Fuzzy Futures and Frenzied Futurists
By Reed Phillips, DC, PhDThe first year of the second century of chiropractic is history, but oh what a year it has been. Predicting the changes that will occur in the first part of our second century is as popular as predicting those which will occur in the first part of the next millennium. The Association of Chiropractic Colleges (ACC) conducted three retreats in 1996 (Feb., June, Sept.). The chiropractic research community, guided by Drs. Meeker and Hawk of Palmer University, and supported by a grant from the Health Resources Services Administration (HRSA), held a Research Agenda-setting conference in July of 1996. The National Chiropractic Mutual Insurance Company (NCMIC) hosted a futurist conference in September of 1996, and the ACA/ICA are jointly sponsoring a futurist conference in November of 1996. It seems as though everyone is getting into the act.
Crystal ball gazing is both exciting and frightening. If we allow our imaginations to wander, there are no boundaries on what could be. We are free to construct and design whatever we wish. There is no guarantee that our fantasies will become realities but there is no reason why they couldn't. The Berlin Wall came down. The computer age has become a reality. The ACA and ICA have joined to host a conference. These things were someone's fantasy not so long ago.
Association of Chiropractic Colleges (ACC) Retreats
As the chiropractic college presidents gathered in Davenport to participate in the "Grand Celebration," we reviewed two papers: one prepared by Dr. Clum; the other by Dr. Winterstein. These two presidents, representing opposite ends of our profession's philosophical spectrum, were challenged to present their colleagues with a listing of those issues which we agree upon, and those issues which tend to separate us. These two notable presidents offered more areas of agreement than disagreement.
The ACC acted boldly to clarify those issues where differences were noted. A retreat was called the following February, and an impartial facilitator was retained to assure balanced dialogue. The purpose was to identify and clearly state what we as presidents could accept as common definitions about the profession of chiropractic in our schools.
This first retreat was a make-it-or-break-it event. If the process failed to bring us together, even to agree on what we disagreed about, there would be no value in holding additional retreats. To our surprise, as the colloquy progressed and we learned more about each other, we came to a fuller understanding of our individual beliefs regarding chiropractic. Further, we identified numerous issues that impacted our schools. We agreed that through our schools the entire profession is effected. We argued and debated, cajoled and berated, but through it all, our facilitator found nuggets of truth around which we seemed to focus. We entered into a role playing experience where a group of earthlings were making a presentation to the Mars Medical Association. The Earthly chiropractors were seeking the privilege to practice on Mars, but the president of the Mars Medical Association, Dr. Wid Silliams would not hear of it. He wanted us all put in jail. Amidst the humor, we all gained a greater appreciation for the difficulties our profession has faced in trying to express itself.
As the weekend came to a close, 17 tired presidents found that there was a great deal of agreement between themselves regarding the issues in their profession. We agreed to meet again to focus on special issues and definitions that seemed to demand our most immediate attention. This retreat date was set for June. Our purpose would be to finalize our paradigm, approve a statement regarding the chiropractic profession in general, and to move towards an agreed upon definition of the subluxation.
Those of you who throw away your inserts from Dynamic Chiropractic probably overlooked a multi-colored paper which offered our position statement on the paradigm of chiropractic, and the definition of chiropractic and subluxation. This statement is an historical document. It is the first position statement that all college presidents have agreed to and signed (correct me if I am wrong, Dr. Joe Keating), giving signature to our acceptance of said definitions. In case you overlooked your copy, it is being reprinted in Today's Chiropractic and also by NCMIC. The need for this kind of clarification cannot end with a simple effort at definition or even a masterful listing of all our problems, however.
Next, the college presidents decided to tackle "scope of practice" views. We met in September and crafted acceptable definitions for the concepts established in our first position statement. The later statement addresses the purpose of chiropractic and defines chiropractic practice to include diagnosis, case management and the role of health promotion. This statement will also be released soon through Dynamic Chiropractic.
