A minority of military treatment facilities currently staff a doctor of chiropractic, but the House Committee on Armed Services appears committed to ensuring DCs currently contracted within the Department of Defense health care system receive wage rates on par with other providers employed at such facilities. Included in the National Defense Authorization Act for Fiscal Year 2013 (H.R. 4310) is a committee report that makes the following observations regarding chiropractic as provided within the DoD:
"The committee understands that for more than a decade, the Department of Defense has provided high-quality chiropractic health care services to Active Duty military personnel at military treatment facilities throughout the world. Today, chiropractic health care continues to be a key benefit for the men and women of the Armed [Forces] as a result of increased incidences of musculoskeletal injuries sustained in combat. However, the committee is concerned by disparities in pay and job classifications that have resulted in chiropractors receiving lower wage rates than health care providers with either comparable or less training, skill sets, and health care responsibilities for patients in military treatment facilities.
"Therefore, the committee directs the Comptroller General of the United States to conduct a study and submit the findings to the Senate Committee on Armed Services and the House Committee on Armed Services by April 1, 2013, on the wage rates for chiropractors within the Department of Defense as compared to health care providers with either comparable or less training, skill sets, licensure and certification requirements, and health care responsibilities."
The House Committee on Armed Services' report marks the second time the committee has recommended DoD review of chiropractic wage rates. Last year, a letter sent to Dr. Jonathan Woodson, DoD assistant secretary of defense for health affairs, outlined perceived wage disparities experienced by chiropractors within the Department of Defense and requested they be corrected. The language in that letter, signed by 15 committee members, is similar to the language in the committee's 2012 report accompanying H.R. 4310.
As of press time, the FY 2013 National Defense Authorization Act was under Senate deliberation following approval by the House. For current status of the legislation, click here.
While the DoD has been directed to develop and implement the chiropractic benefit at military treatment facilities, and make that benefit available to all active-duty military personnel in the U.S. Armed Forces, for more than a decade, only approximately 60 facilities currently offer chiropractic. In 2005, the U.S. Government Accountability Office said the DoD had failed to "actively promote or closely monitor" the benefit, resulting in significant gaps in the delivery of chiropractic care. With the House Committee on Armed Services' recommendations in 2011 and again in 2012, it seems clear that although chiropractors have advanced within the DoD health care system in the past decade, there is still much progress to be made.
Despite these challenges, the flip side is that chiropractic is definitely on the federal radar. For example, two years ago, the DoD's Defense Health Program for fiscal year 2010 included a landmark Chiropractic Clinical Trial Award "intended to support the rapid implementation of clinical trials that examine the effect of chiropractic clinical treatment either exclusively or as an adjunct to other treatments on health concerns relative to the Warfighter [member of the Armed Forces], including non-surgical orthopedic injury, pain management, smoking cessation, injury prevention, and enhancing fitness for duty."
The Palmer Center for Chiropractic Research, the RAND Corporation and the Samueli Institute reaped the benefits of that award last year, receiving $7.4 million for a four-year, three-clinical-study investigation to be conducted at six military locations.
Goals of the ACT Assessment of Chiropractic Treatment, led by principal investigators Ian Coulter, PhD, Christine Goertz, DC, PhD, and Joan Walter, JD, include the following:
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
