GUEST BLOG: A Chiropractor’s Perspective on the FPD

Thank you to Todd Shulfer from Wisconsin who wrote and submitted this tome to the state-wide acupuncturists’ online forum.  Special thanks for allowing me to re-post it here.

I certainly believe that an acupuncturist should receive training beyond the use of disposable needles. I believe that there should be some grounding in theory, practice, technique and safety. I also feel and believe that the education I received gave me all of that and then some. I do not see how making more education mandatory is going to make this profession greater.

Let me offer this perspective. I am also a chiropractor, besides being an acupuncturist. I went to three and a half years of chiropractic school. During that time I went to school year around. Each trimester I took 30 credits to remain at full time status. This meant that I was in class usually 7-8 hours a day. My labs were at night and I had to study after all of that was done. Weekends were spent studying and juggling which upcoming exam was more important to study for. Finals weeks were absolute hell as we would often have more than 7 exams in a 5 day period. Yes it did get easier as there was less focus on academics and more focus on clinical proficiency at the end of the program, but it never got less intense. When I graduated I was very proud to have achieved the status of “doctor”. I had went to the best school. I had studied hard and was on the Dean’s list most of the trimesters I was there. I attended extra technique seminars while I was in school and became very proficient in my techniques and clinical knowledge. I felt I had been called into this great profession of chiropractic. I was ready to save the world.

However the other side of this story is this. I came out of school with over 100 thousand dollars in school loans. While I really wanted to start my own practice, there was no bank out there that would loan me the start up capital needed to start a business with that much of a debt from school loans. I was forced to go to work for someone else and essentially practice how they wanted to. Not how I wanted to. My next big lesson was in the realm of insurance reimbursement. I realized I was no longer in control of my patient care. When patient’s come in and they are in pain or trouble, they often say things like “I never want this to happen again, I will do anything you tell me doc.” “Yes I am interested in prevention and wellness and whatever you say, just please get me out of pain.” So then you go to verify the patient’s insurance and they tell you that that person has no chiropractic coverage or perhaps they will cover the patient for 12 visits. So you see the patient for 12 visits and they are hopefully out of acute pain. And you tell them that their insurance coverage is no longer going to pay. They say well I can’t afford this anymore, I am sorry I have other priorities to pay for. But I thought you were interested in prevention and wellness. “Yes but I don’t have time for that right now,” they will say. “I have to get back to work at my 2nd or third job so I can pay my other bills and your bill.” After a while you just smile and say OK because you know the problem has not been fixed and they will come back. But sometimes they won’t come back, because they will think I tried that once and it didn’t work and this time it is a lot worse. I wonder if that chiropractor made me worse. I heard those guys were quacks anyways. Besides my insurance coverage for chiropractic coverage has ran out. I better go see my MD, I have to get back to work. So enter the medical model. They do not see things like chiropractors. It is not their fault. They are trained in the use of pharmaceuticals and surgeries. Those are their tools, that is all they know. And while I will admit it is changing slightly with the younger MDs, I have no more respect because I am a chiropractor or an equally trained physician. It has been determined that chiropractors have the same if not more academic training as medical doctors and the public opinion of us has not gotten better. In some ways it has gotten much worse.

Let me offer my opinion and theory if I may as to why this might be. Chiropractic was founded in 1895 in Davenport, Iowa. It was first discovered when Harvey Lillard, a janitor went to DD Palmer (who was not a “doctor” at the time, but a magnetic healer). He went to Palmer because he had recently lost his hearing. After examination, DD Palmer, found that Mr. Lillard’s third thoracic vertebrae was “protruding” . He placed Harvey Lillard face down on a wooden bench and “racked the vertebrae into place” as he states in his book. Harvey Lillard instantly regained his hearing. At that instant in the evolution of human beings something changed. The specific chiropractic adjustment was created. As the word about this miracle spread, people sought out chiropractors for all sorts of ailments. Chiropractors educated people and told them how the very simple modality of chiropractic worked. They said things like, “the body needs no help, just no interference. ” But the medical profession was getting angry about this. We cant have these quacks making us look bad. In fact, chiropractors were jailed for “practicing medicine without a license”. They did not care. They stood for something. They didn’t care if they became “doctors” or not. In fact many of them adjusted their fellow inmates while they served time in prison, because there was a need for them and chiropractic. There was a tremendous split that occurred. It had to occur. Chiropractic was all about vitalism. Medicine is based on materialism. The two will never see eye to eye. BJ Palmer, DD’s son wrote volumes and volumes of books, they are called the green books, explaining this principle of chiropractic and vitalism. Clarence Gonstead, another simple chiropractor in the Wisconsin town of Mt Horeb, was such a great chiropractor that people flew from around the world to see him. There is a map in the Gonstead Clinic in Mt Horeb, that has pins in it from all the locations in the world that people traveled from. In this tiny small town, he had to build a hotel next to the clinic so people could stay for extended visits and regain their health. There are many more stories like this in the early days of chiropractic that I will not go into. But what is sad is that not many people know this anymore. And this is my theory as to why.

