As expected, I am posting Part 2 of Dr. Steve Agoc’s interview today. Enjoy!
Dr. Brandon Harshe: You are very knowledgeable about the history of chiropractic. What is it about chiropractic history that interests you?
Dr. Steve Agocs: “My love for chiropractic history goes back to my research stage when I was an undergrad and learning what chiropractic is. I loved reading about the various techniques and how they began, and so that dovetails into history pretty nicely. Of course, Palmer College is loaded with history from above, down, inside, out so I was immersed in it there, although my history class when I was a student was not so great. I’ve always had a lot of respect for the people who’ve come before me, so I had a moderate interest in history as a student and as a practitioner, mainly from the technique side of things, again.
When I came to Cleveland Chiropractic College, the course was taught by someone who was stepping into more administrative roles. I begged for the class, even though I really didn’t want to spend more time in the classroom than I already was, because I knew I could teach the class well. It was a good choice, though, because I love teaching it and I have really gotten in touch with my history geek side! I have a modest, but nice, collection of old memorabilia, signs, cards, etc as well as a little table collection. I own a 1940’s pre-Thompson upper cervical side posture table, I’ve owned two 1970’s Zenith 420 Thompson tables (sold one to a protégé) and I have a great wooden Meric table from 1923 that is beautiful. I just obtained a “Thompson Adjusting Trainor” from the early 1950’s that I believe was handmade by Clay Thompson in his workshop, and I am hot on the trail of a 1920’s Palmer School diploma with all the greats’ signatures on it! My office and my home are known around the school as the Nerditorium and the Fortress of Nerditude, respectively!
I just love chiropractic’s rich and interesting history, the sometimes weird people involved, and really everything about it. I encourage everyone reading this to join the Association for the History of Chiropractic, which is a great organization and really affordable to be a member of. It’s well worth it.”
Dr. Brandon Harshe: As a clinic doctor at Cleveland Chiropractic College in Kansas City, what is it like being in charge of and guiding interns on their path toward graduation?
Dr. Steve Agocs: “It’s really rewarding to see students transition from classroom to internship to graduation. My job at Cleveland is nuts, though. I spend afternoons on Monday, Wednesday and Friday at Kansas City Free Health Clinic, seeing my own patients in one of the country’s largest free clinics with one intern in tow.
To be a clinician at Cleveland, you have to really, REALLY be on your toes. On a Thursday, for example (when I’m writing this), I start the morning off with an hour of Case Management Review (CMR). This is when one of my assigned interns brings me one of their case files for a new patient and we go through every page of paperwork making sure nothing was overlooked or missed, then I work with the student to diagnose the patient and come up with a treatment plan. It’s really tough because, chances are, I have never met, seen, or certainly examined this patient, as our interns do not schedule appointments only when their assigned clinician is on the floor. It’s mentally very challenging. After an hour of that, where I do 2 CMR’s, usually, I then spend an hour managing the clinic floor, which involves signing SOAP’s, assessing adjustments, answering questions, putting out fires, etc. Whatever needs to be done. Then I teach my history class up in a classroom for an hour, then I’m back on the clinic floor for an hour. Then it’s an hour off for lunch, followed by two more hours on the clinic floor and finishing up the day with an hour of Thompson Technique in the classroom. So, every hour I tend to be doing something completely different, and then every second on the clinic floor requires you to switch gears from meeting a new patient to helping out with an adjustment to having an intern ask about a shoulder x-ray, for example.
In private practice, you tend to block large amounts of time off, for example, you may reserve one afternoon a week for paperwork, planning, etc, you usually lump new patients into a couple hours of the day, and then you see your established patients in blocks of time during other parts of the day. The nice thing about that is you give yourself a chance to get into a “groove,” but we never get that chance in the clinic here, so it is very hard work, really.”
Dr. Brandon Harshe: What are the benefits of teaching interns? What are the challenges?
Dr. Steve Agocs: “Teaching requires me to really know my stuff. Students ask good questions, often challenging questions, sometimes just to see if you can walk the walk or if you’re just full of hot air! So, I’ve had to re-learn a lot of stuff I was hoping I could forget way back when I passed all my boards! It’s super rewarding to work with a student and help them develop. The hardest challenge is that we are transitioning from a relatively hands-off clinic system to a more clinician-based system, and so the chaos I mentioned in the last question drains a lot of energy that I could be using to work with interns. I’m looking forward to a truly clinician-based system where I am in charge of a dozen interns, maybe, and I am not running around with my hair on fire all the time, so I can really teach and work with my interns rather than just signing their files and moving them through the system.
Another big challenge in clinical education is letting a student take the reins, and knowing when and how to resume control in a way that the student saves face and also doesn’t get their ego beat up too badly. This requires a lot of delicate maneuvering with the patients and interns, and it’s really tough to do.”
Dr. Brandon Harshe: Where do you see the chiropractic profession going in the future?
Dr. Steve Agocs: “The chiropractic profession is really at an important crossroads. I think that in an effort to be more “evidence-based” there has been a lot of shedding of the identity that makes us chiropractors, so while the colleges think they are giving the students the research tools to succeed in an “evidence-based” environment, they’re really creating a very confused graduate who doesn’t have a principle to guide his procedures.
I would like to see chiropractic get back to a defining principle (philosophy) and then build from that principle to teach the students the ever-emerging science and art of what we do. Chiropractic isn’t changing… The application may be, and the science that explains what we do is always changing, but chiropractic’s principle should be stronger than ever, and it isn’t being taught that way. So, education has a long way to go, in my opinion. I think a big focus of chiropractic as a profession needs to be on opening up more markets for DC’s. The profession is really stagnant here in the USA, and I think it’s because we’re still practicing in a mode that was common 100+ years ago. The MD’s have been doing group practice for decades, with great success, so I think the future of chiropractic is in group practice situations modeled after other professionals (MD’s, attorneys). The benefits are huge.
Continuing to make inroads in the VA and military systems are important. There is also the entire hospital, clinic and public health community that is largely untapped for chiropractors. Our doctors in the VA, at free clinics like where I practice, and in other non-traditional locations are paving the way for a future generation of DC’s who will be able to seek meaningful, gainful employment in these systems, working alongside other health care providers for the betterment of the patient. It’s coming, but we need more DC’s pushing into these systems.
There is also a trend toward large companies having on-site interdisciplinary clinics, and I am very interested in the potential of that market. Finally, there are now more chiropractic colleges outside of the USA than there are in the country, and the international healthcare market is wide open. I’ve lived overseas and it isn’t easy to go from a little town in the midwest, for example, to Rome, Italy to practice, but chiropractors are alive and well all over the world and there are thousands of places just waiting for a DC to take care of people. Who wouldn’t want to practice on some little island in the Caribbean, or in a modern Asian city, or walking distance from the Forum in Rome, etc? Chiropractors need to start thinking outside the box, and it has been a long time coming. So, in summary, I see the next ten years of the profession about opening up types of practice that have never really been open to DC’s in all sorts of markets both domestically and internationally. It’s pretty exciting!”
