PDA

View Full Version : 2012 as a NEW ERA in Chiropractic Medicine



NUHS-AUC
10-02-2011, 01:15 PM
Will 2012 be the begining of a NEW ERA in Chiropractic Medicine

With progressive institutions like NUHS adding MScACP and adding Pharmacology and Minor surgery to DC education, in addition to requiring a BSc/BA with GPA>2.75. I wonder if 2012 will be the begining of new ERA in Chiropractic medicine, and how we can push forward to support public's demand for Primary Care Physicians, and how DCs can help fill the void:

I figured we better take a proactive approach and help fix the current issues in the profession:
Specifically:

1. DCs to expand scope: to include minor surgery and prescribing rights
2. Have Chiropractic become mainstream: adopt NUHS curriculm & new admission requirements (GPA>2.75) perhaps even require MCAT
3. CCE requirements to follow NUHS curriculum & ADD: a. Residency & Hospital affiliation b. Pharmacology 220 hrs & Minor Surgery 100hrs
4. Amend chiropractic dogma: Subluxation theory & practice are part of Chiropractic first year Philosophy & history class, spinal manipulation and physical medicine are to be continued as evidence based MSK classes in years 2-3. (PT, Flexion Distraction, Manipulation, rehabilitation as is.)
5. Have Chiropractic degree (DC) become accepted as "Doctor of Chiropractic Medicine" or DCM, with FULL scope in accordance to NEW CCE Requirements and training. DCs that were part of the old curriculum wishing to expand scope are to take the MScACP, or any program that is recommended, and accredited by the CCE.

Thanks,

Forsaken38
10-06-2011, 09:20 PM
Everything you suggest will be determined by politics. I would love to see every one of these changes implemented by 2014, but it will take some serious legislative action in every state. The CCE will slowly start to implement some of these in the next 5 years, but we will have to fight opposition of both ends of the spectrum to achieve anything more than that. The residencies will be a huge game changer. Even without minor surgery training, the hospital affiliation would be the largest milestone, I think. Becoming mainstream, changing guidelines to include chiropractic tx in the standard of care according to research (published in indexed journals), and being recognized by established medicine as mainstream will be the greatest uphill battles. Changing the education is a great start, Legislation is the next step, but after starting hospital affiliations/residencies everything else will fall into place.

The education could be changed and have little effect without the residency and hospital privileges. These hospitals are not going to do anything without making sure Joint commission approves. In order to change that, we have to change the guidelines for tx to include conservative chiropractic as the standard of care. It will all be a political battle until we get this done. More funding for PAC's and research will help, but we have to convince the legislators on both the state and federal levels that its time things were changed.

Just my two cents, but if we're going to do something, what are we waiting for? Let's just get busy and do it.

hopefuldoc74
10-07-2011, 12:17 PM
Just an honest question here, why in the world would you expand the scope of Chiropractic instead of just going DO???

Forsaken38
10-07-2011, 10:47 PM
It's about being a better chiropractor, not being a DO. Going DO doesn't make you a better chiro or help the profession, it just makes you a DO. Going DO is like giving up on chiro as a whole. Yea we all know that we can be PA, NP or MD/DO and have prescriptive rights. But when you go those routes, you are no longer practicing as a chiro. You practice as a PA, NP or DO/MD. Everything we are trying to do is to improve the profession, force it to expand so to speak. If we all get PA, NP, DO then chiro has no need to expand its scope and will remain stagnant as it has for the last five decades.

Also to more directly answer the question, Osteopathy was mostly swallowed and integrated into allopathy. Yea there are some who still practice OMT but it is very few. The lines between MD and DO have become less distinct and more hazy so that it is difficult to tell where one ends and the other begins. Chiropractic is about the conservative responsible practice of manual therapy. Expanding chiropractic scope allows us to better serve our patients and be better doctors. Conservative, limited, perhaps even supervised prescriptive authority gives the chiro more treatment options within our current scope. I think that would be a good trial model. Allow DC's to have limited prescriptive rights and see how it goes. If well, then expand scope and add more tx options, maybe minor surgery. This would lead to DCM and Chiro's as PCP.

There are pluses and minuses to everything, so yea the whole idea has its problems and nobody will have all the answers, but it is not unattainable.

