Are Podiatrists Trained How To Do This

[AgActual]

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Right now I am a student at National University of Health Sciences and I am studying chiropractic medicine. My school's philosophy and that of the guy who has been running the place for about 25 years , is quite a bit different from that of many chiropractic colleges. Basically my school wants chiropractors to move away from the "subluxation" nonsense and have them become "chiropractic physicians", which i guess means a primary focus on treating musculoskeletal problems with manipulation, as well as having basic medical training, such as being able to give physicals or diagnose ear infections (then refer to an MD for proper treatment).

So what does this have to do with podirty? Well I think that chiropractors should be more like podiatrists and just fill a niche that medical doctors don't focus a lot on, instead of trying to create an entire alternative field to medicine. My school's philosophy seems to be moving in that direction but I am wondering if they are still over doing it. I believe that chiropractors should pretty much only treat back and neck pain, maybe occasionally pain in the limbs, as well as being able to give very general health advice. I am not sure it is necessary for chiropractors to know how to give physicals or diagnose common medical problems that have nothing to do with back pain.

I think this is a situation where I would like to see what podiatrists are trained to do, in order to see what the proper scope is for chiropractors.

So, do podiatrists know how to give physicals, look for ear infections, diagnose hypertension, etc. or do your schools see such training as pointless for people in your profession?

 

[PADPM]

Yes, DPM's are trained to perform H&P's and recognize, not necessarily diagnose ear infections. We are also trained to recognize the signs and symptoms of all systemic diseases, but it's not necessarily our responsibility to diagnose or "work up" a patient. Recognition and timely referral to the proper specialist is part of our training and responsibility.

The foot and ankle are not independent structures, and are attached to a human body. As such, it would be irresponsible to have tunnel vision and ignore other potentially serious contributing diseases or disorders. Systemic illness such as diabetes, arthritic disorders, vascular disorders, collagen diseases, neurological disorders, thyroid disorders, cardiac disease, metabolic disorders, etc., can all manifest themselves in the lower extremity.

Having additional knowledge is never "pointless". Additionally, our profession performs surgery and enjoys the ability to admit patients to the hospital. Many of these hospitals allow and EXPECT us to perform our OWN H&P's. We also write prescriptions, and as a result must have a thorough understanding of how those medications will effect the body systemically.

There is quite a difference between chiropractic medicine and podiatric medicine/surgery. Our profession writes prescriptions, performs surgical procedures and admits patients to the hospital and is expected to perform H&P's, so the comparison is really not vaild.

 

[AgActual]

There is quite a difference between chiropractic medicine and podiatric medicine/surgery. Our profession writes prescriptions, performs surgical procedures and admits patients to the hospital and is expected to perform H&P's, so the comparison is really not vaild.

Don't worry, I am very aware of that. I did type my question around 3:30 in the morning, so perhaps it wasn't as clear as I had thought 😉

What I was trying to say is that I think chiropractors, interested in reforming our field, could learn a lot from podiatry and its history, when trying to find a proper scope of practice, getting adequate training, earning respect among other health care professionals, etc.

My view is that chiropractors should become the experts in back and neck pain (and dump all of the pseudoscientific nonsense in the process), in a similar way that podiatrists are the experts in diseases and conditions of the foot, and lower leg. What I am trying to figure out is if my school's vision of the "chiropractic physician" is a good way of achieving the reforms that I would like to see in the field or if it is overreaching and unfocused (even if it is far better than the old school chiropractic education).

So overall, I think talking to podiatrists about the training they receive outside of their main area of focus, could be helpful in trying to determine the type of "extra" training that chiropractors should receive, if this field is ever to get its act together and really reform itself.

 

[ldsrmdude]

There was actually an article about this exact subject, where the authors proposed that a good model for making the chiropractic profession a "respected mainstream profession" is the example of podiatry. As has been mentioned, the two professions differ significantly in many areas, but there are some similarities that the authors point out. Here is the link: http://www.chiroandosteo.com/content/16/1/10 You raise several points that the authors bring up, and I think that they are valid arguments that could be made to bring the chiropractic profession further.

 

[Danae00]

Don't worry, I am very aware of that. I did type my question around 3:30 in the morning, so perhaps it wasn't as clear as I had thought 😉

What I was trying to say is that I think chiropractors, interested in reforming our field, could learn a lot from podiatry and its history, when trying to find a proper scope of practice, getting adequate training, earning respect among other health care professionals, etc.

My view is that chiropractors should become the experts in back and neck pain (and dump all of the pseudoscientific nonsense in the process), in a similar way that podiatrists are the experts in diseases and conditions of the foot, and lower leg. What I am trying to figure out is if my school's vision of the "chiropractic physician" is a good way of achieving the reforms that I would like to see in the field or if it is overreaching and unfocused (even if it is far better than the old school chiropractic education).

So overall, I think talking to podiatrists about the training they receive outside of their main area of focus, could be helpful in trying to determine the type of "extra" training that chiropractors should receive, if this field is ever to get its act together and really reform itself.

Out of curiosity, where do you see other health professionals fitting into this mold? For instance, physiatrists, orthopedists, osteopaths who use OMT, physical therapists (near and dear to my heart), etc etc?

I guess I'm asking if there really is a need for chiropractors to move into this territory of being "back pain experts"? Or do other fields adequately provide care in this area already? And if there is a need, what makes chiropractors the logical choice as opposed to these other professions?

Not knocking your idea, just food for thought.

 

[AgActual]

Out of curiosity, where do you see other health professionals fitting into this mold? For instance, physiatrists, orthopedists, osteopaths who use OMT, physical therapists (near and dear to my heart), etc etc?

I guess I'm asking if there really is a need for chiropractors to move into this territory of being "back pain experts"? Or do other fields adequately provide care in this area already? And if there is a need, what makes chiropractors the logical choice as opposed to these other professions?

Not knocking your idea, just food for thought.

Oh i have heard it before.

I think that chiropractors, my vision of them anyway, would be able to distinguish themselves from osteopaths, orthopedists, and MDs when it comes to treating musculoskeletal problems by the fact that they typically treat such problems with medication and/or surgery. Many are trained in OMT but very few utilize it. As the article posted by ldsrmdude states (one that I have read many times chirobase) chiropractors should move in and try to be the non-surgical and non-medical option for treating MSK issues. So even though those professions can and sometimes do use manipulation, they under utilize it enough for chiros to slip in and take it over.

As for physical therapists and related fields, well that is my fear. They certainly can and do, in increasing numbers, perform procedures that would more or less be what an MSK focused chiropractor would do. Why should chiors take over non-medical and surgical MSK treatment and no DPTs? Well....because we called it! Or perhaps because physical therapists do many other things and I think that one field should really be focusing on issues pertaining to neck and back pain. I think DPTs may have their hands full if they also started seeing patients that currently go the chiropractor for such services. Really there are any number of self serving answers I can come up with.

 

[whiskers]

If you don't believe the quackery now, you certainly will have a hard time with dishing it out on your patients.

Maybe you should just go to pod school?

Just saying. Chiropracters are not going main stream any time soon.

 

[AgActual]

If you don't believe the quackery now, you certainly will have a hard time with dishing it out on your patients.

Well most of the quackery comes from the detection and treatment of the phantom "vertebral subluxation". I dont' believe such things exist, so i will have little problem in not selling patients on that. Thankfully, for the most part, my school has little interest in dealing in subluxation based practice, so it isn't likely to be something i will need to deal in, if i don't want to.

As for other nonsensical treatments, like homeopathy, unfortunately my school does teach it but it is more peripheral and something i can largely ignore. It isn't hopelessly interwoven into the training or philosophy, so for me personally, it isn't a big deal. Plus it is only half of one course that teaches it. As soon as I graduate, I can just blank it from my memory and never think about it again.

A chiropractor can easily practice ethical, evidence based medicine but they have to chose to do so, therefore, i am not too concerned about being a quack or a con artist.

 

[spo01]

From the article on who they want the chiropractor to be and how they want the field:

...a profession of non-surgical spine specialists who not only offer one useful modality of treatment for spinal pain (manipulation), but offer something much greater and more important – expertise in the diagnosis and management of spinal pain patients. But, most importantly, it means becoming experts in patient management, i.e., helping patients overcome spinal pain, whether that means providing adjustments, exercise, short-term medication use and/or education regarding the issues related to LBP provided in a cognitive-behavioral context. Currently, there is no profession that adequately fills that role, although as we noted earlier, the physical therapy profession is moving quickly in this direction.

Sounds a lot like what you are doing now. Notice the physical therapy part, they have already hopped on the bandwagon. I really don't know what to think. Next we'll have naturopathic doctors demanding to do hospital rounds and write drug prescriptions and do surgeries to fix patients.

