United We Stand

The goal of this column has always been to provide various points of view from people in chiropractic who have a reputation for being knowledgeable, but most of all, for being caring and helping our profession to be everything it can be. Thus, I am pleased to announce that Dr. Bob Hoffman has authored the following article on unity. Dr. Hoffman graduated from New York Chiropractic College in 1978, and has served as president of the International Chiropractors Association and chairman of the board of the New York Chiropractic Council. He is currently president and COO of The Masters Circle, a leadership-coaching, practice-building and personal-development program for DCs who are serious about achieving success. I look forward to making progress on the challenge of chiropractic unity with you in 2005. Together, we will make this work! - Kent Greenawalt

It has often been said that the single biggest problem our profession suffers from is a collective lack of self-esteem. As a result, the chiropractic profession suffers from an identity crisis. There are many causes, but fortunately, there is a cure.

Many in our profession cling to the status quo and do not want to speak out or even stand out. They accept their current circumstances and think that is good enough. Many try to assimilate by thinking and acting like "real doctors," in spite of the mounting evidence that medicine is the third leading cause of preventable death in our country. Others reduce their value by giving away free exams and charging reduced fees. Close to 90 percent of our colleagues elect not to belong to any national association and the vast majority of chiropractors do not support their alumni association. Enrollment in most chiropractic colleges is down 30 percent in the past six years, in spite of the growing awareness and acceptance of what we do.

These are all the end results of low and limited professional self-esteem.

After 109 years, this dilemma shows up with 50 different definitions of the practice of chiropractic, as a result of allowing every individual state to define who we are and what we can do. It shows up when our future colleagues are mandated to take national licensing exams that consistently test them on primarily non-chiropractic subjects. It continues to manifest by each chiropractic college having significantly different teaching curriculums and vastly different levels of professional philosophy, purpose, and faculty competency.

To make matters worse, we have succeeded in confusing the public, the media and legislators as to who we are. Yes, it only stands to reason that if we are confused about our own identity, our message to the masses must be confusing as well. This lack of identity, self-esteem and definition creates a lack of unity. It is a vicious cycle that must be altered and corrected.

Over the past decade, we have in fact made great strides in creating an environment of professional unity. In creating the necessary culture of cooperation, we have altered and adjusted the status quo that has held us back all of these years.

In the past 10 years, we have fortunately seen the end of the rugged individualism that so dominated the professional scene for our first 100 years. It was necessary for our founding fathers to set the course for our profession's success, but it has now become an impediment to our growth.

We have witnessed much better cooperation and communication between our national organizations, and new organizations such as the Congress of Chiropractic State Associations have influenced our professions thinking for the better.

The Association of Chiropractic Colleges (ACC) paradigm statement from a few years ago has been pivotal in creating the proper circumstances for our unity and our identity to emerge and enlarge. What is so important about this statement is that it can easily become the unifying definition of chiropractic, as it was written and accepted by all chiropractic college presidents. It should also guide and direct the consistency and quality of our education system.

It is important to know that it has already been accepted by all major chiropractic organizations, including the World Federation of Chiropractic; it should be the governing document as our profession shifts from its previous childlike actions to its decidedly more adult behaviors.

The ACC's position on chiropractic is very clear and extremely powerful. Its paradigm statement says chiropractic is a health care discipline that emphasizes the inherent recuperative power of the body to heal itself without the use of drugs and surgery. It also says that the practice of chiropractic focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system), and how that relationship affects the preservation and restoration of health. In addition, DCs recognize the value and responsibility of working in cooperation with other health care providers when it is in the best interest of the patient.

The statement goes on to say that the ACC continues to foster and advocate a unique, distinct chiropractic profession that serves as a health care discipline for all; a profession that generates, develops and utilizes the highest level of evidence possible in the provision of effective, prudent and cost-conscious patient evaluation and care.

This important document also elegantly states that the purpose of chiropractic is to optimize health.

Just this year, the ACC college presidents committed their support by signing a declaration of national public relations unity and a pledge of professional unity. By signing these documents, the college presidents agreed to retain a qualified, experienced national public relations firm, one experienced in delivering a nationwide message, which will develop and carry out a plan for a public relations campaign to motivate the American public to better utilize chiropractic care.

In addition, a powerful and significant study and book, How Chiropractors Think and Practice: The Survey of North American Chiropractors, was published by the Institute for Social Research from Ohio Northern University within the past year. This important study contradicts the long-standing stereotype that DCs are divided; the truth is, it actually documents the opposite. It states that chiropractors are united on many key issues, such as vertebral subluxation, the chiropractic adjustment and the appropriateness of living and teaching the chiropractic lifestyle.

