The John A. Sweaney Lecture: Athens, Greece, May 2015, Given by Dr Vivian H.E. Kil. To Inspire the Chiropractic Profession to Dream More, Learn More, Do More, and Become More.

The following is The John A. Sweaney Lecture delivered by Dr Vivian H.E. Kil at the Biannual Meeting of the World Federation of Chiropractic in Athens, Greece, on May 12, 2015.

When I received the invitation to deliver this lecture, I was very surprised. And, I suspect, many of you were surprised to find my name associated with The John Sweaney Lecture this year. With previous lectures being delivered by great names like Drs John Sweaney, Ingar Villadsen, Scott Haldeman, and Louis Sportelli, I felt like an odd person out in this honorable list.

Before accepting the invitation, I asked myself: why would the World Federation of Chiropractic (WFC) Council ask me? So to find out, I looked up the policy document for The John Sweaney Lecture, which says:

“At its June 2006 meeting in Johannesburg the WFC Council decided to honour WFC Past-President Dr John Sweaney of Australia by having a keynote address at all future biennial Assemblies of Members titled The John A. Sweaney Lecture. This was in recognition of his outstanding services to the profession and the World Federation of Chiropractic, recently including his services as WHO’s consultant for the WHO Guidelines on Basic Training and Safety in Chiropractic (2005), and his inspiring bravery in confronting ill health.”

“The theme and subject matter of each lecture shall be chosen by the speaker. The lecture shall address an issue or issues of significance to the profession throughout the world, and the speaker is encouraged to give a lecture with a challenging and/or inspiring message.”

Why would the WFC Council think that I have a challenging or inspiring message to bring to the audience? What would this message be? After all, I do not have many years of experience or the fun anecdotes from years of work for the profession like my predecessors have. So what is it that I can bring to this lecture?

I had another look at the invitation for this lecture, which said the following:

“As you will know, this is the keynote address at the Assembly. For background and subject matter see the attached memorandum. Your invitation comes after a unanimous decision of the Executive, and following input from the full Council. It is a reflection of the respect in which you are held, and the desire to have the views of a younger leader in the profession.”

This helped me to understand better; so it is about youth, enthusiasm, and energy. It is about inspiring all generations of chiropractors. This is something that I understand. However, this is also quite a big challenge.

After I accepted this challenge, I received a message from Dr John Sweaney (Fig 1). I had to smile when I read his note:

Fig 1

Dr Vivian H.E. Kil (left) with Dr John A. Sweaney (right) at the biannual meeting of the WFC in Athens, Greece, on May 12, 2015. (Color version of figure appears in the online version.)

“We of the aging generation need to be re-energized and inspired by the significant talent and outstandingly sharp minds of the current professional leadership.”

These are the reasons why I am standing here before you today: as a young leader in our profession. I have been asked to reenergize and inspire you and to bring a challenging and inspiring message to this assembly. At least, my assignment is clear. In addition, I think that I may have figured out why the assignment has been given to me. I wrote an article for the European Chiropractors’ Union (ECU) titled “On a quest to inspire….” Thus, I have myself to blame that I am standing here to fulfill this assignment today.

My Dream

“If your actions create a legacy that inspires others to dream more, learn more, do more and become more, then you are an excellent leader.”

For the next 20 minutes, I will try to inspire you to dream more, learn more, do more, and become more. And, I would like to start by telling you about my dream for chiropractic.

Inspire to Dream More

Any leader needs to have a clear vision for the future. In my opinion, any profession needs to have a clear vision for the future. I have a dream for our profession, and in sharing this dream with all of you today, I am hoping to inspire you to dream more and to dream big.

The chiropractic profession has an interesting past, and our past has brought our profession to where we are now. Often, at meetings like this, we look at the past, reflect on the past, and talk about the past. Two years ago in Durban, South Africa, Dr Louis Sportelli presented The John A. Sweaney Lecture, and he gave us a brilliant review of the history of our profession.

