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If you are thinking of becoming a chiropractor, think again! The profession is riddled with delusion and dishonesty. Although I entered it with great enthusiasm, I now realize I made a terrible mistake. Here's my story.
When I was a teenager, my father underwent what appeared to be successful chiropractic treatment following a work-related injury to his back. Coincidentally, I happened to be dating the daughter of the chiropractor's assistant, which helped to facilitate my developing a closer relationship with the chiropractor. He was extremely successful and was highly respected in his community. I was as impressed as any 16-year-old kid could be. The financial potential, the almost magical effectiveness of his methods, and the idea of being a kind of "rebel" all influenced me to choose chiropractic as my future profession. Seeing the chiropractor's success, my family and friends were encouraging. My family doctor was the only person who warned that I was making a mistake. I now wish that I had listened to him.
I entered college in 1985 with a scholarship for premedical studies. During my first semester, I was involved in an accident with a drunk driver. I suffered injuries to my head and neck, missed nearly half my classes during the following semester, and, as a result, lost my scholarship. My chiropractor seemed to help the neck and head pain quite a bit, and any doubts I had about pursuing this career were assuaged.
I received my bachelor's degree in 1990. That fall, I entered the now-closed Pennsylvania College of Straight Chiropractic (PCSC), which was my chiropractor's alma mater. It did not take long to see that school's belief system and mine were incompatible. PCSC taught that "subluxations" were the cause of all "Dis-ease" in the human body. These alleged entities were portrayed as "bones out of place" that caused interference with nerves exiting from the spine. Subluxations supposedly interfered with the transmission of "nerve impulses" -- adversely effecting the target organs and tissues, reducing their state of "ease," and rendering them vulnerable to disease. This information clashed with what I had learned in the basic science courses I took in college. Finding PCSC's "philosophy" difficult to swallow, I switched to New York Chiropractic College (NYCC), which appeared to be less radical and "more medical." Because PCSC was not recognized by the NYCC's accrediting agency, my credits did not transfer and I had to repeat the first year.
NYCC's approach seemed far more rational. Our science courses were taught by PhDs in their respective fields, using standard professional-level textbooks. During the first semester, I thought that I'd found what I was looking for. During the second semester, my pathophysiology professor was a former medical school instructor who viewed his position as a challenge and an opportunity to bring chiropractic students closer to the level of their MD/DO counterparts. However, most students felt that his classes were too difficult. I had the privilege of serving on a joint faculty/student committee with him that semester. After a meeting, he asked about my reasons for attending chiropractic college and whether I thought I'd be satisfied as a chiropractor. When I said yes, he replied that I was completely mistaken, that there was no place in this profession for someone like me, and that I should drop out immediately and do whatever was necessary to go to medical school. He resigned from the college a few years later.
As we went along, my friends and I assured ourselves that our preclinical courses would prove beneficial once we began seeing patients. However, the "clinical" phases of my education were even worse. The General Diagnosis course, taught by a chiropractor who had a nursing degree, covered diseases whose symptoms and course we were expected to memorize by rote. The only physical examinations we performed were on our fellow students. Except for a radiology course in which we actually viewed x-ray films, our other disease-related classes provided little practical information. Nonetheless, after finishing seven semesters and passing a "clinic entrance exam" we were designated "interns" and began clinic work.
The clinic duty during the eighth semester was part-time and turned out to be little more than a chance to wear a white lab coat and carry a stethoscope. The clinic served chiropractic students and their families and provided little opportunity to see "real" patients. Yet we were told that upon graduation we would be qualified to practice as primary-care providers, responsible for diagnosing whatever ailment a patient might present.
During our final (9th and 10th) semesters, we worked full-time at the clinic. The school portrayed this experience as an opportunity to practice what we had learned and to hone our diagnostic and manipulative skills. Nothing could have been further from the truth. As "interns," we were required to perform 200 adjustments, 20 physical exams, and 25 blood and urine analyses. Many of the lab write-ups were completed using old reports that were made available to us. We were told that the accrediting organization had no problem with this practice. Even worse, we were forced to recruit most of the required patients. An easy method was to bring family and friends to the clinic during "free exam" times. At other times, patients needed to pay to see the students. Another strategy was to pay strangers to pose as patients. It was then simple to manufacture a problem, exam findings, and a treatment plan. It was possible to convince some of these people to have x-rays taken, thus helping to fulfill the requirement in this area. The most efficient way to reach the goal of 200 outpatient adjustments was to have everyone you saw come in as often as possible. Clinical necessity was irrelevant. Compared to the experiences of my friends in medical and dental school, my "internship" was an embarrassment.
