On August 28, 1963, Martin Luther King gave his famous "I have a dream" speech. He said, in part:
"I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character."
I have paraphrased his famous words on several occasions as follows:
"There will be a time when a person will not be judged by the initials behind his name, but by the quality of his education and training."
For many years, chiropractic has been looked upon as a less than adequate provider of health care. As a student at National College in the early 70's, our "enemies" focused on the lack of scientific evidence supporting the efficacy of chiropractic care. In fact, we were charged with doing harm by delaying our patients from receiving adequate and appropriate care.
The charge has changed. Now scientific evidence provides support for chiropractic care, at least for the back pain patient. Our enemies can no longer speak of the absence of research. Their current cry is that our theories are based in mysticism and have no place in an evidence-based culture. While medicine condemns a mystical-based philosophy, alternative forms of health care have become vogue in society and provide opportunities for financial gain even in medical practice. Still, chiropractic remains outside of orthodox Western medicine, even as the most frequently used form of alternative health care.1
As the world of health care continues its metamorphosis and the barriers between the health professions fragment, pondering the position of chiropractic can be most fascinating. Will the future find a place for chiropractic? What will be our role, and how will it be determined? Will the chiropractic profession self-destruct because of its self-centered interests? Will it naturally fragment and dissipate? Will some other branch of healing subsume the art of chiropractic care? Will the doctor of chiropractic of the 21st century be the central figure in the delivery of health care? Finally, will the profession select its own destiny or will it be determined by others?
The Vision
There have been many luminaries representing diverse perspectives in chiropractic who, while gazing into their crystal ball, have made glorious projections for the future of chiropractic. They speak of being the primary care giver of the future. They talk of a wellness paradigm where people will be seeking health care rather than illness care. Most prognosticators agree that medicine will remain in a prominent role as chronic illness, drug-resistant mutations of various pathogens and new viral strains continue to plague humans with disease. Yes, there will also be a role for emergency care as long as humans continue to live destructive lifestyles. But in the eyes of most chiropractic futurists, health will prevail over disease and wellness and disease prevention will be the focus of the primary care giver -- a natural role for chiropractic.
This health and wellness perspective will be vaulted into prominence on the wings of the information age. As the public becomes a more serious consumer of knowledge through technological means such as the Internet, awareness and sensitivities regarding health will be more widespread and available. Dependence upon the doctor for knowledge about health will decrease. Those seeking help to increase their health and wellness will turn to the wellness care giver of the future, the doctor of chiropractic.
There is a critical catalyst, however, that must not be overlooked. An increased knowledge of health and heightened sensitivities regarding care in the general population will engender higher levels of accountability. The care giver of the future must be prepared to explain and to justify every phase of care rendered under their direction. Acceptance on faith will be limited to those seeking spiritual healing from a faith-based provider.
Will chiropractic serve the population in the capacity of wellness doctor or spiritual healer in the 21st century?
The Division of the Vision I: Quality of Education & Training
For a century, the terms "straight" and "mixer" have been used to describe the division in chiropractic. I disdain these terms and wish to discard them, for they are ill-defined and inappropriate. Over the last two years, the Association of Chiropractic Colleges (ACC) has labored diligently to seek consensus on fundamental issues in the profession. Two position statements describing the paradigm of chiropractic care and definitions regarding the breadth of practice have been released. For the first time, this centenary profession came upon a modicum of agreement among its educational and political leaders. What a wonderful feeling, as these statements were released, to think of the potential as a united profession.
But this hope may be fleeting. In January, 1997, the Council on Chiropractic Education (CCE) voted to raise the entering GPA requirement from 2.25 to 2.5 by 1999. As a result, one of the colleges has bypassed normal CCE grievance procedures and is threatening legal action to revert this requirement to its original status. The basis of the legal action is that the new standard will create a hardship for ethnic minorities who wish to seek a chiropractic education.
Hence, within a shared paradigm and associated definitions of practice, significant differences regarding the value of academic performance exist. Can two programs with different standards leading to a common outcome co-exist? Can the quality of education and experience be provided at the same level of intensity and complexity for applicants who enter at different levels of preparation? Not unless the level of training is standardized to the lest qualified applicant. If this is true, how can chiropractic be considered equivalent with other health care professions when our entry level requirements are significantly less? Does the health care provider of the 21st century need more or less education than their 20th century counterpart? How does the quality of education relate to the need for accountability?