Our history is of key importance to us and not to be forgotten, as there are many things we have learned through this history. However, I think that if the lecture I have been asked to present today was supposed to be about the past, the WFC Council would have found someone much more qualified than me to talk about the past of our profession. So for today, I am simply going to focus on our future. I would like to share with you my dream for the future of chiropractic.

Some of you may have listened to the inaugural McAndrews Leadership Lecture presented by Dr Scott Haldeman at the 2015 American Chiropractic Association’s National Chiropractic Leadership Conference a couple of months ago. During his presentation, Dr Haldeman reviewed the growing maturity of the profession over the past 5 decades. He spoke about the history of chiropractic in a way in which only someone who has been there during these important events can do so. He concluded his lecture with a challenge to all of us, which went something like this: The health care world now needs, and is ready to accept, the chiropractic profession as the source of nonsurgical, nonpharmacological, primary spine care expertise and management—but is the profession prepared to do the necessary work to fulfill that role?

My dream for the chiropractic profession nicely fits with this challenge as set by Dr Haldeman. However, my dream is 3-fold (because I am planning to be around for a long time, I think that I am allowed to have a 3-stage dream). My dream is:

That we will (the chiropractic profession) set aside our differences within the profession, unite as a profession, and agree that becoming the source of nonsurgical, nonpharmacological, primary, spine care expertise and management should be a primary common goal.

That for us to do the necessary work to fulfill this role and do it with the entire profession, every chiropractor will be involved and not just a small active group of leaders.

And finally, that we will become the source of nonsurgical, nonpharmacological, primary, spine care expertise and management worldwide.

There is huge potential for our profession. In 2010, the Global Burden of Disease study identified low back pain as the leading cause of disability worldwide and neck pain is the fourth leading cause of disability worldwide. Combined, back pain and neck pain are second only to ischemic heart disease in their impact on the global burden of disease. This means that back pain and neck pain have a greater impact on global burden of disease than breast and lung cancer combined, stroke, Alzheimer disease, depression, HIV/AIDS, and traffic injuries.

In 2011, the WHO and the World Bank presented the World Report on Disability. This pivotal document was presented as a standard for evidence-informed health care policy for the years to come. In the chapter on noncommunicable chronic diseases, back pain, arthritis, and rheumatism are among the common health conditions related to disability. The preface of this report states that “people with disabilities have poorer health outcomes, lower education achievements, less economic participation and higher rates of poverty than people without disabilities.”

Thus, the treatment and prevention of back pain are not only essential to individuals but, looking at it in a broader sense, have great impact on the world. This leads us to the following question: Who would be the best providers of primary spine care to the world?

The WFC defines chiropractic as:

“A health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation.”

This places the chiropractic profession in the position of great potential. Therefore, in my view, our profession has a vital role and moral obligation to fill not only for its patients but for communities and for society. The chiropractic profession has a duty to the world. In my dream, we will accomplish this duty and serve the world with our services. Thereby, we will fulfill our responsibility by decreasing the global burden of disease.

However, this dream could also turn into a nightmare. I fear that it is also a necessary reality that if we do not grasp the opportunities that are before us, others will instead of us. Osteopaths, physiotherapists, kinesiologists, medical doctors trained in manual therapy, and others will recognize the opportunity that lies ahead. Dr Haldeman predicted that our profession only has 5 years to assume this role or lose this opportunity. I hope that we have a little more time. However, the decade to come, 2015-2025, will be a pivotal one in our history. We need to step up to the challenge and work toward achieving our position as primary spine care specialist right now, or we will miss the boat. If we miss the boat, the nightmare has set in, and our profession may no longer have a reason to exist.

To live up to this dream, there are a few steps we need to take. Dr Haldeman identified several steps that were essential elements to ensure the future. The most important of these elements is our ability, but also our willingness, to learn.

Inspire to Learn More

We need to learn more. Looking back at my dream, there are a couple of things our profession needs to learn to take up our roles in primary spine care. For years, leaders in the field of chiropractic politics have identified 4 basic pillars for our profession. These pillars could be described as essential elements for the future: clinical excellence, education, research, and politics.

