Articles by JCS
Path Less Traveled
JC Smith, MA, DC
Flying into Chicago on a clear night is a sight to behold. As we approached O’Hare on our descent, our plane from Atlanta first flew northerly over the eastern edge of the city and slowly turned to port as it circled the city. To my starboard, the darkness of the Great Lake made for complete blackness, unable to distinguish the sky from the water except for the stars. As we turned back over land, we crossed over the shoreline and suddenly the city lights shone from millions of lights in a perfectly repeating grid fashion. What a beautiful sight for the few seconds it lasted!
Our first trip to National College of Chiropractic in Lombard was to be just as enlightening as seeing the city lights. An invitation to speak to the NCC students soon to enter their preceptor program enabled me to visit for the first time the Mecca of Mixer Chiropractic, or so I had been told years before as a student at both Sherman and Life colleges, two diploma-mills well-known to vilify broad-scope chiro education.
Entering the supposedly evil empire of "medipractors" and "chiropractoids," as the Innatists disparagingly term this Midwestern bastion of progressive chiropractic, I expected to feel alienated to the goals of NCC due to my religious-right fundamentalist chiro education. Straight chiropractors had constantly hammered into their students many mistaken ideas about the world of mixers as we were soon to learn.
To my surprise, what I discovered was a president and faculty devoted to raising the bar in chiropractic in terms of academic excellence and in terms of practice ethics and clinical excellence. While some Innatists may be stuck in a comfortable rut clinging to the outdated clinical principles and anti-Educated Mindset of BJ Palmer, I found NCC was taking the path of greatest resistance in its pursuit of scholarly and political issues.
Unlike the "cram-regurgitate-cheat-your-way-thru-chiro-college" educational philosophy of most students and the anti-intellectualism faculty/administration’s beliefs I encountered at the two Bible Belt colleges, this well-established Midwestern institution raised its own standards recently not only in terms of entrance GPA requirements, they also raised the bar of educational excellence when they implemented a Problem-Based Learning program similar to Harvard University, a revolutionary approach to teaching and learning.
With an average class size of only eight, students are given problems to research/discuss/solve via their own research and proactivity--a refreshing change to the doldrums of rote memory teaching methods most of us had encountered in college. With their heavy emphasis on diagnostic and clinical skills, students at NCC are geared to become chiropractic physicians as primary providers, not only as NMS specialists. As we've recently seen in Illinois with the BC/BS HMO's decision to use 17 NCC grads as portals of entry, the role of DCs is quickly evolving into the mainstream as gatekeepers.
Our trip to NCC was memorable in other ways too. Drs. Winterstein and Bruce Hodges gave my wife and I a first-class visit--from a waiting limo at the airport, a guided tour of their college, lunch at the DuPage Club, to a dinner of Sam Adams beer and Chicago deep-pan pizza with the guys to chew on topical issues.
All in all, we had a great time, and I came away with the belief that not all of chiro education is a sham seemingly aimed at operating a diploma-mill and exploiting student loans. Indeed, no one would ever accuse certain straight chiropractic colleges of searching for excellence in education as NCC has done.
My presentation was "Building a Practice from the Inside-Out," a shorten version of the same show I had done at five FCA conventions last year. My show was hopefully an eye-opening talk since these 8 trimester students were completely naive to the nuances of practice management, just done without the Money Hum, NOOPE or free chicken dinners. Hopefully they now have a more comprehensive idea of the Whole Idea of operating a practice, at least they have my paradigm of Patient Education, Case Mgt, Staff Mgt, and Smart Marketing.
Just as I have found previously at the three shows I've done at Palmer-West in San Jose and the shows I've done at NYCC and Life (off-campus, of course), the students were good-looking kids eager to get started in their preceptor practice. But of great interest to me was to learn of the changing sociology of chiro students. For myself and many older DCs, it was an epiphany with our own spinal injury/care that motivated us to pursue our careers, but no longer is that a quasi-prerequisite for admission to chiro college.
