by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
Chiropractic Journal of Australia : CJA March 2012
13 Chiropractic Journal of Australia Volume 42 Number 1 March 2012 STEERING THE CHIROPRACTIC MODEL MOORE “…everyday chiropractors are often content with the current status quo as marginal professionals, wishing to remain tied to the traditionalist lexicon and an expansionist range of application and treatment authority. Until the market position, self interest/proft, or range of treatment prerogatives are affected, the identity crisis of chiropractic will not become a true reality nor a cause for concern for this segment of the profession” (p.10). While the neuroscience-model, based on our historical precept will always remain the cornerstone of chiropractic one may ask if this singular identity is addressing the health- care priorities of the 21st century directly? Have we placed all of our subluxation eggs into one, yet to be realised, neurophysiology basket? REFUELING THE TANK I believe there is a need for faster reform within the chiropractic profession if it is our goal to advance ourselves towards being a more respected, widely utilised and collaborative allied health-profession. This goal will require our profession to establish and present a more focused and effective cultural identity to society. Murphy et al18 observed that the strongest factor that assisted the podiatry profession to expand, was the clear identity and purpose it has managed to established in fulflling a specifc need within society regarding the care of a wide range of recognized health problems of the feet. He provides that podiatry did not limit itself to a single "lesion" or a single "philosophy" or continue to make claims far in advance of any credible levels of evidence. The same is true for dentistry with regards to dental care and psychology with regards to mental health. The current opportunities now available to our strongest evidence-based credentials may slip past brand- chiropractic in Australia, while we primarily obsess to fnd the evidence to match our more far-reaching neuroscience vision and philosophy. Spine care however, remains the strongest link within the profession at large today and yet other professions will continue to co-opt chiropractic while we fail to provide stronger legitimacy and authority within this vast, lucrative, billion dollar spine healthcare arena. Indeed the vast majority of studies on how most chiropractors practice and how the public actually perceives both the profession and our education is weighted toward our capacity within the non-surgical spine-care domain.11, 22-25 Nelson, et al26 further reports that our patient population still consists - almost in its entirety - of people with musculoskeletal pain complaints, the overwhelming majority of which are spine related and that only a very small number of our patients present with complaints that fall outside of these categories. Another recent Australian example is public perception report in Australia27 which further supports the view that the most common positive perception for chiropractic-care was toward the relief of back/neck pain (92%) and our authority as spinal-care experts (67%). The survey revealed only 9% would visit a chiropractor for wellness. The World Federation of Chiropractic’s 8th Biennial Congress held in Sydney, Australia, in June 2005, provided a unanimous agreement on our public identity as “the spinal healthcare experts in the health care system.” WFC did not single out spinal pain, nor subluxation-care, nor spinal biomechanics, nor spinal treatment, nor spinal rehabilitation -- but ALL aspects of spine neuromusculoskeletal health. This report was based on two years of intensive research, including a grassroots electronic survey of chiropractors and chiropractic organisations worldwide in October 2004. Is this where chiropractic is going in Australia? This is NOT a pragmatic panic that we dump or deny the largely theoretical neuroscience model behind subluxation- care. Healthcare models must however have teeth if they are going to cut through into the mainstream at this time and they must be consistent with recognised mainstream health concepts and provide suffcient evidence-based standards. It is my growing concern that a chiropractic identity that is excessively limited to a less validated vitalistic paradigm built on an unclear model of subluxation-care and one that is still poorly recognised within the public domain is not yet ready to do this. While this historical precedent successfully carried chiropractic’s past, there is now growing evidence that we must take the opportunity to harness the benefts of a greater mainstream positioning with the opportunities available to particular and more focused models of care currently available. This acknowledgement is crucial, if we are to best meet the ongoing requirements for the expansion we will seek within university training, licensure, registration, access to health funds and government funding and our capacity to respond to governing regulatory authorities. The growing strength of other allied professions has not come from a dominant focus on less-substantiated models of care, nor from adversarial positioning. They have earned respect by defning a recognised cultural authority within a specifc health feld FIRST. They have not limited or narrowed this authority to a single treatment protocol. They have not narrowed the beneft of care to a single domain or theory. They have focused on public health priorities within their feld of expertise. I therefore encourage chiropractic policy to be driven more by the requirements of greater mainstream allied-health positioning inclusive of the most effective models of care available. This vision can capitalise on both government health-care reform and healthcare policy that is directed toward the need for a profession that can step-up and provide cultural authority around spine-care. This mainstream pursuit must take into consideration the growing intolerance toward the ambiguity of less focused models of care. It may strengthen our footing within the mainstream healthcare team, with third-party payers, health departments and regulatory bodies. It takes into consideration the massive market share to be found inside the mainstream market place and the current gap in our isolation and credibility. REFERENCES 1. Corderoy A. Costs of health therapies rocket. The Sydney Morning Herald. 2011 May 30th;Sect. 1. 2. Roxon N. ed. First Medicare Locals to Continue Primary Health Care Reform. In: Aging, Dept Health & Aging 2011. 3. Australian Government DoHaA. Integrated GP and primary care. Aust gov. Dept Health & Aging 2011. 4. Villanueva-Russell Y. Caught in the cross-hairs: Identity and Cultural authority within Chiropractic. Social Science & Medicine 2011; 71:1826-37. 5. Halpern S. Dynamics of professional control: internal coalitions and crossprofessional boundaries. Am J Sociol 1992;97:994-1021.
CJA June 2012