You want to learn more about the whole body and systemic problems? Good, but that won't make the field any more respected. It's what you have to offer that counts...something that is proven to be effective and no one else can do it as good as you, and from reading what you wrote and what that article talks about it doesn't sound like you know what that is exactly. Exercise? Patient managment? Adjustments? Educating the patient? This is fluff talk.
It seems you want to go beyond just expanding scope for chiropractors, it seems you want to break away from your roots, break away from the subluxation principles and all this and completely redefine the profession. But unless you are attending schools mirrored like an allopathic curriculum along with a residency (ex: perhaps in back surgery?), and have a list of set goals the field is to accomplish that is based off science based medicine then this won't happen. Podiatry is a heavily science based medicine. It started with different grounds and a different approach to medicine than chiropracty did which is why it is accepted at the hospitals and gaining increases in scopes of practice.

 

[AgActual]

If you don't believe the quackery now, you certainly will have a hard time with dishing it out on your patients.

Maybe you should just go to pod school?

Just saying. Chiropracters are not going main stream any time soon.

Just as a side note, I see you are a psychology student. I have a B.S. in psychology and I spent time in grad school for clinical psychology. Left with a 4.0 actually. Trust me when I say, if you are looking for a field without quacks or one that doesn't have a loose association with science, I wouldn't recommend getting into psychology. Read into the reliability and validity of the DSM-IV, diagnostic tests, and treatment efficacy. More disturbing perhaps are the number of clinicians that just ignore evidence based diagnostics and treatments, and just go with their gut.

I'm certainly not saying chiropractic is more scientific or less problematic than psychology (not in a thousand years would i ever claim that) ,but there are some rather shocking problems with our current understanding of mental health or just psychology in general. Tread carefully, because you are guaranteed to have your own quackery and pseudoscientific nonsense to deal with, if you pursue a career in psychology, whether clinical or any other area.

 

[JaggerPlate]

Right now I am a student at National University of Health Sciences and I am studying chiropractic medicine. My school's philosophy and that of the guy who has been running the place for about 25 years , is quite a bit different from that of many chiropractic colleges. Basically my school wants chiropractors to move away from the "subluxation" nonsense and have them become "chiropractic physicians", which i guess means a primary focus on treating musculoskeletal problems with manipulation, as well as having basic medical training, such as being able to give physicals or diagnose ear infections (then refer to an MD for proper treatment).

So what does this have to do with podirty? Well I think that chiropractors should be more like podiatrists and just fill a niche that medical doctors don't focus a lot on, instead of trying to create an entire alternative field to medicine. My school's philosophy seems to be moving in that direction but I am wondering if they are still over doing it. I believe that chiropractors should pretty much only treat back and neck pain, maybe occasionally pain in the limbs, as well as being able to give very general health advice. I am not sure it is necessary for chiropractors to know how to give physicals or diagnose common medical problems that have nothing to do with back pain.

I think this is a situation where I would like to see what podiatrists are trained to do, in order to see what the proper scope is for chiropractors.

So, do podiatrists know how to give physicals, look for ear infections, diagnose hypertension, etc. or do your schools see such training as pointless for people in your profession?

Medical training + an emphasis on manual techniques, with deferment to modern treatment??? Your boss is about 120 years too late, and apparently unaware DO schools exist.

 

[AgActual]

Medical training + an emphasis on manual techniques, with deferment to modern treatment??? Your boss is about 120 years too late, and apparently unaware DO schools exist.

How much do DO schools focus on manual manipulation? And how many actually use it when they get out into the real world? I would think that a chiropractor, focusing on MSK issues, and trained in basic medical diagnosis is going to be doing very different things on a day to day basis than your typical, American osteopath. Not unless you think you and I are going to be doing the same things in a few years?

And can't we turn this around and say that aren't American osteopaths aware of allopathic schools? 5 years out of school, an MD and a DO are going to be doing virtually the same things. I feel like there is far more redundancy in the MD and DO training than in DO and "chiropractic physician" training.

 

[air bud]

I think you could get some of these answers in the DO forums

 

[JaggerPlate]

How much do DO schools focus on manual manipulation? And how many actually use it when they get out into the real world? I would think that a chiropractor, focusing on MSK issues, and trained in basic medical diagnosis is going to be doing very different things on a day to day basis than your typical, American osteopath. Not unless you think you and I are going to be doing the same things in a few years?

And can't we turn this around and say that aren't American osteopaths aware of allopathic schools? 5 years out of school, an MD and a DO are going to be doing virtually the same things. I feel like there is far more redundancy in the MD and DO training than in DO and "chiropractic physician" training.

Yes, MD and DO education is identical besides the OMM component. I just struggle to see what your president/dean or whatever is trying to do here, and it's frankly impossible for him to integrate things into the curriculum in an attempt to expand practice rights without state board approval. Chiropractors are not primary care physicians, nor do I believe additional training in a DC school will make them PCPs.

If you're looking for a medical professional who can act as a PCP and act as a MSK/manual medicine expert, you should seek a DO FM who trained in a FP/OMM residency, or did a +1 NMM/OMM residency. This is 3-4 years post graduate education, which enables them to act as a primary care physician as well as a MSK doc. You can be idealistic about a chiro as a PCPish person who stays within their scope and refers when necessary, but the reality is ... this won't always happen. There will be instances where they will choose to enlist their own services instead of shipping time and money to someone else. The best way to deal with this situation is have chiropractors be chiropractors, and physicians be physicians. Frankly, MDs/DOs go through a lot of training to do a lot of the medical things you want chiros to do, without appropriate measures.

So, I suppose the easiest way to put this is no ... I do not believe in any sort of expanded DC rights, nor do I think there really is any type of nitch to fill with DOs who utilize OMM.

I hope this doesn't come off harsh, I just don't think this expansion is safe or advantageous to patients.

 

[AgActual]

First off, do you mean primary care as in primary contact for general medical problems or primary care as in someone needs an MD to refer them to a chiro instead of going to them directly? If it is the former, then i agree, in a way. I think chiropractors should be taught to use general medical diagnostics more passively. If someone comes in for back problems and a chiropractor finds the person also has high blood pressure, great (assuming they refer to correct health care professional). But i don't think chiropractors should tell people to come see them first if they have something unrelated to an MSK problem, even if they would refer to the proper medical expert. That is just a waste of time and money.

With that all said, i do think you are wrong. I believe some states, which includes Illinois i think, do let chiropractors act as PCP's, in every respect. Again we must ask why, because I see no reason for such things. I am a chiropractic student and if i get an ear infection, I'm not going to a chiropractor for a diagnosis and then a referral for treatment. It makes little sense.

Really we are probably very much on the same page. I don't think chiropractors should be going out of their way to get people in for diagnostics that have nothing to do with MSK problems. But I think we can both agree, they need basic general medical diagnostic skills, just in case a serious problem does pop up on their radar. I don't think it would be good for a chiropractor to miss possible lung cancer on an x-ray because we want chiros to have a limited scope of practice. The question is, do they need to know how to check for sinus infections and how to do physicals?

As for our president's vision, i'm not sure if i share it or not. There certainly is a lot of overlap with my stated views at the beginning of this thread and his, but in a lot of ways it feels too broad. You ask why a chiropractor should be a primary contact health care provider, even if they were appropriately trained in diagnosing common medical conditions, and I have to say I can't find a good reason either. As someone said, extra training probably can't hurt. All i would say is that my school training students with their "chiropractic physician" model, with non-subluxation based practice, focus on MSK problems, and general medical diagnostic training, seems to be far better than what I would get at any other chiro school, which is at least a step in the right direction.

Yes, MD and DO education is identical besides the OMM component. I just struggle to see what your president/dean or whatever is trying to do here, and it's frankly impossible for him to integrate things into the curriculum in an attempt to expand practice rights without state board approval. Chiropractors are not primary care physicians, nor do I believe additional training in a DC school will make them PCPs.

If you're looking for a medical professional who can act as a PCP and act as a MSK/manual medicine expert, you should seek a DO FM who trained in a FP/OMM residency, or did a +1 NMM/OMM residency. This is 3-4 years post graduate education, which enables them to act as a primary care physician as well as a MSK doc. You can be idealistic about a chiro as a PCPish person who stays within their scope and refers when necessary, but the reality is ... this won't always happen. There will be instances where they will choose to enlist their own services instead of shipping time and money to someone else. The best way to deal with this situation is have chiropractors be chiropractors, and physicians be physicians. Frankly, MDs/DOs go through a lot of training to do a lot of the medical things you want chiros to do, without appropriate measures.

