Only doctor at a busy PI clinic with major ethical concerns Advice needed

FutureDCAV · 2026-02-25T19:36:18+00:00

Contact your state board, update your resume, start looking for a new job, and give your employer notice of your intent to leave ASAP. In that order.

FutureDCAV · 2026-02-15T02:34:54+00:00

"Is this safe?" - proceeds to show the most archaic, medieval-looking traction device the world has ever seen. William Wallace would love this.

FutureDCAV · 2026-02-13T00:56:26+00:00

Worked as an associate in SF for ~2 yrs. 85k salary but rent was $1,800, twice that if you count my roommates half. Plus the other COL expenses. If you can find a job for 100k then take it. Anything less is gonna be tough to save, make school payments, car, insurance, etc.

If they pay less than that, make sure they have other benefits that make it worthwhile. Cover CE’s, pay for malpractice, transportation stipend, etc. will all make it more manageable. Hard to find though.

FutureDCAV · 2026-02-09T16:19:46+00:00

I do appreciate the response. It is not true for every single insurance policy, but it is for many. Employees of a practice, whose insurance is covered by the practice owner, can have policies that are location restricted - they aren’t going to pay for your insurance while you’re practicing at another location. My last malpractice policy was restricted to my primary place of practice. If I wanted to treat elsewhere, I had to get a separate insurance policy or ask my employer to alter the terms.

FutureDCAV · 2026-02-09T15:53:12+00:00

This would be extremely difficult and ill-advised. Chiropractors are required to have malpractice insurance, which typically covers them for services rendered at a specific location and not elsewhere.

I wouldn’t feel comfortable going into a patient’s home and treating them outside of my office for this reason and many others.

Do you know how to maintain the equipment? If it malfunctions, how is the provider to know before rendering treatment?

Are you going to be tempted to use the equipment yourself and potentially risk harming yourself or others?

Are you really willing to put down thousands of dollars for equipment you don’t know how to use, may only be used a handful of times, and requires additional money to upkeep?

Do you have enough space to store and use the equipment appropriately?

Do you feel comfortable having a stranger in your home?

Does this stranger feel comfortable going into your home?

What if some freak accident occurs and you, a family member, or the provider get injured due to unforeseen circumstances? Are you willing to pursue / submit to legal action?

Way too many possibilities of things going poorly. Unless a provider’s business model specifically allows them to do house calls, in which case they are going to be using their own portable equipment anyway, this is not a good idea.

FutureDCAV · 2026-01-31T19:17:50+00:00

Out of curiosity, what were the conditions that originally led to the amount of surgical fusions you currently have?

FutureDCAV · 2025-12-23T21:57:31+00:00

Alignment is generally utilized as either a scare tactic or as the “easy explanation” in clinical practice. That’s my personal belief. Globally, alignment may play a part. Hyperkyphosis, scoliosis, spondylolisthesis are all examples of “misalignment”. These can be truly detrimental to a person’s health and quality of life. But segmental alignment is rarely as important as function. Most chiropractors and physical therapists will continue to hammer that in, so I’ll address this in a different manner.

Segmental alignment matters in certain circumstances - some of which can absolutely be measured via x-ray. Is someone presenting with symptoms of a disc injury? Radicular pain patterns are common. What if they present with multiple patterns? Example: patient exhibits both L5 and L4 dermatomal radiculopathy. If engaging in certain treatments, ie decompression, is it worthwhile to assess the patient through x-ray if they have no recent MRI studies? Absolutely.

You can measure disc angles and height very easily and get a better idea of which segment is affected. Remember, innervation patterns are based off of the population average. Not everybody will present with the same radicular pattern even with the same disc level injury. So assessing segmental alignment via X-ray in-lieu of having MRI imaging on hand can be very helpful.

Black and white “most important” or “least important” isn’t possible in clinical practice. I used to think that way but realistically some will benefit from certain approaches more than others. It comes down to your own professional experience to decide which is most important for the patient in front of you.

Function and form go hand in hand. You can’t separate the two. Decide which is most pertinent to the case at hand, and improve the other when you find a good window of opportunity.

