Category Archives: Politics & Chiropractic

Physical Therapists Want to Be Chiropractors

This has been an ongoing discussion in this country over the last few years.  Despite what they sometimes tell the public physical therapists (PTs) know that chiropractic manipulation works, which is why they want to be allowed to do it.  The most recent story about this came yesterday as PTs in Washington state  have a bill submitted to their legislature that would give PTs the ability to perform spinal manipulation if it passes.

The primary problem with allowing PTs to adjust is one of public safety.  initialsIn most studies conducted about manipulation the reports of injuries are disproportionately caused by non-chiropractors. To begin with not all physical therapy schools teach manipulation as part of their curriculum.  Yet this bill would allow all PTs who graduate this year or later to adjust regardless of their education in the subject.  Of those schools that do teach manipulation most of them include it in the form of a single integrated science course.  Some offer it as a weekend seminar, and some offer a single dedicated course in adjusting.  The best I found offered by a physical therapy school was about 100 hours of training in manipulation.  (Please tell me if you find one with more.)

“…the WHO has established a minimum of 2,200 hours of additional training for any other regulated health care professional, whose scope of practice includes the controlled act of manipulation, and who wishes to become proficient in the assessment and diagnosis of neuromusculoskeletal conditions and the application of spinal manipulation to address those conditions.”

The full guide is here if you’d like to read it, but essentially, in order to practice manipulation safely the World Heatlh Organization (WHO) says that even fully trained medical professionals of other professions who want to utilize manipulation should have at least 1000 supervised clinical hours of training in that subject.  No PT school offers that.

Among the reasons that the original article gives for allowing PTs to adjust is, “Washington is one of only two states (Arkansas is the other state) in the nation that prohibits physical therapists from performing this procedure.”  This is false.  Here in Utah, and about half of the other states PTs are strictly prohibited from performing spinal adjustments.  Though they are allowed to do mobilization which is probably what they are refering to.  Mobilization is limited by range of motion and velocity.  It is not manipulation.

Utah is not immune from this issue.  In years past PTs in Utah have attempted similar legislation and were unsuccessful, however this is a new year and a new legislature.  For those of you in Washington please contact your legislator and let them know of your concern for public safety with this bill.  If you are in Utah, know that the PTs are submitting new legislation this year.  I don’t know what is in that legislation.  We need to keep our eyes open.  They have tried to get this before and they may try again.

Don’t get me wrong.  I want people to be adjusted.  I think that any person dealing with health care should be adjusting people, if they have the training to do it safely.  But if they had the training they’d be chiropractors. -sigh-


Obama Win May Mean Commissioning of Chiropractors in the Military

I’ve always tried to avoid talking politics on this blog, which for me is difficult, as I’m very patriotic and interested in the function of our government.  However, I thought today I would weigh in on how the election may effect the profession of chiropractic, without trying to give away my leanings. 

Regarding chiropractic, President Elect, Barack Obama has recently said, in a letter to the American Chiropractic Association,

“We need to expand the range of chiropractic services covered by Medicare, facilitate integration of doctors of chiropractic into the health care systems of the Department of Veterans Affairs and Department of Defense, and allow commission of doctors of chiropractic as officers in the Commissioned Corps of the U.S. Public Health Service”

This may be a prime time for chiropractors to get some good policies in place, to push for commissioning of chiropractors in the military and getting all of our troops the chiropractic care they need and deserve.  I urge all chiropractors, patients, friends and family to look into your newly elected officials.  What ever their policies and agendas may be they are our elected officials, and represent us, and now may be a prime season to move the cause of chiropractic forward.

Election day is not the only day that we should participate in our government.  It is a government by the people.  Our representatives need to hear from us now as they are preparing for the transition.  If we let them know what we want done now we may be able to get something done before they start running for re-election.

There are still two resolutions sitting in committees in congress.  Let’s get chiropractors commissioned in this election cycle!

Celebrate Your Independence

Independence Day means something only if we make it mean something. (I actually prefer to use that name for it instead of the 4th of July.) If we choose not to remember, and not to do anything with the freedoms that we have they will be taken away. There are people in the world who don’t want us to be free. The best way to stay free is to use freedom, love it, live it. Watch fireworks and remember. Eat BBQ and teach your children why we are able to do just that. Enjoy each other. I wish you all the happiest and healthiest Independence Day ever.

