Our professional landscape is changing along with the tide of increased health care technology. Radiology is going digital, and treatment protocols are close to Star Trek magic with lasers and all. Doctors are extending their knowledge concerning rehabilitation and physical performance; and with the reality of obesity and diabetes, nutrition has been given a closer look. These all fall within the scope of chiropractic branching beyond the physical adjustment into lifestyle adjustments. The purpose of enforcing continuing education (CE) hours is simply to have doctors touch base with the nuances of practice protocols on a yearly basis.

My state board requires 20 hours of CE classes per year. Five of these hours focus on risk management with an hour concerning our state law. Fifteen additional hours must be educational in nature, not merely practice or patient management. I imagine that your state has similar rules with variations on the same theme.

In previous years, my CE classes consisted of general radiology, sports performance, nutrition, technique review, diagnostic testing, and caring for patients from pediatrics to geriatrics. If the intention was to increase my knowledge and keep me updated, then the shape of CE in my state is both sound and intact. Problem is, it isn't, and the future of our profession rests between what is accepted and what is neglected. Let me explain.

A Truly Necessary CE Program

Practicing for nearly 30 years has afforded me a bird's eye view of where we are headed. The supply of chiropractors is here, but the demand has not changed. Rather than having local police controlling traffic through our doors due to the high demand, too many chiropractors are defaulting on student loans, going bankrupt, and/or leaving the profession for more financial stability. Considering that only a small percentage of people in this country, let alone the world, seek chiropractic care, or worse yet, know anything substantial about it, we have a huge and obligatory role to play.

If any continuing education program is needed for the future, it would be this: "Communicating and Delivering Chiropractic Care to the Community." Granted, this is a mouthful, and it may reach beyond the stale confines of acceptable CE credit programs. However, before you flip the page, first hear me out.

What better mechanism to reach the demand than to allow our seasoned and wise senior citizens to literally reach new patients from birth? What better approach than to aspire to focus our practice attention and purpose on meeting the needs of this cycle of community life? Future CE programs should consider incorporating our technical and diagnostic skills within every phase of community life along with practice and patient management.

Rather than shunning these classes that help coalesce our knowledge with our patients, we should encourage focusing more on daily activities and how best to be an advocate of proactive conservative health care and wellness along with increased human performance. This only enhances patient cooperation, enthusiasm, and desire to tell others, furthering our goal to reach so many more. Here are my thoughts.

There is a circle of community life. This life cycle may begin with birth, but for parents, physical and emotional demands began prior to and throughout the pregnancy. Our profession has a great role to play. Every woman should be evaluated for structural and neurological stress via a chiropractic biomechanical evaluation. Is there anyone reading this not in agreement that chiropractic would help with pregnancy and create a wholesome approach for mother and child?

Conservative chiropractic and obstetrical care would complement each other beautifully. If you question why, or have no idea how to align your office with medical professionals, then both practical and technical advice would be helpful for the community as a whole and would be a useful portion of any CE program striving to enhance our technical expertise along with the ability to educate our community and patients.

Consider the parents who, through personal development, had forged through nutritional, emotional, physical, and structural stressors to reach the point of birth, usually resulting in neurological and physiological stressors that often taxes a weak nervous system, evolving into a myriad of symptoms and syndromes offering future fodder for the medical profession. To stem this tide, our state boards and association leaders must consider the health of our profession and realize that collectively, we've done a poor public relations job that often resorts to individual promotions to get the message out.

This is unacceptable. We must recognize that our collective efforts have not changed the chiropractic landscape with noble slick advertising in periodicals or local newspapers. We have simply spread the message too thin, and the public considers us merely back specialists with limited abilities to help every aspect of the cycle of life. Here we need to change their perception by our conception of reaching them.

The Mother of All Approaches

I recommend that state boards and continuing educational councils begin to realize that public relations and technical prowess work hand in hand. The demands of the pregnant woman and the weeks and months following birth will keep an enlightened doctor quite busy. A quick search of available data reveals that pelvic alignment and reduced physical stress help these women prior to and after their delivery. Nursing and transporting babies sets into motion additional physical demands that need to be addressed, or future visceral problems may follow. Young new mothers find that demands on their neck and shoulders aggravates brachial and cervicothoracic plexuses, resulting in various symptoms and pain. The typical medical answer for this gestation of chronic structural and visceral ailments is either a wink of compassionate understanding or chemical intervention.

