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Is the WCA Trying to Create a New Profession?

Is the WCA Trying to Create a New Profession?

The Chiro.Org Blog


SOURCE:   Dynamic Chiropractic ~ March 15, 2016


The Wisconsin Chiropractic Association (WCA) is the driving force behind the introduction of a bill to create a new health care profession to be known as “primary spinal care practitioners.” [1] This is the apparent culmination of significant effort that began when “the WCA Board of Directors – at a special meeting on August 7, 2014 – voted unanimously to release a white paper outlining the Primary Spine Care Physician (PSCP) initiative to WCA members and the public.” [2]

According to the bill’s authors, Wisconsin Senator Frank Lasee and Representative Joe Sanfelippo, “[T]his bill creates a new type of health care provider in Wisconsin called the Primary Spine Care Practitioner (PSCP) designed to address the growing burden of spine related disorders and the overuse of prescription drugs in Wisconsin. The Primary Spine Care Practitioner would be a new practice act governed by the Medical Examining Board available to licensed chiropractors who meet the educational and clinical training requirements.” [3]

The bill includes rights and privileges for primary spinal care practitioners not currently enjoyed by doctors of chiropractic. In addition, the bill:

  • “[E]stablishes a licensure program for primary spinal care practitioners to be administered by the Spinal Medicine Affiliated Credentialing Board, which is created in the bill and attached to the Medical Examining Board.

  • “[D]efines ‘spinal medicine’ in relevant part as the integration and application of the practice of chiropractic and the practice of medicine and surgery, both as defined under current law, that is limited to conditions of the spine and the musculoskeletal, neuromuscular, and nervous systems.

  • Provides that “a licensed primary spinal care practitioner has authority to prescribe and administer prescription drugs.” [4]

In a letter to association members, WCA Executive Director John Murray stated: “For the past three years, the leadership of the WCA has been discussing how chiropractors through additional training and clinical excellence can better serve their patients and play a greater role in the integrated, team based health care model evolving in Wisconsin.” (Emphasis added) The letter goes on to describe the WCA’s effort “to pursue the development of an expanded scope of practice for chiropractors … The result is a new practice act called the Primary Spine Care Practitioner (PSCP).” [5]

Murray also announced that “the Medical College of Wisconsin and the Wisconsin Chiropractic Association are in initial discussions to form an academic partnership to develop an accredited Master’s Degree known as the Primary Spine Care Practitioner (PSCP) that would be only available to chiropractors. The rationale behind potentially partnering with the Medical College of Wisconsin is to develop a chiropractic specific program that builds on your doctoral level training in highly effective, conservative care, but add training in other evidence informed, patient centered interventions. The PSCP Master’s would require 500 hours of clinical training in evidence informed interventions. This additional education will allow chiropractors to have the skills to work independently as well as in the team based, integrated care model.” (Emphasis added)

An article in the local Journal Sentinel provides additional clarity: “Chiropractors would have to complete an accredited master’s program and 500 hours of clinical training to become primary spine care practitioners. They would be licensed by the Wisconsin Medical Examining Board and the Chiropractic Examining Board.” In the same article, Rod Lefler, DC, president of the Wisconsin Chiropractic Association, “estimated that 10% of the state’s roughly 2,000 chiropractors might be interested in getting additional training and becoming primary spine care practitioners.” [6]

According to Dr. Gene Yellen Shiring, chair of the WCA Government Affairs Committee, “[T]raditional chiropractic offices could integrate a Primary Spine Care Practitioner into their practice and manage cases from a conservative perspective, coordinate interventions, order advanced special studies and procedures and achieve better patient outcomes.”7 (Emphasis added)

The language used in much of the information provided by the WCA reveals the association’s perceived superiority of the primary spinal care practitioner health care profession. As emphasized above, these include the ability to “better serve their patients,” “achieve better patient outcomes” and “allow chiropractors to have the skills to work independently as well as in the team based, integrated care model.” (See “Creating Our Own Competition” for a further discussion of this issue.)

