Young Professionals: What Is Your Vision for Practice?

Young Professionals: What Is Your Vision for Practice?

Author: Robert Jones/Monday, June 24, 2019/Categories: Professional Development

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By Robert C. Jones, DC, ACA President

It has become quite evident that our profession is at a watershed moment.  Some want no differential diagnosing, high-volume, no-insurance practices.  Others want integrated, very clinically interprofessional practices that participate in the evolving insurance reimbursement models. And then there are those who want … something in between. Now is such a different time compared with when most of the leaders in our profession graduated, knowing they were going into solo or generational family practices. When I graduated, for example, it was considered cutting-edge practice for non-family members to join together to form a multi-chiropractor clinic.

As I watch the chiropractic profession struggle with the issues that make these types of practices different, I cannot help but wonder what our young professionals think. Some are taught in schools of very traditional thought, and others are taught in very progressive schools of thought.  What do they think when they look at the ACA House of Delegates and see physicians who are generationally different in thinking and practice than the way they want to practice?  Do they have concerns that the established (older) generation of physicians will not look to them for input on how they want to practice when chiropractic healthcare policies are made? The student ACA (SACA) members I have talked with, when we met in Washington, know their education is on par with other primary care/portal-of-entry providers, yet the reality is that they are limited, once in practice, depending on the state scope of practice. Then other SACA members will comment to me regarding how chiropractic education is much too intense for the tractional way they wish to practice. As a profession, how do we reconcile these differences so that our young professionals can have a long and fulfilling life of clinical experiences?

Being an ACA leader, I struggle with this as I discuss with leadership the future projection of our practice.  I am ever grateful for the foresight of [ACA Vice President] Dr. Michele Maiers, who recognized this years ago and lead the formation of the ACA NextGen. This group is made up of ACA members who have been practicing for five years or less. The NextGen works on issues that affect them and that are generally off the radar of established physicians. By interacting with these young professionals, it is evident to me that their aspirations in clinical practice enviroments and experience are very different than when I graduated. It’s abundantly clear to me also that integration of the younger professionals in our leadership structure is necessary to ensure they have a voice in our developing healthcare policies and interprofessional interactions. As such, it is important that we start a dialogue between the generations of physicians. It’s my hope that this blog will initiate that dialogue.

To the young professionals: I ask that you share your dream of what chiropractic is to you. … What do you envision as the clinical setting and patient base you would like to treat?  What chiropractic health policies do you think are needed to support your clinical paradigm?  What mentorship/experience are you looking for from the generations of physicians before you?  What thoughts do you have regarding how we can implement changes you would like that are not necessarily on the radar of the older generation of physicians? I invite everyone to join in the discussion by leaving a comment below.


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3 comments on article "Young Professionals: What Is Your Vision for Practice?"

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Alex Kocken

6/26/2019 8:45 PM

Dr. Jones, thank you for writing this. I’m 6 years into practice.

-the patient base I enjoy treating is everyday Americans experiencing MSK issues that are interrupting their lives and increasing the 8-12% who see a DC annually to find where ceiling is. Outpatient setting that’s patient-centered. (Solo, multi-doc, integrative is all great, but has to be about the the patient). Although I’m a solo-practioner, I work weekly with other providers in the best interest of patient at hand.

-I’m looking for those before me to be investors (time, energy, $) mentors, and advocates for DCs.

-I’m looking for ways to become more patient-centered and outcome centered but realistically. To measure outcomes not in 27 Questions, but in 4. Outcome measurements that are meaningful to patient, Doc and payor. I’m looking for ways tech can innovate care and engage patients. I’m looking for DCs to LEAD in value-based care for spine, MSK for acute, persistent and chronic conditions. I’m looking for DCs to be at the table leading these conversations in how value based care will be implemented.

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Robert Sanders

6/27/2019 1:11 PM

Dr Jones:

Patient base: General, family practice. Any forays into elite care are great, and I do them, but the general population is my base.

Clinical tone: differential, doctor-first, chiropractor-second care. I expect insurance to do a better job of covering their insured for chiropractic, our work should not be out-of-pocket. This needs to be priority 1 for health policy.

Mentorship: It seems a lot of the art of chiropractic is getting lost in the science. School was great for teaching us diagnosis, and it seems after school is where we learn from the old masters on what to do with our hands.

What can the old guard do for us: It was said at my school that the only solution for the vitalist chiropractors that drive our profession away from contemporary health science is to wait until they retire. Sadly, I see more young doctors coming from this paradigm than from the evidence-informed one. This "battle" continues and is more critical than ever. I don't see a way to get government policy and the resulting insurance policy to embrace chiropractic as a key member is the modern health care solution when high volume, diagnosis free clinics want the same status and rights as those of us practicing at a more sophisticated level. TL:DR: Not only do we need to keep advocating for evidence-informed policies, but we need to bolster our efforts as this struggle is only getting worse at the clinical level.

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Stephanie Halloran

6/27/2019 2:13 PM

What do you envision as the clinical setting and patient base you would like to treat? I intend to work in a hospital-based/integrated setting within the VA or privately.

What chiropractic health policies do you think are needed to support your clinical paradigm? I believe there are a lot of issues that need to be addressed, but I think an increase focus on integration with other organizations like NASS, APHA, APS, etc. is imperative to our progress regarding any form of health policy change. Aligning ourselves with other specialties and having the opportunity to collaborate on health policy that impacts not only our profession, but other aspects of our patient's care will enhance our abilities to improve patient outcomes. Additionally, as we integrate with other organizations they will understand we are not necessarily trained to only address musculoskeletal conditions, but we can also seek additional training in other specialities -- which may influence the issue of expanded scope of practice.

What mentorship/experience are you looking for from the generations of physicians before you? I have been fortunate with my mentorship team through my residency and fellowship, but I wish others had this opportunity. I think having access to those who are interested in being mentors in specific areas: clinical practice guidelines, introduction to research, sports chiropractic, etc. would be a good opportunity to have virtual mentors. In this example, one who is interested in sports medicine may receive advice on approaches to care for specific conditions from a mentor who has been in sports for an extended period of time and may work for a professional team. If the mentee has a difficult case or something they have not seen before, the mentor could make them self available to help work through the case with them. This allows the mentor to share their expertise, the mentee to learn a new skills and have a better understanding of clinical approaches, and the patient to have a better outcome.

What thoughts do you have regarding how we can implement changes you would like that are not necessarily on the radar of the older generation of physicians? Our profession is fairly young, many of the older doctors started private practices right out of school and do not understand the change in environment. I think some of the things that need to change are increased funding for postdoctoral opportunities, increased regulation on what a specialty really is and require mentorship and/or observations hours in that specialty, and increased influence for schools to include research training as an elective at their institutions. Additionally, there needs to be an increase of mentorship within associateships that supports the new practitioner to be self-sufficient. This is not just reasonable wages and hours, but also assisting in the clinical side of things and being both a boss and a mentor and teaching the business aspects of being in private practice.

Overall, in regard to early career practitioner involvement, I feel the ACA has started progressing toward inclusion of the newer generation but we still have a long way to go. Facilitating a workshop at Engage 2020 between HOD and NextGen would be a great way to have face to face interaction to discuss these topics and negotiate ways in which the new generation can integrate with the old generation in such a way that both parties feel their needs are met and the ACA continues to progress seamlessly forward.

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