Research Agenda Conference
Palmer University researchers, Drs. Meeker and Hawk, secured HRSA funding to sponsor a futurist conference on research. It was an impressive gathering of individuals involved in, or at least interested in, research in chiropractic. The futurist included both chiropractors and non-chiropractors. The goal was to identify our problems and seek solutions. Five papers were presented dealing with research issues in basic science, clinical science, outcomes research, educational research and health services research. A consistent and relentless dialogue scorched into our minds the fact that the chiropractic profession and its colleges have failed to appreciate the value of research, and consequently have not provided the necessary support and leadership required to place the profession on a sound scientific foundation. The papers were prepared and presented by the researchers.
The burning truth has scarred the profession, and the colleges are some of the arsonists guilty of not having placed research at the top of the priority list. A lively discussion yielded a fresh perspective why the profession and the colleges struggle so in this area of importance. After feathers were smoothed, we settled into work groups charged with developing solutions. The meeting formally disbanded, but the process is still in motion as I write this column. The outcomes may well appear before this article meets the printing press.
Irrespective of the specifics regarding our future research agenda, it was obvious that more meetings of this sort would be required to bring into focus specific action plans which will help move research forward in this second century of chiropractic.
National Chiropractic Mutual Insurance Co. (NCMIC)
Not to be out of the loop, NCMIC sponsored its own conference with leaders of the profession. In preparation for the meeting, a futurist organization worked with NCMIC to paint potential scenarios of the year 2010, speculating how the profession will be affected. They produced some very interesting work. I am obliged to let NCMIC present the details of the meeting as they wish, except for some of my general observations as follows. The first order of the day was to identify the problems and consider mechanisms for solutions. The discussion was active and the audience was well represented with optimists and pessimists. What is the state of the profession? "Practice income is down because of managed care. Insurance companies are paying less and demanding more paper work. Operating costs are up and the future looks glum. However, chiropractic college enrollments are up and our graduates are getting into practice in percentages in excess of 95%. Research grants are becoming more available and chiropractic acceptance by managed care companies is increasing. While we have gained greater "cultural authority" or "cultural recognition" we are suffering on the business side of practice." What to do?
There were many solutions offered. Our public image seemed to be a major focus of concern and the need to improve it was an obvious conclusion. But at the risk of usurping any report forthcoming from NCMIC, let me conclude by simply congratulating the leaders of NCMIC for the work they did in creating a forum for vision, and inviting leaders of the profession to grapple with some very significant issues.
ACA/ICA Joint Conference
Our two national political organizations have joined hands long enough to bring the leaders of the profession together to address common problems, identify common goals and set a futuristic vision. My understanding is that many of the same folks who attended the NCMIC meeting will be in attendance at the ACA/ICA meeting. With a little practice, we may actually get this process down: identifying internal and external problems and seeking solutions.
I do not know the precise agenda for this meeting, but I would expect that (after attending other meetings of this type) there could not be too many unidentified problems left to introduce. The greater challenge for each of the groups I've reported on is to find ways to achieve solutions for the problems that we know confront us.
There have been no less that six major conferences on the future of the chiropractic profession held in 1996. The problems have a similar grain, but the solutions are not as clearly defined and present a great opportunity for the profession to unite and seek consensus. If 17 college presidents can find grounds for agreement, is it beyond our imagination to think that the rest of the profession can also lay aside any shallow personalities and ideological extremism for the betterment of chiropractic? The question was raised: "Who has ownership of this process? Is it the profession, the schools, the doctors in the field or some organization?"
My response is that we all do. The problems and challenges are too great for us to expect that we can divide our talents and resources and still conquer the enemy. When we divide and fight amongst ourselves, we become the enemy.
As president of the ACC, I can assure you that the college presidents are committed to the process. We are committed to the need of working out our future with the leaders of this profession, with input from the rank and file members, from our patients and from the leaders in the communities in which we work. We believe in being pro-active! We believe that we are standing on the edge of a potentially bright and prosperous future for the chiropractic profession, but we have to reach out and grab the gold ring as the merry-go-round continues to circle. If we continue to persist in knocking each other off our horses, we will miss the whole ride.
Reed Phillips, DC, DABCR, PhD
Click here for previous articles by Reed Phillips, DC, PhD.