day soon, more than 20 million veterans and their dependents
will have a new choice in health care. For the first
time in history, doctors of chiropractic will be a part
of the mammoth Veterans Administration healthcare system,
where they will be checking for subluxations and providing
care to former service men and women on a par with medical
least that’s the idea behind legislation signed
by President George W. Bush last January calling on
the VA to make chiropractic care available to all
vets. Before the first adjusting table is installed,
however, a somewhat reluctant bureaucracy must figure
out what this upstart profession is all about and
how it can best be used in hospitals and outpatient
the idea seems simple in theory, there are studies
to be completed and questions to be debated before
chiropractors can be hired. When it comes to introducing
a new idea into the federal government, nothing is
the final say on details rests with the Secretary
of Veterans Affairs, Anthony Principi, much controversy
has swirled around his appointment of a Chiropractic
Advisory Committee. The 11-member body—made
up of six chiropractors, two MDs, a physical therapist,
and a doctor of osteopathy—is charged with issuing
recommendations. They must come to grips with sticky
issues such as scope of practice, whether chiropractors
should be contracted or hired, and whether patients
have to get a medical doctor’s permission prior
to seeing a D.C.
is new territory for everyone involved, and the committee
members are determined to tread carefully.
need to make sure we don’t jump into this just
to get chiropractic’s foot in the door,”
says committee member Dr. Leona Fischer, an Elmhurst,
Ill., D.C. and Navy veteran who serves on the World
Chiropractic Alliance’s International Board
of Governors. “If it’s done in a haphazard
manner it’s not going to reflect positively
on chiropractic. So the object of the game is to make
sure we have looked at what’s going to work
best to get direct access and deliver quality care.”
committee came together for the first time in September
and that meeting was largely consumed with getting
acquainted and “housekeeping details,”
says member Brian Murphy, a PT and clinical manager
of rehabilitation at the VA’s Salt Lake City
real work will take place in the coming year as the
committee members come to grips with the details of
the new program.
is in those meetings that early congeniality is likely
to be sorely tested. The non-D.C.s on the committee
frankly admit that their own knowledge of chiropractic
a concern for me, because I’m not sure how you
can advise on something that you have not experienced,” observers Fischer.
help remedy that problem, Committee Chairman Dr. Reed
Phillips directed that the first order of business
at the December meeting be a mini-seminar on chiropractic.
Each D.C. is charged with delivering a presentation
on the ins and outs of chiropractic education, practice,
and politics for the benefit of their non-D.C. colleagues..
addition, the committee plans to visit a site where
the Defense Department is providing chiropractic services
to military personnel.
to see how (chiropractic) has been implemented in
the military is one part of it, but also I understand
we will be able to witness patients being treated,”
says committee member Dr. Cynthia S. Vaughn, president
of the Texas Board of Chiropractic Examiners. “They’ll
be able to see patients receiving treatments in the
The fact that chiropractic has gotten this far represents
a considerable victory. The VA Healthcare System—dominated
by medical doctors—has long resisted any inclusion
of chiropractic. Many within the medical community
are continuing to voice concern over the prospect
of D.C.s acting as primary care providers.
American Medical Association—powered by a $7.3
million lobbying budget—has fought to keep chiropractors
from winning the right to be primary care physicians.
chiropractors themselves must also come to grips with
their own widely divergent philosophies. The major
associations held together a shaky alliance long enough
to shepherd the VA legislation through Congress. No
sooner did it pass, however, than the infighting that
has long characterized the struggle between straights
and mixers flared up.
ACA argued that members of the advisory committee
that participated in the Defense Department’s
chiropractic project should be reconstituted for service
on the veterans’ panel. When this proposal was
rejected in Congress, each organization submitted
their own nominees.
members of the Defense committee were named to the
new advisory body, but there were also representatives
from medicine, osteopathy and physical therapy. To
the horror of many D.C.s, even Dr. Charles DuVall,
Jr. president of the National Association for Chiropractic
Medicine, and a longtime ally of anti-chiropractic
QuackWatch founder Dr. Stephen Barrett, was also given
Daryl Wills, ACA president, believes that “it
is very alarming to me that the (VA) Secretary would
also choose to include someone like Dr. DuVall on
the committee. He is a divisive force, and, in my
judgment, does not want the chiropractic profession
to gain additional acceptance, nor does he wish us
to make progress in any way. I fear that his appointment
is a warning sign that the well-entrenched, anti-chiropractic
bureaucracy at the DVA is alive and well, and will
be working hard to sabotage or severely limit the
scope of the new benefit.”
accusations weren’t directed just at the VA
bureaucracy. The ACA was also quick to blame the ICA
and WCA for this turn of events.
in Dynamic Chiropractic, Garrett Cuneo, ACA executive
vice president, charged, “Once President Bush
signed the legislation, the agreement was broken by
the ICA and the WCA. . . How much of this disunity
encouraged the VA to appoint a committee, which appears
to have a majority bias against chiropractic, is difficult
members are optimistic that the committee will be
able to put aside their differences and make the legislation
know historically the ICA, ACA and WCA have all had
contentious issues, but this meeting was wonderful,”
contends Fischer. “Everybody was committed to
working together for the greater good of chiropractic.”
