Expanded Practice

Chiropractic Identity, Role and Future: A Survey of North American Chiropractic Students

By Frank M. Painter|September 6, 2016|Expanded Practice, Prescription Rights|

Chiropractic Identity, Role and Future: A Survey of North American Chiropractic Students

SOURCE: Chiropractic & Manual Therapies 2015 (Feb 2); 23 (1): 4

Jordan A Gliedt, Cheryl Hawk, Michelle Anderson,
Kashif Ahmad, Dinah Bunn, Jerrilyn Cambron,
Brian Gleberzon, John Hart, Anupama Kizhakkeveettil,
Stephen M Perle, Michael Ramcharan,
Stephanie Sullivan, and Liang Zhang

Logan University College of Chiropractic,
1851 Schoettler Rd,
Chesterfield, MO 63017 USA.

BACKGROUND: The literature pertaining to chiropractic students’ opinions with respect to the desired future status of the chiropractic physician is limited and is an appropriate topic worthy of study. A previous pilot study was performed at a single chiropractic college. This current study is an expansion of this pilot project to collect data from chiropractic students enrolled in colleges throughout North America.

OBJECTIVE: The purpose of this study is to investigate North American chiropractic students’ opinions concerning professional identity, role and future.

METHODS: A 23-item cross-sectional electronic questionnaire was developed. A total of 7,455 chiropractic students from 12 North American English-speaking chiropractic colleges were invited to complete the survey. Survey items encompassed demographics, evidence-based practice, chiropractic identity and setting, and scope of practice. Data were collected and descriptive statistical analysis was performed.

RESULTS: A total of 1,247 (16.7% response rate) questionnaires were electronically submitted. Most respondents agreed (34.8%) or strongly agreed (52.2%) that it is important for chiropractors to be educated in evidence-based practice. A majority agreed (35.6%) or strongly agreed (25.8%) the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes. A large number of respondents (55.2%) were not in favor of expanding the scope of the chiropractic profession to include prescribing medications with appropriate advanced training. Most respondents estimated that chiropractors should be considered mainstream health care practitioners (69.1%). Several respondents (46.8%) think that chiropractic research should focus on the physiological mechanisms of chiropractic adjustments.

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PRESCRIPTION RIGHTS: The Timex Topic: It Takes A Licking But Keeps On Ticking

By Frank M. Painter|August 29, 2016|Expanded Practice, Prescription Rights|

PRESCRIPTION RIGHTS: The Timex Topic: It Takes A Licking But Keeps On Ticking

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2016 (Aug 24)

Peter C. Emary, Taco A. W. Houweling, Martin Wangler, Stephen J. Burnie, Katherine J. Hood and W. Mark Erwin

201C Preston Parkway,
Cambridge, ON
N3H 5E8 Canada.

The last I heard, all the significant National and International Associations, who comprise the “Chiropractic Summit” had all agreed (back in 2013) that chiropractic should maintain Drug-Free. However, I am also a member of a FaceBook group (Evidence-Informed Chiropractic Medicine) and the topic keeps popping up.

Our Blog has posted on medical resistance to chiropractic’s use of manipulation under anesthesia (MUA), and that one STILL has me scratching my head. After all, the DC isn’t knocking anyone out, a medical anesthesiologist does that, so this inter-professional service benefits both our professions, as well (in theory) the Patient.

We have also posted on the “expanded practice” movement in general, and we don’t need to revisit that here.

So, I have collected all our Blog postings on the prescription rights and “expanded practice” movements into one nice neat package in the new Prescription Rights and Expanded Practice Debate page.

The upper Background Materials section contains all our Blog postings, and the lower Recent Additions section contains this and earlier thoughtful articles on the expanded-practice and prescription rights movement,

The last section is titled Drug Evidence and it includes articles discussing the evidence base for various drugs for spinal pain.

I have no interest in rehashing all those conversations. I hope that if this is a hot topic for you, that you will read all these materials, and then let them percolate. It’s called informed decision. You have to get informed before you set your Profession on a different course. I hope you will take the time to absorb these materials.

A Commentary on the Implications of Medication Prescription Rights for the Chiropractic Profession
Chiropractic & Manual Therapies 2016 (Aug 24)

There is a growing desire within the chiropractic profession to expand the scope of practice to include limited medication prescription rights for the treatment of spine-related and other musculoskeletal conditions. Such prescribing rights have been successfully incorporated into a number of chiropractic jurisdictions worldwide. If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the healthcare system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine / musculoskeletal disorders.

However, if the chiropractic profession wishes to lobby to expand the scope of practice to include limited prescriptive authority, several issues must first be addressed. These would include changes to chiropractic education and legislation, as well as consideration of how such privileges could impact the chiropractic profession on a more theoretical basis. In this commentary, we examine the arguments in favour of and against limited medication prescription rights for chiropractors and discuss the implications of such privileges for the profession.

