If you haven't heard the latest news in the health reform movement it is the announcement that Obama has appointed Donald M. Berwick as the Director for Medicare and Medicaid. I consider this to be very big news - even if he ends up being marginalized and has his hands tied for the next several years.

Why is this big news and why should we as chiropractors care about this?

I've been writing over the past few years that the chiropractic profession is in the midst of a 20 year perfect storm. The perfection is in the storm however - not necessarily its outcome. its made up of several things ocurring simultaneously within the profession, within the larger culture of health care and within the larger societal culture in which health care operates.

I rarely take a stand on an issue or espouse an opinion regarding an issue with an attitude of certainty. But on this issue I have few, if any, doubts.

This perfect storm includes the slow painful march towards payment for health care based on outcomes. That's where Berwick comes in - he is a leading, if not the leading, guru on this subject. When children born today reach their 30's and 40's they are going to look back at the dark ages of health care and wonder what the hell we were thinking. "You mean you had a system of health care where people actually paid for things that didn't even work?"

With all its faults organized medicine does not have the outright disdain for research that our profession has. So while its going to be painful for them to go through this - its nothing compared to what our profession is about to experience. You are going to have spent $200,000.00 and 6-8 years of your life to treat a very narrow range of neck pain, back pain and headaches. Release the imprisoned impulse? LOL.  The general disdain for research in this profession is bad enough - within the various subluxation based factions it is even worse.         

Add to this that within chiropractic we have the 40% decline in chiropractic college enrollment that has ocurred over the past decade.

 

I predict that several of the smaller chiropractic programs are going to fold up their tents in the next 5-10 years which will consolidate enrollment in just a handful of larger schools. I predict that enrollment will remain flat, as it has for several years, and even inch downward a bit.

This will happen for a few intertwined reasons. Students no longer enter chiropractic soley because they had a personal experience that changed their lives or because they had a family member who got them into the profession. Most are entering because they simply made a career choice. The savvy health sciences student absent a life changing chiropractic event or being brought up in the TIC is considering chiropractic, osteopathy, medicine, physical therapy, pharmacy, dentistry etc in terms of a career choice. 

The savvy potential student is weighing the costs of a chiropractic education with what he will get at the other end. Given that it costs about the same $200,000.00 to become an osteopath or MD as it does to become a chiropractor and given the perks, discounts and sign on bonuses being offered by pharmacy programs and drug stores to become a pharmacist, and given that physical therapists are now doctors, have primary care status and are fully integrated into the health care system - the potential chiropractic student has much to weigh.

Chiropractic's move away from being drugless and its embracing of the primary care physician designation in order to get paid for more codes has just further diluted our brand. On the other end of the spectrum there is the move to present oursleves as all things "wellness" to the public when we don't own the patent on that either. Why spend $200,000.00, four years, four parts of the National Boards etc to do what any gym rat or stay at home mom can do? $200,000.00 to tell people to eat right, exercise, get proper rest and have a positive attitude?

I spoke to a graduating student recently with $200,000.00 in student loans who was asking advice about what to do after graduation. His plans included setting up a practice by borrowing over a $100,000 with his parents co-signing and putting up collateral. Oh, and by the way his wife is also about to graduate as a chiro, and they just had a baby and are buying a house. Nearly a million dollars in debt between them and they haven't seen a single new patient yet.

Our profession needs to take a serious look at itself politically, academically and research wise if we are going to survive this storm. And I'm not talking about individual chiropractors. I know very well that an individual chiropractor can see hundreds of patients a week and make millions of dollars a year. But the average chiropractor won't - and those seeing 500, 600, 1000 a week (and getting paid for each visit - not the $10 and I'll see your whole family BS) are in the tail of that normal distribution. Yes, its possible - but not probable.   

And just where are those 1000 + a week practitioners in terms of the politics of the profession? Are they speaking up about the direction a small rogue faction of the profession is taking us? What about the groups that train them? Are they mobilizing their armies of chiropractic warriors to unseat the entrenched powers in the profession? Are they donating gobs of money to fund the research we are going to need in order to even be an afterthought in the coming outcomes based healthcare system?

Because it is coming whether we like it or not. And its coming no matter how hard we click our heels together and wish we were back in Kansas.

Will this third generation of chiropractors be the last? Will those in the second generation who made money in the Mercedes 80's and now make it by running schools, teaching students how to run a practice after they graduate, and selling their wares to the new graduates dare upset the status quo? Will they worry more about the sacred trust and responsibility for the stewardship of the profession than they worry about their own retirement?   

These are important questions as we arrive at the proverbial fork in the road.

Will we embrace our singular uniqueness in the marketplace or will we marginalize ourselves by becoming third rate providers of whatever we can sell today?

Is chiropractic in us or are we in chiropractic?

As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor  
Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net