So, I suppose the easiest way to put this is no ... I do not believe in any sort of expanded DC rights, nor do I think there really is any type of nitch to fill with DOs who utilize OMM.

I hope this doesn't come off harsh, I just don't think this expansion is safe or advantageous to patients.

 

[JaggerPlate]

First off, do you mean primary care as in primary contact for general medical problems or primary care as in someone needs an MD to refer them to a chiro instead of going to them directly? If it is the former, then i agree, in a way. I think chiropractors should be taught to use general medical diagnostics more passively. If someone comes in for back problems and a chiropractor finds the person also has high blood pressure, great (assuming they refer to correct health care professional). But i don't think chiropractors should tell people to come see them first if they have something unrelated to an MSK problem, even if they would refer to the proper medical expert. That is just a waste of time and money.

With that all said, i do think you are wrong. I believe some states, which includes Illinois i think, do let chiropractors act as PCP's, in every respect. Again we must ask why, because I see no reason for such things. I am a chiropractic student and if i get an ear infection, I'm not going to a chiropractor for a diagnosis and then a referral for treatment. It makes little sense.

Really we are probably very much on the same page. I don't think chiropractors should be going out of their way to get people in for diagnostics that have nothing to do with MSK problems. But I think we can both agree, they need basic general medical diagnostic skills, just in case a serious problem does pop up on their radar. I don't think it would be good for a chiropractor to miss possible lung cancer on an x-ray because we want chiros to have a limited scope of practice. The question is, do they need to know how to check for sinus infections and how to do physicals?

As for our president's vision, i'm not sure if i share it or not. There certainly is a lot of overlap with my stated views at the beginning of this thread and his, but in a lot of ways it feels too broad. You ask why a chiropractor should be a primary contact health care provider, even if they were appropriately trained in diagnosing common medical conditions, and I have to say I can't find a good reason either. As someone said, extra training probably can't hurt. All i would say is that my school training students with their "chiropractic physician" model, with non-subluxation based practice, focus on MSK problems, and general medical diagnostic training, seems to be far better than what I would get at any other chiro school, which is at least a step in the right direction.

Here's the thing about the PCP definition/state comment you brought up. It's false. Some states may recognize chiropractors as chiropractic physicians, or allow advertisements as PCPs, but without a full scope of practice, medical license, prescription rights, etc, etc ... what good is it? Frankly, it's NO good. It is dangerous.

Take your example with the physical ... should chiropractors be able to do a physical examination of the patient before a chiropractic adjustment? Sure, if it is part of the therapy. If the chiro sees a bad, simple warning sign, should he/she refer to a DO/MD? Yes, but then again ... so can anybody who sees, thinks, or hears something weird from friends, family, etc, and says 'go see my doc.' In that sense, sure ... it's okay to refer. HOWEVER, should a chiropractor be able to perform a physical in the sense of a H/P or a physical exam for like high school sports or something ... no, absolutely not.

What happens if you do a physical on a high school student, miss something because it wasn't covered in your prior education, clear the kid, and he dies on the soccer field. Well, the parents and their lawyers are going to RIP down your door ... and guess what. You're screwed. It's out of your scope, and guess what you're missing ... appropriate malpractice.
Forget the money, you're done ... like bankrupt, in debt forever, processed on criminal charges done. DO/MDs go through medschool, residency, and pay out the ass for malpractice so when this happens ... they aren't destitute.

I read an article a few years back about a chiro who started seeing a patient who suffered from bad seizures, but with meds had them under decent control. The chiro told her to get completely off the meds and only see her for adjustments. Well, long story short ... that young woman died a horrible death, and the chiro went to PRISON, never to be able to even adjust a patient again (ie license gone).

You can talk all you want about your school integrating medicine or how people will be responsible and refer when it is necessary and catch simple things like ear infections ... but this simply won't happen. People will get greedy, or narcissistic and thinks they can treat, or they know what they are doing, when something horrible could be spreading and worsening, while a medical doctor could catch and fix it. Just out of the scope of practice, no need to expand, period. I know my above example is extreme, but it happens ... and trying to expand rights, or tout the term PCP is only going to increase the number of these unfortunate situations.

Bottom line ... good chiropractors should stay within their scope, and practice there. If you want to be able to diagnosis as well as treat, I really suggest looking into DO schools. There was a thread in pre DO earlier this week about DC to DO schools, and there were about 4 people who were finishing up DC degrees, saying it wasn't what they expected, not for them, etc, so they were going DO.

Now, of course a far too few DOs use manipulation. However, there are some that do, and they fill this nitche market just fine. If you do a little research, you can probably find an OMM specialized close to you ... these people will be able to treat, diagnosis, and manipulate the MSK system, just as you've essentially said chiros should. There isn't a need to expand to fill this market, and it isn't safe.

 

[AgActual]

Damn, I thought we were on the same page but that doesn't appear to be the case.

The problem here is that are coming up with these horrible scenarios if we one day find ourselves with a chiropractic profession that is closer to my school's model. I am not sure how logical it is to say that if chiropractors are trained to look for ear infections and know how to give physicals, suddenly they are going to tell people to stop taking life saving medication and we will be up to our knees in dead bodies.

You seem to be operating under the assumption that chiropractors + knowledge=death. When is having extra knowledge and better training a bad thing? You seem to be suggesting that chiropractors, on a wide scale, would be unable to handle their new found abilities and this would lead to patients being killed left and right. I am not sure that keeping us in the dark on how to use an otoscope or how to check for testicular cancer is going to save lives.

And no one said chiropractors should be treating general medical conditions unrelated to MSK issues that can be helped through manipulation. I didn't and my school didn't.

 

[JaggerPlate]

Damn, I thought we were on the same page but that doesn't appear to be the case.

The problem here is that are coming up with these horrible scenarios if we one day find ourselves with a chiropractic profession that is closer to my school's model. I am not sure how logical it is to say that if chiropractors are trained to look for ear infections and know how to give physicals, suddenly they are going to tell people to stop taking life saving medication and we will be up to our knees in dead bodies.

You seem to be operating under the assumption that chiropractors + knowledge=death. When is having extra knowledge and better training a bad thing? You seem to be suggesting that chiropractors, on a wide scale, would be unable to handle their new found abilities and this would lead to patients being killed left and right. I am not sure that keeping us in the dark on how to use an otoscope or how to check for testicular cancer is going to save lives.

And no one said chiropractors should be treating general medical conditions unrelated to MSK issues that can be helped through manipulation. I didn't and my school didn't.

Semantics and scope are a different thing, let me see if I can clarity ...

I have no problems with chiros learning a few simple tests, learning some medical procedures, etc ... HOWEVER, I do not think their scope of practice should be expanded because I do not think they are adequately trained to be a PCP (a DO/MD PCP does four year of medical school - 2 of hardcore sciences 2 of hospital based rotations, then 3 years of residency in a PCP field, then can also choose fellowships (for example, FPs can do sleep, sports medicine, etc), all before they hang a shingle as a PCP. If DCs take the extra classes, they are going to want something to show for it, and this will be the ability to use/bill for this new knowledge. This is where the scope of practice comes in, and this is where I see the Chiropractor + medical knowledge = whatever you were saying.

Plus, what does this mean for old DCs or DCs who didn't go to your school? They have the same degree, shouldn't they be able to do the same things??? Well, technically no because they haven't learned the same medical stuff you're talking about learning, but I'm not sure if this would stop them.

Here's the bottom line, and I cannot be any clearer than this ... Chiropractors should stick within their scope of practice, which is spinal manipulation. There is no need for expansion. It is dangerous and not in the best of interest of the general public. I do not think DC schools should incorporate more medical testing/exams into their curriculum because it will a. encourage an expanded scope of practice b. decrease referring to medical doctors for necessary exams c. lead older DC who haven't received such training to do these tests and fall into the same fallacies. There isn't a nitche available for chiropractors than the one they already fill, and if you want to diagnose and treat outside of spinal manipulation, you should attend medical school to become a DO or MD.

 

[sorham]

I think you could get some of these answers in the DO forums

I agree this is not the forum to be arguing this point, take the discussion somewhere else!

 

[AgActual]

Here's the thing about the PCP definition/state comment you brought up. It's false. Some states may recognize chiropractors as chiropractic physicians, or allow advertisements as PCPs, but without a full scope of practice, medical license, prescription rights, etc, etc ... what good is it? Frankly, it's NO good. It is dangerous.