Today, however, many if not most of the students have never had a serious back injury if my informal poll was accurate. Yet they've made the expensive and arduous decision to pursue our path in the biased world of healthcare based on its growing role in alternative healthcare. Instead of an epiphany, these kids have made their own informed decision to pursue a chiropractic career working within the medical establishment rather than fighting it. To these youngsters, apparently, the medical war is over.
Indeed, the 21st century will be a different world than the last century for the chiropractic profession. Nonetheless, building a practice during the next 100 years will still be done best from the inside-out using innovative communicative technology to enhance the doctor-patient relationship. Instead of flip charts, wall charts and plastic spine models, DCs in the next millennium will tell the story more likely using computer-generated images of the NMS systems, the Internet with web sites and email, and PowerPoint presentations for patient education, as well as other software programs in the clinical documentation and administration of their offices. In fact, it’s a brave new world for young DCs.
Whatever the technological tools, perhaps the biggest change for these future chiro physicians will be to tell a positive story to the public about the benefits of our wonderful spinal care rather than a defensive posture aimed at skeptical patients and hostile medical corps as we now experience. Before all this goodness occurs, we still need to teach students the operational side of our people-business that they are most naive to--management, education and marketing—which was my goal that day.
Before my presentation to the students, I suggested we all play a game. I announced a contest and raffle of four books I had brought to share with them, my three books and Stanley Greenfield's new textbook on student debt reduction and financial mgt. I asked the students to write on the back of a business card either what their practice paradigm would be and/or why they deserved to have a copy of each book.
To my surprise, many of the practice paradigms were the same--to have a multidisciplinary practice using alternative methods like acupuncture and naturopathy along with traditional chiropractic and medical care. Many shared their desire to help alleviate pain and suffering using natural methods only. All in all, I was inspired by what I read on those cards to learn that we have many of our own chiropractic versions of Patch Adam. Most of all, I was gratified to learn that not all DC grads did the Money Hum, nor did NCC staff waste money on statues of themselves.
The comments from those students who told why they deserved my books were heartening as well as funny. Here’s a few to enjoy:
“I would like to win because I’m I the right place at the right time for the right experience.”
“I deserve to win the book because I have a vision—a vision of what my practice will be, however, it can’t be done alone. I need as much help as I can possibly dig up. Hopefully I’ll be even more wiser about the ‘vision’ after reading your book.”
“I plan to develop a practice that focuses on patient education and prevention so my patients will learn how to care for themselves and their bodies before they hurt themselves. Don’t get me wrong—I’ll treat the hurt ones too.”
“I’m smart enough to know I need help with business, and I have to start somewhere!”
“The books I’m reading outside of school relate more to what I’ll be doing when I get out. Therefore, the more I can read now the more prepared I’ll be when I graduate.”
“I want to build a successful practice that will benefit and educate my patients, yet I know little when it comes to business and management.”
Perhaps the most interesting dialogue I had all day occurred before my lecture while chatting in Dr. W.'s office. We were discussing the upcoming homecoming event in which we both would participate--a panel on the future of chiropractic. Since it is still mostly in the formative stage, I suggested that the panel might include Dr. Tedd Koren of FTC vs. brochures fame. Tedd is a prolific writer and one of the more rational, learned voices in the straight movement, so I thought his input would add diversity of thought plus be interesting to discuss the future of chiropractic with a broad input of ideas.
Coincidental or what, but no sooner had I suggested that idea than Dr. W. handed me a recent copy of The American Chiropractor magazine containing an article by Tedd titled, "How to Freak People Out and Turn Them into Patients." He suggests measuring their height and discussing their shrinkage as a patient acquisition method. While he did accurately describe the anatomical degeneration that most everyone develops as we age, the tone of the headline could also be viewed as very tacky—perhaps a simple case of a bad choice of words by the editor?
No sooner had we left Dr. W.'s office, Dr. Bruce Hodges came to take us to his classroom, walking in hand with the same TAC article. "One of my students just gave me this, asking if this was standard ethics for practicing chiropractors." He was fuming over this "gimmick," ranking it up there with the “free chicken dinners” and “killer subluxation” schemes—anything to con or scare patients into care.