We have soldiers who love freedom, and are fighting for it. We can remember our freedoms by remembering our soldiers. We can also remember by being active in our communities and in our government. Right now the chiropractic profession is trying to use that freedom and trying to give something back to our soldiers at the same time.

There are currently three bills before congress that chiropractors are trying to advance. The first two are HCR 294 and SCR 75. These bills express the desire of congress that the Department of Defense (DoD) commission chiropractors in the military so that all of our soldiers may benefit from our care, not just those here stateside. The other bill is HR 5658. This has already passed the House and is soon to be debated in the Senate. This is the 2009 DoD funding bill. The House put in a section funding the placement of chiropractors at all military treatment facilities. So that all of our troops would be able to receive the best treatment options for the number one injury to our soldiers, musculoskeletal conditions. This will not commission chiropractors, but it will at least provide their services to those soldiers who need it the most.

You can celebrate your independence by being a part of this effort. Click here to help, and Happy Independence Day.

Disturbing News and a Lesson to Learn

Recently in California a man was arrested for more than one reason. He was practicing chiropractic without a license, in so doing he had snapped a mans neck, killing him. This man had set up shop without training. It is not easy to break someones neck and kill them. Especially not on accident. This man got very unlucky. It doesn’t happen like in the movies, but as we can tell from this one incident, training does matter.

Oddly enough he will probably be charged with practicing medicine (not chiropractic) without a license. This topic has bothered me for some time, that of scope of practice. Law makers have always been very careful to limit health care providers scope of practice to that which they are trained. Every provider has a limited scope of practice except one group. Medical doctors have no limitation on their scope of practice. Go ahead, try to find a limit for a medical doctor. Generally definitions of the practice of medicine include:

the diagnosis, treatment, correction, advisement, or prescription in any manner or by any means, methods, or devices, any human disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real or imaginary.

This is ridiculous. Medical doctors train for 4 years and then are given leave to do anything. Recently the American Medical Association created the Scope of Practice Partnership not to determine what scope medical doctors should be limited to, but how others should be limited. This has often been referred to as a turf war.

“While nonphysician providers have been, and will continue to be, important elements in the provision of health care, it is important that our patients know and receive the care that only physicians are uniquely qualified to provide,” said Dr. Michael Maves, the AMA’s executive vice president and CEO.

Medical doctors are uniquely qualified. And should be limited to their unique training. I think Scope of Practice limitations are a great idea, and should be set by each professions education. I think that you should be allowed to do what you have been taught to do.

In light of this recent article I think that it is obvious that someone not trained in chiropractic such as a medical doctor should not be allowed to practice it. The same goes for all health care providers. If you want to utilize a treatment method, you should be trained to do so. Schools should recognize the training of other professionals and offer accelerated courses to allow providers to receive additional training.

I guess what I’m saying is: Medical Doctors should have a limited scope of practice.

Do Chiropractors Practice in Hospitals

The full question was Are chiropractors allowed to practice in hospitals or use medical outpatient facilities? I think the real question is, why don’t chiropractors work in hospitals.

The answer is, some chiropractors do practice in hospitals, though they are few and far between. There are none here in Utah were I practice. Chiropractors have in their scope of practice the ability to order lab tests, MRIs, etc… Hospitals and labs across the nation honor this, and will perform medical outpatient procedures for chiropractors.

Here are some, of the many possible reasons chiropractors aren’t working in hospitals:

  • Doctors are trying to get out of hospitals. Hospitals tell you how you can practice even more than insurance companies do. They set your income, rather than your earnings being determined by your efforts. They set what you do and how much you will be paid for it, they are a business after all.
  • Politics of the past, medical doctors and chiropractors did not get along well. We are very near the end of that era, but there is still some animosity between the older generation on both sides, and it sometimes will trickle down into the younger doctors. That inhibits some from joining forces.
  • Hospitals don’t really know what to do with chiropractors. They have a structure, and chiropractors don’t fit well into it. Even if we did, they don’t know what we can do, or how to bill for it. It would take some effort to integrate a chiropractor into a medical system, and there aren’t really many models to work from.

Hospitals are always looking to improve patient satisfaction. Chiropractors have the highest patient satisfaction rating in healthcare. A way that we can improve that rating for a hospital is by offering relief and improvement where previously there was none. The two places I would begin is in the Emergency Room, and the Women’s and Children’s department.

