In 2002, President George W. Bush signed into law HR 3447, also known as the Department of Veterans Affairs Health Care Programs Enhancement Act, which established a Department of Veterans Affairs Chiropractic Advisory Committee designed to provide "direct assistance and advice" to the Secretary of Veterans Affairs in "the development and implementation of the chiropractic health program" within the Veterans Health Administration (VHA). The committee was charged with advising Sec. Anthony J. Principi on protocols governing referrals to doctors of chiropractic, direct access to chiropractic care, scope of practice of chiropractic practitioners, and definitions of service to be provided, as well as advice on the development and implementation of the chiropractic health program.1
In June 2004, after the advisory committee submitted a list of more than 30 recommendations regarding chiropractic involvement in the VA system, Sec. Principi announced that chiropractic care would be offered at 26 Department of Veterans Affairs facilities throughout the country beginning this fall.2 Only three months after Sec. Principi's historic announcement, the VA officially hired its first chiropractor. In September, Tim Dennis, DC, CCRD, was selected to begin treating patients at the Togus Veterans Affairs Medical & Regional Office Center in Augusta, Maine, the oldest active VA facility in the country, and one of the largest in New England.
Dr. Dennis brings a wealth of practical and clinical experience to Togus. A 1974 graduate of National College of Chiropractic, he began practicing in Bath, Maine, in January 1975. He has been active in the state's chiropractic professional and regulatory agencies, first as president of the Maine Chiropractic Association from 1979 to 1981, then as a two-term member of the state's board of chiropractic examiners. He is also familiar with the military on a personal level, having served a two-year tour with the U.S. Naval Reserves at Guantanamo Bay Naval Air Station in Cuba in the 1960s.
Upon learning of his hiring, Dynamic Chiropractic contacted Dr. Dennis to learn about his new role at Togus, and the benefits chiropractic care can provide to the nation's veterans.
Dynamic Chiropractic (DC): How did you get involved with the VA originally?
Tim Dennis (TD): I read an article in DC about the VA program and happened to notice that Togus was one of the 26 facilities on the list, so I called them up. It's only about a half hour away from my office.
They told me that they had been swamped with applications from all over the country - Texas, Hawaii, California, and so on - and were considering closing down the applications. During the course of the conversation the fact that I was a veteran came up. I think that was a positive for me.
DC: What was the application process like?
TD: It was really interesting. I have to tell you up front that I'd read some things in DC and elsewhere that things could get contentious - that they didn't really know what was going to happen when they started interviewing. But I can tell you, from my perspective, the people at Togus were very professional and very helpful, and the whole process was just really wonderful. They really extended themselves, and they appeared glad that they were going to have a chiropractor on board.
DC: When do you start?
TD: Officially, it's September 30th, but I've gone up a couple of times already. They hired me around the middle of September. I'm going to be working with a pain management team that consists of a physiatrist, a nurse practitioner, myself, and an anesthesiologist.
Getting back to the interview process - I initially went up, and they had me interview with a primary care physician. It was interesting; he was an MD, but he had also graduated from the New York School of Chiropractic, so he obviously knew about chiropractic and what they felt they should be looking for.
He showed me the various departments, including occupational therapy and physical therapy. I met with some of the PT's, who appeared to be a bit uncertain about the prospects of having a chiropractor on staff. We talked for a while, and I assured them that I would willingly refer to them for evaluation and treatment, and not just piecemeal modalities, like exercise instruction, etc. They seemed to be OK with that.
I next met with the pain management group consisting of an anesthesiologist, a nurse practitioner and a physiatrist. This is the group I will be working with primarily. We discussed different case scenarios and how we would treat them differently. They appeared to be excited about the potentially new approaches that chiropractic had to offer.
The initial interview process lasted approximately three-and-a-half hours. At the end of the interview I was told that I would hear back from Togus within a week. After a week went by without a callback, I contacted the Human Resources department to find out what the status was and to let them know that I was still interested in the position. At that point, I guess I assumed that they had chosen someone else to fill the spot.
The following week, I received a call from the chief of staff's office asking me to come back for a second interview. My hopes were up because I knew I was still being considered for the position. My second interview was with the chief of surgical services.
