Is Chiropractic Being Lost By Default?
Originally published: 2013-04-11
The Degradation of Chiropractic Education
Disturbing as it sounds, the evidence seems to support the title of this article. As noted on page one of the current issue of Dynamic Chiropractic (March 1, 2013 Vol. 31, Issue 05), in “Which Road Leads to Spine Surgery,” by Peter W. Crownfield, Executive Editor, chiropractic is glaringly absent from the mainstream mindset. When patients ask us why this remains true, we like to point out the relative youth of our profession and perhaps throw in just how far we have come. While those truths may comfort us, consideration of the profession’s actual progress and direction are a great discomfort.
We all agree that the world needs chiropractic, yet our profession is facing unprecedented challenges. The numbers of students entering chiropractic programs and the income of chiropractors have both been in a state of decline for a decade and the sad reality is that the profession is in an unsustainable situation. It’s embarrassing to see desperate chiropractic educational institutions diversifying their offerings with courses like massage therapy, naturopathy and other inapt offerings. Instead, why haven’t they considered strengthening the quality of their chiropractic offerings? What’s revealed is that the leadership of these institutions fail to see that as a viable option and the profession should be asking, “why?”
Former President Truman was famous for the sign on his desk that read, “The buck stops here.” Acknowledging his wisdom and the responsibility of leadership, we can find some clues by turning to another recent Dynamic Chiropractic article, an interview with Dr. James Winterstein, retiring president of National University of Health Sciences (NUHS). Dr. Winterstein has helped shape today’s profession and his retirement is well deserved.
In the interview, Dr. Winterstein described the good, the bad and the ugly of chiropractic as he sees it. Amongst the good, he listed items like the influence of the CCE; the successful antitrust suit against the medical profession; and the expansion of evidence-based practices. Relating to the bad, he liberally berated the division of the profession with which he disagrees, labeling his perspective as pro-science and theirs as dogma:
“Science and dogma cannot co-exist. Some will suggest that I am too caustic when I use the term dogma, but the definition of that word is clear – "a principle or set of principles laid down by an authority as incontrovertibly true."
With regard to the ugly, he favors the creation of a new social order within the profession:
“With this perspective, one of the greatest challenges facing the chiropractic profession is finding a way to move into the future with clear professional tiering.”
Understanding that the differences in opinion are primarily ideological, it is obviously counterproductive for one division to blame the profession’s problems on the other. Let’s instead recognize the reality that most practitioners in both divisions are grounded in science, offer evidence-based and patient-centered-care, and strive for high academic standards and ethical practices.
We have the power to continue feeding our differences, using our resources on the one-hundred year old internecine war and blaming the other faction for the decline, or to adopt a win-win attitude, resolve these issues and have each division use its resources to advance its mission. To do so, we must analyze the problem and examine our options.
Dr. Winterstein’s comments reflect his strong belief in using the Council on Chiropractic Education (CCE) to transition the profession into the practice of primary care medicine, prescribing drugs and performing other medical services. While president of NUHS, National’s chiropractic mission changed to one of alternative and primary care medicine. Winterstein had a significant impact on the direction of the CCE, working toward initiating policies and standards that imposed a “primary care” curriculum on all programs.
The US Department of Education (USDE) recognizes CCE as a specialized accreditor for Doctor of Chiropractic Degree Programs. The degree is "Doctor of Chiropractic" not “Doctor of Chiropractic Medicine”, nor “Primary Care Chiropractic Physician.” These terms are illegal in most states and always misleading to the public and prospective students. CCE should require all colleges to accurately refer to the “Doctor of Chiropractic” degree in their publications.
NUHS’s website indicates: “At National's clinics, you'll learn first-hand how to practice chiropractic as primary care medicine under clinical supervision.” This statement clearly reveals that NUHS is attempting to train graduates to practice primary care medicine. The fact is, chiropractors are not licensed to practice primary care medicine as defined by accepted authorities such as the World Health Organization and the Institute of Medicine. In the United States, primary care medicine includes vaccination and drug prescription for the treatment of common acute and chronic diseases such as flu, diabetes, cancer, and cardiovascular conditions - none of which chiropractors are licensed or trained to treat in any state (including Illinois). NUHS claims to prepare primary care physicians but we were unable to locate any data on the placement of NUHS DC graduates in the field of primary care medicine. By continuing NUHS’s accreditation despite this misrepresentation, CCE is complicit in misleading Doctor of Chiropractic programs’ graduates to believe they are trained as primary care physicians (like medical doctors).
Dr. Winterstein erroneously asserts that the vertebral subluxation centered division of the profession “…wants to continue to promote ideas that are unsupported by science.” That allegation, though unsupported and unconvincing is inflammatory and reminiscent of how the AMA tried to label chiropractic when it said that to the degree chiropractic differs from medical thinking it is not supported by science. Further, he complains, “…..some members of the profession are attempting to involve the federal government in the internal affairs of the profession.” Perhaps he forgot that when the chiropractic profession sought federal recognition for the CCE, it pledged to allow the government to examine CCE for compliance with federal criteria and oversee chiropractic’s vital component, the education of future practitioners and leaders. Many chiropractors, organizations and students have complained to the federal government that CCE is not in compliance with those criteria. Many of those who complained to the USDE first took their concerns to the CCE. Only after CCE failed to address their concerns in accordance with its own policy, did they submit their comments and complaints directly to the federal government. The USDE staff found many more areas of non-compliance than those cited by the complainants. The CCE was found to have an astounding 42 areas of non-compliance.
