Barriers to expanding primary care roles for chiropractors: The role of chiropractic as primary care gatekeeper

Gaumer, Gary; Koren, Annette; Gemmen, Eric

doi:10.1067/mmt.2002.126474

Cited by 24 publications

(7 citation statements)

References 30 publications

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“…In addition to government and private insurances designating chiropractors' as specialists in health care systems, chiropractors role as neuromuscular specialists is also is due to patients’ impressions of their services – patients tend to view chiropractors as “back doctors” not as primary care providers [27]. Many within the US chiropractic profession are content with their role as neuromuscular specialists and those who wish to provide more primary care roles likely have numerous barriers to overcome [28]. …”

Section: Discussionmentioning

confidence: 99%

The United States Chiropractic Workforce: An alternative or complement to primary care?

et al. 2012

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BackgroundIn the United States (US) a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation’s primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians.MethodsWe used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types.ResultsAccording to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson’s correlation 0.17, p-value < 0.001) and appear to be more responsive to market conditions (i.e. more heavily influenced by population characteristics) in regards to practice location than primary care physicians.ConclusionThese findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access.

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Section: Discussionmentioning

confidence: 99%

The United States Chiropractic Workforce: An alternative or complement to primary care?

et al. 2012

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“…The role of the chiropractor in healthcare has been eloquently debated in several articles [1,2,5,16-18]. Our interest was to provide preliminary data in the process of determining if chiropractic training provides the chiropractor the ability to recognize undiagnosed LTC which is a fundamental requirement of all physicians.…”

Section: Discussionmentioning

confidence: 99%

“…There are several different definitions of what constitutes a primary care physician [1,2]. Most of these definitions incorporate the concept of “assumption of longitudinal responsibility for the patient regardless of the presence or absence of disease” [3].…”

Section: Introductionmentioning

confidence: 99%

Self-reported recognition of undiagnosed life threatening conditions in chiropractic practice: a random survey

et al. 2012

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BackgroundThe purpose of this study was to identify the type and frequency of previously undiagnosed life threatening conditions (LTC), based on self-reports of chiropractic physicians, which were first recognized by the chiropractic physician. Additionally this information may have a preliminary role in determining whether chiropractic education provides the knowledge necessary to recognize these events.MethodsThe study design was a postal, cross-sectional, epidemiological self-administered survey. Two thousand Doctors of Chiropractic in the US were randomly selected from a list of 57878. The survey asked respondents to state the number of cases from the list where they were the first physician to recognize the condition over the course of their practice careers. Space was provided for unlisted conditions.ResultsThe response rate was 29.9%. Respondents represented 11442 years in practice and included 3861 patients with a reported undiagnosed LTC. The most commonly presenting conditions were in rank order: carcinoma, abdominal aneurysm, deep vein thrombosis, stroke, myocardial infarction, subdural hematoma and a large group of other diagnoses. The occurrence of a previously undiagnosed LTC can be expected to present to the chiropractic physician every 2.5 years based on the responding doctors reports.ConclusionBased on this survey chiropractic physicians report encountering undiagnosed LTC’s in the normal course of practice. The findings of this study are of importance to the chiropractic profession and chiropractic education. Increased awareness and emphasis on recognition of LTC is a critical part of the education process and practice life.

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“…But information from the Council on Chiropractic Education (1999a, b) and from a direct analysis of curricular time allotments as reported in each college's catalog reveals that less than 10 percent of the time in chiropractic colleges is devoted to subjects beyond the NMS system. It is not surprising, therefore, that chiropractors’ knowledge base has been questioned, not only by chiropractic's critics (e.g., Barrett, Jarvis, and DuValle 2001), but also by MDs who refer patients with NMS conditions but not with viscerosomatic disorders (Jamison 1995) and by private insurers who restrict chiropractic coverage to NMS disorders and create other barriers to the ability of chiropractors to serve a primary care role (Gaumer, Koren, and Gemmen 2002). Nonetheless, an interdisciplinary panel composed mainly of chiropractors concluded that chiropractors could evaluate at least 90 percent of typical primary care, participate in the treatment of 60 percent, and provide primary management for 45 percent.…”

Section: New Horizonsmentioning

confidence: 99%

Chiropractic in the United States: Trends and Issues

Cooper

McKee

2003

Milbank Quarterly

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From its origins as an unconventional therapy in the late 19th century through decades of marginalization during the 20th century, chiropractic has acquired legitimacy and prominence (Meeker and Haldeman 2002). Signs of its success abound. They include a broadening of the laws and regulations affecting its licensure, scope of practice, and reimbursement; greater acceptance by both physicians and health plans; and a sustained demand for its services. Chiropractic's political base is strong, and it enjoys a high degree of patient satisfaction. Moreover, it is at the vanguard of complementary and alternative medicine (CAM), which receives ever greater proportions of health expenditures (Eisenberg et al. 1993, 1998) and which is being increasingly integrated into conventional medicine (Macy Foundation 2001). Even so, chiropractic's future seems uncertain. Recent expansions of chiropractic colleges are swelling the ranks of practitioners while managed care is restricting payment for what chiropractors do and evidence‐based medicine is demanding that what they do must have demonstrable value. Chiropractic is the best established of the alternative health care professions. Although marginalized for much of the 20th century, it has entered the mainstream of health care, gaining both legitimacy and access to third‐party payers. However, the profession's efforts to validate the effectiveness of spinal manipulative therapy, its principal modality, have yielded only modest and often contrary results. At the same time, reimbursement is shrinking, the number of practitioners is growing, and competition from other healing professions is increasing. The profession's efforts to establish a role in primary care are meeting resistance, and its attempts to broaden its activities in alternative medicine have inherent limitations. Although patients express a high level of satisfaction with chiropractic treatment and politicians are sympathetic to it, this may not be enough as our nation grapples to define the health care system that it can afford.

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Barriers to expanding primary care roles for chiropractors: The role of chiropractic as primary care gatekeeper

Cited by 24 publications

References 30 publications

The United States Chiropractic Workforce: An alternative or complement to primary care?

The United States Chiropractic Workforce: An alternative or complement to primary care?

Self-reported recognition of undiagnosed life threatening conditions in chiropractic practice: a random survey

Chiropractic in the United States: Trends and Issues

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