November 2004

American Medical Association presents solution to “doctor shortage”


An article in the October 11, 2004 edition of the AMA’S prestigious Archives of Internal Medicine, provides dramatic evidence that the care for chronic back pain and neuro-musculosketal problems, by doctors of chiropractic, rather than medical doctors, is less costly and more effective.

The article cited that back pain accounts for more than $100 billion in costs each year in the United States, the second-leading reason for all visits to doctors. Similar Canadian studies have confirmed that one third of all visits to health professionals are for spine and related conditions.

Authors of the report titled Comparative Analysis of Individuals With and Without Chiropractic Coverage, consisted of several MDs, chiropractic doctors and scientists. The study focused on the 4-year history of 1.7 million members of a California managed health plan, only 700,000 of whom had added chiropractic benefits. The study concluded that if all members of the plan had chiropractic coverage, total health care costs would drop by 12 percent and the plan would save $47.5 million per year. This would be the result of less utilization of hospital beds, drugs, surgery, x-rays and most important, speedier recovery.

“This confirms what our profession has said for years: before we start worrying about ‘doctor shortages,’ we should ensure that we match the right doctor with the right problem,” said Dr. Jim Cooper, president of the British Columbia Chiropractic Association. “We respect and admire the medical profession within the areas of their expertise and request only that they pay attention to fellow health professionals who have skills and knowledge in certain areas.”

The AMA article reported:

"Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs."

The authors said that a comprehensive study of scientific literature demonstrates that chiropractic spinal manipulations have superior results than “conventional treatment” and that not only one study suggests results “substantially worse.” Irrespective of insurance coverage variances for chiropractic care and sometimes greater costs to patients, “there is significantly higher patient satisfaction compared with patients who receive conventional treatment.” 

Among the authorities cited by the authors is a celebrated Canadian report authorized by health economist Professor Pran Manga of the University of Ottawa and several associates, for the Ontario Health Insurance Plan in 1993. Dr. Manga, who played a key role in the evolution of the Canada Health Act, said he studied 400 research projects worldwide, all of which confirmed superior outcomes from chiropractic and “not one” demonstrating effectiveness of conventional treatment. Dr. Manga revised his numbers in 1998 and calculated that Ontario would likely save $548 million per year if it more effectively utilized chiropractic care. Extrapolated nationally, that would have meant a 1998 saving of $2.2 billion.

Manga’s findings in Ontario were reviewed and confirmed by a blue ribbon panel chaired by the late Tom Wells, a respected cabinet minister in previous governments and a panel of public policy and scientific experts.  

Among Dr. Manga’s most vociferous criticisms of health management in Canada today, is that governments fail to understand the language of the Canada Health Act. The “comprehensive” clause was designed to ensure that the most appropriate professional provides care, not exclusively medical doctors and hospitals. If a specific condition is covered by the Act, the plan was designed to pay the fees of any licensed, regulated professional who provides the treatment.

“We applaud the AMA and the Archives of Internal Medicine for the integrity and intellectual honesty of publishing these findings, “ Dr. Cooper said. “Unfortunately, in Canada, the medical associations have somehow invented monopolistic language – ‘core services’ – which they, and the politicians they’ve hoodwinked, seem to view as synonymous with the words ‘medical doctor’ and ‘hospital’. This has never been the case.”

The BCCA president described the ‘doctor shortage’ as a myth. “If we respect all of the accomplished professionals within health care, including MDs, chiropractors, nurse practitioners, optometrists and many others and then asked ourselves how can we make the best use of each talent, astonishing results would be realized in better and speedier care, lower costs and patient comfort.”

FOR MORE INFORMATION, PLEASE CONTACT: Dr. Don Nixdorf, Executive Director BC Chiropractic Association #125-3751 Shell Road, Richmond BC V6X2W2 Phone (604) 270-1332