NeuroPractice Journal interviews Dr. Carrick in the September 1998 Vol 5,No.9 issue submitted with supportive statement by the ACA Council on Neurology congratulating Dr. Carrick on his fine explanation of our specialty.
NeuroPractice Interviews Dr. Carrick
A recent interview with ACA Council on Neurology President, Dr. Frederick R. Carrick has been published in the September 1998 issue of NeuroPractice,
Volume 5, Number 9. This article entitled "Chiropractors Who Specialize in Neurology" related: "We had the opportunity to interview Frederick R. Carrick, DC, PhD, president of the Council on Neurology for the American Chiropractic Association, about his specialty and its possible integration with traditional medical-based neurology.
We present Dr. Carrick's views here as a means to keep our readers informed of alternative treatments that might be requested by patients.
NEUROPRACTICE: What exactly is a chiropractic neurologist?
CARRICK: As in medicine and dentistry, we have individual specialists within the chiropractic profession. Through their education, training and board certification, they choose to limit their practice to a certain specialty to assist members of their profession and allopathic physicians in the diagnosis and treatment of a variety of conditions. Within the chiropractic profession, there are specialists in radiology, orthopaedics, neurology, and physical rehabilitation.
Typically, a chiropractic neurologist serves in the same consulting manner as a medical neurologist. The difference is that the therapies or applications of a chiropractic neurologist do not include drugs or surgery. As a result, certain conditions are more customarily seen by a chiropractic neurologist as opposed to a medical neurologist, and vice versa. Specifically, our people see patients with a variety of movement disorders, dystonia, post-stroke rehabilitation, and radiculopathy or nerve entrapment syndromes that are consequences of peripheral or central types of lesions. Chiropractic neurologists can provide therapies and treatments as well as counsel when there is a diagnostic dilemma or a question of appropriateness of care regarding an individual lesion or scenario.
There are conditions not amenable to the type of treatment we might do. Myesthenia gravis, diabetic neuropathy, and forms of epilepsy are some examples. On the other hand, I would argue that there are many conditions that are not appropriate to pharmaceutical interventions.
NEUROPRACTICE: What does training consist of?
CARRICK: The training to become a board certified neurologist in the chiropractic profession is an additional three years after the doctor’s degree, which is conducted under the auspices of an accredited university or college that is recognized by the U.S. Office of Education. During that training, there is a didactic and residency – based/clinically based training. After completing those requirements, the chiropractor will sit for a board examination in neurology, which is held once per year by our independent examining board. The areas that are examined are specific to the field of neurology and include clinical and diagnostic techniques and knowledge of neurophysiology. The certification examination includes oral and practical portions as well as a battery of psychometric testing.
There are 250 board certified chiropractic neurologists in the world.
NEUROPRACTICE: What is the interaction between medical neurologists and chiropractic neurologists?
CARRICK: Generally, chiropractic neurologists serve as consultants to medical doctors, third party payors, and other chiropractic physicians, especially in the treatment of pain. Many referrals from medical neurologists are to differentiate central from peripheral lesions and to determine whether or not manipulative procedures, specifically, will be safe in certain conditions. A lot of the work is done in consultation where the chiropractic neurologist will examine a patient and then give direction to the referring doctor regarding the mode of therapy or the appropriateness of the therapy.
NEUROPRACTICE: How are your physicians paid for their services?
CARRICK: It depends on whether the consultant or practicing neurologist wishes to participate in a managed care plan. Some of our members are very much involved in managed care plans. The general trend, however, seems to be that many of our specialists are going outside the managed care parameters. But interestingly, our specialists seem to be able to exist quite well outside these parameters and most are very, very busy. Part of the reason for this is that the services they render are non duplicative. For example, if a medical neurologist sees a patient with dystonia, he or she may recommend a Botox injection or type of procedure, whereas the chiropractic neurologist might recommend a type of afferent stimulation or a nonpharmaceutical intervention that may not be in the armamentarium of the medical person. (Afferent stimulations are environmental stimulations such as manipulation of the neck, back, or extremity; and the use of light, heat, water, sound, and electricity – things in the physical environment that are non-invasive and non-surgical in nature.)
There seems to be a growing demand for nonpharmaceutical approaches in a variety of disciplines, which benefits the chiropractic neurologist. Although we are not vehemently against the utilization of surgery or drugs, our therapies do not entertain the use of them. We will refer a patient to someone else who uses these modalities if that treatment is the most appropriate for a given condition.
NEUROPRACTICE: Isn’t chiropractic treatment typically considered as a last resort?
CARRICK: That is changing. The normal course of things is that patients who seek service of a chiropractic neurologist have largely been around the block a few times and have seem many other types of practitioners.
NEUROPRACTICE: Doesn’t this put you at a greater risk?
CARRICK: The successes in chiropractic are the ones that have not been successfully treated by other therapies. Chiropractic is the second largest healing profession in the world right now. When it comes to liabilities and danger, I think every physician who undertakes the treatment of patients must evoke responsibility of care and appropriateness of service. Certainly, the chiropractic neurologist is very realistic about what he or she is doing, the dangers or liabilities of an individual treatment, the responsibility of direction and teaching of the patient, as well as the ethical and moral decisions which one might have to make in concert with the needs of the patient.
As for physicians, as part of state licensure, chiropractors have to have malpractice liability coverage. Malpractice statistics are really fairly low in terms of our discipline. The number of chiropractic claims for negligence is no where near that of medical claims.
NEUROPRACTICE: How do you see your profession evolving?
CARRICK: As greater emphasis is placed on patient outcomes and appropriateness of services, I believe greater opportunities are being created for cooperative relationships between medical neurologists and chiropractic neurologists. Certainly, our training is similar. There may even be an intertwining of disciplines to some extent in coming years. Recently a large percentage of medical doctors have been enrolling in our chiropractic neurology training programs. We have several physicians – neurologists, orthopaedists, neurosurgeons – who travel from Europe and Asia for the training.
We’re really pleased that it seems that our brand of neurological application is being accepted as complementary to medicine and occupational, physical, therapeutic modalities, and that it is in concert with what seems to be the direction of research and intervention for a variety of conditions."
The ACA Council on Neurology commends President Carrick on this fine representation of our specialty and looks forward to future articles.
Julie K. Bjornson, DC, Secretary
ACA Council on Neurology