Clarification on the New York Senate Bill
Dear Editor:
I was just directed to the article in your July 12 issue regarding the spinal manipulation bill in the New York state legislature. I would like to correct some inaccuracies reported in the article.
The presentation of partial facts falsely portrays the deputy commissioner as a lone person who can make a consequential practice determination in a vacuum when, in fact, she cannot. It also conveys a false impression that I work outside the Education Department, when in fact, I am an employee appointed by and serving at the pleasure of the state board of regents.
As the executive secretary to the New York State Board for Chiropractic employed by the State Education Department, I did not send a letter to my own employer requesting clarification of the lawful scope of physical therapy. That letter was sent by a state assemblyperson nearly two years ago, who had been an original sponsor of the bill to restrict spinal manipulation to MDs, DOs and DCs.
The legislator had been approached by PTs who provide spinal manipulation in their practices, thus causing the legislator to request clarification from our department. As part of the department, I contributed to the gathering and discussion of information about this issue, as did my counterpart for the State Board for Physical Therapy and relevant members of our administrative and legal staff, and members of the state boards for the two professions. We studied this joint practice issue for more than a year, culminating in a legal interpretation provided by our Office of Counsel.
As Deputy Commissioner Johanna Duncan-Poitier wrote in her April 23, 1999 memorandum: "The Department responded to this question through a lengthy process of research, analysis and discussion. In addition to an intensive review of the Education Law, information about spinal manipulation was obtained from such sources as bill jackets, health care literature, the criteria of national accrediting bodies, national examination blueprints, and the statues of other states ... We officially provided the information ... to the Office of Counsel and requested a legal opinion ... which states that Section of Article 136 of the Education Law clearly authorizes physical therapists to perform spinal manipulation and/or mobilization and has done so for at least nineteen years."
Norman Cohen
New York State Education Department
Albany, New York
"Chiropractic Association of the United States"
"Or Maybe We Just Need a Mother"
Dear Editor:
After reading your editorial regarding the low numbers in the U.S. national chiropractic associations and the lack of coordinated efforts, I feel the state associations should take up the model of the WFC and force the two national associations to get it together (and in my personal opinion, just work for the common good). Each state association should become a part of one new national association and pay per member. Call it the Chiropractic Association of the United States.
Let the two national associations, the ACA (not really an "American" association but a U.S. association, as "American" means North and South America), and the ICA (really not an international association anymore) just blend them into this new structure. Find a good arbitrator to get this done; better yet, just get a business person - or maybe we just need a mother.
Realistically speaking, let the WFC force us to peace. We also need to stop being so egocentric as "Americans." The world is watching.
If there are two state associations, let them come from each as a representative system. We could then duplicate as needed a structure similar to our national government, with a House of Representatives, a Senate, and executive branches with committees such as science, art and philosophy. Let them battle it out in the committees behind closed doors like civil people, and stop telling the world our differences with all those back-stabbing jokes, since there really are just a few of them arguing anyway. Eighty percent of us are just working out in the field quietly.
The state senate representatives (two each) should get together as they are doing now to share ideas on the state level and help decide the national issues. Let the executive branch create the consensus vision and implementation. Then the House of Representatives could vote on other pending general issues just like stockholders.
We will always be divided the way we are. What a waste of money, talent and resources. It is not financially ecological. No one has the money anymore. The state dues in Connecticut, for example; are $800 per year; a license is $450 per year; and ACA dues are $600 per year.
Karen Shields Wright,MS,DC
Greenwich, Connecticut
Dear Editor:
Having just returned from a successful California Chiropractic Association convention in Monterey, I had the opportunity to read your latest editorial, "How Low Must We Go," and found it to be one of your better questions. If indeed there is only 16% membership combined in both the ACA and ICA, then all doctors of chiropractic, be they national association members or not, must give serious consideration to your question and what it means to the growth and preservation of our profession.
Certainly many field practitioners may wonder why there is any need for two national associations. With ACA membership at approximately 7,500 and ICA membership at 2,500, many may have the opinion that one organization united would be more beneficial to the profession. With a total of only 2,500, the ICA may in fact be smaller than some state associations.
A second question may arise, which asks if a national association should define itself from a specific philosophy rather than serving to protect our rights to practice with the philosophy we choose. In doing so, it may exclude those with varying philosophical opinions, ultimately leading to diminished membership. Undoubtedly, this question can be explosive in nature considering the ongoing political debate regarding chiropractic philosophy, but certainly no answer is ever discovered by ignoring the question. Those same practitioners who wonder about the need for two associations are not oblivious to the politics involved in such an arrangement. Perhaps because the question is ignored, apathy results.
Few would disagree with the need for a powerful national association that protects our rights on the federal level and works to promote chiropractic nationally. This need is reflected in the mission statements of our national organizations.
Such a mission statement, however, does not translate to a vision statement; thus many a practitioner may be clueless as to the direction the ACA and ICA are leading them. Not knowing where they are taking us, why follow an opinion that may play a part in decreasing membership statistics?
