scope of practice??

[50960]

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Quick query here..please do not take this as a flame.

I have recently seen 2 articles in my local paper that seem a bit weird to me. The first is for an RN who supposedly does laser surgery; is this possible? The second is for a Chiro who is treating people for weight gain/obesity.... I have been in health care for over 10 years, and know the scope of practice for most providers (RNs, PhDs, PAs etc..), but these just seem a bit off to me. Any insight?? 😕

 

[deleted6669]

the "laser surgery" is probably minor derm stuff that you can learn in a 2 hr seminar. the weight clinic stuff is probably lifestyle modification, diet, and herbs......anyone can do these things......

 

[FoughtFyr]

Quick query here..please do not take this as a flame.

I have recently seen 2 articles in my local paper that seem a bit weird to me. The first is for an RN who supposedly does laser surgery; is this possible? The second is for a Chiro who is treating people for weight gain/obesity.... I have been in health care for over 10 years, and know the scope of practice for most providers (RNs, PhDs, PAs etc..), but these just seem a bit off to me. Any insight?? 😕

While standards vary state to state, in Illinois, a chiropractor is well within their rights to "treat weight gain/obesity". According to Illinois law a chiropractor is licensed to "treat human ailmentments without drugs and operative surgery" In other words, chiropractors in Illinois are considered general practitioners under the law. They can treat any human ailment - including weight gain. The question often asked on this forum is can they treat it effectively?

Here is the law setting the education standards for chiropractors.

Treating human ailments without drugs and
without operative surgery. For the practice of treating human ailments without the use of drugs and without operative surgery:

(1) For an applicant who was a resident student
and who is a graduate after July 1, 1926, of a chiropractic college or institution, that such school, college or institution, at the time of the applicant's graduation required as a prerequisite to admission thereto a 4 year course of instruction in a high school, and, as a prerequisite to graduation therefrom, a course of instruction in the treatment of human ailments, of not less than 132 weeks in duration and which shall have been completed within a period of not less than 35 months except that as to students matriculating or entering upon a course of chiropractic study during the years 1940, 1941, 1942, 1943, 1944, 1945, 1946, and 1947, such elapsed time shall be not less than 32 months, such high school and such school, college or institution having been reputable and in good standing in the judgment of the Department.

(2) For an applicant who is a matriculant in a
chiropractic college after September 1, 1969, that such applicant shall be required to complete a 2 year course of instruction in a liberal arts college or its equivalent and a course of instruction in a chiropractic college in the treatment of human ailments, such course, as a prerequisite to graduation therefrom, having been not less than 132 weeks in duration and shall have been completed within a period of not less than 35 months, such college of liberal arts and chiropractic college having been reputable and in good standing in the judgment of the Department.

(3) For an applicant who is a graduate of a
United States chiropractic college after August 19, 1981, the college of the applicant must be fully accredited by the Commission on Accreditation of the Council on Chiropractic Education or its successor at the time of graduation. Such graduates shall be considered to have met the minimum requirements which shall be in addition to those requirements set forth in the rules and regulations promulgated by the Department.

(4) For an applicant who is a graduate of a
chiropractic college in another country; that such chiropractic college be equivalent to the standards of education as set forth for chiropractic colleges located in the United States.

(Source: P.A. 89‑702, eff. 7‑1‑97; 90‑818, eff. 3‑23‑99.)​

Even scarier is this law that allows a chiropractor to "challenge" the MD/DO state boards. Now, as far as I know, no chiropractor has attempted this, and there would still be significant obstacles to overcome (such as a DEA # to prescribe drugs, privledges to perform surgery, etc.) but this law looks like skiiboy wrote it!

Physician licensed to practice without drugs and operative surgery; license for general practice.