At Togus, chiropractic will be part of the Department of Surgery. The chief surgeon, who was an orthopedic surgeon, put me at ease right off the bat by informing me that he had a friend who was a DC and had been adjusted by the DC. He further stated that he performed some manipulative procedures himself.
It wasn't long before he started to discuss how it would be my responsibility to order whatever equipment I needed, and to do various other things to get ready to go. I guess this was his way of letting me know that I was hired.
The official notice came within a couple of days. I went back to my office and immediately called a local chiropractic vendor to order a new adjusting table.
DC: It sounds like they were very open-minded about chiropractic.
TD: They absolutely were. I've ordered some new equipment since then. I ordered a table and some other things, and they're getting my office ready right now.
DC: Will the center eventually have a chiropractic department? Is that part of their plan?
TD: As far as I know, I'm it.
DC: Do you have a contract with Togus?
TD: Yes. I'm listed as a fee-basis chiropractor right now. That could change, though. Unofficially, they're talking about a full-time position for somebody. It could be me, it could be somebody else. Right now, I'm on a part-time basis.
DC: Are they looking at hiring other DCs in the future?
TD: They just don't know right now, but I think that once things get going, they're going to realize that they need to bring more people on board. They're just waiting to see right now. They're open to that; they understand that's probably what will happen.
DC: What's your relationship with the rest of the medical staff?
TD: I've really not met many other staff members other than those I interviewed with. The administrative officer to the chief of surgical services took my wife and I on a tour that lasted approximately two hours, at which time I was introduced to a lot of different people, but I didn't really have a chance to talk with them.
DC: I have a couple of specific questions about chiropractic, if that's all right.
TD: Sure.
DC: What do you think chiropractic has to offer veterans that allopathic medicine doesn't have or can't offer?
TD: Obviously the nondrug, nonsurgical approach above all. During my interview, I was asked what was the most challenging part of my practice. I told them that treating chronic postsurgical failed backs was probably the number one thing that I prided myself on. They said that they have a lot of those cases, so my guess is that I'll be seeing a lot of those cases initially.
In terms of what I'll be able to treat, it was my understanding that the scope of practice will be determined by whatever state the facility is located in. The delineation of clinical privileges that I will be governed under at Togus parallels my scope of practice in the private sector.
DC: Did you ever think, when you started out 30 years ago, that you'd see a day when chiropractors would be part of the VA?
TD: Never. I never did. I would have thought it would have happened in the private sector, but the military is usually slow to move or make a change. In the state of Maine right now, I don't know of any chiropractors that are on staff at any hospitals in the private sector. So, I would probably be the first chiropractor to officially be on the staff of a hospital, which is sort of unusual.
DC: That makes you something of a pioneer.
TD: In a way.
DC: What do you think the future holds for chiropractors in the military? Will we be seeing more DCs and more centers offering chiropractic services?
TD: I absolutely do. They started with 26 centers. I think you'll see that expand to all VA facilities within a very short period of time. Right now at Togus, they used to have a bed capacity of around 800, but now they're down to less than 200, so most of their services are being geared toward outpatient services, and that's right where we fit in. We should be right there with the rest of them as far as outpatient services go. That being said, a lot of VA hospitals are also teaching facilities. I hope that in the future, you'll also see residency programs set up for chiropractors. You'll see research being done in VA facilities with chiropractic involved. Certainly I would want to do that, and I've already expressed an interest in that.
It is my understanding that pay-wise, we're going to be on an equal footing with other primary care providers - MDs, DOs, etc. That would be a great incentive, especially for young graduates getting out of school. They could step into a job and get a decent salary right off the bat. These will be highly prized positions, I'm sure.
I'm really excited about all this. I should be finishing up my career; I've been in practice for almost 30 years now, and here I am taking on this position. My main reason for doing it is to ensure that chiropractic is going to start out on a good footing, and I think that my years of experience will help to ensure that for future chiropractors.
DC: It's as if you're setting the table for the next generation of DCs.
TD: I think so. I think it's important to have somebody with experience. So, I'm looking forward to it. It represents a new challenge for me, and we all need challenges, so that's how I'm looking at it. I've also gotten calls from chiropractors around the country wanting information about the interview process, so hopefully this article will give them some insight on that.
DC: Thank you - and good luck.
References
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