Licensing, continuing education, disciplinary actions, recognizing chiropractic colleges, reviewing complaints and investigating violations -- these are the methods our state boards use to insure competent care within chiropractic. But are these enough?
The functions of our state boards as listed above, appear to be a combination of gatekeeping and policing -- deciding who should be licensed and then dealing with those doctors accused of ethical or legal violations.
Is there perhaps another function that our state boards could use to insure quality chiropractic care?
What about prevention?
For a profession that promotes health care maintenance, we seem to have forgotten about that concept when it comes to monitoring our own doctors. For this we rely on the disaster principle -- wait until a doctor of chiropractic has done (or not done) something that will cause him to lose his license (or worse) and then deal with it.
The MDs at least have peer reviews. They have both hospital reviews and surgical reviews that tend to keep their practitioners on a very short tether. What do we have?
Consider just this one idea:
Imagine if you will a system whereby, during the first six months that you were in practice in a particular state, you received a visit from a "State Board Consultant." This consultant would set a time to spend one full day with you.
The consultant would help you understand the laws unique to that state. He could go over your patient files and show you where your records may be deficient. You would be able to talk confidentially about issues concerning how you practice -- issues that could ultimately be the very problems that could expose you to board discipline, civil action, or worse.
This consultant could be a wealth of information for that area of the state. Consider the time and money that could be saved if you could learn about the area you were practicing in without having to practice there for ten years.
For the first two years after your initial visit, this consultant could visit you annually. In the interim, you would be able to arrange phone conferences to seek further information. Ultimately, you might only see your consultant every three to five years.
Sound expensive and time consuming? It most certainly would be. But consider the results. The state board would spend less time disciplining and more time directing. Instead of having the job of "keeping the profession clean" the board could focus on its real job: insuring that the chiropractic care received by the public was the best care possible. Ultimately, this kind of an approach would translate into increased utilization of chiropractic care and a much higher public image. The benefits dramatically outweigh the costs, both economically and professionally.
The government, insurance companies, and especially the public are demanding more accountability. We have, as always, a choice: either we create mechanisms that will insure that the public receives the best (best suited, highest quality, most ethical and least expensive) chiropractic care possible or bear the consequences.
The consequences are very simple. They range from limited access to complete exclusion.
This is why the states where chiropractic is very strong have incorporated some sort of "peer review" process. Georgia, for example, has had a peer review board for many years. They understand the values of self-monitoring. The Florida State Board not only has a form of peer review, but is enacting legislation that would require each new Florida licensee to complete "a 3-month training program in this state of no less than 300 hours with a chiropractic physician licensed in this state."
These may not be perfect solutions, but at least they address the problems. As we seek solutions, the best ones will prove themselves.
The state boards will ultimately be held responsible for the condition of the chiropractic profession in that state. If they don't do the job, using whatever means are necessary, someone else will.
And as you can readily see, when an "outsider" does the disciplining, it lacks compassion and understanding.
It's YOUR state. It's YOUR state board. It's YOUR future.
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Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