Any physician licensed under this Act to treat human ailments without the use of prescriptive drugs and operative surgery shall be permitted to take the examination for licensure as a physician to practice medicine in all its branches and shall receive a license to practice medicine in all of its branches if he or she shall successfully pass such examination, upon proof of having successfully completed in a medical college, osteopathic college or chiropractic college reputable and in good standing in the judgment of the Department, courses of instruction in materia medica, therapeutics, surgery, obstetrics, and theory and practice deemed by the Department to be equal to the courses of instruction required in those subjects for admission to the examination for a license to practice medicine in all of its branches, together with proof of having completed (a) the 2 year course of instruction in a college of liberal arts, or its equivalent, required under this Act, and (b) a course of postgraduate clinical training of not less than 24 months as approved by the Department.
(Source: P.A. 89‑702, eff. 7‑1‑97.)​

- H

 

[50960]

Interesting foughtfyr. FYI, I am in Ca.
I disagree with the statement that anyone can do those things. As a licensed clinical psychologist with medical training to boot I would be considered by my pees to be practicing unethically if I advertised to treat something I was not trained in and had no expertise in. A psych is much more relavent to teaching lifestyle issues for weight loss than a DC!

🙂

 

[FoughtFyr]

Interesting foughtfyr. FYI, I am in Ca.
I disagree with the statement that anyone can do those things. As a licensed clinical psychologist with medical training to boot I would be considered by my pees to be practicing unethically if I advertised to treat something I was not trained in and had no expertise in. A psych is much more relavent to teaching lifestyle issues for weight loss than a DC!

🙂

Yes, but there have been many discussions here as to the complete lack of standardized scope of practice within chiropractic. So there would unlikely be any peer resistence to the idea. Secondly, weight loss / obesity is clearly within the realm of "human ailments" so it is legally within an Illinois-based chiropractor's scope of practice. Third, chiropractic training does emcompass the chiropractic theory, part of which is a "healthy lifestyle" (called the "chiropractic lifestyle" at chiropractic training institutions), so a chiropractor may feel well trained to address weight loss.

- H

 

[50960]

OK thanks. I have to admit I know very little about chiropractic.

🙂

 

[rooster]

OK thanks. I have to admit I know very little about chiropractic.

🙂

psisci-

-Perhaps a call to the respective ads would be informative to find out specifics.

-To specifically address your "knowing very little about chiropractic", you are not alone. Many posters here, claiming to "know" all about chiropractic, are not up to date( I am being generous here-----perhaps they intend to mis- inform).

-per your DC & diet/weight loss inquiry:
from NWUHS(required degree credits)

CLINICAL NUTRITION 1 - 36350 Description
Credits: 4
Clock Hours: 60
Lecture Hours: 60
Prerequisites: Biochemistry 1 and 2; Physiology 1 and 2

Discussion of nutrient metabolism and physiologic function in the body. Components of nutrition including vitamins, major minerals, and trace elements. Macronutrients and micronutrients are discussed along with clinical applications.



CLINICAL NUTRITION 2 - 36470

Description
Credits: 3
Clock Hours: 30
Lecture Hours: 45
Prerequisite: Clinical Nutrition 1

Current application of nutritional management of common conditions encountered in chiropractic practice, including disorders of the organ systems. Discussion of nutritional needs throughout life. Students practice assessing nutritional status. Discussion of general, individual, and community nutritional needs along with special patient populations.




- Not to flame- What are medical school class hours in nutrition?

-Hey that's OK though- I would rather have them devoting their hours concentrating on what they do best( heart attacks, crisis intervention/emergency procedures, infectious disease, etc. etc.)

- I have ads in my local paper soliciting/"dessert with the doc" for gastric bypass. Gastric bypass is NOT the answer to weight loss/obesity in 99% of obese people, but it is certainly profitable to those promoting and performing said surgery.

