William E. Morgan, D.C.

Whether we like it or not the medical profession maintains a dominant role in directing the health care of a vast majority of Americans. In spite of our best efforts to increase our market share, our percentage of the market has not grown in decades. Instead of seeing more patients, many chiropractors see the same patients more often. If we want to reach the people of America with chiropractic, we need to be included in mainstream healthcare. To be included in mainstream healthcare, chiropractors need to be included in the referral algorithms used by the medical profession.

Teaching hospitals are centers where medical students, interns and residents are transformed into the doctors of tomorrow. During their time in these centers, medical doctors create patterns of clinical practice that will last a lifetime. They learn how and when to refer patients to the various specialties in the hospital. Of course one noticeable problem with this method of learning is that few M.D.s learn to refer to chiropractors in the clinical portion of their education. This is because of the rarity of chiropractors practicing in teaching hospitals.

Must Be Present to Win

To teach future generations of physicians to value chiropractic care, we need to establish Chiropractic Departments within teaching hospitals. By being present in teaching hospitals and interacting with the various hospital departments, chiropractors will establish a rapport with the various specialties resulting in a natural flow of referrals and cross referrals. This paradigm will persist long after the medical students leave the hospitals and enter into private practice. Slowly the numbers of chiropractic patients will increase as progressive medical practitioners continue to refer to DCs long after they have left the teaching hospital. In addition to altering the referral patterns of MDs, teaching hospitals are a great location for chiropractors to learn.

Cross-Pollination

By having chiropractors and chiropractic students rotate through the various clinics of the hospital, I have observed a tremendous maturation and growth in their clinical competence. When a student who has read exhaustively about various neurological or rheumatologic conditions spends several weeks in those (Neurology and Rheumatology) clinics experiencing firsthand the manifestation of those diseases he or she is able to fully conceptualize the significance of those conditions. This clinical experience is further deepened when a sympathetic physician turns to the chiropractic student and asks, "What would a chiropractor do for a case like this?" When satisfied with the student's answer, the physician refers the patient to the chiropractic clinic.

Meanwhile, in the chiropractic clinic a medical resident, student, or intern may be shadowing a chiropractor observing evaluations, treatments, and interactions. During their time rotating through the chiropractic clinic these medical practitioners see firsthand patients responding to chiropractic care. They learn which patients to refer to chiropractors and how chiropractors treat patients. They also see how smoothly chiropractic can integrate with mainstream healthcare.

Prospects for the Future

Currently chiropractic's biggest advance into teaching hospitals has occurred in the VA and DOD healthcare systems where doctors of chiropractic work daily in teaching hospitals. Some of these VA and DOD hospitals have chiropractic students or fellows rotating through the various specialties as well as working in the chiropractic department. At least one of them has medical students and residents rotating through the chiropractic department. As these programs expand, more and more opportunities will arise within teaching hospitals. This is especially exciting when we realize that a large percentage of medical doctors train at some point in their career in a military or VA facility.

Most chiropractic colleges are working to establish collaborative relationships with teaching hospitals. I feel that this is a wise idea, and I hope that one day every chiropractic student has the opportunity to train in a teaching hospital.