 Exploring chiropractic episode 48, diversity in chiropractic with doctors Foshay and Warnakey. Welcome back to exploring chiropractic. I'm your host Dr. Nathan Cashin and in this episode I bring two guests who are members of the American Chiropractic Association's Commission on Diversity which was convened just about a year and a half ago to spread awareness and begin to make some changes within the profession with regards to diversity. We discuss what diversity is, all the different components and aspects of it, and how it will affect the profession and the individual chiropractor in the future. Dr. William Foshay is the chair of the Chiropractic Association's Commission on Diversity and he's a 2017 graduate of Northwestern Health Sciences University. He practices in Dallas, Texas and his goal is to positively impact culturally competent delivery of chiropractic care both locally and nationally. And my other guest Dr. Rebecca Warnakey is in her second year of practice just outside of Grand Rapids, Michigan. Prior to graduating from Palmer College Dr. Warnakey completed an eight month clerkship at the Martinsburg VA Medical Center in West Virginia where she provided chiropractic care to veterans working in an interdisciplinary environment alongside primary care physicians. She's an active member of both the American Chiropractic Association and the Michigan Association of Chiropractors and for the ECA she is a member of the Commission on Diversity and quality assurance and accountability. Hope you enjoy this interview with Dr. Foshay and Warnakey. So thank you guys for doing this. After seeing a couple posts and reading about it I was like huh this is actually pretty important and it's something I don't know enough about so part of the reason I'm doing this is so that I can learn more and understand better but also to get the word out and to clarify some myths and some misconceptions about it. So as I mentioned the notes I always like to get to know you guys a little bit better so Rebecca when you were a little kid what did you want to be when you grew up? Yeah so my background is a little bit unique. I'm definitely the stereotypical chiro kid. I was actually adjusted for the first time when I was five days old and I've been adjusted literally my entire life. There are almost nine chiropractors in my family now so growing up I think I just had a very different perspective than most. You know I thought everyone got adjusted all of the time. I didn't know any better and I think I was about six or seven when I told my father for the first time that I really wanted to be a chiropractor just like him. I grew up being in his clinic on weekends after school after seeing so many amazing things at a young age. I just knew very early on that it's what I wanted to do. Cool. Yeah that's that really isn't the normal path. There's a lot of people like that come from those big chiropractic families and sometimes they don't want to be a chiropractor. I find that interesting. Yeah I almost fell off from it in college actually. I think I was I think I was a sophomore in college at Iowa State when I first thought okay science is definitely my thing. Human anatomy and physiology is definitely my thing and then I started to kind of question what avenue of health care I wanted to take to make a long story short. My dad actually had a brain aneurysm so I've always been really fascinated with neurology in general so I thought you know maybe I want to be a neurosurgeon maybe I want to have some other type of avenue when it comes to health care and I kind of dabbled for about a year and a half but once I got to shadowing pretty much every provider you can think of it really just drew me right back to chiropractic which I think is important that I had both experiences it really taught me you know why am I doing this why am I choosing this profession is it for me is it for my future patients is it only because I come from a chiropractic family so I really got to learn to the core you know why I was going into the field that I was going in. Have you taken or do you have any interest in taking any of the neuro the neurology courses like from Carrick or functional neurology seminars? Yeah so I've definitely thought about it I think when you're fresh out of school you're kind of trying to decide which which one is going to be most beneficial to you in practice and I think currently where I am and where I'm working it doesn't make sense at this moment but that doesn't ever stop me from you know reading as much as I can online and you know studying up on articles and obviously we learn every single day but I think down the road I would love some extra education if I could be in school forever I would so down the road who knows but definitely some interest there. Yeah that's how I feel too so Dr. William Foshe when you were a little kid what did you want to be when you grew up? You know my mom was a nurse and so I I always felt like I wanted to be a doctor and you know I took the long route to become a chiropractor you know I was a an adult learner I took a gap between high school and college and whenever I decided to do something more significant you know I still wanted to be a doctor but the truth is the type of doctor that I wanted to be had really changed my life was you know I have one of those chiropractic conversion stories you know someone changed my life with a you know a couple of simple adjustments and you know eight years later there I am. Interesting so this is a second career for you. That's right. Do you want to share what you were doing before that? Of course you know I realized as soon as I said that's right that there was a follow-up you know that I could just kind of take a little more information so my first career was working in hospitality so my last couple of jobs were administrative management so my last position was a vice president of operations and field support and before that I was a