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Chiropractic Doctors Hit a Trifecta in Move for "Cultural Authority" |
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Written by John Weeks
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Chiropractic Doctors Hit a Trifecta in Move for "Cultural Authority"
This column was first published here at IntegrativePractitioner.com.
Chiropractic doctors have always been a limbo profession.
They
have more recognition and inclusion in health policy and third-party
payment than any of the other so-called "complementary and alternative
medicine" professions with which they are sometimes lumped. Yet they
have struggled mightily, internally, for years, with self-esteem and
what they call "cultural authority."
Evidence is afoot that a new era of recognition for doctors of chiropractic is dawning.
In
July 2013, the chiropractic profession hit a trifecta. The American
Chiropractic Association, a persistent lobbying force in the nation's
Beltway, successfully inserted a plan
to expand their program with the Veterans Administration into an
omnibus bill. The strategy creates a good chance of the legislation's
passage.
 Continuous advocacy
Of course, lobbying success is a guarantor of cultural
authority in only the most cynical world. Bullies and millions often
prevail.
Notably, when the chiropractors' leading professional
association, working laboriously for years with the Association of
Chiropractic Colleges, successfully convinced Congress to initiate the
VA program in 2001, they were successful despite opposition from medical
doctors.
Political victory, yes. Cultural authority, no.
In contra-distinction, the proposed 2013 expansion of access to chiropractic services came amidst new reports
albeit yet informal, that show the step-wise acceptance of doctors of
chiropractic by the VA's medical doctors. One piece of published
evidence is a study by Andrew Dunn, DC who found statistically meaningful improvement in patients at the VA's Buffalo facility.
Directed by a savvy, diligent administrator, Anthony Lisi, DC,
the VA's chiropractic program is gaining stature based on the most
authoritative of platforms: human contact and positive patient outcomes.
The medium of exchange is relationship. The VA's medical doctors are
finding that the partnerships with doctors of chiropractic have value in
patient care.
 Lisi: directing the VA initiative
The crowning achievement of the chiropractic-VA program is about to have jewel placed in its center. A release on July 26, 2013 announced that VA will establish up to six chiropractic residencies in partnership with chiropractic educational institutions.
This
V.A. move also followed prior relationships, these between the VA and
chiropractic academic institutions. The veterans' healthcare behemoth
has more than a score of academic agreements with chiropractic
institutions including 15 via Palmer College, plus a pioneering residency via New York Chiropractic College.
This investment of the nation's largest delivery system in establishing chiropractic residencies is a mark of arrival.
Completing the Trifecta was news
from the nation's largest payer, the Center for Medicare and Medicaid
Services. The agency announced a dialogue on potential coverage of the
evaluation and management (E&M) of patients by chiropractors.
Cultural
authority is a tough nut if the full education, skills and scope of a
professional are reduced by third-party payers to a fee to deliver a
modality. This long-overdue covering of E&M codes marks a
transformative shift toward respecting the broader, intellectual
participation of a chiropractor as a guiding hand in the care of
patients.
 ACC: partnered with the ACA in lobbying
These changes came amidst powerful recent studies
supporting the cost savings associated with chiropractic care. Insureds
in Tennessee Blues plans that first saw chiropractors cost 20%-40% less
than those whose care was managed first by a medical doctor. Insureds
in Washington State who saw licensed complementary and alternative
medicine practitioners cost $1420 less than non-users. Chiropractic care reflected the majority of use. A national study reached a similar conclusion.
With
the well-known positive patient experience of chiropractic doctors,
these studies underscore the alignment of appropriate chiropractic
services mainstream medicine's push to create a values-based system.
These
changes are prompting new kinds of possibilities for chiropractors.
Those involved with the always forward-thinking Chiropractic Health Care
Section of the American Public Health Association (APHA) have engaged new collaborations.
They have co-developed programs with other AHPA special interest groups
on Aging and Public Health, Injury Control and Emergency Health
Services on two separate topics at the upcoming APHA meeting.
The
battles of the doctors of chiropractic for appropriate recognition are
far from over. They can still see themselves with osteopaths to the left
of them, and physical therapists to the right, taking their modalities
and leaving them like Rodney Dangerfield, with no respect.
Yet
these changes suggest that maybe it's time for the profession to adjust
its self-image and reframe its role. The field's most significant 2014
academic and research conference is titled "Aiming for Effective Change: Leadership in Chiropractic Education, Research and Clinical Practice."
Perhaps
the chiropractic profession might drop the self-centric modifier and
set its sights on a broader sense of social responsibility: Leadership in Healthcare Education, Research and Clinical Practice.
Now that's cultural authority.
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