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October, 2012

Expand Your Skills: Become a Neuromusculoskeletal Specialist

By James Lehman, DC

Are you wondering what will happen next in the world of health care? If you have been in practice more than thirty years, you remember when health insurance companies actually paid chiropractors 80 percent to 90 percent of the bill after the patient met their deductible. You also recall how the health insurance companies, disguised as Health Maintenance and Preferred Provider Organizations decided that profits and dividends were more important than reimbursement of chiropractic care or high quality care. Now, we have health insurance reform or the Affordable Care Act (ACA) and the National Prevention Strategy This innovative health care strategy promotes holistic, integrated and patient centered care within primary care facilities. I suggest you read the National Prevention Strategy. It is available online and without cost.

Can you imagine what it would be like to be a valuable member of the primary care team providing chiropractic care within a health center without reimbursement discrimination? You can do it thanks to the ACA, which makes it possible for chiropractors to integrate health centers and receive reimbursement at the same rate as a medical doctor. Please read Section 2706 of the Affordable Care Act.

The Need

The Mayday Fund published "A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform," which describes the problems encountered in primary care with the evaluation and management of patients with chronic pain. Most people in pain, including those with chronic symptoms, go to primary care providers to get relief. But current systems of care do not adequately train or support internists, family physicians and pediatricians, the other health care providers who provide primary care in meeting the challenge of treating pain as a chronic illness.

Primary care providers often receive little training in the assessment and treatment of complex chronic pain conditions. They tend to work under conditions that permit little time with each patient and few options for specialist referrals. It is an unusual patient who has access to coordinated interdisciplinary therapy for ongoing pain symptoms. This report indirectly beckons chiropractic physicians to become valuable members of the primary care team and part of the solution to the treatment of patients suffering with chronic pain. Read the Mayday Fund conclusion and consider becoming part of the solution to this medical challenge.

Reducing the burden of uncontrolled chronic pain is a societal necessity, a medical challenge and an economic requirement. Chronic pain, if not recognized and treated as a chronic illness, takes an enormous personal toll on millions of patients and their families, and leads to increased health care costs. Chronic pain can also compromise the productivity of the U.S. workforce. Although the impact of pain on patients and on society is among the most serious of public health concerns, chronic pain has been largely left out of the current national debate on health reform. The nation must take the necessary steps to re-define chronic pain as a unique chronic illness and must immediately address this public health crisis.

The Advantages

Hence, properly trained and credentialed neuromusculoskeletal (NMS) medicine specialists are in demand in the primary care health centers.

It is my opinion that credentialed chiropractic physicians are the most appropriate professionals to fill this role. If you want to evaluate and manage chronic pain patients and those suffering with musculoskeletal conditions that have not responded to medications or physical therapy, as members of the primary care team, become a board certified neuromusculoskeletal medicine specialist. Primary care providers will fill your schedule with patients in need of your care.

There are many advantages for the younger practitioner who is not interested in owning a business. As an employee, you would not have the starting into business expenses or responsibilities of managing a business. You would direct your marketing efforts toward the primary care providers and patients of the health center. There would be no reason to invest in advertising or practice management consultants.

Younger chiropractors with student loan debt employed as an NMS medicine specialist with a non-profit health center, possibly a medical home, would also benefit from the Federal Student Aid program, Loan Forgiveness for Public Service Employees. If you were employed with a non-profit organization under section 501(c)(3) of the Internal Revenue Code that is exempt from taxation under section 501(a) of the Internal Revenue Code (includes most not-for-profit private schools, colleges and universities) as a chiropractic physician, you would be eligible for forgiveness of debt. Consequently, if you work for a community health center for ten years and you have $150,000 of remaining debt, you may apply for total forgiveness of the debt. Please investigate the program.

Chiropractic Neuromusculoskeletal Medicine Specialist

You have never heard of a board certified chiropractic neuromusculoskeletal medicine specialist because the training has not been available until recently.

The Academy of Chiropractic Orthopedists and the University of Bridgeport have collaborated to create a resident training program, which prepares chiropractic physicians to provide neuromusculoskeletal medicine services and leads to board certification. The three-year, 1000-hour advanced clinical training program will provide a blended course of study with on-site clinical education (300 hours), distance learning (100 hours) and resident training (600 hours). This advanced clinical training program will prepare the chiropractic physician to perform orthopedic-neuromusculoskeletal evaluation and management services as a specialist in primary care. Completion of the training will qualify a chiropractic physician to sit for The Academy of Chiropractic Orthopedists specialty Board certification examination leading to a Diplomate in Orthopedic-Neuromusculoskeletal Medicine.

As a chiropractic orthopedist, board certified in neuromusculoskeletal medicine, your training and credentials enable you to meet the needs of patients suffering with chronic pain and musculoskeletal conditions. In addition, the training and credentials prepare you to become a valuable member of the primary care team. Primary care providers in all 50 states are in need of your advanced clinical skills to care for patients experiencing chronic pain.

This is the time for all evidence-based and patient-centered chiropractic physicians to consider integration into primary care as a specialist. If you want to become a valuable member of the primary care team within a community health center or another form of medical home take action now.

Expand your practice capabilities with advanced clinical training and credentialing as a neuromusculoskeletal medicine specialist. The University of Bridgeport Health Sciences Postgraduate Education Department is willing to offer you an opportunity to receive advanced clinical training and credentialing necessary to become a neuromusculoskeletal medicine specialist. The University of Bridgeport is offering this three-year resident training program to chiropractic physicians in practice. This training with mentoring, onsite and online advanced clinical training is evidence-based, patient-centered, chiropractic care focused on chronic pain and musculoskeletal conditions.


Dr. James Lehman is an associate professor of clinical sciences and Director of the Health Sciences Postgraduate Education Department at the University of Bridgeport College of Chiropractic. He can be contacted at .

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