Following the publication of "To Tier or Not to Tier Chiropractic?" in the Sept. 1, 2004 issue,1 DC received a variety of responses from chiropractors around the globe. In an effort to facilitate productive dialogue within the profession, we have reprinted as many correspondences as possible, as follows. Although some responses have been excerpted, and others omitted entirely due to space constraints, we offer our sincere appreciation to everyone who took the time to address this important issue.*
Dear Editor:
As a doctor of chiropractic, I have long supported the concept of "doctor of chiropractic medicine" and the broad-based practice described - even with limited prescription rights and possibly minor surgery, like those of Oregon. I don't think I've used the word "subluxation" more than 10 times in my 14 years of practice, and rarely to a patient.
John H. Riggs III, DC
Midland, Texas
Dear Editor:
I read this article with a heavy heart, because as a practitioner for over 28 years, I hoped it would never come to this. Unfortunately, we have to decide if this tiering is what will help us move into the next century and allow our profession to thrive. With the cuts in insurance, workers' comp and personal injury, our livelihood is being slowly withdrawn from us. We are being pushed to the back of the bus, and we have no way to stop this from happening. If tiering would solve some or all of the infighting, then I would be all for it. I don't know if it would, but my thoughts are these:
- We have lost respect in the health care community. Tiering may bring some of it back.
- Legislators all over the country are often confused about what chiropractors need for their practices. This may make it clearer to them.
- Tiering may make the profession respect itself. Infighting has never done us any good, and it may solve the problems.
- As a practical matter, will there have to be two different licenses and two different licensing boards?
- Will tiering change our reimbursement? Will there be less for one type and more for the other?
- Will there be different requirements for relicensure each year?
- Will there be allowance for expansion of either type of license?
Just some thoughts, but I have to agree with Drs. Kremer, Winterstein and Phillips - It is time to do something, and tiering may be the solution that we have been waiting for.
Ken Martin, DC
Temple City, California
Dear Editor:
As a 45-year veteran of chiropractic's intraprofessional wars, the recent article by Drs. Kremer, Winterstein and Phillips provided much food for thought. Primarily, however, it brought to mind the egalitarianism proposed by Karl Marx: It sounds wonderful in theory, but simply will not work in the long term. Such is the case with the two-tier system proposed by the good doctors.
There are several impediments to the success of such a system. First are the huge egos of the established leaders on both sides of the Great Divide, which will not permit them to relinquish their real or imagined positions of power. Second, and perhaps most important, is the deeply ingrained sense of mistrust and/or lack of respect that most field doctors have for members on the opposite side of the Chiropractor versus Chiropractic Physician controversy. The three authors should certainly not expect straight chiropractors to accept such a system, which would eventually relegate them to the second-class status of chiropractic technicians. Conversely, surely they would not expect chiropractic physicians to share equal status with chiropractors who choose not to present a formal medical diagnosis.
What is the answer? I don't know, but I offer two suggestions for consideration. First, let us all dispense with the negative comments regarding the other side. Let each side do its best to improve their service, and let the patients decide which approach they prefer. It should be obvious to all that some patients prefer straight chiropractors and some patients prefer chiropractic physicians. Second, let us forget the elusive dream of unity. Let things be the way they are with different professional associations. Competition makes all of us better, and, as we all know, absolute power corrupts absolutely.
James W. Visconti, DC
Latrobe, Pennsylvania
Dear Editor:
As a 4th trimester (equivalent) student at RMIT in Australia, I wholeheartedly agree with these proposals. Further, as someone with degrees in finance and law, I have foregone significant opportunity to pursue this career path - I didn't do so to "pop and pray." If there are those out there who are happy to let innate do the talking, so be it, but get them the hell off my tier and on to their own.
Scott Charlton
Melbourne, Australia
Dear Editor:
I disagree. If some in the profession want to be other than what chiropractic has always been, they should break off and be another kind of "physician." Doctors of Chiropractic own the name and the profession; whether they are straight or mixer, subluxation-based or broad-scope, is each doctor's choice. It should be a united profession with wide borders. Tell the "three tierers" to join the crowd, not destroy our profession.
Dr. Jeff Smith
City/State unknown
Dear Editor:
Tiers might best be established by an individual state's scope of practice. As I recall, Arizona required part 3 of the national boards to be passed for a DC to use some modalities, years ago. Why not offer a limited DC license to perform only manipulations, X-rays and posture advice? Call it a "chiropractic technician" or maybe chiropractic "dumba&%." Then offer a DC "physician" license in each state. The other alternative is to force the subluxation evangelists to conform or get out. The CCE should jam requirements down their throats 'till they choke. They have no right to dumb down the profession.
Peter J. Stanton, DC, DABCO
Burke, Virginia
Dear Editor:
I expect my response to your article concerning tiering to be in large part in line with the vast majority of chiropractors. Please stop this insanity. My Dad, a chiropractor for 30 years, and I discussed your very proposition two years ago. As I recall, the solution to this problem is that those people who want to be medical doctors should go to medical or osteopathic school in the first place. Leave our profession out of it. Why do you insist on changing a profession into something that already exists? I just don't get it. I do now get the troubles that Life has, the weird things that are just beginning to happen at Palmer, and the problems with the VA legislation. It's all beginning to make sense. ... We don't need any tiers; we just need some good old common sense!
Dr. Brian Lumsdon
City/State unknown
Dear Editor:
I have been in favor of "clinical recognition" for some time now. As you well know, there are many DCs out there doing good work. A particularly motivated group of chiropractors has kept the holistic, broad-scope-style torch alight since day one - all the while, never forgetting our functional neurological beginnings. Unfortunately, many entrepreneurial types have rallied around a once-charming "one cause-one cure" concept. They hide their chosen ignorance of physiology behind a pseudo-philosophy and accept a limited view of innate.
This concept cannot reflect positively on hard-working, primary-care-oriented DCs in a world of expanding awareness. Although it is true that those VSC-only folks can make a lot of $$, what does that do to our professional reputation? I feel that too many chiropractors out there abuse the public's trust with their "doctor" status. My long-term projection with a tiered chiropractic profession is that the public will prefer the greater professionalism and services offered by the PCP DC vs. the VSC-only "doctors." ...
There are far too many citizens who don't know they have health care options. The American public deserves better, and we non-VSC-only DCs can lead the way.
Brandon Tinlin, DC
Salt Lake City, Utah
*Overall, approximately two-thirds of the reader responses to "To Tier or Not to Tier Chiropractic?" favored some form of professional tiering.
Reference
- Kremer R, Winterstein J, Phillips R. To tier or not to tier chiropractic? Dynamic Chiropractic, Sept. 1, 2004: www.chiroweb.com/archives/22/18/13.html.
