In last issue, I discussed the potential for chiropractors in taking the lead in the establishment of a primary spine care provider (PSCP) designation, a clinical specialty with advanced training in the area of spine care and spine-related disorders (SRDs).
In last issue, I discussed the potential for chiropractors in taking the lead in the establishment of a primary spine care provider (PSCP) designation, a clinical specialty with advanced training in the area of spine care and spine-related disorders (SRDs).
It is reasonable to assume the PSCP role would offer the following benefits:
- Faster patient recovery through timely patient-centred, evidence-informed interventions, active treatment plans, appropriate triage and patient education/empowerment
- Cost containment and savings by avoiding unnecessary treatments and imaging/diagnostic tests
- Avoidance of iatrogenic disability via consistent communication and avoiding unnecessary medicalization of imaging findings with questionable significance
- Increased productivity through patient activation and targeted return-to-work programs
- Higher patient satisfaction and shared decision-making
- Unburdening family physicians and other primary care contact points, as well as ensuring more appropriate and necessary specialist referrals
At the very least, chiropractors could lead the way in a team-based or multidisciplinary solution. We must, however, approach this in a reflective, evaluative and logical manner. Overt reform in our profession would be required in some areas and this is something we cannot take lightly, as there are certainly other professions that would contend to be, and would be, appropriate for this role.
Unfortunately, we are currently not viewed nor utilized as PSCPs. A 2009 national survey by the Canadian Chiropractic Association revealed 60 per cent of Canadians view chiropractors as those treating back pain, and just over 40 per cent regard chiropractors as experts in back pain. In addition, the utilization rate for chiropractors has remained stagnant for years (around 10 per cent according to most data).
A way forward
In a society-wide effort to establish a PSCP and implement an effective primary care approach for SRDs, there are some significant factors we must acknowledge and address:
Education: Currently, educational institutions are not graduating clinicians who meet all requirements for a PSCP. Chiropractic programs certainly check a number of the required boxes, but would have to add additional training in areas such as basic pain medications, indications and efficacy of various surgical interventions, advanced imaging and diagnostics. Such advanced training may best be implemented in optional programs over and above existing chiropractic education. This is not unreasonable and such programs have been established in some regions.
Professional prejudice: It is likely that the best fit for the PSCP role will come from outside the traditional allopathic disciplines. This may be met with significant resistance from some parts of the medical community. Since the solution to SRD-related problems often require some non-traditional thinking, it is crucial a competent PSCP be accepted regardless of the degree after his or her name.
The supermarket approach: Many practitioners (in all disciplines) see high volumes of patients while offering treatments that are of little benefit to the patients. The establishment of a PSCP would represent a significant shake-up in most health-care systems – referred to as disruptive innovation – putting some of these practitioners at risk. This is an acceptable and necessary consequence of improving health-care delivery. Successful practices can, and do, utilize patient-centred, evidence-informed care.
Resistance from within: The philosophical and practice differences among chiropractors are well known to readers. Simply put, there are those who feel the role of PSCP would limit our perceived (and actual) expertise to spinal conditions. To this I say – so what? The vast majority of our patients see us for SRDs anyway (most surveys indicate ~90 per cent); this would not be a significant shift in our caseload or patient population. In addition, since virtually everyone will suffer a SRD at some point in their lifetime, wouldn’t it be beneficial to be the profession that patients seek for care?
The burden of SRDs is significant and undeniable. As evidence-informed chiropractors, we are perfectly positioned to play a key role as the PSCP of the future, or at least a critical member of a team approach to this important issue. Taking action now can raise our credibility and ensure a successful future for younger practitioners. For this to happen, we must collectively take action while remaining accountable, collaborative and open-minded.
Dr. SHAWN THISTLE is the founder and president of Research Review Service, an online, subscription-based service to help busy practitioners integrate current, relevant, scientific evidence into their practice (www.researchreviewservice.com ).
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