"If the chiropractic scope of practice were broadened, chiropractors would be more successful."
"If the chiropractic scope of practice were broadened, patients would be better served."
If either one of these statements were true, I’d lead the parade to the statehouse to amend the practice act laws. But neither is.
This past weekend I sat in on a one-hour presentation by a proponent of broadening the chiropractic scope of practice in Colorado to include prescription rights. I heard firsthand the flimsy arguments for doing so. There were seven of them. Allow me to refute each one.
Thankfully, it's an easy task.
1. Health care continues to evolve and so must chiropractic.
Really? It must? This is a favorite of progressives who are quick to discard the Bible or anything else that has a couple of years on it. True, when compared to 1895, we know more about the body, vitamins and even the human genome. However, that doesn't change the fundamental truths on which the chiropractic profession is founded.
Those embarrassed by the colorful characters of the profession's past, or who see subluxation as some "historical artifact," probably see chiropractors reluctant to budge on scope of practice expansion not only as less enlightened, but card-carrying members of the Society for the Creative Anachronism.
The fact is, more than a century later, the principles of chiropractic still hold true. The body still heals from above down inside out. Drugs merely slow things down or speed things up. And doctors (of any ilk) don't heal; only the body can do that if there’s no interference to its innate capacity to do so. And yes, since D.D. Palmer’s time, we’ve added drop tables, adjusting instruments and computerized decompression. But the body still heals the same way it always has.
2. Chiropractors should become the musculoskeletal experts.
Notice it's not neuro-musculoskeletal specialists. Just bones and muscles, please. Apparently, if principled chiropractors were to just abandon the neurological implications of this thing they call a "subluxation," it wouldn't be seen as such a kooky, isolationist profession with "imaginary whole-body implications." This, as the thinking apparently goes, would encourage more medical doctors to refer to chiropractors, increasing patient volume and life would be wonderful.
However, what this small cadre of chiropractic expansionists overlook is that chiropractic was never about bones and muscles. It was founded on tone, mediated by the nervous system. Remove the nervous system component from chiropractic, and you have a profession of overeducated physical therapists.
3. Prescription rights would be a natural brand extension for chiropractic.
When academics put on a marketing hat, stand clear! The argument Friday evening was that adding the ability to prescribe medication to the chiropractic scope of practice is just like "…McDonald's adding salads to their menu."
I'm not making this up.
Ever heard of Welch’s apple juice? Or Tropicana grape juice? In spite of the evidence that brand extensions don’t work, the annals of marketing history are replete with attempts at failed brand extensions that seemed perfectly natural. Here are some actual examples:
- The Life Savers candy people thought Life Savers gum would be a hit.
- Coors brewery thought Coors water was an easy slam-dunk.
- Heinz ketchup brought out Heinz baby food and it promptly failed.
- Adidas running shoes took an expensive write off by offering Adidas cologne
4. Our country needs more doctors.
This argument suggests that there are areas of the country underserved by doctors. This, along with the fact that medical schools aren’t graduating enough general practitioners, implies that if chiropractors could be pressed into service as primary care physicians, the world would be a better, healthier place.
Purveyors of this argument often cite the growth of osteopathy colleges and the growing numbers of their ranks, while chiropractic college enrollment declines. How about this. If there’s a shortage of medical doctors keen on being the lap dogs of the pharmaceutical industry, either the free market will answer the need or big pharma will step up with a plan to rectify the situation.
Turns out, fewer medical practitioners can be a good thing:
- According to the Jerusalem Burial Society, a month-long doctors’ strike in Israel in 1973 lowered the country's death rate by 50%.
- When Canadian physicians went on strike in the 1960s, the nation’s mortality rate dropped.
- In Bogota, Colombia, doctors only treated emergency room cases for 52 days in 1976, and the death rate fell by 35%.
Expansionists aren't merely proposing an evolution of chiropractic; they're proposing a betrayal of the very foundation that makes it a separate and distinct profession.
5. Just because the scope is enlarged, it doesn't mean you have to change.
In other words, "…please don't hold us back just because we're more enlightened than you. You may cling to your primitive subluxation model if you wish. Just support us in our efforts to expand chiropractic to its fullest potential."
This creates a two-tiered profession and confuses the marketplace. Adding this additional level of complexity to a profession that is already misunderstood is a luxury no chiropractor can afford.
6. Prescription rights gives chiropractors a seat at the big table and on the bus.
This is a retread of the civil rights movement of the 1960s. Back of the bus. Separate water fountains. Nice metaphor, but misused.
Chiropractic is doing quite well where it is NOT under the big tent of mainstream medicine. Pick virtually any commonwealth country and chiropractors are doing pretty well. Granted, there has been some slipping and checking in Canada as chiropractors, who were previously included in the provincial government health care schemes, have been delisted. However, turn to the United Kingdom, Australia and New Zealand, where chiropractors have never “sat at the adult table,” and you’ll generally see massive cash practices filled with patients who consciously choose to avoid the medical version of the Department of Motor Vehicles and pay out of their own pockets for the privilege.
7. Chiropractors will be able to help more people.
While this argument hits below the belt, since most chiropractors would like to help more people, the ends simply don't justify the means.
Here, if memory serves, if you’re more respected and part of the establishment, singing an inclusive tune, you’ll see more patients.
This argument might actually be true. Granted, the price to be paid for this acceptance is to forsake the unique difference chiropractic offers to the world, but it might eventually increase patient volumes.
However, consider these other strategies that could similarly increase patient volume:
Chiropractic car wash. Your car gets washed and detailed while you get your spine adjusted.I’m kidding of course. The point is, mixing chiropractic with other services might increase traffic, but at the cost of diluting or damaging the reputation and limited identity that chiropractic enjoys.
Chiropractic comedy club. Comedians tickle your funny bone in the reception area before the chiropractor finds which bones are out of place.
Chiropractic Starbucks. Turn your reception room into a “third place” by adding the popular coffee franchise to your practice. (Waiting becomes a feature, not an annoyance!)
It seems relatively easy to neutralize the arguments put forward by the chiropractic prescription rights crowd. What proponents of this incursion into chiropractic medicine rarely reveal, is that their real motive for adding prescription rights is the fact that their practices are floundering and they are struggling to make a living.
There. I said it.
“If I could do more stuff like real doctors, I’d be respected and see more people,” I’m imagining the thinking goes.
Meanwhile the busiest chiropractors, relying on nothing more than their adjusting prowess, communication skills and clarity about their purpose, have little time to attend association meetings or court legislators, begging for an enlargement of their scope of practice.
Chiropractic does not need to evolve. Chiropractic does not need to become something else. Chiropractic merely needs chiropractors who understand the principles of chiropractic, who apply them with confidence and explain them with consistency. If that’s too challenging, if the hard, difficult, narrow path is too arduous, I recommend a career change.
I hear that enrollment at medical schools is down and opportunities abound.