Editor's Note: The following article is co-authored by the inaugural class of VA residents: Clinton J. Daniels, DC, MS, Amanda Dluzniewski, DC, Derek Golley, DC, Benjamin Liang, DC, and Rachel Perrucci, DC.
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.1-2 This program is the result of years of dedication and strategic planning by the VA chiropractic leadership, and is congruent with the VA's mission to train providers to serve the VA and the nation at large. As the inaugural class, we are honored to have participated in the first phase of the three-year pilot program.
In March 2015, we had the opportunity to gather for a VA meeting held in advance of the Association of Chiropractic Colleges /Research Agenda Conference in Las Vegas. At this meeting, we worked with representatives from VA Central Office, the five residency program directors, and representatives from each program's academic affiliates: Logan University, New York Chiropractic College, Southern California University of Health Sciences and the University of Bridgeport.
After this, many of us attended the ACC/RAC conference itself, where we participated in workshops and observed several cutting-edge research presentations. In our interaction with many of the ACC/RAC attendees, we noted a tremendous amount of interest in the VA Chiropractic Residency Program. We received questions ranging from inquiries about our future career plans to how perspective residents may apply. The following are some of the most frequent questions we fielded, as well as personal residency experiences.
How long is the residency program and is it a paid position?
Dr. Daniels: The residency program is one year long, extending from July 1 to June 30 of the following year. The resident is paid an annual stipend funded by the United States Department of Veteran Affairs' Office of Academic Affiliations. Salaries vary based on geographic location, and residents are eligible for other benefits such as vacation time, medical leave, federal holidays, and life and health insurance.
What is the breakdown of your activities in the residency?
Dr. Dluzniewski: Most of our time is spent in the chiropractic clinic treating patients under the mentorship of senior VA DCs. Some of us have our own clinic grid, meaning we have our own patient schedules. This can be one day per week or all days of the week, depending on the site. Clinical rotations are mostly observational, with some hands-on opportunities. Many of the rotations are done within the VA; however, some are at non-VA facilities and hospitals.
Clinical rotations have included primary care, pain clinic, physical medicine and rehabilitation, emergency department, geriatric evaluation and management (GEM) clinic, home-based primary care, mental health, and spinal cord injury, to name a few. Some procedures that we have seen include epidural steroid injections, radiofrequency ablations, occipital nerve blocks, and botox injections. I am hoping to observe a few neurosurgery cases before the end of the residency.
Are you involved in research?
Dr. Golley: Yes, I have had the opportunity be an investigator for an approved VA study of kinesiophobia among treatment-seeking veterans with chronic low back pain, which will also satisfy the thesis requirement for a master's degree program I am currently finishing up. Many VA chiropractors have been actively performing research since their inclusion in the VA system in 2004. The chiropractic residency directors serve as wonderful mentors for research, as many of them are well-published themselves.
What departments in the hospital have you rotated through?
Dr. Liang: VA of Greater Los Angeles (VAGLA) has the largest physical medicine and rehabilitation department in the nation, with many specialty clinics. This has given me the opportunity to rotate easily through the departments and interact with numerous attendings, residents, and students in the following departments: general, pain clinic, neurosurgery, acupuncture, occupational therapy, kinesiotherapy, physical therapy, amputee clinic, exercise tolerance, EMG/NCV, interventional medicine, and wheelchair clinic. Outside rotations have included the Los Angeles Minimally Invasive Spine Institute, where I witnessed numerous laparoscopic discectomies, epidural steroid injections, and radiofrequency ablations.
I also recently visited Guarneri Integrative Health at Pacific Pearl La Jolla, where they take a proactive approach to health and incorporate a team of medical doctors, naturopathic doctors, acupuncturists, massage therapists, and healing touch and hypnosis practitioners. In addition, I participate in daily didactic courses alongside PM&R medical residents, weekly Pain Medicine Fellowship Program lectures, monthly morbidity and mortality lectures, as well as the annual medical staff meeting.
Who is eligible to be a resident and why should they apply to the program?
Dr. Perrucci: Applicants are required to have earned their Doctor of Chiropractic before entering the residency program on July 1, and must meet VA requirements for employment, including U.S. citizenship. The program is aimed at early-career chiropractors interested in learning how to work in a comprehensive medical setting. This program will not only help you grow clinically, but it also provides the unique opportunity to rotate through other clinics and to learn how to interact with different types of providers in an integrated health care system.
How have you been received by the VA medical community?
Dr. Daniels: I have spoken with the other residents on multiple occasions about this topic; overwhelmingly, our interactions with medical and therapy colleagues have been positive. Personally, I have not had any conflict with other providers and have been met with a lot of interest. In my opinion, many of my medical colleagues did not have a bad opinion about chiropractic, but rather had little idea what we even do or whom we can help.
The residency program has great potential as a tool to be an ambassador for chiropractic and build stronger interprofessional collaboration. Several of my rotations have resulted in an increase of referrals from those departments.
What are your plans after the residency?
Dr. Dluzniewski: The program strives to prepare graduates for careers in hospitals and other integrated health care systems. The majority of us are hoping to obtain positions at a VA medical center. Other options that we have considered are other hospital settings, private multidisciplinary practices and/or a position at one of the chiropractic colleges.
There is no guarantee of employment post-residency, but the residency directors are very invested in our future success. Most of us have already accepted appointments at VA medical centers that will begin after our residencies are complete. In my case, I am very excited to announce that I have accepted a full-time chiropractic position at the Minneapolis VAMC and am looking forward to working with Rick Branson, DC, and the rest of the pain clinic team.
What is the role of your chiropractic clinic within the VA?
Dr. Golley: The Buffalo VA Chiropractic Clinic is administratively placed within primary care and shares physical space with the orthopedics and pain management departments. We serve a wide range of veterans with musculoskeletal, back or neck pain, ranging from Afghanistan- / Iraq-era veterans recently finishing their military service, to older adult WWII-era veterans. All patients are referred to the chiropractic clinic from other services, with primary care accounting for the vast majority of patient referrals. Pain management, orthopedics and other services also send their patients to us as appropriate.
How much collaboration is there with other providers?
Dr. Liang: We here at VAGLA, have daily opportunities to collaborate with one another, whether it be participating in the various lectures and didactic classes, conferring with attending physicians during observational rotations, or discussing complex cases informally. One of my goals with accepting the residency position was to have the opportunity to work with other health care providers on a multidisciplinary team. VA has the largest integrative delivery system in the United States and provides excellent opportunities to do this.
Veterans' needs are coordinated by various clinics and health care providers, which necessitates that everyone stay informed and current on the patient's treatments. We are able to communicate and collaborate through the VHA electronic health records system, which was implemented in the 1970s and re-engineered in 1995; this system enables clinicians to review and analyze patient clinical data, order laboratory tests, document care, and review radiology and other data to support clinical decision-making. It also gives providers the ability to create interdisciplinary consults for patients to be seen in other clinics and receive care in our clinic.
This system allows all providers the ability to view the patient through a whole-body approach, provide integrative treatment plans, and improve quality of care.
Do you enjoy the program and would you do it again?
Dr. Perrucci: Most definitively. I entered this program with the goals of building my clinical skills and learning how to interact with other providers in an integrated environment. The VA has not only been the perfect setting to achieve those goals, but also has given me the opportunity to attend conferences and seminars, work with students, and learn proper research protocol. This program has been an invaluable experience. I would jump at the chance to do it again.
More information regarding the VA Chiropractic Residency Program is available by clicking here.
References
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