master's degree in Applied Clinical Nutrition and a Doctorate degree in Chiropractic Medicine from New York Chiropractic College. Alex Rinehart, DC, CCN is on Twitter.