Chiropractors in the United States, Canada, parts of Europe and Australia face challenges, but at least in these countries the battle for chiropractic licensure has been fought and won. These countries also have established accredited chiropractic colleges. In other parts of the world, however, the situation is much different, and each country has its own complex set of chiropractic licensure and education issues.
At the core of this issue is the battle for the hearts and minds of health care consumers throughout the world. For chiropractic to be accepted worldwide as the credible, scientific health care of choice for lifetime subluxation-based care, our challenge is to be ethically sound in everything we do. The battle for the hearts and minds of today's patients can only be won with personal and professional integrity. Our integrity is tested when we are offered lucrative and otherwise attractive opportunities to teach chiropractic technique at seminars abroad. Because of the growing popularity of chiropractic in nonlicensed countries, chiropractors, particularly from America, may come face-to-face with this ethical challenge.
You may be invited to teach chiropractic technique in a seminar outside your home country where nonchiropractors, especially MDs, physical therapists and other health care practitioners are in attendance. They may want to learn and utilize the techniques of chiropractic without comprehensive training in the principles that define us as a unique profession, not just a procedure. You must refuse. To accept such an invitation is unethical, because it contributes to the misuse of chiropractic by uneducated practitioners, and thus, possible injury to patients.
It is also a detriment to the development of a stable, licensed profession. This practice also fuels public misconceptions about chiropractic and its philosophy, and sets back the efforts of those seeking legitimate recognition of our profession through appropriate licensure.
In Germany, when it comes to licensure, chiropractors are lumped into a category of natural health practitioners called Heilpraktikers, who may not receive any formal education, but take an examination intended to weed out those who may be dangerous to the public. This is obviously a far cry from the stringent educational and licensing requirements for chiropractors graduating from accredited colleges in the U.S., Canada, Australia and parts of Europe. Licensure or credentialing of chiropractors in Germany doesn't reflect the prestige and scope of the "real" chiropractor's education. In fact, the German public often views Heilpraktikers as unscientific cultists or "massage-level" practitioners.
The situation in Germany is further complicated by the fact that in addition to chiropractors who practice as Heilpraktikers, medical doctors have the option of specializing in orthopedics with a sub-specialty in chiropractic. These practitioners, who focus their attention on a "sick" joint or vertebra, have a very different approach and much narrower focus than chiropractors.
Earlier this year, a Palmer graduate went to court in Germany to become licensed as a doctor of chiropractic, comparable to a medical doctor or dentist in terms of professional stature and opportunity. He lost. He has now taken his case to the next level, and Palmer will be there to provide expert testimony on his behalf, about the quality of education available at Palmer and other U.S. chiropractic colleges. Clearly, we would like to see him win his case, so that chiropractic licensure in Germany attains equal status with other licensed health care professions in that country.
Even though chiropractors in Germany aren't punished for practicing without a license, they do not have the prestige or access to insurance reimbursement that their MD counterparts do. I can't help equating the Palmer graduate's legal battle with that of the hundreds of early chiropractors in the United States who went to jail rather than pay a fine for "practicing medicine without a license." They were willing to make personal and professional sacrifices; to draw public attention to their cause; to be considered separate, but equal to medical doctors in terms of state licensure. Their courageous actions over the years ensured chiropractic's credibility, and perhaps its very survival as a separate profession in the United States. Now, it seems we must fight similar battles in the international arena.
This is just one example of a disturbing international trend. Not only do qualified chiropractors who've been educated at established, accredited colleges face licensure discrimination, but the credibility of chiropractic is challenged by another practice. The German Chiropractors' Association said in a letter faxed July 21, 2000 to U.S. and European chiropractic organizations and colleges that they "have observed many instances of foreign (usually American) doctors of chiropractic teaching chiropractic techniques to nonchiropractors in our country. Chiropractic has become quite fashionable, and MDs and Heilpraktikers have been taking courses in chiropractic techniques."
The letter specifies that one of the organizations that has been marketing chiropractic in Germany is the Berlin School of Chiropractic, and that it advertises "American chiropractic." This is just one example of the many organizations proliferating around the globe without high-quality, accredited chiropractic educational infrastructures. These groups offer to teach "American chiropractic" to nonchiropractors in weekend seminars throughout Europe and in Pacific Rim countries. At Palmer, while we agree that good relationships with other health professions are desirable, we feel it is neither in our patients' best interests nor our own to teach chiropractic techniques out of context with our science and philosophy, and outside of a rigorous, accredited academic program.
This unethical practice must stop. I pledge that at Palmer College we will do everything possible to assist organizations such as the German Chiropractors' Association to eradicate this practice and to support appropriate licensure for chiropractors outside the United States. We will not admit nonchiropractors to technique seminars we sponsor, and I encourage all other chiropractic colleges, organizations and practitioners to do the same. Through our efforts in establishing the Feevale University program in Novo Hamburgo, Brazil, we are supporting the appropriate education and licensure of chiropractors in that country. There is still work to be done, but we are making progress, and the university graduated its first class of 24 DCs from Feevale this April.
In many parts of the world, there is no formal training available in chiropractic, and anyone who performs manipulation of any sort can call themself a chiropractor. Japan has some 16,000 health care providers who practice manipulation, but less than 100 of them have degrees from accredited chiropractic colleges. As in Germany, graduates of CCE-accredited chiropractic colleges may set up practices in these countries, but they do not have licensure equality with medical doctors, dentists and other highly trained health care practitioners.
This issue boils down to one question: Are we a procedure or a profession? Some would argue that to bring chiropractic care to countries where it is not readily available, we should take every opportunity to educate those who have the desire to learn chiropractic techniques. That would equate chiropractic with a procedure: manipulation. We need to do what is necessary to establish sound, accredited educational infrastructures wherever they are needed. We must support chiropractic education programs worldwide that strive to teach the art of chiropractic in proper context with our science and philosophy, and as a separate and distinct health care profession.
Chiropractors who knowingly teach techniques to nonchiropractors outside this context are supporting an erroneous, backward notion. They are sanctioning the idea that nonchiropractic health care practitioners can learn how to adjust spines during a weekend seminar. If that idea is perpetuated, the battle for chiropractic to gain worldwide recognition and licensure status as a separate and distinct health care profession becomes a losing one. I urge you to do everything in your power to make sure we win this battle worldwide. Uphold the high standards our profession has set in the United States, Canada, Australia and parts of Europe, and make ethically sound judgments to ensure that our profession wins the hearts and minds of health care consumers worldwide.
Guy Riekeman,DC,
President, Palmer College of Chiropractic
Davenport, Iowa