The Royal Melbourne Institute of Technology (RMIT) struggles with these issues in the Far East. They have opened schools in Japan and Korea. Both schools boast of university affiliation and both offer a two-tiered program. The first level is a two year program that trains other health care providers (acupuncturists, physical therapists, Oriental MDs, sports trainers, etc.) to become chiropractors. The second tier is an additional three-year program that leads to a doctor of chiropractic degree.
As educational leaders in our profession gravitate towards two standards of admission requirements and probably two standards of training in the DC program, should the CCE study the feasibility of a dual degree program? The first degree would be that of "chiropractor" and the second degree, "doctor of chiropractic."
The Division of the Vision II: Philosophy
While the leaders of the profession were accepting and adopting the ACC position statements, the debate over chiropractic philosophy or chiropractic dogma (the choice is yours) raged on. LACC has published its own position paper regarding the philosophy of chiropractic. The paper accepts many tenets of holistic and vitalistic concepts but places them in a more academic than religious context.
As an example, the LACC paper on philosophy recognizes the power of the body to heal itself, given the right set of circumstances. We recognize that many mechanisms of healing can be explained without knowledge gained through research; in those areas where a phenomenon can not be explained, further research is pursued.
A dogmatist in chiropractic philosophy would recognize the self-healing power of the body as an act of innate intelligence being influenced by a universal intelligence. Whatever mechanism can be used to explain the phenomenon is only a reaffirmation of the presence and power of the innate. The purpose of research is to seek new understanding that will confirm the fundamental belief system. Research failing to confirm preconceived beliefs is considered flawed research.
The resulting outcome of these two points is what brings discord to the profession. In the first, recognition of a natural phenomenon leads to hypothesis formulation and testing that leads to theory formulation. In the second, recognition of the natural phenomenon is acceptance of the presence and action of a higher power to which an explanation may not be found. But since the phenomenon confirms the belief, no further explanation is needed. Also, this second belief system supports attitudes of anti-intellectualism and is the antithesis of what we strive to achieve as we teach our students at LACC.
My Vision
The Chiropractic Profession The doctor of the 21st century, the chiropractic physician (or doctor of chiropractic) will be the primary care giver in a health-oriented paradigm. This person must be accountable in an evidence-based culture for the care provided, and his/her focus in this holistic approach to health care must be patient-centered. All health care has philosophical roots. The chiropractic physician of the 21st century must respect our philosophical underpinnings, while garnering the skill of a critical thinker and being a consumer of new knowledge and information. Mysticism and anti-intellectualism in health care must be discarded. Standards of education and training must be raised to a level at least equivalent to any other health professional using the title of "doctor."
Chiropractic Education
Several chiropractic colleges are poised to lead the profession to higher levels of professional education and training. LACC has focused a great deal of time, energy and resources in the development and implementation of the Advantage program, and in acquiring WASC accreditation. We have set high standards for competency that our students must meet to graduate; some other schools are doing likewise. Chiropractic education must commit to raising standards above current CCE minimums until our training is equivalent and consistent with other doctoral level health care providers. Our graduates must be the best trained providers of health care in the next century.
Not only must we enhance the quality of our graduates, chiropractic education must seek to assist the doctors in the field to lift their level of competence and prepare them for the future. We must reach out to our alumni and others who wish to follow our philosophy, our model of care and our vision of the future. By reaching out, we must help them to be more successful, more competent, more confident and more effective in their delivery of chiropractic health care. We must train them for the 21st century wellness paradigm. We must provide the leadership around which those who desire can rally as we separate and segregate ourselves from the faith-based fundamentalists in the profession.
The profession generally (and chiropractic education specifically) must also reach out to the communities that we serve and do more for them. We must provide more cost-effective, efficient and comfortable care that will enhance their health and well-being. We need to make sure that chiropractic care is accessible and affordable for all patients. We must reach into areas of the world where chiropractic and health care in general are nearly nonexistent to help alleviate the pain and suffering. With chiropractic care, we have the opportunity to provide basic health care in areas where high technology and drug dependent health care is not even available. Only be reaching our can we expand within. We must do both if chiropractic is to survive the 21st century. We plan to take the lead!
Reference
1. Elder, Gillcrist & Minz. Use of alternative health care by family practice patients. Arch Fam Med Vol 6, Mar/Apr 1997, pp.181-184.
Reed B. Phillips, DC
President
Los Angeles College of Chiropractic
