Addressing the primary care shortage

In the debate surrounding our state’s primary care shortage, proposed solutions abound, yet the root problem remains clear: millions of presently uninsured Californians will be covered under the Affordable Care Act (ACA) starting in 2014. Yet in order for the coverage to succeed, patients must have convenient and timely access to health care services and primary care providers who can diagnose, treat, and manage patient health needs.


California Doctors of Chiropractic (DC) can, and should, play an important role in addressing the state’s primary care shortage. Expanding chiropractic doctors’ role in California’s healthcare workforce would improve access to primary healthcare, while at the same time reducing costs – goals that most everyone can agree upon.


More than 10,000 doctors of chiropractic are licensed to practice in California. As the state legislature considers expanding primary access to mid-level health care providers – physician assistants, nurse practitioners, pharmacists and optometrists – to fill this alarming shortage, it should be taken into account that doctors of chiropractic function fully in the capacity of primary treating, “portal of entry” providers.


Since 1922, DCs in California have been educated and licensed by the State of California to serve as portal of entry/primary care providers. Doctors of Chiropractic are educated to differentially diagnose all conditions of the human body. After undergraduate study, chiropractic students earn a four-year doctorate degree with classroom and laboratory work in basic clinical sciences, physical examination, diagnosis and differential diagnosis, x-ray and interpretation of laboratory blood work and other treatment procedures. Clinical education includes a year -long internship overseen by a licensed DC on patients with various clinical presentations using manipulation as their primary clinical procedure.


Additionally, Doctors of Chiropractic can provide many of the essential health benefits covered by the ACA as dictated by their scope of practice.  If a condition is detected that is not a part of the chiropractic scope of practice, chiropractors are required by law to refer patients to another health care provider.


The services provided by Doctors of Chiropractic are cost effective and have consistently demonstrated high levels of patient satisfaction. Studies have shown that using DCs as first contact providers reduces costs of care and can reduce the need for dangerous pain medications and spinal surgeries. A study published in Medical Care showed the mean total payment when chiropractic doctors were the first providers was $518, whereas the mean payment for cases in which an MD was the first provider was $1,020.


A primary focus of health care reform is the shift in health care delivery to a preventive and wellness  model. Prevention and wellness have been the cornerstones of chiropractic education and practice since its inception. The incidence of conditions such as heart disease, stroke, Type II diabetes, arthritis, and certain cancers can be reduced by eliminating smoking, eating properly, getting regular exercise, managing stress, and partnering with health care providers to take an active role in maintaining a healthy and balanced life style. These recommendations are foundations of a chiropractic practice.


Expanding the role of chiropractors in our state’s health care work force would contribute to an improvement in access to and a reduction in the cost of primary health care. California is leading the way in ACA implementation, and the rest of the nation is likely to follow our lead. Doctors of Chiropractic should be more fully utilized to respond to the primary care crisis, reducing costs while helping millions of patients throughout the state and nation.

Ed’s Note: Tracy Cole, DC is president of California Chiropractic Association (CCA). Dr. Cole has practiced in Crescent City since 1991 and has been active in CCA since 1993.

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