We invited Dr. Bobby Braile, the newly elected President of the International Chiropractors Association (ICA) to discuss his role and goals as the new president of the organization started by B. J. Palmer, the developer of chiropractic.
Dr. Braile is the first graduate of New York Chiropractic College to hold this historic position, and he has recently assumed the position of Director of Postgraduate Education at Life College, where he also serves as a member of the chiropractic philosophy faculty.
Dr. Braile assumed the office as the eleventh president in October of 1995, following Dr. R. James Gregg, who served for four years. Dr. Braile has been active in the ICA since his student days, and has received numerous honors from state, local and national organizations. This interview addresses the following statement issued by Dr. Braile shortly after taking office.
…The fact of the matter is this. No matter what numbers have been boasted by national chiropractic organizations, over two-thirds of our profession do not belong to any national chiropractic association. This number is staggering, considering the challenges our profession faces on a regular basis. One would think issues such as managed care, attacks from the press, Medicare, standards of care, research, and political lobbying efforts would be enough to motivate all doctors to join. Obviously it hasn’t. The question of “Why don’t they join?” has been baffling national association leaders for years. NO LONGER!
The answer is clear. To the question of, “Why don’t they join?” I reply, Why should they? Have we as national associations given the profession something they can use? Have we truly served our members? Or have we been asking them to serve our needs? Let’s look at the history of our association and ask the question, “If we were not politically motivated (most practicing chiropractors are not), would we join us?” I’m afraid the answer might not be pleasing to our ears. The history of both major national associations is marred with in-fighting, egos, and an “I know better” attitude. I dare say that in certain instances the practicing chiropractor has been treated like a commodity, kept in the dark, and used as a financial resource for personal agendas. THIS ENDS NOW!
AS OF NOW, the in-fighting STOPS! AS OF NOW, the concept of straight vs. mixer dies. AS OF NOW, ICA will not ask you for your hard earned money without giving the value you deserve for your dues. AS OF NOW, the ICA rededicates itself towards SERVICE to its members and the profession at large in a way that reaches into your practice and benefits you and your patients directly. AS OF NOW, the history of our national associations’ behavior ends with the ICA.
I will not ask you to join the ICA! All I ask is that you put aside all concepts of the past and give us the opportunity to earn your dues dollars. If we do not prove ourselves worthy of this task, do not join! As president of the ICA, I refuse to take your money and not give you the value you deserve.
Over the coming weeks and months you will see articles, ads, and programs started by the ICA to serve you. In the process I hope we can earn your confidence and trust. We in chiropractic are at a critical point in health care. As we enter the second hundred years of our profession, we are poised to shape the very consciousness of society’s viewpoint on health. With communication, education and perspiration, we will make history. No matter what you thought of the ICA or any national association in the past, everything has changed, AS OF NOW!
Dr. Braile, as the newly elected president of the Inter-national Chiropractors Assoc-iation, what is your primary objective while serving as president?
Service to our members and the profession. For the longest time I have felt that our national associations placed more emphasis on their institutional needs than on the average practicing doctor. I want to turn the emphasis of the ICA in the direction of being a service organization, an organization that helps chiropractors in their office be more productive and prosperous.
Why do you believe managed care, attacks from the press, Medicare, standards of care, research and political lobbying efforts are not motivation enough to join a national organization?
Most chiropractors view these things as matters that are out of their control. They feel that none of the national associations can make a difference with these issues. This then leaves the doctors feeling their major concern must be to worry about number one, and use their precious resources where it will best help their personal practice. Obviously, the doctors who are politically involved with national organizations don’t agree. These doctors see a benefit to themselves and the profession be to a member. Our job as leaders is to show all chiropractors that membership offers a real benefit to the practitioner.
How do you plan to get chiropractors to unify and put aside the in-fighting?
Common cause! All minorities unify to accomplish a common cause. This may be in response to a threat such as managed care, or a positive program such as a massive public awareness campaign. When the cause becomes bigger than the egos, the common cause becomes the unifying point. WE in the ICA plan to initiate a massive plan of positive public awareness that we hope will begin just such a process.
Do you believe that if the ICA sets an example and puts aside the concept of straight v. mixer, practicing chiropractors will follow? Why?
