Editor’s Note: The following is an interview with Dr. James J. Lehman, director of the Health Sciences Postgraduate Education program at the University of Bridgeport, regarding chiropractic resident training.
Why did the University of Bridgeport create a chiropractic residency program? Shortly after accepting the position as the director of the Health Sciences Postgraduate Education Department, I was invited to a meeting with the Community Health Center, Inc. (CHCI), of Middletown, Conn. This community health center was credentialed as a Patient-Centered Home and a Federally Qualified Health Center. Dr. Margaret Flinter, senior vice president and director of clinics, organized a meeting of the senior leadership team and invited the University of Bridgeport to attend.
At that time, Dr. David Brady and I attended the meeting with keen interest. We knew there was an interest in adding chiropractic services, but we did not realize how motivated CHCI was to integrate chiropractic services.
We were warmly received by all of the CHCI leaders. It became clear that the organization wanted to add a non-pharmacological treatment for chronic pain patients and the choice was chiropractic medicine. Yet, the organization started in 1972 and 38 years later, not one CHCI patient had been referred for chiropractic services. Hence, CHCI requested that UB participate in a pilot study, which would determine the levels of patient and primary care provider satisfaction with chiropractic services. In addition, the study evaluated the change in functionality.
I volunteered to evaluate and manage adult patients with chronic pain and provide clinical training for fourth-year chiropractic students. Three chiropractic students accompanied me with each clinical rotation. They were permitted to participate in the patient evaluation, management, and documentation for each patient encounter. I was engaged with each encounter and provided 100% supervision of all services provided by the students.
The six-month study was lengthened to nine months. Fortunately, the outcomes were exceptionally good and CHCI offered a one-year agreement to the University of Bridgeport. The agreement required the university to provide chiropractic providers in exchange for compensation per patient visit. The terms enabled the university to pay its costs and experience a profit.
Then we hit a problematic credentialing issue. The initial two chiropractic providers were not acceptable to CHCI. The chiropractors included one doctor with a DC and a PhD., and the other doctor was a DC with an advanced-practice status. So, I was perplexed and asked why the two doctors were not acceptable. Dr. Darin Anderson (CHCI vice president / chief quality officer) explained to me that chiropractic services were considered to be specialty services and the chiropractors were required to be board-certified chiropractic specialists.
Consequently, I realized that if we were to participate with Federally Qualified Health Centers, we would need more board-certified chiropractic specialists. It was my opinion that the university should commence a postdoctoral program in chiropractic orthopedics that would lead to board certification. Two years later (2013), the university started the resident training program, which would not have become a reality without the invitation to integrate chiropractic services into CHCI.
Would you please describe the residency program? The University of Bridgeport offers a three-year, full-time resident training program, which prepares licensed chiropractic providers to become members of the primary care team and board-certified chiropractic specialists. The training of licensed chiropractic providers takes place within Federally Qualified Health Centers. Chiropractic residents are credentialed as members of the medical team. The focus of the chiropractic interventions include evaluation and management of patients suffering with acute and chronic pain caused by neuromusculoskeletal conditions.
The resident training requires doctors to provide high-quality, non-pharmacological treatment for patients with both acute and chronic pain due to neuromusculoskeletal conditions.
How many residents have been accepted into the postdoctoral program? The first resident was accepted into the program in October 2013. Since that time, an additional 11 residents have been accepted. Every resident is a full-time employee of the University of Bridgeport, receiving a salary and benefits.
Is the residency accredited? Yes, the International Academy of Neuromusculoskeletal Medicine accredited the chiropractic Neuromusculoskeletal Medicine residency program on Aug. 1, 2021. In fact, the academic portion of the training is a 300-hour, online, neuromusculoskeletal medicine course, which is approved by the Veterans Administration.
Is there a demand for this postdoctoral training, and should other schools offer resident training? Yes, I believe other schools should offer resident training that leads to board certification as a chiropractic specialist because there is a demand for board-certified chiropractic specialists.
From your perspective, what is the future of chiropractic resident training programs? Resident training programs will create a contemporary career pathway that enables a young chiropractic graduate to complete postdoctoral training with board certification, which will provide employment opportunities with Federally Qualified Health Centers, chiropractic and medical schools, medical health care systems, the VA and other hospital systems.
The chiropractic schools will realize the value of resident training, which will enhance postdoctoral training, improve the quality of chiropractic services within health care organizations, and produce auxiliary revenue for the schools. It is my goal to create 100 neuromusculoskeletal medicine residencies within Federally Qualified Health Centers over the next ten years.
Thank you for accepting the invitation for this interview. I appreciate the opportunity to inform the profession of the need to provide additional clinical training to chiropractors interested in board certification and integration into the health care systems.
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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