By Anthony J. Lisi, DC
Through this essay, I mark more than 10 years of experience in the Veteran’s Affairs (VA) chiropractic program, and I thank, inspire and provide some forward-looking thoughts to ACA. It begins with a story:
I WAS RUNNING LATE IN CLINIC. An overbooked consult, a late follow-up and a particularly complex case had put me about 40 minutes behind schedule. If I could move fast through the next follow-up, then get to the last morning consult, I could use whatever remained of my 30-minute lunch break to catch up on notes before starting the afternoon session. I brought in the next patient from the waiting area, a gregarious 44-year-old male Army veteran nicknamed Sully who had served in the first Gulf War. I tried to get right to work, but Sully was excited, and that made him more talkative than usual.
“Have you heard of the Battle of Pointe du Hoc?” he asked, brimming with enthusiasm. “No, I haven’t,” I replied. “It was one of the most famous battles in Army history,” he continued, “where a battalion of Army Rangers landed on Normandy Beach on D-Day and took a cliff and knocked out the German big guns!”
“That’s great,” I said, using a flat vocal inflection and every nonverbal cue I could muster to get him to sit on the table and begin to focus on the purpose of his visit. But Sully would have none of that. He was too excited.
“You don’t understand,” he continued. “This is part of Ranger fame! These were the guys that scaled the cliffs with ladders and grappling hooks like you see in the movies! These guys took the hill and held off a larger German unit for two days before reinforcements arrived. These guys were real heroes. Three hundred guys went in and only ninety guys survived!”
“That is amazing, Sully,” I replied sincerely, “but why are you telling me this now?” With sheer reverence in his voice he said, “Because I was just sitting next to one of those guys.”
Joseph Myjak was 21 years old when he stepped into the landing craft that morning on June 4, 1944. He was the embodiment of valor as he risked his life and saw his comrades fall in order to preserve freedom for the world. He was part of our country’s Greatest Generation. He was brought back to Normandy as a hero years later in a famous delegation with President Reagan. And now at 89 years old, he was being kept waiting for a doctor’s appointment because of me.
After I finished with Sully, I took a few seconds to choose the words I would use to apologize to Mr. Myjak and introduced myself to this living, breathing part of U.S. history.
“Hello, Mr. Myjak. I am Dr. Lisi, one of the chiropractors here, and I am so sorry for keeping you waiting.” With a smile he shook my hand, looked warmly into my eyes and said, “Oh that’s no problem, doctor. I appreciate your time seeing me.”
The story could end there. It could be enough to describe the grace and humility he exhibited – attributes that seem to fade each time we lose another from his generation. But there is more to this tale. Mr. Myjak was born and raised in New Haven, Conn., and lived there after the war. In later years, he became a local celebrity, always willing to share his story with the media, schoolchildren and at veterans events. He carried the burden of battle on the frame of a man who lived and worked 89 years. And despite a number of musculoskeletal problems, he never had a chiropractic consultation. “I always heard you guys were no good,” he told me sheepishly but honestly, “so I stayed away.” When I asked him what made him finally come to a chiropractor, he said that his primary care doctor, a colleague of mine at the hospital, had referred him. “Dr. Jones told me to come see you,” he said, “and I figured if chiropractors are here with all of these other good doctors, then you guys must be good.”
And for that, to all of ACA – leadership, staff, members and students – I say thank you.
The thanks are not linked to my professional pride in my VA position, nor being associated with the Ivy League medical staff at my facility. It is not linked to the opportunities, collaborations, presentations, publications and awards that have emerged through the work of any VA doctor of chiropractic (DC). I thank you because due to ACA’s efforts, Mr. Myjak, along with tens of thousands of veterans who otherwise might never have done so, have now received high-quality chiropractic care through the VA.
For more than a decade, chiropractors have been providing care at VA hospitals. We are not in a separate path of access. We share the same mission, goals and clinical processes as other VA physicians and health care providers. Most readers of this publication will be very familiar with ACA’s role in advancing legislation for VA chiropractic services. In the 1990s, ACA built a coalition of supporters, including the Association of Chiropractic Colleges, several veterans service organizations and others, in advocating for laws ultimately enacted in 1999 and 2001. The latter resulted in VA beginning its chiropractic program in late 2004.