In defense of Tedd, he explained to me later that this tongue-in-cheek article was an innocent attempt at humor and a worthwhile clinical observation to discuss regardless of the tacky headline. Be that as it may, his article certainly freaked-out the NCC staff, and illustrated the diverse ethical differences between the two camps. I imagine the eclectic panel idea is pretty much freaked-out too (hopefully not).
But I take my hat off to Dr. W. and his dedicated faculty. Their campus sits in a beautiful setting with many diversely-designed buildings and comfortable dorms, similar to the NYCC campus in Seneca Falls, NY, just without the golf course! These two campuses were a far cry from my experience as a chiro student sitting in the initial Sherman College in a department store and the Life College classes given in the old Cobb Co. unemployment office.
Although raising entrance requirements admittedly put a hit on NCC's enrollment, Dr. W.'s proactive dedication to an innovative educational PBL system to produce quality chiropractic physicians capable of integration into the healthcare delivery system is real feather in his cap. When their first class of PBL grads passed their national boards with flying colors and with the selection of 17 NCC grads as gatekeepers for BC/BS, anyone aware of these academic and professional accomplishments must tip their hat to Dr. W's success at NCC.
But the real tip of the hat goes for his constant battle with the more regressive elements within chiro education. Along with Reed Philips at LACC which also uses PBL, Dr. W.'s fight to upgrade our academic standards and scope of practice has been a constant war since he began his presidency in 1986. In fact, this battle has raged since 1906 when progressive chiropractors saw the Palmer branch of the chiropractic tree had its limitations due to the narrow vision that BJ Palmer had chosen for PCC.
Although the Sherman and Life bias had taught me that NCC was a mixer college more interested in producing medical wannabes than principled DCs, I found that to be a bunch of bunk, much like a lot of what the super-straights had taught their impressionable students. Rather than focusing solely on an adjusting procedure and the dogma of Palmer as the Innatists have done, the NCC branch of the chiropractic tree has focused on diagnostics and clinical excellence/diversity instead.
At one point in my visit with Dr. Bruce Hodges, their ethical practice mgt. course instructor, he mentioned that NCC didn't emphasize the so-called philosophy of chiropractic as much as it was focused on more practical matters. Although I knew what he meant, I disagreed with him in part. There's a strong philosophy there, it's just not the Innatist dogma. It seems to me NCC has a very progressive philosophy of education with its PBL system, and its wholistic philosophy of health teaches a much more comprehensive, patient-based, clinical operating system that far surpasses the pop and pray to Innate straight stuff the diploma-mills are teaching under the guise of “subluxation-based” chiropractic.
This is a point I've always held in contention with the Innatists who think if one doesn't subscribe to the spiritualism of BJ (or one of his clones like Big Sid or Reggie) and refrains from poppin’’ and prayin’ to Innate, then one cannot considered himself a "principled, subluxation-based" chiropractor. In essence, they've glorified a technical procedure draped in vitalistic rhetoric, foregoing diagnostic and clinical skills.
Indeed, they've chosen to deify the immaterial "force" behind the matter, no matter what's the matter with the patient. Revere the adjustment, and glorify the Developer to the exclusion of all else seems to be their credo. If this is chiropractic’s version of a Renaissance as some straights proclaim, then our profession is in dire need of a Reformation, if not a complete Revolution from the intellectual stagnation that has suffocated progressive chiropractic.
Dr. W's "patient-based" philosophy of a principled DC fills this refreshing void. Rather than focusing on the procedure, the patient-based practitioner focuses on the patient's needs, and that starts with diagnosing their problem first, then taking an eclectic approach to helping them, whether it means SMT, acupuncture, naturopathy or even referring to an MD for allopathic methods. I guess it all depends upon which principle you're subscribing to--helping patients or glorifying techniques.
