As the rhetoric and legislative agendas escalate nationally about chiropractic and pharmaceutical prescriptive rights, we, as a profession, need to pause and consider the long-term effects of our actions. The question is: Are we responsibly evolving or are we creating a problem that could set chiropractic back decades in utilization? Please understand that this argument is totally devoid of any philosophy or beliefs in chiropractic principles or results; it is purely focused on increasing the utilization and business of every chiropractic practice in the country for the betterment of our patients.
Based upon an informal but lengthy poll of many in our profession, one of the core reasons for wanting to add prescriptive rights is to help increase utilization at the practice level. The majority of those polled believe that if we could prescribe even non-narcotics, then patients would stay in our offices rather than seek medical care for pain relief and a pro forma prescription to physical therapy with a resultant decrease in utilization of our offices. Unfortunately, that has been the national trend for far too long.
^The question begs: Are prescriptive rights the solution for both the chiropractic profession and our society?
The question begs: Are prescriptive rights the solution for both the chiropractic profession and our society? Over the past decade, I have been focused on increasing the level of clinical excellence of the practicing chiropractor, which has nothing to do with technique, philosophy, or documentation. The level of clinical excellence has been centered on patient management, including accurately diagnosing, prognosing, and triaging patients. Medicine focuses on patient diagnosis and management while chiropractic has focused historically on treatment, too often bypassing rendering a thorough and conclusive diagnosis prior to providing care. Therefore, my areas of focus are MRI spine interpretation, spinal biomechanical engineering, accident engineering, spinal trauma pathology, and diagnosing spinal issues beyond subluxation, biomechanical changes or anything else you choose to call what you treat, because the designation is not important to who we treat.
Why concern ourselves with the medical community? Quite simply, the answer is that medical utilization is over 95% nationally and chiropractic is well below 8.4%, and it has been eroding steadily over the past decade. If chiropractic can “tap” into that 95% and have every medical doctor in the nation consider chiropractic as the first choice for mechanical spine issues (excluding fracture, tumor, or infection), then we will rapidly change the culture of our society and resolve our utilization challenges. This is called “primary spine care.”
Over the past 10 years, I have taught in both chiropractic and medical academia and have cooperatively created courses in chiropractic in both fields. As a result, doctors who have taken these courses receive the exact same level of education as many of our medical counterpart. That has resulted in our doctors functioning at a “peer” level that has garnered respect not because of our results; those are expected. That respect comes from our understanding of the spine at an extremely high level, often more so than our medical counterparts, so they consult with us on many of their more challenging cases to find solutions. In turn, they also have referred many of their mechanical spine cases to chiropractors to manage because many medical doctors realize they are poorly equipped with nothing but drugs that are often too addictive or surgery as the only options.
The primary care medical providers, medical specialists, and emergency rooms that we work with nationally have expressed their gratitude for helping these patients by redirecting their care to the properly credentialed chiropractor and preventing further opiate abuse or the side effects of non-narcotics. The way they thank us is in the form of a perpetual stream of referrals. A case in point was in Cedar Park, Texas, where one of our doctors, eight years into practice, sat with an orthopedic surgeon and discussed MRI spine interpretation. After a one-hour conversation, the surgeon said to the doctor, “I love chiropractic; I just couldn’t find a smart enough chiropractor to trust with my referrals until now. Your knowledge of spine and MRI is equal to mine, and from here forward, you will get all of my nonsurgical referrals!” That doctor left the meeting with eight referrals, and a year later, he still has had a steady stem of referrals. I could share similar stories from Dayton, Ohio; Buffalo, New York; American Fork, Utah; Denver, Colorado; Fair Lawn, New Jersey; and dozens of other locations across the United States. The formula is working; it is reproducible and based purely upon clinical excellence beyond adjusting!
As a note, many get angry with our chiropractic colleges for not teaching us enough. Remember, our chiropractic colleges are charged with giving us the basics to get started and they do an outstanding job in that role. I applaud them, and so should you in the form of donations to their research departments. In medicine, it is no different; they get a basic education and then go back to school to become specialized. What you do with your career after graduation is on you.
We now have hospital emergency departments nationally reaching out to our doctors solely based upon their curricula vitae (CVs) because the doctors are trained in what needs to be on their CVs and the knowledge base behind those credentials. In addition, for clarity (unlike my former beliefs), letters after your DC are not as important as the specific citations or credentials in your CV.
Having been involved politically at the national and state levels for quite some time, I can say with a great degree of certainty that very little healthcare legislation (chiropractic falls under this category) in this country at either level gets passed without the blessing of the medical community. By attempting to add prescriptive rights to our scope, we will be threatening the utilization of medicine on a national scale, and it will potentially close many of those doors that are currently opening at a rapid rate. Medical schools and research departments that have opened their doors to chiropractic have done so primarily as a possible solution to the opiate epidemic in our country. We cannot be “Pollyanna-ish” and say we only want to prescribe non-narcotics. It has been documented clearly that it is a well-established “gateway” to addictive narcotics because when non-narcotics fail to offer relief, those patients need something else. Chiropractic care is that “something else” for mechanical spine pain, which is in the top 10 diagnoses for both emergency rooms and primary care medical providers who often have no solution other than drugs or surgery. Medicine’s only other historical care path with regards to mechanical spine diagnosis and management has been physical therapy, which renders significantly inferior outcomes for spine versus chiropractic, based upon recent literature (a topic for another article), and one where far too many patients have ended up in pain management (narcotics) as the final solution.
Currently, our profession is at a crossroad on the prescriptive rights issue, and if the wrong road is taken, it could turn out to be a “very slippery slope” that could further erode our utilization and lead to increased iatrogenic issues in our society. I empathize with those doctors clinging to hope for a “quick fix” for their individual practices. However, as outlined earlier, there are viable solutions for every practice in the nation with none involving “get-rich-quick” paradigms. Since I also consult many medical providers at various levels, I can report that their prescription pads are not making them wealthy, should they practice ethically. Their utilization and income increase as they get better at what they do, and in chiropractic, we are no different.
Although our paradigm for increased utilization is working by increasing our clinical excellence, we are just starting to see this happen on a larger scale. The only way to have that upward spiral go faster is if more chiropractors realize that the only way up is through academia and a strategic plan behind their new level of clinical excellence. So please hurry because your local medical community is waiting for you with that 95% to refer.