When I started my first day in Chiropractic school I was certain I had started a process of fulfilling my life’s purpose. Very quickly I met a few classmates that had no such delusions. There was a group of students that chose Chiropractic because it seemed appealing as a career for various reasons, but with little or no personal experiences with chiropractic care. There was also a group that fell into the “MD wannabe” category that was settling for a career that would at least give them a title of Doctor.
Our lack of public adoption was something that attracted me into becoming a Chiropractor. Like so many before me, I had experienced firsthand how a Chiropractic adjustment could change the course of one’s life. I found this obviously effective form of health care, yet widely unaccepted reputation, appealing when I was first considering a career in this field. I have always preferred to go against the grain and take a path less traveled.
These “physician” minded groups were the ones that would roll their eyes at the mention of Chiropractic philosophy and subluxations. Meanwhile I thought it was some of the coolest stuff I had ever heard. The contradiction among us was immediate. This group preferred the term manipulation over adjustment, and they seemed to love all of the PT and insurance coding classes. I was busy attending every technique club and practice management seminar that I could find. I earned extra money and experience by spending my weekends at spinal screenings for Docs in the area.
This contradiction, or difference in opinion, is not new within our profession. This has been deep seeded within our culture for decades now. It has been around since we have been around. What is different however about chiropractic compared to other industries is that we have maintained this contradiction for more than a century now. We are still operating together inside of the same profession. The subluxation centered lifetime family wellness practice, and the emergency, pain relief primary care practitioners are still inside of the same ring.
This is unique because most all industries eventually evolve into specializations. Industries break up and divide over time into sub-categories, specialties, and spin-off industries. Martial arts prove to be a great example here. There are many different forms and offshoots that have all spun off of the original identifiable disciplines such as shuai jiao. Think of all of the many ways you can practice martial arts today, let alone different venues and competitions that have evolved out of this industry such as mixed martial arts (MMA.)
The fact is people develop preferences for how they practice, or utilize products or services. The beauty of a capitalistic marketplace is that it allows this evolution of a market or industry. Those that provide value survive. Those that do not provide value will go out of business.
This is where the nuances of our licensed profession come into play. It is not so easy for us to splinter and fragment within the constructs of today’s licensure process. If we want the title of “Doctor of Chiropractic,” then we have to follow the one set licensure pathway to practice.
Enter the chiropractic drug cartels. In 2010 I first learned of a bill in our New Mexico state legislature that would expand the scope of Chiropractic practice to include the prescription of pharmaceutical drugs. I was confused by this. Even the group that could not get out the word chiropractic without following it with the word “physician” seemed to understand that our identity as a profession was as the largest drugless health care profession in the world.
The really crazy part is before this bill was introduced, the New Mexico board of Chiropractic examiners had begun changing the rules and regulations on their own. They decided they wanted injectable substances in our scope of practice so they added them into our scope of practice on their own without input from any other boards or the state government. This is a perfect application of “its easier to ask forgiveness than permission.”
I did not immediately understand why any of my colleagues would want to do such a thing as introduce drugs into the profession. I soon learned that a vocal few local and influential leaders in the New Mexico chiropractic community were influencing others. The utopia painted was that prescriptive rights would create a rosy future of acceptance by medical colleagues and public acceptance along with financial equality from insurance companies. Many of my colleagues feel this is the proper evolution of our profession.
This approach has also proved to be very profitable for the New Mexico Chiropractic Association. They found a hungry niche within the profession that wants the ability to prescribe and so they quickly formed classes to serve this need. Financial incentives are so often the engine behind change.
The logic presented to me by these chiropractors fighting for prescriptive rights is that in order to gain wider acceptance, and still maintain a primary physician status in the eyes of the government and insurance companies, then they had to create a level playing field with MD’s, DO’s, physicians assistants and nurse practitioners. They also claim the ability to help provide a solution for the primary care shortage in rural areas. That is the educated mind’s reasoning for such radical change as the introduction of drugs into a formerly drugless profession. This is the logic and reasoning provided to the public, and our politicians for such a change.
The more innate reasoning that I see is that this group still yearns for acceptance, and likely another revenue stream to support anemic practices. They want desperately to be considered on the same diagnostic playing field as our allopathic counterparts. Listen to their vernacular and it makes a medical doctor tilt his head. It is over compensation to the max degree. Terms like doctor of chiropractic medicine, chiropractic physician, manipulation, etc. are used in lieu of subluxation, adjustment, and chiropractor.