I finally graduated, took the state board exam, and received a Pennsylvania license in January 1995. Someone had cheated on the oral portion of the exam and distributed several of the questions to others waiting to take the test. Nevertheless, under intense pressure, the board decided to issue licenses. A few weeks later, thinking the worst was over, I began working in the satellite office of a local chiropractor. I took a job because my heavy debt made it impossible to open an office of my own, and because I thought that working with an experienced chiropractor would enable me to sharpen my clinical skills, which I believed were inadequate.
It soon became obvious that my employer's goal was to see as many patients as often as possible. Some had been coming three times per week for years. These, and others who were seen consistently but less frequently, were referred to as "good patients." Those who came to the office only when they felt they needed symptomatic relief, were considered "bad patients."
During my student days, I had heard that many chiropractors aim to "get 'em in and keep 'em coming." I didn't believe this and had vigorously defended the chiropractic profession. Yet now, as I began my career, I encountered many chiropractors who did exactly that. (Some even said they were seeing more than 100 patients per day.) I spent a great deal of time wondering whether I had chosen the right profession. I phoned the doctor who had been my pediatrician. He listened intently as I described my dissatisfaction with what I could do for the patients, the mill-like atmosphere of the office where I worked, and my feeling that I could not possibly do this for the next 40 years. He urged me to apply to medical school, which I resolved to do.
By this time it was late summer, so I had to wait until the following year to apply. Meanwhile, I had applied for and been offered an associate position with a chiropractic group practice near Pittsburgh. The initial salary was sufficient to live on, and the promise of a much larger income made the offer very tempting.
I arrived on a Sunday morning at the impressive Ohio home of one of the owners, a man in his middle thirties who had made a great deal of money by running a growing number of chiropractic practices. His chiropractic employees were well compensated for their efforts. I was optimistic about reducing the enormous debt I had incurred attending chiropractic college -- an amount that makes many new DCs willing to do things that are unethical and illegal.
On Monday, the established chiropractic employees welcomed me and five other "new guys" to "chiropractic boot camp" in the basement of the home. The entire atmosphere was geared towards fostering a total commitment to building the practice. We were subjected to Tony Robbins chants, role-playing, and lots of cheerleading for chiropractic. Then we learned that for the next 3 to 6 months our job would be patient recruitment rather than treatment -- and that if we did a good job, we would get to work in an office that was under construction. We were assigned locations to perform "spinal screenings" with a goal of signing up at least 20 patients per day.
The situation seemed a bit cult-like and made me quite uncomfortable. The six of us were required to live at the boss's home and were told that we would not be permitted to return until this daily goal was met. I was a few names short the first day, and when I returned to go to bed around 9 PM, they wouldn't let me in. One of the partners then drove me to a bowling alley where I was instructed to approach people, ask to take their blood pressure, and get them to sign up for a visit. I made the remainder of my list but found the whole situation humiliating.
The next day, we were given keys to the house, because the partners would be going out of town later that week. The game was the same though, although at a different location. I couldn't bear to harass the people walking by my table, so I fabricated names, addresses and phone numbers and spent the remainder of the time writing letters to home telling how miserable I was and how this chiropractic thing was the biggest mistake of my life. I called my parents from a pay phone that night and explained the situation. They told me to get home immediately, as these guys sounded like trouble. I went back to the house that night, quietly packed my things, and stuffed them in a closet. The next day, I went to the screening location, waited a few hours, then drove back to the house. I collected my belongings, left a note telling the entrepreneurial chiropractors what I thought of them and their practice methods, and took the long drive home, more determined than ever to get into a medical school and become a "real doctor". In March 1996, I learned that the FBI had raided their offices, seized records, and closed them down. I remember that the sun seemed to shine more brightly that day.
After returning home, I found a part-time position with a small practice and enrolled as a full-time college student. I took 17 credits, achieved a 3.9 grade-point average, and was working towards a master of science degree in education and biology. Things were well on their way when my car was struck by a bus and driven into a median barrier. Because of missed classes and a dispute with my insurance company, I was forced to withdraw. Financial factors forced me to take a full-time position with another chiropractic practice.
