“If I have seen further it is only by standing on the shoulders of giants.” These are the words of Sir Isaac Newton. This quotation vividly describes how much we owe to those who teach, mentor, and over time mold each of us. While serving as the National Vice Chair for the Student American Chiropractic Association (SACA) I received exposure to many of our profession’s greatest minds (researchers, administrators, political leaders, clinicians, etc). After multiple conferences (ranging from Parker Seminars to the ACC Research Agenda Conference) uniting themes shared by a diverse set of chiropractic thinkers were the association of chiropractic with the following topics: wellness and prevention, research, public health, and collaborative “mainstream” healthcare models. This essay will share some of the current thoughts of our profession. I hope you enjoy and consider how you can contribute to these very important conversations.
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Student leaders today are on a burgeoning path that will lead them to expanding professional opportunity – many will become influential members of the chiropractic profession as well as take on leadership roles throughout an evolving American healthcare system. As the acceptance of chiropractic into mainstream medicine continues to grow, commonplace collaboration and integration is ever nearing an emphatic tipping point.[i] [ii] [iii] [iv] [v] [vi] [vii] While political medicine still wages battles against the chiropractic profession around the country (Connecticut, Texas, etc.), grassroots integration of diverse groups of healthcare providers is an emerging reality due to the practical benefits of collaborative/patient-centered care.[viii] As this trend continues it is important that all provider types contribute to building bridges and having chiropractic represented accurately in diverse healthcare organizations (ex. APHA) will be essential for the advancement of this paradigm.
There are few organizations as dynamic and inclusive as the American Public Health Association (APHA). Chiropractic integration and extensive incorporation of a preventative and conservative paradigm are prominent public health issues to be addressed in the near future; the following two quotes will help introduce this prominent, yet often overlooked, connection:
First, the APHA’s professional statement: “The American Public Health Association is the oldest and most diverse organization of public health professionals in the world and has been working to improve public health since 1872. The Association aims to protect all Americans, their families and their communities from preventable, serious health threats and strives to assure community-based health promotion and diseaseprevention activities and preventive health services are universally accessible in the United States. APHA represents a broad array of health professionals and others who care about their own health and the health of their communities.” [ix]
A second quote from Monica Smith DC PHD reveals an apparent change in the focus of public health: “In the early part of the 20th century, the prevalence of infectious diseases was the most important health problem of the time. This early period was characterized by a closely connected and supportive relationship between the clinical practice of medicine and public health in implementing key public health strategies of the day such as quarantine, sanitary reform, safe water systems, pasteurization, and personal hygiene. Over time, the major causes of death and disability increasingly shifted from communicable diseases to chronic diseases. The changes in the social health burden and policy priorities, coupled with the technological evolution of biomedicine, increasingly separated the function and culture of clinical medicine from that of public health.” [x]
As biomedicine continues to evolve and resolve many ailments and illnesses, chronic disease will remain. The most appropriate treatment for these major public health concerns is prevention through early education. Once developed, the leading options for the management of these conditions must include conservative care (exercise recommendations, diet analysis, lifestyle changes). This realization and its practical implications will require a new type of leader in public health. Furthermore, with the current and escalating shortage of primary care providers America will need to utilize a wide range of practitioners to act upon this message. Chiropractic, a profession focused on wellness and prevention from its early origins, is certainly fit to take this position and join the fight against type II diabetes, hypertension, heart and lung disease, obesity and many other diseases that afflict so many.
Before I was a chiropractic student I shared much of my time with three very good friends – Ben, Blake, and Brandon. We were roommates, classmates and throughout our time became very active on our college campus and in the local community; we were student leaders. At the end of our studies, Ben went to medical school; Blake went to osteopathic school; Brandon has since become a physician’s assistant and I ventured out to Portland for chiropractic school. We all had our reasons and desires driving us, but regardless of difference in “philosophy” or “paradigm” we maintain an understanding of each other’s methods and look forward to working together in the future. This vision for American healthcare (a diverse group of providers working together to provide excellent patient centered care) is the desire of many students.
Interested in integrative medicine? Pursue your interest! The remainder of this essay will focus on ways you can pursue your interest while at the University of Western States.
SAIM. Here in Portland, the Oregon Collaborative for Integrative Medicine (OCIM) has helped form and support a diverse student group, the Student Alliance for Integrative Medicine (SAIM), that connects students of nursing, chiropractic, allopathic, naturopathic, dental, and oriental medicine through various academic and social events.[xi] Although this group is only in its second year, it has brought together many students and provides a unique experience to those who invest their time. For more information on SAIM email Tavis Johnson at: Tjohnson@students.uws.edu.
