The Military and Chiropractic: Answers to FAQ

Dr. Duane Lowe currently serves as a Chiropractic Physician, 10th Medical Group, at the United States Air Force Academy in Colorado. From 1995-2002, he worked at the 375th Medical Group Chiropractic Clinic at Scott Air Force Base in Illinois; a 1990 graduate of Logan of Chiropractic, Dr. Lowe was one of the original 20 chiropractors to participate in the Chiropractic Health Care Demonstration Project. In addition to his myriad other responsibilities, Dr. Lowe is the editor for Carpe Spinalis, the monthly electronic newsletter for chiropractors working at military bases.

As most chiropractors are aware, chiropractic became an official benefit for active duty military personnel with the signing of the Defense Authorization Act of 2001. What began as a demonstration project at 10 military bases to determine the feasibility and advisability of chiropractic in the military health system has now expanded to 42 military bases nationwide. Currently, the following bases have chiropractic clinics:

Army: Forts Benning, Bliss, Bragg, Campbell, Carson, Drum, Gordon, Hood, Jackson, Knox, Leonard Wood, Lewis, Meade, Sill, Stewart; and Tripler and Walter Reed Army Medical Centers.

Air Force: United States Air Force Academy; Andrews, Barksdale, Davis-Monthan, Eglin, Keesler, Lackland, Langley, McGuire, Offut, Scott, Tinker, Travis, and Wright-Patterson Air Force Bases.

Navy: Camps LeJeune and Pendleton; Jacksonville NAS, MCAS Cherry Point, NNMC Bethesda, NH Beaufort, NH Bremerton, NMC Portsmouth, NMC San Diego, NH Great Lakes, and NH Pensacola.

The Department of Defense Web site features general information about the chiropractic program (www.tricare.osd.mil/chiropractic).

At the present time, all of the chiropractors who work at military treatment facilities (MTFs) are considered contractors. In most cases, the Navy contracts directly with the DCs, whereas the Army and Air Force have a contract administered by two medical service companies who employ the chiropractors to work at those bases. While there are chiropractors who have joined the military in other jobs and positions, there are currently no active-duty chiropractors working full-time as credentialed chiropractors in the military. There are also no civil service positions as chiropractors.

Minimum Personnel Qualifications

The minimum qualifications for the chiropractors listed previously on the Internet for the Navy positions are listed below: (similar qualification standards for the Air Force/Army, except qualification #10 is not required).

To be qualified for this position, you must:

1. Possess a degree from a chiropractic college accredited by the Council on Chiropractic Education.
2. Possess a current, valid and unrestricted license to practice as a doctor of chiropractic in any one of the 50 states, the District of Columbia, the Commonwealth of Puerto Rico, Guam or the U.S. Virgin Islands.
3. Have experience as a chiropractor, licensed independent practitioner, of at least 24 consecutive months within the last 36 months, during which you have consistently administered both diagnostic and treatment services.
4. Be in good standing with the state board of chiropractic examiners in the state in which you currently practice, with no current chiropractic license restrictions in any state.
5. Be certified in American Heart Association Basic Life Support (BLS) for Healthcare Providers; American Heart Association Healthcare Provider Course; American Red Cross CPR (Cardio Pulmonary Resuscitation) for the Professional Rescuer; or equivalent.
6. Provide statement indicating possession of basic computer knowledge.
7. Provide at least three letters of recommendation, at least two of which must be from physicians. Other letters of recommendation may be from chiropractic peers or physical therapists. Letters of recommendation must attest to your clinical skills. Recommendation letters must include name, title, phone number, date of reference, address and signature of individual providing the letter. Reference letters must have been written within the preceding two years.
8. Be eligible for U.S. employment. Please provide copies of supporting documentation.
9. Represent an acceptable malpractice risk to the Navy.
10. Submit a fair and reasonable price as determined by the Navy prior to contract award.

