The University of Bridgeport, College of Chiropractic Student Government Association sponsored a panel discussion on Oct. 25, 2016. The discussion topic, "primary spine care practitioner," was addressed by eight chiropractors including a past president of the ACA, the president of both state associations, four UBCC faculty members and one state association board member.
The dialogue led to a pertinent question from the audience, "What is chiropractic?" After listening to various definitions from the panel and the audience members, I responded that "chiropractic" is defined by each of our individual practice act and the definition varies from one state to another.
Different States, Different Definitions
Am I wrong? Well, let's examine each of the three practice acts from Connecticut, New York and New Jersey, comparing the definitions of chiropractic and the number of words necessary to describe our profession.
Connecticut
Chapter 372: Sec. 20-24. Definitions. (72 words):
(1) The practice of chiropractic means the practice of that branch of the healing arts consisting of the science of adjustment, manipulation and treatment of the human body in which vertebral subluxations and other malpositioned articulations and structures that may interfere with the normal generation, transmission and expression of nerve impulse between the brain, organs and tissue cells of the body, which may be a cause of disease, are adjusted, manipulated or treated.
New Jersey
45:9-14.5. Definitions relative to practice of chiropractic. (116 words):
"Practice of chiropractic" means a philosophy, science and healing art concerned with the restoration and preservation of health and wellness through the promotion of well-being, prevention of disease and promotion and support of the inherent or innate recuperative abilities of the body. The practice of chiropractic includes the reduction of chiropractic subluxation, and the examination, diagnosis, analysis, assessment, systems of adjustments, manipulation and treatment of the articulations and soft tissue of the body. It is within the lawful scope of the practice of chiropractic to diagnose, adjust, and treat the articulations of the spinal column and other joints, articulations, and soft tissue and to order and administer physical modalities and therapeutic, rehabilitative and strengthening exercises.
New York
6551. Definition of practice of chiropractic. (58 words):
The practice of the profession of chiropractic is defined as detecting and correcting by manual or mechanical means structural imbalance, distortion, or subluxations in the human body for the purpose of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column.
Why That's a Problem
The University of Bridgeport offers a Doctor of Chiropractic program that teaches students the importance of evidence-based practice, patient-centered care, differential diagnosis and high-quality care for patients suffering with diseases. I stress to my students that diagnosis is the key to successful treatment. The students realize that a differential diagnosis must proceed treatment of patients.
Although these professional students are taught evaluation and management of spinal conditions along with other neuromusculoskeletal conditions that cause acute or chronic pain, it is my opinion that the three practice acts do not entitle our graduates to use the term primary spine care practitioner. All three laws do entitle our graduates to use the term chiropractor or doctor of chiropractic.
Since many of our students remain in Connecticut and quite a few of them return to New York or New Jersey to practice, is it reasonable to change our practice acts to include the use of the title, primary spine care practitioner?
Is it time to address the antiquated language that narrows the scope of practice of chiropractic in all 50 states? When I have posed this question to chiropractic leaders, I frequently hear that we should not attempt to change the laws. Why? I ask. Usually, the response is that if we open the law, we might have a negative outcome.
I do not consider this defensive position be reasonable, evidence-based or patient-centered. Certainly New Jersey chiropractors comprehend the value of updating their practice act, which once prevented them from examining and treating patients with extremity conditions.
Threats to Our Scope
Recently, the Texas Medical Association (TMA) claimed victory over the Texas Chiropractic Association with the following statement:
We won! In a final judgment by Travis County District Court Judge Rhonda Hurley, TMA prevailed in its long-held declaration that the Texas Board of Chiropractic Examiners' (TBCE's) rules permitting chiropractors to make medical diagnosis and perform other medical procedures exceed the chiropractic scope of practice.1
The TMA claimed that the regulatory boards cannot expand scope of practice without legislative action. As a consequence of the voiding of the TBCE's rules, chiropractors in Texas may no longer use the term diagnosis or claim subluxation complex to be a neuromusculoskeletal condition, because such actions exceed the scope of practice as defined by the Texas Occupations Code.
Should the chiropractic profession consider a single definition that enables the expansion of scope of practice based upon chiropractic education and credentialing, rather than restriction to a narrow scope based upon dogmatic concepts?
I am tired of the antiquated and restricted practice acts, and Medicare's ridiculous scope of practice and reimbursement schedule! It is time for the use of one definition based upon chiropractic education and credentialing offered in CCE-approved chiropractic colleges. We must prevent another medical association attack on our scope of practice, as experienced in Texas.
A Proposed Definition
To stimulate thought and discussion, I offer the following definition (26 words) of chiropractic for your consideration:
The evidence-based practice of differential diagnosis, patient-centered treatment and prevention of pain and human disease as taught by CCE-approved chiropractic colleges/institutions/schools.
By way of comparison and as a final point, here's the Oxford Dictionary definition of medicine (12 words):
The science or practice of the diagnosis, treatment, and prevention of disease.
Reference
- "Court Sides With TMA in Final Ruling on Chiropractic Scope of Practice Lawsuit." Action (Texas Medical Association newsletter), Nov. 1, 2016.
Click here for previous articles by James Lehman, DC, MBA, DIANM.