 

[BackTalk]

I treat patients for weight loss using Acupuncture/Auriculotherapy. Most all patients who enter my office have already gone through every weight loss program imaginable. They have also had many tests already done by their family doctor to rule out conditions that might be the cause. If they haven’t, I usually send them to the PCP to run the tests or I send them if they don’t have a PCP. I make it a rule that they know that my treatment is not a magic bullet and must be coupled with diet and exercise. The Auriculotherapy specifically deals with cravings and helps suppress the appetite. Auriculotherapy alone, is not enough. It’s probable the chiropractor that is advertising weight loss also uses Auriculotherapy. Auriculotherapy has been around a long time and is nothing new. It’s starting to gain popularity and there has been some positive research published on the subject.

As far as “scope of practice goes” I think it’s within our scope to address weight issues. What you have to understand is these chiropractors aren’t using chiropractic manipulation to address weight issues. They are more than likely addressing lifestyle changes such as diet and exercise along with proper nutrition. There is only one magic bullet to address weight loss, and that is diet and exercise. Again, the treatment of Auriculotherapy is only to help suppress appetite for those who have uncontrollable urges. I think psychologists do great job addressing psychological problems which many times is the cause of a patients weight problem. I’m not a psychologist but can tell when someone is having emotion problems that need to be dealt with. If that is the case I’m more than happy to refer them your way. As far as a psychologist having the training above that of a DC with regard to clinical nutrition, diet instruction and exercise, I have to disagree. Lifestyle changes regarding mental disorders yes. A team approach is the best solution. 👍

 

[DPTATC]

Interesting sub-thread.

I don't have any problem with DCs teaching/counseling weight loss programs. What I have a problem with, is when they sell the supplements that they recommend. When you have "doctor" in front of your name, you are given some additional credibility (for good or ill) by the patient. And that is an unfair to the layperson. They may not have the knowledge to think critically about what their supplementation is really worth to them and will feel pressured.

And before somebody goes off, it IS different than MD/DO prescribing meds. There are laws against self referral and the MD/DOs don't sell the meds that they prescribe.

 

[cecilia]

DPTATC,

While I was doing my rotations, I met a couple of MD's who did sell the medications they prescribed. (they had a little pharmacy room in the back of the office).

 

[cecilia]

FoughrFyr,

I read the law that you posted. I doubt very much that chiros are allowed to take the medical board. Chiros take the chiro boards. It is just probably a very bad written article. That's all.

 

[DPTATC]

DPTATC,

While I was doing my rotations, I met a couple of MD's who did sell the medications they prescribed. (they had a little pharmacy room in the back of the office).

That's pretty unusual isn't it? I have been in practice for 13 years and I don't think I have seen it. Was it in an extreeeeemely rural setting?

 

[FoughtFyr]

FoughrFyr,

I read the law that you posted. I doubt very much that chiros are allowed to take the medical board. Chiros take the chiro boards. It is just probably a very bad written article. That's all.

No, that is actually the law. It was a big deal in Illinois when it was passed. A chiro could present to the department of professional regulation "proof" that their training at a chiropractic college was essentially equivalent to that of a medical college in the areas described in the legislation. They would then be permitted to sit for the exam. If they pass and can can then produce proof of the undergraduate education and well as evidence of two years of postgraduate training, they get an unrestricted medical license. The hitch (thankfully) comes in the postgraduate education. Another section of the act describes the post-graduate education as needing to be AOA or ACGME approved. So there is the rub. BUT - if a chiro could talk his or her way into a residency program they would get the medical license. You can read the whole act at www.illinois.gov. It is the "Medical Practice Act of 1986".

BTW - There was one chiropractor in my MPH class who had applied to the Occupational Medicine Residency at Cook County. Given that he owned a chain of chiropractic collaborative practice occupational medicine centers, he was almost granted the admission. It was two student reps at the SPH that pointed out this legislation to the program. He was quite open afterward that it was his intent to be the first chiro to be granted an unrestricted license under this act. To date, there have been none.

