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Chiropractic Journal of Australia : CJA March 2012
8 Chiropractic Journal of Australia Volume 42 Number 1 March 2012 INTRODUCTION More than other allied-health professions, it may be the autonomy and cultural authority of chiropractic that is under the greatest of third party and public scrutiny. Political and policy intersections have emerged while chiropractic struggles to unite behind the most effective position along an identity spectrum - one that strengthens chiropractic and future-proofs the profession within a rapidly changing healthcare environment. With one foot firmly on the accelerator, chiropractic can seem eager to achieve greater mainstream recognition, acceptance and integration; working as equals alongside medical and allied-health professions. Equally however, we can often have the other foot frmly on the brake with signifcant segments of the profession providing strong resistance to some of the fundamental cultural changes that might enable us to better do so. At a time when we stand and watch the greater funding, autonomy, integration and expansion of dentistry, podiatry, psychology and physiotherapy, it is diffcult not to feel concerned that chiropractic on the other hand is in the slow lane. Political discourse on the direction for chiropractic cannot avoid a greater discussion on the cultural changes that may be necessary, if we are to move up gears to better meet the criteria to succeed as mainstream allied-health. Yes, our indicator may be on, but slipping into the mainstream fast lane will require a more committed policy toward greater collaboration of care, evidence-based care and perhaps a more focused scope of care. This is a challenging expressway for a profession based historically on vitalistic precepts, a profession that has lived largely inside a healthcare silo and one that has fostered an unlimited scope of care under a generalist subluxation-model. Craig Moore, BAppSci, FCBP Private Practice of Chiropractic Crows Nest, NSW Received: 9 November 2011, accepted: 1 December 2011. One Foot on the Brake, the Other on the Accelerator: Steering the Chiropractic Model CRAIG MOORE ABSTRACT: We live in a time of rapidly changing healthcare reform built on a foundation of greater collaborative and evidence-based care. The criteria necessary to advance within this new environment will require chiropractic to clearly understand how to establish credible and effective cultural authority. This paper provides discussion on the high stakes involved in achieving greater utilisation and acceptance inside mainstream health. It seeks to explore the current opportunities available under particular chiropractic models of care and the current limitations facing a single vitalistic identity within an evidence-based mainstream environment. INDEX TERMS: (MeSH) CHIROPRACTIC; ALLIED HEALTH OCCUPATIONS; SPINE; AUSTRALIA. (Other) CHIROPRACTIC MODEL; CHIROPRACTIC PARADIGM; MAINSTREAM CHIROPRACTIC; SPINE-CARE. Chiropr J Aust 2012; 42: 8-14. From the perspective of a practitioner in private practice, this commentary attempts to explore the high stakes involved in achieving wider utilization, public confdence and the greater mainstream acceptance of chiropractic. THIRD-PARTY SCRUTINY It is evident that chiropractic in Australia is facing the challenges of increasing third party control and scrutiny. We see most health-funds limiting the cover they provide for chiropractic-care with some funds actively investigating the level of evidence-based care chiropractors are providing to their members. There has been no expansion for chiropractic funding within the government Enhanced Primary Care (EPC) scheme, while other allied-health professions have achieved an expansion of either funding or programs within those clinical felds. The Chiropractic Board of Australia is increasingly examining and investigating our professional conduct and performance as registered health practitioners under AHPRA guidelines. We see increasing lobbying by allied-health professions who are willing to encroach upon and co-opt the more recognized aspects of chiropractic-care while at the same time challenging the more unsubstantiated aspects of our legitimacy. We see national health reform that demands a more integrated team approach between allied- health professionals and medical doctors toward patient-care. Finally, we have ongoing media and medical commentators exposing those aspects of chiropractic that still require considerable clinical validation or which are out of step with respected public health policy. This mainstream and public condemnation demeans the credibility of chiropractic when it is labelled as “dangerous”, “a religion”, or “good placebo at best.”1 These worrying signs can suggest chiropractic may face comparative constraints rather than controlled expansion during a critical time in Australian health reform. Steering the course with effective policy-making must not leave brand-chiropractic marginalised or left behind. We stand
CJA June 2012