University of Missouri Launches Chiropractic Internship Program
Editorial Staff
National University of Health Sciences recently announced an exclusive agreement with the University of Missouri School of Medicine that allows NUHS students to participate in a 15-week internship program at the Missouri Orthopaedic Institute (MOI). K. Jeffrey Miller, DC, MBA, developed and directs the new program, which welcomed its first chiropractic interns in January 2023.
"MOI strives to be a comprehensive facility where patients can receive treatment from multiple providers on the same day. The arrangement allows immediate interaction among a patient's providers," said Dr. Miller in an NUHS press release.
Per the release, the Missouri Orthopaedic Institute "is considered the most comprehensive orthopedic center in the region and attracts students, residents, and fellows from around the world. With 400 staff members and state-of-the-art technologies, MOI offers patients total neuromusculoskeletal care in a single location."
Dr. K. Jeffrey Miller, who developed and directs the new internship program.
"NUHS students ... interact with medical students, residents, fellows, and physicians from multiple neuromusculoskeletal specialties. Specialties include general orthopedics, sports medicine, physical medicine and rehabilitation, orthopaedic oncology, podiatry, pain management, pediatric orthopaedics, orthopaedic research, and more. The interactions ... allow NUHS students to observe a wide variety of cases. "
Dr. Miller is an assistant professor of chiropractic at the University of Missouri School of Medicine, working in two departments within the medical school: the Department of Orthopaedic Surgery and Department of Physical Medicine and Rehabilitation. He has hours three days per week at the Missouri Orthopaedic Institute and two days per week at the Missouri University Women's Hospital.
In an exclusive interview with DC, Dr. Miller provided additional insights into the internship program:
How did you get involved with the Missouri Orthopaedic Institute; and how did that ultimately lead to this internship program? In early 2016, the Missouri Orthopaedic Institute began looking for two chiropractors to join their faculty as part of their new comprehensive spine center. Planning for the center had been in progress for quite some time and the new director felt the center could not be "comprehensive" without offering chiropractic care.
Dr. Jose Ramirez and I joined the institute in May 2017. He is gifted in chiropractic athletic/sports care. Our initial orders were to spend the first two years establishing practices in the institute.
After that period, I began developing the idea for this program. I received permission to pursue my ideas from the medical director of the Missouri Orthopaedic Institute and chairman of the Department of Orthopaedic Surgery, Dr. James Stannard, who has been a true champion of the program.
With the support of Bob Schaal, executive director of the Missouri Orthopaedic Institute and a member of MU Health Care's executive management, I made my first presentation regarding the program at a chiropractic college.
National became involved in late 2021, as did NCMIC. From that point, development of the program began to accelerate. President Joseph Steifel and Ron Mensching of National visited MOI shortly afterward in January 2022. Mr. Mensching and Ann Juengermann of MOI began working on the contract details almost immediately.
What does the interns' average day look like in terms of experience / case involvement? At MOI, I practice full time and my classroom is the clinic. The interns work in my practice – a full-time chiropractic practice consisting primarily of spinal and extremity adjusting. They also work in the acupuncture portion of the practice if their training allows. Half-day rotations will occur frequently throughout the program. ... They will also have to complete an assigned reading list. We have medical grand rounds weekly, spine conference weekly and chiropractic grand rounds weekly.
Do you expect the program to grow? What do you envision / hope for in the next few years? The program [is currently] two interns at a time on 15-week rotations. It can expand as the number of full-time DCs expands. There isn't a time frame for that. I am planning for a second program of a sponsored professorship in clinical chiropractic / orthopaedic research. MOI always has a large and productive research department with multiple studies in progress.
After spending several years working alongside non-DC providers, what do you see as the ultimate value of integrative collaboration? It isn't unusual for a chiropractor to see a new patient who has already seen several providers. Here all the providers are in the same building; the same hallway for that matter. We all have access to each other's records, imaging, etc.
Information can be exchanged quickly. Daily I step into the hallway and discuss a patient with my medical counterparts, and they do the same with me. Everyone is there, here and now. This prevents redundancy and care can move at a faster pace. All parties are learning what the other fields treat, how they treat and why they treat the way they do. Misunderstandings and misconceptions are fading (on both sides).
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
Some pundits say that the upcoming presidential and congressional races, and many local races, might be the most consequential in our country’s history. We do not have the choice of sitting on the sidelines and hoping our patients will carry our water. Unlike other medical professions such as physical therapists, podiatrists, nurses, etc., the health care class (AMA) will not protect us. We must be in the game.
The most common condition affecting the shoulder is rotator-cuff disease. From acute tears to chronic tendinopathy, it’s common and needs a thorough workup. In fact, even asymptomatic shoulders can have full-thickness rotator-cuff rears in up to 40% of instances. Let’s look at additional conditions that can present to the office with weakness, loss of motion and pain in the shoulder beyond rotator-cuff tears.
