Chiropractic is faced with a serious dilemma. Its present accepted model by society, the correction of misalignments for the purpose of achieving or maintaining a healthy back, cannot support the quickly growing number of practitioners. With most of the schools showing no signs of limiting enrollments, the profession will need to expand its population base. (Present estimates are that the profession is only serving 18% of the US population in the course of a year.) Almost everyone in the profession has perceived this problem. The solutions are numerous. They include:
1. Limiting enrollments. While some of the broadscope schools have chosen to do this, their efforts have been negated by a number of schools that appear to have (right or wrong) an unlimited enrollment vision. The problem with this, of course, is that we live in America. Should not anyone be given the opportunity to become a chiropractor if they want? Professional birth control would seem to be un-American.
2. Replacing medicine. This is the solution of the “Chiropractic First” thinkers. The problem is that chiropractic cannot offer the immediate relief (although temporary) and the quick fix (although decreasing the overall level of health) that the practice of medicine affords. Nor can it safely and effectively serve as a replacement for medicine as it is without tools of medicine at its disposal.
3. Being a part of medicine. Joining the medical profession like the osteopaths did is an option, but even if we could persuade the profession to become drug- dispensing physicians and persuade the lawmakers to allow us to do it, we are still faced with a very big problem. With the onset of managed care, medical doctors are fighting amongst themselves for their financial lives. Consequently, they are not too likely to cordially invite another 50,000 doctor into their profession. So being part of medicine would be no better than competing with it.
4. Become part of the growing alternative health-care field. Joining this field presents similar problems to joining the medical profession. For one, alternative health care is also a crowded field. Additionally, it would necessitate incorporating various idiosyncratic procedures, some rather unusual, and associating with some very suspect practices. Further, while this field is growing, it will probably never assume a significant share of the health-field market and that share will always be further divided into the hundred or more alternative therapies.
5. Striking out into new territory. This is the solution I would recommend. Admittedly, it too has problems, however, the profession will never be able to change its model as long as chiropractors keep taking (and depending upon) new patients who have had accidents or injuries or who have symptoms of any kind.
We must reach the asymptomatic masses, those who believe they are healthy or reasonably healthy and do not see the need to visit not only a chiropractor but any kind of doctor. Many of us have tried to reach those people. Unfortunately, our attempts have usually come only after the person has come into the office with a particular problem, was helped and now no longer sees the need for a “doctor’s care.” With some we are successful in communicating the need for continued care but with most we are not. The problem is that we may not have accepted them because of their symptoms but we accepted them with symptoms. Unfortunately, in the mind of most patients that is the same thing, despite our best efforts at patient education. I am not suggesting that we stop accepting patients with physical problems. I am not suggesting either that we curtail our educational programs of those patients. On the contrary, we should be stepping up our efforts so more people realize that their chiropractic care is not for their condition but regardless of their condition. Our major effort should not be reaching the 82% that have not been under chiropractic care but the 99+% who think chiropractic care is only good for medical conditions. We need to develop a public education program that deals with what we do, not a wellness care program. That term, while it is very descriptive, has been sullied by the medical profession with its “early detection and treatment” distortion of the concept. We need a new phrase, a new vision, a fresh approach that addresses the total of the human experience and not just that associated with medical problems. We need to put our collective heads together and come up with a professional mission statement that reflects what we are all about!v13n4