We Need a Chiropractic Tea Party
In Dr. Alan Fuhr's article, "Lessons Learned from the Recession" [Sept. 9 DC], I appreciated his historical perspective about experiencing 13 recessions and his assessment of this one as being the longest and deepest.However, I question his statement that most chiropractors are doing well during this recession. From personal experience, talking with other chiropractors, and my own observations, I would say a large number are struggling to survive.
I know of several new graduates who have gone out of business, and of a chiropractic couple in successful practice for 25 years who have closed their doors. In spite of expensive consultants, new equipment, advertising and numerous changes to our practice over the past four years, we have gone from a six-figure net income to making less last year than I was making as a school teacher 30 years ago (adjusted for inflation).
I have always been told, "It is not what happens out there that makes a practice successful, but what happens in here." This is only partly true. The reality is we are competing with the richest, most powerful, and well-entrenched monopoly that has ever existed in the history of mankind, and it is getting more powerful. The medical and drug monopoly is succeeding in hurting chiropractors and other natural healing professions by economic strangulation. Because they control every aspect of the health care market, they are able to control payment for health care services as well.
Payment to non-medical health care providers has become increasingly below what it costs to deliver that service, while the medical monopoly receives triple or more for the same service. When the average citizen puts their dwindling funds into health insurance and pay ever-increasing co-pays and deductibles, a large number see chiropractic as a service they can no longer afford. This happens even though most prefer chiropractic and natural health care.
In a free market, the provider who gives higher patient satisfaction at lower cost should dominate the marketplace. This cannot happen with health care in the United States because economic freedom is not permitted.
In a county of 50,000, our private not-for-profit hospital employs over 150 medical doctors. It is also the area's largest and highest paying employer, with over 1,500 of the area's best talent. Over the years, it has taken over every nook and cranny of the health care market and aggressively competes with private, taxpaying providers with the best marketing millions can buy.
In the United States, the government agencies (FDA, CDC, NIH and HHS), the drug and medical device manufacturers, the AMA, the medical schools and research departments have a strong economic incentive to see that the medical monopoly continues. Allowing a free market in health care would likely slash health care costs by a third of the current 17 percent of the GNP, but these organizations will never allow it.
As a profession without drugs and surgery, we will never be included no matter how well we document or show decreased costs and high patient satisfaction, or have positive research studies. They do not care! Monopolies are out to eliminate competition, period.
We need to organize to do what the colonists did at the Boston Tea Party in 1773 to protest the British monopoly and restriction of the tea trade. We need to publicly protest medical monopolies, organize some pickets for free trade, and start a free trade movement in health care.
As for me, I will continue to practice chiropractic even if I have to support myself with another job. I will continue to proclaim our motto: nature first, drugs and surgery when necessary.
Don Selvidge, DC
It's Time to Move On
It's time to move on. It's time to define who we are as a profession and what we do in a meaningful way. It's time to let a subluxation be "just" a manipulable lesion and allow chiropractic to move into the next century. We project an antiquated definition of who we are and what we do. Kind of like a dentist who practices without novocaine and uses a pedal-powered drill (and brags about it). Why would an MD want to refer or a patient want to come? I suppose we may have to leave a few of the more vocal dinosaurs behind, who have become so petrified in their practice and myopic in their point of view that they think they know what's best for all chiropractors and all chiropractic patients. But it's time to move on, whatever that means.
It doesn't take a weatherman to see which way the wind is blowing in health care these days. If this profession continues to be marginalized by our "definition of chiropractic," then we will be considered nonessential and our services will not be covered. It's time to move on. The subluxation-based chiro will always be here. So long as they are selling the subluxation or some variation of it, there will be those who will want to buy it and will be willing to pay cash. But for those who take the degree of Doctor of Chiropractic seriously and who want to practice as they were trained - as doctors - in an evidence-informed way, we will have it hard.
In a system that is desperately in need of our education, skills and training, we struggle more and more to make a living and struggle even harder to do so with some integrity. And by integrity, I don't mean that philosophical scat; I mean knowing and telling people the best scientifically verifiable truth, even if it's not profitable, and referring them when it's in their best interest. This is why people go to a doctor and how cultural authority is established. We are educating and training an army of doctors who will have scant patients, no cultural authority and no access to the system. For them, for our patients and for ourselves, we need to move on.
It's interesting how often the ICA's and occasionally the ACA's goals for chiropractic are very close to the AMA's, which is to contain and limit chiropractic. As much as I dislike it, I understand the AMA's motivation, which is what it always has been: the idea that if growth is stifled long enough, chiropractic will die on the vine. However ,as far as our chiropractic associations go, I cannot begin to fathom their actions and have absolutely no faith in their leading us into a better future. And now, with our classification as physicians under attack in Texas and elsewhere, and our ability to diagnose in question, the AMA may get its wish, with us complicit in our own demise. How's that for an ugly irony?
Personally, I am increasingly frustrated and embarrassed to have to explain to patients who have had a very aggressive ROF that no, subluxations don't cause cancer, and no, there is no evidence to show that ADD/ ADHD can be treated with manipulation or that autism is the result of an untreated subluxation due to birth trauma, etc. It's time to move on. And those more esoteric among us who want to practice by telling patients there are ghosts in the machine to explain what they do, fine. But let the rest of us move on. The CCE has a singular opportunity to bring this profession into the next century, and every rational individual should be rallying behind it.
Sidney McCauley, DC
We Must Protect Our Rights
We all should be watching the effort in Texas to take away our full rights to diagnose. [See "Texas Judge Rules on Diagnosis Issue: Is Some Diagnosis Better Than None?" in the Oct. 21 issue.] What state will try next? More than any other insult initiated against chiropractic, this one could truly affect our ability to practice and provide patient care. As usual, once your rights are limited, it is very difficult to get them back.
Regarding the 2009 ruling by Judge Yelenosky about MUA and needle electromyography, I believe we are qualified to interpret and respond to the outcomes of these treatments, so in my mind, they should be included in our scope whether or not doctors choose to provide those services themselves. MUA is certainly a topic that deserves discussion and hopefully, consensus of our position. One thing you can easily observe about our medical colleagues is that they have no limits on what they will try on the human body.
No contraction or expansion of rights happens without a fight. This seems to be the time for all chiropractic organizations to merge mailing lists and get the professional and financial support from all chiropractors to keep the TMA and TMB in their proper place (not the exalted, bullying position they assume). Our detailed training meets all the criteria established to diagnose. The time is here to gather and legally protect our right to practice as physicians wherever that fight takes place.
Paula Strauss, DC