Note that these are minimum qualifications. Other factors to be used in determination are (taken from the Navy position announcement, but pertinent to the Air Force and Army positions as well):

1. Experience as a general chiropractor in excess of the minimum requirement, as it relates to the duties contained herein. Candidates with hospital-based experience, and those exhibiting referral patterns with allopathic or osteopathic physicians, may receive a higher ranking for this factor. Such referral patterns may be exhibited in letters of recommendation, then,
2. The letters of recommendation required [as noted in qualification #7 above] may enhance your ranking if they address such items as clinical skills, professionalism, or specific areas of expertise. Additionally, letters of recommendation from orthopedic physicians or other physical medicine specialists may enhance your ranking if they attest to your clinical skills, then,
3. Completion of a chiropractic residency approved by a college accredited by the Council on Chiropractic Education, then,
4. Total continuing education hours related to osseous and soft-tissue procedures, then,
5. Prior military experience in a medical setting (if applicable, provide a copy of Form DD214).

The initial requirements easily qualify most practicing chiropractors. The additional factors, however, are important if you desire to work in one of these positions.

The number of positions is relatively limited (57 at present). To be considered for a position as a chiropractor working at a military medical treatment facility, there are several factors to be taken into consideration by both the applicant and by those considering the application:

1. You represent the entire chiropractic profession to all of your patients, the hospital and base personnel.
2. You represent the contracting company that hired you (Army/Air Force).

Any less-than-optimal behavior by the chiropractor will reflect badly on both our profession and the companies that endorse our position at these bases. It is a great honor to be an ambassador for our profession, but it is also a serious responsibility that carries with it many repercussions, good or bad, depending on how chiropractors are perceived.

In the Army/Air Force, your performance also reflects upon the company you work for and can impact their relationship with Army Contracting, so only the most professional and appropriate personal behavior can and should be accepted. These companies are there to help and support you in your duties, and will be your closest ally if you work with them and strive to be an appropriate representative of the quality chiropractors these companies provide.

Also recognize that you will be an employee, with all the rights and responsibilities that this implies. If you are not the type who can comfortably accomplish delegated responsibilities, or if you are someone who needs to "be your own boss," then I do not recommend applying.

You will work closely, both physically and professionally, with the other clinicians/professionals who commonly work in a hospital environment (MDs, DOs, PTs, RNs, support staff, etc.) In general, all of the chiropractors have been well-received by the staffs at these facilities. Initially, there is some teaching and learning that must go on in order for other professions to better understand what we do, why we do it, and how effectively we do it.

There may be a few individuals at some of the MTFs who do not initially support our clinics and practice. While these are in the minority, all activity in a hospital system requires the most professional, patient and understanding cooperation in accomplishing the primary duty of getting patients well. If you get offended, frustrated or angered easily, rather than professionally approaching problem-solving in a team-like manner, then I highly recommend that you not apply.

1. You will be working in a military system, with a specific command structure and chain of command that must be understood and adhered to.
2. You will work in an ambulatory clinic within a military treatment facility that must conform to JCAHO (the hospital accreditation agency) regulations and guidelines.
3. You will work in an environment in which regulations and guidelines may affect your practice outside of your work for the military.
4. You will have nonclinical responsibilities that are necessary for the effective support of the hospital/facility in which you practice.

There are two institutions at work here: the hospital organization and the military organization. After becoming a member of the staff, each chiropractor needs to learn how we fit into each organization, and how they are constructed to help us perform our duties effectively. There are standard operating procedures and operating instructions that need to be developed by the chiropractic clinics, as well as medical group instructions and military instructions that apply to us, how we perform our jobs and fulfill the ongoing requirements of our clinic operations. This includes attending required meetings at which instructions and training are given and to coordinate care, as well as to support the general military mission at the various bases. This may include being part of various committees, etc. In order to be successful in these positions, you must be a team player and willing to go above and beyond just treating patients. The success of all other clinics and the MTF becomes equally important in those instances in which you can help.

Practice outside the military facility may require that you submit a request to both the hospital commander and your employer for permission before pursuing this endeavor. While I have never heard of anyone being refused, it is important that you comply with all MTF regulations and contractual obligations in this regard.