The ER sees many cases where people just want to make sure things are not life threatening. The prime example is a car accident. Even if you don’t feel really bad after an accident it is a good idea to get checked out, just in case. When the ER finishes it’s tests and finds nothing broken or bleeding they usually send you away with serious pain killers to cover the pain of your “whiplash”. These are the kind of things that chiropractors deal with all of the time. We can reduce the healing time, and treat the issue without masking it with medication.

The same kind of thing is important for expecting mothers. They visit their OB in the hospital for their back pain. There isn’t much that they can take, medication wise, due to possible effects on the baby. This leaves the doctor with few options. Chiropractic is a proven medication free treatment that can relive the back pain of pregnant patients.

Hospitals can be a great help to chiropractors also. There are many times that chiropractors will find something that needs to be treated, but the pain that the patient is in is too much to allow chiropractic manipulation. Muscle relaxants and pain medication in these situations can allow a chiropractor to perform the needed procedures. Not to mention the many illnesses that chiropractors find that are out of their scope for treatment. Being in a hospital would allow them ready access to the best person for the job.

I think that hospitals incorporating chiropractic would be a great synergistic relationship. I hope that Utah hospitals will soon be open to this kind of opportunity. Things would improve, even if they just set up a working relationship with each other. They don’t have to be in the same building.

Brief Update RE: Commission Chiropractors

Total co-sponsors of the House Resolution 294 are up to 20 now. The most recent addition signed on just yesterday. For details see www.CommissionChiropractors.com. The Senate Resolution is moving well also, but they both still need your support. Please give your stories, and your support. Let’s get our troops the care they need and deserve.

The Department of Defense Answered Me

After months of waiting and re submitting I finally received an answer from the Department of Defense today. Here’s the story of how it happened, paper trail included. I found the DoD contact site and it is basically a database of previously answered questions (a knowledge base). So I looked through the KB and did not find any reference to my question, so the last option they give you is to ask a question. I did. here it is:

Question Reference #080225-000014

Category Level 1: Department of Defense Category Level 2: Military Healthcare/TRICARE

Date Created: 02/25/2008 02:47 PM The DoD has authorization and has been requested by congress to create a career path for chiropractors in the military. There is a new House Concurrent Resolution 294 renewing this request. What is the reason behind not commissioning chiropractors yet, and is there a plan to do so in the near future?

I think my first mistake was claiming that a career path has been requested. That’s not entirely true. Commissioning chiropractors was mentioned in previous legislation, but the desire to get soldiers the care was the priority. It is also my desire to get soldiers the chiropractic care that they need, and I would be fine if the DoD had actually followed through with their plan to do just that, but the problem is that they haven’t. It also seems simpler to commission chiropractors and send them where ever needed than to try to get civilian DCs to go to a war zone. Anyway, the replies came quickly and repeatedly:

Auto-Response – 02/26/2008 03:26 PM

Auto-Response – 03/24/2008 02:36 AM

Auto-Response – 03/26/2008 07:35 PM

These auto responses were merely KB articles that had nothing to do with my query, but were merely FAQs. I was sent these replies and my question was given a status of Solved. I then updated the query as follows:

03/26/2008 07:35 PM Why was this question marked resolved. I looked through each of these auto-response articles, and none of them had anything to do with commissioning chiropractors in the military. I repeat the question, What is the reason behind not commissioning chiropractors yet, and is there a plan?

This update was followed by:

Auto-Response – 03/27/2008 03:11 PM

Auto-Response – 04/04/2008 05:22 PM

To which I responded:

04/04/2008 05:22 PM The auto response is always the same, and does not relate to my question. Please respond.

I got back:

Auto-Response – 04/07/2008 10:09 AM

Auto-Response – 04/07/2008 10:32 AM

You may have guessed I was getting sick of this and resolved to just keep checking the status and not do anything unless they tried to mark it resolved again. My patience paid off. Today, I was rewarded with this (emphasis added):

Recently you requested personal assistance from our on-line support center. Below is a summary of your request and our response.

Thank you for contacting the Department of Defense…

…We are the Office of Public Communication, a part of the Office of the Assistant Secretary of Defense for Public Affairs…

…Response (jclark) – 05/06/2008 02:30 PM

Dear Chris Duncan:

Thank you for your comments and for taking the time to contact the Department of Defense.