Our role is clear. We need to advise and evaluate women prior to pregnancy and monitor them throughout it. Our rehabilitative procedures should be an answer to this beautiful phase of life. Our adjusting techniques should focus on the rigors of pregnancy and the demands of a new mother. An ergonomic appreciation tailored around posture and balance should not be just a therapy, but a proactive approach to community wellness. We need to establish the protocols and be the go-to professional from cradle to grave.

Start Small

Even at this early stage of life from toddler to teenager, physical and structural demands produce reduced performance and wellness. Postural distortion found rampant in our adult society began when it was much younger. The average chiropractor pitifully sees few child patients and probably only for a crick or sore neck or lower back. It's a sad testament to our inability to share our skills with parents and pediatricians.

To watch children playing youth sports from gymnastics and soccer, to football, and not feel obligated to monitor their growth while they aggravate growing structure and paraspinal support seems a professional demerit. Parents, with knowledge, would insist that a chiropractor be available for their child's team, bur neither they nor local coaches appreciate our role. How many chiropractors are cognizant of the nuances of youth sports and biomechanical health care or assisting children in general?

Wouldn't it be a blessing to have schools invite us to discuss chiropractic and reveal our global approach to health and wellness, or to have school principals and nurses invite us to review book-bag selection and proper book placement to stave off future spinal impairment? I'm tired of us being looked upon as technicians rather than advocates of health and wellness.

New Avenues and Approaches

The Employer
Our responsibilities do not end as the circle and cycle continues. If we neglect the ravages of adulthood with its overbearing physical stress, microtraumas, and nutritional insufficiencies that often create chronic, life-altering pain, we defeat the purpose of our professional responsibilities. Rather than accepting the trickle of new patients who turn to us in pain, we should explore further means to reach their employers with preventive ergonomic awareness programs, establish on-site evaluations, and help create safety committees while providing conservative treatment for work-related injuries. The correlation between physical demands of work and preventive steps to avoid and/or contain physical wear and tear is right up our alley, and again we should be the go-to professional.

The Attorney
We must also appreciate the reality of the whiplash injury and how to consult with a new patient, examine x-rays, and provide the best adjustment with adjunctive therapy as possible. This requires increased vigilance as litigation may result in testing our skills in deposition or court, and as learned health care providers we can help defend our patients. The nuances of professional relations extend to the attorney and how best to handle personal-injury cases.

The Senior Citizen
The cycle continues as we mature and our bodies physically strain to endure. We missed so many opportunities in their past that treatment during this time is often self limited and used as containment. As our population ages, very few medical advances have kept pace. We needn't keep pace with them, but instead we should use our knowledge to strategically place ourselves as the "go-to doctor." Seniors demand respect and dignity within their golden years and are concerned with mobility and balance. Our role is to manage their posture and offer them sound nutritional and physical advice while advising on safety and physiological wellness.

The Heart of the Future

To learn more about educating your patients about chiropractic, go to "Roundtable: Add 'Education' to Your List of Services".

Our future is clear and bright if we capture the hearts and minds of our community with both technical and managerial skills. The technical components of continuing education must be adhered to while increasing the management skills of each doctor. Unfortunately, our schools are stressed to teach technical skills while leaving the graduate no option but to take expensive postgraduate practice-management seminars and hire consultants.

Research should extend to our clinics with the life cycle of a community in mind. Physical and physiological wellness should be enhanced with reduced nerve pressure and decreased postural stress. Our future depends on our ability to reach our community with educational and supportive advice while assisting with specific adjustments and life cycle advice. Yearly CE classes emphasizing this would be a great beginning.

Joel E. Margolies, DC, has an active practice in Atlanta. He has written four practice-management books, titled Smart Start, Chiropractic Marketing and Public Relations, Workshop Workbook, and Personal Injury Workbook; and he has a number of PowerPoint lecture presentations. He also sends a free weekly e-mail to more than 10,000 chiropractors in 31 countries and maintains an active chiropractic resource Web site, www.chirosmart.net. Contact him at .