My message for the readers of Dynamic Chiropractic in this Presidents' Forum is that chiropractic colleges, with the support of the entire profession, ought to aggressively pursue tougher educational standards in chiropractic education. For one reason, doing so is in line with expectations that the public and lawmakers have for health care professionals. If we want our profession to play a key role in the emerging health care system -- and we're about there for low back pain -- we must be perceived to be the educational equals of other primary care providers.
The second and overriding reason is simply that higher standards will help our chiropractic colleges produce more effective and successful chiropractic practitioners. It's the old "quality in/quality out" principle. The difference in knowledge and maturity between those entering our schools with two years of college and those with a bachelor's degree is remarkable. Those less prepared slow down the instruction in the classroom, and the quality of the graduate is ultimately depreciated.
At the recent meeting in Davenport, Iowa of the Association of Chiropractic Colleges (ACC), I submitted a proposal to upgrade admission requirements from 60 to 90 semester hours (based on the rule of thumb that 30 semester hours is approximately one academic year, 90 hours equates to three years, and a bachelor's degree to four years.)
The majority of college presidents approved the proposal, which will be forwarded as a recommendation to the Council on Chiropractic Education (CCE). The new standards would be phased in over the next few years, becoming fully operative in the year 2000.
Upgrading to 90 semester hours at this point is no big hurdle. The majority of students entering the colleges of the Palmer Chiropractic University System already have the 90 hours. Certainly it is difficult for most students to meet our subject material requirements for the sciences in only 60 hours, so this upgrade simply puts a stamp of approval on what is rapidly becoming the status quo.
We shouldn't stop there. When the timing is right, the next step is for all chiropractic college to require a bachelor's degree or the equivalent at least by the time of graduation.
I know that some of my colleagues in chiropractic education and some practitioners in the field oppose this push for higher standards. Their reasons range from the pragmatic to the philosophical, and I respect their right to disagree. We at Palmer College of Chiropractic West are convinced that if our profession truly looks at things from the perspective of the future health care consumer it will recognize the need to upgrade our standards in spite of any temporary twinge in our comfort level.
To begin with, the debate over the qualifications of chiropractors relative to other health care practitioners is far from over. By upgrading our requirements we help render benign the argument of those who contend that doctors of chiropractic are not as well prepared as doctors of medicine. It is our credibility with patients that is at stake, especially as we seek to fill the primary care provider role.
For doctors of chiropractic to satisfy the expectations of those who might consider us primary care providers will require credentials comparable to other health care professionals competing for that primary care role. What's more, the primary provider must possess a host of skills, including so-called people skills, that can only be enhanced by a broad education, including more than a smattering of liberal arts.
An issue of Dynamic Chiropractic last March reported on a Consumer Reports survey that revealed that many patients were dissatisfied with the communications skills of medical doctors. Dynamic Chiropractic went on to point out that poor patient communication is even a greater problem in managed care and the pressures of volume practices. Broad-based and in-depth education doesn't guarantee greater understanding of peoples' needs, but surely it helps. Chiropractors usually pride themselves on superior patient interaction, but clearly, we will need to do even better in the new practice environment. As in so many aspects of life, the demand is increasing for even a specialist to have a generalist's knowledge.
And the need for education goes deeper than that. Coordinated care, another surety in the new health care environment, requires respect and understanding of the expertise of other clinical disciplines. That is particularly critical in the mutual development of patient-centered rather than doctor-centered protocols. That understanding and respect is also aided by education.
One of the objections raised to embracing tougher standards is that we are kowtowing to lawmakers and ultimately pressure from medical practitioners. All of us aware of our profession's history know that those forces have used educational requirements as a tool to limit the growth of chiropractic. Yet our history also teaches that the additional education, whatever motivates those clamoring for it, has been beneficial to the measure of acceptance chiropractic has achieved. In other words, what our enemies thought would be to our detriment we have turned into an advantage.
So the real issue on the brink of the 21st century is not the value of education, but who is to determine what education will be required for a doctor of chiropractic. It is obvious to me that it is in the best interests of our profession to stay ahead of outside forces who want to mandate what we do and who are indifferent to the disruptive impact of their actions on the educational community.
The fact is that four states -- Florida, Maryland, North Carolina, and Wisconsin -- already require bachelor's degree, and other states are contemplating the same. The demand for more and better education will continue inexorably. It is vital that the CCE, with the support of the profession, keep up with the demand lest that organization's credibility and the perceived value of our chiropractic education be diminished.
We cannot afford to stick in a time warp. We need to recognize that things are changing rapidly in chiropractic and all of health care. Education is nothing but an ally for the chiropractor of the future caring for the patient of the future.
On a final personal note, I've been involved with this profession for 30 years, and my experience has been that every time we upgrade our standards our students benefit, our colleges benefit and the profession benefits. A rising tide lifts all boats.
Working for higher standards in chiropractic education is one way our profession can take control of its own future.
Peter Martin, DC
President, Palmer College of Chiropractic
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