SACA. In early 2010, SACA initiated a national Integrative Healthcare Committee (IHC) that will look to encourage this positive interaction between budding practitioners from various healthcare institutions across the country. It is the intent of SACA to use the SAIM student group as a model in which similar groups can be created in each of the 19 cities where chiropractic colleges exist. For more information email me at: eroseen.vc@gmail.com.
Student APHA. From Nov 6-8th, I attended the APHA national conference in Denver, CO. At this conference I was surrounded by members of every healthcare profession in America - all working together towards the same purpose. For those interested in learning more about public health, I would encourage you to contact the chair for the SACA National Public Health Committee, Beth Wisniewski of Palmer West Chiropractic College, at emwisniewski@gmail.com.
Be Proactive. If you look, you will find a growing community of doctors that want to foster growth in the area of multi-practitioner collaboration. As students, seek out exposure and engage yourself in interactive settings. This can be done by any of the following means:
One. Interact with and read the literature of current integrative medicine leaders – utilize their ideas and perspective to develop a model you can use once in solo practice or to integrate into a local hospital. Drs. Bill Morgan and Christina Acampora are two additional examples that I have been exposed to via the ACA. Rick Branson a UWS grad is also a leader of the integrative field – His study, “Hospital – Based Chiropractic Integration Within A Large Private Hospital System in Minnesota: A 10 year example” is one excellent example of chiropractic integration. If you are interested in meeting these types of individuals attend the conferences they attend; one example would be the Association of Chiropractic Colleges - Research Agenda Conference (ACCRAC) [xii] which will be held in Las Vegas, NV March 17-19, 2011. The theme for ACCRAC 2011 is, “chiropractic education and practice in integrative healthcare.”
Two. Challenge yourself to pursue an integrative internship. For most chiropractic students, “hanging your shingle” in private practice is the only option that has any professional longevity. Due to projected effectiveness and cost effectiveness of initial collaborative models (Branson - Minnesota, Paskowski - Massachusetts, etc.) our generation will see increased inclusion of chiropractic services within large hospitals. As this new option becomes apparent, a gap between a chiropractic clinical education and hospital protocols will likely be a challenge for inclusion; Structured preceptorships and fellowships will be important to bridge this gap. Although these internships are currently rare, the Internship with Dr. Bill Morgan DC at Bethesda National Navel Medical Center in Maryland is one example of an extraordinary opportunity that should be competitively pursued by UWS students.
“The price of greatness is responsibility, ” these are the words of Winston Churchill. Although dating back to 1943, this message rings true today and it is Dr. J Michael Flynn DC who reminds SACA leaders of this quotation often. Dr. Flynn is the current president of the World Federation of Chiropractic (WFC) and for years has served the chiropractic profession and has continually seen the profession grow and mature; he believes that by 2020 the chiropractic profession will be one of the most respected healthcare professions – worldwide. With national healthcare reform being a catalyst for change, and the decisions being made now and in the near future affecting our careers more than any doctor currently in practice - how will you contribute? Much that has not been accomplished yet will be accomplished in the years to come – expect big things of yourself and encourage and support the efforts of your classmates.
[i] White AR et al. Complementary medicine: use and attitudes among GPs. Family Practice 1997; 14:302-6.
[ii] DeMaye-Caruth B. Complementary medicine: health care trends for the new millennium.Hosp Mater Manage. Q 2000; 2:18-22.
[iii] Berman BM et al. Physician’s attitudes toward complementary or alternative medicine: a regional survey. J Am Board Fam Pract 1995; 8:361-6.
[iv] Boucher TA et al. An organizational survey of physicians’ attitudes about and practice of complementary and alternative medicine. Altern Ther Health Med 1998;4:59-65.
[v] Crock RD et al. Confronting the communication gap between conventional and alternative medicine; a survey of physicians’ attitudes. Altern Ther Health Med 1999;5:61-6.
[vi] Berman BM et al. Primary care physicians and complementary-alternative medicine: training attitudes, and practice patterns. J Am Board Fam Pract 1998;11:272
[vii] Cherkin D. et al. Family physicians’ views of chiropractors: hostile or hospital? Am J Public Health 1989; 9:636-7.
[viii] Branson RA. Hospital-Based Chiropractic Integration Within A Large Private Hospital System In Minnesota: a 10-Year Example. J Man Phys Ther 2009. 32:740-8.
[ix] http://www.apha.org/about/
[x] Johnson C et al. Chiropractic And Public Health: Current State And Future Vision. J Man Phys Ther 2008. 31:397-410.