The personal and professional rewards of working in the military environment are numerous. One of my colleagues recently stated, "I have never been happier." This sentiment is common among the doctors I have talked with in the program. Treat patients, get patients well, go home and enjoy family. In comparison with private practice, it can be a relatively low-stress working environment. We also now have closer relationships with all types of health professionals on a day-to-day basis than most of us could ever imagine having in practice.

I once taught an in-service lecture to the Primary Care Clinic. When I finished, I asked if there were any questions. The comment from the doctors was "Hey, you're preaching to the choir, we love you guys." The military medical system is not built on financial competition. If an occasional physician is uncomfortable with chiropractic, it is most often overcome with education, patience and experience working with us. The ability to present chiropractic rationally and with detailed biomechanical and neurological explanations can often gain a physician's confidence. For the rest, once they see the feedback and results from the patients, they often lose their trepidation. This is an environment in which familiarity usually breeds cooperation.

Most of you have had the opportunity to read about Dr. Bill Morgan's impressive qualifications and activities in Washington, D.C., but he is not the exception. [Editor's note: See "Spotlight on William Morgan, DC" in the March 11, 2004 issue: www.chiroweb.com/archives/22/06/05.html.] At present, we have a number of notable doctors with some very impressive credentials and past experience. There are diplomates of sports chiropractic, orthopedics, neurology, internal disorders, pain management, rehabilitation, and more. There are former army medics, colonels, Navy captains and lieutenant colonels, etc. - all with some fairly impressive service histories. There are quite a few who are still active in the military reserves, a few of which have been activated during the current conflict. Many of the doctors had very impressive practice histories and experiences before working in the military system. To work at one of the current and future MTFs is to be in company with some of the best of our profession.

As the Department of Defense opens more chiropractic clinics at various military bases around the U.S., you may decide that you would like more information about applying for those positions. You can contact either of the two contracting companies (for Army and Air Force positions, respectively), and/or monitor the Naval Medical Logistics Command Web site listed below (for Navy positions):

For Army positions:

Aliron International, Inc.
5257 River Road, #400
Bethesda, MD 20816-1415
(254) 542-4505
www.aliron.com

For Air Force positions:

Cherokee Nation Industries
18945 FM 2252, Ste. 115
Garden Ridge, Texas 78266
(210) 651-0027
rmiles@cherokeemedical.com

For Navy positions:

Naval Medical Logistics Command homepage: www-nmlc.med.navy.mil/.

Note: As of September 2004, all Army and Air Force positions have been filled, and no new positions have been announced as of yet by the Department of Defense. For Navy positions, monitor the NMLC Web site listed above. Also, Aliron and Cherokee are not connected to the Department of Veterans Affairs at all; for more information on VA openings, monitor www.vacareers.com and/or contact VA hospitals directly for their application procedures. (A list of the 26 VA medical facilities currently designated to provide chiropractic care, along with their contact information, is available at www.chiroweb.com/archives/22/16/11.html.)

In addition to the Department of Defense, the Department of Veterans Affairs will also soon begin hiring DCs in one capacity or another (civilian employees, contractors, etc.). More doctors will join our ranks in serving those who serve us in the armed forces. Their situation will be different, but similar, and it will take chiropractors who are willing to work as a team with both the medical staff as well as the "federal" chiropractic community. The chiropractors at the military facilities now are already preparing resources for these new VA chiropractic clinics, so that those new doctors will have a team in their corner to help them get up and running in the most efficient manner possible.

Both the military and VA programs continue to do a lot to increase the visibility of chiropractic and add to its positive reputation. If you feel that you would be an asset to these programs, I recommend you apply as positions become available. We would all welcome you as an addition to our ranks.

 

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Author's note: The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the United States Air Force, Department of Defense, or the U.S. government.

Duane T. Lowe, DC, DABCI, CCSP
U.S. Air Force Academy
Chiropractic Clinic
USAFA, Colorado