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John A. Amaro D.C., FIAMA, Dipl.Ac.

Recently, a communiqué came across my desk, which I found to be of great interest. It was the Journal of the National Board of Chiropractic Examiners. Within the reports, which were illustrated, there was one of particular interest which caught my attention and that was the "overview of job analysis".

This particular report shares with the world through an official publication (Job Analysis 2000) exactly what chiropractors do and what we treat. I don't know why this report bothered me as severely as it did probably because I didn't really want to believe it.

The official report states that in a typical week chiropractors treat spinal subluxations and joint dysfunctions, headaches, neuralgia, joint problems, extremity subluxation, sprain, osteoarthritis, intervertebral disc syndrome along with myofascitis, tendinitis, strained and torn muscles. Treating less frequently are things such as gout, carpal tunnel syndrome and fibromyalgia. I guess what bothered me most is the fact of the items listed of what D.C.'s treat, is exactly what athletic trainers treat as well. Perhaps this report would not have bothered me as much except the same week I received a popular chiropractic publication, its contents was totally geared toward athletic training and rehabilitation. This was not a special edition, it was the regular monthly magazine. I couldn't help but think how much the chiropractic profession has changed. It barely holds a resemblance to what it was just 25 years ago, let alone 50.

The National Board report did however, point out that in a typical month a chiropractor "may" treat viral infection, asthma, emphysema, high blood pressure, diabetes and allergies among other things. However, to those reading this report, it is clear that chiropractors primarily focus on musculoskeletal complaints and are considered musculoskeletal practitioners.

Thank heavens, I graduated at a time when chiropractic was as or more involved in the treatment of somatoviscero problems than it was in simple musculoskeletal complaints. I feel a sense of remorse for those practitoners of chiropractic who limit their patient base to musculoskeletal complaints. However, I feel more remorse for the patient who experiences a visceral problem whose D.C. is limited to a musculoskeletal practice. To deny chiropractic for a somatoviscero condition because the practitioner has only been taught and discouraged from treating anything other than musculoskeletal in my opinion, is criminal.

The transgression from D.C.'s being fully trained primary care practitioners to the practices we see today, was a slow steady insidious decline from a complete system of health care to a very limited scope in which we compete with massage therapists, athletic trainers, and physical therapists. Even the National Board of Chiropractic Examiners report states that "over 80% of chiropractors use ice packs, trigger point therapy, electrical muscle stimulation, hot packs, massage therapy, nutritional counseling, mobilization therapy ultrasound, bracing and sometimes acupressure.

Now don't take me wrong, I'm not suggesting for a moment we eliminate these things from our practice. We as a profession are very successful at treating musculoskeletal problems and these are some of the tools to use, it is just that chiropractic is so much more! I despise seeing it isolated to one system.

Having practiced for close to 30 years, I have seen chiropractic work seemingly miracles in a host of somatoviscero problems. I recall what I call the "glory" years of chiropractic, (at least in my lifespan). These were the years of the early "70's" where practically every D.C. I was acquainted with, had lucrative practices, and treated virtually scores, if not hundreds of conditions, other than musculoskeletal.

These practitioners did not file insurance claims as insurance did not cover any chiropractic services at that time. Yet their practices flourished as patients paid cash and were in and out of their offices in a minimal number of treatments. Referrals were extremely high. D.C.'s were happy, successful and content.

When acupuncture was introduced to the chiropractic and medical profession in 1972, thousands of D.C.'s added the principles of Meridian style Japanese and Asian acupuncture to their practices. Bear in mind, this would be a good 13-14 years before Traditional Chinese Medicine (TCM) as sanctioned by Chairman Mao Tse Tung would come to America.

Those early practitioners of chiropractic and acupuncture saw their practices grow to enormous proportions. If they did not, it was clearly the fault of the practitioner as the demand for this work was overwhelming. In those days of the early "70's" there was no outside competition it was only amongst each other, and that was never a threat. Again, practices escalated.

At about this same time, the profession was taken in by Medicare and private insurance carriers and life as we knew it was about to change. Suddenly, written diagnosis was the general order of conducting business with insurance carriers and of course Medicare would only cover subluxation as proved by x-ray. It was mandatory in Medicare diagnosis to show the vertebral subluxation level as the diagnosis. Insurance companies would not accept a somatoviscero diagnosis, they wanted musculoskeletal diagnosis. Now the profession was changed both mentally and physically to meet the needs and wants of the insurance industry which we would be totally attached to for the next 25 years. In fact the National Board of Chiropractic Examiners report shows that 70% of practitioners are aligned with managed care programs as their direct source of income with others being involved with private insurance companies and some receive cash for their service.

I would love to see the chiropractic profession get back to the mission of what chiropractic is by changing its awareness to include somatoviscero treatment as one of its main focal points of importance. Of course we will always be involved in musculoskeletal conditions, we are too good not to be involved, it is just that unfortunately, the hundreds of conditions chiropractors used to treat as a profession, are now seeking other providers as the profession as a whole has gotten away from treating visceral conditions.

I find it so interesting that as I watch non-doctor acupuncture practices develop around the nation, most of them are involved in the treatment of all of the things chiropractic used to treat before our transgression. Their primary focus is on a myriad of complaints with most of them being somatoviscero. Of course, acupuncture also lays claim to being extremely effective in musculoskeletal conditions as well, in which that is quite true. .

The fact of the matter is that while we have been sticking our heads in the sand with our little behinds totally exposed, an entire new profession which rivals chiropractic has developed and in fact in more cases than I like to admit, have brought us to our knees legislatively.