We apologize for the delay in responding to your e-mail. We appreciate your e-mail and thank you for your interest.

We’ve tried to find a definitive answer to this query but the unofficial word is there are no plans to make a career field for chiropractors because the services are able to supply the service through civilian practitioners. The understanding is that Congress only required the service, not to put chiropractors in uniform.

The Office of Public Communication

USARCENT image

OK! So the official, unofficial answer is basically, we’re not gonna do it. My knee jerk reaction was to yell at someone, “If the Services are supplying chiropractic then why are soldiers still coming to me paying out of pocket to see a chiropractor and telling me they can’t utilize the TRICARE benefit?” The answer is that only around 40 of the over 200 military treatment facilities provide “the service.” You know that service that was guaranteed to them years ago. The nearest site for the soldiers returning to my area to be treated is in Colorado, and I’m in Utah.

That was my knee jerk reaction. After having thought about it for a little while I decided just to take action instead of being angry. It’s OK that I’m passionate about providing for the troops, but being angry doesn’t help anyone. So, here’s what I did. I gave a copy of the email to www.commissionchiropractors.com and now I’m blogging about it. Hopefully I will get others to read this blog and do something about it. Try visiting that site, look at some of the information, and help out if you can.

I’m an Army brat that would love to serve my country in my current profession, but I’m not allowed to serve those who I think need it the most. Please help out.

Hawaii the Navy and Me

Exactly 4 weeks ago I applied for a civilian position with the US Navy. I figured that this would be one step closer, and put me in a better position to talk to people about commissioning Chiropractors in the Militarychiropractors. So far, no news. The application says that they will let me know one way or another, but 4 weeks, wow. I guess that’s good news. They would have sent me a letter already if I wasn’t even in the running, right? So, to keep up my optimism I thought I’d let everyone else know how great it is to not know if I’ll be heading to Hawaii soon.

Even if I don’t get the position with the Navy I plan to keep up with the goal to get chiropractors commissioned. I have sent letters/email to every candidate for president asking their position on the topic, and why they haven’t signed up to cosponsor the current resolutions. The current senate resolution is in the Armed Services Committee which both Hillary Clinton and John McCain sit on. I would hope that they would respond regarding a resolution that is before them at this time.

The house bill is faring a little better. The committee there has co-sponsors of the bill in the committee. A congressman from my state sits on that committee, but will not respond to me because I am not in his district. My call to everyone else out there if you have a Senator or Rep. who represents you please contact them, find out their position on this topic and urge them to co-sponsor the resolutions (HCR 294 & SCR 75). Then, report back to me so I can post their responses.

To find who your representatives are visit www.commissionchiropractors.com. The get involved section there will link you to find your reps. There is all sorts of other good information there also.

Commission Chiropractors in the US Military

Many of our brave soldiers serving overseas have been promised chiropractic care in their health care benefits, but are not able to access them because there are no chiropractors commissioned in the military to be stationed overseas with them.

Soldier

The history of chiropractic support of our military personnel is long. In 1944 the first bill to commission chiropractors was introduced in the United States Congress. In 1985 the DoD was directed to determine cost effectiveness of chiropractic. The first President Bush authorized the DoD to commission chiropractors in 1992. The Chiropractic Health Care Demonstration Program (CHCDP) that ended in September 1999 showed overwhelmingly that chiropractic would be beneficial to our troops and to the military. It was replaced by the Chiropractic Care Program in 2001, which was to extend chiropractic care to all active duty military personnel by 2003. In 2004 the Secretary of Defense was required to speed up the implementation of this program so that all service men and women would be able to access chiropractic care by October of 2005. Currently in 2008 according to Tricare’s website, barely a fifth, 49 of 232, Military Treatment Facilities (MTF) offer chiropractic services. This information is from www.commisionchiropractors.com. Please visit there for additional information.

Recently in both the US House and Senate concurrent resolutions were introduced calling for the immediate commissioning of chiropractors into the US Armed Forces.

These are great steps but unfortunately these resolutions do not have the force of law. The Department of Defense still has to choose to act on this. They have had 16 years to act. Contact your Senator or Representative to let them know of your support for this action.