Cheers


Just an honest question here, why in the world would you expand the scope of Chiropractic instead of just going DO???

hopefuldoc74
10-08-2011, 12:50 AM
Yeah, the DO's are becoming closer and closer aligned with MD's because science and evidence is on the side of the MD's... That's why Chiropractic must change - the science that forms its foundation is flawed. If you want to be a PCP and still do manipulation, become a DO. I still am not convinced by your argument why DC's are even necessary. We have PCP's currently that practice evidence-based medicine. It seems as if we are diluting the field and possibly confusing the patient by adding yet another doctorate.

Forsaken38
10-08-2011, 10:33 AM
I wasn't trying to convince you of anything. You simply asked a valid question which I answered. I too think that chiro should be more aligned with the allopathic model, but when we are talking about research and science as the basis for practice I think we need to define ourselves. I would agree that the research and science of the first 50 years of the profession was flawed. And things didn't start to become better until the mid 1980's, but the research of the last 20 years or so has been of very good quality. There are very few who still practice based on the early methods or research.

I understand your position on chiropractic and osteopathy. But knowing a little on the history of osteopathy, it was not so long ago that they were in the same position as chiropractic, historically. But that changed. And now chiropractic is trying to change much in the same way. Why try to stop it from aligning more closely with the allopathic model? The only problem people seem to have is that they disagree philosophically. Osteopaths use omt, but it's not part of how they typically practice. Chiropractors use it as a primary way of dealing with biomechanics that have gone awry. Most of us do not want to be pcp. But we would like more evidence based options for treating MSK when manual methods need augmentation or simply aren't working because of some other underlying cause. I was simply presenting a bare bones model of how it might work best, because i think eventually it will go that direction. And I doubt most patients are confused, they are getting more intelligent each decade and most do their research before they agree to treatment from any doctor. Yes their are some idiots out there but I feel it's the responsible practitioner's duty to inform patients about any and all treatment options. Lastly let me pose a question to you, how are we diluting the field if there is a major shortage of doctors in the US? Wouldn't that be normalizing the ratio somewhat?

NUHS-AUC
11-07-2011, 03:56 PM
DCs nationwide, should voice their support of expanded scope, and email state associations, and DC schools on the importance of adding more EBM, pharmacology and minor surgery to their curriculum, in addition to opening up more residency spots.

Good luck !



I wasn't trying to convince you of anything. You simply asked a valid question which I answered. I too think that chiro should be more aligned with the allopathic model, but when we are talking about research and science as the basis for practice I think we need to define ourselves. I would agree that the research and science of the first 50 years of the profession was flawed. And things didn't start to become better until the mid 1980's, but the research of the last 20 years or so has been of very good quality. There are very few who still practice based on the early methods or research.

I understand your position on chiropractic and osteopathy. But knowing a little on the history of osteopathy, it was not so long ago that they were in the same position as chiropractic, historically. But that changed. And now chiropractic is trying to change much in the same way. Why try to stop it from aligning more closely with the allopathic model? The only problem people seem to have is that they disagree philosophically. Osteopaths use omt, but it's not part of how they typically practice. Chiropractors use it as a primary way of dealing with biomechanics that have gone awry. Most of us do not want to be pcp. But we would like more evidence based options for treating MSK when manual methods need augmentation or simply aren't working because of some other underlying cause. I was simply presenting a bare bones model of how it might work best, because i think eventually it will go that direction. And I doubt most patients are confused, they are getting more intelligent each decade and most do their research before they agree to treatment from any doctor. Yes their are some idiots out there but I feel it's the responsible practitioner's duty to inform patients about any and all treatment options. Lastly let me pose a question to you, how are we diluting the field if there is a major shortage of doctors in the US? Wouldn't that be normalizing the ratio somewhat?

AgActual
11-09-2011, 03:11 PM
Yeah, the DO's are becoming closer and closer aligned with MD's because science and evidence is on the side of the MD's... That's why Chiropractic must change - the science that forms its foundation is flawed. If you want to be a PCP and still do manipulation, become a DO. I still am not convinced by your argument why DC's are even necessary. We have PCP's currently that practice evidence-based medicine. It seems as if we are diluting the field and possibly confusing the patient by adding yet another doctorate.