KEYWORDS: Attitudes; Behaviour; Chiropractic; Drug prescriptions; Evidence-based practice; Knowledge

From the FULL TEXT Article:

Background

Despite a growing number of surveys demonstrating a positive attitude among chiropractors and patients towards the limited use of medication within chiropractic practice, chiropractors remain unable to prescribe medication in most parts of the world [1–8] (2007 and 2011 Ontario Chiropractic Association member surveys: B. Haig; personal communication, 3 November 2014). In many countries, chiropractors also lack direct access to musculoskeletal (MSK) diagnostic imaging and laboratory testing – limitations that have real implications for the clinician in accurately diagnosing and managing their patient. Meanwhile, allied health care professions such as optometry, chiropody, and naturopathy have been steadily expanding their respective scopes’ of practice and gaining limited medication prescription rights relevant to their areas of training and expertise. [9–11] Most notable for chiropractors is that physiotherapists are also interested in and have been granted prescriptive authority in some countries. [12, 13] Moreover, there are increasing examples of physiotherapists with advanced training in medication prescription and diagnostic testing who now manage patients with MSK disorders at the primary care level. [14–16]

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ACA House of Delegates Passes 2 Controversial Resolutions

By Frank M. Painter|April 14, 2015|Expanded Practice|

ACA House of Delegates Passes 2 Controversial Resolutions

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic – April 15, 2015

The American Chiropractic Association’s House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.

The first is “Resolution #2 – The Six Key Elements of a Modern Chiropractic Act.” Resolution #2 includes two “elements” that call for “prescriptive authority.” The second, “Resolution #12 – Establishment of College of Pharmacology & Toxicology” establishes the “College of Chiropractic Pharmacology and Toxicology of the American Chiropractic Association.”

To better understand how these resolutions are viewed by ACA delegates – and perhaps the profession at large – we asked Michael Taylor, DC (Oklahoma delegate) and Edward McKenzie, DC (Kansas delegate) to give their opinions regarding the resolutions. (Dr. Taylor, an author on both resolutions, deferred to Tony Hamm, DC, newly re-elected ACA president, who is also an author on Resolution #12.)

Dynamic Chiropractic: The Six Key Elements of a Modern Chiropractic Act (Resolution #2) includes the following four elements:

1) “Chiropractic Physician” and “Chiropractic Medicine” as the Regulatory Terms of Licensure;

2) Scope of Practice Determined by Doctoral and Post-Doctoral Education, Training and Experience Obtained Through Appropriately Accredited Institutions;

3) Full Management, Referral and Prescription Authority for Patient Examination, Diagnosis, Differential Diagnosis and Health Assessment; and

4) Full Management, Referral and Prescription Authority for the Care and Treatment of Neuromusculoskeletal and Other Health Conditions or Issues.

In your opinion, do these four elements suggest doctors of chiropractic should have the authority to prescribe drugs?

Dr. Hamm: No. The American Chiropractic Association supports the Summit statement: “The drug issue is a non-issue because no chiropractic organization in the Summit promotes the inclusion of prescription drug rights and all chiropractic organizations in the Summit support the drug-free approach to health care.”

Dr. McKenzie: There is a saying in the Midwest: “If it looks like a pig, acts like a pig and smells like a pig … it probably is a pig … and no matter how much lipstick you put on it … it is still a pig.”

In my opinion, it would be hard to draw any other conclusion than to suggest that these elements are there explicitly for the purpose of furthering the agenda towards acquiring prescription authority.

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Beyond Spinal Manipulation: Should Medicare Expand Coverage for Chiropractic Services?

By Frank M. Painter|January 12, 2015|Expanded Practice, Medicare|

Beyond Spinal Manipulation: Should Medicare Expand Coverage for Chiropractic Services? A Review and Commentary on the Challenges for Policy Makers

The Chiro.Org Blog

SOURCE: Journal of Chiropractic Humanities 2013 (Aug 28); 20 (1): 9–18

James M. Whedon, DC, MS, Christine M. Goertz, DC, PhD,
Jon D. Lurie, MD, MS, and William B. Stason, MD, MSc

The Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth College, 30 Lafayette St, Lebanon, NH 03756, USA.
james.m.whedon@dartmouth.edu

OBJECTIVES: Private insurance plans typically reimburse doctors of chiropractic for a range of clinical services, but Medicare reimbursements are restricted to spinal manipulation procedures. Medicare pays for evaluations performed by medical and osteopathic physicians, nurse practitioners, physician assistants, podiatrists, physical therapists, and occupational therapists; however, it does not reimburse the same services provided by chiropractic physicians. Advocates for expanded coverage of chiropractic services under Medicare cite clinical effectiveness and patient satisfaction, whereas critics point to unnecessary services, inadequate clinical documentation, and projected cost increases. To further inform this debate, the purpose of this commentary is to address the following questions:

(1) What are the barriers to expand coverage for chiropractic services?
(2) What could potentially be done to address these issues?
(3) Is there a rationale for Centers for Medicare and Medicaid Services to expand coverage for chiropractic services?

METHODS: A literature search was conducted of Google and PubMed for peer-reviewed articles and US government reports relevant to the provision of chiropractic care under Medicare. We reviewed relevant articles and reports to identify key issues concerning the expansion of coverage for chiropractic under Medicare, including identification of barriers and rationale for expanded coverage.

