Managed care acknowledges that resources are finite. Successful professionals will be those who understand costs and satisfy the patient. What is patient satisfaction? Frankly, it is the recognition that each person is biologically unique, and that their fears and concerns are recognized. It is synonymous with caring, and is the result of a patient's judgement, not the doctor's viewpoint. Thus, the patient has concluded that the professional services they received were valuable because the benefits were balanced with the costs.
Certainly the chiropractic profession, which has significant research support from numerous patient satisfaction studies, should place more research emphasis on this vital area of care. The marketplace knows that the "bottom line" is enhanced by customer satisfaction.
On September 20-21, 1996 in Chicago, the long desired meeting of the many segments of our profession took place. To all who attended, it was a surprise, because the conversation was constructive, problem-focused, and free of ego, pomposity and politics. I saw collaboration, discussion, direction, soulful thinking and civility throughout the two days. These qualities are the ingredients of leadership.
However, this collegial meeting almost did not occur. One wonders why a few political leaders would try to kill this very necessary meeting. My guess is that they would rather see nothing happen if they can't control it. I have been to more meetings that I care to remember; but this one was a no hype, serious attempt to identify our professional problems.
The Association of Chiropractic Colleges presented a written paradigm that all DCs can buy into. I must gleefully add, this paradigm is supported by all CCE chiropractic colleges. It wasn't too long ago when we engaged in pro and anti CCE belligerence. Thank God we achieved accreditation status, or we would be "bye-bye" in this managed care age. In spite of the small minds, I hope the NCMIC conference will ignite us to brush aside political spin and substitute serious problem solving immediately, otherwise there is no chiropractic for tomorrow. Chiropractic Services
As we mature professionally we will recognize that chiropractic services offer a unique opportunity to help mankind. Furthermore, as financial support for research grows, we must direct basic research to the effects of the subluxation. Without a doubt, the neurophysiological effects of the subluxation must be studied by us. Otherwise, we will never know whether our philosophy of health is truly essential for mankind. Yes, I know chiropractic care has helped millions, but we still need to admit that the centrality of the nervous system and the effects of abnormal musculoskeletal conduct have not been established beyond a reasonable doubt.
Yes, there is sound empirical data which supports the positive physiological responses to spinal adjustments in a variety of clinical problems such as hypertension, headaches, and other stress related conditions. However, this is not enough. We need to demonstrate through basic research that our desire to help sick people is not a copy of physical therapy, osteopathy, et al. I believe basic science, while very expensive and demanding of special expertise, must be addressed with the same vigor that achieved our CCE status.
It is sad that financial support for chiropractic research is so minimum when we realize the tax payer support for the millions of NIH projects which heavily favor drugs and surgery with next to no concerns for natural health research. But, political effort by various US senators created an Institute for Alternative Medicine. So, politics can give rise to worthy achievements. When DCs realize that allopathic medicine's social authority resulted from politics, we will stop blaming our failures on others, and advance chiropractic to a more prestigious state. It was political action on the state level which passed insurance equality laws in 41 jurisdictions. We need the same unselfish spirit of the '70s in the '90s if managed care is going to open its gates to chiropractic care.
Why don't we get all state associations to pass POS (point of service) legislation in 1997. That way, we become gate openers by protecting the public's direct access to chiropractic. Then, gate keepers who have been mostly MDs, can concern themselves about their colleagues. Gate opening should be chiropractic's 1997 goal. Maybe the Congress of Chiropractic State Associations can adopt this worthy project.
Is There a Future?
After attending the NCMIC conference I believe we have the ability to solve our problems. The only question is, who will lead? The present heads of our trade associations don't seem to have what it takes. Perhaps, the new leadership will result from coalitions. In my mind it is unfair to think any trade association has all the talent and money to put our house in order. The AMA with all its resources can't fix their problems, so why do we think we can fix all of ours? This is the age of information which lends itself to the transfer of data and ideas; this is what coalitions are made of.
Let's make 1997 the year of gate opening, not only for managed care problems, but for the present intraprofessional obstacles to truth and cooperation. Only by this direction will we stop the erosion of the profession. How do you feel?
Arnold Cianciulli, MS, DC
Bayonne, New Jersey