Hospital privileges bring numerous benefits to individual chiropractors, the chiropractic profession and the public. The most important aspect of hospital chiropractic practice is the opportunity and personal fulfillment that comes with serving the community. A chiropractor with hospital privileges has the opportunity to fulfill the mission of making chiropractic care available to many people who have the potential to benefit, while helping them to avoid medication and surgery.
Many people who would otherwise not have had the opportunity to encounter the benefits of chiropractic care are given the chance to do so. Patients who believe they need a medical evaluation to rule out pathological conditions can receive treatment with the confidence that a medical physician has ruled out "red-flag" diagnoses. Patients who were previously unfamiliar with chiropractic care have the opportunity to receive an introduction.
Patients unable to receive treatment in a chiropractic office due to extreme pain are able to receive chiropractic care due to comanagement with a medical physician. Emergency department (ED) patients who do not respond to analgesic medication have the opportunity to receive treatment by a chiropractor, rather than risk the effects of additional medication or discharge without adequate relief. An inpatient with uncontrolled diabetes who suffers from additional comorbidity, including back pain, has the opportunity to have the back pain treated by a chiropractor, without additional medications and the attendant risk of drug interactions. Patients, previously treated with medication solely because the ED physician had no other options, now have the opportunity to choose chiropractic as a viable alternative.
A chiropractor with hospital privileges has the opportunity to participate in reducing the cost of health care. ED physicians have called me numerous times over the past six years to treat patients, with the primary objective being to prevent hospitalization and enable the physician to discharge their patient home. ED doctors and nurses have told me they have been able to reduce repeat medication or the addition of stronger medications. They also report having fewer return visits to the ED since the introduction of on-call chiropractic. ED doctors and nurses are able to have their workloads reduced when they are able to transfer the care of a patient to the on-call chiropractor.
The chiropractic profession benefits by having chiropractic ambassadors working in close proximity to other health care professionals, including medical physicians and nurses. Many of the medical profession's misconceptions about chiropractic come from a lack of education about chiropractic and/or exposure to doctors of chiropractic. We all tend to fear those things with which we are not familiar. Practicing chiropractic in the hospital allows for direct observation of the benefits of chiropractic. In my years of working within the hospital, I have had the opportunity to answer the questions of medical physicians as well as treat some of these physicians and their family members. My experience has changed from wondering what they think of me as a chiropractor to having medical physicians call me to the hospital to treat their patients and having them bring family members to my office.
The chiropractor who works in a hospital benefits from the vicarious respectability of association with a respected facility. A patient who might not otherwise consider using the services of a chiropractor may be willing to begin chiropractic treatment because the chiropractor is associated with a hospital. Medical physicians may be more willing to refer patients to a chiropractor who is associated with a hospital. Physicians are likely to more appreciate the chiropractor's ability because the chiropractor is able to pass successfully through the hospital's thorough credentialing process.
As a member of the hospital staff, the chiropractor may have opportunity to address the medical staff during a continuing education lecture. Soon after obtaining privileges, I had the opportunity to provide a lecture during a lunchtime education series in the doctor's lounge. After fielding a few intelligent questions, I felt as if I had been welcomed into an exclusive club. Some of the physicians verbalized appreciation of finally getting some education concerning chiropractic. Soon afterward, I received my first office referrals from the medical staff.
It is crucial to remember that a chiropractor working in a hospital is working strictly as a chiropractor and is not as a substitute for another member of the hospital staff. What may surprise some, especially those familiar with hospitals, is that there is a valuable niche for chiropractors. Hospitals do not need chiropractors to administer medications, suture wounds, act as orderlies or do most of the other activities that are common in hospitals. The hospital needs us to provide chiropractic care because no one else in the hospital shares our unique training.
In the ED, much of the work involves medication, suturing and casting, for which most chiropractors are untrained. Since we do not provide the aforementioned services, the chiropractor serves best to be on-call. The on-call chiropractor will not be wasting their time or be taking up space while waiting for the intermittent patient who needs chiropractic care.
Before setting out to obtain hospital privileges, it is important that the chiropractor understand the obligations as well as the benefits. While most hospitals will not require chiropractors to serve on committees or attend continuing education, attendance at staff meetings is frequently a requirement. Some training sessions (e.g., CPR) may be a requirement. While the frequency of staff meetings will vary from hospital to hospital, quarterly meetings are common. Attending hospital staff meetings, functions, continuing education and meals at the hospital is a great way to network with medical physicians, develop friendships and foster professional relationships.
Some may fear approaching a hospital, believing that while the administration may appreciate the extra referrals for hospital services, the medical staff will fight against the perceived competition. If you approach the hospital properly, you need not be afraid. I recently had dinner with a world-renowned neurosurgeon from a prestigious university hospital. My intention was to educate him about chiropractic in hospitals and ask for his help in approaching his hospital to obtain privileges for chiropractors in his state. A former emergency-room doctor at the table spoke so highly about chiropractic and promoted a pilot study so well that I did not have to say a word. The neurosurgeon spoke of his professional relationships with referring chiropractors and was very open to the idea of welcoming chiropractic into his hospital. This neurosurgeon was not representing a hospital in financial need, but rather a prestigious hospital on the forefront of medicine. Because of his professional stature, he has no shortage of patients. His interest in chiropractic was to find the alternatives that best fit the patients presenting to his service.
Medical physicians have never confronted me with objections when I present chiropractic as an ancillary hospital service. The only objections I have encountered are from physicians and administrators who have not been adequately educated about the role of chiropractic in patient care, specifically in the hospital setting.
If you are considering hospital privileges, evaluate the type of privileges that will suit you best. Consider your motivation. If you are not interested in the altruistic goal of making chiropractic available to help a larger number of people, the hospital will not be the right place for you. If you are not willing to use your time and energy to support the hospital as an institution, the hospital may not be the right place for you. If you do not want to risk being awakened to go to the ED, you may want to consider hospital privileges, but not be part of the ED on-call schedule. There are other arrangements whereby chiropractors can work in an outpatient wellness clinic or as part of the rehabilitation medicine department. Whatever relationship you choose to establish, stay determined to adhere to the goal of serving people by providing them an opportunity to receive chiropractic care as an alternative or supplement to traditional medical therapeutics.
For additional information on hospital chiropractic, please see the American Academy of Hospital Chiropractic Web site: www.hospitaldc.com.
