Toward a Mainstream Chiropractic Identity
By Dennis Marchiori, DC, PhD, Chancellor, Palmer College of Chiropractic
The greatest challenge now facing the chiropractic profession is our need for greater public awareness of the benefits of chiropractic care. In part, this will be accomplished through a clearly defined professional identity – one that allows our profession, our patients and the general public to understand the essence of whom we are, what we do and how we contribute significant value to the health care system and society as a whole.
It is no secret that we currently lack such a broadly recognizable identity; surveys consistently show strong majorities of chiropractors agreeing that the profession requires a clear public identity if it is to thrive in the 21st century, while at the same time stating that we currently lack such an identity. How can we square this circle? The stakes are high. For the past three years, Palmer College of Chiropractic has engaged in a rigorous chiropractic identity project to develop a marketable identity statement we can communicate to the public and our fellow health care providers; an identity statement that is also supported by the broad mainstream of the chiropractic profession.
Leading from the Center at a High-Stakes Moment
Because 25 percent of the world's doctors of chiropractic are Palmer graduates and because Palmer's own identity combines a deep respect for chiropractic tradition with full engagement in cutting-edge developments in evidence-based practice, we feel we are uniquely positioned to aid in the profession's transition through its current identity crisis and to help it emerge with a renewed sense of clarity and commitment. We see this as "leading from the center" with broad-based, common-sense approaches. We sincerely believe our work will strike a resonant chord with an overwhelming majority of the profession. Most importantly, we want to grow this movement. We ask other chiropractors and chiropractic organizations to join us in using these identity statements as core components of public outreach.
A Wide-Ranging Process That Builds on Previous Work
We deeply appreciate previous efforts to explore chiropractic identity and develop identity statements, most notably that of the World Federation of Chiropractic (which represents the national associations of more than 80 nations, including the ACA and ICA). Those familiar with the 2005 WFC Identity Statement will recognize some of its insights incorporated into our new documents. We did not seek to reinvent this wheel, but rather to refine it and in certain key respects, enlarge its scale.
Before presenting the product of our work, I want to explain our process so readers can understand its wide-ranging nature. From the outset, we sought to create a series of identity statements that would resonate broadly both inside and outside the profession. To accomplish this, we needed dependable data not only from our college community and alumni, but also from the general public and patients at our clinics. While the WFC extensively surveyed the chiropractic profession to formulate its conclusions, it did not collect data from patients and the public.
Palmer's leadership felt this kind of expansive outreach was critical to ensure we would avoid an "echo chamber" effect, whereby we assume that our internal messaging will resonate externally with the general public because it has resonated internally within the profession. A thorough "reality check" is critical if we are to make our case effectively in the court of public opinion, particularly because past research has brought to light some stark discrepancies between the way chiropractors see the profession and the way the public sees us. If we are to change public perceptions of our profession, we need to know what those perceptions are and then craft our messages accordingly, with great care.
Questions in our survey were developed through two rounds of data collection. The first was an internal Delphi process at Palmer's three campuses involving faculty, academic administrators and alumni. What emerged from this process was a series of phrases and concepts encompassing three primary domains: seven phrases related to the central focus of chiropractic, nine phrases on the practice of chiropractic and 11 phrases addressing the characteristics of chiropractors. These phrases formed the foundation of our survey.
This internal process was followed by external outreach, in which the survey was sent to Palmer College alumni, recent graduates, patients and the general public in the United States. For this phase, we utilized the services of SSR International, a well-respected company with extensive experience in survey research. Individuals receiving the survey were asked to rate each of the statements on a scale of strongly agree; agree; neutral; disagree; and strongly disagree.
What the Survey Results Tell Us
Robust majorities of our chiropractic community – alumni, recent graduates and clinic patients – agreed that chiropractors are health professionals and are concerned with spinal health care. On these issues the general public strongly agreed. Palmer constituencies, including patients, also strongly agreed with statements identifying chiropractors as spine doctors, musculoskeletal doctors, neuromusculoskeletal doctors, and prevention and wellness doctors. On these statements, the public also agreed, but with smaller majorities.
The sharpest split between the chiropractic community and the public came in response to the statement, "Chiropractors are primary care doctors." Nearly 90 percent of our recent graduates agreed, as did 72 percent of alumni; however, barely half of our clinic patients and a strikingly low 16 percent of the public saw DCs in a primary care role. As our profession moves to more fully define our role in primary care, the differences between how we perceive ourselves and how the public sees us must be central to our strategic planning.
Reinforcing and Expanding Upon Positive Public Perceptions
Every chiropractor should feel a deep sense of satisfaction that a majority of the public recognizes our profession's expertise on the spine and the neuromusculoskeletal system. We should also be pleased that our concern with prevention and with our patients' overall well-being is now part of our profession's public identity. This gives us a solid foundation upon which to build.
For a chiropractic profession that has faced numerous external and internal challenges in the course of its 117-year history, a forward-looking 21st century professional identity document must extend beyond merely reinforcing positive public perceptions. Crafted well, it can act as catalyst for greater public understanding of our full role in health care and in society.
Primary Care Is Now an Essential Component of Chiropractic Identity
Speaking on behalf of the Palmer community, I want to emphasize the importance and the urgency of including the term primary care in our statement of professional identity. We want to be very clear what we mean by this: we are primary care professionals within our scope of practice.
Just as dentists are widely seen as providing primary care within their scope of practice, chiropractors must strive to be recognized for primary care delivery within our own scope. But before the public will see us as primary care providers, we need to consistently define ourselves in those terms and reach a shared understanding of what we mean. Chiropractic possesses numerous characteristics of primary care. We are portal-of-entry providers; 85 percent of our patients come to us directly, not on referral. We are a self-defining and self-regulating profession whose practitioners are extensively trained and licensed for both diagnosis and management. This is what allows us to serve as doctors who are far more than expert technicians of chiropractic adjustment and manipulation.
It is what enables us to collaborate and coordinate care with other health professionals for the benefit of our common patients, giving due consideration to evidence, clinical experience and patient values and preferences. Also of great importance for our primary care role is our profession's growing emphasis on guiding our patients to minimize risk factors for chronic disease through lifestyle-based prevention and health promotion.
Claiming a primary care mantle does not mean we seek to be all things to all people; it means that in our area of expertise, we are ready, willing and able to take on the core duties and responsibilities required of primary care practitioners: diagnosis, treatment, case management and referral where needed, with evidence-based preventive care as an integral part of our domain. After due consideration of all these factors, the Palmer community believes it is in the role of "primary care professionals for spinal health and well being" that the chiropractic profession can best fulfill its mission of service in ways that meet the needs of the coming era.
Unity, Not Uniformity
The "big tent" of our profession has always included a rich variety of opinions, approaches and perspectives. In seeking widespread support across the profession for the chiropractic identity statement we have labored over these past three years, we understand that a call for unified action cannot achieve success if coupled with a demand for uniformity. We believe that any widely acceptable statement of chiropractic identity must focus on what unites us: the true essence of our contribution to the health and well-being of the people and communities we serve. We believe our professional identity statement and the explanations that support it will meet these needs; and we hope that our joint efforts in the coming years will bring forth a spirit of renewal that lights our way forward through challenges and triumphs yet to come.