The Chiropractic Neurologist

To better help our patients understand chiropractic neurology, the following is an interview with Frederick R. Carrick, president of the ACA Council on Neurology.

What exactly is a chiropractic neurologist?
As in medicine and dentistry, we have individual specialists within the chiropractic profession.  Through their education, training and board certification, they choose to limit their practice to a certain specialty to assist members of their profession and allopathic physicians in the diagnosis and treatment of a variety of conditions.  Within the chiropractic profession, there are specialists in radiology, orthopedics, neurology and physical rehabilitation.  Typically, a chiropractic neurologist serves in the same consulting manner as a medical neurologist.  The difference is that the therapies or applications of a chiropractic neurologist do not include drugs or surgery.  As a result, certain conditions are more customarily seen by a chiropractic neurologist as opposed to a medical neurologist and vice versa.

Specifically, our people see patients with a variety of movement disorders, dystonia, post-stroke rehabilitation, and radiculopathy or nerve entrapment syndromes that are consequences of peripheral or central types of lesions.  Chiropractic neurologists can provide therapies and treatments, as well as counsel, when there is a diagnostic dilemma or a question of appropriateness of care regarding an individual lesion or scenario.  There are conditions not amenable to the type of treatment we might do.  Myesthenia gravis, diabetic neuropathy and forms of epilepsy are some examples.  On the other hand, I would argue that there are many conditions that are not appropriate to pharmaceutical interventions

What does training consist of?
The training to become a board-certified neurologist in the chiropractic profession is an additional three years after the doctor's degree, which is conducted under the auspices of an accredited university or college that is recognized by the US Office of Education.  During that training, there is a didactic and residency-based/clinically-based training.  After completing those requirements, the chiropractor will sit for a board examination in neurology, which is held once per year by our independent examining board.  The areas that are examined are specific to the field of neurology and include clinical and diagnostic techniques and knowledge of neurophysiology.  The certification examination includes oral and practical portions, as well as a battery of psychometric testing.  There are 250 board-certified chiropractic neurologists in the world, and three practice at Hamilton Clinic.

What is the interaction between medical neurologists and chiropractic neurologists?
Generally, chiropractic neurologists serve as consultants to medical doctors, third-party payers, and other chiropractic physicians, especially in the treatment of pain.  Many referrals from medical neurologists are to differentiate central from peripheral lesions and to determine whether or not manipulative procedures, specifically, will be safe in certain conditions.  A lot of the work is done in consultation, where the chiropractic neurologist will examine a patient and then give direction to the referring doctor regarding the mode of therapy or the appropriateness of therapy. 

How are physicians paid for their services?
It depends on whether the consultant or practicing neurologist wishes to participate in a managed care plan.  Some of our members are very much involved in managed care plans.  The general trend, however, seems to be that many of our specialists are going outside the managed care parameters. But interestingly, our specialists seem to be able to exist quite well outside these parameters and most are very, very busy.  Part of the reason for this is that the services they render are non-duplicative.  For example, if a medical neurologist sees a patient with dystonia, he or she may recommend a Botox injection or other type of procedure, whereas the chiropractic neurologist might recommend a type of afferent stimulation or a non-pharmaceutical intervention that is not typically used by the medical neurologist (afferent stimulations are environmental stimulations such as manipulation of the neck, back or extremity; and the use of light, heat, water, sound and electricity--things in the physical environment that are noninvasive and nonsurgical in nature).

Isn't chiropractic treatment typically considered as a last resort?
That is changing.  The normal course of things is that patients who seek the service of a chiropractor have largely been around the block a few times and have seen many other types of practitioners.

Doesn't this put you at a greater risk?
The successes in chiropractic are the ones that have not been successfully treated by other therapies.  Chiropractic is the second largest health profession in the world right now.  When it comes to liabilities and danger, I think every physician who undertakes the treatment of patients must evoke responsibility of care and appropriateness of service.  Certainly the chiropractic neurologist is very realistic about what he or she is doing, the dangers or liabilities of an individual treatment, the responsibility of direction and teaching of the patient, as well as the ethical and moral decisions that one might have to make in concert with the needs of the patient.  As physicians, as part of state licensure, chiropractors have to have malpractice liability coverage.  Malpractice statistics are really fairly low in terms of our discipline.  The number of chiropractic claims for negligence is nowhere near that of medical claims. 

How do you see your profession evolving?
As greater emphasis is placed on patient outcomes and appropriateness of services, I believe greater opportunities are being created for cooperative relationships between medical neurologists and chiropractic neurologists.  Certainly, our training is similar.  There may even be an intertwining of disciplines to some extent in coming years.  Recently, a large percentage of medical doctors have been enrolling in our chiropractic neurology training programs.  We have several physicians--neurologists, orthopedists, and neurosurgeons--who travel from Europe and Asia for the training.  We're really pleased that it seems that our brand of neurological application is being accepted as complementary to medicine and occupational, physical, therapeutic modalities  and that it is in concert with what seems to be the direction of research and intervention for a variety of conditions.

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