The Diplomates: American Chiropractic Board of Sports Physicians

J Amer Chiropr Assoc 2005 May-June;42(4):5-7

Abstract: Bill Moreau, DC, of Estherville, Iowa, huddled on the sidelines as the injured high school football player complained that his legs felt odd and his head hurt. Minutes later, the player collapsed, started vomiting, and went into convulsions. Dr. Moreau, a diplomate of the American Chiropractic Board of Sports Physicians (DACBSP), suspected the player had suffered a subdural hematoma, and immediately began administering oxygen, which he had brought along in case of need, and providing other supportive care while an ambulance was summoned.

At the hospital, Dr. Moreau’s hunch about the subdural hematoma was confirmed. The patient recovered fully and is now a pre-law student at the University of Iowa.

Dr. Moreau credits the thorough and extensive training received in his sports diplomate coursework for preparing him to deal with a life-threatening emergency. He knew what to do and had the appropriate equipment-and selfassurance. “Without the training I received in the diplomate program, I would not have had the confidence to handle a situation like that,” he says.

Bill Moreau, DC, of Estherville, Iowa, huddled on the sidelines as the injured high school football player complained that his legs felt odd and his head hurt. Minutes later, the player collapsed, started vomiting, and went into convulsions. Dr. Moreau, a diplomate of the American Chiropractic Board of Sports Physicians (DACBSP), suspected the player had suffered a subdural hematoma, and immediately began administering oxygen, which he had brought along in case of need, and providing other supportive care while an ambulance was summoned.

At the hospital, Dr. Moreau’s hunch about the subdural hematoma was confirmed. The patient recovered fully and is now a pre-law student at the University of Iowa. Dr. Moreau credits the thorough and extensive training received in his sports diplomate coursework for preparing him to deal with a life-threatening emergency. He knew what to do and had the appropriate equipment—and selfassurance. “Without the training I received in the diplomate program, I would not have had the confidence to handle a situation like that,” he says.

Dr. Moreau is a past president of the American Chiropractic Board of Sports Physicians (ACBSP). He believes that the program has been invaluable to his career. After getting credentialed as a Certified Chiropractic Sports Physician (CCSP), a requirement to enter the diplomate program, Dr. Moreau’s practice began to grow significantly, he recalls. Like many CCSPs, he subsequently completed the diplomate program. As he put into practice what he had learned, he found that it made a major difference in patient outcomes, helped him get people better quicker, and enhanced his confidence as a clinician.

The diplomate program, which takes about 2 years to complete and requires 200 hours of coursework (in addition to the 100 hours required for the CCSP), is a real milestone, Dr. Moreau says. “You really feel proud that you’ve earned your DACBSP. You know that anyone who achieves that diplomate has gone through a significant amount of education and effort. You know it takes tremendous dedication to achieve that goal.”

Dale Buchberger, DC, DACBSP, is a former president and current director of the ACBSP. Dr. Buchberger initially enrolled in an orthopedic diplomate program before switching to the sports diplomate. “I decided it was more practical, that there would be more for me to use in my office on Monday morning,” he recalls. Like other DACBSPs, Dr. Buchberger found that completing the diplomate program made a difference in his practice. “The diplomate increased my confidence in dealing with sports injuries,” he says. “At the time I was doing the diplomate program, I was also the team doctor for a high school football and basketball team. So while I was going through the curriculum, I had an opportunity to see the injuries I was learning about on the field. It was very, very practical.”

After getting his diplomate, says Dr. Buchberger, he found that his practice grew as he increasingly received referrals involving local and out-of-town athletes— mainly high school players. He also started to see more recreational athletes.

In addition to accelerating the growth of his practice, the diplomate training greatly enhanced his technical vocabulary. That improved his ability to interact smoothly with other health professionals, he says. “The program really gave me the vocabulary and the knowledge of what the physical therapists and orthopedists who deal with sports injuries on a regular basis are doing. This, in turn, gave me greater confidence,” he says. It is hard to overstate how important this is, he adds. “If you can’t communicate, it’s tough to work in that environment. I interact with an athletic trainer and an orthopedic surgeon every day. The first thing they told me when we started working together was that I had a better knowledge and understanding of sports injuries than any DC they’d ever met.” That is true only because he took the diplomate program, Dr. Buchberger points out.

