Opportunities Ahead: Two Leaders’ Views

One voice for a friendly future/ Reorganizing to meet challenges

Ensuring chiropractic’s place in health-care delivery and policy-making

“In your position as a leader in the chiropractic profession, what threats and opportunities do you see ahead?”

What will the next 100 years of chiropractic practice in Canada look like? The future of the profession presents many opportunities. At the same time, there are challenges to ensuring Canadians have equitable access to chiropractic care.

However, I am of the opinion that the future lies primarily in our own hands. It is ours to mold and I believe the profession is moving steadily forward to create an environment in which chiropractic treatment will be the first stop for neuromusculoskeletal care.

"I believe the profession is moving steadily forward to create an environment in which chiropractic treatment will be the first stop for neuromusculoskeletal care."

"Interprofessional collaboration is another road into the future that we must tread with vigour."

One important step into the future is the development of university-based chiropractic research chairs. This program is gaining momentum and has an important role to play in integrating the profession into the health-care continuum. This activity, combined with the clinical practice guidelines initiative, will steadily move the profession into the centre of evidence-based practice and pave the way for enhanced referrals, insurance coverage and patient access. Research will be the currency of credibility in the health system of the future. The CCA, the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards, and the Canadian Chiropractic Research Foundation are committed to building a future based on a solid research foundation.

Interprofessional collaboration is another road into the future that we must tread with vigour. Collaborative care pilot projects such as those at St. Michael’s Hospital in Toronto, and Carlingview in Ottawa are the wave of the future. Multidisciplinary studies such as the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders also strengthen interprofessional relations, as does membership in organizations such as the Health Action Lobby (HEAL). These are directions that the CCA will continue to pursue to ensure that the chiropractic profession is at the table as an equal partner in health-care delivery and policy-making.

Lastly, internal collaboration is vital to our future.  This year, the CCA formed the Strategic Planning Advisory Committee, composed of representatives from all of the profession’s national organizations. The purpose of this committee is to harness the talents and expertise of our advocacy, regulatory, educational, research and protective bodies to build a roadmap for the future that addresses the challenges and seizes the opportunities before us.

It is only through working together, pooling our resources, and speaking with one voice that we can achieve our goals for the future.  This must happen across organizations and jurisdictions if we are to fully leverage our resources in the pursuit of success.  If we can do that, then we can be confident that the future is friendly!•

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The Federation works for uniform high standards in self-regulation and education

“In your position as a leader in the chiropractic profession, what threats and opportunities do you see ahead?”

I prefer to look at the question from the point of view of “challenges” and opportunities.  This is indeed a timely question and in my 13 years of service on the Council of the College of Chiropractors of Ontario and at the national level as a director of the Canadian Federation of Chiropractic Regulatory Boards (CFCRB) I can tell you that there has never been a more exciting time in the regulatory field.

The challenges we face include ensuring:
• practitioners have up-to-date information on best practices
• that interactions with patients are consistent with the standards established to promote and protect patient well-being (and which coincidently enhance the credibility of the profession)
• that we build a feeling of collegiality and engagement within the profession so that individuals take an active interest in continuing education as well as participating in the life of their associations and regulatory boards
• that our regulatory boards are effective in their roles so that the privilege of self-regulation is not lost – as happened recently to MDs in Britain

These are among the challenges that led the CFCRB and the Canadian Chiropractic Association (CCA) to jointly appoint a task force in early 2005 to evaluate the current organization of the profession with regard to regulatory issues, and to propose changes to better serve the profession and the public interest.

"I can tell you that there has never been a more exciting time in the regulatory field."

The task force noted that the size of regulatory boards’ membership varies greatly, ranging from 8 DCs (both P.E.I. and Yukon) to 3,500 DCs (Ontario), and thus the resources available also vary even though separate boards are expected to undertake the same basic functions. Also, with the implementation of the Agreement on Internal Trade by the federal, provincial and territorial governments 10 years ago, which mandated that the regulatory boards of all professions establish systems to allow the movement of registrants from one jurisdiction to another, the need for uniform high standards is more important than ever.

While noting that the regulation of professions is under provincial jurisdiction, the task force concluded that, in order to make the best use of limited resources and strengthen the ability of regulatory boards to fulfil their mandates, change was needed to the patchwork of organizations doing elements of the regulatory job. The CFCRB was the forum for regulatory boards and for overseeing specialty colleges. The Council on Chiropractic Education of Canada (CCEC) has accredited the teaching programs, and the examination of graduates is done by the Canadian Chiropractic Examining Board (CCEB). Each of these bodies has existed to serve the provincial regulatory boards, yet each has had an autonomous structure, board and budget.

The task force concluded that an amalgamation of some or all of these bodies was appropriate, and invited the CCEC and CCEB to discuss what this might look like. While the CCEB indicated disinterest in exploring the issue, the CCEC welcomed the opportunity. Discussions ensued and the CFCRB and CCEC have now joined into the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (known as “the Federation”). This means approximately $40,000 in governance and administrative cost savings can be redirected to other priority areas to strengthen the capacity of the regulatory boards through providing services, policy development and furthering external relations with other professions, federal government agencies and the media. The Federation will also continue the vital role of partnering with the CCA to develop clinical practice guidelines and with the Canadian Chiropractic Protective Association (CCPA) and the Journal of the Canadian Chiropractic Association (JCCA) to disseminate this information to practitioners.

Thank you for this opportunity to answer this question for your readers.
More information about the new Federation is available at www.chirofed.ca.•