Educating primary care chiropractic physicians

Abstract

The Council on Chiropractic Education (CCE), the U.S.Department of Education’s specialized accreditingagency for chiropractic education, has established stan-dards for education of chiropractic physicians that in-clude specific reference to primary care. In the Forwardto the Standards, the following statement appears: “Adoctor of chiropractic is a primary care physician andclinician whose purpose, as a practitioner of the healingarts, is to help meet the health needs of individualpatients and of the public, giving particular attention tothe structural and neurological aspects of the body....Asagatekeeper for direct access to the health de-livery system, the doctor of chiropractic’s responsibilitiesas a primary care physician include wellness promotion,health assessment, diagnosis and the chiropractic man-agement of the patient’s health care needs. When indi-cated, the doctor of chiropractic consults with, co-manages, or refers to other health care providers” (1).Section H of the CCE standards charge the educationalprograms with the following responsibility: “DCPs ac-credited by the COA of the CCE prepare students to beprimary care chiropractic physicians serving as a portalof entry for patients to access illness and wellness-related care” (1). The CCE Standards for accreditationensure that all doctor of chiropractic degree programsmeet the minimum educational expectations of a pri-mary care provider curriculum. The adoption of the“primary care physician and clinician” status by the CCEhas been a relatively new development and the manychiropractic institutions and programs within the U.S.are at varying levels of implementation. In some cases,there has been marked resistance to the primary carestatus.As has been indicated by other speakers at this summitmeeting, there are many different definitions of primarycare. The Institute of Medicine (IOM) definition is prob-ably the simplest: “Primary care is the provision ofintegrated, accessible health care services by clinicianswho are accountable for addressing a large majority ofpersonal health care needs, developing a sustained part-nership with patients, and practicing in the context offamily and community” (2). The IOM definition doesnot stipulate which health-care providers can be classi-fied as primary-care clinicians. This can be contrastedwith the definition provided by the American Academyof Family Physicians, which differentiates between pri-mary-care physicians (M.D. and D.O. only) and limitedprimary-care providers (which include nurse practitio-ners, physician assistants, or health-care providersworking in close consultation with a primary-care phy-sician (3). In this paper, no attempt will be made todefine a primary-care clinician, but instead we will lookat the educational needs of training these providers.