Expanding Scope of Practice: What Your Peers are Saying

To help you enhance your practice and increase your bottom line, we ask practicing doctors of chiropractic like you for ideas and solutions that have been tested in real-world environments. In this issue, we asked: "If you could expand your scope of practice in 2013, what would you like to add to what you currently offer your patients?" Based on your responses, this is definitely something many of you have thought about.

No Expansion

After much thought and years of practice, some doctors of chiropractic say they would add absolutely nothing to their current scope of practice.

Dr. Ronen Mendi, a chiropractor in Israel, thinks "it is a mistake to add anything to chiropractic. It mostly confuses the physical therapists and the public. Adjusting subluxation enables the body to function at its best/optimum. It helps a lot when the chiropractor gives only adjustments and it builds retention big time. And cooperation with other health care practitioners can happen only when you give them their right space."

Dr. James Caballero from Oxnard, Calif., concurs, saying he "would not expand [his] current scope of practice."

Unlimited Scope

But while some of you want no expansion in your scope, others would like to go as far as possible in the other direction, including into areas that are highly controversial.

For example, Dr. Cesar Mavila from Temecula, Calif., believes that "chiropractors, in order to set themselves on par with other same-level physicians, need to have an unlimited scope of practice so we may practice as narrow as we want. This may be accomplished by obtaining proper residencies aimed to place DCs in primary care, whether in community clinics or hospitals."

Dr. John Radabaugh from Toledo, Ohio, agrees. "Integration of chiropractic within the medical model should be part of our business plan. As a profession, most of us have the education, training, experience and qualifications to participate within the structure of multi-modal medical clinics and hospitals. We have a strong argument to provide services within PM&R, pain management, orthopedics, and yes, even primary care. One need only to study the profession of optometry to learn how they are solidly growing by working closely with the ophthalmologists."

Dr. Radabaugh continues his argument by pointing to the past: "We cannot afford to remain static and stubborn to an ideology of dated principals and purism. Like it or not, we practice under a new order of evidence-based medicine, which, by the way, tends to support what we do. So, let those who want to get on board do so without interference from those few who fear change. I submit that the future of this profession will be defined by our willingness to tolerate our clinical diversities."

Prescription Authority

Dr. Owen Powers from Norton, Va., wants to see chiropractic move toward unlimited prescriptive rights. He adds, "But if I were to have unlimited prescription rights, I would want to be the premier musculoskeletal specialist to include any injections or medications needed."

Dr. Steve Engen of Kearney, Neb., agrees. "I think it is a no-brainer that if we could expand our practice as DCs, it would be to include some forms of pain-control medications. When needed, it can be essential in order for the patient to be able to follow through on their treatment plan with the DC."

Even if expanding your scope means going back to school for additional education, many doctors of chiropractic seem to be all for it. "I want to expand the scope of practice to include full prescription rights and minor surgery, and if that means going back to school for another year, so be it," said Dr. Richard Marcel.

"It is time to move up and change or the profession is doomed. Manipulation is only one tool and for most doctors it is the only tool. The profession is way over 100 years old and still sees 4 to 7 percent of the people. It either changes or I go back to medical school and practice the way I want to, not the way ideological straights tell me to," added Dr. Marcel.

Injections are another common expansion of scope mentioned by many DCs. Dr. Cesar Mavila would like to add "joint injections as the likes of prolotherapy, intramuscular injections and vitamins. Prescription authority would be great to remove patients off unnecessary medication when appropriate."

Florida doctor of chiropractic Joseph Mane wants to prescribe and administer, "medications, vaccines (for NMS), nerve blocks, lumbar/cervical injections, lumbar punctures trigger-point injections, joint injections, minor surgical repairs, arthroscopy procedures and casting, splinting and taping."

Dr. Christopher Wellwood from Medical Lake, Wash., seemed to sum up what more than a few DCs think about the prospect of expanding your scope of practice. "Expanding our scope in these ways will allow us to capture a broader patient base, and hopefully allow our newer graduates to succeed instead of leaving the profession."

An In-Depth Discussion

An upcoming issue of our biweekly newspaper, Dynamic Chiropractic, will take a closer look at the issue of prescription drugs and injections in chiropractic, so stay tuned. Want to comment on this topic now? Contact us at .