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Is “Expanded Practice” our Pandora’s Box?

Is “Expanded Practice” our Pandora’s Box?

The Chiro.Org Blog


SOURCE:   A Chiro.Org Editorial


I just read a Press Release from the Foundation for Vertebral Subluxation (FVS) this morning, titled “Chiropractors Lash Out in Massive Campaign Against Accrediting Agency“.

Previous press releases from this group have denounced (perhaps rightly) any movement to include prescribing rights for DCs, and this Blog has published extensively about both sides of that debate in the past. [1–15]

Personally, I think that seeking prescription rights is a bad idea because of the political and legal turmoil it will invite from Organized Medicine. The authors of the Foundation typically paint the “Pro Drug” movement as an attack against the idea of the Vertebral Subluxation and of the profession’s historical foundation, as one that does not use drugs and surgery to accomplish our goals.

It’s now time for the Profession to determine if this is “Chicken Little” paranoia, or if the FVS has a valid concern that MUST be addressed.

According to their Press release, there is a “massive and historic outpouring” of dissatisfaction by “at least 6000 chiropractors” via “Facebook, Twitter and e-mail“. The author goes on to state that “At issue is the systematic remaking of the profession by these groups into a branch of medicine.”   OK, that got my attention.

NOTE: It may be true that this page has 6000 “members”, but MANY of them (like myself) were added to that list without our knowledge or permission.   So their claim of 6000 “members” is spurious.   Further, even if it WAS true, 6,000 DCs represents less than 10% of our Profession. Hardly a ground swell.

I view splinter groups who want prescribing rights with a rather dim view, because the term “increased market share” invariably pops up somewhere in their impassioned plea for “expanded practice”.

My natural reaction is the firm belief that, if these same individuals developed their ability to refer patients who needed temporary drug relief for co-management by a local MD, this would eventually lead to stronger professional ties in their community, leading to more referrals from their medical counterparts, and the “increased market share” they had hoped for.

I don’t believe that trying to co-opt medicine’s legitimate right to prescribe will EVER generate that same good will, but that’s just one man’s opinion.


This press release does force us to ask (and answer) some serious questions:

  1. What percentage of the Profession actually wants prescription rights? I’m not talking about the “LIVE AND LET LIVE” contingent. I mean DCs who actually plan to prescribe.

  2. Why did the CCE remove the “no drugs and surgery” portion of the description of chiropractic? Who exactly encouraged this decision?

  3. Is the “Expanded Chiropractic Practice movement” really a last-ditch attempt by some (failing?) schools to shore up enrollment, simply to keep their doors open?

  4. Is the Profession financially prepared for the inevitable legal backlash from Organized Medicine? Please refer to references [9–14] for more about that very real topic.

  5. Is staging a protest in front of the National Advisory Committee on Institutional Quality and Integrity a sound idea?   Sure, this group is the administrative watchdog over the CCE, but are they also in a position to dictate policy to the CCE, on behalf of those protestors?   Or could this backfire into another Life College fiasco, where the CCE loses it accreditation, and all the Chiropractic Schools suffer from the fallout?   Is this the can of worms we really want to open?

I find myself asking many of the same questions the VS Foundation raises. I don’t know if their approach is sound, so I believe it’s time that OUR Profession speaks out, because there are a couple of splinter groups at work, moving their pet agendas forward, and unless the whole Profession is heard from, I fear that these small groups will have their way, and the rest of us will have to live with the consequences.

The following articles detail the progress of the expanded practice movement, from first wanting MUA (manipulation under anaestehesia), to injectable vitamins to finally wanting prescription privileges for things like steroids and muscle relaxers.

If you’ve been like me, standing on the side lines, waiting to see which way the wind blows, then I invite you to get informed, wake up, and make a choice.

If you are for expanded practice, then get out your checkbook, because every State Association is going to need a fat wad to pay for the court battles. If you’re against, then let your State Association know that now.

The time for standing on the sidelines is over.