operations manager and special projects managers and that those sorts of positions but it wasn't very fulfilling at all and you know I graduated a couple years ago and I'm starting a practice now and I'm really getting kind of excited about leveraging some of my other experiences you know to really have a fruitful and enjoyable career. Very cool, very cool. Well we're doing this interview because it came across my radar that the ACA has formed a new committee is a commission I think is the proper term on diversity and so this is a topic that's becoming I've kind of seen it bubble up a few times here and there in different places so diversity is becoming well it's always been but it's really coming to the forefront of important discussions to have and reach out to you so that we can discuss this so how did this come about and why is diversity so important in the chiropractic profession? So I'll jump in so you know I think that diversity is extraordinarily important for the chiropractic profession now because in the regular medical marketplace reimbursements are more accessible for consumers to see physiotherapists in place of chiropractors and in my connections with folks who have backgrounds in public health in the effort to increase our capacity to have access to NIH funding we have to be able to demonstrate a more robust aptitude for serving a broad a much broader swath of the American public which as you know is projected to become you know white Americans are projected to become a minority around 2050 and so you know if we don't get a grip on this now what happens is a diminishing white American public with a you know a diminishing chiropractic workforce you know will will essentially not necessarily serve a purpose if we don't really acclimate ourselves in diverse in diversity care and in initiatives that that really improve inclusion yeah go ahead I was gonna add to that you know I love the way this is already this conversation has already started because a lot of people have a misunderstanding as to what the purpose of this group is but Dr. Pochet hit it right on the head I mean this is to increase patient access to chiropractic care you know in the Palmer Gallup poll back in 2015 only about 14 percent of the US population is seeking chiropractic care annually there's a lot more people out there and the reality is not everyone is a Caucasian middle aged male you know we have Hispanic populations we have Asian populations we have obviously females and we have people of difference socioeconomic status and genders and sexuality and all of these people have healthcare needs right low back pain does not discriminate and if for some reason we have a barrier that is not allowing us to reach these people our professions really going to struggle so let's let's clarify exactly what diversity is because we've mentioned a few different aspects certainly there's there's a race we've talked about the the race ethnicity color of America's changing a lot of states are already nearing that Caucasians being a minority and you touched on some others so the LGBTQ community certainly women can be you know considered a minority in a lot of ways what other aspects of diversity should we keep in mind as we keep going through this conversation personally one of my favorites to talk about and to really try to understand is socioeconomic status it's one that really gets forgotten in the realm of diversity quite often but there are dramatic differences between those on the lower end of that scale versus the higher end in terms of their education in terms of their access to health care in terms of equality for a number of different things and there should really be no reason why someone who makes twenty five thousand dollars a year and has low back pain can't get the same kind of treatment as someone who makes two hundred thousand dollars a year and also has simple low back pain that a chiropractor could take very good care of so that for me is one that's very heavy on my heart because it it's it really is the forgotten the part of diversity in my opinion yeah I completely agree especially when we step outside of of the USA mentioned on the podcast I'm involved with world spine care and that's kind of the the key goal of that is to bring spine care to people in under-serviced areas Dr. Foshe any other things any aspects of diversity you'd like to add sure so you know they are the standard protected classes you know age you know sex but in the United States there aren't really no protections for sexual orientation or gender identity there's no sort of systematic protections and so oftentimes you know even in in medical environments and including chiropractic practices you know we don't have the best practices that inclusion now because I happen to you know be in the LGBT community it you know it rings true for me a little differently but there are some other things that are really really kind of affecting my perspective on diversity over the past year as I've done more work with the Diversity Commission one of those is how it is we you know advocate for and make ready our services to folks who have differing levels of ability and so I don't just mean like mobile disability I mean are we equipped to deal with patients who are are nonverbal or deaf and you know do we have linguistic competency and another big thing that's kind of kind of on my radar these days is you know there's the big push in the regular like non chiropractic diversity realm to talk about things like nutrition in terms of like food deserts and how it is that folks where they live might impact their capacity to be able to access services and fresh foods and I think the same thing that happens for chiropractic you know we're not putting our offices in a zip code where you know the majority of students are on free or reduced lunch and so those are a couple of things that have popped up on my radar with more significance over the past year I wanted