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March 5, 2013
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Indian Health Service Retains Chiropractic in Federal Loan Repayment Program

By Gary Auerbach, BS, DC

The Indian Health Service (IHS) has retained complementary medicine occupations, including chiropractic, in its Federal Loan Repayment Program. This reversed an earlier proposal to remove these occupations based upon a low response rate from a survey to tribal health directors, asking them to rate the importance of occupations.

The Federal IHS Loan Repayment Program, details of which were published in the Federal Register on Feb. 4, 2013, retains chiropractic, acupuncture and naturopathy as eligible occupations. The inclusion of 28 professions in the repayment program was first published in the Jan. 12, 2012 Federal Register.

The Priority Categories Survey was determined to have significant weakness in its format, distribution and response mechanisms. The survey was sent to tribal health centers, urban Indian health centers, IHS facilities and other sites, asking the medical directors to rate the importance of various professions from low to high. The survey did not state that only "high priority" ratings were to be counted, nor were there follow-up or reminder notices sent. Of the 800 mailings sent, only 103 responses were received.

Chiropractic was listed as a high priority on responses received from four tribal groups – Lac Vieux Desert Tribe, the Chippewa-Cree Tribe, the Sac & Fox Nation and the Confederated Tribes of Grand Ronde. It was later determined that the Tulalip Tribe had also responded, but that response was not counted because of its selection of "medium priority" for chiropractic.

Based on faulty survey findings and an unjustifiable 5 percent response rate criterion, there was a campaign to address the possible removal of complementary medicine occupations by IHS. Support for inclusion came from four tribal health centers and their respective DCs who received LRP awards in 2012: the New York Mohawk St. Regis Tribe, Dr. Gerald Lauzon (Akwesasne); Pyramid Lake and the Walker River Tribes in Nevada, Dr. Adrian Emm (Paiute); and Southcentral Foundation (SCF) in Anchorage, Alaska, organized by Dr. Angela Michaud with support from Dr. Genevieve John (Mentasa), both full-time DCs at this large regional health center.

Other support came from Alaska's congressional delegation: Sen. Mark Begich (D-Alaska), Sen. Lisa Murkowski (R-Alaska), and Rep. Don Young (R-Alaska), with assistance from Dr. Angela Michaud of the Southcentral Foundation, and former American Chiropractic Association Board of Governors member, Dr. Bill Pfeifer, both of the Ketchikan Indian Community. The ACA provided valuable Washington, D.C., coordination and technical support.

For example, in a Jan. 15, 2013 letter from Sen. Begich to IHS Director Dr. Yvette Roubideaux, Sen. Begich stated: "Since its inclusion in the program, all accounts indicate that the addition of chiropractic medicine has been successful and valued by Alaskan Native and Native American patients and communities. Numerous doctors who benefited from the program are currently providing high-quality health care within several tribal health programs.

"It is my understanding that when Alaska Native and Native American patients struggle with acute and chronic pain, access to chiropractic care can reduce the use of pain medications and other drugs. The utilization of the non-drug, non-surgical services provided by doctors of chiropractic in treating pain management can be an effective way to combat the danger posed by overreliance on powerful drugs."

In a similar letter to Dr. Roubideaux sent on Jan. 9, 2013, Kathryn Gottlieb, president / CEO of the Southcentral Foundation, emphasized that "[a]t a time when acute and chronic pain have escalated the use of pain medications and other drugs across Indian Country, complementary medicine providers can be looked to as part of the solution. They offer a non-drug, non-surgical approach to health and wellness for our Native people, which results in both improved health care outcomes and cost savings.

"The Southcentral Foundation (SCF) Complementary Medicine Clinic is integrated into our primary care system. It employs five chiropractors, four massage therapists, and an acupuncturist, and receives over 15,000 visits annually. Our primary care providers refer customer-owners to the clinic for acute musculoskeletal conditions. This collaboration and integration has been recognized around the world as a best practice and helped SCF earn the Malcolm Baldrige National Quality Award in 2011."

It has been requested that next year's Priority Category Survey include more information about the survey's impact and reminders for deadlines. An electronic survey also has been discussed. As for 2013, Loan Repayment Program applications are being accepted as of Feb. 15. To qualify, individuals must be employed full time at a tribal health center, urban Indian health center or IHS facility. Proof of outstanding college school loans needs to be established. Contact the IHS for more information at www.ihs.gov/loanrepayment.

Dr. Gary Auerbach, founding president of the World Federation of Chiropractic, holds a graduate certificate in public health from the University of Arizona, Zuckerman College of Public Health. He is the administrator of the American Indian / Alaska Native Doctors of Chiropractic Ad-Hoc Committee. If you are an American Indian / Alaska Native DC in the U.S., visit www.aiandc.org to learn more.

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