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When the pain is the practitioner

Photo: Many Australians turn to their local chiropractor to deal with acute and chronic....
A new study shows a small element of the chiropractic profession accounts for a worryingly high number of complaints, making it more complained about than either osteopathy or physiotherapy

By Cheryl Critchley, University of Melbourne

Many Australians turn to their local chiropractor to deal with acute and chronic back pain.

A good chiropractor can help ease back pain and other musculoskeletal complaints. But a small element of the profession is attracting a worrying number of complaints.

A University of Melbourne study of chiropractors, osteopaths and physiotherapists across Australia found that chiropractors attracted many more performance and conduct complaints.

The overall complaint rate for the three professions was eight complaints for every 1000 practitioners per year. The chiropractors’ rate (29 for every 1000 per year) was three times higher than osteopaths (10 for every 1000 per year) and six times higher than physiotherapists (five for every 1000 per year).
While the vast majority of chiropractors (92 per cent) were not subject to any complaints during the study period, a small number were named in multiple complaints. Just 1.3 percent of chiropractors accounted for more than a third (36 per cent) of all complaints within their profession.

Complaints focus regulatory risk 

Published in Chiropractic & Manual Therapies, the retrospective cohort study analysed all formal complaints about all registered chiropractors, osteopaths and physiotherapists in Australia lodged with health regulators from 2011 to 2016 as part of a broader research partnership with the Australian Health Practitioner Regulation Agency (AHPRA). Internationally, it is believed to be the first nationwide study comparing complaints data from these three professions, and was undertaken to explore areas of regulatory risk.

Overall, nearly half of the complaints about chiropractors, osteopaths and physiotherapists (48 per cent) involved chiropractors, even though they made up less than one-sixth (14 per cent) of the workforce across the three professions.

Melbourne Medical School senior lecturer Dr Anna Ryan worked with Melbourne School of Population and Global Health research fellow Dr Lay San Too and Associate Professor Marie Bismark.

Dr Ryan says it is too early to explain the chiropractors’ results, as more detailed analysis is needed.

Older practitioners have more complaints

“Clearly the small group of practitioners who are the subject of more than one complaint (70 out of 5450) are having a significant impact on the complaints rate for chiropractors,” she says.

“Understanding more about this group so that they can be helped to meet their regulatory obligations appears to be a key first step in responding to these data.”

During the study period there were 5450 chiropractors, 2241 osteopaths, and 31534 physiotherapists registered to practice in Australia. In total, 1139 complaints were lodged across the professions.

Across all three professions, practitioners aged 66 or older had higher rates of complaint compared to those aged 35 years and younger.

“These findings raise an interesting question about whether chiropractors, physiotherapists and osteopaths should follow the Medical Board’s lead in considering fitness to practice checks for older practitioners,” Associate Professor Bismark says.

Male practitioners received more than twice as many complaints as female practitioners, even after adjusting for their age and the number of hours worked. This finding is consistent with previous research with doctors, which has found that male doctors are also at higher risk for complaints and malpractice claims compared with their female peers.

“Within the osteopathy profession, more than one quarter of complaints related to interpersonal boundaries or behaviour, such as rudeness or disrespect,” the researchers say in the paper.

“While absolute numbers are low, measures to monitor and address these areas are likely to be of importance to the osteopathic profession.”

Is private setting a factor? 

Dr Ryan says more research is needed to understand the reasons for differences in complaints rates between these professions and important areas to explore include profession-specific therapeutic techniques, patient volume, group practice, interdisciplinary integration and evidence based care.

On a more positive note, she says we should also investigate why physiotherapy attracts relatively few complaints.

“It could be that there are models of care in place in physio care settings which are somehow protective against complaints,” she says.

“For example, when patients are treated by teams of professionals in a public health setting, rather than an individual in a private practice, does that improve the quality of care and make concerns less likely to arise?

“And if so, are there elements of that model which can be adapted in some way for private practice to achieve the same benefits for patients?”

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