to make sure I said something about them because there's such a big deal you know even those little minor things you know like like do we have one or two steps going up into our offices you know makes it sometimes not impossible for not just a person with mobility challenges but just a you know average run-of-the-mill person with low back pain you know it's tough for them to get in it does make it a challenge how do we as we talk about this and as I think of some other conversations I've listened to there seems to be the possibility and I think a lot of people have the concern that when we discuss diversity we can become so nuanced and start to pick out all these different subcultures and so I'll throw myself there because I was listening to the women chiropractors podcast and as they were talking about all these challenges that you know that a female chiropractor who's had some kids and is trying to get back into practice I realized it's not about just women I mean stay-at-home dads like myself right experience a lot of the same issues but I don't know that I want to throw stay-at-home dads out there as a minority population that's you know that's being oppressed in that type so I guess I'm just curious like can we get to minute on on these cultures and how do we maintain the big picture without diluting this idea of diversity I like to personally believe that one person's oppression or one person's minority group is not better nor worse no nor more important than another so to be honest as a stay-at-home dad you're gonna face some challenges right you're gonna face some awesome benefits to that too and the same thing can be said that you know for being a female you know as a female chiropractor have I gone through some really unfortunate situations because of my gender 100% have I also had some pretty great experiences because I'm a female absolutely you know any patient can choose to go to you because you're a man choose to go to you because you're a woman so I think what I always try to remind myself is you know everyone's going to face some kind of battle because we're all so unique and different and all of us are gonna face challenges too but the second that you know people's try to say oh what my situations were snow I'm my situations terrible I think that's when we lose an appropriate stance on what diversity really is and what our goal should be you know I I personally although I stand up for being a female in a male-dominated profession I recognize the fact that I can be excuse me if this is an appropriate but I can be just as good as any male chiropractor right I can do anything that a male chiropractor can do I can side posture a 447 pound man which I have done right it doesn't matter if I'm a female or you know five foot three and three quarters so these are things that I I just encourage people who are going through anything you know regarding diversity that's negatively affecting them I encourage them to embrace that and use it as a motivator you know the fact that I am a smaller female only encourage me to work harder and when I'm 50 years old am I still going to have you know some difficulty with being a female probably but I'm prepared for that because I kind of make sense absolutely and I certainly have heard many stories where those obstacles became the strengths you know I think of one of my professors for adjusting technique was probably taller than me and definitely bigger than me he used to brag about his gone stead pillow that he had developed from going to buffets all the time and so he had no trouble adjusting anyone but when you're in that situation oftentimes become complacent and so often times as you mentioned smaller women become the best adjusters because they have to become much more technically skilled right I've seen certainly at the MPI seminars that I took with I think it was Dr. Sarah Mackie who is a very petite woman but man can she deliver well and just to kind of throw a short story out there I as you already know I did work I did make an internship clerkship at the VA on the east coast and I had the amazing opportunity to work under Dr. Sean Meff who's currently the chiropractor at the Martinsburg VA in West Virginia and I will never forget my first week there you know he started asking me what kinds of techniques I use what things I feel comfortable with and as I watched him adjust patients throughout the day you know very you know aggressive manual gone stead type of type of approach diversified he literally told me that I will be adjusting exactly like him and I thought I laughed at him you know here I am a student and I laughed because I thought oh no no no no some of those things I just witnessed you do there's no way someone like me can do that and he told me to my face without a shadow of a doubt you will do this and it's because I had someone like that in my life tell me that but I think I was able to become that that's very cool so before we lose the question for a second I want to circle back around to what I think is a really profoundly important topic in terms of diversity and it was how do we you know assess and not become overly critical or burdened by the variances in diverse folks and ultimately the group of us who've been working on the ACA Diversity Commission have been really working on you know establishing some tools that chiropractors can utilize to improve cultural agility and that's a skill set that we're able to sort of apply to you know many types of individuals and so it doesn't mean that you have to have you know specialized training on East African patients and specialized training for Sub-Saharan patients as much as you know having an improved skill set that just makes us more you know more capable and and I just wanted to make sure that we didn't lose that because I do get that question fairly often you know how do I know I'm doing the wrong thing or the right thing or you know what happens if I get this