- H

 

[50960]

The old dispensing physician model?? I doubt it still is in practice with all the pharma regs, but who knows. I do know MDs who sell supplements (omega 3, vits etc), but this is regulated differently. In the old days physicians were dispensers as well, I am not sure handing out samples is much different as it is usually followed up with a script for the same med. Is this bad?? Not really. Most of the patients I see in my rural office live off samples by necessity..#30 lexapro bites into feeding their kids!

😱

 

[BackTalk]

Interesting sub-thread.

I don't have any problem with DCs teaching/counseling weight loss programs. What I have a problem with, is when they sell the supplements that they recommend. When you have "doctor" in front of your name, you are given some additional credibility (for good or ill) by the patient. And that is an unfair to the layperson. They may not have the knowledge to think critically about what their supplementation is really worth to them and will feel pressured.

And before somebody goes off, it IS different than MD/DO prescribing meds. There are laws against self referral and the MD/DOs don't sell the meds that they prescribe.

I don't have any problem with DCs teaching/counseling weight loss programs. What I have a problem with, is when they sell the supplements that they recommend. When you have "doctor" in front of your name, you are given some additional credibility (for good or ill) by the patient. And that is an unfair to the layperson. They may not have the knowledge to think critically about what their supplementation is really worth to them and will feel pressured.

I understand your point of view. Pushing supplements for financial gain is a terrible thing to do regardless of who is doing it. Unfortunately, I’m seeing more and more massage therapists peddling supplements to their clients. At least with legitimate chiropractors they have training in diagnosis and also are trained in clinical nutrition. Massage therapists have none.

And before somebody goes off, it IS different than MD/DO prescribing meds. There are laws against self referral and the MD/DOs don't sell the meds that they prescribe.

I think when it comes to MD/DO that sometimes certain meds might be pushed or prescribed in order to keep those free catered lunches and football tickets coming.

 

[rooster]

Interesting sub-thread.

>>snip<<

And before somebody goes off, it IS different than MD/DO prescribing meds. There are laws against self referral and the MD/DOs don't sell the meds that they prescribe.

DPT-
What about MD referral to a POPTP? I know this is a big topic for PTs. It is, in essence- self referral.

 

[truthseeker]

DPT-
What about MD referral to a POPTP? I know this is a big topic for PTs. It is, in essence- self referral.

It is WRONG WRONG WRONG

It eliminates independent decision making. The doctor refers to the PT who sends them back to the doctor who sends them back to PT . . . ripe for misuse. In some rural areas, they have difficulty providing services and in most cases it is handled legitimately, but if the doctor doesn't own the PT practice, there is no chance for malfeasance. I support eliminating the POPTS.

 

[truthseeker]

I don't have any problem with DCs teaching/counseling weight loss programs. What I have a problem with, is when they sell the supplements that they recommend. When you have "doctor" in front of your name, you are given some additional credibility (for good or ill) by the patient. And that is an unfair to the layperson. They may not have the knowledge to think critically about what their supplementation is really worth to them and will feel pressured.

I understand your point of view. Pushing supplements for financial gain is a terrible thing to do regardless of who is doing it. Unfortunately, I’m seeing more and more massage therapists peddling supplements to their clients. At least with legitimate chiropractors they have training in diagnosis and also are trained in clinical nutrition. Massage therapists have none.

And before somebody goes off, it IS different than MD/DO prescribing meds. There are laws against self referral and the MD/DOs don't sell the meds that they prescribe.

I think when it comes to MD/DO that sometimes certain meds might be pushed or prescribed in order to keep those free catered lunches and football tickets coming.

Some of that happens, but I think it is very limited with new legislation in place. I think it varys from state to state but there is a limit as to the amount of bribery that can occur. Besides, I think it has more to do with the looks of the salesperson as to how often the docs want them in the door. But seriously, the docs I work with would rather not see any pharmaceutical reps at all, in fact they are downright pissed at the pharm companies telling the patients what drugs they should be taking, spending all that money on advertising and making the cost of the drug go up.