Shortly after chiropractors got their “doctoral” status. They received insurance equality. Or did they. For a while there, it was a hay day. You could go to a chiropractor if you “thought” you were going to get a headache and it would be covered by your insurance. Those chiropractors were making some big insurance dollars. The game has changed though folks. Insurance pays for what “they deem medically necessary and what can be proven through research”. So it has come to be known that “doctors of chiropractic” are back and neck doctors. Oh and don’t forget headaches. Medical research has shown that it should take basically 12 visits to “cure” such a malady. Most people that come into see me do not know about nervous system interference or vertebral subluxation. They “heard” that chiropractic is good for back and neck pain. Most are surprised to hear the chiropractic story when I share it with them. Luckily, many are even more surprised when they actually do get relief from some of their other symptoms. And yes chiropractic can help everything from gastrointestinal problems to infertility. How many of you acupuncturists out there know that? That is what is sad to me. You see because of our need for doctoral status and then insurance equality, we have become “technicians” and sometimes we look like even more quacks than we did in the early 1900’s. If you talk to some of the old time chiropractors they will tell you that they did not to have to go to as much school as I did, yet they probably helped more people. It is my belief that most of this extra schooling is due to insurance coverage, lawyers and malpractice, NOT more clinical competency.

Again here is my theory as to why.

If you believe that insurance reimbursement is going to give you the cash price that you are getting now you are in for a tremendous awakening. Currently Medicare pays for a very small portion of the chiropractic adjustment. Many insurance companies use this as a guideline to set their reimbursement rates. Therefore Chiropractors have resorted to what may be called unethical practices by some. These are things like expensive treatment plans, gadgets and gizmos, and supplement sales to stay alive in this tough market. If you get an adjustment from most chiropractors today it is usually not very specific. They have no time. They have to make up their lost revenue in volume. They have to hire an employee to do the billing full time and there are a ton of headaches that go along with that. Insurance companies will deny you and tell you that it is not medically necessary. Insurance companies work from facts and figures, not real live patients who are standing in front of you who may still need your care. They are trying to save money and make profits, while you are trying to help real live people who need you. On top of that you have school loans to pay back, a staff payroll to make, a high overhead to pay for( you are a doctor right?, have to be in a professional building now). However, in order to pay for all of those things and that deficit that is now incurred by the insurance reimbursement, you will do things that are no longer chiropractic. Until you yourself don’t even know what a chiropractor is anymore, or what you started all this for in the first place. All you really wanted to do was help people, right? Or did you want to be a DOCTOR? I would gladly turn in my doctor status to get back the status that chiropractors had in the early 1900’s. I am now a back and neck technician and a supplement salesman, but I smile every time I introduce myself as DR. Todd. Oh, don’t get me wrong. I love being a chiropractor and I am very passionate about it. I constantly spread the true chiropractic message and philosophy. And you know what else, my best patients are the ones that get it. And they in turn, pay cash for it. I don’t have to set them up on expensive treatment plans. They are trained to understand the adjustment and when they may need it. They come in during times of stress and pay cash. Health care reform IS communicating to people how to get healthy and stay healthy. It is NOT more insurance coverage and definitely NOT more government intervention.

You see insurance coverage does something very weird to the mindset of the person utilizing it. In my humble opinion most people do not deserve health insurance. Before you get all flustered, yes I believe in catastrophic insurance and insurance for emergency situations. However, should insurance pay for the person that lives on processed food, sugar, caffeine and tobacco and depletes themselves to the point of exhaustion. Should we really be mad when the insurance company won’t cover them when they are “sick”. Something very weird happens when insurance reimbursement enters your office. You understand that there is no money (which is another form of energy) exchanged directly between you and the patient. Therefore, it becomes more difficult for them to put actual value on your care. And many “doctors” out there become more and more tempted to pad the bill, so that they get what they feel they deserve for a reasonable fee to pay for their increasing overhead. It is a viscous circle that can often times end up in corruption, unethical practices, and eventually the dissolution of a beautiful great profession. If most people were asked today what the difference would be between a chiro and a physical therapist, the majority of the population would not know. Heck, there are many chiropractors that don’t know. Very few chiropractors give a specific adjustment anymore. I don’t know about you, but I also don’t know of many chiropractors having people fly in from around the world to receive their care anymore either. Why has this changed? Why was chiropractic so powerful at one time and is not anymore? What could have happened? Hmmm, I wonder.