This exclusion of communication may well be at the heart of the dwindling membership numbers. From an organizational perspective, it is easy to assume that one is communicating to the membership via monthly publications, but such an assumption also presumes that practitioners have the time to read every periodical. Equally, the message printed may too often be interpreted as "talking at" the reader rather than "talking with" the member. By including members in a dialogue that is part of the decision making process, those members take greater ownership of the organization. By excluding them, any organization creates the apathy that leads to member resignations.
Unfortunately, the very nature of our national associations' organizational structures makes it difficult to be perceived as responsive. With multiple houses of governance developed as a form of "checks and balances," an adequate response to a given situation may come long after it is needed and thus cause a perception that the organization is unconcerned with the member's needs. Such perceived indifference may also quickly contribute to the decline in membership.
Providing the excuse that the decline in membership is the result of DCs participating in their state associations and cannot afford ACA or ICA membership undermines the effort of state associations to get practitioners involved. Such a statement also belies the fact that for most practitioners, it is their state association that addresses their needs and does so in a timely manner. Many believe that the future of our profession will be best addressed by strong state associations that can organize their efforts nationally. In doing so, they will seek cooperative efforts among themselves, seek to enhance their communication to each other and practitioners nationally, seek to organize national lobbying throughout each state, and work to share a common vision with which all might take ownership.
Should this movement occur, there could be less of a need for a separate ACA and ICA, and a greater need for a third, or combined, organization to emerge to serve as an administrator. Perhaps an organization like the Congress of Chiropractic State Associations, which maintains an apolitical stance, or another organization that forms as a unified national entity, would serve to maintain a national dialogue between state associations and coordinate national action plans that involve all doctors of chiropractic. Certainly, such a scenario could occur if we ignore the underlying causes of declining membership in our current national associations.
It is difficult to point to any one reason as cause for membership declines. I suspect that the average field practitioner is more interested than our national associations in the concept of unity. The idea of having 62,000 doctors of chiropractic standing shoulder to shoulder fighting for each other rather than amongst themselves remains an attractive, if not elusive, dream. Somehow, we must believe it is possible, if only to provide a reason for active participation. To this end, a unified national vision for the profession is clearly more important than organizational mission statements, for it provides all of us the opportunity to focus on a commonality rather than on our differences.
It is a difficult task for our elected leaders to carry out the goals of the organization while balancing those actions with the needs of practitioners at large. While those goals may be paramount to the organization, leadership will need to remember that those goals may be less important to members if they are not communicated. It may also be inherent in some practitioners to be actively involved in their association. To not have their options expressed or their voices heard, to not have the opportunity to rise to a leadership position, may be something that leads to further apathy and possibly to non-membership.
We put tremendous demands on our leadership. We want them to be heroic so that we too might find our own heroism in their accomplishments. By trying to win the good fight, we can take pride in their actions. Even if they try and fail, we have the opportunity to embrace them with our compassion. We want strong leaders who earn their positions as a result of their actions, not simply leaders who were politically placed there because of their tenure in the organization. By making our leaders bigger than life, we place on their shoulders all of our hopes, expectations and dreams.
As our hopes are pinned on their actions, so too can be our disappointments. If private agendas are placed ahead of actions that benefit us all, we are quick to mistrust. If leaders involve themselves in whisper campaigns to discredit a divergent opinion, we recognize poor leadership. And if they fail to communicate a common vision and welcome us as an integral part of that vision, we grow disenfranchised. Feeling unneeded or unwelcome, feeling intrusive in the process, feeling uninformed, we find it easy to quit.
At the precipice of a new millennium, we have the opportunity to make changes that will positively affect the future of chiropractic. Such changes call for increased communication and an open dialogue that leads to a better understanding of the place from where we came, who we are today, and what we wish to be tomorrow. It is an opportunity that lies within our grasp, should we be brave enough to reach out, to focus our organizational and individual attention on those bonds we already possess and on the dreams we can share. We can ill afford to wait to watch membership decline as indifference grows. It's time we talk and do so openly on a national level. It's time we determine our own destiny.
Robert David Argyelan,DC
El Cajon, California
DrArgy@aol.com
Dear Editor:
I have been in practice for almost 13 years and am a Palmer graduate. My father has been a chiropractor for 38 years. In Kentucky, we have two associations: the KCS and the KAC. I am a member of neither. It seems that several years ago, two old farts with egos larger than their clinical skills started feuding. They each gathered a camp of support, and behold, two completely ineffective organizations were formed. They have spent the past several years locked in mortal combat with each other, while the enemies of chiropractic laugh it up.
As the old farts got even older, they groomed a few middle-aged and young idiots to think like them so their legacy of stubbornness would follow them to the grave. We now have a new set of egotistical leaders who have convinced themselves that two associations are necessary. The rational usually given is that by having two associations, we can have a better voice in Frankfort, our capital. Yeah, right.
The reality is that nobody wants to give up their perceived position of power. The stupidity continues. I would venture to say that most chiropractors in the state feel like I do and most are not a member of either association.
