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Reflections After 28 Years in Chiropractic Education

Dear Editor:

After retiring from teaching and from serving as an administrator at a chiropractic college, I find I spend a good amount of time thinking about the Big Picture of the profession. Big Picture thinking is not a luxury those in the trenches can afford given the pressure of day-to-day issues confronting chiropractic educators. Now, with the added gift of time to reflect, I recognize that despite the great strides the profession has taken, a few in our profession remain in the rut that was dug years ago. Those who have crawled out of the rut are often labeled heretics. The profession still has two major national organizations, and even though I understand they now play well with one another, how sad to remain separate when so much more could be accomplished by unifying.

Following 28 years in chiropractic education, I have a deep respect for my colleagues, both at my college and at other chiropractic colleges. Possessing the audacity to get up in front of a classroom of students day after day takes enormous intestinal fortitude. We DC educators must face students who have been educated at major universities taught by established, university-trained professors, while we primarily have been educated by other chiropractic educators who were trained by other chiropractic educators; well, you get the picture. For those interested in reflections on teaching, I highly recommend a book by another educator, Parker Palmer, PhD (no relation to either famous chiropractor), titled The Courage to Teach. The book is superb, and he describes so well the joys and the tragedies of teaching.

Admittedly, it takes a strong ego to prevail at this educational effort. A few teachers take it a step too far, however, and use the stage of the classroom as a tool to indoctrinate. I have observed instructors use "academic freedom," a necessary value for an educational institution, as an excuse to teach, as absolute truth, concepts that have never enjoyed the benefit of scientific scrutiny, let alone become established as evidence-based.

The profession has come a long way; the impressive gains in research accomplished, especially given the scarcity of funding, is amazing. Sadly, many leaders in our profession regard research results mainly as fuel for the next advertising campaign. Equally egregious is the increase in practice-management organizations. This profession should be able to offer graduates a successful practice simply based on their education and the fact that they are duly licensed. Practice-management groups should now be obsolete and unnecessary.

The technique wars seem to be dying down – or am I simply not paying attention? That battle was a total waste. I recall one of the first research conferences I attended where a technique guru presented a paper on the results of a study using his preferred technique. During the question period afterward, a prominent researcher stated that the method of analysis cited had never been demonstrated to be a reliable method. The technique presenter rather confidently responded that there wasn't a problem because, in addition to the method of analysis mentioned, they also used methods "b," "c" and "d" to analyze the patient. Apparently this technique proponent believed that if you add several unreliable methods together you somehow achieve reliability. I was stunned.

That was one of the first times I seriously questioned the future of chiropractic. Another time was in 1995, at the Chiropractic Centennial celebration in Washington, D.C., where a large room-full of chiropractors debated – then voted on whether or not DCs are primary care providers. I could have handled a poll on whether or not DCs should strive to become PCPs or whether or not the patient population thought of DCs as PCPs; but, no, the results of the "voting" was that DCs are primary care providers. Hey! Why not just vote yourself to be a DC, and all those pesky college years could be avoided? I had to go for several cocktails that evening just to clear my head.

Reiterating my previous statement that the technique "wars" were a total waste, I'll add that the semantic battles about "subluxation" versus any other phrase we might choose and "adjustment" versus "manipulation" are equally wasteful past times. I wonder if we have any idea how foolish we appear to the scientific community when we spend time and energy in these ridiculous debates.

The last reflection I will share is of an occurrence during the late '80s or early '90s. I don't recall the details because I had my head in chiropractic education, but it appeared that in some areas of the country the profession had an opportunity to be included in medical circles, within hospitals, and in additional third-party-pay provider groups. The hitch was that we would be "accepted" only as musculoskeletal specialists. The battle cry from the ranks was, "I heal the whole body when I give an adjustment; how dare they relegate me to a role as a limited provider?"

Some 20 or so years later, many chiropractic colleges struggle to enroll sufficient numbers of students, while a local physical therapy program turns away over 400 applicants each enrollment period. It seems physical therapists were willing to accept a limited role. How many more DCs would be in successful practices, and more importantly, how many more patients would have benefited from chiropractic care, if we would have simply reigned in our collective ego? How many more chiropractic colleges would be needed to support the increased demand for DCs?

What would be the percentage of the population DCs treat under that scenario? How many lives could be improved if patients could receive chiropractic care in the only setting many will ever consider using?

I can already hear the cries of how correct that ego-driven decision was because we might have been "absorbed into the medical system just like the osteopaths were." Poor osteopaths. Imagine the shame of being accepted alongside medical physicians as equals, and in being included in hospitals, clinics and virtually every third-party-pay system in the country. It is sad. I admit that the osteopaths had to denounce their founder's claim that "the artery rules supreme." At least chiropractors can take pride in never negating B.J.'s directive to be "separate and extinct" – sorry, I meant to say "separate and distinct."

Ruth Sandefur, DC, PhD
Overland, Kan.

Flabbergasted While Reading

Dear Editor:

I trust I wasn't the only doctor flabbergasted while reading the Nov. 18, 2012 issue. I first came across a News in Brief article on page 18 that describes a $3.9 million award to Allstate Insurance against Dr. Daniel Dahan (owner of Practice Perfect) and two other individuals. The court found that Dr. Dahan had set up a "dummy medical corporation," presumably so DC services could be billed under an MD's provider number. Now comes the flabbergasted part: I continued to read through this issue of Dynamic Chiropractic and on page 24, came across a half-page advertisement to "Create an MD/DC or DC/PT Practice" by the very same Dr. Daniel Dahan of Practice Perfect! I would very much like to hear from the editors of DC as to why they would continue to run this advertisement.

John M. Ventura, DC
Rochester, N.Y.

We Need to Start "Cleaning House" and Send a Message

Dear Editor:

As reported in Dynamic Chiropractic on Nov. 18, 2012, the last meeting of the ACA House of Delegates passed a resolution "promoting strict standards of conduct by encouraging members to adhere to not only the ACA's Code of Ethics, but all relevant federal and state statutes providing anti-fraud standards." Another resolution provides "guidelines on participating in multidisciplinary practices to help chiropractic physicians evaluate whether such opportunities emphasize financial gain over clinical appropriateness."

In the same issue under "News In Brief," there was an article about a $3.96 million judgment awarded to Allstate Insurance after J. Scott Neuner, DC, Daniel H. Dahan, DC and Robert Barsody, Esq., were found to have set up a bogus corporation that misrepresented a chiropractor-owned clinic as a medical physician-owned medical center in New Jersey.

Given this information, how is it that DC feels it is ethical to display an advertisement on page 24, in the very same issue, for Dr. Dahan's Practice Perfect company (the very same company named in the aforementioned lawsuit), which offers its services to help chiropractors start MD/DC or DC/PT practices?

The public will not respect chiropractic physicians until we start "cleaning house" and send a message that unethical practice management will not be tolerated.

Erin Ducat, DC, CSCS, CCSP
Bloomingdale, Ill.