It is just a shame all of the State Boards of Chiropractic Examiners who do not allow for the practice of acupuncture by D.C.'s cannot wake up to the fact chiropractic is going to be eliminated by its own ineptness unless something dramatic changes. While acupuncture practices are growing at an unprecedented rate and medical doctors are adding it to their practices with an alarming rate of interest, numerous States are literally sitting by watching the chiropractic profession wither on the vine. Wake up State Boards don't you see what is happening?

Recently it was announced Los Angeles College of Chiropractic was going to add an acupuncture school to its curriculum. National College of Chiropractic has announced the same. University of Bridgeport College of Chiropractic already has an acupuncture school in progress. You can expect more chiropractic colleges to add acupuncture schools to their curriculum in the near future. Why? Simple, survival!

Frankly chiropractic college enrollment is down significantly whereas acupuncture colleges are thriving. I have been quoted as saying as much as 15 years ago "There are currently more acupuncture colleges in just three of our States than there are chiropractic colleges in the world".

Ultimately, the chiropractic profession will be replaced by acupuncture as chiropractic colleges slowly dissolve into the acupuncture educational system. There will be no need for chiropractic. Why become a chiropractor when you can become an acupuncturist and treat everything. Besides, acupuncture is much more accepted by both the general public and the scientific community. The handwriting is on the wall the business and survival of chiropractic colleges is happening in front of our eyes. Without exception everything I predicted would happen 20 years ago has happened or is happening now.

My predictions for the future! Straight chiropractic will survive and thrive because its practitoners are focused on their belief systems, who they are and why they exist.
They will attract a certain type of patient. They will be effective in their very limited role.

D.C.'s practicing in States that allow for the practice of acupuncture and who are adept at acupuncture, as a part of their scope of practice will thrive. In fact they will without question be the most popular, and successful practitioners in the healing arts. Patients will gravitate to their practices, as they are truly the most well rounded practitioners in the professions.

There will be two different and distinct chiropractic professions which will be more antagonistic towards each other than ever in the past. Chiropractic College will focus on the practice of unadulterated Straight chiropractic, as the so-called mixer colleges will have become acupuncture schools with chiropractic offered as a sideline or redescribed as "tui na".

D.C's practicing in States which do not allow for acupuncture, will ultimately be forced to go back to their alma matter which is now an acupuncture school in order to become re-licensed as an acupuncturists so they may stay in practice. This will create major disharmony in the profession as those D.C.'s who are now forced to go to a three year acupuncture school (which used to be a chiropractic college) will exhibit jealousy and sour grapes for those D.C.'s who practice in States which allow for acupuncture to be practiced as a part of their practice.

The medical profession will totally and unconditionally embrace acupuncture and as high as 75% of medical practitoners will practice forms of acupuncture. Acupuncturists as a profession will wither on the vine, as John Q. Public would prefer to go to a medical or chiropractic doctor for acupuncture than an acupuncturist. Those D.C's who went back to school so they may trade their profession to practice as an acupuncturist will have a rude awakening.

Acupuncturists will continue to attack the medical profession as well as D.C.'s practicing in States which allow acupuncture. They will continue to proclaim the doctors are untrained to practice because they are practicing forms of acupuncture other than Traditional Chinese Medicine as sanctioned by Chairman Mao. John Q. Public will continue to seeing the doctors for acupuncture. In the meantime, only those doctors of chiropractic practicing acupuncture in States sanctioning its practice will thrive.

Even though the last several paragraphs sounds very intense, and every bit of it may soon come to pass as it has already begun, there is a cure for all of this and it is a simple one at that.
The cure is to simply re-take the Chiropractic profession. Insists to all of the colleges to teach the significance of chiropractic and to let the students understand that chiropractic is for more than sore backs. To launch the effort for States to bring the scope of practice for Doctors of Chiropractic up to an acceptable level. Doctors (D.C.'s) in many states cannot by law, perform some of the most elementary procedures involving simple needle piercing. Then we have the audacity to refer to ourselves as "Doctor". Who are we kidding?

Take a hint from the acupuncture profession who clearly state in many instances, we are a separate and distinct form of healing. We have our own philosophy and procedures. This is not the practice of medicine it is the practice of acupuncture, we are distinct and unique.

But perhaps the number one cure is to realize the science of chiropractic is as powerful a healing modality as anything on the planet today. It has been responsible for helping millions of people with thousands of different and varied conditions. It is just as powerful today as it was in the 1920's. When we speak of the clinical response of acupuncture rest assured, chiropractic has similar response. When you add the two, the response is mind boggling.

Yes, I highly recommend all D.C.'s have a working knowledge of Acupuncture. Remember that "Acupuncture is a principle not a technique". Understand even if you reside in a State that currently does not allow for the practice of acupuncture with a needle, it is not against the law to learn the concepts it is only against the law to use needle penetration. There are numerous ways to apply these principles which may be used through physiotherapy modalities, the same ones the National Board report states that over 80% of the profession uses.

It is high time we re-take the Chiropractic profession. Re-dedicate yourself to what chiropractic really does. Let the public become aware of who we are and what we do. The colleges are doing their best to survive with the only way they know how to. If we could only rediscover chiropractic for ourselves and share it with our patients. The foot on the garden hose concept worked very well for generations of D.C.'s who explained what we do with ease. The profession of chiropractic could be so well accepted if all we simply did was just to "Take it Back"

John A. Amaro D.C., FIAMA, Dipl.Ac.
Carefree, Arizona