Part of a series on the chiropractic residency program in the VA health care system
Like Dr. Steven Huybrecht, I frequently find myself fielding questions about my day-to-day routine in the Veterans Administration (VA) from family, friends and colleagues. The Connecticut VA Healthcare System has two chiropractic sites located in West Haven and Newington. I am primarily at the West Haven campus, but spend at least every other Tuesday in Newington. Collectively I work under the guidance of Drs. Anthony Lisi, Christopher Coulis, Lauren Austin-McClellan, Nathanial Majoris, and Todd Kawecki. Although each day can vary, I’ll take you through a typical VA resident schedule.
On Mondays and Fridays, I have my own resident clinic under the supervision of one of my attending physicians. Monday mornings are reserved for consults with new patients, while Monday afternoon and Friday mornings consist of 30 minute follow-ups. If I am fully booked, I have the capacity to see two consults and 15 to 17 follow-ups per week. Having my own clinic allows me to establish a patient grid where I follow veterans’ care from start to finish. This gives rise to a continuous dialogue with my attending physicians about treatment strategies and management plans, some of which are very straight forward and others require a bit more discussion due to the complexity of the patient. As an added bonus, attending physicians are required to co-sign all my notes. With their guidance, I have the opportunity to properly develop verbiage and format of the electronic documents to ensure translation across the multitude of disciplines within the hospital.
Every other Tuesday I have a resident follow-up clinic in Newington. I generally see between 13 to15 patients on these days, primarily manual chiropractic care with a few acupuncture patients sprinkled in. These are bread and butter days that allow me to hone in not only on my manual skills, but also my time management skills and the feel for what a normal fully booked day in a hospital is like. The Tuesdays I am not in Newington are spent helping in Dr. Coulis’ consult and follow-up clinic in West Haven or doing scholarly work.
Wednesday and Thursdays are a mix between my attending physician’s clinics and rotating in different specialties. Up to this point I have spent time with physiatry and rheumatology observing consultations/follow-ups, electromyogram/nerve conduction studies, injections (corticosteroid, Botox, Hyalgan) and more. This month I will be spending time in the pain management clinic observing consults/follow-ups, as well as procedures that may include epidural steroid injections and medial branch blocks. These rotations are invaluable experiences that expose me to what these specialties do, help me understand indications for referral and increase my ability to work on an interdisciplinary team. The physicians are brilliant, welcoming and happy to have me participate in physical exams, differentials and some procedures. When I’m not rotating, I spend time in either Dr. Lisi’s or Dr. Austin’s acupuncture clinic. Under their guidance and instruction, I am (slowly) learning how to perform acupuncture for common musculoskeletal complaints.
Thursday afternoons are reserved for scholarly time where I am able to work on projects, complete coursework, and organize materials for our University of Bridgeport College of Chiropractic (UBCC) students on rotation. This past quarter, I worked on a presentation with Gregory Reed in Buffalo, N.Y., investigating the Advanced Fellowship Programs within the VA, specifically the ones for which chiropractors may qualify. Thursday afternoon is also the time reserved for the weekly resident conference call where we discuss current projects and topics associated with job searches, interesting cases, approaches to care and even personal events like getting married!
No matter what my schedule is or who I’m working under, every day my attending physicians challenge my knowledge not only about what I’m doing but why I’m doing it and the evidence to support it. My proficiency as a diagnostician as well as a competent member of my patient’s medical team is consistently elevated and I have been exposed to exponentially more complex cases in the past few months than all my time in chiropractic school. I am so excited to have the opportunity to serve our wonderful veterans and to share these experiences with the chiropractic community along the way!
Dr. Halloran is the chiropractic resident with the VA Connecticut Healthcare System under site director, Anthony Lisi, DC, and concurrently working towards her Master of Science in Human Nutrition and Functional Medicine through the University of Western States (UWS) as well as her Diplomate in Diagnosis and Internal Disorders through the ACA. Dr. Halloran’s professional interests include advocacy and toxic exposure, nutritional deficiencies and chronic musculoskeletal pain within the veteran population.