wrong or or you know those sorts of things and they come up for us all the time and I believe that the majority of us really want to do the best thing for our patients and we just don't want to get it wrong in a way that harms them or or you know provides an additional barrier for them to access our care. So can you explain a little more what that cultural agility means I think I have an idea but I'd like to get some clarity on that. Sure so you know there are so many languages in the world right there's so many types of cultures that it's impossible for a chiropractor to or any person to have you know a skill set that is relatable to each of those individual groups. So ultimately you know having the capacity to you know serve folks where they are find out how to meet their needs not to put the burden of education on the patient. So if a patient comes in and they have a specific set of beliefs or if they have like one of my favorite examples is about intersectionality. So intersectionality is this idea that it's really a topic that's most related to feminism but it's this idea that that folks have multiple intersections of their identity. So for example you know I'm 42 and I'm a guy and I'm identified as queer and I'm a chiropractor and I'm all these things sort of all together. My favorite example of you know a marginalized person with a complex with a complex identity is this idea that you know say there's a woman who is a trans woman who has HIV and she's a sex worker and she goes to the doctor's office and she's treated poorly. So on the inside she treated poorly because she's a sex worker because she has HIV because she's transgender because she's African-American because she has housing and security. So those intersections of identity really are these these things that come that complicate our potential to be marginalized or or reduce our access to services. So cultural agility sorry so cultural agility is the capacity to sort of navigate in those things in a way that doesn't dehumanize the patient in particular and really you know at the end of the day none of us actually care how our folks live as long as you know they're getting better under our care and you know you know feeling safe in their lives. And so how do we as as practitioners develop that cultural agility is it continuing education on cultural competency is it going to a different country and working on a mission trip I mean what are the ways that we can develop that skill set which can be very difficult especially if we grow up in a you know a very niche community and aren't exposed. I personally think it's a combination of everything exposure and experiences are really really crucial to developing your clinical skills and your interpersonal skills. So obviously doing some kind of mission work is definitely going to give you those skills but you know it doesn't have to be just that right and what I love about what ACA is doing and about what this commission is doing is that our goal is to create some materials so that doctors of chiropractic will have them readily available so they won't have to search very far. For example if you know a patient walks through your office as a new patient and she's literally from a country you've never even heard of you can maybe guess it's in Africa and you can't just say can you please hang on a second I'm going to go to the computer and google everything I can in 35 seconds right there's that's not how we would naturally handle that situation so I think it's important to educate doctors of chiropractic especially on how we can get through that kind of situation without coming off as incompetent or afraid or worst-case scenario indifferent right because even even if where we're from isn't of isn't something we're desperately looking to learn more about we need to know how to best serve that patient and that's going to include meeting them where they are at. You know I speak several languages but very often I have patients that come in that do not speak one of the ones I know and I can't just pretend that I know that language I can't tell them how great it is that I know Spanish when they're Russian right so I have to I have to find a way to make them feel comfortable um if I do have a translator present I have to find a way to not appear again incompetent or worrisome um because they need to feel comfortable right if I if I appear like I'm uncomfortable in that situation how are they going to feel so I feel like young doctors especially or maybe doctors that have never been exposed don't really know how to handle those kinds of situations if they've never dealt with them so how great would it be to you know in a sense role play in school or maybe go outside of the box and treat a patient in your student clinic who's a Muslim or while you're in the student clinic ask your clinic supervisor if you can spend a day shadowing a doctor in an outreach clinic so you can learn more about how to work with spanish-speaking people or maybe those who are poverty-stricken so I think it's a lot of experience and exposure that that really needs to happen I think that's kind of a right on time sort of uh I love that you talked about you know the starting with the the ed you know with our education I think that that you know uh this is not the kind of thing like improving cultural competence for an entire profession which by the way is behind many professions but actually not behind many others you know um we did a fair amount of research to determine sort of where chiropractic lands in comparison to other healthcare provider types and there are some who knock it out of the park and there are some who just don't and we're kind of right in the middle and so we're really getting our feet wet and and getting our feet wet essentially what we're doing is you know we are affecting uh you know public information so public information as accessible through you know peer reviewed papers there's like in the