“Life has got a habit of not getting hitched. You got to ride it like you find it. You got to change with it. If a day goes by that you don’t change some of your old notions for new ones, that is just about like trying to milk a dead cow.”—Woody Guthrie
Chiropractic has had its share of challenges since Harvey Lillard received his first adjustment from D.D. Palmer in Davenport, Iowa, back in 1895. We have survived early persecution with many of our profession’s pioneers suffering time in jail, fighting for our right to practice in every state and surviving attempts to contain or eliminate us as a profession by state and national medical associations. As we move forward and consider chiropractic adaptation, we face even more changes and challenges and the question begs: what is our vision for chiropractic heading into the 21st century? Do we evolve, taking the best of chiropractic philosophy with us, and expand our competence? Or, do we revert to a more narrow and rigid view of our role as chiropractors?
Prejudice and professional bias still persist toward chiropractic and much of it is driven by jealousy or a belief that health can only be found in a pill. But some of the prejudice and judgment has also been justified if we are honest as a group and look at our own shortcomings with an eye on healing our own contradictions as a profession.
Managed care and lower reimbursement has done more to contain and eliminate chiropractors than the AMA has done in the past few years. It is a combination of forces, including the rise of other professions, decrease in reimbursement and slow adaptation that is institutional within our own ranks, which has limited or even reduced our significance as a more dominant force in the healthcare market.
Active vs. passive participation from the industry
Notably, passive apathy also prevents chiropractic from expanding its influence. Just ask the California Chiropractic Association, where currently only 20% of the chiropractors in that state belong to the CCA with a significant number of non-members complaining about how bad times are. That kind of self-serving is how chiropractors sabotage their own well-being while blaming an outside force as the cause of their woes!
Chiropractors treat a variety of maladies and one constant is that lower back pain and disability are not only here to stay but require a pressing need for prevention and treatment that is global in scope.(1) Conservative, effective treatment of spinal pain has always been in our “wheel house,” but the number of different types of health practitioners and effective new approaches for treatment are on the rise and here to stay.
We need to all take pause with national utilization of chiropractic. Dr. Mark Studin (2) quotes a study from the Health Research and Education Trust that reports from 2003 to 2006 chiropractic utilization was used by 4.12% of adults in U.S. In the early 1990s, this rate was 7.7% of the adult population, realizing a net drop of 3.58% in just a decade. The causes of this decline are multi-faceted.
Becoming a hybrid practitioner
Today there is a “supermarket” of spinal care, wellness and fitness professionals who are learning advanced techniques for the treatment of spine-related conditions. Physical therapists have a goal to all be Doctors of Physical Therapy by the year 2020, as stated by the American Physical Therapy Association. Physical therapy and chiropractic have had their share of turf wars. In many states, chiropractic has been successful at lobbying to keep PTs from primary access and manipulation but that will change. They are just as dedicated as we have been to expand their scope of practice, and those in our profession that want to narrow our scope with simple philosophical ideals do so at our peril.
Once we had nearly a monopoly on adjustments and manipulation – especially when the osteopaths went to prescribing drugs and performing surgery. Now, PTs are adjusting more and some osteopaths are rediscovering the “lost art” they once had in addition to their medical skills. And by the way, they are good at what they do!
The real news is what I would define as the hybrid practitioner. The industry of personal training is exploding. Trainers may not be able to go “hands on” or diagnose but the wellness side of the health equation only requires improvement or restoration of health vs. identification of disease. The latest in what could be described as “bridging the gap” between rehabilitation and fitness are courses and certifications enabling trainers to treat spinal conditions without diagnosis.
The short list of many of these courses and techniques available include Functional Movement Systems (FMS), Postural Restoration Institute (PRI), Dynamic Neuromuscular Stabilization (DNS), Stretch to Win, Poloquin Performance Institute, Titleist Performance Institute (TPI) and The Chek Institute. Add a massage therapy license with personal training and you have a powerful combination of hands-on muscular and fascial therapy with rehabilitation and fitness that defines a present-day wellness practitioner.
