When Demand Exceeds Supply: Allocating Chiropractic Services at VA Medical Facilities

ABSTRACTObjectiveWith limited Veterans Affairs (VA) doctors of chiropractic (DCs) in geographically disparate VA medical facilities of varying capacities, the potential of demand for care exceeding supply can be realized. The purpose of this paper is two-fold. First the authors propose a model for VA chiropractic clinic operation to maximize appropriate access to care and utility of services provided. Second the authors suggest an ethical basis for making potentially difficult administrative decisions regarding the distribution of chiropractic services within VA medical facilities.DiscussionThe authors suggest practices to maximize clinic efficiency and effectiveness under conditions of demand for chiropractic services in excess of available supply. In terms of access, the service agreement and gatekeeper instructions for ordering a consultation should help shape demand and avoid inappropriate consultation requests. Consultation requests should also be screened by VA DCs. Scheduling should work to minimize no-shows through a patient reminder system. With regard to utilization, the delivery of chiropractic services should be made more efficient through the use of templates within the electronic medical record. Lastly, evidence-based outcome measures should be applied to objectify clinical progress and help to identify clinical end points in care. Utilitarian theory serves as a possible ethical framework to guide VA DCs in maximizing the benefits of chiropractic care for our veteran patient population as resources allow.ConclusionsVA doctors of chiropractic must balance the demand for patient care with the limited availability of resources. Suggested practices may enhance appropriate access to and efficient utilization of chiropractic care within the VHA.