next couple of years I know a fair number of folks who are working on papers for publication that are on broad topics of diversity the ACA just recently established a council on women's health and the most amazing thing about that was I had the benefit of being at a conference speaking with Dr. Petroko Napoli she's the council president and she um gave this reminder that women's health is not just pregnancy care and I thought oh yeah of course you know because that's that's the extent of you know where I recognized my contribution to women's health in a chiropractic clinic what a disservice and you know I serve more women than men and I was really delighted to you know to be able to hear her and I think that that you know those sorts of efforts you know part of it is public information part of it is going back to our schools and our associated service providers and saying things like hey your intake forms are not inclusive so you know meaningful use now says that you should ask about sexual orientation and gender identity I mean it's the law it's not my opinion it's what the government wants to know so you know the majority of even university clinics don't really offer that and the last thing I'm going to say is our team on the diversity commission just this year were assigned a two student liaisons for SACA so I think that's a really fantastic thing because those folks will go back and be able to directly affect the diversity conversation for a couple of thousand students a year and you know I think that you know having a platform like that is a really good start for shifting the the conversation on on diversity that's great so so can students get involved in this commission directly or is this a kind of a flow down process right now where the commission is going to be passing on information and resources to this to SACA so essentially the the two liaisons are creating their own student-led diversity initiatives they'll be in conjunction with our greater commission we have a couple we have both Dr. Warnke and Dr. Peggy Chen who is on our commission have expressed significant interest in working with the the students to be able to affect their deliverables in a way that that is useful to them and their colleagues at their chiropractic programs so you know I'm not sure what that will look like and we are only like 15 months into having a diversity commission even though it was in 2012 that there were a couple papers published that said hey you chiropractic profession need to do this thing and so here we are doing it you know several years later things do move a little bit slow so it's been 15 months what are the goals short-term and long-term for this commission on diversity let me let Dr. Warnke talk on that for a moment please sure so I think because this was such a new thing that's never been done before you know when you first start something especially something of this great importance we really had to start with the basics right we had to one establish the group we had to create ourselves within a large organization such as the ACA and then we had to really nail down what it was that we wanted to do so we started with the charter and then we started with the actual overall commission and setting our goals both short-term and long-term and then now that we've actually established ourselves you know we've done a Facebook live speaking to doctors of chiropractic we've set up and emails have gone out from ACA you know letting everyone know hey we exist which is great now that we've actually created a platform and a foundation now we're actually able to create some deliverables so some of the really big short-term goals that we have are to literally just produce content right again that's where exposure comes into the picture so creating things like blogs which Dr. Foshe has already gotten us started with creating blog posts just to spark interest and spark some ideas and concepts among the profession and also creating things like infographics explaining just what a tiny detail involving diversity what that tiny detail can do for your profession one of my favorite examples of that is that when a female over the age of roughly 45 to 50 comes into your office we need to be talking to her about bone density right we need to be talking to her about you know her exercise and is she only doing pool therapy and aquatic therapy and cardio or is she doing some kind of resistance training because guess what one of the top things medically medically wise among that population is osteoporosis right and that's not that's one of many medical conditions that has a diversity component to it right in the Jewish community there are diseases um taste acts disease that's more common among you know african-american males we have children obviously we have the elderly population we have the veteran population so i think it's really important to educate those who maybe don't want to dive into diversity as much as Dr. Foshe and I do but just to educate that one chiropractor can make a huge difference just by learning one little detail that we could potentially put out through this commission that one little detail could help hundreds if not thousands of people so you know one thing that i think is super cool is just before we were getting ready for this conversation i looked down at my phone and i had gotten an email from the aca and then as we were getting ready to to get this conversation kicked off you know we noted that we had received the link to a survey so the aca has randomized a few thousand aca members to take a a short survey and really the short survey is not about you know what do you think about this and and you know how are you that or any of those things it's how can we help you better meet the needs of your patients how are we able to better serve your practice and what types of topics are interesting to you and how should aca deliver them or do we even have a responsibility to deliver them