Richard E. Vincent, DC
I had the unique pleasure of living a multifaceted chiropractic career for 58 years. Those days began with the pursuit of the legislative authority to practice under statutory legitimacy and have taken us to today, where we continue to pursue professional and cultural authority. The road traveled, from humble beginnings, has been rather tortuous at times, colorful and certainly not without bumps along the way.
Now you might ask, what has that got to do with my perspective on the past 25 years and what the future holds? Simply put, if you do not know where you have been and where you are, it becomes virtually impossible to predict a course for the future. It's my opinion that the past 25 years, 1983 to the present, have been more than significant. As a snapshot in time, it was the most productive period in the 113-year history of the profession. During those years, the profession has experienced a multitude of advancements.
The most noteworthy event to take place was the 1987 Wilk decision. The successful antitrust suit was of historic proportions and brilliantly masterminded by attorney George McAndrews, who was driven by the need to end the injustices cast upon the chiropractic profession by the AMA plan to contain and destroy. The antitrust action removed the shackles that had bound the profession.
In 1992, the Guidelines for Chiropractic Quality Assurance and Practice Parameters were published. This document, commonly known as the Mercy Conference Guidelines, was a representation of the consensus of a full spectrum of the profession in which, for the first time, evidence was the major player.
The U.S. government's Agency for Health Care Policy and Research (AHCPR), based on a comprehensive literature review, established guidelines for assessment and treatment of acute low back pain in adults. The 1994 guidelines represented a turnaround from all previous medical guidelines, providing evidence that validated spinal manipulation as a treatment of choice.
The 1993 Canadian study known as "The Manga Report" should not go unmentioned. Funded by the government of Ontario, Canada, in its search for health care services that were cost-effective and appropriate, the study recommended chiropractic services be fully integrated into the system. Although its recommendations were not fully implemented, the study was valid and another testimony of the value of evidence.
In January 1993, TheNew England Journal of Medicine published a study titled "Unconventional Medicine in the United States." The principal author of the seminal study was David M. Eisenberg from the Department of Medicine at Harvard Medical School. This study spawned interest in the subject of alternative health, giving rise to working models of "alternatives" functioning within mainstream settings. Today, the newest and most contemporary model is the Osher Clinical Center for Complementary and Integrative Medical Therapies at Brigham and Women's Hospital in Boston, also affiliated with Harvard Medical School.
The four-phase RAND study in the 1990s endorsed the effectiveness of manipulation in the treatment of low back pain. The study was based on a comprehensive review of the scientific literature, further validating the profession's quest for authority. It also opened the door to increased cooperation and collaboration between the professions.
It's very evident to me the past 25 years have demonstrated a stronger presence in terms of studies, trials and research in comparison with the first 88-year history of the chiropractic profession. Of significant note is the 2000 enactment of the National Defense Authorization Act making chiropractic services available to active-duty personnel. It was followed by a legislative mandate that chiropractic services be included as a benefit within the VA system. Today, chiropractic services have an expanding presence throughout the U.S. and the world, wherever we have a military presence. On a personal note, I have yet to engage in dialogue with chiropractors in the military or the VA system who do not savor the experience and benefits of collaborative integrative care.
On another note, the chiropractic educational world has expanded. There are now more chiropractic colleges beyond the continental U.S., and in many instances they have affiliation with universities. The world of sports has been enriched with the inclusion of chiropractic services for the purpose of injury prevention and treatment. More than ever, there is a strong chiropractic presence at the amateur, collegiate and professional levels of athletics. Of significance is the role chiropractors played at the 2008 Olympic Games in Beijing.
Not to be forgotten are the number of chiropractors who have gone on to acquire further doctoral degrees and who have brought credit to the profession as they teach and interface with the various disciplines. Twenty-five years ago, the idea of interdisciplinary practice was purely a dream. Today, chiropractors rub elbows on equal terms with members of the medical profession in a variety of settings. Chiropractors are employed in hospitals, serve as faculty in medical schools and triage for medical specialty groups. These are but a few highlights of the past quarter-century that have moved us to the present time.
The health care world is at a time of unprecedented change in demographics, technology and interdisciplinary transformation, and yet there are some elements of our profession that remain unchanged and serve as excessive ballast holding the profession back from maintaining a pace progress demands.
The division within the profession still runs deep. The results of the dichotomy are reflected in a public that holds us in relatively low esteem. A market share of 7 percent remains as the status quo. Uncontrolled commercialism by certain members of the profession does little to enhance the reputation of the profession. The insecurity and business inadequacies of far too many DCs drive them to the lure of less-than-desirable consultants. Because of the tuition dependency of colleges, chiropractic admission standards remain modest. National and state service associations remain anemic from a lack of members. Too many DCs do not view membership as a benefit and professional obligation.
With that said, the past 25 years have set the stage for changes to come. These changes will be driven by a converging unrest within the chiropractic profession that will lead to a clear distinction between those who will remain as traditionalists and limit their practice to the correction of subluxations, and those who will define themselves as conservative musculoskeletal specialists and place an emphasis on the diagnosis and treatment of spine and spine-related dysfunction. The latter segment of the profession will seek to work in clinical centers of excellence where collaboration and integrative care prevails. There also will be a third choice for the public: the chiropractor who offers an alternative health perspective in the treatment of illness through a spectrum of natural means.
Government also will play a defining role as to where the profession will fit in the turbulence of change. Access to high-quality affordable health care for all Americans is the call for the future. The Medicare provision for chiropractic services as we know it will become something of the past. The possibility of a federal super agency redefining health care regulations could well make statutory definitions of chiropractic obsolete.
Chiropractic educational trends will be impacted by the emergence of a chiropractic college within a state university system, providing substantive resources. It will raise the bar on educational standards and research. On a personal note, I see a reformation taking place in the profession. The question remains as to what forces will precipitate that movement.
In retrospect, I believe the past 25 years have brought us far past the obscurity of the first 88 years of our existence. The next 25 years will hopefully bring order and greater maturity to the profession. The train to the future is preparing to leave the station - don't be left standing on the platform.
