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The Past, Present and Future of Chiropractic

– Dr. Gerry Clum, Dr. Ron Oberstein, Dr. Lauren Clum – 

There are many ways of presenting this topic and one of the more pleasurable was a recent conversation hosted by Dr. Ron Oberstein with two members of the Clum dynasty: Dr. Gerry Clum, first president of Life West and long known for his leadership and wisdom, and his daughter Dr. Lauren Clum, now Clinical Director at the Life West Health Center. Dr. Gerry began his career in the early 1970s when there were 16-17000 chiropractors in the United States and the US Department of Education and accreditation agencies did not recognise the DC degree. The profession was very much in its establishment phase. Dr. Gerry saw the initial recognition of the CCE and ultimately recognition of the regional accreditation agencies, and as each of these steps happened, they opened new opportunities for the profession. The ACA held to a position that chiropractic was whatever the individual states said it was, while the ICA perspective was that chiropractic is a measurable, defined, identifiable body of knowledge and skill. These positions permeated the educational and political dimensions of the profession, influencing licensure and reimbursement.

From the next generation’s point of view, the profession is no longer in the uphill battle it seemed to be in the past. As Dr. Oberstein observed, “on a certain level the profession was in a fight phase, the sympathetic phase, that we just couldn’t get out of.” Dr. Lauren’s experience for her generation of chiropractic was different due to the growth of the profession. Dr. Lauren’s experience is that chiropractic has been readily accessible and readily accepted. The obstacles now are more about where we go from here. Students in the past typically had a tremendous personal experience with chiropractic or someone close to them did, and counselors were definitely not talking about chiropractic in high schools or undergraduate colleges. Dr. Lauren sees today’s students mostly understanding chiropractic college as a genuine career in healthcare. “And then the school environment becomes part of their lifechanging experience with regard to chiropractic. And that is super exciting!” Dr. Gerry Clum added: “I think it is wonderful to see the direction the profession is going, to self-directed learning, shifting the responsibility from the faculty to the student, with the faculty becoming a facilitator of learning rather than the focus of learning.”

In the practice environment the same evolution has happened. From 16-17000 practitioners when Dr. Gerry began his career, to 90,000-100,000 around the world today. “Our sheer numbers have reached a tipping point where we are making a meaningful contribution to the ecosystem of healthcare.” Dr. Gerry gave malpractice as an example, where it was once something nice to have and patient records were on 4×6 index cards. Today it is needed for renewing licenses in a significant number of states. “So where our levels of responsibility have gone up, so have the levels of accountability. The consequential nature of our actions and the profession in general has gone up.” The 1970s was when chiropractic was accepted for MediCare, and crucially the accepted diagnosis of subluxation changed the landscape. “As the numbers of practicing DCs went up so did the number of dollars associated with chiropractic care, and the balance of responsibilities and accountability became a function of our maturation as a profession,” Dr. Gerry said.

Dr. Lauren opened her practice in 2007 and the advice she got was: You might as well start cash because you can always start billing insurance, and it’s really hard to go in the other direction. And it worked! “I started with a cash practice and never billed insurance for chiropractic care. I can honestly say that yes, you can run an upper cervical cash practice successfully without billing 3rd party payors.” Looking at the current state of play, Dr. Lauren sees the majority of practices having a degree of billing. But running a cash practice adds a level of responsibility because the financial relationship is directly between the patient and the doctor. “In running a cash practice one has to get very good at communicating with one’s patient the value of what we are doing because they are paying out of pocket. What is that brain-body connection, how is it impacted by the chiropractic adjustment? We have to be able to scientifically answer questions because of that level of accountability. I think we need to own that as chiropractors, it elevates who we are as practitioners.” Dr. Oberstein agreed: “the stronger the chiropractor, the stronger the profession.”

Moving to technology and techniques, Dr. Gerry’s comment was that everyone has always wanted better results. When he was in school the big debate was between Gonstead and Upper Cervical. Gonstead was about the base up, and Upper Cervical was from the top down. This debate has not been reconciled to this day. Other techniques like CBP took a mathematical model, or Atlas Orthogonal took an instrumental model. “But the fundamentals of what we do and why we do it have not changed dramatically. And that is one of the great anchors of the profession,” he stated. Dr. Lauren’s take on technology is that “innovation has allowed us to provide a level of objectivity to our analysis that hasn’t always been there. The goal has always been to improve outcomes and to explain the outcomes we are getting. Technology has in that way upped the ante with accountability.”

“…a world where it is natural for moms to take their babies to get checked as soon as they’re born, and everyone in the family getting checked for vertebral subluxation as well. “

Looking further into the future, Dr. Oberstein posed the question to both Dr. Clums: “where do you want to see chiropractic?” Dr. Gerry saw the profession accepted as another part of the fabric of society, and the value of the adjustment realized and applied to the greatest extent possible for the health and well-being of the population. Dr. Lauren was on the same page – a world where it is natural for moms to take their babies to get checked as soon as they’re born, and everyone in the family getting checked for vertebral subluxation as well. “Because that is what helps us serve better in our capacity as humans.”

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