Make no mistake, just because you have firm convictions with an advanced degree that says “doctor.” These new hybrid practitioners are learning sophisticated, state-of-the-art treatment modalities and they are extremely dedicated and competent at their craft. In addition, clients who visit them are not conditioned to ask how many visits their insurance will cover!
Physical therapists are taking many of these same courses and integrating treatment modalities with rehabilitation and sports performance training. The trend is now wellness centers that look like small- to medium-sized fitness centers that are one-stop shops. That is, treatment for pain or injury is offered as well as ongoing fitness or personal training that keeps customers/patients coming back with little or no selling. In addition, PTs are not only adding the latest treatment (including adjusting) and exercise modalities, but in some states adding “dry needling” or deep acupuncture to their tool belts.
Establishing yourself as the functional movement expert
The public is told, “See your doctor before starting any exercise program.” Beyond a good history and physical exam, what do most MDs know about fitness and how to move in a functional and safe manner? The same can be asked about us. That is, are we the experts who people automatically go to before they embark on their own personal mission for health and fitness? Are we the experts on the latest approaches to chiropractic, rehabilitation and corrective exercise? Do we teach our patients how to move well and move often, including our expertise for treatment of spinal-related conditions? What was the last state-of-the-art skill you added to your tool belt?
Just a few years after the birth of chiropractic in 1895, industrial revolution icon Henry Ford built the Model T and not only introduced an automobile that the common person could afford but ushered in mass production into our modern world. At one time, the Model T enabled Ford to have over 50% of market share for the entire automobile industry. It was the perfect car for its time and from Mr. Ford’s perspective could never be improved upon. In fact, the mere mention of change would result in his wrath.
When change occurred and General Motors and Dodge began to make a better product, Ford still would not adapt to self-evident facts. Sales steadily decreased until Ford Motor Company was in danger of bankruptcy or worse – and all the selling and marketing of the old product wasn’t going to make a difference in spite of Henry Ford’s angry insistence.
It was Ford’s son, Edsel, who saved the company and introduced the Model A, adjusting to public demand and changing times. The Model A was still a car in the true sense but it was greatly improved and met the expectations of the public.
So who does the public think are the experts at spinal and alternative care? It depends. After all, the public does vote with their pocket book and today’s consumer is more sophisticated than ever. As individuals and as a profession we can ask ourselves if the Model T analogy fits us today. The trend for the future is following a multidisciplinary wellness center model where PTs and personal trainers are gaining contemporary knowledge and getting results. DCs need to consider this as a possible business model. Or, just stay with one idea and sell it. The question is, which model is more satisfying for you and your patient?
Diversifying your skills and avoiding the pay phone route
Perhaps we should view our practices like a smartphone. For instance, last century we had an abundance of pay phones. Chiropractic has been similar to pay phones in that we are simple, safe and effective. In today’s healthcare environment, we need to add value to our adjusting skills. For sure, we always need to be the best at those diagnosis and adjusting skills but we also need to consider “apps” or new tools to make chiropractic stronger and more relevant in these changing times. More and stronger selling may make a difference for the individual doctor with firm convictions and a charismatic personality, but much like one of our political parties just found out, it won’t make a difference if chiropractic falls behind – either through petty internal differences or an inability to expand and grow with the times and give the public what they need.
Today, more than ever, the pressure is on for reducing the costs of healthcare. Gone are the days when chiropractors were paid well to provide a cookie-cutter approach to every spinal condition according to how many visits their insurance companies paid for or we could sell in a package plan. Other professions aren’t “out to get us” as much as we have resisted improving on our own foundation for health.
What is our vision for the future in terms of our own competence and excellence as an individual and profession? Are we going to be the “thinking” profession or are we going to try to fit an old form into a rapidly changing and dynamic time? If we don’t adapt to change and continue to grow, the public will suffer and we will lose the opportunity to fulfill our potential as a premier profession for health and well-being.
1. “Back Pain Is #1 Cause of Disability Worlwide” Peter Crownf ield, Dynamic Chiropractic, Feb. 15 2013.
2. “What is chiropractic and who is the real enemy?” Mark Studin, D.C., The Chiropractic Journal, Nov. 2012
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