This concept of certification has always been a part of the chiropractic MUA courses, like that of the original Texas College of Chiropractic, taught back in the early '80s. The concept has not changed for our profession. There are not as many chiropractic colleges teaching MUA as there were at one time, but the idea of certification from a CCE-accredited chiropractic college on this procedure has not changed.
In 1995, the National Academy of MUA Physicians (NAMUAP) was formed by a group of multidisciplinary physicians to formulate national standards and protocols for the MUA procedure.2 It was the hope of this initial group that state boards, insurance carriers, and anyone else interested in MUA standards and protocols could use these as a source for the betterment of the procedure, and as a guide for its proper performance.
The standards and protocols that were established have been well received by many as an evolutionary guide for the MUA procedure. The NAMUAP is now also affiliated with the American Academy of Pain Management, and is considered a nationally recognized organization. The best part of these standards and protocols has been to establish forms of progression for patient selection, for proper quality assurance parameters for doctors, nurses and facilities, and for establishing a format for patient outcome assessment.
The other important part of the NAMUAP standards and protocols is that they validate the credibility of having certification taught through CCE-accredited chiropractic colleges or CME-accredited institutions.
It is vital that we have the highest quality assurance parameters that we can achieve for the MUA procedure. To do this, we must require the highest standards of education that we can achieve. To take this program through a non-CCE-accredited or CME-accredited program is cause for concern if we are interested in making MUA a standard of care in the general arena of pain management for neuromusculoskeletal conditions.
How can we ask for inclusion in the multidisciplinary pain management arena if we take a course in MUA that is not affiliated with any accreditation standards? If you do take one of these nonaccredited courses, will that group support you if the worst scenario happens and the patient has a problem that turns into a malpractice case? It is quite evident that the malpractice carriers are interested in this information. To cover a doctor for the MUA procedure, most quality malpractice carriers want to know where the doctor got the training and request a copy of the MUA certificate. It is very important that our malpractice carriers confirm that the course that the doctor takes is approved through a CCE-accredited institution, and that the certification is backed by an accredited postgraduate education program.
Another important fact about state "scope" issues is: If you take a course that is not through an accredited chiropractic college, then you are not following the "scope of practice" act in your state, which basically states that as long as the course that you take is taught through a CCE-accredited chiropractic college, the course falls within the scope of chiropractic practice.
A statement from the North Carolina Board of Chiropractic in August of 1994 summarized the endorsement of one board that recognizes MUA as being within the scope of chiropractic in the state by saying: "Manipulation of a patient under anesthesia by an MUA-trained chiropractor is within the scope of chiropractic in North Carolina. MUA is an exceptional combination of effective pain management procedures that has expanded the option to help relieve persistent pain. MUA is not an experimental procedure. It is well established within the chiropractic and medical communities, and the utilization of MUA has been enhanced by the professional cooperation of these two professions."3
The other aspect of certification involves the facility where you want to practice the MUA procedure. All facilities will want to know where you got your training, whether that training was completed through your profession, and whether that training was through an accredited institution. They have to know this if they are accredited and licensed. They are required to carry liability insurance on their facility and that liability program includes information about the educational background of all staff members that perform procedures in their facility. If your facility is accredited by the Joint Commission on Accreditation of Health Care Organizations, you will not practice in their facility unless you can show certification by a higher education/professional institution that has granted you certification to perform MUA. A course that is not taught through an accrediting institution will leave a facility high and dry if something were to happen to a patient of a doctor who did not take a properly certified MUA course through an accredited institution. Audits are almost a routine part of pain management facilities these days, and they will not let doctors who have not taken properly credentialed training use their facilities. Facilities that don't have the highest standards may let you practice MUA if you didn't take a CCE-accredited MUA course. But do you really want to leave yourself open to that liability, if something were to happen to one of your patients?
I would hope that all doctors who practice MUA would want only the highest standards of care for their patients, and only the highest of standards for the facilities where they practice the procedure. A CCE-accredited chiropractic college MUA program is going to teach these standards, ones that have been established by the NAMUAP for doctors, anesthesiologists, nursing, and facilities.
I think it is very important that if we are going to have this procedure in our profession that it be taken very seriously. Results achieved using the MUA procedure over the past 60 years since its inception have demonstrated its value as a very real part of the pain management arena. If you are going to take this educational training and become part of the fraternity of practitioners who have learned to practice it, then please consider taking a CCE-accredited chiropractic college program. Those of us who have taken the training, and those of us who teach, hope that you will join us as educated colleagues. What scares us, however, are doctors practicing this procedure who have taken the MUA course by means other than through accredited institutions. So far nothing has happened - but it only takes one mishap with a patient to cause trouble for all of us. If you are planning to take the MUA course, please consider the importance of taking it through a CCE-accredited chiropractic college program. The fees for tuition are sometimes less, and the credibility is so much better for you, your patients, and the facilities that you seek out to perform the procedure.
Editor's note: Dr. Gordon is a full-time postgraduate faculty member of the Lincoln School of Postprofessional and Continuing Education, a division of the National University of Health Sciences (formerly the National College of Chiropractic). For more information about the NAMUAP, please contact the academy (636) 256-0125.
References
1. Siehl, D. and Bradford, W., Manipulation of the low back under general anesthesia, J. Am. Osteopath Assoc. from the article (Persol's International Med. Clinic Case Study 1938; Dec., 239,1952.
2. The National Academy of MUA Physicians, Standards and Protocols, Headquarters: NAMUAP, 14319 Manchester Road, Manchester, MO 63011, 1995. 3. North Carolina Board of Chiropractic Examiners position statement: Taken from Williams H. Manipulation Under Anesthesia: Part I Review of the Literature and Discussion of the State of the Art. ACA J Chiropractic, Dec., 1997.
3.North Carolina Board of Chiropractic Examiners position statement: Taken from Williams H. Manipulation Under Anesthesia: Part I Review of the Literature and Discussion of the State of the Art. ACA J Chiropractic, Dec., 1997.
Robert C. Gordon, BS,Ed,BS,Bio,DC,DAAPM
Miramar, Florida