Well I suppose the biggest question we have now, since after rereading your posts I feel that there are only very minor differences in our opinions, is if you think people should need a referral from an MD or DO in order to see a chiropractor? I think we both agree that chiros should not be first contact for every medical condition under the sun, only MSK issues for those interested in non-surgical and medical routes. However, what about the aspect of PCP that allows chiros to see people without referrals, much like dentists, optometrists, and, like the people that are probably tired of us being here, podiatrists. Certainly you agree that people should be able to go to a chiropractor without having to go through another health care professional, namely medical doctors, right?

And just a clarification, I never said that chiropractors need an expanded scope of practice. I want chiropractors to be dealing with pretty much only MSK issues. I only made this thread in the interest of education reform. Since podiatrists are similar to chiropractors, in terms of their limited scope of practice (in other words, they aren't medical doctors and aren't concerned with the whole body in day to day practice), I was simply trying to figure out how much general medical training chiropractic students should be getting and if it would be a good use as time. However, it would seem that you think that chiropractors having an expanded role would be more dangerous and i think it would be mostly pointless but such distinctions are probably not too important.

 

[air bud]

Since podiatrists are similar to chiropractors, in terms of their limited scope of practice (in other words, they aren't medical doctors and aren't concerned with the whole body in day to day practice)

in 3,2,1.......GO!!!


EDIT: I hit accidently hit a button without realizing it and put that stupid frown face on there. I am anti-emoticons, I repeat, I am anti-emoticons. I did this unknowingly and I truly regret it.....

 

[AgActual]

in 3,2,1.......GO!!!

So podiatrists are medical doctors and do focus their practices on the entire body?

Is that what you think people are going to get in an uproar about or is it that I compared your field in a minor way to chiropractors, and this is somehow a slap in the face? I happen to think that both chiropractors and podiatrists are more limited in their scope of practice than medical doctors, which is a similarity. Not sure how that is controversial but maybe I am just a naive young man?

 

[JaggerPlate]

Well I suppose the biggest question we have now, since after rereading your posts I feel that there are only very minor differences in our opinions, is if you think people should need a referral from an MD or DO in order to see a chiropractor? I think we both agree that chiros should not be first contact for every medical condition under the sun, only MSK issues for those interested in non-surgical and medical routes. However, what about the aspect of PCP that allows chiros to see people without referrals, much like dentists, optometrists, and, like the people that are probably tired of us being here, podiatrists. Certainly you agree that people should be able to go to a chiropractor without having to go through another health care professional, namely medical doctors, right?

And just a clarification, I never said that chiropractors need an expanded scope of practice. I want chiropractors to be dealing with pretty much only MSK issues. I only made this thread in the interest of education reform. Since podiatrists are similar to chiropractors, in terms of their limited scope of practice (in other words, they aren't medical doctors and aren't concerned with the whole body in day to day practice), I was simply trying to figure out how much general medical training chiropractic students should be getting and if it would be a good use as time. However, it would seem that you think that chiropractors having an expanded role would be more dangerous and i think it would be mostly pointless but such distinctions are probably not too important.

Jesus. Okay:

1. Pods aren't 'medical doctors,' but I seriously wouldn't lump them in with DCs at all. Pods go through rigorous education, complete residencies, and do some complex surgical stuff. They can also admit to hospitals, work with DO/MDs in ortho groups, etc, etc. Chiros can't do this. In fact, they actually reject this kind of treatment, for the most part/my understanding.

2. Our points really aren't that similar, in fact, I feel like we are kind of completely opposite. You're whole thesis was that DCs could fill an untapped nitche, kind of like Pods did with the foot and ankle. My response was 1. No 2. This nitche doesn't exist because of DOs who do OMM, PM&R docs, DPT/PTs, etc, and 3. DCs aren't trained to fill this area, even if it was available, and I think further training to do so would lead to an overstepping of boundaries which is not advantageous to patients.

Furthermore, I don't think DCs should be the guys to see with MSK problems ... I think it should be DOs who practice NMM/OMM and from there, Orthopods, PM&R, and Pain Management docs for surgery, injections,etc.

3. I'm a little confused about the referral question?? Why would someone need a referral to see a DC? Couldn't they just go see them if they were so inclined??? I don't know how often DO/MDs refer to DCs, my guess is that it's not too often, but no??? They shouldn't need a referral? I don't know, that point confuses me.

4. As to how much medical training DCs should receive ... I don't personally think a lot. Like I said, people are going to want additional benefits for additional training, and this is where people are going to try and stretch their scope of practice, and again, dangerous.

DCs should stick to spinal manipulation. It is what they are trained to do. If one wants to diagnose, and use medical treatments, I really suggest looking into medical school and either going DO and specializing in NMM/OMM, or going DO/MD and looking into PM&R or Pain Management.

 

[AgActual]

Wow, sorry. If i knew conversation was going to make you so frustrated and emotional, I would have stopped the discussion last week.

You don't like chiropractors, point taken. Just don't have an anger stroke, alright.

Jesus. Okay:

1. Pods aren't 'medical doctors,' but I seriously wouldn't lump them in with DCs at all. Pods go through rigorous education, complete residencies, and do some complex surgical stuff. They can also admit to hospitals, work with DO/MDs in ortho groups, etc, etc. Chiros can't do this. In fact, they actually reject this kind of treatment, for the most part/my understanding.

2. Our points really aren't that similar, in fact, I feel like we are kind of completely opposite. You're whole thesis was that DCs could fill an untapped nitche, kind of like Pods did with the foot and ankle. My response was 1. No 2. This nitche doesn't exist because of DOs who do OMM, PM&R docs, DPT/PTs, etc, and 3. DCs aren't trained to fill this area, even if it was available, and I think further training to do so would lead to an overstepping of boundaries which is not advantageous to patients.

Furthermore, I don't think DCs should be the guys to see with MSK problems ... I think it should be DOs who practice NMM/OMM and from there, Orthopods, PM&R, and Pain Management docs for surgery, injections,etc.

3. I'm a little confused about the referral question?? Why would someone need a referral to see a DC? Couldn't they just go see them if they were so inclined??? I don't know how often DO/MDs refer to DCs, my guess is that it's not too often, but no??? They shouldn't need a referral? I don't know, that point confuses me.

4. As to how much medical training DCs should receive ... I don't personally think a lot. Like I said, people are going to want additional benefits for additional training, and this is where people are going to try and stretch their scope of practice, and again, dangerous.

DCs should stick to spinal manipulation. It is what they are trained to do. If one wants to diagnose, and use medical treatments, I really suggest looking into medical school and either going DO and specializing in NMM/OMM, or going DO/MD and looking into PM&R or Pain Management.

 

[JaggerPlate]

Wow, sorry. If i knew conversation was going to make you so frustrated and emotional, I would have stopped the discussion last week.

You don't like chiropractors, point taken. Just don't have an anger stroke, alright.

I'm perfectly calm, and have no problem with any health care provider when they stay within their scope or practice. I have absolutely no problem with a DC who is trained and practices spinal manipulation in an appropriate manner. However, a huge problem with healthcare today is people wanting the prize without putting into their dues. I've always felt this is not in the best interest of patients, and that is what's important.

 

[vanbamm]

I think that most schools are getting away from the subluxation theory and incorporating more of a research core at chiropractic colleges. I do not expect any of the close minded people in other fields to realize this because they are not experiencing it. As far as the future for chiropractic, that can not be predicted. It is going to really be up to the next few generations of graduates that turn things around based on the new teaching guidelines. Patient visits to chiropractors has gone up over the past decade, and recently due to the shortage of PCP's in areas where there is already a shortage of doctors, so really thanks to the medical students for specializing. The more MD/DO students specialize, the greater the scope of chiropractic practice. Chiropractors have already been legally termed "physicians" in a small group that includes MD,DO,OD,DPM, and the DDS. So whether or not some people like it, deal with it, chiropractic has the potential spread out. With only 50,000-60,000 chiropractors in the US, this means less competition and more patients to yourself. Also, chiropractors are legally entitled to conduct physical exams for anyone that needs one (routine, or required for college etc.), and the state of Michigan just allowed chiropractors to prescribe drugs, so all the pharmacology classes are actually going to go to use rather than just recognizing drugs and interactions.
More and more chiropractic schools are also sending the students on rounds with the medical students to get exposure to a greater variety of diseases and complications, a move that was pushed because of the shortage of PCP's...so thanks again there. Some medical residencies in radiology, ortho, and sports medicine are also accepting chiropractors. So the medical profession has even realized that the abilities of chiropractors are not to be discounted. That school of thought is as old and irrelevant as DD Palmer.