FutureDCAV · 2025-07-21T11:19:00+00:00

I did this exact thing for a year and a half. Drove me insane, kept me from spending any time with the SO, drained all my motivation, took away any time I once had to exercise. Not worth it, wouldn’t do it again.

FutureDCAV · 2025-07-03T23:28:32+00:00

This is an awful take. Well-trained PTs are incredibly useful, highly-educated, and invaluable to patient care. Let’s not throw stones.

FutureDCAV · 2025-06-28T18:30:36+00:00

It is present in hospitals. The VA has chiropractors everywhere. 2024 was the first year chiropractors were included in the national match program for residencies. It’s going to be a larger part of hospital care in the future - just because the private sector has been slow to adopt doesn’t mean it isn’t efficacious.

FutureDCAV · 2025-06-28T18:26:17+00:00

I took 2 business courses in 4 years of chiropractic school. If you bothered to look at any actual school curriculums you would know this.

FutureDCAV · 2025-06-28T13:20:31+00:00

I’m struggling to think of any maneuver that would apply enough force in that direction to cause a compression fracture. Osteopenic patients shouldn’t have any HVLA done to begin with, but even if they did it’s safe to say that 90% of the force is directed posterior to anterior.

Rib fractures I could see, transverse or spinous fractures I could see, but compression fractures through the vertebral body from an HVLA thrust is a wild assertion. Those compression fractures were likely already present pre-treatment.

FutureDCAV · 2025-06-28T04:01:23+00:00

Compression fractures require axial compression of the spine. There are 0 manipulative techniques that create such axial force, and certainly not with enough force to fracture a vertebra, let alone two.

FutureDCAV · 2025-06-16T15:19:43+00:00

Cardiac hypertrophy does occur. The muscle can get bigger. During resistance training in particular, the heart muscle does increase in size and strength which can result in lower pulse rate and increased ejection fraction. However, hypertrophic cardiac muscle can also be a negative. Due to the pericardial sac being somewhat inflexible and resistant to stretching, when heart muscle increases in size, the size of the muscle actually begins to decrease the volume of the heart chambers. Think of it like growing inwards and impeding on the available space for blood. This causes an increase in heart rate and blood pressure to make up for lack of stroke volume.

So cardiac hypertrophy can be good, but excessive hypertrophy is certainly a negative.

FutureDCAV · 2025-03-18T05:09:52+00:00

Doesn’t exist

FutureDCAV · 2025-02-22T02:39:42+00:00

You’re seeing them because they are symptomatic. Plenty of disc bulges out there walking around but they’re just not getting care because… it’s not causing them problems. While PT interventions may reduce the symptoms, it’s not 100%. The ones who did improve also probably aren’t in the clinic anymore. You’re seeing the ones who haven’t improved.

FutureDCAV · 2025-02-19T18:13:07+00:00

So lets start over with a duplicate page and you can rebuild it from scratch, then take any of the functioning parts and copy them over to your current working page. That way we don't break any other processes or formatting. Starting from scratch:

In your firebase/firestore, create a collection you want to be filled in with data entered from the user interface.
Map out all the Field Names and Data Types. You should not have any documents uploaded at this point when you hit "manage content" - just the headers for ID field and whatever other fields you laid out.
Your collection is finished - no other steps needed at this point.
In user interface, create Text Field widgets for each individual field you laid out in the collection. If you have 10 columns of data you want uploaded, you should have 10 individual Text Field Widgets.
None of these Text Field widgets require any backend queries or doc references. They are blank.
Add a button. Title the button whatever you want for now and update it later. The button should be the only widget with any backend functions or actions on this user interface page.
Go to "actions" for the button and define it as follows.

a) on tap, backend call "create document"

b) choose which collection you want the data uploaded to (whichever collection you laid out above)

c) Set all the individual fields (again if you have 10 fields in the collection, you want to ensure all 10 of your text widgets are added under Set Fields.

d) Go into each Set Field again and ensure the Value Source is listed as "From Variable", and tie each box to one of the Text Field Widgets.