In New Mexico I watch this group of “advanced practice” chiropractor’s attempt to influence change through state law. The interesting thing to me is I always felt that influencing the public was a better approach to acceptance. We have supported this theory of mine with the ability to generate a tremendous public response every time a new drug bill is introduced. We have been able to generate huge public outcry using our high volume practices. Our subluxation oriented patients have been able to effectively mobilize into action when one of these drug bills hit the state legislature. The public has tremendous influence over politicians. Those that serve a greater number of our public citizens, have access to this influence in a way that lawmakers alone do not. We serve more people, so we have more influence.
As I began to understand the advanced practice culture I was even more shocked to learn that me personally, and our sizeable practices, were being hailed as the poster child of archaic, dogmatic subluxation focused care by this group of drug wielding chiropractors. I am the epitome of how the chiropractic drug cartel does not want to be perceived. I have been told that the radio shows we do along with our spinal screenings at malls, and trade shows are all things that no respectable doctor would do.
Since our earliest days as a profession, Chiropractic has been lodged in a realm far outside of what any of us would consider general acceptance by the public. Today’s sub 3% utilization rate confirms this. I smell opportunity in that statistic. Advanced physician chiropractors argue that is why we need to start prescribing.
I have seen significant cultural changes in my past 11 years in practice. I have seen a tangible shift in how society views both doctor’s, and medication. I would say the great majority of people seeking care in our offices do so because they want a doctor that thinks differently. The inside out approach resonates with the many in the public. Drugs have literally built our company. Many people do not want them, they do not feel healthy or empowered taking them, and they are starting to smell the lie that pharmaceuticals some how create better health. We benefit as chiropractors when we can provide an effective alternative.
So why are we running into this allopathic burning building when so many people and practitioners are running away from the “better health through better chemistry” paradigm?
I have found opportunity in staying outside of the drug paradigm. I found that if our level of service and value is exceptional, then we thrive. We have to be good to justify an individual paying us several thousand dollars out of their own personal hard earned money. Our product has to be phenomenal or our reputation will quickly put us out of business. When you rely on insurance and Medicare dollars to supplement the care you provide, your service levels can be sub-par and you can still exist in business.
Therein lies my concern. When you supplement any kind of industry with government funding, you create the potential for decreased standards and service. It is my opinion that the very best thing that could happen for our profession is the removal of all insurance benefits to chiropractic care. Suddenly, the playing field would dramatically shift.
In fact, it is fascinating to me that here in New Mexico the leaders of our state association that are celebrated by our AP colleagues, along with a few of those that have recently been voted on as “Chiropractor of the year award” actually have some of the worst online reviews out there. How is that possible? Hailed by the profession, but lauded by the public. Our company is in fact on the other side of that coin. We are chastised as outlaws, and yet consistently win “best of” contests, and have exceptional online reviews that support our good standing with the public. I recently learned that our company is the only Chiropractic company in Albuquerque registered with the better business bureau. That seems odd to me.
In my opinion this is all possible because insurance hungry drug practitioners are getting by on supplemental incomes from insurance. In fact, the ability to prescribe drugs helps ensure that these practices will survive because they can keep their foot in the insurance company handout line.
There has always been something romantic in my eyes of serving in a profession with such an inherent contradiction. Our patients love us, an often swear by how Chiropractic care has impacted their lives in a favorable way. Often times when their particular situation was unresponsive to allopathic medical care. What we do changes lives, and yet there is so much vocal opposition to our natural, above down, neurologically focused approach to impacting the human body.
However, this contradiction has shifted to a new level in recent years. [quote_center]It is my Opinion that we Need to Fragment.[/quote_center]
It is time for us to distinguish ourselves within the profession for the services and type of care that we provide. The fact is they do not like being associated with us, and I sure do not like being associated with them. Imagine friends when that first patient dies because of an adverse drug reaction from something administered by a chiropractor. Unfortunately, as things stand today, I am lumped into their same category.
So, I think the “Advanced Practitioner” chiropractors have taken a big step to begin this process of splitting up the profession. I think in many ways that is a good thing. However, until a dependence on health insurance is removed from the equation, it will be difficult to accurately assess what the public wants.
Graduate Parker College in Dallas, Texas with a bachelor of science degree in anatomy, and
doctoral degree-Chiropractor. Dr. Miner founded Health Quest Chiropractic in 2003.
Today Health Quest operates 4 offices in the Albuquerque area with two more offices scheduled
to open in 2014.
-Grew the original Health Quest office to see 1100 weekly patient visits.
-Host of “Ounce of Prevention” weekly radio show airing on 770 AM KKOB and 107.1 FM Calvary Connect
-Published Author of “The Chiropractic Code”