A primary goal of the ACBSP is to gain national accreditation for the sports diplomate program through the National Organization for Competency Assurance (NOCA). It is increasingly important for credentialing programs to have outside accreditation, says Dr. Buchberger. Virtually every academic program and institution is now under pressure to get outside accreditation, he notes. “Our programs can’t go anywhere without it.”

Despite the relevance and value of these programs, the outside world has often disdained programs that lack outside accreditation. “We want our certificates to mean something,” Dr. Buchberger asserts. “Up to now, many people have said, ‘Well, you did 300 hours of coursework, but it doesn’t mean anything.’” It is critical that both patients and other health care professionals know that a diplomate program reflects a meaningful body of knowledge, he adds.

John McDaniel, DC, DACBSP, is the pesident of ACBSP and practices in Mountain View, California. The choice of a diplomate depends on personal interest, Dr. McDaniel observes. “I think every DC should pursue some diplomate,” he asserts. “You need to do more than the minimal 10 to 12 hours of required continuing education. If you want to work with patients as a team doctor, and want to be at a sporting event standing on the sidelines and dealing with injuries, this is the one to have.” When he was still building his practice, being a sports doctor was a tremendous benefit, allowing him to build relationships on the field and then see those same athletes in his office for treatment, he recalls. Now that his practice is mature, Dr. McDaniel has discontinued regular attendance at sporting events. Dr. McDaniel says that if he had the time, he would have many opportunities to do on-field sports medicine.

“I think all diplomates are going to become more valuable,” says Dr. McDaniel. “The growth of standards of care throughout health care will result in more and more scrutiny of how all providers treat—DCs included. What that means is that more education is going to be more valuable. If you have to prove your credibility to some insurer or governing body, having more education helps.”

Victor Dolan, DC, DACBSP, a director of the ACBSP, vividly recalls one occasion when his diplomate training proved crucial. Not long after getting his diplomate, he was serving as attending doctor at the Cowtown Rodeo in Woodstown, New Jersey.

“The diplomate training was fresh in my mind,” recalls Dr. Dolan. A bucking bronco threw a cowboy to the ground and then came down hard on the thrown rider’s upper right abdomen. The cowboy got up, walked a few steps, and then collapsed.

An ambulance attendant with two EMTs was on the scene, and Dr. Dolan worked with them to remove the rider’s shirt and flak vest. Even underneath the flak vest, the bronco had left a hoof mark on the cowboy’s upper right abdomen. Based on his observation of the bruising, Dr. Dolan surmised that there were rib fractures and possibly spinal fractures.

It turned out that the rider had suffered liver lacerations, several broken ribs, and a tear in his intestines. “My diplomate training helped me recognize the severity of his injuries and provide appropriate treatment to the patient and instructions to the EMTs,” Dr. Dolan says. He applied mast pants, known formally as an antishock garment that compresses legs and the abdomen to keep blood in the body’s core. He also worked with the EMTs to quickly place the patient on an immobilizing board to protect the spine. The patient ultimately made a full recovery.

As an active and outgoing individual, Dr. Dolan finds the sports diplomate particularly well suited to his practice style. “The sports diplomate gets you out of the office, onto the playing field, and into the community,” he observes. “And it allows you greater ease in dealing with the unfortunate occasional crisis situations that occur. The outside world looks for credentials. The public is happy to see that you know not only your profession as a whole, but also a specific niche within your profession.”

As a former college football player, an interest in sports medicine came naturally to ACBSP’s vice president, Robert Nelson, DC, DACBSP. “As soon as the CCSP and sports diplomate programs came out, I signed right up,” he recalls. “There were other courses I was taking, including acupuncture, but I really wanted to take the sports program.”

Being based in Colorado also made the sports diplomate program particularly attractive, he says, because Colorado has the highest number of citizens who either consider themselves athletes or actively participate in fitness programs.

Like other DCs who have pursued the sports diplomate, Dr. Nelson says he found the coursework not only stimulating, but also highly practical. “It was very stimulating because each time we went to a course, there was something I could take back to practice the next week. It was all useful.”

“A diplomate gives you more tools,” he says. “If the only tool in your toolbox is a hammer, everything looks like a nail.” But with the diplomate knowledge, a broad range of options opens up. He finds that his higher level of knowledge and the continuing education required to remain an active diplomate have given him ways not only to treat athletic injuries, but also to help athletes enhance performance. “I know how to help athletes in ways that I would not have known before.”

