Is this the best we can do?

Is this the best we can do?

A Critical Point in Chiropractic History:

It is no secret that Chiropractors only see 6-10% of the population while some 85% or more of people will experience back pain at some point in their life. Underutilization of chiropractic is not a result of chiropractic not working or failing to provide value to the health system. In fact, of all the therapies for low back pain, spinal manipulation is one of the few therapies (pretty much the only one alongside exercise) to show clinical utility. Chiropractic has also been shown to be cost-effective as chiropractors manage back pain cases more efficiently – keeping patients from becoming chronic back pain patients.

Chiropractors, if you haven’t learned by now, we’ve been fighting too long for a decreasing chunk of the healthcare pie in a system disproportionately focused on acute, reactionary care. While delivering the message of chiropractic for back and neck pain, we are still seeing the same 6-10% of the population with the same message. If we were a publicly traded company, Chiropractic would be bankrupt or at least receiving a bailout. Now, I don’t see a bailout coming our way anytime soon either. Ever since I started Chiropractic college, I’ve struggled to figure out why chiropractic is so underutilized by the general population. What has Chiropractic done wrong? More importantly, what can we do to reverse the trends?

A Profession at Odds With Its Competition:

Chiropractic has struggled to compete in a biomedical model at odds with its basic principles. Although a vitalistic perspective of the adjustment will never be proven by a randomized controlled trial, many chiropractors practice passionately with vitalistic aims. This alienates us from policy-makers, from insurance companies, and other health professionals, but it doesn’t mean we are not on to something useful. As powerful as the adjustment is, it is still limited in its ability to produce clinical outcomes that can be measured by traditional standards – even the staunchest, principled among us are beginning to realize the utility of working with massage therapists and other types of professionals.

To “rebrand” chiropractic, we need to one: redefine outcomes assessment tools consistent with a holistic model of health and become results-driven from a Wellness perspective – ultimately forcing policy-making bodies and insurance companies alike to either recognize our worth or lose authority in the marketplace. Secondly chiropractors need to focus beyond just the adjustment and involve the other missing ingredients of the subluxation – the physical, chemical, and psychological factors that are all required for optimum expression of health. Fortunately aspects of these three elements are all supported by the literature and chiropractors should begin owning this information as it really is evidence and proof of everything we’ve been saying circa 1895.

Moving Towards a Viable Solution:

Chiropractors are taught advanced neurology, but are not given ample clinical opportunities in their education to own it out in the field. Chiropractors are taught more nutrition than medical doctors, but yet practice none of it in their clinical experience beyond fish oil, vitamin D, and health talks. Chiropractors contain some of the most motivating professionals out there. I cannot expect chiropractors to own both neurology or nutrition, or become tomorrow’s Tony Robbins, but we need educational systems that give adequate clinical experience in these fields where we can work along-side other professionals to hit at the physical, biochemical and psychological factors required for health.

We have worked our way slowly into the Veteran’s Administration system which is powerful, but we have been limited to strictly massage and mobilizations. Why aren’t we pushing for better care for these individuals. Just because a person has more serious diagnoses doesn’t mean their musculoskeletal complaints, nutritional needs and social needs simply disappear. Proper integrative comanagement has evaded the profession and left millions with poor, overpriced care, ill-suited to meet their needs. Chiropractors have the pieces, and great movements like the Foundation for Chiropractic Progress (http://www.f4cp.com), AdjustTheVote (http://www.adjustthevote.com), ChiroVoice (http://www.chirovoice.com), 8 Weeks to Wellness (http://www.wscenters.com), Creating Wellness(http://www.creatingwellness.com)  and Eat Well, Move Well, Think Well (http://www.eatwellmovewellthinkwell.com) are becoming more and more popular. Are they perfect? No. Are they pushing the market in the right direction? A resounding yes.  Chiropractors are making a strong attempt to influence Public Health at the political level, but not with a distinct message. Instead our message of “we’re just like you” is just reinforcing a secondclass persona for our profession.

From a health perspective, chiropractors must design a practice that incorporates exercise, nutrition, and psychology can be achieved with a proper business model that brings together like-minded practitioners. The branding issue with chiropractors is that patients do not trust chiropractors at all. Whether its reverberations from Wilk vs. AMA or loud, passionate chiropractors who put business and philosophical interests over patient interests, the fact is chiropractic has became a bad word in the marketplace. Don’t get me wrong, I love our profession, but unfortunately the public just simply doesn’t “get” us.

Now I do not mean to underestimate the value of chiropractic in the management of acute and chronic musculoskeletal complaints. My take is that we can do so much more and increase our market share at the same time. You see, we can’t treat chiropractic care as “take two adjustments and call me in the morning” – people need step-by-step, adjustment by adjustment lifestyle modification.

A Vision for a Increased Utilization:

For chiropractic to grow beyond the 10%, we need to jump aboard a wellness movement and incorporate acute musculoskeletal care within that framework. Baby-boomers are aging and want to keep living active lives. 2/3 Americans are overweight or obese, 1/3 kids will have now diabetes later on in life. The medical profession has not found the answer. Insurance companies are insuring sick care, not wellness. Chiropractors need to attract patients under a better definition of wellness like the World Health Organization’s offers. While demonstrating leadership and trust in Wellness, we may finally find the audience with which to demonstrate chiropractic’s worth as a viable and cost-effective healthcare option.

Combine this message with long-proven cost-effectiveness and a unified political message and Voila you have a recipe for increased cultural authority, and a favorable brand image and increased utilization for Chiropractic care.