The profession has agreed over the past few decades that we need great clinicians, as this is what our profession is all about. We need to train clinicians to provide the highest possible quality of care. But we also need researchers who will provide the best evidence for evidence-informed practice. We need qualified educators to educate our clinicians. We need good politicians to represent our profession at national and international levels. And we need qualified people to represent our profession at health policy meetings.

We need people to excel in all of these categories, and we need to promote career options in all categories. Historically, chiropractors are educated to become clinicians. But there is a serious need to educate educators, researchers, and politicians if we want to professionalize chiropractic to develop into a mature and respected entity worldwide. Therefore, we need to learn more and our colleagues need to be inspired to learn more. Those with talents in any of these categories need to be supported by the profession and motivated to choose a career path other than or in addition to the clinical path.

Inspire to Do More

Much has been said about the need to learn. The next thing is that we also need to be inspired to do more. I shared with you my dream for the profession and a vision on how our profession could reach its full potential. However, this is not going to happen if we sit still. All of us need to do more and be action oriented. I made it my personal quest to inspire the people around me to do more, to be involved, and to take responsibility for the future of our profession.

I wrote an article titled “On a Quest to Inspire.” In this article, I shared how the younger generation needs to stand up, to take responsibility for the profession, and to become involved. Locally, nationally, internationally, and globally, we need more people. We need more people sharing the workload because inevitably the workload will grow if we are to realize our potential. Chiropractors need to be represented and will be asked to be represented in many more committees, workforces, and think tanks both locally and globally. It will no longer be enough to have the same small group of chiropractic trailblazers doing all the work because these few people cannot be in 25 different places at the same time. Therefore, we all need to do a little more work, but we also need to inspire our colleagues and coworkers to get involved.

I hear from colleagues who are my age. They say that they feel that they are too young and too inexperienced to perform tasks for the profession outside their clinical jobs. Now I think that is a ridiculous argument not to get involved. I always use myself as an example to show that there really is no such thing as being too young to get involved and that there is nothing to be scared of.

I will share with you a personal story. I graduated from Anglo-European College of Chiropractic in 2007. I moved back to the Netherlands and started working as a chiropractor in a large clinic. I was doing my job, treating patients every day, and enjoyed it very much. Then one day, one of my colleagues asked me whether I would do some work for the Netherlands Chiropractors’ Association (NCA). In my enthusiasm, and perhaps naivete, I said yes. It was at that time when it all started for me.

In the years that followed, my eyes were opened to all the work that needs to be done outside the office to secure a bright future for our profession. I started my work heading the committee of Public Relations and soon realized how our profession needs to work on public awareness. After a couple of years on the board of the NCA, I was 27 years old at the time, I became the youngest ever and the first female president of the NCA. That was in 2012, and recently I finished my first term (3 years in the Netherlands) of presidency. When I became president of the NCA, I also became General Board member of the ECU and, recently, after 3 years on the general board, I have been nominated to become the Vice President of the ECU, elections for which will be held this Wednesday (May 13, 2015).

Over the years, I have been present at many meetings national and international, and often I was the youngest person in the room. I have never considered this a disadvantage. In fact, I have had the pleasure of working with and learning from many very experienced colleagues. Every one of them has been ready to support me whenever I needed advice, and they have allowed me to learn from their experiences. So to all the young professionals out there, to my generation, I say to you that there is no such thing as being too young to get involved, just as there is no such thing as being too old to learn. Please take up your responsibility and help me and others to take on the challenge which Dr Haldeman has so eloquently set for us.

Inspire to Become More

Inspire to become more. If we take this literally, you could say that we need to become bigger as a profession; therefore, we need to look at numbers. Historically, the chiropractic profession has been a small profession in health care, often overshadowed by the bigger and more established professions, mainly the medical and pharmaceutical world.9, 10, 11 This may look like a holiday photo with 2 very tall brothers on either side of their short little sister, with the tall brother on the right representing the medical world, and the one on the left representing the pharmaceutical world, both looking down on the small chiropractic profession in the middle represented by the little sister. I think that the chiropractic profession suffers something called the Calimero effect. I do not know whether many of you recall Calimero. He is a Japanese/Italian cartoon character developed in the 1970s. Calimero is a small chicken with an eggshell on top of his head. He plays with his much taller friends, but whenever something happens that he thinks is unfair, he will stamp his little feet and yell out: “they are big and I is small … that is not fair!”