Dr. Winterstein is wrong if he believes chiropractors should allow their accrediting agency to function outside of USDE criteria for recognition and not be accountable to the profession and the public. The CCE modus operandi reflects the significant influence NUHS has had on CCE since its inception and in view of the facts, Dr. Winterstein and his colleagues must take some responsibility for these problems. Deep reform of CCE is needed, and to be meaningful, CCE governance must represent the full chiropractic community on its Council and the Site Team Academy.
CCE has degraded the chiropractic portion of educational programs
CCE requires all DC programs to provide training in differential diagnosis and primary care far beyond what is needed to practice chiropractic safely and effectively, while at the same time, fails to require or assess the clinical competencies related to vertebral subluxation evaluation and adjustment. The CCE site team training manual confirms that CCE site visitors are not trained in the area of vertebral subluxation assessment and adjusting competencies; and there is no evidence that site teams assess the clinical skills training needed in this most important chiropractic area. Furthermore, the term “subluxation” is not found in the current CCE Manual of Policies, Accreditation Manual, or Site Visit Team Manual. The sad reality is that we are losing the core value of the profession by default. The degrading of vertebral subluxation related training, due to the diversion of curricular time toward content related to CCE’s favored model of care (primary care medicine), is what has created unsustainability of the profession. This situation has led to our colleges graduating DCs without sufficient chiropractic knowledge, skills and abilities; and crushing debt. As a result, confidence about the future of the profession has dwindled as the ideological divisions have widened.
Many of us are proud of the profession’s advancement as dedicated chiropractors overcame great challenges. As members of the chiropractic profession:
- We recognize the significant role of the many chiropractic pioneers who went to jail for adjusting vertebral subluxations. We applaud the patients who fought for their right to receive spinal adjustments and the dedicated efforts of generations of chiropractors to legally establish our profession in many jurisdictions and countries against an entrenched medical establishment.
- We recognize that D.D. Palmer founded the chiropractic profession on the discovery that vertebral subluxation occurs and interferes with the function of the nervous system, making vertebral subluxation chiropractic’s core value.
- We recognize and acknowledge the body’s innate striving to restore and maintain its health and that VS interferes with that striving. The scientific evidence that vertebral subluxations can be objectively identified is well established. That reality, together with the accumulating knowledge about VS, its implications and manner of being adjusted, is the basis for an ever-expanding, relevant clinical practice.
The basic chiropractic tenets and accomplishments were unanimously adopted as the Association of Chiropractic Colleges (ACC) official position by all of the North American chiropractic college presidents. The ACC Chiropractic Paradigm remains a landmark document, recognizing that subluxation is the focus of the chiropractic profession. After an extensive two-year study the ACC issued its position papers. Additionally, subluxation - which is central to chiropractic science and practice, remains a federal requirement for Medicare in all 50 states. Medicare Part B pays only for correction of a subluxation (as documented in the Code of Federal Regulations http://cfr.vlex.com/vid/410-21-limitations-services-chiropractor-19805416). In view of this requirement and the absence of oversight by CCE on training related to vertebral subluxation, we could raise the question, “Are graduates of CCE accredited programs being properly trained to provide care to Medicare patients?” How long dare we ignore this federal proviso and the profession’s core value when accrediting our educational institutions?
In discussing the ugly of the profession Dr. Winterstein recommends tiering the profession. By "tiering" the profession, Winterstein seems to envision that his concept of chiropractic medicine would be the division in charge and the vertebral subluxation centered division would be relegated to a lowered technician status. This is both unrealistic and contentious. To reduce doctors practicing precise vertebral subluxation centered chiropractic to technician status is not only repugnant to them, but it also insults all persons who understand the high level of training and practice involved. Furthermore it ultimately diminishes both divisions of the profession. It would be far more productive to seek a more rational solution. Instead of harmful tiering, the profession should acknowledge its ideological differences and open the door for each division to flourish with neither tiered above the other. A necessary transition could be phased in. It could begin with the CCE opening up two educational tracks as the National Board and licensing boards adapt to reflect the different missions. This would take some worthwhile effort including negotiations by people on both sides, but ultimately it would establish a means of coexistence and advancement without destroying the profession.
Chiropractors provide safe, competent analysis and necessary adjustments. They should be available to everyone, regardless of gender, age, race, or concurrent conditions. Today, leading universities are spearheading various new technologies to offer quality education using new, more cost-effective modes of instruction. Many countries are eager for the expansion of chiropractic education and we need to think in terms of increasing our profession’s service many fold. That is the road to a sustainable future for chiropractic.
About the Sustainability Committee: The Sustainability Committee is a think tank dedicated to sustaining and advancing vertebral subluxation centered chiropractic. Founded in 2009, the Sustainability Committee is composed of colleagues holding diverse viewpoints within chiropractic. As an autonomous body, it is neither linked to nor does it replace any professional association.
The Sustainability Committee : Myron Brown, DC, Former Executive Vice President/Provost, Sherman College; Arno Burnier, DC, MCQI co-founder & former CE faculty of SCC and LCCW; Brett Casanova, DC, President, Illinois Prairie State Chiropractic Association; Bill Decken, DC, Chair, International Federation of Chiropractors & Organizations; Richard A. Franks, B.S., D.C., President, Chiropractic Lifecare of America; Thom Gelardi, DC, Founder and Former President, Sherman College; D.D. Humber, DC, Former Vice President, Life University; Christopher Kent, DC, JD, President, Foundation for Vertebral Subluxation; Serge Sautre, DC, Sustainability Committee Chair and former Life University Faculty and Personal Assistant to Dr. Sid E. Williams; Felicia Stewart, DC, ACP, Board member IFCO & PSCA; Steve Tullius, DC, Co-founder MCQI.