The ICA has done just that many years ago. If you look over our policies, our code of ethics, our governing documents and our publications, you will not find the terms “straight” or “mixer.” These antiquated terms were abandoned years ago in the ICA. But as with many minorities, other groups outside the ICA still use these terms to describe us. Such descriptions are inaccurate and politically incorrect. If you wish to know what ICA stands for, simply read our policy handbook.
How can we as a profession best influence society’s viewpoint on health and chiropractic?
Singularity of message. The dental profession years ago defined its role in society with the filling of cavities. Today we know that dentists deals with all maladies of the oral cavity, but they set their niche early. Our profession needs to take a lesson from the dentists and set our niche. Subluxation correction and spinal health are our niche. If we focus on this one singular message, we will accomplish more in public awareness in a few short years than we have over the last 100 years.
How many members does the ICA currently have? What is the breakdown of the membership?
ICA’s current membership is, as of January 1, 1996, 6,949, in all categories. Of the above total, 2,905 are students. We have numerous membership categories within our DC membership, including international members, faculty, etc. We also have about a hundred dues-paying lay members.
How has the breakdown of your membership changed over the last five years?
ICA’s membership mix has changed considerably in recent years. Our student membership has grown considerably, and we have seen a great shift brought about by the retirement of hundreds of DCs in the generation that received their chiropractic education on the GI bill after World War II. We have replaced these members, as well as recruiting enough additional DC members to provide for steady, if somewhat slow growth in recent years.
Why do you believe two thirds of the chiropractic profession have not joined a national organization?
Why should they? If we are to be honest with ourselves, why should they. Have we as national associations given them enough tangible benefits for their membership dollars. Oh sure, I’ve seen some great spins on political activities that have netted minimal results. But really the question that needs to be answered is this. “Have any of the national associations done anything to make life better for the practicing chiropractor?” The answer is a scary no! Life is harder now than a few years ago. We as national associations need to re-focus, and I intend for the ICA to do just that.
There has been some discussion about whether the ICA meets the requirements under CCE By-Laws to maintain a seat on CCE’s-COA considering your membership levels. Do you now, and have you for the past five years, maintained sufficient full-time dues-paying membership to secure ICA seat on the CCE’s Commission on Accredit-ation?
The answer to this question is an emphatic, YES! ICA has invested over $1.5 million in support to the Council on Chiropractic Education over the years on the basis of our DC-membership numbers. Unlike other organizations, ICA does not play a public relations game with our membership statistics. It degrades us as leaders and generates suspicion within the profession when an organization claims, for example, 25,000 members and on the CCE membership census, certifies only 8,000 or so. What we claim is what we have. It is also important to note that these membership numbers are frequently verified by independent audit by an objective CPA auditing firm.
What is your relationship with Dr. Terry Rondberg’s group, The World Chiropractic Alliance?
I am not a member, and have no relationship professionally with the WCA either on an individual basis, or as the President of ICA. Dr. Rondberg is a vocal member of the ICA, and he publishes a newspaper. The ICA often sends press releases to his newspaper, as we do with most chiropractic publications.
Is it true that Dr. Rondberg has urged WCA members to hold joint membership in WCA and ICA’s sagging membership enough to maintain its seat on the CCE’s Commission on Accreditation?
Your question confuses some facts with incorrect premise. Dr. Rondberg has vocally endorsed the ICA in his publication. For this we are thankful and appreciate his efforts. The concept of ICA having sagging membership is incorrect, and the premise of ICA’s seat on CCE being ever in jeopardy is incorrect. Despite other national associations reportedly losing thousands of members, the ICA has posted moderate and steady gains.
What specialty council does ICA officially sponsor? What are the criteria for successful completion of each program? How are the credentials of the program and instructors verified? Are the councils recognized by any other organizations, such as managed care? What is the ICA’s position on managed care participation by its members?
ICA formally sponsors Council on Pediatrics, Fitness and Sports Health Science, Applied Chiropractic Sciences and Chiropractic Imaging which includes a specialty program in thermography. All ICA programs follow the standard program of coursework and examination prior to the granting of any certification or diplomate credential. ICA operates the instruction in all its council programs through CCE-accredited chiropractic colleges. This institution providing the post graduate and relicensure credit assumes responsibility for the credentialing of faculty. Frequently, managed care organizations ask for information on post graduate certification from DC’s who are seeking to be participating providers. We are working to insure that all such organizations have full information on ICA’s councils. I do know that ICA’s councils have been recognized and accepted in many instances. This is an element that is quite new and developing quite rapidly. The decision to seek to participate in managed care programs is up to the individual member doctor. ICA fully supports those who wish to do so and the ICA staff and committee system routinely provides assistance in the application process.
