Life is a whirlwind of change. Some areas change faster than others, but change they do. In the past six months, during what some have referred to as a global economic meltdown, we have seen corporate mergers and takeovers, bankruptcies, bailouts, stock market corrections, plant closures, home foreclosures, rising unemployment, perishing pensions, fluctuating gas prices, and a fear-gripping recession.While the rate of the economic decline appears to be slowing, no one is predicting the decline is over; more change is surely yet to come.
In the area of health care delivery, change is also at our doorstep. Providers of care and their patients, regardless of their professional roots, should be concerned. With a firm resolve and health care industry support exceeding that of the early 1990s, President Obama has promised change in how health care will be delivered to U.S. citizens. No one plan has been accepted, but movement toward a single-party pay system has significant popularity. As health care reform blows across the skies, creating a "perfect storm," as the ACA calls it, chiropractic cannot be left "blowin' in the wind." We must be a prominent player at the table of decisions as the reform process moves forward.
No One Is Going to Bail Us Out
Fear of the unknown - the outcome of this reform process - makes for restless nights and anxious days. At this point, we can only speculate with predictions of "things will change." Perhaps a glimpse into the business and corporate world can offer some insight. Will the low-pressure gradient of the storm center be the catalyst for a merger of national associations? Times of economic stress hardly justify duplication of effort and costs merely to maintain egos and philosophical differences residing in the minds of those at the margins of the profession.
Is there an organization or individual with adequate resources to bail out failing industries within chiropractic? I know of no one in the chiropractic profession able to print their own money, like the federal government, and use that money to shore up bankrupt or near-bankrupt chiropractic enterprises. It doesn't take a PhD in economics to surmise that in the chiropractic industry, bankruptcies, plant closures, unemployment, and other financial exigencies are being discussed. Will the current storm bring about closure of our teaching institutions, consolidation of practices, loss of dollars for research support, aggressive or unscrupulous marketing, new political alliances, interprofessional assimilation, or dissolution of some of our historical professional icons?
Change = Opportunity
Not wanting to be associated with predictions of gloom and doom, I offer a perspective that change, while individually painful at times, can be beneficial when considering the "greater good" of the community. I am often asked if chiropractic will survive this storm. I usually respond, "Chiropractic care of people with pain and dysfunction, appropriately administered, has existed in some form (not necessarily called chiropractic) for as long as history has been recorded." What we do with our hands and our knowledge of health and disease is a highly desirable service for a large segment of the human family and will never disappear.
How we posture ourselves as a profession through our national and local political associations; how we support efforts to explore new clinical horizons and explain current clinical success through research; and how our educational institutions train the next generation of doctors, given their constant struggle for adequate resources, will largely determine the status of the chiropractic community and industry. Low membership support in any organization, the near absence of support for research and development, and superfluous schools - many with low enrollments and nil alumni support - do not bode well for a sustainable financial future.
And yet, the continued expansion of acceptance for alternatives to Western medicine by society creates a hole in the storm cloud through which safe landing can be maneuvered. The presence of a National Center for Complementary and Alternative Medicine is a statement of presence by the National Institutes of Health that CAM care, which includes chiropractic, has a role to play.
Acceptance of chiropractic services in the Veterans Administration health care system, the Department of Defense health care system and many other similar organizations represents a toehold in health care reform that must be strengthened and expanded in spite of the storm's intensity. International bodies working on standards for education, licensure equivalency, portability of services, and international research collaborations have created a worldwide image of a profession recognized by the World Health Organization.
In the flatlands of mid-America, when a storm front rolls over the landscape, the air smells of ozone and static electricity; funnel clouds present a frightening scene and residents are trained to run to the basement or the root cellar for safety. In the storm of health care reform, the tendency to bury ourselves below the ground for safety may protect us individually, but does precious little for the protection of the community - the larger chiropractic community.
Get Involved and Be Prepared
Fortunately, rather than dealing with the forces of nature over which we have little control, the storms of health care reform can be controlled if we exert the most powerful kind of influence collectively as a profession. Changes in health care reform are inevitable and unpredictable, but not predestined. We, the chiropractic collective, must be alert and ready for change while working diligently to effect that change for the benefit of those we serve, our patients. Hiding in the root cellar of nonparticipation is not the course of action that will have consequential influence. Get involved and be prepared.
Click here for previous articles by Reed Phillips, DC, PhD.