While visiting a group of chiropractic and acupuncture students recently, I posed the question: “How many of you plan to enter solo practice upon graduation?” Less than 10 percent acknowledged that solo practice was their model of choice. When asked what their ideal practice model would resemble, most agreed that it would involve some type of interdisciplinary setting. Is this an indication that practice models are evolving, or are the students misinformed?
Over the past few months, I've had the privilege to participate in panel discussions with both the Association of Chiropractic Colleges Research Agenda Conference (ACC-RAC) and the World Federation of Chiropractic (WFC). Interestingly in both venues, the topics of discussion revolved around opportunities in spinal health care and interdisciplinary collaboration.
It appears that the visionaries in health care and many in our profession are recognizing that in order to thrive, we must de-emphasize isolation and embrace collaboration. It’s also remarkable that the overwhelming majority of panelists participating in both the ACC-RAC and WFC presentations agree that the further chiropractic is embedded in quality, evidence-based and value-driven approaches to spine care, the greater the opportunities to increase utilization of the services we offer. DCs must demonstrate the clinical skill sets necessary to work within new and emerging (integrated) health care models.
What we now understand from a population point of view, according to Anthony Woolf of the Institute of Health Research, University of Exeter Medical School in the United Kingdom, “Neck and back pain are extremely common, and although often short-lived, are often recurrent or chronic to some level…this impact is also when pain is not present as people modify behavior to avoid recurrence.” Global Burden of Disease studies support the notion that musculoskeletal-related pain (including spine-related conditions) plays a major role throughout populations.
When patients with back pain choose a provider, similar numbers decide to see either a DC or their primary care provider. There are recent studies that suggest instituting a stratified “best practice” model for primary care physicians when evaluating back pain patients yields both improved outcomes and lower costs. According to Nadine Foster, U.K. Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, “Among the most successful examples of real-life behavior change in spinal health care are those that make sense, those that are simple to operationalize and those that are repeated continually.”
There is simply no shortage in the demand for back pain intervention. Patients are often unsure of which provider to turn to, and primary care practitioners seldom understand all the reasonable options. Spine care can be complicated and outcomes unpredictable if all you have in your toolbox is a prescription pad, advanced imaging and surgical referral. Should the roughly 40 percent of the U.S. population with back or neck pain, with or without radicular symptoms, presenting to their primary care provider be referred appropriately to chiropractic physicians, one would expect better outcomes and lower costs. As Nadine Foster asserts, this will require education and behavioral change, and it should be simple to operationalize.
With these thoughts in mind, perhaps the visionaries are correct. Perhaps those students I alluded to earlier, in fact, comprehend the dynamic of the new and emerging health care models. They see the future of health care and specifically spine care clearly in the hands of chiropractors. They also seem to recognize that as long as we remain isolated and de-emphasize patient-centered care, we will continue to manage less than 10 percent of the population.
We have an opportunity and a responsibility to make a contribution to population health by easing the global burden of disease by successfully managing acute and chronic spine pain. And it is our responsibility to promote continuing research and evidence that supports positive outcomes with conservative management of painful conditions. It’s equally important to identify our role as spine care experts to the allopathic community.