Topic 8: National scope of practice

National Scope of practice

"What steps could be taken to create a national Scope of Practice?”

Future Perceptions Survey responses highlighted that a national scope of practice is a topic that could have a strong positive impact on the profession, but that overall, the profession was not well prepared for this. Over 80% of respondents said having a national scope of practice is an important driver which could shape the future of the profession. How should the chiropractic profession seek to create and implement a national scope of practice?

We would love to hear your thoughts!

“How should the chiropractic profession seek to  create and implement a national scope practice?”

This discussion board community is intended to spark forward-looking discussions, and aid in developing the focal points for interactive events with facilitators. We invite you to share your thoughts and ideas, in a forward-looking manner. Posts that specifically reference or are intentionally divisive and/or overtly negative towards an individual or organization or intended as a barrier-building ‘history lesson’, may be blocked. We thank you for your participation and your thoughtful forward-looking thoughts and insights!

14 Comments

Work with FCLB, the ACA and ICA and all of the state boards to support a scope of practice dependent upon training rather than ideologies.

I agree with Dr. Lehman, we are missing out on advancing our profession to become mainstream healthcare providers. Example; how hard would it be for the chiropractic profession to step up and fill a void for providing the covid-19 vaccine.

I agree with the above two comments. We Must broaden the training of the students in our Chiropractic colleges. If any DC desires to only move the Atlas then do so however let’s not try to stop other doctors from practicing in a much broader manner . Look how the dental profession is specialized within itself with wonderful results.
We must broaden our training and our profession. We must stop legislating to narrow the chiropractic definition. We must recognize that in order to continue to practice we must think in terms of expansion.
After 50 years of practice I can assure each DC in this country that time is of essence.
It’s time to move forward and stop trying to make every DC believe they must think and practice exactly alike. This can not continue.

We offered expansion of the scope of practice following additional education more than 10 years ago and have developed a working relationship between our APC(advanced practice chiropractic) and general chiropractic practitioners. This has been very successful and we have seen DC’s with APC certification working in hospital and multi-disciplinary settings with respect of the other practitioners. The addition of chiropractic VA residencies is a huge step forward in creating a better interdisciplinary understanding and reduced doubt about how DC’s can fit into the current system.

Leaving scope to what is trained in a college is no scope at all but a free for all. The, Lets teach more in our colleges, above proves that point. But this question is moot since in the United States the states have the right to rule within their borders.

You are very correct. Not only do state boards limit the scope, the Medicare Federal system has pidgeon holed us. We can ONLY be reimbursed for spinal manipulation, not exams or physiotherapy. Furthermore, the exams are required. The profession has been boxed into spinal manipulation only paradigm while DPT can do manip, physio etc.

We need to create a unified core curriculum of training for the colleges. Everybody learns to read and order lab tests. Everybody learns exercise protocols for musculoskeletal injury. Everybody gets to bill for these procedures after graduation because they are within the scope of practice. During chiropractic school, everybody gets really good at a predictable, core product. The public understands our scope and other health professionals refer to us because they understand us as well.

Our scope already is mainstream and is exactly what the public is looking for, less medication and a path towards wellness naturally. Consider the models of psychoneurophysiology and psychoneuroimmunology and how chiropractic can advance in these models instead of expanding our scope with more procedures and a script pad.

Doc, I heard that a lot while being in school. Unfortunately, being outside the mainstream will cut the ability to help patients and the revenue. As an example, in New York State Chiro’s were able to do CDL physical exam. In 2016 it was a rule out that physicals are outside of our scope, lots of doctors lost their revenues. Why would I want to push some sort of idea that we are unique and being kicked around as a ball VS ability for each doctor to specialize in what they believe. Chiropractic philosophy hurts the profession a lot.

As a DC who has been in practice 28 years, I too, do not want a script pad or to become psuedo-pcp. What I would like is for when I identify a medical issue and make a referral to a specialist or PCP, that that professional send me a consult note. Often, when I send a pt to a neurologist or orthopedist, those docs sent the notes to that patient’s PCP and do not copy me even though I made the referral!! This is very frustrating.

Many years ago the colleges and associations decided the Chiropractic curriculum would equal that of medical schools. D.C.’s were to become Portal Entry Physicians, essentially we were trained as “medical” General Practitioners, apparently because few medical students wanted to be GP’s, preferring the bigger paychecks of specialists, such as Cardiologists. The GP was expected to do everything they knew how to do and if all failed, refer the patient to the specialist.

Upon graduation, D.C.’s were then expected to recognize disease/dysfunction yet refer everyone to “real doctors” and restrict ourselves to the spine, even if we had ideas that might circumvent the need for oft times aggressive medical interventions.

All schooling is an agreed upon minimum amount of knowledge, whether bachelors, masters, or doctorate degree. We have not and cannot expect the colleges to be the end of all training and certification. Over the last 26 years, I have attended post-graduate coursework that were teaching advanced testing and treatments, all of which was accredited and approved by the licensing boards. Much of this coursework led to diplomate status in fields addressing the structural and functional integrity and interconnectedness of the entire human organism. The goal being to use natural means to facilitate the restoration of the body’s ability to heal itself. Yet these same state boards often pursues D.C.s who used their approved post-grad beyond adjusting the spine.

Many States have already expanded their scope to allow the use of natural derived prescriptions, such as I.V. Nutritional therapies, requiring appropriate post-grad certification.

Instead of reinventing the scope of Chiropractic, we might consider adopting the scopes of these States, across the board.

There are enough sick people in this country for every type of doctor, no matter how they choose to practice within their scope.

With over 40% of the U.S. population suffering from chronic illness, people are desperate for alternatives to what mainstream medicine can offer.

It is important to balance this discussion with the reality that health professions (and the practice of medicine) are regulated at the state level. The states are the laboratories of democracy, and this is true in chiropractic as well. We have work to do in federal programs such as Medicare; but nationalizing the scope will likely create a narrow scope that no one is happy with. There is also a discussion nationally about nationalizing health care in general, nothing on the table in the discussions indicates this would be a plus for chiropractic.

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MORE INFORMATION

For more information about the Future of Chiropractic strategic visioning and planning project, please contact:

Elizabeth Klein, Executive Director
Congress of Chiropractic State Associations
Phone: (503) 922-2933
lizz@chirocongress.org
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