So if you think doctoral status and government funded research is going to bring respect to your profession, I firmly believe you are dancing with the devil. There are three basic questions every patient wants to know when they walk in through your door.

1. Can you help me?
2. How long will it take?
3. How much is it going to cost?

The average person does not care what your grades were in school. (I have yet to have a patient ask me what my grades were). You see the medical profession is failing where we are exceeding. No, I am not medical bashing. In the areas of emergency medicine and some other areas, the medical arena has made great advances. And yes we do need them. However, they will respect you no more just because you are a now called a doctor. And frankly I could care less. I serve my patients not the medical profession. If they accept me or not is of no concern of mine. I mind my own business. If more practitioners spent time educating the public about this great medicine, we would get the credit that you so desire. That is the satisfaction I want from my practice.

As far as government funded research, be careful with this slippery slope also. What happens when the “medical research” disproves what you know to be true in your clinic all day long? The press will say, “It has now been determined that acupuncture does not work for this.” And you will say, yes it does, I see work everyday in my clinic. Sorry, “Doctor”, there are no papers to prove this. Insurance will not cover this. It will be medically unnecessary. Sadly, but true people get alot of their information from the press. More research is not always better. If any of you think that research helps sort out the “bull-oney”. Tell that to the people that are cured of incurable diseases using some of this “bull-oney”. They will laugh in your face doctor. Truly sick people don’t care about status and if it has been proven or not. They want to know if you can help them, how long it will take, and how much it will cost?

You see, I believe honestly in my heart that I can help every single person that walks in my door and I encounter. I may not cure them, but I can help them. Maybe the person is in so much pain that they have been unable to sleep. Maybe the pain never truly goes totally away, but they can sleep now because it is lessened. Did I help that patient? I could care less about your research.

If a doctoral status is determined necessary for this profession. It will mean this. You will come out of school with higher school loans than you already do. You will not be able to get a startup loan to start a practice of your own. You will be forced to work for someone else and most likely a hospital. A hospital is a business. They will not care if you can get people better or faster. I very highly doubt that your herbal medicine will be able to compete with pharmaceuticals in a hospital. A medical doctor will not look at you equally just because you can call yourself a doctor now. You will not make a high salary. You will be miserable.

If you are able to go out on your own and get into the insurance reimbursement realm or enter it now with your current level of training. You will have constant headaches. You will have to work longer hours or hire someone to do all of that for you. You will not get reimbursed at the cash level you are now. You will have to spend LESS time with patients to make up for lost revenue that you need while having an increasing overhead.

If you think I am wrong, take a survey of some chiropractors you know out there. Most of them that I know wish that they were not so dependent on insurance coverage. A cash practice is easier and the patients that you acquire are more willing to stay because they understand the value. You do not require the overhead that an insurance practice does either.

You, as acupuncturists have absolutely everything you need right now. You do not need doctoral status or insurance coverage. Patients will come to you because they like you, they value you and what you do is effective. They WILL pay for that and they will not care less what the research shows. Perhaps you will be lucky enough to build hotels to house them all. And you will have less headaches. All you need to do is educate the world on how this great medicine can help everyone. No it may not cure cancer, but it may help a cancer patient to cope or may buy them some more time to take care of “unfinished business” before they pass. What more could anyone want? There is nothing greater than this. And you already have it.

Respectfully,

In Love and Revolution,

Todd Shulfer DC, C.Ac

(Emphasis added is mine. ~  Thank you, Todd, for sending-in your petition to the ACAOM, as well as helping to gather more WI signatures.  Viva la revolucion!)

Author: Jessica Feltz

<p> I learned about Community Acupuncture while studying at the Midwest College of Oriental Medicine (MCOM) in the Spring of 2006 when Lisa Rohleder's first article about her clinic appeared in Acupuncture Today. Coming from a middle-class background myself, I was the only student in my acupuncture class to have not experienced the healing benefits of this medicine prior to beginning studies at MCOM. I couldn't afford it. And my family couldn't understand what I was doing by investing in an education that they didn't perceive to be financially sustainable. </p> <p> The Community Acupuncture model is a perfect fit for me, balancing social justice and taoist simplicity with the patient's innate ability to heal him/herself (with a few gentle nudges from strategically placed needles). I am grateful every day to have found CAN and the love it brings into my life. I want to share that joy by spreading the message about how we can create a new health care experience in our communities through each of our very small efforts...and how those very small efforts can in turn change the world. </p> I enjoy my two sons, my 4 cats, and big stacks of books.  I own and operate...