Visits

Our education and profession is heavily burdened with having to balance the margin with the mission.  Due to our lack of full integration with medicine, we are put into a peculiar situation to make our numbers in order to keep the clinic operating and our time at school productive.  We students, some more than others, must find a way to get patients into our clinics in order to finish clinical requirements while we watch the school take absolutely no responsibility or action to help us achieve these goals.  This follows many into practice once they graduate - when the numbers needed become money earned.

It all begins by putting a quantitative amount of visits on the interns in chiropractic school.  The motivation isn't to learn all we can about each case, it is to get as many visits completed as quickly as possible so we are not stuck in the system for a long period of time.  This motivation sets up the mindset of a stereotypical chiropractor looking to milk each patient as long as they can.  The ethical boundary is stretched due to this unfair pressure placed on every student and doctor in the field.

I can't speak for everyone, but I do know that it has taken a long time for me to generate visits at both the CIC and WBC.  It wouldn't be fair to say this is equal to those at the CHC or GIC clinics.  However, it hasn't been handed to me.  It has taken a fair bit of work and quite a bit of frustration.

When a patient is getting better and my attending physician makes an effort to end patient care, I tend to go against her efforts to kick the patient out.  She largely tries to end patient care when the patient is only a few days past the subacute phase of an injury.  This leaves me scrambling to figure out where I am going to get a new patient.  On average, I see 5-6 patients a week and primarily on returning patients.  I do not see very many new patients and can add up on one hand how many I have seen at the CIC.

In the journal, Chiropractic and Osteopathy, an interesting article was written in 2008 in regards to reform of the chiropractic profession.  Many researchers and outspoken DC's in the field have recognized this by making efforts to push the profession in a "spinal specialist" model of care.  Despite what people think, this is largely what we do as a profession.  We provide non-surgical, non-pharmaceutical spinal care.

In the the C & O article - How can chiropractic become a respected mainstream profession? The example of podiatry, by Donald Murphy et al, they outlined how podiatry filled a gap that medicine was failing in and became a respected, integrated university-level profession.  Much of the respect was built upon requiring entrance exams and higher education requirements to matriculate into podiatry school.  Once these standards were set in place and uniform in the profession, large universities allowed integration of this profession.  Chiropractic hasn't done this yet.  You will not find chiropractic medicine offered as a professional program at your state college.

Chiropractic has been reluctant to enforce the "Publish or Perish" rule that most colleges and universities require of their professors.  Instead, the colleges hire professors who want to teach and researchers who want to research.  Not saying the professors aren't top notch.  The lack of research, however, is a huge detriment to the profession as a whole and partly the reason for lack of integration because it attracts people who want a cushy job with no research requirements.

When podiatry adopted the MCAT requirement, they saw an increase in student interest.  This could be the same for our profession.  Like chiropractic, podiatry has an evil twin - foot reflexology.  In the article, the author suggests bagging the subluxation theory and focus intently on being non-surgical spine specialists.  Of course there could be offshoots of specialities in sports medicine, women's health, pediatrics etc.  Largely, this is what is happening with our profession but there are two professions operating as one.  One is evidence-based and one is a belief system.

The unfortunate thing is that we are stuck in the rigor of this program until our visits are completed and we cannot do anything about it unless we jump ship into an accepted program of study, such as podiatry, physical therapy or medicine.

How can we market without focusing intently on building a practice on a handful of patients?  Focus on medical practitioners that do not know how to treat back pain.  Primary care doctors suck at back pain.  We just read an awesome article in our evidence-based practice class that showed a significant improvement in disability with acute low back patients under chiropractic care.  The article revealed medical management of LBP is a cluster of randomness that operates on whatever the doctor feels is the right choice, while chiropractors in the study followed a specific protocol. Disability markers stayed the same for 24 weeks with medical management of back pain and 78% of patients were still on narcotics at week 16 of the study.  Chiropractic care consisted of 4 weeks with visits between 2 and 3 per week focusing on spinal manipulation and active care.

You can find the above articles here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2538524/
http://www.dynamicchiropractic.ca/mpacms/dc_ca/article.php?id=53496


All for now