Looking Back and Looking Ahead...

As we enter this new year, our thoughts look forward not only to 1997, but to the year 2000. A new millennium. A brand new thousand years. Considering the changes that we have seen in just the past two decades, what will the world look like 10, 20, or 40 years from now? And what will the chiropractic profession look like? Will it remain an alternative to orthodox or traditional health care? Will it continue to struggle to gain credibility and parity with medicine? Or will it succumb to internal and external pressures and fade into obscurity as have so many other alternative approaches? Let's take a few moments to look objectively at the pluses and minuses of our profession. Perhaps then we can begin to realize our potential as a legitimate and equal part of the health care team of the 21st century.

On the plus side, during the past 25 years we have seen our educational institutions improve tremendously. We have raised our academic standards and dramatically improved the quality of our educational programs. Students now entering chiropractic colleges have a minimum of two years in undergraduate school and an increasing number have baccalaureate degrees, even masters and PhDs. A far cry from 1972 when I entered chiropractic college. At that time, one of my classmates received his GED (high school equivalency) during our first term. It should come as no surprise that much of the criticism lodged against the profession was directed at the education, or lack thereof, of its members.

Since the early '70s we have struggled to gain accreditation of our chiropractic colleges. In spite of significant resistance to the accreditation process, and some rather glaring differences between the content and scope of chiropractic education at different schools, the educational experience is far better today than even a few years ago. We take pride in comparing the number of hours in anatomy, physiology, biochemistry, etc., to that of medical education. We even use this information in our advertising and public relations programs. However, there is still some disagreement about the needs of chiropractic students. Not everybody agrees that we should continue to improve the educational demands on the next generation of chiropractors, but if we are to compete in the information age, our students must be comparably prepared to those in other health care disciplines, that is, they must have the same educational preparation prior to enrolling in chiropractic college. The chiropractic profession can no longer afford to have colleges accept students with a minimal level of educational preparation. We must move to a four year liberal arts or science degree as a minimum entrance level prerequisite to chiropractic college.

Also in the past 20 years we have seen many of our chiropractic colleges move from strictly educational institutions (some would say diploma mills) to an increasing emphasis on research. Many of the recent hard fought political victories have been made possible because the research database has grown, due largely to the efforts of a few dedicated researchers in the profession. Each of us owes a debt of gratitude to the pointy-headed researchers who are always asking "Why?, What if?, How?" As we continue to investigate the science and art of chiropractic we must be cautious, however, about how we interpret and use the information that we gather. As members of the scientific community, if that is what we want to be, we must be critical consumers of the literature. We are too often guilty of using positive research findings to justify our claims of efficacy. We make too many far-reaching assumptions about the significance of a single piece of published research. It is incumbent upon the members of the profession to stay current in the state-of-the-art by subscribing to and reading the relevant scientific journals.

In addition to an expanding research base, we have seen the development of a literature base that includes a growing number of widely distributed textbooks, and a handful of peer-reviewed journals. Prior to 1980, if you wanted to learn about chiropractic methods, procedures, or theories, you were limited to self-published notes and home-grown course manuals. Today, we have a small but significant assortment of texts that compete for shelf space, not only in chiropractic college bookstores, but in medical schools as well. Yet, it is still difficult to find information in public libraries about the chiropractic profession. Young individuals interested in a career in chiropractic often go to the local public library to find out more about the profession. Imagine their surprise when there are only one or two books about chiropractic. Or, imagine the impression they get when there are no books at all about the profession. Other students go to the library at the college or university that they are attending. Once again, even though these facilities are the primary source of information for large numbers of students and faculty, only rarely can one find much information about the chiropractic profession. For a number of years I have issued a challenge to chiropractors around the country and around the world to buy chiropractic textbooks and donate them to the local public library, to the high school library, or to the college or university library in their area. Every college library should have a subscription to the JMPT, Chiropractic Technic, and JNMS. I would like to challenge each of you reading this column to spend a few dollars and send a subscription of one of the above journals to a library of your choice.

As we witness the end of the 20th century and the beginning of the 21st, we are faced with both challenges and opportunities. Many of the things that we took for granted a few short years ago, like doctors making their own decisions regarding treatment plans, are now in the hands of health care administrators. The advent of managed care is forcing every aspect of the health care industry to re-evaluate and re-tool. The driving forces in the new managed care paradigm are largely economic, with clinical efficacy often taking a back seat to cost-containment. It is interesting to me that now, not only is the chiropractic profession faced with serious challenges to its survival, but the health care system, itself, is struggling, unsure of what the future will bring.

I am convinced that the key to our survival in the next millennium lies in our ability to adapt to changing times. I recently read an article about a well-known orthopedic surgeon who had begun a cash practice in the fitness facility of a local hotel. While he still maintained his insurance based office, this fee for service practice was an attempt to adapt. I must admit, I derived some small amount of pleasure hearing that an orthopedic surgeon was having to be creative. After all, they've had it fairly easy when it comes to economic survival. But, I was impressed that this individual, rather than bemoan his situation, had the foresight to try new things. No doubt, he will survive. I was also struck by the idea of how easy it is for us to adapt to such a situation and how difficult it is for an orthopedic surgeon. After all, we don't require a highly sophisticated support system to use our clinical skills.

The question of the day is, how can we adapt to survive in these uncertain times? What changes should we make, if any, to compete in the health care arena of the 21st century? I have my own ideas but I'd really like to hear from you. If you would care to comment, please send your suggestions to:

Dr. Paul Hooper
Injury Prevention Technologies
2562 Castle Rock Road
Diamond Bar, California 91765
e-mail: HoopPD@aol.com

P.S. Thanks to those of you who have taken the time to write, phone, or e-mail me during the past couple of years. I appreciate knowing that some of the things we discuss have been useful and I am pleased with some of the suggestions that you have made.

Paul Hooper, DC
Diamond Bar, California