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!)

This story was posted on November 21 2009 by Jessica Feltz.
Tags: economics fpd

Comments

  • November 21 2009 at 9:51 AM
    Justine writes:

    THANK YOU!

    I fear the day that insurance takes over acupuncture.  Dealing with insurance would be SUCH a nightmare!  The fact that coverage is limited is so outrageous, dealing with the insurance companies is awful (the paperwork, waiting for money, claims failing).  I can’t imagine being limited to treating only pain conditions, or
    whatever it is that acupuncture is “proven” to help - and being given
    only X number of visits to make it better.  There are too many people who get better than relapse, or have conditions so chronic that they truly need ongoing care for management.  The whole thing makes me cringe.

    I’m so glad community acupuncture exists.  My patients sometimes ask about insurance - I tell them what they’re paying is essentially the same amount as a co-pay - and their coverage is not limited, and they’re getting the best deal in town.  And they can be treated for anything they want/need, and I get to enjoy treating that variety.  They can come in anytime they want and it’s the same reasonable price.  I hope it continues this way always.

    And you’re right, we didn’t go to school to become doctors.  I didn’t want to become a doctor - that is one reason I became an acupuncturist.  A doctor comes with a different set of responsibilities and works in a different manner.  I didn’t want to deal with insurance.  I didn’t want to be on call.  I didn’t want to administer drugs or deal with pharmaceutical companies buying me lunch and wooing me toward unethical things.  I didn’t want a massive office staff and the paperwork and headaches that go along with insurance.  Being a doctor is not a glorious profession - it is hard work.  I feel for you and the limitations imposed on your profession being taken over by insurance.  Thank you, Dr. Shulfer and thank you Jessica!

      0 likes
  • November 21 2009 at 11:41 AM
    Linda inDetroit writes:

    This letter is so important,

    This letter is so important, the acupuncture profession has a chance to learn from the experiences of chiropractors.  The DCs I work with have cash based practices, they charge very reasonable fees, and I can see how focused they are on their patients overall health, they aren’t worried about what insurance will pay for.

    I’m not going to lie, there is a small part of me that would enjoy having a doctor title, but I’m not under the delusion that a doctorate would have any real effect on my practice or my relationship with the MDs in my community.  I have a number of MDs who refer to me, they do this because I have helped their patients, I earned their respect by providing effective treatment.  I don’t believe for a second that they would refer to me if simply had a doctorate, but hadn’t helped their patients. An acupuncturist who really wants to have a doctorate can go back to school and get one, but making it entry level will hurt much more than it will help.

    Another important aspect of this letter is the fact that we don’t have places to work the way chiropractic graduates do, acupuncturists coming out of school looking for jobs are usually SOL. so we don’t even have that option to help pay off higher loans. How on the world would having an entry level doctorate create jobs as proponents profess?  It makes no sense at all!

      0 likes
  • November 21 2009 at 12:46 PM
    LarryG writes:

    got me

    “Perhaps you will be lucky enough to build hotels to house them all”

    thanks, Todd.

      0 likes
  • November 21 2009 at 12:56 PM
    LarryG writes:

    let’s play a game

    shall we?

    The game is called “Count The Myths”.

    Which myths does Todd dispel with his letter?

    Who wants to go first?

      0 likes
  • November 22 2009 at 11:17 PM
    Lisafer writes:

    thank you Jessica and thank you Todd

    This letter is so important. I’ve been hearing rumors for years of DCs who think that insurance reimbursement is the worst thing that ever happened to their profession, but I’ve never read such a thorough and eloquent explanation. I wish all L.Acs would read this.

      0 likes
  • November 23 2009 at 2:00 PM
    River Jordan writes:

    dispelling myths

    Thanks Todd, Your contribution is a clear, if sad account, of how seeking greater status - if continually pursued - ultimately causes a downfall. Does’t Chuang Tzu or Lao Tzu write about this also - be humble like water, always seeking the lowest place, but useful to all.

    Hopefully more people will read your words and understand the foolishness of following that path.

      0 likes
  • November 23 2009 at 5:06 PM
    Moses.C writes:

    keeping it simple

    Thank you so much Dr Shulfer (& Jessica for noticing this and posting it here) for sharing your story and experience openly, at a time in the acu profession when we need to hear it the most. I hope more people read this post!

     

    “can you help me? How long wiill it take? How much does it cost?”

     

    Those basic patient questions are a great reminder of how simple our clinics can be. We have the opportunity to address the basic needs of our patients more effectively when we keep the business model very simple and easy to deal with for both patients and practitioners. A great reminder!

     

      0 likes
  • November 23 2009 at 5:34 PM
    bottley writes:

    Hit the nail right on the thumb, Todd

    Thank you for this. I think your letter may turn out to be one of the most important documents of this whole process. It’s not only important in and of itself, but it’s important for us to see that another “established” profession has been through this very similar thing already and that chiropractic has always had its punks as well. As a matter of fact, they started out as punks and then the “official” profession lost the thread. Sound at all familiar?????????!!!!! 