For anybody who is doing work in the field, the emergency procedures taught in the diplomate are particularly important. “We are trained as DCs, not EMTs or emergency room physicians. We’ve got to be able to recognize traumatic injuries so that, first, we do no harm, and second, we treat or refer as necessary,” Dr. Nelson says.

There is a great deal of flexibility in the continuing education requirements, which means that almost anything related to evaluating and treating athletes is valid for the CE requirement, according to Dr. Nelson. This could include studying acupuncture, taking rehabilitation courses, receiving CPR or EMT certification, or getting a certified strength and conditioning specialist certification (CSCS).

Like his colleague Dr. Victor Dolan, Dr. Nelson has experienced the value of his diplomate training most dramatically while serving as an attending doctor at rodeos, allowing him to quickly evaluate severe injuries, reset dislocated shoulders, and deal with other situations, he notes.

“Think of it, a 140 lb. man vs. a 1,500-lb. bull. Who’s going to win? And talk about whiplash!” quips Dr. Nelson. Of all the so-called collision sports, rodeo is the one with the highest proportion of traumatic injuries, he says.

He recalls several situations where his sports diplomate training proved critical. In one case, a rider was bucked off a bull and landed on his neck and shoulders. “An EMT and I were able to get right out there and do an initial examination, take vital signs, put a cervical collar on the rider, and arrange for transport,” says Dr. Nelson. The rider had fractured his cervical spine. Later, Dr. Nelson learned, he made a full recovery.

In another case, he reset a shoulder dislocation caused when a bareback rider was thrown from a horse. He performed the procedure on the spot, and the rider was able to return to the sport after a period of rest and recuperation.

The availability of distance learning for the sports diplomate is helping to promote the specialization and make it more available and more appealing to prospective candidates, according to Dr. Nelson. In addition, he believes that NOCA certification is just a matter of time. “With outside recognition through NOCA certification, we will be known not only in the chiropractic world, but also in the international sporting community,” Dr. Nelson says.

The importance of distance learning as a means of making diplomate programs more accessible is echoed by Dr. Moreau. The sports program, he notes, is normally completed over a 20-month period by taking courses one weekend per month. With distance learning, coursework need not be limited to weekends.

Dr. Moreau stresses that although this is more convenient, the work is still challenging. “Distance learning is not easier; it takes self-discipline and dedication, but it is more convenient and saves a tremendous amount of travel and lodging money.” He notes that people often travel from places as far off as Alaska and Japan to attend diplomate programs in the continental United States.

Even in the distance program, some travel is required. There is still a lot of hands-on instruction, Dr. Moreau says. Generally, the diplomate candidate has to travel to a location 8 weekends in the course of completing the program. “But that’s a lot better than 20 times,” he notes. “It’s a savings of thousands of dollars in travel, hotel, meals, and in lost practice income—not to mention time away from family.”

“I honestly believe distance learning is the wave of the future,” says Dr. Moreau. Dr. nelson adds, “I see this diplomate process growing with online, as well as hands-on, learning.”

In addition to coursework, completing the sports diplomate involves both a written and a practical examination. The practical examination involves x-ray analysis, soft-tissue techniques, taping, and managing an injured athlete in an emergency situation. The other requirements include logging 100 hours of practical experience or showing proof of learning outside the clinic in a mentoring environment. The candidate is expected to write about what he or she sees and does. The mentor may be another diplomate, an orthopedist, or an athletic trainer, according to Dr. Moreau. The candidate must also write an article of publishable quality involving a literature review, a case study, or any of the other manuscripts traditionally found in scientific journals.

There are currently about 180 sports diplomates and nearly 3,500 CCSPs, according to the ACBSP. Managed care has had an adverse impact on the number of DCs seeking postgraduate education. But Dr. Moreau predicts that there will be a resurgence of interest in postgraduate programs, including diplomates, as health care practitioners strive to distinguish themselves from other practitioners in a tough, competitive economic environment. “These types of programs are one way to do that,” he points out.

Anyone interested in either the CCSP or the diplomate programs should contact the nearest chiropractic school for more information on programs, dates and locations. The entire program runs about $7,500, including the CCSP program (since the 100 hours of the CCSP is part of the 300 hours required for the DACBSP), according to the ACBSP.

Those interested in further information may contact Jenny Quastad at the ACBSP, 103 South 6th Street, Estherville, Iowa 51334, or call 712/362-8860. Her e-mail is acbsp@myclearwave.net. The website is www.acbsp.com.