Chiropractic Scope of Practice, Competency Evaluation and Licensure

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Chiropractic Scope of Practice, Competency
Evaluation and Licensure

• Cynthia Vaughn, D.C.

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Introduction

• Purpose of this presentation will be to
• Provide an overview of the legal scope of
  practice for Doctors of Chiropractic
• Outline the testing procedures that ensure
  clinical competency
• Describe state licensure requirements and
  disciplinary procedures

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Preamble

• Primary Care versus Primary Contact versus
  Direct Access
• These three terms have different meanings to
  different people, yet for all practical
  purposesmean the same thing.

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Definition of Primary Care

• The provision of integrated, accessible health
  care services by clinicians who are accountable
  for addressing a large majority of personal
  health care needs, developing a sustained
  partnership with patients, and practicing in the
  context of family and community.
• - Institute of
  Medicine

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Primary Care

• Regardless of misconceptions, Doctors of
  Chiropractic provide all the components of that
  definition since they
• Provide integrated, accessible health care
  services
• Are clinicians accountable for addressing a large
  majority of personal health care needs
• Develop a sustained partnership with patients
• Practice in the context of family and community
• Nevertheless, this presentation will use the
  terms Primary Contact and/or Direct Access

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Chiropractic Scope of Practice

• Other than a few isolated exceptions, all 50
  States and the District of Columbia
• Authorize DCs to perform physical examinations,
  diagnostic imaging, laboratory studies and
  physiotherapy modalities.
• Require DCs to diagnose
• Require DCs to refer when indicated
• Permit DCs to serve as primary contact, direct
  access providers. (ALL 51 jurisdictions)

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Chiropractic Scope of Practice

• Other than a few isolated exceptions, all 50
  States and the District of Columbia prohibit
  Doctors of Chiropractic from
• Utilizing Prescriptive Medications
• Performing Surgery

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Testing Measures That Ensure Clinical Competency

• National Board of Chiropractic Examiners (NBCE)
• Established 1963
• Four Parts Physiotherapy SPEC
• Parts I, II and III accepted by all 51
  jurisdictions
• Part IV accepted by 46 jurisdictions

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NBCE Examinations Part IWritten Examination

• Six Basic Science Subjects
• General Anatomy
• Spinal Anatomy
• Physiology
• Chemistry
• Pathology
• Microbiology Public Health
• Implemented in 1965

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NBCE Examinations Part IIWritten Examination

• Six Clinical Science Subjects
• General Diagnosis
• Neuromusculoskeletal Diagnosis
• Diagnostic Imaging
• Principles of Chiropractic
• Chiropractic Practice
• Associated Clinical Sciences
• Also implemented in 1965

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NBCE Examinations Part III

• Written Clinical Competency Exam
• Case History, Physical NMS Examination
• Roentgenologic Examination
• Clinical Laboratory and Special Studies
• Diagnosis
• Chiropractic Techniques
• Supportive Techniques
• Case Management
• Implemented in Fall of 1987

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NBCE Examinations Part IV

• Practical Examination
• Objective Structured Clinical Examination (OSCE)
  methodology
• Standardized patients
• Trained examiners
• X-ray Interpretation and Diagnosis
• Physical Exam and Case Management Skills
• Chiropractic Technique
• Implemented in 1993

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NBCE Examinations - PT

• Physiotherapy Examination
• Case History and Examination
• Physiotherapy Modalities
• Indications, contraindications and Applications
  of Modalities
• Therapeutic Exercise and Rehabilitation

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NBCE Examinations - SPEC

• Special Purposes Examination for Chiropractic
  (SPEC)
• Used by state licensing boards for licensure by
  endorsement or for license reinstatement after
  suspension or revocation.
• Computerized exam designed to assess
  practitioners in clinical areas encountered in
  general practice.

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Credibility of NBCE Exams

• Widespread acceptance by state licensing boards
• Adhere to the American Psychological
  Associations Standards for Educational and
  Psychological Testing and the American
  Educational Research Association
• Validity and reliability scores

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State Licensing

• Licensing is required for Doctors of Chiropractic
  
• in all 51 US jurisdictions (state law)
• and on federal military bases (DOD policy)
• All 51 US jurisdictions license Doctors of
  Chiropractic to serve as primary contact, direct
  access providers.
• 3 states (KS, IL VA) have composite licensing
  boards composed of MDs, DOs and DCs

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State Licensing

• Responsibility of the licensing boards
• Protect the public by
• Ensuring appropriate education and examinations
• Interpreting and applying statutes and
  regulations
• Identifying and recommending legislative
  improvements

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State Licensing

• State licensing boards commonly
• Adopt the accreditation standards of the CCE
  (Chairman Reed Phillips is CCE President)
• Require 12 24 hours of CE every year
• Re-evaluate practitioners every 12 years during
  the license renewal process
• Discipline DCs who do not comply with acceptable
  professional standards as codified in statute and
  regulation
• Report violations to the national CIN-BAD
  database so other states will have information.

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Presentation Summary

• Doctors of Chiropractic are
• extensively examined prior to state licensure
• legally licensed and regulated in all 51 US
  jurisdictions
• professionally trained in the primary care
  subjects and required to diagnose and refer when
  indicated
• qualified to serve as primary contact, direct
  access providers
• permitted by state law to perform a wide variety
  of conservative procedures