RESULTS: The literature search yielded 29 peer-reviewed articles and 7 federal government reports. Our review of these documents revealed 3 key barriers to full coverage of chiropractic services under Medicare: inadequate documentation of chiropractic claims, possible provision of unnecessary preventive care services, and the uncertain costs of expanded coverage. Our recommendations to address these barriers include the following: individual chiropractic physicians, as well as state and national chiropractic organizations, should continue to strengthen efforts to improve claims and documentation practices; and additional rigorous efficacy/effectiveness research and clinical studies for chiropractic services need to be performed. Research of chiropractic services should target the triple aim of high-quality care, affordability, and improved health.

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The Death of the CCE Cartel

By Frank M. Painter|February 20, 2012|Expanded Practice, Legal Action, News|

The Death of the CCE Cartel

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic ~ February 12, 2012

By James Edwards, DC

After several organizations [1] testified in favor of the Council on Chiropractic Education (CCE) being renewed as the accrediting agency for chiropractic colleges, some of those organizations issued less-than-accurate communications implying that the CCE was victorious in its effort. The fact is that nothing could be further from the truth.

It is not my intention to identify the organizations that misinterpreted and/or misrepresented what occurred. For those organizations that attempted to “spin” the facts in order to place the CCE in the most favorable light, I will leave it to them to correct the record. Instead, I will rely solely on transcripts and the reporting of the objective and highly prestigious Chronicle of Higher Education, and let you make your own judgments. After your review, I think it will become obvious that in a word, the CCE got publicly “spanked” for blatantly and steadfastly ignoring the wishes of the majority of the chiropractic profession.

While using the word cartel might seem harsh, it is important to stress that the description of the CCE as being a “virtual cartel” did not originate from me or even from within the chiropractic profession itself. It actually arose during a previous hearing by a member of the United States Department of Education (DOE) National Advisory Committee on Institutional Quality and Integrity (NACIQI). For your reading pleasure, the committee member’s harsh comments are below [with emphasis added]:

“Madam Chair, we’ve heard charges and countercharges from I trust a wide, fairly wide spectrum of the chiropractic profession. At least that’s the way it seems to me. Battles over turf, battles over philosophy, maybe battles over personal ambition, but divisions of every kind.

And some of this, maybe most of it, is a consequence of, at least as I see it, a monopoly control of a profession which has led to the establishment of a virtual cartel, not unusual. There are several other professions that we deal with that have a virtual cartel control of the profession. We can’t change that, but we can consider measures that will try to send a message to the prevailing control group that they should try to be more inclusive rather than less inclusive and I suggest that we try to figure out what is within our range of alternatives to do that.

Because I believe if we simply hear it, discuss it, anguish over it, and then give them five years of recognition, that we haven’t been the impetus for any corrective action for the profession and I worry about the profession.” [2]

Harsh Words

And now to the objective reporting of the highly prestigious Chronicle of Higher Education. Sit down, fasten your seatbelts and read what this impeccable, trusted source reported [again with emphasis added]: (more…)

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ICA Files Suit in New Mexico Court of Appeals Seeking A Stay on Illegal State Chiropractic Board Actions

By Frank M. Painter|January 19, 2012|Announcement, Expanded Practice, Legislation|

ICA Files Suit in New Mexico Court of Appeals Seeking A Stay on Illegal State Chiropractic Board Actions

The Chiro.Org Blog

Acting on behalf of concerned members in New Mexico and out of concern for the integrity and credibility of the chiropractic profession at large, on December 21, 2011 the International Chiropractors Association (ICA) filed an extensive memorandum in support of a motion to stay what is being held to be illegal actions on the part of that state’s Board of Chiropractic Examiners. In its memorandum of explanation, ICA’s attorneys argued that it was important for the court to carefully consider the urgent issues of the letter of the law and the protection of both the public and chiropractic practitioners and prevent the “New Mexico Board of Chiropractic Examiners from implementing its new rule establishing an advanced practice formulary to include dangerous drugs and drugs to be administered by injection…and implementing its new rules establishing a certain course of training to certify advanced practice chiropractic physicians to administer and prescribe dangerous drugs and drugs to be administered by injection” because such actions were outside their authority under the law.

On August 30, 2011, at an official rulemaking hearing and meeting, the New Mexico Chiropractic Board adopted new rules to greatly expand the chiropractic formulary to include certain dangerous drugs and drugs to be administered by injection that had not been approved by either the New Mexico Medical or Pharmacy Boards as specifically required by state law. At that same hearing, lawyers representing the State of New Mexico were very clear in their advice that the Board was acting outside their authority and should not proceed. The Chiropractic Board ignored those admonitions and acted to adopt a new formulary anyway.

ICA representatives were present at both the August and December Board meetings and, in concert with New Mexico DCs, urged the Board to act only within the rules established by statute but to no avail. At their meeting of December 13, 2011, the New Mexico Chiropractic Board denied all requests to stay the implementation of the new rules pending appeal. ICA received official documentation of the New Mexico Chiropractic Board’s official denial of a request to stay the controversial rules on January 5, 2012. Having exhausted all administrative remedies, ICA is seeking the protection of the courts in the face of the Board’s questionable actions. (more…)

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