The Chiropractic Scope of Practice in the United States: A Cross-sectional Survey
SOURCE: J Manipulative Physiol Ther. 2014 (Jul); 37 (6): 363–376
Mabel Chang, DC, MPH
National University of Health Sciences-Florida,
Pinellas Park, FL.
OBJECTIVE: The purpose of this study was to assess the current status of chiropractic practice laws in the United States. This survey is an update and expansion of 3 original surveys conducted in 1987, 1992, and 1998.
METHODS: A cross-sectional survey of licensure officials from the Federation of Chiropractic Licensing Boards e-mail list was conducted in 2011 requesting information about chiropractic practice laws and 97 diagnostic, evaluation, and management procedures. To evaluate content validity, the survey was distributed in draft form at the fall 2010 Federation of Chiropractic Licensing Boards regional meeting to regulatory board members and feedback was requested. Comments were reviewed and incorporated into the final survey. A duplicate question was imbedded in the survey to test reliability.
RESULTS: Partial or complete responses were received from 96% (n = 51) of the jurisdictions in the United States. The states with the highest number of services that could be performed were Missouri (n = 92), New Mexico (n = 91), Kansas (n = 89), Utah (n = 89), Oklahoma (n = 88), Illinois (n = 87), and Alabama (n = 86). The states with the highest number of services that cannot be performed are New Hampshire (n = 49), Hawaii (n = 47), Michigan (n = 42), New Jersey (n = 39), Mississippi (n = 39), and Texas (n = 30).
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CONCLUSION: The scope of chiropractic practice in the United States has a high degree of variability. Scope of practice is dynamic, and gray areas are subject to interpretation by ever-changing board members. Although statutes may not address specific procedures, upon challenge, there may be a possibility of sanctions depending on interpretation.
KEYWORDS: Chiropractic; Health Resources; Health Services; Legislation; Licensure
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Chiropractic is the third largest health profession in the United States and the largest and most recognized of the complementary and alternative professions.  Chiropractors in all 50 states, the District of Columbia, Puerto Rico, and the United States Virgin Islands provide direct access care to patients. 
Scope of practice is the regulation of professionals in a specific jurisdiction and is used to legally create boundaries by restricting the allowed activities for a specified profession.  Its purpose is to protect the public by setting legal limits for what a provider can do, and it can be used as a means to define a profession in a particular locale. [3–5] Some scholars counter that practice laws have failed to protect the public but have been used as a tool to limit competition. [6–12]
Practice laws are the responsibility of each state, and this has caused variations in scopes of practice for a wide variety of health professionals. [3, 13–17] The United States does not have a unified scope of practice for most health care professionals. This has contributed to fragmentation of health care across jurisdictions. The only health care professionals that have a unified scope of practice across state lines are medical doctors and doctors of osteopathy.  The medical profession was the first to have licensure standards, and because they were the first to become licensed, their scope of practice is uniform and broad. [4, 5, 18] As each health care profession sought licensure, the American Medical Association aggressively defended their practice rights and ensured that limitations were put on other professions. [7, 18–21] It should be noted that all health professional organizations have followed the same tactics in defending their practice rights. [22, 23]