How do you respond to Dr. Gerald Clum’s statement at the 1995 meeting of the Association of Chiropractic Colleges, where we urged chiropractors to “get back to cash-based practices…forget all these expensive tests, to get ’em out–we could all make a lot more money…” especially in view of adequate diagnosis and competent patient care issues as required by practice statues?
I was not present during these statements. I therefore, do not know in what context they were made. I would suggest that you contact Dr. Clum for a response. Our profession has far too much miscommunication. In all my past dealing with Dr. Clum, I have found him to be one of the most intelligent, honest, visionaries of our profession. If I understood the theme of his entire talk, I might better be able to interpret the segment you have asked me to comment on.
Is Dr. Sid Williams still Chairman of ICA’s Board of Governors? (Board of Directors)?
No. Dr. Sid Williams is not Chairman of the ICA Board. Dr. Williams holds a Board seat. Based on my nomination Dr. Jim Gregg our past president has been elected Chairman of the Board.
How would you respond to criticism that by you and Dr. Williams holding the two key leadership positions in ICA, the organization is simply an extension of Life College?
For years the ICA was accused of being nothing more than a Palmer fraternity. This did not deter myself and others not from Palmer in working in ICA. The fact is our Board has the widest mix of school representation ever. I am a NYCC graduate, our Chairman of the Board came from Logan, our vice president is from Palmer, and our secretary from Cleveland College. Those that would criticize this arrangement are not looking at the facts. By my appointments to ICA committees, I am proud to say that the ICA has now more diversity represented than in any time in its history. I would dare argue that the ICA represents a greater cross section of our profession than any other national association.
Please describe your professional responsibilities at Life College. Are you responsible for credentials verification for post-graduate faculty? If not, do you have someone for this phase of the post-graduate faculty selection process?
I am the new director of Postgraduate education at Life College. This means that I set up and run seminars for license renewal. One of the duties of past directors was to head up a credentialing committee. Since I am also ICA president, I have refused this position. A blind committee has been established to review all credentials when needed. At my request I have not been informed of the members of this committee.
How do you respond to recent accusations that Dr. Jay Holder, Life College postgraduate instructor, has misleading or failed credentials?
As of my response to these questions, the credentialing committee has not released its findings to me. I have categorically refused to intervene in this matter as If eel the proper academic body should render a decision.
What is the ICA’s position on credentials verification for post-graduate continuing education instructors?
By ICA’s involvement in CCE, and other standards processes, the ICA of course stands for only the highest standards in postgraduate education. But, since all postgraduate education credentialing is done by our colleges the ICA can have no role in interfering with this important process.
How do you propose the problem can be rectified for the chiropractic profession?
I personally believe this is a concern for the colleges. Our chiropractic colleges represent the highest levels of education our profession has ever enjoyed. Now that concerns on this issue have come to light, I believe you will see all the colleges respond accordingly.
What major changes do you plan during your term as ICA president?
Service to our members is a major concern to me. I want programs and initiatives that reach into each chiropractor’s office and give them the tools they need to succeed.
I am a strong believer in organizational structure. I have already been in the ICA office twice in the first two weeks of my presidency.
Programs, especially membership recruitment..
I believe that each organization in chiropractic must validate its existence by what it does for chiropractic and for the individual D.C. In the months ahead, ICA’s focus on legislation, the employment of new communications technology to better disseminate the chiropractic message, new public education initiatives and a new focus on the traditional activities of a member association, such as sales programs, seminars, insurance, etc., will demonstrate the utility of ICA membership. I am particularly excited about our prospects greatly enhancing our communications capacity through computer and other technological improvements, as I am about our growing post-graduate council system, which presently involves some 1,500 DC’s, many of whom are not actually ICA members, even though they belong to an ICA council.
I intend for the ICA to take the leadership role in chiropractic information. I plan to do this with the high tech media. I will be instituting a program to make ICA the major source of news for our profession. This does not only mean with present publications, but also with electronic media.