      0 likes
  • November 24 2009 at 12:45 PM
    david villanueva writes:

    Thanks Jessica and Todd for

    this blog. I think so highly of it that I propose it be kept way up on the blog page through January ‘10 so visitors see it right away.

      0 likes
  • November 27 2009 at 11:49 PM
    acuguy writes:

    Don’t forget the schools’ part in all of this

    I thought Todd made some very useful points but I would add one other aspect of the evolution of the chiropractic profession we see happing in the acupuncture profession and that is that the schools started pumping-out many more practitioners. Most of the problems chiropracters now have are greatly compounded by the increased number of Chiropractors during the years of higher incomes. Of course, when the chiropractic schools started training so many more chiropractors, they could honestly sell the profession as one generating soild incomes. Our acupuncture schools on the othr hand, can’t say this honestly but it seems this has not stoped them.

      0 likes
  • November 30 2009 at 9:52 AM
    Guest writes:

    DC

    Hey Dr. Todd

    Do you still reccomend people to enter the Chiropractic Profession? What are your thoughts on someone becoming a DC after AOM college

      0 likes
  • November 30 2009 at 1:53 PM
    Guest writes:

    I certainly do.  However I

    I certainly do.  However I will often recommend that they consider a career in Acupuncture and Oriental Medicine due to the fact that it costs less to go to school for that.

    As I stated in the essay, I AM and I LOVE being a chiropractor.  I stand in awe of it’s simple yet incredibly profound philosophy.  Find it, Fix It, Leave it Alone.  Let the body do the work and I get the paycheck.  Miracles happen everyday with quality chiropractic as I learned in school.  However, just making noise in someone’s spine ussually will yield nothing more than a glorified massage.  That is what deeply saddens me.  I have a responsiblity, as a chiropractor, to gaurd what the founders developed in the early 1900’s.  That philosophy, art and science was developed to find the vertebral subluxation and correct it.  If you do anything other than that, you are simply NOT practicing chiropractic.  It may work for you, but you are NOT practicing chiropractic.

    You can still go into chiropractic and make a decent living.  And you can still do it honestly by practicing the subluxation model.  However, if I could do it all over again, I would just stopped at chiropractic.  Don’t get me wrong.  I love Oriental Medicine and acupuncture.  However, when I got all done with Oriental Medicine School I had increased my school loans tremendously.  Furthermore, it took me all that extra schooling to realize that I already had everything I needed to be successful.  I did not need more knowledge.

    Now, to answer your question.  I often asses the person asking the question.  Some people would do better in the profession of chiropractic and some would do better in acupuncture and oriental medicine.  It just depends on what you like.  I honestly don’t think you need both though.  You would be much better off to find a competent chiropractor to share space and patients with than to try and be both.  I am finding that it is much harder than I anticipated.

    You can make a very decent living in Acupuncture.  When you come out of school you are at the very same place as any chiropractor coming out of school only without as many school loans.  The one who will be more sucessfull is the one who understands business and marketing.  You can have all the degrees and doctorates that you want, but if no one comes through your door it will not matter much.  That is why one out of two chiropractors will never practice.  Acupuncture, as well as chiropractic,  always works.  If it does not work check your application of the principles.  And remember, we are not “treating disease”.  We are providing balance to the body.  The body does the work.  Acupuncture and chiropractic are two paths up the same mountain.  If you are good at either one, you will be so busy that you will not have time to do the other.  I wish someone would have told me this before I went back to school.

    Something else to consider is that your credits may not transfer into chiro school from acu school.  Mine did as I went from chiro school to acu school.

    You already have everything you need, just keep practicing.

    Todd

      0 likes
  • December 7 2009 at 2:54 PM
    Guest writes:

    Personally, I am in somewhat

    Personally, I am in somewhat disgusted with the profession of chiropractic. I certianly do not want to follow their path. I do not want to be called a doctor. Patients might call me doctor, but that is their choice. I have no desire to have a pseudo “doctorate” degree. I think the title of Doctor for chiros is confusing for the patient. I do think that adjustments can be helpful when needed, but to state that adjustments can treat anything and everything is something I do not believe for many reasons.  When an adjustment is what is needed then that is what is needed, but people “going out” the minute they step out of the DCs office tells me something is not working and the “root” is not being addressed. I have worked with, gone to and know many chiropractors and all too often they are happy to adjust 3 times a week for this many months and on and on and on…got have my car payment attitude.
    Todd, you do not seem this way, but so many of your fellow practitioners are.
    Todd states “However, just making noise in someone’s spine usually will yield nothing more than a glorified massage.” This mind set by DCs which I interpret as arrogant is something I see way too often in the many chiropractors I meet. Maybe it is the false “doctor” title, but I think too many chiros have an inferiority complex and so need to put down other professions. Massage can be as profoundly significant as the best adjustment, it matters what the patient needs, what is wrong. If all you have is a hammer then everything looks like a nail.

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