I'm a DC. I don't practice in Texas, so I can't speak to specifics of their scope, etc. The linked article is the first I've heard of this.
Clearly, this is about turf. Medical physicians are feeling an encroachment from NPs, CRNAs, and other mid-levels, and they are trying to reduce as much competition as possible. So the effort to contain now extends out to podiatrists (as in the article) and apparently most recently chiropractors.
The idea that a chiropractor can't refer a patient for diagnostic testing to rule out a suspected pathological condition is ridiculous. Don't misunderstand; if I notice a suspicious mole on a patient, I am sending that patient straight to the dermatologist. But if my history and exam suggest something suspicious in the musculoskeletal system, I am referring that patient for whatever imaging is appropriate.
As far as the idea of patients being pre-screened by an MD first, I have no problem with that. But to suggest that a patient NEEDS to be pre-screened before chiro care, now that I disagree with.
Let's take a few examples from my own practice:
Mid-40s male referred by family physician for back pain. After taking the history, his pain was atypical. My initial exam noted tenderness in epigastric area. Long story short, pancreatic cancer. I found it, not the PCP.
Female in her 60s, had an MVA about a year earlier and had seen at least 2 orthos, a neurologist, and I can't remember who else. Day 1, I'm palpating her neck, note a large mass in the left submandibular area. So I asked her "how long has this lump been here?", to which she responded "what lump?". Uh-oh. Referred her to ENT; cancer; at least he had the honesty to tell her that I likely saved her life. Several specialists had missed it, I found it.
Woman in 40s, presents to me for left midback pain. She had gone to the ER for this pain a few days earlier; Xrays were performed and she was discharged with a "sprain". I look at the films and note an expansile lesion in one rib, exactly where localized tenderness was present on exam. Long story short, neoplastic lesion. I found it; ER docs missed it.
Male, in his 60s. Earlier hx of melanoma. Family physician sees him for right upper arm pain, diagnoses "strained biceps". The patient comes to me, and it took about 1.5 seconds to realize it wasn't a strained biceps. MRI: tumor. MD missed it, I found it.
So, feel free to screen away before referring to DCs. But DCs aren't hanging our hats on the MD evaluation alone. Each of the above cases was handled professionally; I could have said to those patients, "boy, what an idiot MD you have", but what does that accomplish. We are all doing our best for our patients, everyone has something to contribute, and nobody's perfect.
As far as the Texas thing and chiropractors, the knock against DCs was always lack of evidence for spinal manipulation. But that doesn't work anymore, so the 'DCs can't diagnose' thing is just the new approach I guess. It's all about turf and control.