Some people beat the entrance requirements of chiropractic school to death. Anyone that comes in still has to pass 5 board exams, a state and also another national exam. So you might get in, but you might not get out with a DC degree. Also, the physical exam board exam has been the gold standard for testing and is actually the same exam that the medical schools adopted because it was much more thorough. The required courses for entry are similar to medical schools, but the GPA is low, about 2.8. There has been talk of increasing this in the next 5 years to match medical school GPA's in order to keep the field small and exclusive just like podiatry and dentists have done. This is also a small nudge towards the medical schools to start putting emphasis on primary care so chiro can make the effort to become spinal specialists.

As far as competition with the PT's, that is not really something to worry about for now. The DPT thing is not that revolutionary. There is no clinical significance to the degree except for the ability to have a solo practice, but then that is not going to fly with the MD/DO when patients start seeing a DPT directly, cutting them out of the picture except as specialists for referal. Chiropractors have a greater range of skills than the PT, who is responsible for rehabilitation. They will never be PCP's, or prescribe, or conduct physicals...and I honestly do not see the DPT degree really being that big of a deal. They will never have the hours in radiology or physical diagnosis that chiropractors have.

 

[vanbamm]

PS jaggerplate you have no idea what you are talking about and everything you say just emphasizes how little you know about chiropractic. And FYI, your thoughts about why or why not you think chiropractic is ok, don't matter.

 

[Cowy1]

Uh, Jaggerplate knows exactly what he is talking about. Frankly, he is being too generous; the vast, vast majority of chiropractors are still prescribing to biotheistic nonsense and apply completely quack treatments to their patients. Or they get involved in scandalous practice management firms (google "Maximized Living" for a relatively common one) designed to bilk ignorant patients out of their money.

Even at National (a supposedly "scientific" chiropractic school) grads routinely walk out believing in garbage like TCM or homeopathy. Last night I had to opportunity to listen to a recent National grad talk about the importance of routine spinal screening to help support the nervous and immune systems! And he also produced a quack temperature probe device he said would help him find misalignments in the spine that supposedly would lead to disfunction and disease.

The vast majority of the time it is woo and the rest of the stuff could be replaced with some ASA.

 

[JaggerPlate]

PS jaggerplate you have no idea what you are talking about and everything you say just emphasizes how little you know about chiropractic. And FYI, your thoughts about why or why not you think chiropractic is ok, don't matter.

Oh are you done posing as a medical student and giving out medical school advice in the medical student forums? You're right, I'm the one who doesn't know what I'm talking about. I'd love to see this bill from Michigan. The only info I found said they were 'thinking' about expanding rights for more MSK issues and giving more experience doing rads stuff ... hardly prescription rights, this won't happen. Also, chiros had their chance to be part of the medical profession a long time ago, and they told the AMA where they could stick their offer. Don't expect the lobbying power of the AMA/entire medical community to allow DC expansion rights. There are so many issues YOU don't understand whatsoever, and you spewing off bull**** about research at DC colleges, and expanded practice rights, and 'scientific' chiropractic is pretty laughable.

You know what ... try to act as a PCP without the medical knowledge, residency, script rights, and malpractice. I've said it before, and I'll say it again ... there is NOTHING wrong with DCs practicing within their scope, which is spinal manipulation, anything else ... is not advantageous to patients, and won't stick. It also cracks me up that chiros think they have something to offer primary care. Do you not get that every NP, PA, DNP, etc is just ready and waiting to take over primary care??? Not to mention wal-mart clinics and any potential reform which pumps money back into primary care. Spinal manipulation + no medical knowledge offers NOTHING to primary care ... it just makes it unsafe.

There is no market to expand that isn't already being sought after by qualified medical personnel, and it's far, far too late for DC schools to decide to become legit and start churning out some special brand of primary care physician. Even if they did (which is impossible), what happens to practicing DCs??? Do they get the expanded rights? Do they stick with spinal manipulation for ethical reasons, but watch their peers get paid more with better scope ... NOPE. Dangerous, dangerous, dangerous. There is no risk of DC expansion and AGAIN, if you want to be a physician and diagnose, treat, and prescribe ... go to medical school. There will be no DC expansion in this current health care climate.

 

[JaggerPlate]

Scope of Practice

Michigan Public Health Code, 1978 PA 368, being MCLA 333.16401

UPDATED FEBRUARY 19, 2010 06:02:46 AM

Part 164. Chiropractic
Sec. 16401. (1) As used in this part: (a) "Chiropractor," "chiropractic physician," "Doctor of Chiropractic," or "D.C." means an individual licensed under this article to engage in the practice of chiropractic.

(b) "Practice of chiropractic" means that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. practice of chiropractic includes:
(i) Diagnosis, including spinal analysis, to determine the existence of spinal subluxations or misalignments that produce nerve interference, indicating the necessity for chiropractic care.
(ii) The adjustment of spinal subluxations or misalignments and related bones and tissues for the establishment of neural integrity utilizing the inherent recuperative powers of the body for restoration and maintenance of health.
(iii) the use of analytical instruments, nutritional advice, rehabilitative exercise and adjustment apparatus regulated by rules promulgated by the board pursuant to section 16423, and the use of x-ray machines in the examination of patients for the purpose of locating spinal subluxations or misaligned vertebrae of the human spine. The practice of chiropractic does not include the performance of incisive surgical procedures, the performance of an invasive procedure requiring instrumentation, or the dispensing or prescribing of drugs or medicine.

(2) In addition to the definitions in this part, Article 1 contains general definitions and principles of construction applicable to all articles in this code and Part A 161 contains definitions applicable to this part.
Sec. 16411. A person shall not engage in the practice of chiropractic unless licensed or otherwise authorized by this article.
Sec. 16412. (1) An individual shall not engage in the practice of chiropractic as part of his or her chiropractic education without a limited license to practice under this part.
(2) A limited license for practice as part of chiropractic education shall require that the individual has successfully completed two years, 4 semesters, or 6 quarter terms in a chiropractic college approved by the board. An individual granted a limited license may engage in the practice of chiropractic only under the supervision of a licensed chiropractor.

(3) The limited license is valid for not more than 6 months and is nonrenewable.
Sec. 16421. The Michigan Board of Chiropractic is created in the department and shall consist of the following 7 voting members who shall meet the requirement of parts 161:5 chiropractors and 2 public members.
Sec. 16423. (1) The board shall promulgate rules to establish criteria for the approval of analytical instruments and adjustment apparatus to be used for the purpose of examining patients in locating spinal subluxations and misalignments of the human spine. the criteria established shall be substantially equivalent to nationally recognized standards in the profession for the use and operation of the instruments. The board may approve types and makes of analytical instruments that meet these criteria.
(2) An individual shall not use analytical instruments or adjustment apparatus which does not meet nationally recognized standards or which is not approved by the board.
Sec. 16431. Notwithstanding the requirements of part 161, the board may require a licensee seeking renewal of license to furnish the board with satisfactory evidence of either or both of the following:
(a) Evidence that during the 2 years before the application for renewal, the applicant has attended not less than two 2-day educational conferences approved by the board, in subjects related to the practice of chiropractic and designed to further educate licensees.
(b) Evidence of continuing competence which the board determines by rule is necessary to demonstrate that the licensee continues to meet the educational and practice standards for the profession.

http://www.chiromi.com/scope/

 

[JeetKuneDo]

So, isn't a big part of why DPM's can coexist with Orthos because Orthos don't really want to operate on the foot or ankle when they can do other body parts? With OMM and PM&R, I don't see how DC's can come in to play by taking over only MSK, especially back and neck pain.

 

[JaggerPlate]

So, isn't a big part of why DPM's can coexist with Orthos because Orthos don't really want to operate on the foot or ankle when they can do other body parts? With OMM and PM&R, I don't see how DC's can come in to play by taking over only MSK, especially back and neck pain.

This was part of my main point (before I was vilified into some DC hater) ... there isn't an open niche to fill.

 

[vanbamm]

Uh, Jaggerplate knows exactly what he is talking about. Frankly, he is being too generous; the vast, vast majority of chiropractors are still prescribing to biotheistic nonsense and apply completely quack treatments to their patients. Or they get involved in scandalous practice management firms (google "Maximized Living" for a relatively common one) designed to bilk ignorant patients out of their money.

Even at National (a supposedly "scientific" chiropractic school) grads routinely walk out believing in garbage like TCM or homeopathy. Last night I had to opportunity to listen to a recent National grad talk about the importance of routine spinal screening to help support the nervous and immune systems! And he also produced a quack temperature probe device he said would help him find misalignments in the spine that supposedly would lead to disfunction and disease.