An email from the bill’s authors notes, “[Th]is bill would grant an expanded scope of practice to chiropractors who become PSCP’s that would include the ability to order advanced imaging, the ability to order advanced studies, procedures and the ability to proactively manage over-the-counter medications and pharmaceuticals.” [3] (Emphasis added)

What still isn’t clear to anyone is the point of all of this effort. As the Journal Sentinel article points out, “[Th]e shortage of primary care physicians in Wisconsin … is limited to rural areas. The state also has a growing number of nurse practitioners and physician assistants who provide primary care.”

In the same article, Jay LaGuardia, DC, president of the Chiropractic Society of Wisconsin, notes: “No one in the public is clamoring for chiropractors to be able to prescribe medications.”

And Joseph Kerschner, dean of the school of medicine at the medical college where the WCA hopes the PSCP master’s degree will be offered, adds, “We are not advocating for the chiropractors to have this enhanced role.” [6]

This all leaves too many unanswered questions, including the following:

  • Why is the WCA leadership spending so much of its members’ resources to create a new health care profession that will compete directly with the chiropractic profession for the potential benefit of only 10 percent of its members?

  • How does the current WCA leadership hope to represent two competing professions when meeting with legislators, third-party payers and the public?

  • How long before nurses, physician’s assistants, physical therapists and others are able to take coursework to become PSCPs?

  • Being educated by the Medical College of Wisconsin and governed by the Medical Examining Board, what’s to keep the new PSCP from becoming a medically controlled profession?


References:

  1. Legislative Analysis:
    The PSCP Proposal. Wisconsin Chiropractic Association; analysis by Legislative Reference Bureau.

  2. Filling the Shortage of Primary Care Health Care Providers in Wisconsin: The Primary Spine Care Physician, a New Class of Health Care Provider.
    Wisconsin Chiropractic Association Policy White Paper.

  3. E-mail from Senator Frank Lasee and Representative Joe Sanfelippo
    on Feb. 5, 2016, regarding “Co-sponsorship of LRB 3787/1 –
    Re: Creation of Primary Spine Care Practitioner.”

  4. State of Wisconsin 2015-2016 Legislature LRB−3787/1.

  5. WCA Executive Director Dr. John Murray’s letter to the membership.

  6. Boulton G.
    “Medical College of Wisconsin Would Consider Master’s for Chiropractors.”
    Journal Sentinal, Feb. 9, 2016

4 comments to Is the WCA Trying to Create a New Profession?

  • Frank Painter

    JMHO, this is the first “expanded practice” group I have encountered that appears to be doing everything right.

    I have registered my opinion on all this previously (see references below), with the biggest issue being the massive push-back this will generate from the many related medical communities, but then again, its not my fight.

    They are designing a specialty program (like a mini-diplomate program) and are securing training from an established Medical institution, with registration and oversight being co-managed to assure quality.

    So, even though they are only creating a sub-specialty of chiropractic and not a whole new hybrid, they are certainly calling down the hounds of hell upon themselves (AMA and State Medical groups a-plenty).

    it does appear (at least from a distance) that they have constructed a sensible program for their initiates. Only time will tell if this will pan out for them.


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

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

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

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

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

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

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

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

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

  • Peter G. Furno, DC

    When all the dust settles the fundamental question still becomes whether or not we want to continue to be a so-called health care profession on the outside looking in.

    For years we as a profession pointed fingers at mainstream medicine bugging our eyes and frothing at the mouth shouting discrimination and all sorts of other paranoiac issues. Yet, concurrently we realize that we must be accepted in main stream health care to survive as a profession – but we continue to demand separatism. What a conundrum.

    The Wisconsin recommendations is the first step towards legitimization of the chiropractic profession – the integration of chiropractic with mainstream medicine.

    For over 100 years we have lacked cultural authority. Although we can debate the various reasons for this until the cows come home, the fact remains we have always been regarded as a quasi-profession because of our lack of cultural authority, regardless of all the research the chiropractic profession has accomplished over the past two decades.

    The salvation of the chiropractic profession hinges on whether or not we accept and join forces with mainstream medicine. Pure and simple. Getting rid of the private, self-serving, so-called chiropractic “universities” will be a major step in that direction. With chiropractic students attending basic science courses with medical students in a State medical school, and later branching out into their separate specialty studies will make for a gigantic step towards cultural authority and hence acceptance into mainstream health care – the survival of chiropractic as an individual profession.

