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Chiropractic Journal of Australia : CJA March 2012
10 Chiropractic Journal of Australia Volume 42 Number 1 March 2012 Medicine (CAM) professions do attempt to co-exist in a more integrative setting with orthodox medicine, that a level of “paradigm assimilation” (p. 34) does takes place. It is rightly argued that certain integrative healthcare settings and funding opportunities will demand paradigm assimilation when we are expected to participate and contribute toward a common clinical goal as a health team member. These integrated or collaborative healthcare settings may not provide the opportunity to contribute under a vitalistic- model of chiropractic-care and some in chiropractic will see this as the ideological equivalent of bedding down with the devil. Yet we are now faced with mainstream government health policy that is increasingly driven by an integrated and collaborative approach to care that is based on the evidence-based credentials of particular health professions. Advancement under these terms of engagement will require chiropractic to consider some reconciliation between the application of isolationist and vitalistic identity drivers that have steered much of our past, versus what is required to meet the current demands of government health reform and major third-party payers. Participation may give chiropractic the much needed stepping-stone toward greater access to the massive market-share found inside the mainstream healthcare structure compared to policy that may keep us on the sidelines. This interdisciplinary approach allows professions to work closer together for the good of the patient. It may provide major opportunities for our more established evidence-based musculoskeletal credentials. While the same benchmark of clinical validity has not been reached under the neuroscience-model of care, it is a time to consider if the opportunities under one model must be sacrifced for the aspirations we are yet to validate under another? Will the mainstream opportunities for our musculoskeletal-care be included and respected within the political scope for chiropractic at this critical time? It may be diffcult to enjoy the success derived from greater compatibility, an approach being seized upon by other allied-professions, if chiropractic policy risks keeping us on the sidelines. 3. Growing Consumer Demand Thirdly, Villanueva-Russell4 explains the integral role of solid public support and consumer demand in driving the growing utilization and acceptance of CAM professions. Several international studies10-12 warn of growing concern and competition for chiropractic within this massive mainstream market place with physiotherapy, massage therapy, acupuncture, and medicine. This may be refected in the Australian National Health Survey conducted in 2004-05 which showed only 3.8% of the Australian population consulted one of seven selected CAM therapists in the previous two weeks (up slightly from 2.8% in 1995).13 The most commonly consulted CAM professions were chiropractors, naturopaths and then acupuncturists. The number of people visiting osteopaths however, increased by 88% to over the same period. Inside the mainstream, the survey revealed a massive 32% of the Australian population (6.4 million people) had consulted a doctor, dentist, chemist or other allied-health professional such as a physiotherapist, psychologist or audiologist, the same proportion as in 1995.13 In a country of similar size but with greater mainstream positioning, chiropractic utilization in Canada is now at least 12%14 with the Canadian Chiropractic Association boasting that number to be closer to a massive 15% and climbing.15 It may be diffcult to strengthen our Australian cultural authority unless policy, driven by the most effective models of care, improves the current low level of public support. MERGE RIGHT OR MERGE LEFT There is no doubt our efforts to establish a greater role within the mainstream healthcare marketplace have met, and will always continue to meet challenges and resistance. I do not believe this will mean chiropractic in Australia is doomed to mainstream rejection over time when it is supported by effective policy-making. Offering an ever-expanding range of paradigms and protocols or by co-opting other healthcare domains may not be the solution to this resistance or this objective long-term. Presenting healthcare models that have evidence-based answers will matter far more than models still largely based on theory. An excessive promotion of an adversarial and isolationist position further adds to the dangers of remaining marginalised from the table with allied-healthcare and our access to the massive market-share to be found inside the mainstream. There is now a critical opportunity for chiropractic to participate within modern-day health reform and move past the ‘semi-professional’ world in which we have lived. The correct policies alongside a more focused cultural authority could move chiropractic away from a life of part mainstream and part-fringe. It may also strengthen our capacity to better manage third party examination. FORMAL PATHWAYS -- THE ROAD LESS TRAVELLED The acceptance of formal specialisations is seen as the hallmark of a maturing health profession. Unlike other allied health professions such as physiotherapy,16 dentistry, podiatry and psychology, chiropractic in Australia has been slow to accept, adopt and fund the pathways toward specialization of knowledge beyond a generalist model of care. Canada today demonstrates a strong chiropractic culture of mainstream evidence-based care and has an impressive 10 chiropractic research chairs under a range of PhD specializations and with a further 15 chiropractic PhD’s currently nearing graduation.17 It is specialisation of knowledge that can formally help to drive research and embed a stronger framework and clearer parameters around who we are and where we are truly heading within specifc felds of chiropractic practice. Some segments within chiropractic have strongly resisted specialisation and argue it will result in our profession knowing more and more about less and less and thus narrow our wide reaching yet increasingly scrutinised scope of care. Contrary to this political fear, we are already living in a time of expanding and specialised global chiropractic knowledge and this may now be providing us with a recognised status for knowing more about more. It may be an opportunity to expand our credibility, our skills and access to the massive patient-base found inside the mainstream. Some sections within chiropractic have already made signifcant contributions towards peer-reviewed research, widely published and recognised within the biomedical STEERING THE CHIROPRACTIC MODEL MOORE
CJA June 2012