REFERENCES:

1.   Point/Counterpoint: Seeking A Second Opinion on Expanded Chiropractic Practice
Chiro.Org Blog ~ June 5, 2011

2.   Best for the Profession or Best for the Public?
Chiro.Org Blog ~ June 5, 2011

3.   Are Chiropractors Protecting Patients From Medical Care?
Chiro.Org Blog ~ May 23, 2011

4.   The Evidence-based Rap, or What’s Wrong With My Pain Meds?
Chiro.Org Blog ~ April 23, 2011

5.   Just In Case You Don’t Believe Me…
Chiro.Org Blog ~ April 12, 2011

6.   New Podcast Interview: Two College Presidents Discuss Prescription Rights for Chiropractors
Chiro.Org Blog ~ March 31, 2011

7.   For Those Who Wish To Be Medical Chiropractors — Look, Before You Leap
Chiro.Org Blog ~ March 13, 2011

8.   Majority of Alabama Chiropractors Favor Limited Prescription Rights
Chiro.Org Blog ~ February 18, 2011

9.   UPDATE: Texas Judge Finally Rules on Diagnosis Issue
Chiro.Org Blog ~ September 14, 2010

10. The Council on Chiropractic Education Accreditation Standards Draft for 2012
Chiro.Org Blog ~ September 17, 2010

11.   TMA v TBCE–TRIAL UPDATE
Chiro.Org Blog ~ July 21st, 2010

12.   AMA’s “Contain and Eliminate” Tactics Are Alive and Well
Chiro.Org Blog ~ July 15th, 2010

13.   A Constitutional Challenge to DCs Diagnosing – What This Means for Health Care
Chiro.Org Blog ~ April 27th, 2010

14.   Live and Let Live?
Chiro.Org Blog ~ March 24th, 2010

15.   Organized Medicine Attempts To Deny Chiropractors Right To Diagnose in Texas
Chiro.Org Blog ~ February 4th, 2010

9 comments to Is “Expanded Practice” our Pandora’s Box?

  • Let’s not ignore the simple fact that people recognize the ability to legally prescribe drugs as powerful and authoritative. There is a little bit of that mixed in there as well.

    The willingness to throw grenades at each other within the profession is at an all time high, and the lack of chiropractic fundamentals is what has created it. I spoke about this while I was in my first quarter at Life University, and 15 years later things seem worse than ever.

    While I agree with your statements, is it possible that we are incorrect? Maybe the accrediting agency sees things more accurately and in an attempt to save the profession they are attempting to expand our scope to be relevant?

  • Seth Gross, DC

    If DC’s do drugs…Can you imagine how our malpractice premiums will skyrocket?! ($1500/year to $25,000+/year). Who’ll need a DC when they can go to an expert in drugs,knives,and needles(MD)? You want to talk about confusing the millions who seek chiropractic to get away from drugs, knives, and needles? Mandatory reading of BJ’s Green Books is what the “Mediprators” are missing…not drugs, knives, and needles.

  • Lisa

    I am sick of hearing about drugs. Yes, why bother going to a chiropractor, people will have no clue what we provide. The CCE and state licensing are all one sided. At least congress has a house and senate. I am tired of this.

  • Nick

    Interestingly, the “6000 chiropractors” on facebook did not join the page by choice. They were added by other chiropractors en masse… if you do a search of those members, you will find doctors who are known to support the CCE, even some who are outspoken against the attack on the CCE. Many of the people on that page are not chiropractors… or even chiropractic students.

    The REAL indicator would be how many ACTUAL U.S. licensed DCs sent in letters in support of the complaint.

    Reply from Frank:

    Nick, I was one of the DCs who was unwittingly subscribed to that page by one of the organizers, and it became very clear very fast (before they unsubscribed me) that they were not interested in answering questions or having any forum at all.

  • As someone who will complete the advance practice program in New Mexico this month, I can say with certainty that those organized to oppose this expansion are seriously misleading the profession. Let me give my perspective as someone who has spent the better part of the last year in the program.

    1. Most importantly it is an elective process. It will only effect those who choose to be educated.

    2. Second the entire program is designed to provide alternative to drugs and at the same time allowing trained DCs to have legal authority to DC (no pun intended) a patient’s meds. It will lower drug utilization.

    3. As for insurance rates, this is a straw man. DCs in Oklahoma have been doing IV therapy for years. In New Mexico no such increase has occurred, none is expected.

    4. The New Mexico medical, osteopathy and pharmaceutical boards have signed off on limited prescription rights. So no “backlash” will be forth coming.

