BTW, it’s Dr. Painter.

My commentary is accurate. Freeman designed a study and gave it to 1st year ortho residents: folks with their MD, having already taken their full complement of Hospital rotations. I made no mention of orthopedists.

So, in fact, these Residents represent the average MD, and their totally incomplete training.

If you actually review the test, it is not highly demanding either, for anyone who has just passed through a full spectrum of classes, as did the DC students.

Orthopedics has it’s place, doing hip replacements etc, but if we are talking about the average patient with whiplash or non-specific low back pain, I believe non-invasive, conservative chiropractic care will provide them more benefit and will garner higher satisfaction scores.

Finally, I had to grin at your comment about “chiropathy student(s)” As an educated doctor, one would hope you would be aware of the proper names of other licensed healing professionals.

Would you like to guess what percentage of my patients already sought care from a full-blown orthopedist BEFORE they came to me?

You are correct that there is insufficient musculoskeletal education in medical schools. In the average US medical school curriculum, there are no dedicated MSK rotations apart from a few weeks early on where the physical examination is taught. This is especially problematic, since family physicians will encounter MSK complaints in their practice and not know how to deal with them.

But lets be clear…your statement that ‘orthopaedic residents are incompetent to diagnose and treat MSK complaints’ is quite simply FOOLISH. You have NOT PROPERLY read the study you quote.

Here is what the study says: First year orthopaedic residents scored 59%.
How much training in MSK medicine has a first orthopaedic resident received? Answer: Perhaps 1-2 Months.
Why? Because they get a few weeks in medical school PLUS one or 2 month rotations in their 1st year of residency. The first year of residency is often a mix of medical and surgical rotations (general surgery, radiology, rheumatology, etc)

Now second year to fifth year of residency is different. Its ALL orthopaedics, ALL the time!
What the study said: Fifth year residents scored >98% on the exam.
Why? Because they have received years and years of dedicated orthopaedic rotations!

I sincerely suggest you get your facts straight.
By the way, I am an MD (therefore this preceding statement has been made by an MD, and is based on actual curriculums from accredited orthopaedic programs in North America).

As a fourth year resident, I am happy to challenge any chiropathy student or practitioner to compete with my MSK exam knowledge!

Here is another paper from 2005 that shows that if medical students take a one month elective in orthopaedics, their exam score jumps 20%. Incredible that one month exposure would bring them up to what final year chiropractors students acheive…that must explain why some people get into medical school, and some people do not!

This editorial reports on a series of articles published in the bible of orthopedics: the Journal Bone and Joint Surgery. It clearly reports those authors findings:

“We therefore believe that medical school preparation in musculoskeletal medicine is inadequate.”

That is a statement made by an MD, not a chiropractor. And, it was based on solid evidence…not opinions, like yours.

As I wrote in my other editorial [1]

For clarity sake, you need appreciate the actual difference between the chiropractic and the medical participants in these studies.

The medical group had already graduated medical school, been awarded their MD degrees, completed all their hospital rotations, and finally been accepted into a highly competitive orthopedic residency program.

One would expect that, during their 5 years of medical training, followed by endless hours of hospital rotations and residency programs, that those new residents *might have* picked up a little musculoskeletal knowledge along the way. Evidently this is NOT the case.

1. End Medical Mis-Management
of Musculoskeletal Complaints
http://www.chiro.org/ChiroZine/End_Medical_Mis-Management_of_Musculoskeletal_Complaints.shtml

The study, however, does not comment on the proficiency of orthopaedic residents. While the test-takers in the study were technically in their first years of residency, this year is almost exclusively within the realm of general surgery.

RESPONSE from Frank:

That’s not the same as saying that every Orthopedist is incompetent, or that every DC is a Wizard…the Bell Curve applies to every profession. However, the training in DC Programs is sooooo much more extensive that, on average, a patient with any NMS complaint would be much better off seeking assessment and care from a DC.

RESPONSE from Frank:

It’s one thing to get a passing score on a multiple-choice test, and it’s something else completely to accurately assess loss of joint function, and to know what to do to correct it.

I wouldn’t go that far…if someone’s insurance will pay for care, why force them to pay out-of-pocket?

But meanwhile, we also need to educate the patient that their health is their responsibility, and if their insurance company puts unreasonable limitations on the care they can receive, they shouldn’t let the bean-counters dictate what care they get.

My personal opinion is that I am not dependent on the Insurance industry. If insurance coverage stopped tomorrow, I would still see patients because I deliver a VERY high quality product that cannot be found elsewhere. I may not drive a Mercedes, but I’ll still be living.

I understand your concern. This has been happening for many years, but not at the level it is today.

Unfortunately, it has nothing to do with us *letting them*. The MD license is unlimited…and we have no say over what they do or don’t do…only their licensing boards can control that.

PTs typically work under the MDs license (and supposed supervision), so we can’t control that either, UNLESS the PT does something that the PT Practice Act precludes. In Kansas they are prohibited from manipulating.

So, if you want to halt this *threat*, all you need to do is to mobilize your profession locally, and do what they did in Kansas. Cut them off at the knees. Complaining won’t change anything. Take action. Change the rules.

I saw two things that gave me great concern, I was watching a Russian SMT specialist adjust a patients upper cervicals with an SEMG attached and he showed that the adjustment “immediately negated the pathological condition” He was touted as a “genius” a ” pioneer”

Approximately 2 months ago in Pain Mangagement an MD was discussing “his new science of Spinal segmental Dysfunction and Chronic Pain Syndrome” I almost fell off my chair..lol…you have to be kidding me! I just wrote the ACA about this website, they need to spend 3 days here… I have been writing them constantly about the wholesale theft of our profession. You know why??? It has been estimated that the fastest growing part of healthcare is what we do. Neuromusculoskeletal. The deep cuts they are making in Healthcare have brought their kind to the DC table and they just sat down without asking and we let them, we let the PTs steal what we did first, The late Dr Shaeffer said it best we perfected the art of therapeutic modalities before the profession of PT even existed!!!! They stole that already manipulation is right around the corner.. I guarantee it..

So far as I know, the only State that precludes PTs from “manipulating” is Kansas.

My concern is that PTs are not doctors, are not trained to diagnose, and work under Masters who likewise do NOT understand the problem.

What we do, the adjustment, is a mechanical trick that can be learned. However, to accurately determine *which* joint is the *cause*, rather than a compensation, is why our educational program is 5 years, with almost 1000 hours devoted solely to find-it and fix-it.

The World Health Organization (WHO) recently crafted and published the WHO Guidelines on Basic Training and Safety in Chiropractic (FULL TEXT Adobe Acrobat 512KB.) in consultation with the World Federation of Chiropractic, the Association of Chiropractic Colleges and various chiropractic, medical, osteopathic, and other groups.

The Guidelines make it clear that chiropractic is a separate profession rather than a set of techniques that can be learned in short courses by other health professionals.

They also make it clear that medical doctors and other health professionals, in countries where the practice of chiropractic is not regulated by law, should undergo extensive training to re-qualify as chiropractors before claiming to offer chiropractic services.

In some countries there have been recent efforts by medical groups to provide short courses of approximately 200 hours in chiropractic technique. UGH!

The World Health Organization guidelines indicate that a medical graduate should a require an additional minimum of 1800 class hours, including 1000 hours of supervised clinical training, before claiming to offer chiropractic services