Where We Fit in Is Where We Stand out!

Where we fit into the nation's health care system has been the subject of a century of debate, both within the chiropractic profession and without. It still goes on, and the intensity and future implications of this debate are rapidly reaching profound levels of significance. This definition process has sometimes been termed an identity crisis for chiropractic. We are not physical therapists. We are nonmedical doctors. We are not part of the conventional medical system, as are MDs and PTs, though there are some chiropractors who have historically wanted to be a part of medicine. The vast majority of us, however, recognize and embrace with great pride, the unique differences that identify chiropractic as a separate and distinct science, art, philosophy, and practice, based on the principle that the spine and nervous system are essential components in health, and that interference with their normal functions is our special area of clinical concern.

The pressure to extend chiropractic scope of practice into the medical arena, as fringe and unsupported as I believe it to be by most of us in the profession, has not gone without notice by our critics and competitors. Through the International Chiropractors Association (ICA), I received a copy of a resolution recently considered by the American Medical Association (AMA) House of Delegates. (Editor's note: see Don Petersen's Report of Findings, "AMA Resolution 623 -- Action or Reaction," in the Sept. 23 issue of DC).

I would like you to read this resolution and consider both its implications and its motivation. I also invite you to consider the question: "Would resolutions like this be forthcoming with such regularity if chiropractic stuck to its recognized and unique turf?"

American Medical Association House of Delegates
Resolution 623
(A-96)

Whereas, During this election year, large financial resources are being expended by non-physician health care providers to lobby legislators and the general public concerning the benefits of their independent practice of health care services; and

Whereas, These non-physicians globally include primary care and specialty health care providers; and

Whereas, There is a motivated and organized effort by non-physicians to expand and broaden the scope of practice of non-physician health care providers; and

Whereas, the general public and legislators are being informed by organizations of non-physician health care providers that their capabilities and education related to the provision of patient care are comparable to the education, training, and capabilities of physicians; and

Whereas, Non-physician providers are currently providing and are attempting to perform additional unsupervised services, which is in opposition to current AMA policy (275.986.475.989); and

Whereas, It is beneficial for physicians to be proactive rather than reactive with respect to educating the public concerning the education, credentials, and qualifications of physicians, therefore, be it

RESOLVED, That the American Medical Association educate the public about the difference in education and professional standards between physicians and non-physician health care providers.

Fiscal Note: $200,000-$500,000.

We must be realistic, and most important of all, honest with ourselves regarding our criticism of physical therapy or orthodox medicine when they seek to expand their clinical activities into the realm of chiropractic, or when chiropractic is pushing into theirs (on too many fronts in my opinion).

I feel that the question of where chiropractic should go regarding the direction of our expansion ought to be a top priority at the upcoming chiropractic summit meeting hosted jointly by the American Chiropractic Association and the International Chiropractors Association. This unique forum represents an excellent opportunity to evaluate the state of chiropractic and see if we can come to some understanding of the direction in which the profession should go.

I realize that chiropractic will always have its critics, especially among those in other professions who feel threatened by the increasingly effective competition chiropractic is offering in the worldwide health care marketplace. We must unite as a profession to proactively fend off attacks such as those implied in the AMA resolution. We have so much we can be proud of in chiropractic, and I am sure you resent as much as I do the attacks we have suffered in recent years on everything from our education, to the appropriateness of the care we provide to children.

We have no data on the AMA's plans to act on or implement the resolution cited here. It is a reminder, however, that the battle for our future continues in the face of a determined enemy. I, for one, will feel much more confident if we can agree on the value and strength we gain for chiropractic in standing firm on our uniqueness, expanding the reach of our nonduplicated practices into every household, leaving medicine to the MD, physical therapy to the PT, and making sure that chiropractic is preserved for the DC.

R. James Gregg, DC, FICA
Garden City, Michigan