Stephen M. Perle, DC, MS
When I graduated from Texas Chiropractic College in 1983, I joined the American Chiropractic Association and the New York State Chiropractic Association. Why? Well, I thought that's what one's duty was to one's profession: join a national and state professional association. I still think that. Of course, at the time, there were a lot of recent or current challenges that led my instructors at TCC to talk about the importance of professional association membership.
I started at TCC in 1979 and Louisiana had only achieved chiropractic licensure five years earlier. It was a recent memory for those in the region. My teachers talked about seeing a sign that a Louisiana medical group put up on the border with Texas (prior to chiropractic licensure) proudly proclaiming that Louisiana was the only state that didn't license quack chiropractors. The AMA boycott of chiropractic was still in effect and the first Wilk trial had ended with a jury decision for the AMA during my third year in school in 1981.
When I started practicing in New York, our enabling law was simply horrible. We couldn't order radiographs of minors or below T12, and we didn't have an insurance equality law that protected our patients' right to have chiropractic care covered by third-party payers, among other problems. Being under attack by a well-funded enemy or having significant legal impediments to daily practice is usually a good reason for people to join protective organizations. So it was with chiropractic back then; membership in our associations was much higher than today.
While I joined, I wasn't active in the associations beyond paying my dues and going to meetings. Then a district officer in the NYSCA asked me if I was happy with what was going on in New York. I said no, and he said that the only choice I had was to become more than a dues-paying member. The phrase is trite, but he let me know, "If it's going to be, it's up to me," and this changed my professional life.
For the whole profession, I think something happened when people started making a lot of money after the battles over insurance equality were won. People got complacent. They did not see the importance of the professional associations. Then when managed care rolled in and incomes were stressed, people started quitting their associations to save money at the very time when they needed to join, get involved and collectively seek legislative reforms to improve our practice situation.
Instead, people blame weakened associations and quit, further weakening them; or they join splinter groups and further weaken the major association(s). It is sort of like the story of cooking a frog by slowly heating the water it is in. It won't jump out and it doesn't notice the rise in temperature until it's cooked. We went from good incomes and complacency to being cooked without noticing it and not listening to our associations because we weren't members.
I have heard it said that since so many doctors are not members of any state or national professional association, that the most popular association is the NCA - the No Chiropractic Association. This is an ethical problem. Those who have never joined an association or terminated their membership after a period of time have left the heavy lifting to the rest of us. As readers of this publication have seen in the headlines issue after issue, the challenges are not going away. In Connecticut, we have been under attack regarding stroke. Answering this threat has cost the state associations a lot of money, yet still many doctors in Connecticut remain members of the NCA. Recently on the national scene the ACA has had to step up to the plate and lobby to protect our patients' rights to have chiropractic care reimbursed under PPACA and get Kaiser Permanente to reverse its decision regarding reimbursement for cervical manipulation. Yet still many chiropractors remain members of the NCA.
There is a Native American proverb that I want to rephrase in chiropractic terms. We do not inherit this profession from our ancestors; we borrow it from our children. The responsibility to protect and improve the chiropractic profession is our responsibility, each and every one of us. Thus, we shouldn't say that many doctors are members of the NCA; they are really members of the PCA - the Parasitic Chiropractic Association. If you aren't a member of your national association or state association, then you are a parasite.
If our ancestors in this profession did like you, there wouldn't be a chiropractic profession. If you aren't happy with how things are going in our profession, you should be paying your dues and volunteering to help change the association and the policies that government and third-party payers impose upon us. Don't be a parasite - join; it's a professional ethical duty you owe your profession and your patients.