Oddly, too many "principled, subluxation-based" practitioners seem to have embraced Alfred E. Neuman's philosophy of "What, Me Worry?" about patient care and the legal responsibilities to do what's best for the patient's needs. They seem to neglect professional responsibilities like diagnostics, referral or using natural methods of health care other than SMT--those Educated Mind “mixer” issues that Innatists shun.
While Innatists contend their ethical duty is to only adjust VSC, others may contend there's more for a doctor of chiropractic to offer patients than just that singular act. Most ironically, many “principled, subluxation-based” straight chiros refer to themselves as “full-spectrum” practitioners because they embrace Innate to heal all rather than “limited” DCs who focus primarily on pain and dysfunction of the NMS systems. Oddly, these conservatives appear to be the radicals in light of their narrow clinical focus and their vitalistic claims of helping everyone and everything via Innate. It does get confusing listening to them—are they practicing or preachin’?
Obviously Dr. W. and his faculty at NCC are between a rock and a hard place with their emphasis on a patient-based, wholistic healthcare approach within the chiropractic profession. On one hand you have the medical world, legislators and the public demanding more professionalism from the chiropractic profession and, on the other hand, you have the Palmer Innatists minimizing the role chiropractors should play in this game.
By raising the bar of standards for students to have a minimum GPA along with a BS degree, Dr. W. has constantly struggled against the diploma-mills who prefer the lowest standards and the easiest curriculum possible in order to matriculate as many students and capitalize on their student loans. It's painfully obvious who are the progressive elements within chiro education, and who are the regressive ones geared more at killing the golden goose of student loans than doing what may enable our profession to fulfill its rightful place at the healthcare table in the future. Then again, it all depends upon your philosophy, doesn’t it—helping the profession succeed or helping your own pocketbook?
I doubt the Illinois BC/BS would have allowed 17 DC gatekeepers if they had professed the straight subluxation-based dogma of "we don't diagnosis, we don't refer, we don't treat anything but VSC, but we cure everything because we’re full-spectrum chiropractors prayin’ to Innate!"
Does anyone think the Illinois legislators would have supported any efforts to make chiropractic physicians on par with medical physicians if NCC had professed the anti-intellectualism similar to the Innatists who, like BJ, may still believe that "education constipates the mind"? Does anyone think the state legislators would grant NCC over a million in state funds if they felt NCC was operating a diploma-mill exploiting student loans and scamming its non-profit status with huge salaries for the administrators?
I left with the impression that Dr. W and NCC were on a path less traveled in chiro education and practice ethics. I wish every tainted Lifer could experience for themselves the refreshing academic environment there. No megalomaniacs with a book-burning mentality, no autocratic censorship of ideology, clinical technology or research topics--nothing is taboo there, much unlike my experiences with the two Bible Belt chiro colleges' strict chiro catechism. Nor will you hear at NCC the line that "good grades don't equate to good chiropractors," as Gerry Clum testified at the CCE hearing on raising the entrance requirements for students. Nor do the top five administrators take home $2.7 million in compensation, chanting the Money Hum all the way to the bank.
While Dr. W.'s path's at NCC may be less traveled and a tougher one than many have chosen, perhaps our future will be left in better hands than I once had thought after experiencing the Bible Belt chiro colleges. Indeed, the evil mixer empire may very well carry the candle that all chiro colleges may follow into the future.
Imagine more chiro colleges professing excellence rather than anti-intellectualism; imagine broadening our clinical effectiveness rather than limiting it to a pop and a prayer; imagine administrators doing what’s best for students rather than what’s most profitable for themselves; imagine students well-prepared to serve patients and to survive in business rather than stooping to free exams and gimmicks. Time will tell which educational paradigm prevails, but I know which one I’m betting on to lead the charge into the next millennium.
But, what do I know? I’m just a born-again eclectic chiro refusing to do the Money Hum. I’ve seen the light of progressive chiropractic, and it doesn’t rest with ol’ time chiro dogma and a pop and prayer to Innate, no matter what’s the matter!