Editor's note: Of the five chiropractors for which you voted to lead "Our Virtual Chiropractic Association," we have previously published the vision statements of Drs. Wilk, Riekeman, and Kent on the front page of DC. The commentaries of the electees have been published in the order that they were received.
I thank Dynamic Chiropractic for developing the concept of a virtual chiropractic association. I thank those of you that voted for me and have thereby allowed me the privilege of offering some thoughts on the organizational needs of the profession, and how those needs could be fulfilled through a "virtual" chiropractic association.
This is a tall order, as the needs are many, the strategies are plural, and the desired outcomes are ill defined. As president of Life West, my views on the desired nature of the profession are well known. Chiropractic, chiropractors, and consumers will be best served by concentrating on the role vertebral subluxations play in adversely impacting the health and well-being of people. Our efforts should be directed toward a better understanding of these conditions, their correction and their prevention. Those who have preceded me in these pages have offered considerable attention to these ideas. Rather than offer views that represent a restatement of similar thoughts, I would like to take a more pragmatic approach.
Why Don't Chiropractors Belong to National Associations?
After various stints with the boards of directors of the International Chiropractors Association (ICA), the Council on Chiropractic Education (CCE), the Association of Chiropractic Colleges (ACC), and the World Federation of Chiropractic (WFC), it is my conclusion that chiropractors don't line up! The very spirit that brought a person into chiropractic in the twentieth century (does that make you feel old?) was one of individualism, of anti-establishment beliefs and views, and a general sense of contrariness. We did not like health care as we saw it, and we desired to see something replace or augment the traditional thinking. It was this drive that caused us to survive. It was the "me-against-the-world" sense that caused us to succeed, and, in part, it is the same trait that causes us not to join various groups or organizations - no matter how great the perceived good offered by the organizers.
Another reason why chiropractors are hesitant to join professional associations is an aspect of the circumstances of the chiropractor. I believe it is similar to that of the surgeon. The medical practitioner relies on a drug, a potion or a nostrum, and the surgeon and chiropractor are the embodiment of the result. When a drug does not work, it isn't a direct reflection on the physician, but when the surgery goes bad or the adjustment doesn't produce a desired result, the outcome is placed squarely at the feet of the surgeon or chiropractor. This breeds a sense of ego and professional bravado that can get out of hand. When this happens, a positive motivating force becomes destructive much like the warming fire in the fireplace that burns down the house. When this sense develops, the individual feels little need to be part of an organization. After all, it is the chiropractor's skill and talent that create results. What could an organization add to the equation?
A third impediment to organizational involvement is the isolated nature of chiropractic practice. The chiropractor, unlike the physician and surgeon, is not in a hospital environment that compels interaction and exchange among practitioners. Do you know chiropractors that behave like professional hermits? They come out for license renewal and head back to their caves, not to be seen for another year.
A quick look at social attitudes and organizational involvement over the past 50 years offers another insight into why professionals have become slow to line up. Five decades ago, the American Medical Association was the unquestioned voice of medicine in the United States. Their membership represented over 70 percent of physicians in this country. Today, AMA membership has dropped to the mid-30-percent range. Five decades ago, the percentage of laborers belonging to a trade union was many times greater than it is today. The decline in national membership of most professional groups and trade organizations reflects participation trends that are consistent with the trend toward decentralization of efforts and actions on a broader cultural level.
The Argument for Belonging to a National Association
The national associations assert that if more practitioners join a national association, greater accomplishments will follow. "What have you accomplished?" the nonmember will ask. It is a valid point. After all, in 25 years, our national associations did not pass a single piece of federal legislation, so why wouldn't the cry from the field be reasonable? This reality becomes clearer when we remember that 85 percent of the profession today was not a part of the profession when Medicare - our federal legislative high point - was passed; that 85 percent have been told for their entire careers that Medicare and its attendant language was a hindrance for the profession. (Like many things, it wasn't as good as some said, and it wasn't as bad as others.) Why would they value the activities of a national association?
In the medical world, we have seen physicians withdraw from national participation and increase their state and specialty association participation. Similarly, we see chiropractors becoming more involved in local community or county-level cooperative efforts, county and state efforts and less national efforts. We are seeing the fulfillment of the admonition to "think globally, and act locally."
The majority of chiropractors believe that the goods and services available from the ACA or ICA are not of sufficient value to justify the expenditure. Those who belong to the national associations either see the cost-value analysis as favoring them, or they feel a moral obligation to belong to support the profession even if it costs them personally.
The "success formula" I offer to the virtual chiropractic association is to make the return on the membership dollar so great that you would be a fool not to belong. I'll offer two real world examples: The Auto Club (AAA), and the American Express Platinum card. For $35 a year, I don't have to worry about a dead battery, a flat tire, or my wife or daughters being stranded on the Bay Bridge. This is a great value for my membership dollar!
American Express asks that you pay $300 to carry a credit card you must pay off within 30 days; meanwhile, you get 20 free credit card offers a month from other companies. However, the AmEx Platinum card has a $75,000 repatriation benefit. If I am injured any place 100 miles or more from my home, the repatriation benefit automatically kicks in. I travel 150,000-175,000 miles a year, have fallen in Mexico and Minnesota, and have been flown home at costs of tens of thousands of dollars. The Platinum card, for me, is neither a status issue nor a perceived value - but a very real value. Our national associations must generate real value on a day-to-day basis for the chiropractor in Fresno, Topeka, Wilmington - and every place in-between.
What does this mean? It means getting on with the business of serving the needs of the customer - you, the member. It means to stop wasting resources showcasing what you do to make the other party look like less to achieve a perceived value edge. It means accepting the practitioners as they are and providing for their needs and not asserting, "They shouldn't think or act that way." It means examining what the practitioner member needs on Monday morning and making the acquisition of it easier, cheaper and timelier for them. It means being creative about supplying the needs of the DC member. It means investing in R & D to get information and services into the hands of the member. It means developing strategic alliances with other entities and businesses to make cutting-edge technology available to Joe and Mary Chiropractor. It is hard work, damned hard work, but it is also the only way to go.
An Illustration
Throughout history, victories have always gone to those who possessed greater information and put it to work. Over time, this has gotten more evenly distributed, and as a result the opportunity to put it to work has broadened. At this moment, information is available to any man, woman and child who has a $400 computer and a $10-a-month internet service provider (ISP), or is willing to walk to the public library. It is not the right of kings, nor the holdings of the captains of industry. It is available to everyone in our society. We must access it, learn to make use of it, and be as creative as possible with its applications. The chiropractor making a living over an adjusting table doesn't have the time or desire necessary to get this part of the job done, but OVCA could deliver it to them 24 hours a day, seven days a week, 52 weeks a year. Can you imagine a membership-accessible database of articles and briefing papers on the top 20 issues facing the profession that is available to you, your attorney, or your legislator at a moment's notice?
Summary
The association management mentality asks, "Why don't they belong? We could do so much for them."
The individual mentality asks, "Why should I belong? What have they done for me?"
The task-at-hand is to get each group to reason and function from the other's perspective. In addition, it is important that association managers understand that there is a change in what people want and expect from trade associations. They do not see the associations as their rudders. They control their own rudders; they just want resources to maximize their efforts.
Chiropractors do not belong to national associations for real and pragmatic reasons:
Gerard Clum,DC
President, Life West
Chiropractic College
San Lorenzo, California
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