    But, what are we seeing? A tsunami of dissension! Let’s keep on doing what we’ve been doing for the past 100 years and expect a different outcome! What did Einstein say about that? Let’s call for equality with all health care professions, but refuse to meet the stipulations for acceptance. Let’s keep pointing fingers and having pity parties without realizing that other professions like the PTs are bypassing us – obtaining the DPT and doing SMT to our exclusion. Then, we’ll wake up and want to know what happened? And we’ll continue with our pointing of fingers and our pity parties!

    • Frank Painter

      Dr. Furno

      Thanks for your response.

      Although I appreciate your conviction, I believe you may have glossed over several glaring historical realities.

      Your comment that:

      For years we as a profession pointed fingers at mainstream medicine bugging our eyes and frothing at the mouth shouting discrimination and all sorts of other paranoiac issues.

      seems to ignore that we were, in fact, suppressed by Organized Medicine for almost 100 years.

      I certainly agree that future students would benefit from attending Universities to take their classes from leaders in each subject, but don’t forget that the AMA et al. prevented their own MDs from teaching at our own schools, threatening them with loss of hospital privileges. They were the barrier, not us.

      I think we are all at a place where we would benefit from burying the hatchet and moving on. I hope that this Wisconsin program bears fruit.

      However, ignoring the lessons of history is the first step towards being marginalized within a whole new framework, managed by a profession that prefers dominance to cooperation.

      Spouting phrases like:

      “cultural authority”,
      “integration”, and
      “survival of chiropractic”

      come from your lips like salvation for the oppressed masses, but they also smack of histrionics, and pandering.

      I wish this program well, but I am keeping my eyes open for the “tell”.

  • Peter G. Furno, DC

    I am well aware of the historical time-line vis-a-vis chiropractic vs. medicine. It was through the Flexner Report that medicine pulled itself up by its boot straps, based its teachings on the scientific method and thereby ensured for itself a cultural authority that exists to this day – regardless of all the “medical mistakes”, patient deaths and pharmaceutical errors.

    On the other hand, chiropractic chose to take an antagonistic, pseudo-scientific, semi-religious stance towards scientific endeavor generally, carving out a niche for itself in the annuls of questionable and non-evidence based therapeutics.

    It was only in the ’90s, with a steadily declining market-share (15% then, to about 5% now)did chiropractic begin to realize that 90% – 95% of its patient-base was under the control of mainstream medicine, and an effort to access that patient-base was instigated.
    The tools used to give credence to our cause was utilization of the Scientific Method – which so far has increasingly supported our claims with regard to painful and ubiquitous bio-mechanical dysfunctions of the spinal column and in some headache conditions.

    That being said, the tide is slowly beginning to turn, to wit, the University of Pittsburgh Medical Center (January 2012), mandating first-line conservative care (chiropractic included), for 3-months prior to consideration of advanced imaging and surgical consult, for all non-specific/uncomplicated spine pain. Slowly chiropractic increases its cultural authority within mainstream health care, as specialist-providers in the field of musculoskeletal conditions – but only musculoskeletal conditions.

    However, in my opinion, “Cultural Authority” has much more to do with the public’s perception of our profession, rather than acceptance by the medical profession, per se. In most public polls taken on professional trustworthiness, honesty and professionalism, chiropractic is always way down the ladder. Why is that?

    The reason is because the public does not perceive us as “real” health care providers – yet! Once they do, our market share will surely increase as we slowly are considered first-line providers in the musculoskeletal field.

    For this to happen chiropractic must do the obvious – as the podiatrist’s and osteopaths did in the ’60s – increase our perception in the public eye as real doctors, be educated in real universities with legitimate and real health care training. Only then will the public grant us cultural authority, which will open the door to mainstream health care and that massive patient-base awaiting us.

    I spent Christmas in Zurich with a chiropractic colleague I went to school with here, and who now practices as a neuro-musculature specialist within a 9-man group of neurosurgeons. Zurich University Medical School runs a parallel chiropractic course within their university, which accords the graduating chiropractor the prestige of cultural authority within the public domain immediately upon entering private practice. This avenue should have been explored years ago by our leaders, instead of insisting upon “separateness”.

    Now Wisconsin has taken the first step. In the right direction I think.
    I am not lost on the history of our profession and the adversities we have faced. However, I, like you, believe we should bury the hatchet and get on with preserving our future.

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