... some credit must be given to our fine chiropractic colleges...
Dear Editor,
In the March 27, 1995 Dynamic Chiropractic, Dr. Innes stated: "It was assumed that the chiropractic colleges would teach the others, but this has proven not to be true. So MPI, true to its mission statement, will bring to the profession beginning this year at least one new aspect of the subluxation complex." Dr. Innes continues his column by introducing the "Neurology and the Subluxation Complex" program of continuing education sponsored by MPI.
All members of the ACA Council on Neurology must be graduates of a postdoctoral program of study in neurology of a minimum of 300 hours which has been completed under the auspices of a CCE accredited chiropractic college. The study of neurology and the subluxation complex is not new to the curriculum of chiropractic colleges. The first 200 hour postdoctoral program in neurology was established in the early 1980s, with the profession's first graduates receiving certification in 1987.
Several of our chiropractic colleges have excellent programs of study in neurology which are offered at the postgraduate level. Comprehensive programs are will established by the New York Chiropractic College, Northwestern College of Chiropractic, Los Angeles College of Chiropractic, Parker College of Chiropractic, Texas Chiropractic College, and the Logan College of Chiropractic. All of these chiropractic colleges have graduated doctors who have demonstrated specialist level knowledge in the neurology of chiropractic.
We are very proud of the expertise of our membership who hail from all of the above mentioned colleges. Their training in neurology from their individual institutions is at a level that breeds excellence in both diagnosis and therapeutics. They have been trained to serve as specialists in neurology for the chiropractic profession and promote this function very well. They are tributes to the chiropractic colleges that have instituted graduate programs of study in neurology over the past decade.
If "complete understanding of this material (neurology and the subluxation complex) is MPI's mission," as Dr. Innes proclaims, then I believe some credit must be given to our fine chiropractic colleges and their established programs in chiropractic neurology. The chiropractic colleges that I have mentioned have provided this council's membership with the academic and practical experience to apply the art of chiropractic in a wondrous way. Chiropractors can be assured that all of our colleges that offer these programs have established curriculums that are directed in a similar mission to that described by Dr. Innes.
We would expect that MPI in its tradition of educational excellence would encourage all chiropractors to contact any of the colleges I have listed to assist with MPI's mission. I am sure that the MPI program, "Neurology and the Subluxation Complex," will be at a standard second to none. After all, your instructor is a graduate of a postdoctoral program in neurology from an accredited chiropractic college.
Frederick Robert Carrick, DC, DACAN, DABCN, FACCN
President, Council on Neurology of the ACA
Dr. Carrick is Absolutely Right! Dear Editor,
Dr. Carrick makes some extremely valid and vital points that I would like to embellish. MPI, in its teaching of the various components of the subluxation complex, has a mission: make available to the chiropractic profession a continuing education course or courses on each of the aforementioned components.
Continuing education within the subluxation complex involves an ongoing and ever-evolving collection of current data that relates to the subluxation complex. To disseminate the most up-to-date information available, it has been our policy to recruit from the profession, those doctors whose philosophy, methodology and drive are compatible with those of MPI. David Seaman, DC, DACAN, a former student of Dr. Carrick's course, has been chosen to teach this course. To Quote Dr. Carrick, "We are very proud of the expertise of our membership who hail from all of the above mentioned colleges. Their training in neurology from their individual institutions is at a level that breeds excellence in both diagnosis and therapeutics. They have been trained to serve as specialists in neurology for the chiropractic profession and promote this function very well. They are in fact, tributes to the chiropractic colleges that have instituted graduate programs of study in neurology over the past decade." MPI is also very proud of the fine work that is done by all of our chiropractic colleges both in obtaining the doctor of chiropractic degree as well as those colleges offering postdoctoral programs.
Continuing education is just that... continuing education!
There are not enough hours in the chiropractic college curriculums to teach neurology that could approach any of the diplomat programs depth or level of comprehension, however the chiropractic colleges have prepared us for entry into the ones of our choice. Obviously this fact was recognized many years ago and has resulted in the large selection of postdoctoral programs throughout the U.S. MPI has recognized this fact, and like many diplomat programs, has attempted to fill in some of those interrelated complexities that co-exist between the various component parts of the subluxation complex by once again enhancing that information previously taught by the chiropractic college.
MPI's Neurology and the Subluxation Complex is a 12-hour course that blends, homogenizes and clarifies the role of the neurology as it relates to the other component parts of the subluxation complex. There is no question that in 12 hours this is a formidable task but never the less a task well worth doing, as the students or doctors in attendance can now decide which of the numerous diplomat programs they may want to attend in the future. MPI has and will continue to recommend the postdoctoral programs being offered by our fine institutions of learning.
MPI is extremely proud to have Dr. Seaman, a graduate and living testimony to chiropractic's postdoctoral system, to weave together within a logical working and practical neurological model that which we were taught in school.
I would like to thank Dr. F. R. Carrick for bringing to my attention this unintentional oversight and to wish a CMCC colleague all the best in his future research and teachings.
Keith Innes
Dean of MPI Faculty
Scarborough, Ontario
"... the majority of DCs in Canada are in a survival mode..."
First I would like to say how much I enjoy reading our profession's "Chiropractic News Source," and the comments of its contributors. I have just read the March 27 issue of "DC" and would like to remark on a few items.
