K. Jeffrey Miller, DC, MBA;
William E. Morgan, DC
Remember the good ol' days is a common saying heard frequently in conversations when people are lamenting their current situation. Unfortunately, the saying is very common these days in chiropractic. In many ways this is understandable: We have encountered significant challenges over the past few years. But then again, when haven't we experienced challenges? There always seems to be a fight going on somewhere for the profession.
This is why we want to replace "Remember the good ol' days" with "I am thankful for the progress that we have made." There are multiple things here and now in the profession that should make us proud and thankful. We would like to point out a few.
Dr. Miller: Chiropractic Education
The quality of chiropractic education has greatly improved over the years. Our programs are now as good as any and better than most doctoral programs in any field. The colleges have better facilities, libraries, research programs, faculty and accreditations than at any point in our history.
A number of our institutions have achieved university status and offer multiple undergraduate and graduate degree programs in addition to a doctorate in chiropractic. Many of the degrees are in fields of health care that augment chiropractic. Additional degrees augment the general science and business aspects of chiropractic.
Dr. Morgan: Chiropractic Participation in the Military
While there are still less than 200 chiropractors in the Department of Defense (DoD) and Department of Veterans Affairs (VA), their impact is great. Since a large portion of the medical profession will undergo a portion of their training in a DoD or VA medical facility, chiropractors have the opportunity to influence a large number of medical doctors in training. Just the fact that a chiropractic clinic is in that facility will influence future generations of medical doctors in their acceptance of chiropractic and their referral patterns.
In addition to exposing military members and physicians to the benefits of chiropractic care, the DoD / VA have provided a model for integration. This creates more inclusive paradigms of care and algorithm pathways that include chiropractic.
There are also the benefits of chiropractic education and research within the military system. Chiropractic students and residents learn interdisciplinary co-management of complex cases, as they are exposed to more complex cases than typically seen in chiropractic academic health centers. Finally, research in the DoD and VA has a lot more bang for its buck and has the added advantage of institutional validation.
Dr. Miller: Chiropractic in Business and Industry
I had the opportunity to serve as a company doctor for local divisions of Black and Decker and Reynolds Aluminum. My program was one of several programs available during the past 25 years for chiropractic involvement in business and industry, and the field is growing.
More employers than ever are working with doctors of chiropractic. A significant step in this field has been the participation of chiropractors in health and wellness programs. Chiropractic's involvement is advancing beyond the treatment of work-related injuries to stress their prevention and the promotion of overall health.
Dr. Morgan: Chiropractic Boards
We now have four national board examinations instead of one for each of the 50 states, territories, districts and protectorates. Even though I hear complaints about the current national board system, it is a big improvement over the previous system. When I graduated in 1985 there were two parts to the national board exam, plus the physical therapy portion and individual state boards. It was common practice for recent graduates to test in every state in which they might ever want to practice and maintain multiple licenses. That made the old system more expensive, less standardized and more cumbersome.
The current system of is a vast improvement over what was in place 30 years ago, even when you consider the expense of the Part IV examination. I took Part III and Part IV several years ago (almost 20 years after graduation) and found that they were well-written and executed. I could see why these tests cost what they do based on what it takes to administer them.
Dr. Miller: Chiropractic Textbooks
In the past 25 years major publishing companies have developed chiropractic divisions. This has had a tremendous influence on the inclusion of chiropractic principles and techniques in health literature. Some of our textbooks are used in medical colleges and have evolved through multiple editions and/or have been consistently reprinted.
Books on technique, radiology, orthopedics, rehabilitation, sports, neurology and other subjects are readily available in college bookstores and online. Gone are the days when all of our texts were loosely bound sets of notes or strictly self-published books.
The newest advancement in chiropractic textbook publishing is the addition of e-books formats for various e-readers. The majority of publishers producing chiropractic textbooks produce the paper and e-reader versions of texts almost simultaneously. Websites with supporting materials for the texts are also routinely established at the time of publication. We are keeping pace with the Electronic Age.
Dr. Morgan: Research and Scholarly Writings
It wasn't too long ago that the mainstream scientific journals would not even accept a submission from a chiropractor. Our scientists would need to drop the DC from their credentials to be considered for publication. There was little funding for chiropractic research and many chiropractors seemed at odds with the mainstream scientific community.
Today, chiropractors are accepted to submit to virtually any relevant peer-reviewed journal, and there is an active and growing culture of intellectual writings. Chiropractic now has a few indexed journals dedicated to the science of chiropractic, and the culture of research and evidence-based care is being embraced by the profession. Funded chiropractic research is more common today than it was 30 years ago, and chiropractic scientists meet every year at the national Research Agenda Conference (RAC) to promote the culture of intellectual advancement in chiropractic.
Dr. Miller: Imaging Advancements
I started practice on Leap Day of 1988. At that time, my X-ray machine was a used fluoroscopic unit with a control panel the size of most refrigerators. It was embellished by a manual developing tank and racks for hanging film to dry.
I soon upgraded to a high-frequency unit with automatic exposure control and an automatic processor. At that time, they were state of the art. Today, that machine could be considered a relic compared to digital machines. This might also apply to early digital machines 10 or more years old. Today, digital X-ray machines or add-on units are reasonably priced and provide image quality that will make a doctor wonder how they ever practiced without them.
Despite the affordability of digital units today, there is another, cheaper option: referring patients to hospitals and imaging centers for studies. Chiropractors have traditionally owned X-ray units. This was in part because in years past, if an X-ray was needed, the chiropractor could not refer the patient out.
This has changed. Today there are imaging centers and hospitals everywhere accepting chiropractic referrals. This can be a big benefit for the new chiropractic graduate. The expense of square footage, build-out, equipment and supplies can be foregone in starting a practice if there are imaging facilities nearby. Other advantages include better image quality and having a medical radiologist read every series.
Dr. Morgan: Chiropractic Acceptance
While chiropractic acceptance is not what we would like it to be, it is significantly better than in years past. In my lifetime the advances have been tremendous. When I think back to the times when chiropractors were arrested and put in jail for practicing chiropractic, before insurance or Medicare recognized chiropractic, before the DoD and the VA had any chiropractors, to when a medical doctor who referred to a chiropractor would be chastised, I realize that we have overcome incredible odds to attain the acceptance we now enjoy.
Today I practice in a referral-based hospital practice where 100 percent of my patients come from referrals from medical doctors, physical therapists or other medical professionals. In the past 20 years I have been credentialed in five hospitals, a feat unheard of a generation ago.
Chiropractors now can join multidisciplinary societies (such as the North American Spine Society, the American Academy of Pain Management, and the American Public Health Association) to broaden the exposure and acceptance of chiropractic into mainstream health care.
Recently the AMA moved from its historically strong adversarial position toward chiropractic to give it a nod of approval in JAMA (April 24, 2013). The JAMA Patient Page (used for patient education purposes) included this statement: "Some people benefit from chiropractic therapy."
On May 9, 2013, Wayne Jonas, MD, testified before the U.S. Senate Committee on Veterans Affairs. During his testimony he cited the recent research that showed the benefits of chiropractic care, and he strongly recommended the expansion of evidence-based chiropractic within the VA and DoD systems. We have a long way to go, but the acceptance we now enjoy is much greater than our predecessors could have anticipated.
We have been blessed with chiropractic careers of over 25 years each. We have experienced the challenges and the blessings of the profession. When all is said and done, the blessings have outweighed the challenges. We are proud of our profession's advancements and proud to be chiropractors. We hope you are, too.