and so you know it's a really fantastic survey and the survey ultimately will guide our our work for 2019 so all of us have been appointed through 2020 and so what we'll hope to do is is take that information our purpose is to inform the board of governors and the aca staff on topics related to diversity and so we know that the survey will help us do that with a greater you know a greater degree of of authority you know the last thing that we want to do is show up and offer you know a ton of information that's not actually helpful for you know chiropractic doctors to be able to you know improve outcomes with their patients the last thing i want to i want to kind of make sure that that we acknowledge about this is that aca is not the only chiropractic related organization that's doing good diversity work so as i understand it that currently the icpa is working on their own brand of of improved capacity for cultural competence among icpa docs and then you know just you know there's a big conference the wave that's held i guess at life west and just last year one of my favorite aca folks dr kita phantropole was there as a panelist i'm hosted by one of my favorite lgbt chiropractors dr angelo chorea and you know they have this great dialogue and so you know this is surfacing in places beyond the aca and you know i feel really privileged to be able to serve aca in this way because my personal values align in this way but i would be doing this work i think even if i were not associated with aca so dr foshe what are some examples of organizations that are bringing awareness to diversity so you know there are a couple of in the united states there are a couple of small organizations like there is a latino chiropractic association they're very much um vitalistic in nature there's a like an asian american chiropractic association and dr achoe ray has a small gathering of folks from lgbt chiropractic association my favorite most the most active the most active of them is the american black chiropractic association so the thing that i really love about the abca is that they really reach out to students they do a lot to support students not just to improve the student experience in chiropractic colleges but they actively serve the community from you know that surrounds them and and you know one of um whenever we first convened the diversity commission we had uh two uh four two folks who were in former leadership positions with the american black chiropractic association and um you know and and one of the things that that we found ultimately is that um abca members go out and do really really strong work in the community um and i don't you know it seems to um really be um you know inspiring in a way that we had hoped to emulate their drive and impact as a commission you know i find them personally to be extraordinarily admirable as an organization and their leaders are just folks that i look up to i'm going to try to find a link to that video of the of the diversity panel at the wave i came across that as i was researching this topic and i'm glad you mentioned uh dr angela chair rhea because he was actually my second interview on this podcast when he was still at life west and i've been following him since and and he's built his practice um around the lgbtq community i noticed he recently changed the name but it used to be called lg lgbt chiropractic and now it's called spectrum which i like as well um but but it's interesting that this creates a lot of opportunities for chiropractors and i was wondering if uh dr wernicke and dr forche if you can talk a little bit more about what are the benefits to chiropractors if they really embrace diversity and begin um developing their cultural agility and and competency what i personally love about it from a benefit standpoint is that it doesn't matter if you decide to dive into diversity one percent or a hundred percent it will automatically benefit others and it will automatically benefit you as the provider um one you're going to become a better provider because you're going to understand your patients better you're going to be able to provide more positive um environments and situations for your patients as well um and the medical community has done a ton of research on this looking at patient satisfaction rates and um general patient comfort levels um with their experiences with their medical providers and every single study shows that they are more comfortable when they feel that they can relate to their doctor they are more comfortable when they feel like their doctor understands and respects them and will listen to them right um so when it comes to diversity you know if someone wants to talk to me about their um religion for example and if it's something that i either know nothing about or perhaps it's different than my actual beliefs i'm going to listen to that patient right um that visit probably isn't going to turn into a visit about religion but it's it's my position as a healthcare provider to make that patient feel comfortable and if they want to say something that matters and mean something to them i'm going to let them say it and it's important that i continue to make that a comfortable experience for them so i think another way it also benefits providers is you're going to increase your population base right and that that's a pretty blunt way to put it but you're going to get more patients by being better more culturally competent by being more well versed in these kinds of things um i know for me the fact that i speak Spanish it really is a great avenue for me because those patients will feel more comfortable walking through my doors than someone else's even if i knew how to speak a couple sentences that would benefit me my fiance for example i'm always teaching him new sentences that he can use and his patients have been loving it they immediately change their outlook um he can tell them different ways to move during the adjustment he