Maybe you just don't know very much about chiropractic? The problem that I often run across are people that are extremely distrustful of chiropractic often have a very outdated view of the profession. I have had discussions with many, many med students that learned everything they know about chiropractic from reading articles on chirobase, failing to realize that most of those are 30, 40, 50 years old. And that seems to be the misconception found elsewhere on the internet too, that all chiros are big proponents of subluxation treatment, use strange techniques like Logan Basic, and attempt to cure serious illness with spinal manipulations. That may have been kind of how it was until the 1960's but most schools now focus on MSK treatment and nutrition. The old theories have largely been abandoned with some schools giving up things like subluxations nearly 30 years ago. My point is, I am not sure where the faulty science fits in these days. Do they teach things at DC schools, even the good ones, that we will find out are nonsense? Sure, but if you think they aren't doing that in med schools then that is naive.


Now to the issue of being a DO. The problem is that osteopathy is broad based medicine and that isn't what many DC's are looking for. Most chiros want to treat musculoskeletal dysfunction, not treat internal disorders, so why earn a degree that will focus on the latter? DO's learn manipulation, sure, but not very much. Its more out of tradition than for any clinical reason. Over 90% of DO's abandon their OMM training. The reason is because it just isn't a big part of their education. Their techniques are very generic and very simplistic. DC's on the other hand learn more manual manipulation that are far more refined and researched. Additionally, DO's don't learn any of the physical therapy techniques and soft tissue techniques that chiropractors do. Chiropractic education, once you hit the clinical sciences, has its main focus in the musculoskeletal system, unless you are at one of the few remaining, backward schools. Osteopaths mainly learn internal disorders, so not really the same thing and that is why most chiropractors didn't just become osteopaths. This idea that you can go to osteopathic school and be everything that a chiropractic is plus a whole lot more is ridiculous. It is an argument used by people that don't understand what either field is about. Osteopathy and chiropractic are not the same, at all. Osteopaths are good at what they do but what they do doesn't really involve the MSK system.

And lets not get confused about the PCP issue. Primary care is not synonymous with MD or DO. They are involved with primary care but mostly with visceral disorders and severe pathology. Same with a clinical psychologist, they are primary care for mental disorders. Your dentist is primary care for the oral cavity. Optometrists are primary care for eyes and vision. The advocates for DC's earning prescription rights and becoming identifying themselves as PCPs has to do with primary care of the MSK system, since we don't really have a musculoskeletal primary care expert out there. MD's and DO's don't really fit that bill, since the typical allopath or osteopath's training is rather limited in issues of soft tissue and skeletal dysfunction. So, why not have DC's, with some limited prescription privileges, their knowledge of joint manipulation, physical therapy, soft tissue techniques, fill the void? We aren't talking about chiropractors trying to treat cancer or autoimmune diseases or perform heart surgery. Just enough medical and surgical training to fully treat most, common MSK dysfunctions.

And before you say that DC's are not getting the training to know how to do that, you should really research what chiropractic education is like in 2011 (as opposed to 1945 as many people seem to think). Ask NUHS-AUC if he thinks that DC's from National, Southern California, Bridgeport, Western States already have the expertise to handle being PCP for MSK conditions and if some extra training would prepare them for prescription privileges and minor surgery. As a DC/MD I would say he has far better insight into this issue than anyone else here, certainly better than you or me.

rKrause
11-12-2011, 09:48 AM
I was wondering what would be some examples of minor surgery that chiros would be able to perform?

NUHS-AUC
11-12-2011, 02:02 PM
As a former DC graduate and currently, a general surgeon resident, I believe DCs do have the know how and should be further trained in the following, NUHS is already training DCs in Pharmacology and emergency medicine, we just need to provide DCs with further practical experience , and have them fill the void of primary medicine:

Here are some example of basic minor surgical & adjunctive procedures that DCs can & should be able to perform:

Aspiration/incision of abscesses or cysts
Biopsy of skin lesions and moles
Burn treatment
Cryotherapy
Destruction of skin lesions
EKG testing and interpretation
Echocardiogram
Excision of moles for cosmetic or medical reasons
Holter Monitor
Hemorrhoid excision
Injection of medication
Injection of joints
Removal of ear wax
Removal of foreign bodies from ear, nose or skin
Skin biopsies
Shaving of corns or calluses
Spirometry
TB testing
Vaccine administration
Venipuncture blood testing
Wound repair (stitches)
Basic primary care pharmacology



I was wondering what would be some examples of minor surgery that chiros would be able to perform?

NUHS-AUC
01-01-2012, 10:10 PM
Hope that more DC colleges / universities will follow with more MSc(ACP) programs, or amend current program with additional science courses, higher admission standards, etc...

