Integration is defined as "the act or instance of combining into an integral whole." Integral is defined as "belonging as part of the whole." When considering the concept of medical integration, this is an important point to consider.
My wife, Coleen, started her career working as a licensed physical therapist, specializing in traumatic brain injury and stroke rehabilitation. She worked primarily in the inpatient physical therapy departments of hospitals in Detroit, New Jersey and Georgia.
Needless to say, she worked with some very serious cases. In doing so, she worked as part of a team, together with an occupational therapist, a speech therapist and a cognitive therapist – all working under the direction of an MD (in this case, a physiatrist).
They would collaborate and all offer professional opinions as to what each thought they could do for these patients. This was done in a regular team meeting.
This was true integration; each combining their expertise into a whole: health care practitioners from different medical disciplines working together to produce a more unified, comprehensive treatment plan.
Although many of these patients started with very dismal prognoses, the usual result of this treatment is that the patient ends up with a far better outcome because of the collaboration. Not all of mainstream medicine works this way, but when it does, the outcomes are usually better.
The Present State of Health Care
I believe 80 percent of chiropractors got involved in chiropractic because they genuinely wanted to help people. The other 20 percent? Well, let's just say they are the ones who give the rest of us a bad name. But what about medical professionals?
After working with MDs, DOs, NPs and PAs for the past 20 years, I can honestly say they are the same way. Eighty percent of medical professionals got into health care to genuinely help people. Don't believe me? Go to the OIG website and look at the proportions of MDs and DOs who get convicted of fraud vs. DCs. It's usually 10 to one medical vs. chiropractic, which is the same overall proportion of medical physicians to DCs.
Let me state this another way: Medical practitioners started off with the same basic purpose as chiropractors – to help people! What happened? When I have pondered this over the years (and I have), it basically comes down to a viewpoint. That viewpoint is crafted by the standard of care (SOC) or "What would your peers have done in treating that patient?"
Who actually decides this? Do we all vote? Is statistical analysis constantly being updated to determine what our colleagues have decided in various case scenarios? Well, that job is usually left to the boards. In the medical world, that includes the various county boards and state boards, but the granddaddy of all the medical boards, of course, is the American Medical Association (AMA).
Changing the Medical Standard of Care
Everyone pretty much knows this, but rarely do people wonder, "Who is the AMA?" In an article in Physician's Weekly (June 9, 2015), "Is the AMA Really the Voice of Physicians in the US?" Linda Girgis, MD, states that only 15-18 percent of physicians are enrolled in the AMA.
The AMA has tried recently to boost its numbers with discounted or free enrollment to medical students and retirees. Perhaps the association is embarrassed by these dismal numbers.
One might wonder, how does the AMA wield so much power if its numbers are so low? Where does it get the finances to afford that big, beautiful skyscraper in Chicago and the beautiful AMA park that surrounds it? Well, apparently the AMA's primary source of income comes from selling demographic and prescribing-habit data of physicians to, you guessed it, the pharmaceutical industry!
The first time I was made aware of this was in the late 1990s when three medical physicians who worked for me in Pennsylvania informed me that physicians in our county were planning on going on strike to protest their free enrollment into the AMA because they had enrolled in the local county medical association. I asked them, "Don't you all belong to the AMA already?" Their collective response was, "No, that's the drug companies."
Is it possible that the medical standard of care in this country is established by a group with a vested interest to make sure patients get prescriptions? In the U.S., we only make up 5 percent of the world's population, yet we consume 70-80 percent of the world's medication. Our health care is more expensive than the other 95 percent combined and we have the lowest life expectancy of the top 25 industrialized nations in the world, by far! If it looks like a duck...
Many medical doctors are leaving their careers, which is why extenders such as nurse practitioners and physician assistants are getting more and more autonomy with their scope. Many health care practitioners have told me they feel we are way overmedicated as a population. I would say 60-70 percent of providers have told me they don't want to prescribe opioids – a percentage I'm sure will only grow over time.
The Future Has Arrived
Medical integration – incorporating the tenets of multiple health care disciplines – is quickly becoming the wave of the future as chiropractors continue to look for better ways of connecting into the health care mainstream; and as medical doctors look for opportunities that focus less on symptom relief and pharmaceutical remedies, and more on baseline, full-patient recoveries.
Highly lucrative, medically integrated practices are allowing chiropractors to put patient care at the center of their practices like never before and to become beacons of hope in their communities. In short, the medically integrated model works.
