By Casey Rogers
Chiropractic students are often faced with difficult decisions regarding the trajectory of practice we intend to pursue. This becomes increasingly true as we approach the culmination of our education journeys. Some choose private practice while others prefer to participate in the growing multidisciplinary practices across the United States. Some pursue a career in academia while others find callings in hospitals or athletics.
How does one narrow down these choices? As a friend once told me, “You can do anything, just not everything.”
To me, the answer resoundingly comes back to experience. In my case, the experiences I had during my clerkship in the Veterans Administration (VA) health care system helped me to confirm my career path. Along with the satisfaction and honor of providing chiropractic services to the men and women who have served in our armed forces, the experience strengthened my desire to one day return to the multidisciplinary and team-based setting of a VA hospital.
Learning from Mentors, Patients and Other Providers
The Bruce W. Carter Department of Veterans Affairs Medical Center is located in Miami’s Health District, which includes Jackson Memorial Hospital and the University of Miami Hospital and Clinics. The VA center operates 431 hospital beds in intermediate care, medical services, neurology, mental health, rehabilitation medicine, spinal cord injury and surgical services. Among outpatient physical medicine and rehabilitation, one can find physical therapy and chiropractic services.
Under the guidance, support and leadership of Charles Penza, DC, PhD, the Miami VA chiropractic clinic operates Monday through Friday. A Palmer University graduate, Dr. Penza’s unique background—specifically, his PhD in Rehabilitation Science from the University of Florida--has given him a strong foundation to help students, such as myself, understand pain science and the biopsychosocial influences on pain within the veteran population.
Having first-hand experience treating the veteran population, and seeing the regression of pain symptoms, has had a major impact on my decision to choose a career in this setting. For example, a patient once presented with a history of chronic service-related neck and back pain. Prior trials of NSAIDs, spinal injections and opioids had little to no impact on controlling the patient’s pain levels and they wished to avoid surgical intervention. The patient began a trial of conservative chiropractic therapy and within four to five visits the patient reported sustained pain reduction. They also reported the ability to return to normal activities of daily living with managed pain levels as a result of the chiropractic intervention. The patient was ecstatic with the results and grateful for the services provided. Observing patients in our veteran population like this one and others, who can now lift their children, work consistent hours and return to regular civilian activities with reduced pain, was a life-changing experience for me, propelling me to pursue integrative care in the VA system.
Evidence and Collaboration at the Root of VA’s Approach
Utilizing the most up-to-date research, the physical medicine team works together to provide treatments with the goal of achieving the best patient outcomes. For instance, when performing a new patient consult, functional testing demonstrated a weakness of the core stabilizing musculature for one patient. For a treatment plan, we were able to coordinate chiropractic care with physical therapy and work collaboratively to provide the best care for this veteran. These types of situations occur commonly within the department and provide the chiropractic team an opportunity to remain on brand with American Chiropractic Association values such as evidence-based practice and collaboration. Collaboration with acupuncture, pain management and psychology has also produced a great response to care from our veteran population.
Since mid-July, the Miami VA chiropractic clinic has treated an average of 18 to 25 patients per day and has reached 30 and above on some days. With two clerks present, Dr. Penza can provide quality direct observation and feedback for patient care. I now treat an average of eight to 12 veterans per day under his supervision. In addition, I complete multiple new consults daily. As a result, I encounter several different types of cases, some of which have multiple complicating factors that require me to utilize critical analysis and approach each case differently--exploring any and all confounding factors. These patient scenarios, in combination with the increase in patient quantity, have had a positive impact on my approach to care and have prepared me for a vigorous practice. The patients I have treated have ranged from 22 to 92 years old, and many of them have co-morbidities such as diabetes, cancer, prior spinal surgeries, osteoporosis, post-traumatic stress disorder, and military sexual trauma that must be identified during consult and treatment in order to achieve the best possible patient outcomes.
In addition to providing chiropractic services, I have become familiar the VA’s comprehensive electronic health records system. This system integrates multiple facets of the hospital with access to detailed notes across a variety of specialties including primary care, neurology and psychology. Integration in this form enables multiple providers to collaborate on patient-specific care plans and provide the best patient outcomes. Working with this system has also helped me to improve my patient “SOAP” notes.
Lastly, rotations in a variety of departments have been an added benefit. Though rotations may be short for student clerks, they can offer great insight into the inner workings of other professions and their approach to health care services. Rotations can range from physical therapy, spinal cord injury and pain management, to surgery. Students watch first-hand how certain procedures and exams are performed by different specialties. Further, Miami offers a “Pain School” within pain management. As part of the program, multiple professional representatives from psychology, pharmacology, physical therapy, chiropractic and social work interact in a group setting with veterans suffering from chronic pain. This course takes place over a 10-week period and attendees and staff dive deep into pain psychology and conservative treatment options--not relying on opioid interventions. I was privileged to give a presentation to this group on chiropractic care and the services we provide for pain management.
I would recommend any chiropractic student to strive for an opportunity to learn in this setting. Aside from personal development, you have the chance to provide a great service to our deserving veterans. I can personally attest that this experience has changed my life. I believe I will walk away from this clerkship a better student and a better leader. Above all, I will leave this experience with the confidence that I am fully prepared for a career as a doctor of chiropractic.
Casey Rogers is a 10th trimester student at Keiser University in West Palm Beach, Fla. He will graduate in December 2019.