ACA’s vision, dedication and hard work opened the door for DCs to become part of the VA team, collaborating with our colleagues in improving the health of our nation’s veterans. It is a very noble and humbling honor, for which we are all truly grateful. Here is an inspiring synopsis of our progress since 2004.
By the end of 2005, VA had complied with the requirements of Pub. L. 107-135: 24. Chiropractic clinicians were in place at 23 VA medical facilities, and they provided 20,000 chiropractic visits. If the situation remained stagnant, that would likely be the rough extent of the chiropractic presence year to year. But the situation did not remain stagnant. The initial group of DCs did something considered transformative to medical stakeholders in VA – they provided high-quality care. They were patient-centered. They were evidence-based. They were collegial with medical staff at their facilities. They banded together and supported each other and any new DC.
Today, 103 DCs practice on-site at 66 VA facilities. This is likely the largest number of chiropractor clinicians employed by any one entity in the United States. In 2015, VA DCs provided 160,000 chiropractic visits. Adding up every VA chiropractic visit from 2004 through the present, we reached our 1 millionth visit in February 2016.
VA DCs are collaborating in patient care with colleagues in primary care, physiatry, pain medicine, neurosurgery and other specialties. VA DCs are working clinically with MDs, DOs, PAs, PTs, RNs, clinical psychologists, telemedicine specialists and others. Medical residents routinely rotate through VA chiropractic clinics, learning from chiropractic attendings and residents. The medical residents learn about chiropractic care, and moreover, learn broader aspects of case management from DCs. This type of interprofessional education – known to be a facilitator of interprofessional collaboration – is unprecedented in the United States. VA DCs are involved in administrative work with service line chiefs, chiefs of staff and senior central office leadership. VA DCs are also engaged in research and academic work. Partnering with U.S. chiropractic schools, we provided clinical training rotations for approximately 1,800 DC students. Recently, we implemented a groundbreaking integrated practice residency, the first federally funded chiropractic clinical training program.
Although this expansion stems from the initial law in 2001, it occurred without any additional law requiring VA to do so. This is because more VA facilities truly want to include chiropractic services and because VA DCs have established a commitment to quality care and interprofessional collaboration. There are still many areas in which VA’s delivery of chiropractic care needs to be improved, and we continue to work toward that goal. However, the preponderance of our experiences shows that we likely have achieved a certain critical mass of integration. It seems clear that collaboration and cooperation with our medical colleagues will lead to further progress for the VA chiropractic program.
While this applies to VA DCs, I suspect it may also apply to the 100-plus DCs in Department of Defense (DoD) medical facilities, the hundreds more in private medical facilities and the thousands more who are, or will be, integrating with medicine in other manners.
Most health care is local, and integration is driven by relationships. The work of DCs providing care in mainstream medical systems has already influenced their respective systems. But collectively we have only begun to influence the future of the chiropractic profession in the broader health care system. The results we have seen in the VA, and in other medical settings, have set the stage for tremendous growth in the chiropractic profession’s ability to serve patients, improve population health and deliver value.
Yet, there is a catch. A DC cannot be a valued member of a medical system and concurrently support efforts that attack that system. We cannot be insiders and outsiders at the same time. Has the day come to beat our swords into plowshares? Can we envision a time when any patient in need has efficient access to high-quality chiropractic care or when DCs are fully integrated in all health care systems and have earned a level of cultural authority commensurate with the social contract society has bestowed upon medicine? Most challenging of all, can we put historical animosities behind us and begin to live that way right now to create the future we envision?
Of course, there will always be battles. Professions must be vigilant in protecting their interests for the benefit of the populations they serve. However, if we choose to wait until all opposition is gone before we cooperate with our allies, we will be waiting a long time.
We appear to be in the midst of unprecedented opportunity as a profession. Now, more than ever, the medical world wants chiropractors on the team. It is up to us to hone our talents and contribute as highly valued players.
(Postscript: Over the course of about a year, Mr. Myjak was seen in our clinic by two chiropractors, three DC students and four internal medicine residents. All providers found it an honor and pleasure to serve him, and he was exceedingly grateful to us at each visit. He passed away peacefully on Jan. 24, 2015. His family gave permission to use his name.)
Anthony J. Lisi, DC is director, Veterans Health Administration (VHA) Chiropractic Service, Rehabilitation and Prosthetic Services (10P4R). Dr. Lisi is section chief, Chiropractic Service at VA Connecticut Healthcare System.