Are you in favor of renewing discussions with the ACA regarding a merger of the two organizations?
No, I am not. I was in the thick of things in the last go round. This was the most decisive feuding time in our recent history. It cost both national association members, money and wasted efforts. If something like this is to ever happen, it needs to happen naturally, not with a forced political agenda. I do however believe we can and must work together on critical issues. In this light I will be calling for some joint meetings to deal with some specific areas of mutual concern.
What is your relationship with the licensing and regulatory agencies?
ICA routinely provides information to state licensing and regulatory boards. We support the Federation of Chiropractic Licensing Boards and make our code of ethics widely available as well as our official policies. We have found that many boards use these documents as benchmarks by which to evaluate professional behavior. We are very proud of the stands we take on ethical and policy questions. This is part of what distinguishes lCA among chiropractic organizations. We do, on occasion, testify before state bodies on issues where ICA has strong policy stands, such as the incorporation of drug therapy in the chiropractic scope of practice. I can assure you that ICA will always be active in opposition to such a step.
What is the annual budget of the ICA? How would you break down major categories of revenue, and expenses? Will any of these change under your leadership?
The current fiscal year budget for ICA is $2.46 million. Of this total, about half comes from membership dues, about $450,000 comes from royalties and the rest from sales, seminars and conventions. We spend half our budget on fixed expenses such as office, staff, membership service, our publications and consultants and lobbyists. The remainder is spent on aggressive service and communications programs, from public relations to support for local organizations. We spend approximately $90,000 annually to support the CCE, about $16,000 in support of the World Federation of Chiropractic as well. Under my leadership, I will work to gain the maximum advantage and efficiency for each member dollar spent. It is a little early in my term to know exactly what my impact will be.
Since a few chiropractic colleges still espouse a philosophy-based orientation in terms of straight vs. mixer–how do you plan to address this philosophy-based concept of chiropractic practice at the college level?
In the philosophy course that I teach, I cover the concept of the terms “straight and mixer” from a historical viewpoint. I point out how the terms got their origin and then explain to the class that these terms are historical only and have no relevance to chiropractic today. In my mind these terms have no relevance to chiropractic today.
What is the ICA’s position on “diagnosis”?
ICA’s official position on diagnosis as printed in our policy handbook states:
“The Doctor of Chiropractic is educated in the basic clinical and chiropractic sciences,in other health related subjects, and in appropriate physical, clinical, laboratory and radiological investigative procedures. A Doctor of Chiropractic is considered by the International Chiropractors Association to be a portal of entry, primary health care provider.
The ICA holds that it is a basic responsibility of the doctor of chiropractic to employ such diagnostic processes as are necessary in his or her professional judgment to determine the need for care and, in particular, to detect the presence, location and nature for chiropractic lesions (subluxation and attendant biomechanical. biochemical, structural and neurophysiological problems, etc.) and prepare and administer an appropriate course of care within the realm of chiropractic specialty.
In addition, Doctors of Chiropractic use diagnostic procedures for the purpose of:
A. Determining appropriate case management.
- To ascertain the nature of the patient’s problem and respond appropriately so as to secure the optimal care for the patient. Inherent in this concept is the obligation to consult with or refer to other health care providers before, during or after the rendering of chiropractic care, if in his/her professional opinion, it is appropriate and in the best interest of the patient.
- To assess any subluxation complexes, discovered in the patient along with related biomechanical, biochemical and neurophysiological presentations.
- To identify any associated, aggravating or complicating conditions that are found to exist concomitantly with the subluxation complexes.
Where do you envision the profession in five years?
I see us in better shape than we imagine. At the same time managed care, increased regulation, and insurance tightening are occurring, something else wonderful is happening. More people are turning to natural health. More people are getting disgusted with drugs, more people are turning toward a lifestyle that we have been promoting for years. In essence, more people are turning toward chiropractic. It is becoming chic and fashionable to go to a chiropractor. And just as the public is doing with health spas, they are willing to pay for it! Our best allies, our best friends has been the patient all along. Yes the insurance industry may change, but the demand for our services will skyrocket. All we need to do is properly position and market ourselves and the flood of patients will begin. In five years, I see us busier than ever.