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.