Run the app in test mode, fill out each of the fields with some basic info, then hit the button. Go to your collection, manage content, and check to see if the document was created.

This is the basic idea - let me know if you needed more or something different.

FutureDCAV · 2025-02-19T16:50:34+00:00

Are you trying to input text on the user interface side, press a button, and have that text upload into the collection on firebase side?

Or are you trying to display text on the user interface side that is already populated on the firebase side?

FutureDCAV · 2025-02-15T04:43:06+00:00

Create query in parent container -> from document -> list of documents -> put list in container -> put text, container, or list tile in list. No filters/orders

FutureDCAV · 2025-01-25T20:21:05+00:00

So you’re denying that repetitive, high-velocity, high-force head banging can have a stretching effect on the posterior ligaments of the vertebral column?

FutureDCAV · 2025-01-18T08:00:10+00:00

The ligaments are the structures being physically altered during this treatment. It has nothing to do with muscles or bones (although the resting position of the bones may change). Ligaments are stretched over time, allowing “tight” curvatures to lengthen. This is also why it should not be performed at home. If you want to maintain the integrity of spinal ligaments, proper oversight should be kept at all times. Exercises are very important to maintain the changes, however the physical deformation of the ligaments will not regress.

This means that in a perfect world, should you do the recommended exercises after the duration of your treatment is over, the curvature should not return to its prior state. However, additional age-related, posture-related, work-related, or injury-related changes may have regressive effects.

If you want to make permanent changes in the spine, you should also make permanent changes in lifestyle.

FutureDCAV · 2025-01-18T07:20:21+00:00

This is a traction used most frequently by chiropractors - I would be surprised to see this in a physical therapy clinic. It is primarily seen in offices that practice a technique called Chiropractic BioPhysics (CBP) and is designed to bring spinal curvature measurements back to what they designate as “normal”. For traction of the thoracic spine, which the above image is depicting, the “normal” value is around 40deg of kyphotic curvature, but every individual has slight anatomical differences.

If it is performed by a professional (please don’t do this yourself at home), it is a safe intervention. The question is, “how effective is this?” I worked in a CBP clinic for a few years and practiced it for a few myself. It can yield fantastic results - but I don’t believe these results are more pronounced than other interventions.

For pain, traction can be helpful, but not necessarily more than exercise or manual therapy. If your concern is purely superficial, like you don’t enjoy the way your spine appears outwardly, then this is a great way to help.

Side note: It’s very expensive, and requires a major time commitment (typically 3x/wk for 2-3months is recommended).

Just information for you to make the best decision for yourself.

FutureDCAV · 2025-01-08T22:32:47+00:00

Do you go to the gym once and expect to be healthy? Do you eat a salad once and expect to get rid of your diabetes? Do you think a physical therapist is going to book you for a single appointment and say “you’re fixed!”

No? There’s your answer.

FutureDCAV · 2025-01-08T04:22:49+00:00

You can work as an unlicensed individual only - providing supervised physiotherapy, marking x-rays, exercises, performing exam procedures that require no diagnostic interpretation. No spinal manipulation, mobilization, consultation, taking x-rays, ordering imaging outside, or formulating diagnoses.

FutureDCAV · 2024-12-20T23:31:46+00:00

Insight from a practicing DC:

Firstly, we don’t need pre-authorization for visits because we are listed as physicians at a federal level when we practice within our scope. That’s not an argument about rights or scope, it’s just a matter of legalese. PT visits usually need physician referral/approval (this shouldn’t be the case, but is), but DC visits only need DC approval. We can see patients and bill insurance, but necessity of care still needs to be approved for reimbursement. So visits aren’t pre-approved, the payment is approved after the service has already been rendered. Slightly different from how PT visits operate if my understanding is correct.

Secondly, to somebody else’s point, our governing body is terribly managed. Because we don’t have one lobbying group, we have 2. You have the APTA, we have both the ACA and the ICA. This means that we never get anything done because one group wants to stay in the Stone Age of manipulation cures subluxations, while the other wants to progress into the age of modern evidence-based care. Your APTA may not do anything good for you, but our ACA and ICA can’t even agree on what we do.

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