| This sounds like the kind of thing that chiropractors have long sought, to have it become ordinary for chiropractic to be an integral part of the overall health care delivery system. To what extent do the rotating residents, who are medical doctors, interact with chiropractors and observe chiropractors doing their work?
From a standpoint of observation, that’s been fairly limited, mainly because everybody’s busy doing their own thing. We’re hopeful that in the future there will be more direct interaction, but for now, at least at my facility, most of the interaction is indirect, via rumor, myth and legend, as well as by notes and records.
Are there also medical students, as well as residents, who come through the VA?
There are. Actually, one of the things that I wasn’t aware of is that the VA health system is the largest (for medicine and nursing) educational opportunity in the country. It performs the largest amount of research that is not funded privately. One of the core missions of the VA is to increase clinical education and research. Also, many of us in the VA have some sort of academic affiliation, with multiple chiropractic colleges. We’re really starting to fit into that system and be an integral part. It’s not a step-child mentality.
Does the Kansas City Veterans Administration Hospital have an affiliation with Cleveland Chiropractic College because you are on our faculty and work at the VA as well?
I was in a unique situation because when I first started at the VA in 2005, it was as a part-time employee. But I still was a fulltime faculty member at Cleveland Chiropractic College. Over time, that changed from where I was fulltime with Cleveland and part-time with the VA, to where I’m now full-time with the VA while still holding an adjunct position with Cleveland.
As part of this affiliation with Cleveland Chiropractic College, I know that some Cleveland students are able to go to the VA. What role do they play there? Is it mainly observation?
For the most part, it’s observational. They do get to interact with patients as far as assisting in history and examination. They’re able to attain some of their minimal clinical requirements for graduation. But the focus isn’t on their requirements as much as it is for an extension and an enhancement of their clinical educational experience.
In what ways would you say their educational experience is enhanced by having this rotation at the VA as opposed to other educational opportunities?
Some people might say that because it’s observational, it’s limited. What I’ve seen, and what I’ve heard in their feedback, is that it is completely different than the typical field clinic. Students are able to see how the chiropractic services can be integrated into a traditional medical model, and yet still maintain our distinct and unique position as a health care provider in the system. I think that’s number one. Number two is that they’re exposed to a different demographic of patients. Most of our patients at the VA have multiple comorbidities, complicating factors that are different from the presentations you would see in the typical private practice.
In the field, you will occasionally see a patient that has three or four comorbidities, whether it’s hypertension, diabetes, some sort of visceral situation, multiple degenerative changes, myelopathies or radiculopathies. In the VA, we see that regularly, in 75 percent or more of patients. In the field, you may see 10 to 25 percent of your population that way. On top of that, we have traumatic brain injury situations, spinal cord injury situations, so you have a special demographic. And, of course, you have the PTSD [posttraumatic stress disorder] and other psychogenic aspects that come along post-war. That makes a different mix. |
