A New Role for the Doctor of Chiropractic: Whose Opportunity Is This?

The recently published paper by Drs. Sarnat and Winterstein is a must read for every doctor of chiropractic in the world.* (Please see "DCs as Primary Care Providers: New Managed Care Study Finds Improved Patient Outcomes and Significant Cost Savings With DC Gatekeepers," beginning on the front page of this issue.) For the first time, broad-scope DCs went head to head against MDs and DOs in the primary care provider role. While the study was limited in size, the results are exciting.

Compared to patients who saw medical primary care providers (PCPs), those who saw chiropractic PCPs experienced the following:

• Hospital admissions decreased by 43%.
• Hospital days decreased by 58.4%.
• Average length of hospital stay decreased by 23.8%.
• Outpatient surgical cases decreased by 43.2%.
• Pharmaceutical usage decreased by 51.8%.

The lesson from this study - a lesson that will not be missed by Blue Cross/Blue Shield of Illinois (or any other managed care organization, for that matter) - is that they can utilize properly trained alternative health providers as PCPs to save a great deal of money. The side benefits of taking this approach are patient choice and high satisfaction ratings.

And while this study utilized rigorously trained DCs, that doesn't mean a traditional osteopath, naturopath or other type of complementary and alternative medicine (CAM) provider won't work just as well. Because, as we all know, when it comes to managed care, it's about the money. If it works well on the income statement, it works.

What will also not be missed from this study is the use of chiropractic PCPs as "gatekeepers" to other CAM providers. This is an idea that everyone will like - well, almost everyone.

The managed care marketing people can claim that their HMO offers a complete line of CAM therapies; the MDs don't have to deal with CAM providers if they don't want to; and the DCs (assuming we get the position) will be able to keep as much care for themselves as they can, only referring out when necessary.

When the other CAM providers complain to the HMO about restricted access, the response will be: "Don't blame us, it's the chiropractic PCPs who make that decision." Irony runs both ways.

So what do you think?

Do DCs want to be PCPs?

You may not want to be, but in this fiercely competitive health care market, we may have to. Unless we have DCs as PCPs, it will be difficult (if not impossible) to control patient flow (read that as "access") in the managed care arena. We have a choice: We can either sit at the table or wait for the scraps to fall from the plates of those who do.

The good news is that alternative health ("CAM," if you like) is included to some degree in the health care of most Americans. The bad news is that while chiropractic was generally here first, other alternative health professions have joined, and many of these are more than willing to step up to opportunities we fail to take advantage of.

The position of "CAM primary care provider/gatekeeper" is an idea whose time has come. A portion of the public wants it and it saves the HMO money. It may take a while to spread to other HMOs, but it will, provided the cost savings continue.

Doctors of chiropractic are the first to fill these positions in a formal study. We are better qualified and have already proven ourselves in the position. This is a role we can play in health care that will return some of the access and authority we've lost under managed care.

*Thanks to National University of Health Sciences and Elsevier, you can download the complete text of the JMPT study free of charge by going to http://tinyurl.com/6m916.

DMP Jr.