can ask them where pain is he can ask them where um what they feel and what it means to them and that's something that has really changed his relationships with patients imagine what that can do for thousands of doctors of care practice so i think that alone is the biggest benefit that this can bring to doctors it certainly brings humor into the conversation when you try to use a new language yes because i've been uh Haiti and trying to speak Haitian Creole um and yeah it it certainly breaks the ice definitely um dr foshe you mentioned a couple papers which i'll link to down below um but i thought we just mentioned some of the some of the key ideas um we touched on this at the very beginning of this conversation that uh that the nation is becoming diverse um that over the past looks like about 10 years um the the racial diversity has gone from uh let's see if i can find the numbers here because it's on a different page but the number of caucasians is really going down and as you said in 2050 will be below is projected to be below 50 percent um and i don't know that we highlighted this but the idea that minorities use chiropractic less than whites and not just because they're minorities the the percentage that they use chiropractic is much lower um and so how how would this benefit the profession as a whole by embracing diversity what are your thoughts dr foshe so you know there are i guess we didn't we didn't really cover this the three of us together before this but there are some there are some papers out there about minority group utilization of chiropractic using medicare and uh medicaid i think that primarily those studies have been uh limited to african-american individuals and hispanic individuals um which are the two largest minority groups in the united states so that would of course would make good sense um and i think that that when we when we're looking at um you know how it is that that we're able to to serve these folks you know it really comes back to um utilization um it really is about um you know getting folks in the door the thing that we have to offer is i'm pretty fantastic and some people don't like what we do and that's not it you know that we won't change right um i did my i did my internship training at a federally qualified health center in many i did and did two federally qualified health centers in uh minneapolis st poll when i was in chiropractic college so one of them was almost exclusively spanish speaking and um my spanish is rough and i always make these jokes and i say you know i apologize now i know like 150 words in spanish i don't know 150 words i know many more but you know like like we laugh about it and i'm going to tell you that what happened is um consistently i would have someone come in and say oh my sister came here and saw you so as a student i learned that um you know being able to serve minority folks um would have built my practice for me which is exactly you know um what i'm hoping for you know in my my new ventures in in dallas texas where i'll be able to treat patients in spanish i had this um at one of the federally qualified health centers where i trained um there were uh some a fair number of liberian refugees in in that area and um you know there was a woman who came in and i knew just a little bit about liberia and we had a you know like you know how this goes like you know i'm a student so i had a whole hour with her for the intake so we spent like three minutes catching up on what i know and i asked like two questions and we laughed and then the next week her daughter came and then the next week the son-in-law came and like over and over i've seen that happen that when we um really kind of reach out and uh make ourselves relatable especially to to folks who might feel marginalized or or are actually underserved or under under represented that you know it's it's a total practice it's a total practice builder so utilization rates go up and you know and we're not having to do things like like go out and you know knock on doors and do mall screenings or whatever you know it's like like folks folks reach out to the people that they know so i belong to a number of lgbt um social media groups you know close groups secret groups the whole deal right and people say things like hey does anyone know a trans inclusive provider in blank right um so like in vermont um there's a lgbt resource or a resource for lgbt competent um providers and so you get yourself listed on there it's no charge and a trans person wants to know hey who's the best chiropractor to take care of me and they look on there you know it's it's me and my colleague right because uh you know that's what we did and and i think that that you know this is a really long answer but uh you know ultimately it comes down to you know as we do good work that um really embraces folks as they are you know it really does impact not just like a person's individualized health or their family's health but in in my case it has been like the health of their social network and social community and i think that's the whole point right absolutely that's great well i'd like to wrap it up uh and just mentioning again one of the papers that you sent me and i really like this quote that i pulled from it which for me summarizes this quite well um to be contributors to to society is not necessarily enough to acknowledge that we each have a different way of interacting in the world to be truly effective we must understand and grow from the richness that others offer to the social fabric um i've definitely experienced that as i've traveled the world with world spine care and and personally and with family living in brazil being in india being in Haiti there's a lot that we can learn from others that can enrich our lives and i i guess in my mind that's the greatest benefit that we can get from learning more about other cultures other genders races uh and all you know differences that we all share um i'd