Long-held divisions between the camps are obvious
in the struggle over the VA advisory committee.
ACA wanted to ensure that chiropractors be able to
act as primary care providers, diagnosing illnesses
and providing services beyond adjustments.
more conservative groups such as ICA and WCA pushed
for a more limited approach that emphasized adjusting
the spine and correcting subluxations.
the results didn’t seem to satisfy anyone, in
the end it seems that just about every viewpoint is
we are indeed going to work in a multi-disciplinary
facility, I think it probably is wise for us to have
input on how our role will be structured by other
professions who will be impacted by this,” says
committee member Dr. Michael McLean, a Virginia Beach,
believes that differences between chiropractic and
the medical approach can be addressed and worked out
before the program is launched.
how much consensus the committee can reach remains
to be seen, but observers say total agreement isn’t
necessary or even desirable.
advisory committees are not required to come to consensus,”
says Sara McVicker, the VA official who serves as
manager for the committee. “It’s nice
if they do, but on the other hand, if you can get
all these people with all these views in one room
and they all agree, why do you need an advisory committee?”
predicts that over the next two years, before it expires
in 2004, the committee is likely to issue a series
of recommendations—some of which may be unanimous,
while others come in the form of majority and minority
reports championing different points of view.
While the VA is not the first government agency to
include chiropractic—D.C.s are already working
under contract at various defense department locations—the
sheer size and reach of its health care facilities
offers tremendous opportunities for exposure. Presently,
VA patients have to get a referral from their MD or
other provider to see an outside chiropractor under
the agency’s “fee basis” system.
VA doesn’t provide a service, we send the vet
out to someone who is a private provider—in
this case a provider of the patient’s choice,” says McVicker.
fiscal year 2001, just 945 patients received chiropractic
care during a total of 10,938 visits.
really didn’t surprise me much given the age
of our patient population,” explains Murphy.
“In my medical center (Salt Lake City) the average
age of our patients is 73. Half of the people we treat
are over 65.”
many in the medical community—believe patients
suffering from osteoarthritis and other musculo-skeletal
problems common to the elderly are not good candidates
for chiropractic care.
on the Profession
While the details of chiropractic care remain cloudy,
one thing that is clear is that a growing number of
D.C.s will soon be working in the VA system side-by-side
with other health professionals. For many of them
it will be a new experience that may very well require
the development of new skills.
observers predict that the long-term effect on the
profession could be profound, as chiropractic becomes
more closely integrated with the Allied Health Professions.
important to realize that virtually all of the work
that will be done in the VA facilities will be done
in a hospital context,” says McLean.
believes this experience will have a profound effect
on the profession. D.C.s will need to become much
more familiar with not only the methods practiced
by medical doctors and hospital staffs, but with the
nature of patient illness as well.
are definitely protocols if you’re working in
a multi-disciplinary setting,” he explains.
“Many of the patients will have a variety of
problems and may be under a variety of different care
providers while they’re in the hospital, and
we will be one of those. We will have responsibility
for receiving referrals, but if a person should have
some life-threatening condition, certainly we will
have responsibility for making referrals.”
will present a very different environment for most
chiropractors, who are more familiar with a solo office
practice. This change is also likely to force chiropractic
colleges to begin training students in the skills
needed to function within a hospital setting.
certain it will make a big change in the preparation
of chiropractors,” he predicts. “I’m
not saying it will change our scope, but we have to
be more aware of what other practitioners do, and
we have to be more open for professional interaction.”
professional interaction may also change the way the
medical community views chiropractic as well. With
more than half of all medical physicians receiving
their training in VA hospitals, D.C.s have an unprecedented
opportunity to build relationships that can be carried
outside the VA.
these providers to receive training in a facility
where there are chiropractors working will literally
change their view of the chiropractic profession,” says McLean.
the opportunities for chiropractic are great, and
perhaps that explains the passion that surrounds the
push to inclusion in the VA. Much still remains in
doubt, but to a greater extent then ever before, the
profession has been extended the promise of greater
acceptance. What D.C.s are able to do with that promise
is now up to them.
© Copyright 2002 Today's Chiropractic