Chiropractic for Veteran’s

 Dr. Stephanie Halloran is a chiropractic resident at the Connecticut VA healthcare system in West Haven Connecticut and she was also the student American Chiropractic Association membership committee chair and was a chiropractic intern at the Richard L Roodeboks VA in Indianapolis Indiana. How did you land your residency position at the VA?

Dr. Halloran: I was first exposed to the opportunity to do the residency in 2014. I was in Roanoke Virginia at the Foot Levelers facility attending the Student American Chiropractic Association Leadership Conference. It was the first one I had attended and on the docket of speakers that year were all the directors of the residency program. 2015 was the first year that they had the residency program. It was in its first year of the pilot and they spoke of this amazing opportunity to basically do what medical professionals do and go into your training after you become a physician and learn under your attendings and rotate through all these other departments and basically become the best clinician you can.
 
I spent the next two and a half years finding out as much information as I could about the residency and preceptorship opportunities within the VA that were affiliated with Western States Chiropractic College, which is where I went to school and immersed myself in what it would take to become a chiropractic resident.

Noah: What preparation do you think was vital for your selection and then for the work that you’re doing now?

Dr. Halloran: There wasn’t a lot of information available at that time so a lot of the preparation that I did was getting information about the residency program that wasn’t available. For example the information about the different sites.
What they look for in a candidate?
What the timing was for the residency program?
Now that information is more available. I’ve worked with Dr. Steven Huybrecht, who’s at the St. Louis facility, and Dr. Rachel Mooers-Clark. We’ve worked together with the ACA to do a blog series to get more information out.

In regards to actually preparing to be in a residency really focusing on proper diagnosis of spinal conditions, knowing how to differentially diagnose, know how to do a proper neuro exam and being at aware of other professionals within the medical realm are important. Know your pain medicine doctors and neurologists and how they may contribute to your management of the patient. Be aware of the other options a patient has.

My rotation within the VA in Indianapolis was where I did my last three months of school. This gave me a taste for what the patient population is and what a typical day would be like. Take advantage of that VA preceptorship because even if you decide not to do the residency, it’s a great opportunity to learn in about a complicated population and how to handle those situations. I’ve had multiple patients who have had cancer, I’ve seen people with degenerative neurological conditions, I’ve seen people with triple A’s, I’ve seen people who have hemiparesis because of stroke. These scary things become less scary when you see them on a much more frequent basis.

Noah: What does a typical day looks like for you with a focus on the collaborative care aspect of things and really how you interface with other medical professionals?

Dr. Halloran: The general layout or the framework that we follow is this. I have my own patient grid on Mondays. I see consults in the morning and follow-ups in the afternoon. Wednesday and Friday mornings I see follow-ups and then Tuesdays I’m up in the Newington clinic because I work primarily out of the West Haven clinic. On every other Tuesday I’m on rotation in other departments and then the other time is spent either on rotation or doing administrative work or within one of my attending clinics.
For example I worked with Dr. Lisi and the acupuncture clinic or with Dr. Coulis and the chiropractic clinic. I primarily work with departments we would receive referrals from or send referrals to so that would be physiotherapist, a pain medicine specialist, anesthesiologist, neurologist or physiatrist. They’re the ones who do all your interventional procedures like medial branch blocks, RFA’s, SI joint injections and that kind of thing. I work with the health psychologists who do a lot of the cognitive behavioral therapy. It’s very diverse in a lot of ways but it all is applicable to what we’re doing as providers as a whole.

I’ve spent some time with neurology and neurosurgery. I just started a rotation with Rheumatology and  Primary Care. In each department what I do is a little bit different. In neurosurgery they had me taking consults and sitting down and discussing with the neuro surgeon based on what we observed in the consult and with the MRI tech on whether they are a surgical candidate or not.

I learned more in 30 minutes then I learned through my all my chiropractic or schooling. A  lot of times, they’ll have you either do consults or you’ll just observe and then you’ll do something at the end you’ll have a case conference discussion.

On my rotations I’ve been able to spend time with fellows from the University of Connecticut. I’ve been able to spend time in medical residents from West Haven and Yale. I’m working right alongside them talking about cases and if they have someone coming with musculoskeletal pain they’ll go through what they need and have me examine the neck and let them know what I think. It’s a very unique and very rewarding experience to be able to not only work with the clinicians that I work with, because they’re phenomenal human beings and phenomenal physicians in general, but to be able to then work with people who are training at Yale to become medical doctors and they’re letting you participate and they value your opinion, it’s really an outstanding experience.
 
Noah: How do chiropractors and students get involved in this program?

Dr. Halloran: Start with the preceptorships if you see yourself in a hospital setting because it’s a great way to understand how the hospital system. It’s a fairly well established program now and it’s accredited so, I don’t know if there’s anything an outside doctor can do to support the program except to promote it and encourage students to take advantage of those opportunities.

Within the educational setting its important to promote some kind of Hospital rotation for your students. Because the reality is there are five residency locations with only one position at each location. You have 36 valedictorians per year on average. Even, if every valedictorian applied you are still 31 who are not going to get residencies. It’s a very difficult position to get and it’s unfortunate that more people won’t have that experience but what could happen is if you have some kind of rotation through a hospital where you can engage with other practitioners and learn more about an integrative setting that would be very beneficial. So, if any practitioners have access to that or have some kind of connection to get that implemented I would encourage them to do that to help enhance student’s education.
 
Noah: What’s the percentage of job placement for somebody like you after you’ve completed this program is it you know relatively easy for you to then get a job in a hospital with this experience?
 
Dr. Halloran: I believe out of the fifteen residents previously fourteen have been placed in either a private hospital a VA or some kind of academic settings here in Connecticut. We have Dr. Kelsey Corcoran and she is also a Western States grad. She’s now doing a two-year medical informatics fellowship in affiliation with Yale but she works in conjunction with the Connecticut VA system so those are the type of opportunities that you may not be aware of, but they are possible. They have a very high success rate of getting people placed within the first year after graduating from the program.
Noah: What recommendations do you have for students?

I encourage students to challenge themselves. It’s easy to sit back and say; oh it’s just mechanical low back pain, we’re gonna treat it this way. Really challenge yourself to try to do diagnostic tests or take a very thorough history so you can figure out if it is facet or SI joint. Figure out if it is myofascial pain or do they possibly have stenosis and knowing how to differentiate those. I really encourage students to push themselves to have conversations that expand their knowledge outside of just what chiropractic can do and what the medical community can do for a patient all together.

Well, hopefully this will motivate a lot of students to apply their education appropriately and to really push their limits and really get outside of their comfort zone and really help to grow the profession in new ways and new areas.

See the full interview here: https://youtu.be/l8elpjhocde

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