like to have each of you share where students can learn more both about the aca commission on diversity but also you if you'd like them to follow you uh directly and share any final thoughts dr warneke sure so um as a final thought i just would like everyone to know whether you're a student or a doctor of care practice or um a professor or even a patient um what i want everyone to really understand is that you do not have to be a minority to want to get involved with this um you do not have to be a minority to want to serve patients who are minorities um i get questions all the time you know i'm a caucasian 23 year old male what why does this matter to me um you know if i don't want to get involved with the commission you know should i still learn these things for my future practice someday and the answer is always yes um you know on our commission currently we have people that come from all different kinds of backgrounds if someone really wants to get involved you can be anything you are and you can get involved so that's that's the biggest thing i really want to stress um and then when it comes to getting in contact with us dr foshe and i are extremely reachable my email address my personal is actually r followed by my last name w a r n e c k e seven at gmail.com i'm completely open to anyone contacting me on my personal email i'm very easy to find online as well um rebecca warneke and then um as for the commission itself if you're a student i definitely recommend going through those amazing two student liaisons and we can send you that information to post in your show notes as well for students who are interested in that and talk to your colleges talk to your universities if you are interested in anything regarding these things talk to someone in the clinic about how you can serve patients that are of minorities um talk to your professors about when you're in clinic about how a side posture adjustment might change for someone of a different gender race um religious status you know ask questions that is what's going to get us further um with this profession is asking questions and being willing to learn i love that thank you dr for she last thoughts so you know there are some um existing organizations i'm glad that you talked um briefly about uh you know what diversity looks like on a global scale and so really what we've done is highlight what it is we you know we are kind of focusing on the united states but i think it's really important to acknowledge the the strong work that um the world federation of chiropractic and that um world spine and karen and the um what is it the world congress of chiropractic students those groups really reach you know um folks who you know otherwise would not really you know get our care and so i think that you know acknowledging them is super important i think that not all students or not all folks who listen to this will you know necessarily be interested in you know aca initiatives and and you know like i totally embrace that and dr warnecke um i think that that she would feel the same way this is like we embrace that our work um at aca is you know to support aca members right um in general however uh ultimate priority is to improve public health our ultimate goal is to um perhaps make a contribution to improving access for chiropractic patients to chiropractic doctors and so i'm really glad that you asked the question about how could we direct students to sort of plug in because you know aca may not be your brand and if your brand doesn't have a diversity plan i think it's brilliant to ask about it i think it's perfectly acceptable to um make waves in your universities and in your programs about you know measures of inclusion and diversity um and i think that um that ultimately um student you know the the student perspective um it could perhaps be more important even than you know docs you've been practicing for some time because you know those folks who are in school now will you know be practicing for another 30 years when that happens that shift in in you know the american population and so i'm glad you asked about it um i would i do want to plug myself for a second so i can be found easily with handles at a mindful chiro because i'm a little bit of a meditator it's a thing that has really shaped and shifted my life and so it's a part of my identity and that intersectionality that we talked about that i'm kind of most delighted by so anyway i think that's all i have i'm really glad that you invited us to come on and and talk with you about what we're doing and what's what we think is important about this well thank you both so much it's thank you been educational for me kind of stretched my knowledge and understanding and so i really hope that the listeners have learned something from this and are encouraged to get involved and just to become aware of the diversity around them and links to a lot of the things that we discussed will be in the show notes so if you're listening on your mobile phone just check the description of the podcast episode um and you can always go to exploringchiropractic.com to find all the notes and links back to uh dr rebecca warneke and dr william foshe thanks again for being on the show thank you so much thank you thank you once again for joining me on my exploring chiropractic podcast i hope you enjoyed this discussion on diversity with dr's foshe and warneke as always i would greatly appreciate a review on apple podcasts or stitcher just head to your podcast app and leave a review and four or five stars you can follow me on social media by using the handle at exploring chiro on facebook instagram twitter and i think even tiktok and one more thing if you wouldn't mind receiving a very occasional email from me i would appreciate if you sign up for my email newsletter uh just head on over to exploring chiropractic.com slash email or follow the link in the show notes thanks again and i'll see you in the next episode