    5. What is ironic and sad really is the total lack of confidence in chiropractic philosophy displayed by the ICA and related groups. If non-drug, non-surgery is what the public truly wants, then a small group of trained DC’s offering limited medications should quickly die off. A self-limited condition if you will.

    If chiropractic philosophy is sustainable, then limited prescriptions rights should be no threat at all. If on the other hand, the public and the profession identify chiropractic + limited prescription authority as the 21st century chiropractic philosophy, then it is best to do what DCs have always done. Circle the wagons and shoot inward.

    • Dr. Kukurin,

      Thank you for sharing some of your experience with us.

      You mention that New Mexico’s various Boards have “signed off” on approving limited Rx rights for DCs, but what about Texas and California, or the other 47 States?

      I mention those 2 because of the huge backlash against MUA and DCs “right” to diagnose. My point in the Pandora’s Box piece is that some (or many) of these States may have to divert significant funds to lobbying for limited rights for a (small?) percentage of their membership.

      I agree that the profession can survive this type of growing pains, but wonder how this may confuse the public. Will new patients now have to ask “what type of chiropractor” the office represents?

      I will be especially interested in seeing what the Yellow Page ads look like for offices who want to distinguish themselves from non-prescribing DCs. I suspect it won’t be pretty.

      Your 5th point is interesting. It seems to assume that the public has a clear idea that chiropractic IS the “non-drug, non-surgery” alternative, whereas my experience is that a large percentage of the public has NO IDEA AT ALL about chiropractic, and often end up there as a last-ditch resort.

      Thanks for your feed-back. Can you tell us which drugs are part and parcel of limited prescription rights? Will they include steroids or opiates? I hope not.

  • George Kukurin DC

    Hi Dr. Painter,

    Let ‘s look at some of your concerns…

    “I agree that the profession can survive this type of growing pains, but wonder how this may confuse the public. Will new patients now have to ask “what type of chiropractor” the office represents?”

    How can it be any more confusing than straight v. mixer, Gonstead v. Activator, and so on and so on?

    I will be especially interested in seeing what the Yellow Page ads look like for offices who want to distinguish themselves from non-prescribing DCs. I suspect it won’t be pretty.

    I think the advance practice credential would solve this problem.

    Your 5th point is interesting. It seems to assume that the public has a clear idea that chiropractic IS the “non-drug, non-surgery” alternative, whereas my experience is that a large percentage of the public has NO IDEA AT ALL about chiropractic, and often end up there as a last-ditch resort.

    I agree with you! This points to a real failure on the part of the profession and its national organization. After more than a century the public has “NO IDEA AT ALL” Perhaps the money spent by national organization to file lawsuit in state would be better off spent on marketing and PR.

    Thanks for your feed-back.

    You are welcome

    Can you tell us which drugs are part and parcel of limited prescription rights?

    They are listed on the NM Chiro Association website

    Will they include steroids or opiates? I hope not.

    As I stated the program is designed to offer alternatives. There are no opiates as part of the formulary. One of the things taught in class about steroids. They work by inhibiting an enzyme PLA-2. So does the combination of bromelain, quercetin and curcumin. W/O the side affects. Like I said the purpose is for DCs to reduce med use. If not DCs with our philosophy, who then?

    • Dr. Kukurin

      The only people I have seen that are confused about “straight v. mixer, Gonstead v. Activator” are chiropractors. We make a big deal about the fact that our technique is different (or superior) to generic diversified, or that our philosophy is different than someone elses, but I find very few patients who do more than politely listen to that. They come to us for results, and when we deliver, they stay with us.

      I feel like you dodged my question about Yellow page ads. We just discussed the people’s propensity to distinguishing their difference from other DCs.

      Personally I don’t blame the National Associations for failing to educate the masses about chiropractic. The depressing truth is that (at least in 1999) there were only about 5,000 paid members of either group. That doesn’t provide them with the funding required to do the job. The real blame (and shame) lies elsewhere…with the 90% who doesn’t support the profession with dues.

      I am relieved to hear opiates are off the table. I agree that DCs can (and have) provided natural alternatives to using Rx drugs, and it sounds like you will do good work.

      Again, thanks for your feed-back!

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