Initially things went well. It seemed to be the most legitimate of the practices I'd been in, and was located close to a college where I could take classes. Then, one day, after about three months with the practice, a patient questioned me about an explanation of benefits (EOB) report from her insurance company. It appeared that there was a provider number other than mine listed. I questioned my employer, who insisted that it was just a mistake and would be corrected. I had become a bit more cynical by this time and decided to check the copies of the EOBs that were kept on file in the office. Much to my dismay, I found that many of them also listed the same provider number. I checked the number and found that it belonged to the chiropractor who had worked there before me. He had already been enrolled as a provider in several of the insurance plans for which my paperwork was still pending. So the practice was billing under his number in order to get paid. I consulted an attorney who informed me that either they needed to fix the "mistake," or I needed to leave. I was a bit scared as, according to my contract, if I quit, I was required to pay the owner $10,000 for "damages." They refused to re-bill correctly, so I proceeded to get myself fired. It was truly difficult for me to be defiant, unreliable, and openly negligent in my job obligations. Yet, according to the attorney, I had little choice. I needed to separate myself from the practice. It eventually happened, and I joined yet another practice closer to home.
During the interview, I specifically asked, "Do you do anything unethical or illegal? If so, please tell me and I will leave right now and you'll never hear from me again." I thought I was being open and extremely reasonable. They of course said, "No, we are very ethical here." Well, I had bills to pay, and enjoyed eating, so I took the job. (I should point out that I had not, nor have I yet been able to pay a dime towards my student loans. As a result they have accrued over $25,000 in interest since I graduated. It's almost a joke at this point, yet, at present, I have no way of paying them.)
This one turned out to be a volume practice that derived most of its patients from telemarketing. They offered free exams, x-rays, and consultations. I was expected to perform exams and find something wrong with every patient, so that I could sell them on care. There were many sessions in which the owner and the marketing staff would advise how to make the sales pitch. We had role-playing sessions in which my performance was evaluated. Whether I was allowed to treat patients would be predicated on how well I could sell to prospective clients. I soon learned that this task could be accomplished in a number of ways. The easiest was to x-ray the patient, find something that you could say was a "subluxation," and explain how this or that bone was out of place, pressing on some nerve and causing any number of problems -- from headaches or back pain to nasal drip or inability to become pregnant. Another method was to feel around the spine until you found a tender spot (nearly everyone has some) and explain how this indicated the presence of the subluxation that we saw on x-ray, affected the muscles of the spine, and was linked to many diseases and maladies. It was necessary to "sell" as many patients on care as possible and then to keep them coming as often as possible for as long as possible. Chiropractic subluxation theory encourages this strategy.
Once the person agreed to treatment, the "free" exam and x-rays were billed to their insurance company. I worked at this office for almost a year, all the while fighting with the owners, and pointing out to them the illegal and unethical things that they were doing. They tolerated me because I had wonderful rapport with the patients. However, I was eventually fired for not bending to the owners' wishes.
During my time there, I gained weight, developed high blood pressure, and found unparalleled motivation to exit the chiropractic profession. I also became acquainted with an osteopathic physician who practiced in the same office building who became a source of encouragement and support, as well as a fine role model for me. After talking with admissions officers at both medical and osteopathic schools, I concluded that the latter were far more kindly disposed toward chiropractic applicants. So I applied only to osteopathic schools.
I continued to take classes, amass letters of recommendation, and look forward to the day when I received an acceptance letter. It came on February 12, 1998 -- a thick package from the University of New England College of Osteopathic Medicine, sent certified mail, with a letter that began, "The admissions committee is pleased to inform you that you have been accepted to the Class of 2002." I carried a copy in my pocket for the next six months.
It has been a long, twisted, bumpy, pothole-ridden road. Most of the admissions officers told me that applications from chiropractors were viewed skeptically. One even suggested not mentioning my chiropractic background and "making up something" to explain the gap in time. I was amazed. In truth though, given what I've seen of the chiropractic profession, I can understand why schools would be wary of admitting chiropractors. One problem with this caution is that it prevents many who have seen chiropractic for what it truly is from joining the ranks of the medical profession and subsequently making great contributions to the fight against quackery. Hopefully, those of us who do manage to do so, will be able to make a difference.
The amount of opposition and insults that I have received from my former colleagues is astounding. Although a few have told me that I am doing the right thing, the majority consider me a "heretic."
As a physician, I plan to use manipulation and other physical medicine procedures when appropriate. Experience has taught me that there are times when manipulation can be effective. Manipulation is a tool, not THE tool. It should only be performed after a competent physician has ruled out the possibility of serious illness as the etiology of the complaint. Chiropractic training does not adequately prepare DCs to function as competent diagnosticians, and certainly not as primary-care practitioners. I hope this sampling of my experiences will help to dissuade other naïve students from pursuing a chiropractic career.
Dr. Lattanze is a first-year student at the University of New England College of Osteopathic Medicine. He expects to receive his Doctor of Osteopathic Medicine degree in 2002.
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