The vast majority of the time it is woo and the rest of the stuff could be replaced with some ASA.

vast. vast majority? you are wrong. you are not a chiro nor do you interact with or are part of the chiro community. No one knows what is going on inside of chiro schools except for chiro students themselves. Thanks though.

 

[vanbamm]

Oh are you done posing as a medical student and giving out medical school advice in the medical student forums? You're right, I'm the one who doesn't know what I'm talking about. I'd love to see this bill from Michigan. The only info I found said they were 'thinking' about expanding rights for more MSK issues and giving more experience doing rads stuff ... hardly prescription rights, this won't happen. Also, chiros had their chance to be part of the medical profession a long time ago, and they told the AMA where they could stick their offer. Don't expect the lobbying power of the AMA/entire medical community to allow DC expansion rights. There are so many issues YOU don't understand whatsoever, and you spewing off bull**** about research at DC colleges, and expanded practice rights, and 'scientific' chiropractic is pretty laughable.

You know what ... try to act as a PCP without the medical knowledge, residency, script rights, and malpractice. I've said it before, and I'll say it again ... there is NOTHING wrong with DCs practicing within their scope, which is spinal manipulation, anything else ... is not advantageous to patients, and won't stick. It also cracks me up that chiros think they have something to offer primary care. Do you not get that every NP, PA, DNP, etc is just ready and waiting to take over primary care??? Not to mention wal-mart clinics and any potential reform which pumps money back into primary care. Spinal manipulation + no medical knowledge offers NOTHING to primary care ... it just makes it unsafe.

There is no market to expand that isn't already being sought after by qualified medical personnel, and it's far, far too late for DC schools to decide to become legit and start churning out some special brand of primary care physician. Even if they did (which is impossible), what happens to practicing DCs??? Do they get the expanded rights? Do they stick with spinal manipulation for ethical reasons, but watch their peers get paid more with better scope ... NOPE. Dangerous, dangerous, dangerous. There is no risk of DC expansion and AGAIN, if you want to be a physician and diagnose, treat, and prescribe ... go to medical school. There will be no DC expansion in this current health care climate.

the only thing you found is what you googled because you don't know what you are talking about. I have pharmacist that teaches pharmacology, and she knows more about it than you do. Thanks though for your input.

And no, actually the AMA tired to destroy chiro in the 80's and they lost. The AMA never tried to incorporate chiropractic until recently. And no, I am not spweing off crap about anything that goes on at chiro schools. Once again, you are not on the inside, so you don't know what is going on. And as far as posing, what are your credentials??? I would love to know.

NP, PA, DNP's have limited degrees. They are basically the people that wanted the authority without putting in the time and are there to fill in the vacancies because no one wants to put in the time to become PCP's. You can argue all you want about how you think they are filling in as PCP's, but you know what, they still only had 2 years of graduate school,(or in the case of a DNP, which is not recognized in more than 13 states, and you can legally declare yourself a DNP if you so feel you have that much knowledge with herbs and homeopathy)so if you want to be diagnosed by them, by all means go ahead. DC's do four years, and contrary to what you think, A LOT of it is physical diagnosis. We are taught by adjunctive faculty that teach the same courses, use the same books as they do at medical schools. DC's pratice how they want to practice. If they want to be a PCP, they legally are able to and that is because our education covers it. We don't do residencies unless we decide to, but we do clinical portions in hospitals and clinics and are responsible for initially diagnosis if it is evident. If you want to make a legit arguement, I suggest you talk to multiple chiropractors to see how they practice or make more of an effort on research besides google or yahoo.

ps: medical students are NOT getting into primary care, hence the shortage and the push for chiropractors to step in even though most would like to stick to spinal manipulation. But some do want that role, and legally, they can have it if the patient comes to them in that capacity.

 

[that1guyfromFL]

If they want to be a PCP, (1) they legally are able to and that is because (2) our education covers it.

ps: (3) medical students are NOT getting into primary care, hence the shortage and (4) the push for chiropractors to step in even though (5) most would like to stick to spinal manipulation. (6) But some do want that role, and (7) legally, they can have it if the patient comes to them in that capacity.

(1) No, they are not.
(2) No, it does not.
(3) Yes, they are.
(4) Absolutely nobody is pushing except delusional DC's.
(5) Yay!
(6) We don't always get what we want.
(7) I hope you have good malpractice insurance.

 

[vanbamm]

(1) No, they are not.
(2) No, it does not.
(3) Yes, they are.
(4) Absolutely nobody is pushing except delusional DC's.
(5) Yay!
(6) We don't always get what we want.
(7) I hope you have good malpractice insurance.

glad to see you can count. i imagine having a conversation with someone that creates a numerical critque and then offers anemic counter arguements is probably pretty annoying to deal with on a daily basis, but the effort to create the other side to the issue is encouraging. you will get there one day.

 

[that1guyfromFL]

glad to see you can count.

I was only going to type 6 points but then I remembered what comes after 6, it's a 7!

 

[Cowy1]

Nothing I wrote wasn't true; the vast majority of chiropractors (and the diploma mills they attended) still believe the mythical "subluxation" as a meaningful health entity. And I have quite a bit of insight into the chiropractic "profession"; I have a family memeber who is an (idiot) DC and a bunch of my friends got suckered into chiropractic school after not getting into medical school. Now they are stuck with a huge pile of loans and no ethical way to pay them off.

Chiropractors aren't qualified to be PCPs because they don't know anything about it. Even the worst trained physician has far, far more experience and knowledge than the best-trained chiropractor. I mean, at Palmer they had to RECRUIT patients just to hit their minimum quota of like 250 "adjustments" so they could graduate. They only had to do 25 H&Ps, a number I have easily exceeded in the first two years of medical school (and they were on real, honest-to-goodness sick patients!). Seriously, what is back-cracking going to do for a UTI or otitis media?

If you don't like the reality, that's fine keep denying it, but the rest of us (should) know better.

 

[JaggerPlate]

the only thing you found is what you googled because you don't know what you are talking about. I have pharmacist that teaches pharmacology, and she knows more about it than you do. Thanks though for your input.

First and foremost, let me assure you that you are a space man now, and will be a fringe practitioner/quack in a few years. You're giving DCs a worse name than ANY of the crazy vitamin pushing, anti-medicine guys out there. People go to DC school because they believe in spinal manipulation and want to practice it.

Also, what is your point with google? That I was able to prove you wrong with a 20 second google search??? You said DCs were just given script rights in MI, I did a 30 second search, found the official chiro organization, looked up the scope of practice (which was updated Feb 19, 2010), and proved you were wrong. What does this say about your knowledge and skills? You have a pharmacist who teaches pharmacology??? Umm, super? You're nuts.

And no, actually the AMA tired to destroy chiro in the 80's and they lost. The AMA never tried to incorporate chiropractic until recently. And no, I am not spweing off crap about anything that goes on at chiro schools. Once again, you are not on the inside, so you don't know what is going on. And as far as posing, what are your credentials??? I would love to know.

Actually, the only reason the AMA lost the case in the 1980s was because it was deemed they were acting as a monopoly over the regulation of health care, and lost under anti-trust laws. The methods and theories brought up in the 'anti-quackery' boards from the 60s - 80s (which were aimed at chiropractic) weren't brought into question.

Do you even understand how ironic it is for you to claim I'M not inside on DC schools, but then to claim your school teaches you enough anatomy, pharm, path, physio, biochem, etc to work as a PCP when you've NEVER stepped foot in medical school????

My credentials ... legit, and that's all you need to know.

NP, PA, DNP's have limited degrees. They are basically the people that wanted the authority without putting in the time and are there to fill in the vacancies because no one wants to put in the time to become PCP's. You can argue all you want about how you think they are filling in as PCP's, but you know what, they still only had 2 years of graduate school,(or in the case of a DNP, which is not recognized in more than 13 states, and you can legally declare yourself a DNP if you so feel you have that much knowledge with herbs and homeopathy)so if you want to be diagnosed by them, by all means go ahead. DC's do four years, and contrary to what you think, A LOT of it is physical diagnosis. We are taught by adjunctive faculty that teach the same courses, use the same books as they do at medical schools.

I find it ironic that NPs and PAs have "limited" degrees, but their scope of practice is far less limited than yours? Misconception by the medical community, or misconception on your part??

And wow, you are unreal. First off, how many years of graduate school have you gone through which FOCUS on the practice of Western medicine??? I'll give you a hint ... it's between 0 and 0. Even if a PA/NP school was a summer course, it would still be more medical focused than all of your DC school. Just to clarify a little, demonstrate that you don't know what you're talking about, and I do ... let's do a little side by side comparison here, shall we?