Robert Cooperstein's remarks of the ABS Fall Symposium were the next best thing to attending. His comments (p. 41) regarding technical excellence, DCs being slow to acknowledge treatment failure, prophylaxis on the run, and technique wars and patient selection, presented fundamental issues which I found myself comparing to Reed Phillips' comments (p. 44) of validity, reliability and efficacy of techniques. Dr. Phillips challenges us to "seek a more sound understanding of what we do as DCs and what it really means to the health of our patients." Dr. Cooperstein is right in stating we can no longer just "clear the patient," keep maintenance or preventive care going indefinitely and ignore functional outcome. Instead of which procedure applied to which patient, by which DC at which stage of the case, with what desired outcome, as assessed by which particular outcome measure, many DCs are still caught up with ego and technique. The health status questionnaire is one means of showing the impact of your treatment and proving the effectiveness of your practice. Ideally, I like to think we all practice prevention and recommend it to our patients taking into account functional outcome.
MPI has always taught the subluxation complex and motion palpation as the primary means to determine when, when not to, and how to adjust. Dr. Phillips, I hope, is challenging those DCs who are complacent in their practice and office procedures and not re-examing what they are doing.
AK, Activator, Gonstead, Thompson, upper cervical, MENS, to name a few, have all been started by gifted DCs who were striving for validity, reliability and efficacy. We have many instruments and means for analysis and correction of the various components of the VSC, and I am sure we are all thankful for them. DCs still seem to be hesitant to refer to each other but will often let a patient get disgruntled or disappear only to show up, if at all, in another office. Dr. Jay Wipf has suggested in his article, "Associate DC Syndrome" (p. 12), that the group practice will consistently maintain the highest level of practice over the long run. This makes sense today for the reasons he mentioned, but also that the patient would benefit from the varied techniques/analyses likely to be found here than in a solo practice.
For my second point, Palmer Chiropractic College tells us to build from our past and focus on the future. Their ads encourage fellowship, based on embracing the same fundamental beliefs of the benefits of chiropractic and having common goals for our advancement, and to have courage not to abandon what we know, when what we know is about to transform the world of health care.
I would like to suggest that the majority of DCs in Canada are in a survival mode, based on the typical financial picture as compared to our colleagues in the U.S. Ontario has approximately 2,200 DCs, the majority of Canadian DCs. We bill approximately $90 million (Can.) to our provincial health insurance which is only just over $40,000 per DC. We are allowed to balance bill and this equates to approximately another $60,000 per DC, netting approx. $50,000 (Can.). As a comparison, 800 optometrists bill approx. $86 million per year for examinations. Dr. Wipf states his associate DCs are netting about $100,000 U.S. per year (about $140,000 Can.). The ACA I believe says the average visit in the U.S. is $30 (42 Can.).
We would like to have insurance equality but have to deal with insurance disparity. I think we all need to be aware what our colleagues are dealing with, do the best job we can and be faithful stewards of what we have. Our colleges, especially in the U.S., should not be lacking funds, the majority of DCs should belong to the ACA or ICA, we should all have the best equipment in our offices and research should have the necessary funding. It is great to see the explosion of research worldwide for our profession, but I hope we will participate in fellowship and encourage one another in the face of continuing adversities. As you say, "unity without uniformity."
Allan Overgaard, DC
Hanover, Ontario
Quo Vadis Revisited Some very thoughtful questions and issues were provocatively raised in the 3-27-95 "DC" by Publisher Donald M. Petersen Jr. in his editorial, and Lise Janelle, DC, as well as others, to the extent that I, in the hindsight of my retirement (but for an occasionally requested consultation), see that "DC" issue as one posing major consideration for the future of chiropractic. It sets the stage I feel for whether the profession will survive and thrive or struggle to maintain itself in a very secondary role.
Following up on the Consumer Reports survey of patients' major problems with their medical doctors, Mr. Petersen aptly comments about the importance of communication to patient needs and asks who will take the place of the Marcus Welbys, particularly in face of the pressures of managed care?
Tangential perhaps, but certainly related, is Dr. Janelle's observation that, "What has made us good and successful is the approach that we have had about health, to look at the whole individual instead of only a specific part: the wellness type of philosophy as opposed to the pain killer type of approach." Of course that assumes anything but the "rack and crack" approach that in essence is really on a par with simply reaching for the prescription pad. She also suggests replacing the term "innate intelligence" with "homeostasis" and follows up with, "Are we just blind to the success which lies at our finger tips?"
Communication, the basis for our success (even against all the medical-pharmaceutical propaganda) and Dr. Welby are the crux of our future. Yes, Mr. Petersen, the inference most certainly is that we, if we have any sense at all, had best step in to take our rightful place as the hand-holding family physician. We must be willing to forgo the numbers equals dollars pressure, in favor of perhaps a less luxurious but more greatly satisfying mode of the kind of family doctor approach people long for and are destined to receive less and less of. That is, or should be our forte, our growth factor (personally and professionally). As it stand now, I fear we are in danger of becoming more like "them" than "they" are, because we are becoming too business wise.
I know, I absolutely know that by becoming the new family physician the rewards will be greater in the long run, personally and professionally, than trying to keep up with the Joneses, personally or professionally.
I strongly suggest digging out that 3-27-95 edition and rereading it carefully. There's gold and a quality of life in it. I've been through this "what's my line" thing for the last 40 years with my other healing art practitioners. They'll bury themselves in medicine. Let's not do the same. The people need us as we are.
Ray Aronow, MA, DPM, DC
Sebastopol, California
