VA OKs chiropractic care but keeps primary care oversight

It's official. The Dept. of Veterans Affairs will include chiropractors in its network of health care professionals, and patients will have access to them through any of the VA's physicians and other health care professionals. But primary care physicians will retain ultimate oversight of patient care.

This decision ends the debate on how patients will access chiropractic care at the VA. In March, VA Secretary Anthony Principi announced that the department had agreed with most of an advisory committee's recommendations on implementing a federal law enacted in 2001 that requires at least one facility in each of the VA's 21 regional health center networks to provide chiropractic care.

"We recommended that chiropractors be like any other member of the system," said Michael Murphy, DO, a member of the committee and past adviser for the Defense Dept. chiropractic health care demonstration project. "They get equity as a health care provider. It'll be a level playing field."

Chiropractors, who have been part of the Defense Dept. health care system since 1996, see this as a hard-fought victory. Reed Phillips, DC, PhD, committee chair and president of Southern California University of Health Sciences, said the profession had been trying to gain access to the VA since World War I.

"This is a big step forward, but we're not there yet," Dr. Phillips said.

The next leg of the journey includes developing education programs to inform patients and VA staff of the new services and how patients can access them.

According to Sara McVicker, RN, clinical program manager for the VA, the institution hasn't added an independent licensed health care provider since optometrists were brought in 25 years ago.

She didn't know when the VA would hire chiropractors or when they would start treating patients, because there are several policy and administrative changes to be completed first.

Anticipated demand for such care also was hard to measure, she said. At least 21 chiropractors will be hired, but whether these chiropractors will be full time or part time or if more will be hired has yet to be determined.

In fiscal 2002, the VA spent $380,000 to send 1,100 patients to chiropractors outside of the VA. Once patients have access to chiropractors within the VA, the number of patients seeing them is expected to increase.

Committee members said they expected that chiropractors would be overwhelmed with patients within six months of starting but that expansion would go slowly because there is no extra money for these services and administrators will want to evaluate cost effectiveness.

Dr. Phillips said the recommendations also open the door for VA researchers to conduct collaborative work with chiropractors and for chiropractic students and residents to train within the system.

Dr. Phillips said a range of reactions are expected from those within the VA.

"We're receiving indications at the committee level that some facilities are intrigued by the possibility and others are very resistant," he said.

The VA chiropractic advisory committee is made up of six chiropractors, three physicians, a physical therapist and a member of a veterans service group.