NP:
The entry-level training for NPs is a graduate degree. At this time, NPs complete a master's or doctoral degree program. This means that NPs earn a bachelor's degree in nursing (4 years of education), then their graduate NP degree (2-4 years of education). Both types of programs provide the knowledge and clinical skills needed by NPs to perform as independent healthcare providers. Almost 350 universities and colleges have one or more NP program.

so off the bat ... you're wrong. A NP goes through years of education to get the RN, then gets the graduate degree in NP which is 2-4 years of additional education. It's what, 3-4 years for DC???

So let's use my other example now (PA) and look at their curriculum:

PA601 - Human Anatomy 4.0 PA602 - Physiology and Mechanisms of Disease I 3.0 PA615 - Physical Diagnosis 4.0 PA630 - PA History & Professional Issues 2.0 PA617 - Interpersonal Communication 2.0
PA603 - Microbiology and Infectious Disease 3.0 PA604 - Physiology and Mechanisms of Disease II 3.0 PA608 - Pharmacology I 3.0 PA620 - Medicine I 4.0 PA660 - Integrating Seminar I 1.0 PA646 - Behavioral Medicine 3.0
PA621 - Medicine II 4.0 PA609 - Pharmacology II 3.0 PA690 - Research Methods 3.0 PA628 - Diagnostic Methods 3.0 PA624 - Geriatrics 2.0 PA661 - Integrating Seminar II 1.0
PA622 - Pediatrics 3.0 PA623 - Obstetrics/Gynecology 3.0 PA625 - Surgery 4.0 PA626 - Emergency Medicine 3.0 PA627 - Policies and Systems of US Healthcare 2.0 PA662 - Integrating Seminar III 1.0 PA629 - Clinical Skills Lab I 1.0
(that's just pre-clinical ... here's clinical)

P680 - Family Medicine Clerkship 2.0 PA681 - Internal Medicine Clerkship 2.0 PA682 - General Surgery Clerkship 2.0 PA683 - Pediatric Clerkship 2.0 PA684 - Geriatric Clerkship 2.0 PA685 - Obstetrics and Gynecology Clerkship 2.0 PA686 - Emergency Medicine Clerkship 2.0 PA687 - Elective I 2.0 PA688 - Elective II 2.0
See, that is education which prepares someone to be a physicians assistant and a partial primary care provider ... yours does not, ergo, you are not.

http://www.samuelmerritt.edu/physician_assistant/curriculum

DC's pratice how they want to practice. If they want to be a PCP, they legally are able to and that is because our education covers it. We don't do residencies unless we decide to, but we do clinical portions in hospitals and clinics and are responsible for initially diagnosis if it is evident. If you want to make a legit arguement, I suggest you talk to multiple chiropractors to see how they practice or make more of an effort on research besides google or yahoo.

DC's practice how they want to practice ... and then get sued and end up in jail:

http://www.chirobase.org/16Victims/gallagher.html

Read it. A chiro, much like yourself, tried to go outside of her scope, dismiss medical advice and therapy given by a DO/MD, murdered a patient, and went to JAIL. Didn't get a slap on the wrist, went to JAIL. Let me include a little snippet:

Strohecker (patient) saw Gallagher (chiropractor) for about 40 visits between October 1998 and April 1999. During this time, Gallagher repeatedly advised Strohecker to stop taking her anticonvulsive medication. Gallagher also assured Strohecker that once she did this, she would experience approximately three days of seizures, would fall into a deep sleep, and would wake up healed of her seizure disorder. When Strohecker stopped her medicine, she began to experience frequent seizures, including one in Gallagher's office. Strohecker became unable to walk, severely dehydrated, and, shortly before her death, unconscious [1:7]. The autopsy report states that during her final days, friends watched her laying on a mattress on the floor, wearing disposable diapers, with a suction apparatus nearby

Legally, huh? Tell me, where is the legal evidence? Where are you allowed to write prescriptions? Where are you allowed to admit to a hospital? Where are you allowed to perform surgery?

Nowhere ... because you aren't a primary care PHYSICIAN.

You're education covers it?? How the F*CK would you know? Have you ever gone through medical school? Huh? Ever gone through 2 years of extensive sciences, followed by 2 years of clinical education, followed by a 3-4 year residency dedicated extensively to a certain primary care field? Didn't think so. The irony of you claiming other people want the title and the prize and the authority without putting in the proper training is absolutely hilarious. I seriously don't think I've ever laughed at my computer screen more than while reading your response.

Oh you get to decide to do residences huh? I wonder why more medical students don't do that? "Oh well I'm going to opt not to do the residency, but still seek board certification by the American Board of Family Medicine because I'm pretty sure my school covered everything learned in residency." LAUGH.

And about making a legit argument ... what the hell is talking to DCs going to do? I don't have to ... all I need to do is look up your legal scope of practice, which I did ... you can't prescribe medicine, admit to a hospital, or perform surgery. Done. I don't give a **** what a bunch of DCs think they can do, you can't. So go ahead, try it ... you'll start to get nice little visits from lawyers without the malpractice to fall back on, and you'll scar people's lives in the process. I'm also not going to stop googling things because it's super fun to completely wreck your knowledge base with a 30 second google search.

ps: medical students are NOT getting into primary care, hence the shortage and the push for chiropractors to step in even though most would like to stick to spinal manipulation. But some do want that role, and legally, they can have it if the patient comes to them in that capacity.

Yes they are ... people go into FM, IM, EM (which serves as PC in certain rural areas), OB, psych, and g-surg every year ... all considered primary care by different legit organizations, all going to medical student ever year, and ALL outside your educational level and scope of practice. There is also absolutely no push from anyone besides a few DCs who apparently can't wait to be destitute from lawsuits. No one want's chiropractors as their primary care physicians, and if it ever happened in a great enough volume to flicker on anyone's radar, it would be squashed, either my medical organizations or the godless lawyers. Stick to spinal manipulation yourself, you are not educated, trained, or have the legal right to do anything else.

Game over. You're done.

 

[vanbamm]

i have a feeling that your have the initials A.N.A.L. after your name.
by remaining ambiguous about your training/schooling makes it appear it is lacking.
give your copy and paste tools a rest.

 

[JeetKuneDo]

So I remember there was a thread a while back about a DC being a first respondent to a car accident. Apparently, some guy in the accident was lying on the ground and the DC decided to turn the guy over, saying he's a DC, he knows what he's doing.

 

[JaggerPlate]

i have a feeling that your have the initials A.N.A.L. after your name.
by remaining ambiguous about your training/schooling makes it appear it is lacking.
give your copy and paste tools a rest.

Lol, I'm actually probably the least anal-retentive person on the planet, I just advocate patient care and people practicing within their scope. I also want to point out that I have no issues with DCs who stay within their range ... they are good docs, and I used to see one for a few years, and know several more. They believe in spinal manipulation, run successful practices, and like what they do. These aren't the guys who advertise as PCPs, or advocate taking vitamins and spinal manipulation instead of seeking medical care, etc.

As far as my credentials go ... I don't know what it bothers you, and I try to stay fairly anonymous on these boards but:

I graduated with a BS in a science field from a Top 25 university (ranked 1 or 2 for public depending on the source), I've been accepted to one of the oldest, best regarded DO schools around, and I'm currently achieving a masters with a health business focus for another well regarded university.

As far as my copy and paste skills ... I'm winning thus far, don't think I'm gonna swtich to southpaw this late in the fight, know what I mean??

 

[Feli]

Looks like this thread is the kind of sinking ship that's overloaded with shoulder chips, probably best avoided, but anyways...

The way to get more respect and scope of practice is being trained for it. You need to acquire the knowledge and the skills that are proven to work based on medical evidence. Plain and simple. I really have no idea what chiro school entails. I'm sure some extensive musculoskeletal anat, esp axial skeleton, and a good amount of physical medicine. As was said, PT programs offer a lot of the same stuff. DOs or PM&R docs also provide those things... and a lot more.

You ask about DCs being able to "give very basic medical advice" and "diagnose common medical problems." That would be all fine and good. Nurses do that (assessment, triage diagnosis, eval progress, etc), but they also work with docs who will confirm the diagnosis, provide oversight, and decide the definitive diagnosis, workup, and treatment. I really don't know if your education and clinical experience trains you for medical assesments and diagnostics (even at the clinical RN level).