Dr. Prince
09-06-2012, 04:55 PM
I get accepted to start Chiropractic school but after reading all the negative post about the profession, I am scare go. The state of Florida pass a new PIP law which make it really hard for DC. I am a Florida resident and I would like to practice there. I need to make a decision in a couple of weeks. Any current or former DC out there I need your advice. Let me know what you think.

docmobile
11-04-2012, 09:19 PM
Dream on! I heard the same basic pitch as a tri 1 student 24 years ago and IT HASN'T HAPPENED YET! If you want to practice Medicine do what everyone else does who has the same intent; attend Medical School. You can have all the things that you are seeking without trying to change 100+ years of tradition and practice. Subluxation is an accepted "scientific" term (I am sure you love to hear that word), and correcting subluxation is by far the single most significant thing a Chiropractor can do (but certainly not the only thing). The objection that MD's have with Chiro's is keeping the same peolpe coming for weeks/months/years for the same problem under the banner of "maintenance" I think it really comes down to maintaining the practice income more than the health of the patient. The DC's I have spoken to who have attended medical school say that they are glad they did, they have a more fulfilling career and even get many referrals from other Dr's for Chiropractic.

docmobile
11-04-2012, 09:41 PM
Follow the Motto of your school; 'To be rather than to seem' If you want to be an MD, then be one! A DCM is not. When the representative of the admissions office tells prospective students "If you want to be an MD, come to National" and they graduate with a DC degree, isn't that misleading to say the least or even fraudulent? A school in Texas was telling prospective students they would be practicing "medicine" 20 years ago. I advised one of these impressionable young persons that if that is what he wanted to do, he should not go into Chiropractic-he would not be happy. He left discouraged, but isn't he better off knowing the truth? Maybe the motto should be 'To seem rather than to be'

docmobile
11-04-2012, 10:52 PM
Osteopathy was started by Andrew Taylor Still, who was an army surgeon during the civil war. He became disillusioned with medicine following two of his sons dying in surgery. He was a full-scope Dr. of his day, but chose to limit his practice on treating the 'osteopathic lesion'. If you have the opportunity to read his book 'The Philosophy of Osteopathy' it is fascinating to realize the tremendous powers of observation he had when associating bstructure and function. He was not a limited license practioner who was "absorbed" by medicine.

docmobile
11-04-2012, 11:03 PM
The types of minor surgery that DC's would be able to perform are 1) those that require no anesthetic, 2) those that will not require antibiotics and anticoagulants since DC's do not have a DEA# nor prescriptive rights. I am trying real hard to think of what those examples might be......If you want to have surgery done, why not seek someone who has been trained by experts in the field and does it frequently?

docmobile
11-04-2012, 11:05 PM
Is it really politics then that determines the direction of healthcare or is it "Evidence based care"? Are we primarily concerned about what is effective and cost-effective or about becoming good politicians?

docmobile
11-04-2012, 11:08 PM
What hospital are you doing your general surgery residency in? What year are you in and do you currently have a medical license?

canuckdc
11-05-2012, 10:45 AM
haha..get it off your chest docmob!... great rant btw. and so true

docmobile
11-07-2012, 03:31 PM
First of all, Chiropracic Medicine? Only one state (Florida) will allow that title to be used and this is the same state that recently had a substantial reduction in DC's participation in PIP reimbursement. So, where did this intended EXPANDED SCOPE get them? Nowhere, or even worse off than before. Secondly, all this talk about Scientific and Evidence-Based care; did we forget about the government study @ 1994 that showed what Chiropractors are best at was more effective as an intervention for LB pn than meds., p.t. surgery etc? Does anyone really believe that to become a direct competitor of MD's will make us more popular?

Doc Mobile
02-22-2015, 07:43 PM
But, can MD's correct subluxation? Is that within their scope of practice?

Doc Mobile
02-22-2015, 07:47 PM
DO's were never in the same position as DC's in the US. they were always full scope physicians, utilizing surgery as well as neuromusculoskelatal treatments and medicine.

Doc Mobile
10-31-2018, 09:11 PM
If I need any minor surgery, you can bet I’ll be looking up the local DC from National or wherever who had 100 hours of it, probably not taught by a surgeon and who also can’t prescribe any antibiotics, antithrombotics or pain meds! Yup, I’m going to have the “Chiropractic Physician”as my surgeon! ��







Copyright © 2003-2018 ValueMD, LLC. All rights reserved.