The study findings document many central tenets that we have in common. It is time to change our focus away from our differences and toward our similarities:

• 98% of our colleagues recommend exercise.
• 94% offer wellness care.
• 88% offer general nutritional advice.
• 86% give stress reduction recommendations.

These are all totally consistent and congruent with teaching our patients how to live the chiropractic lifestyle. This is important in today's culture that focuses on improving one's quality of life, a focus fueled by the information age and the needs and wants of Baby Boomers.

An even more encouraging study finding was the solidarity and connection to the central core of chiropractic, such as:

• 88% want to retain the term "vertebral subluxation complex."
• 90% oppose having the adjustment limited to musculoskeletal conditions, as the majority of DCs recognize the significance of the nervous system.

It was interesting to note that doctors of chiropractic who were cared for by a DC prior to attending chiropractic school were statistically more likely to hold traditional views regarding issues of practice and philosophy.

It was predictable that chiropractors with larger practices, based on patient volume, were more inclined than others to have traditional chiropractic views. These two circumstances produce a more certain and more confident personal and professional identity. That is, certainty and clarity empower us, whereas confusion paralyzes us.

As further proof to the changing tide of understanding and unity, majorities from each of the broad-scope, middle-scope and focused-scope groups who responded to this survey were in agreement on the following key concepts:

• the term "vertebral subluxation complex";
• the subluxation as a significant contributing factor in a majority of visceral ailments;
• the adjustment as significant for the care of musculoskeletal and selected visceral conditions;
• the practice of teaching patients the relationship between spinal subluxations and visceral health;
• the concept and importance of wellness care; and
• the importance of living and teaching the chiropractic lifestyle.

Chiropractors as a whole strongly endorse the devastating effects of the subluxation and have a high reverence and respect for the power of the adjustment.

The ACC paradigm paper gave the profession a much-needed beam of support for theoretical unity. This study provides strong evidence of a ground-level unity among practicing DCs.

As a profession, we can rapidly march in the direction of unity. We can have a stronger identity and help chiropractic become a worldwide, quality-of-life-driven health care delivery system, featuring chiropractic in the leading role. How can we accomplish this?

1. We must accept and agree on one national definition of chiropractic. I propose the ACC's definition as the perfect starting point.
2. We must all assume our equal responsibility and make a conscious commitment to refer more young men and woman to chiropractic colleges.
3. We need to support our alma maters and ask them to support and utilize the ACC document that they wrote and have agreed to.
4. It is time to insist that the national boards and our individual states test our new colleagues and graduates on chiropractic subjects.
5. We have to rise up and stop thinking of ourselves as second rate or as an alternative to medicine.
6. We must insist that our elected leaders make unity their top priority.
7. We must all commit to expanding ourselves and becoming better versions of ourselves, because as we improve, so will our profession.
8. We need to focus on what we have in common and learn to respect each other. We are one family and only as strong as the weakest among us.
9. We need to play a bigger game and have a bigger vision for the miracles chiropractic is famous for.
10. We must once again become proud to be DCs.
11. It is time for us to follow today's consumer and trade at shoulder level with the medical profession. We must recognize that we have a secret weapon - a profound respect for the body's innate intelligence.
12. We must shift our awareness away from treating patients' symptoms, and focus on maximizing their true health expression and improving their quality of life.
13. We need to commit to a unified message of all that is good about chiropractic to the public, the media and legislators.
14. We need to work at fully understanding and appreciating our true identity as healers.
15. We must put our egos aside and continually do what is right for our patients, colleagues, and for our beloved profession.
16. It is essential that we maintain our unique and important language, as all successful cultures have their own lexicon.
17. We need to be an example for our family, patients and community and live the chiropractic lifestyle ourselves, so that we are incredibly healthy and superb ambassadors for our profession.
18. We desperately need to modernize our message and improve our languaging skills, so that people who hear the chiropractic story choose it for life.
19. We need to explain, live and promote the vitalistic aspect to life and health, as that is what truly makes us different from all other health care providers.
20. It is essential that we continually raise the standards and consciousness of the chiropractic profession.

The profession is at an important crossroads, and the time is perfect for us to take back control of who we are and our significant role in society. It is time to realize once and for all that there has never been a better time to be a chiropractor. Let us stand taller and prouder, and treat each other with dignity and respect.

As we stand more united and raise our standards of excellence, we will win the admiration and respect of others. This is our profession and it is time we stop allowing outside influences and the small minority to decide what chiropractic is for us. There is so much we can rally around to ultimately better serve our patients. Isn't that what it is really all about?

Bob Hoffman, DC
Jericho, New York