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Friday, January 16, 2015

Making The Case for Primary Spine Practitioner Care

Primary Spine Practitioner Care for Back Pain
Better Option to Back Surgery

“The American Association of Medical Colleges has identified musculoskeletal medicine as an area in which students receive inadequate preparation for practice in the real world.[1] North American medical schools have limited time devoted to musculoskeletal education. Only 30% to 40% of schools have required instruction in the musculoskeletal system.[2][3] Graduates entering practice experience the effects of this lack of instruction; one survey found that half of family physicians reported inadequate musculoskeletal training for clinical practice.[4][5]

These are not the words of an opinionated and/or biased chiropractor but those of clinical researchers at the University of Rochester School of Medicine and Dentistry. They admit that as of November 2014,[5] most primary care physicians graduating from medical school lack the confidence to assess and treat musculoskeletal complaints. This fact alone creates a substantial argument for the necessity of an integrative system of healthcare delivery that incorporates Primary Spine Practitioner (PSP) trained providers who possess the knowledge, skill, and ability to triage[6] patients with musculoskeletal complaints.

PSP trained providers [DC, PT, MD, NP, PA] can evaluate and manage the majority of patients with musculoskeletal conditions based upon best available evidence, and in a patient centered model of care. This portal of entry into the healthcare delivery system can then streamline the referral process for those patients who need a level of care beyond that of standard musculoskeletal treatment. Incorporating this type of provider would alleviate the burden of musculoskeletal complaints from primary care practices allowing medical doctors to focus on infectious disease and serious pathology, conditions they ARE TRAINED FOR.  

The desire for this integration became evident to us upon receiving a letter from Excellus Blue Cross/Blue Shield of Rochester dated 29 December 2014. In this letter they outlined a “Waived Copayment Pilot Program” whose purpose is to “help drive care to spine pathway trained practitioners so that the program’s value can be measured and compared to other modalities of treatment for back and neck pain”. This program will extend until 31 December 2015 and only include Excellus employees and their covered family members but underlines the fact that a major health insurer believes PSPs are credible portal of entry providers for patients who present with musculoskeletal conditions.




[1] Association of American Medical Colleges. Medical School Objectives Project. Contemporary issues in medicine: musculoskeletal medicine education. Report VII. 2005.

[2] DiCaprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine in American medical schools. J Bone Joint Surg Am. 2003 Mar;85(3):565-7.FREE Full Text

[3] Pinney SJ, Regan WD. Educating medical students about musculoskeletal problems. Are community needs reflected in the curricula of Canadian medical schools? J Bone Joint Surg Am. 2001 Sep;83(9):1317-20.Abstract/FREE Full Text

[4] Sneiderman C. Orthopedic practice and training of family physicians: a survey of 302 North Carolina practitioners. J Fam Pract. 1977 Feb;4(2):267-50.Medline

[5] DiGiovann, Benedict F., , MD, Richard D. Southgate, , MD, Christopher J. Mooney, , MA, MPH, Jennifer Y. Chu, , MD, David R. Lambert, , MD, and Regis J. O’Keefe, , MD, PhD. "Factors Impacting Musculoskeletal Knowledge and Clinical Confidence in Graduating Medical Students."The Journal of Bone and Joint Surgery E185 96.21 (2014): n. pag. The Journal of Bone and Joint Surgery, Inc. The Journal of Bone and Joint Surgery, Inc.; STRIATUS Orthopaedic Communications, 05 Nov. 2014. Web. 17 Jan. 2015. <http://jbjs.org/content/96/21/e185>. 
Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, New York

[6] Process of organizing several patients for treatment. The process of deciding which people in a hospital department should get medical treatment first, according to how serious their condition is..

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