Also, I don't understand why people would want to go to one guy for a exam/diagnosis when they would then need to go to another for any required treatment (Rx, testing, imaging, surgery, follow-up, etc). If what you are suggesting were to be plausible, I'm guessing it'd have to be in a multidisciplinary setting: chiro finds high blood pressure or abdominal pains and sends it across the hall to the MD. In a separate practice, it just wouldn't work. Many DCs, even if they vastly increased training and could accurately diagnose limited medical pathology, would not want to "lose" the patients by sending them for appropriate follow up. Therefore, overly conservative treatments, herbals or other non-Rx, and gladhanding for the DC's patient's medical and surgical issues would run rampant and probably replace traditional proven medicine, surgery, testing, etc since DCs aren't really trained or licensed to provide the real approaches. I unfortunately see this among some older podiatrists who just aren't adequately residency trained: they sit and putz with overly conservative treatments since they don't know the proper management but are reluctant to lose the patient by making proper referral. That is a recipe for patient disaster as the condition goes neglected... not to mention malpractice. You have to know your training/skill limits.

 

[JaggerPlate]

Looks like this thread is the kind of sinking ship that's overloaded with shoulder chips, probably best avoided, but anyways...

The way to get more respect and scope of practice is being trained for it. You need to acquire the knowledge and the skills that are proven to work based on medical evidence. Plain and simple. I really have no idea what chiro school entails. I'm sure some extensive musculoskeletal anat, esp axial skeleton, and a good amount of physical medicine. As was said, PT programs offer a lot of the same stuff. DOs or PM&R docs also provide those things... and a lot more.

You ask about DCs being able to "give very basic medical advice" and "diagnose common medical problems." That would be all fine and good. Nurses do that (assessment, triage diagnosis, eval progress, etc), but they also work with docs who will confirm the diagnosis, provide oversight, and decide the definitive diagnosis, workup, and treatment. I really don't know if your education and clinical experience trains you for medical assesments and diagnostics (even at the clinical RN level).

Also, I don't understand why people would want to go to one guy for a exam/diagnosis when they would then need to go to another for any required treatment (Rx, testing, imaging, surgery, follow-up, etc). If what you are suggesting were to be plausible, I'm guessing it'd have to be in a multidisciplinary setting: chiro finds high blood pressure or abdominal pains and sends it across the hall to the MD. In a separate practice, it just wouldn't work. Many DCs, even if they vastly increased training and could accurately diagnose limited medical pathology, would not want to "lose" the patients by sending them for appropriate follow up. Therefore, overly conservative treatments, herbals or other non-Rx, and gladhanding for the DC's patient's medical and surgical issues would run rampant and probably replace traditional proven medicine, surgery, testing, etc since DCs aren't really trained or licensed to provide the real approaches. I unfortunately see this among some older podiatrists who just aren't adequately residency trained: they sit and putz with overly conservative treatments since they don't know the proper management but are reluctant to lose the patient by making proper referral. That is a recipe for patient disaster as the condition goes neglected... not to mention malpractice. You have to know your training/skill limits.

Great post, and the bolded points are dead on/things I was trying to say 👍

 

[diabeticfootdr]

So I remember there was a thread a while back about a DC being a first respondent to a car accident. Apparently, some guy in the accident was lying on the ground and the DC decided to turn the guy over, saying he's a DC, he knows what he's doing.

1. All you need to know in a car accident is first aid, BLS, and a little common sense to be of some use.
2. If I was in a car accident and the first one on the scene was anyone, DC, RN, dentist, podiatrist, I'd be grateful.

 

[JeetKuneDo]

I actually found that old thread.

http://forums.studentdoctor.net/showthread.php?t=611704&highlight=chiropractor,+accident

It's only an example of one DC, but if more start considering themselves PC physicians, then it could get a little scary.

 

[janV88]

I actually found that old thread.

http://forums.studentdoctor.net/showthread.php?t=611704&highlight=chiropractor,+accident

It's only an example of one DC, but if more start considering themselves PC physicians, then it could get a little scary.

It was an april fools joke. http://forums.studentdoctor.net/showpost.php?p=7886408&postcount=43

 

[JeetKuneDo]

It was an april fools joke. http://forums.studentdoctor.net/showpost.php?p=7886408&postcount=43

Dammit.

 

[janV88]

I'm just a pre-pod but I think I have a slightly better understanding of the healthcare system than the average pre-med/pod/etc. being that my mom is a nurse and my brother is an EM resident.

Training is everything. More training, with or without expanded scope, is never dangerous.

Remember...MD/DO may legally have "unlimited scope" but actual practice is limited by training. Your hospital privileges are determined by your training. That is why, in most hospitals, EM physicians do not have privileges outside of the ER. And why an IM physician cannot perform surgery without being arrested. And why an Ortho surgeon cannot practice IM. (that last one is probably possible in rural or strictly private practice, but good luck trying to get admitting privileges at a large hospital). The reason for all this is training. Practitioners are held accountable based on their training. Even if the procedure or practice is within scope...good luck with defending yourself in court without sufficient training.

I can argue that the "unlimited scope" of MD/DO physicians is dangerous. I can't even count how many misinformed pre-med/med students on SDN post about how an MD/DO can do anything, etc. These same pre-med/med students will be physicians some day and think they can do whatever they want...regardless of training or proficiency. And if you want a anecdotal example then here it goes. My mom told me once of a pulmonologist who had a patient that was complaining of having a little difficulty breathing. The pulmonologist decided to intubate. Instead of calling anesthesia, he decided to do it himself. Long story short, he failed and the patient died. The patient was non emergent, he was breathing ok but not well. The patient had some difficulty but it wasn't like he would die if he wasn't intubated. My mom told me that the pulmonologist was not used to doing intubations and, unlike anesthesiologists, he was not doing them daily, weekly, or even monthly.

Remember people...scope of practice is just a bunch of laws. With a large enough lobbying group (nurses come to mind), expansion can be easily achieved. The best way to regulate a profession is to find an appropriate niche and assemble the training/curriculum around that niche. If a profession is not performing in that particular niche...less and less of the public will go to them and the niche will eventually die.

In my opinion, I think scope of practice laws do little to properly "police" practicioners. It gives them a clear line of what they can and cant do. And everyone knows human nature, tell them they cant do it and they will. They will fight for expanded scope. And when they will practice to the limits of the defined scope regardless of training. That is why you often hear of DC's referring to themselves as PCP's and so gung ho about doing physicals. I have even heard of DC's saying that they can legally give birth! Yes by law they can (depending on the state) and I bet a small percentage will...just because it is within their "scope".

 

[JaggerPlate]

I'm just a pre-pod but I think I have a slightly better understanding of the healthcare system than the average pre-med/pod/etc. being that my mom is a nurse and my brother is an EM resident.

Training is everything. More training, with or without expanded scope, is never dangerous.

Remember...MD/DO may legally have "unlimited scope" but actual practice is limited by training. Your hospital privileges are determined by your training. That is why, in most hospitals, EM physicians do not have privileges outside of the ER. And why an IM physician cannot perform surgery without being arrested. And why an Ortho surgeon cannot practice IM. (that last one is probably possible in rural or strictly private practice, but good luck trying to get admitting privileges at a large hospital). The reason for all this is training. Practitioners are held accountable based on their training. Even if the procedure or practice is within scope...good luck with defending yourself in court without sufficient training.

I can argue that the "unlimited scope" of MD/DO physicians is dangerous. I can't even count how many misinformed pre-med/med students on SDN post about how an MD/DO can do anything, etc. These same pre-med/med students will be physicians some day and think they can do whatever they want...regardless of training or proficiency. And if you want a anecdotal example then here it goes. My mom told me once of a pulmonologist who had a patient that was complaining of having a little difficulty breathing. The pulmonologist decided to intubate. Instead of calling anesthesia, he decided to do it himself. Long story short, he failed and the patient died. The patient was non emergent, he was breathing ok but not well. The patient had some difficulty but it wasn't like he would die if he wasn't intubated. My mom told me that the pulmonologist was not used to doing intubations and, unlike anesthesiologists, he was not doing them daily, weekly, or even monthly.

Remember people...scope of practice is just a bunch of laws. With a large enough lobbying group (nurses come to mind), expansion can be easily achieved. The best way to regulate a profession is to find an appropriate niche and assemble the training/curriculum around that niche. If a profession is not performing in that particular niche...less and less of the public will go to them and the niche will eventually die.

In my opinion, I think scope of practice laws do little to properly "police" practicioners. It gives them a clear line of what they can and cant do. And everyone knows human nature, tell them they cant do it and they will. They will fight for expanded scope. And when they will practice to the limits of the defined scope regardless of training. That is why you often hear of DC's referring to themselves as PCP's and so gung ho about doing physicals. I have even heard of DC's saying that they can legally give birth! Yes by law they can (depending on the state) and I bet a small percentage will...just because it is within their "scope".

God this post is so wrong and misinformed ... I can't even break it down. Just ignore.