Chiropractors as Primary Spine Care Providers:
Precedents and Essential Measures
SOURCE: J Can Chiropr Assoc. 2013 (Dec); 57 (4): 285–291
W. Mark Erwin, DC, PhD, A. Pauliina Korpela, BSc, and Robert C. Jones, DC APC
Assistant Professor, Divisions of Orthopaedic and Neurological Surgery, University of Toronto, Toronto Western Hospital, Scientist, Toronto Western Research Institute ; Associate Professor, Research, Canadian Memorial Chiropractic College.
Chiropractors have the potential to address a substantial portion of spinal disorders; however the utilization rate of chiropractic services has remained low and largely unchanged for decades. Other health care professions such as podiatry/chiropody, physiotherapy and naturopathy have successfully gained public and professional trust, increases in scope of practice and distinct niche positions within mainstream health care. Due to the overwhelming burden of spine care upon the health care system, the establishment of a ‘primary spine care provider’ may be a worthwhile niche position to create for society’s needs. Chiropractors could fulfill this role, but not without first reviewing and improving its approach to the management of spinal disorders. Such changes have already been achieved by the chiropractic profession in Switzerland, Denmark, and New Mexico, whose examples may serve as important templates for renewal here in Canada.
Keywords: primary care, spine, chiropractor
Between 1999 and 2008 the mean inflationary adjusted costs for ambulatory neck and/or back pain in the United States increased by a factor of 95%.  According to the study by Davis et al the largest proportion of increased costs are associated with specialty visits rather than primary consultations, clearly indicating that spine care places a tremendous burden upon the health care system.  Davis et al make recommendations with respect to cost containment for spine-related disorders which are similar to those put forth by Maniadakis and Gray ten years ago; and many of these revolve around reducing the reliance on specialty management.  A number of professionals with diverse backgrounds (chiropractors, massage therapists, physical therapists, osteopaths, and physicians) care for spinal pain patients. However unlike some other health care professions that have focused upon the management of condition-specific maladies, no one group has chosen to do so for certain aspects of the spine patient. Perhaps lessons learned from other condition-specific professions such as optometry and podiatry could provide important guidance in this regard.
Precedents for Professional Growth and Development:
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