Is it any different on the national level? Not a bit! I am not a member of either national association for the same reason. I see no sense in paying dues to further divide the profession. If there were one united voice to democratically represent our collective views, I would join in a heartbeat. I would be willing to pay a thousand bucks or so if I knew that my money would be wisely spent. You see, in a democracy, the majority rules. All opinions are tolerated and explored to gather their salient virtues. What a great concept! In chiropractic, the majority disrespects the minority; then the minority gets pissed off and forms their own little majority.
Damn, that's stupid. We are a bunch of guppies swimming in a shark tank. Instead of joining together to collectively bite the shark, we bite each other.
Some would say, "Join both and work from within to change them," or "You should join at least one and make your voice heard." Been there; done that; didn't work; very frustrating. With 2,500 new graduates each year, it will not be long before the ranks of chiropractors like me outnumber the old farts and the brainwashed yes-men. At that point, if there is a profession left, someone will emerge to unite us and give us a strong voice. The number one criteria: a humble man or woman who knows what it means to serve others for the pure pleasure of service, not to feed his ego. Seems like Christ had that talent down to an art.
Jim McNevin,DC
Lexington, Kentucky
Dear Editor:
I am a member of my state association only. In my 21 years of practice, I have been a member of both ICA and ACA. Due to drastic cuts in my local market, and due to heavy HMO penetration (more than 60% in the HMO), I have had to cut the "fat" in office overhead. National organizations had to go, as did my membership in the local chamber of commerce.
I have gone from two CAs to 1/2 of a CA. I really don't need her either, but it looks good to have a receptionist and I cling to a slim hope for an improvement of the market since I am not a provider in any of the HMOs here. My numbers (new patients and regular visit patient visits) are down 40% from pre-HMO days (10 years ago).
I just didn't feel I got anything for my dues from the national organizations. The same for the local chamber of commerce. They raised my dues to $175 and now are promoting a health insurance plan for small business which is an HMO -- the chiropractic provider is way out of town. Why should my dues go toward an organization which is actively sending business away from me?
As for the ACA and ICA, I couldn't see any impact or influence in my locality. An advertising campaign would have been helpful. I've always felt that active, informed patients are the best lobbyists instead of ourselves and our hired guns.
Thank you for your work and interest in today's chiropractic issues.
Gary Silbaugh,DC
Sun Prairie, Wisconsin
Dear Editor:
I have just read the article "How Low Must We Go?" and can come away with a number of quite negative future scenarios about the unity of our profession here in the U.S.
I'm a recent Palmer grad, a member of my state association (Iowa), and also ICA. As to the question of why, I belong to the ICA for a number of reasons. Quite simply, I feel one should be "in there," to be involved. Also, by nature of it being international, the ICA is more diverse, thus absorbing more ideas. And, of course, there's the legacy of B.J.
As my practice becomes established and grows, I have every intention of joining ACA to add voice to this organization.
A New DC in Iowa (name not included with letter)
Dear Editor:
The answer to your question of how low must we go is, a lot lower than it is now. However, you are asking the wrong question. You alluded to the question but dismissed the answer when you quoted an explanation such as, "It's because the U.S. DCs have to pay so much for their ... (memberships)" and then said that "it is not a viable excuse." I'm sorry you don't think so, but it is a viable excuse.
I would love to belong to the ACA, the CCA, and any local organization I could. When I first started into practice, I did, and I even worked on the state level as a delegate in Arizona. In Arizona, they allowed me to be a member by working for the association in lieu of paying dues.
I contacted the CCA and asked about membership and benefits. When I explained my financial hardship to the state association and suggested that there may be others in my position who would be willing to afford a minimal $25 to $100 per year membership just to support what we could and give membership numbers to their rosters, I was told it had been considered but rejected in the past.
I was dismayed and upset (putting it mildly) that you summarily dismissed the excuse with the same attitude as the "fat cats' on the various chiropractic boards who can afford to hold the rest of us in contempt. I for one can't afford to belong to any organization, but would be more than happy to be included on their roster for political purposes and to help if I could in some way. I refuse to believe I'm alone. There are too many of us struggling to survive.
Maybe it's time for the "big" organizations to represent us all instead of only the rich doctors. If only 10% of the 62,000 DCs were to pay just $25, it would increase the coffers by $155,000. That's not too shabby.
Kenneth C. Rich,DC
Newark, California
Dear Editor:
I am a member of the ACA, Virginia Chiropractic Association, West Virginia Chiropractic Association, Kentucky Chiropractic Association and North Carolina Chiropractic Association. I am a member of both state and national associations to have representation for issues regarding chiropractic in the states in which I am licensed or regularly attend academic seminars sponsored by state organizations.
I have very little clout or opportunity as part of an organization, but hope to be kept informed and be represented by those who are politically aware and inclined. My dues can at least help get the message across and be involved in the process.
Steward Rawnsley,DC
Narrows, Virginia
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