What I see is that the chiropractic profession does the same thing. Often, we do not engage in communication with the medical world or even pharmaceutics. We give the reason that they are big and that they will not listen to us because we are small. I say that this is nonsense. We need to be proud of our profession and proud of our education. We need to stand up for what we do and what we have to bring to this world and act like it. When I say “act like it,” I mean not acting like little Calimero stamping his feet saying that it is not fair but instead acting like the educated professionals that we are. In my view, there is no need to be afraid of other professions even if we are the smaller profession. Instead, there is a need to collaborate with other professions and act as partners in addressing the challenges that health care will face in the near future. Once again, we need to step up and take responsibility.

In global terms, the profession remains relatively small and vulnerable in a world of rapidly changing health care systems and growing competition for resources and access to patients. In preparing this lecture for you today, I looked at some numbers to calculate how small (or how big) our profession really is. The best global estimate I could find regarding the number of chiropractors comes from The Global Advance of Chiropractic written by Dr Reed Phillips in celebration of the 25th anniversary of WFC in 2013. The estimated number of duly qualified chiropractors worldwide is 100,000. It is estimated that there are about 75,000 in the United States, 8500 in Canada, 6000 in Europe, and 4500 in Australia.

Let us look closer at estimates and averages. Let us say that the average chiropractor sees 5 new patients every week. That gives us half a million new patient visits every week. Five hundred thousand patients learning about chiropractic care every week. If we do this approximately 50 weeks per year, this gives us 25 million new patient visits per year. Thinking about treatment visits, let us say that, on average, every chiropractor provides 50 treatment visits each week. That amounts to 5 million treatments per week and 250 million treatments per year. Globally, our profession handles about 250 million treatments per year. Now who would still argue that our profession is too small to make an impact?

When we speak about “becoming more,” to me “to become more” sounds like “to become a recognized profession.” Ando become more like a profession, I think organization is key. We have a collective responsibility to support our local organizations, the national associations, the ECU or other national/regional associations, and the WFC. The better organized a profession is, and the more it commits itself to being professional, the more it will be respected within the community, and the better it will grow toward reaching its own potential.

While we are supporting our organizations, we need to work toward achieving unity. We need to become a well-organized and united profession. We need to do this all together, every single one of us involved in the process. We still have to learn a thing or two on the way, but by being prepared to put in the necessary work, I believe that we will be able to rise to the challenge.

Over its entire history, our profession has had to learn to deal with internal differences. I think we will always have our differences and we will never get all chiropractors in the world to agree on every single detail. But why fight over the details if we can agree on a common ground? I think that if we remove the extremes, 95% of our profession will be able to agree on a common ground. There will always be extremists at either end of our profession, but generally, I believe that we should be able to form a united profession. If we are to rise to the occasion and fulfill the true potential of our profession, we will need to unite as a profession. We need, at least to the outside, to act as one profession, to speak the same language, and to provide the same message throughout the entire world. It has been said by others before, but because we are in Greece and this is where the ancient Greek storyteller Aesop shared his wisdom, I will say it again: “United we stand, divided we fall.”

My motivation to do as I do, to stand here today, and to spend this work and effort on moving our profession forward lies within the potential to realize my dream for chiropractic. I hope that in sharing my views with you today, I have inspired all of you to join me in dreaming more, learning more, doing more, and becoming more. I wish all of you a very inspiring week, and I hope to see many of you around in the future representing our profession and doing the necessary work to ensure a bright future for our wonderful profession (Fig 2).

Fig 2

Dr Vivian H.E. Kil (1984) was born and raised in the Netherlands and graduated as a chiropractor from the Anglo-European College of Chiropractic in 2007. She was president of the NCA from 2012 to 2015, where she continues on the executive board as Immediate Past-President. In May 2015, she was elected Vice President of the ECU. Vivian lives and works in private practice in the Netherlands. (Color version of figure appears in the online version.)