Chiropractic Scope of Practice, Competency Evaluation and Licensure

1. Chiropractic Scope of Practice, Competency Evaluation and Licensure Cynthia Vaughn, D.C.

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

3. Preamble Primary Care versus Primary Contact versus Direct Access These three terms have different meanings to different people, yet for all practical purposes…mean the same thing.

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

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

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

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

8. Testing Measures That Ensure Clinical Competency National Board of Chiropractic Examiners (NBCE) • Established 1963 • Four Parts + Physiotherapy + SPEC • Parts I, II and III accepted by all 51 jurisdictions • Part IV accepted by 46 jurisdictions

9. NBCE Examinations – Part IWritten Examination Six Basic Science Subjects • General Anatomy • Spinal Anatomy • Physiology • Chemistry • Pathology • Microbiology & Public Health Implemented in 1965

10. NBCE Examinations – Part IIWritten Examination Six Clinical Science Subjects • General Diagnosis • Neuromusculoskeletal Diagnosis • Diagnostic Imaging • Principles of Chiropractic • Chiropractic Practice • Associated Clinical Sciences Also implemented in 1965

11. NBCE Examinations – Part III Written Clinical Competency Exam • Case History, Physical & NMS Examination • Roentgenologic Examination • Clinical Laboratory and Special Studies • Diagnosis • Chiropractic Techniques • Supportive Techniques • Case Management Implemented in Fall of 1987

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

13. NBCE Examinations - PT Physiotherapy Examination • Case History and Examination • Physiotherapy Modalities • Indications, contraindications and Applications of Modalities • Therapeutic Exercise and Rehabilitation

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

15. Credibility of NBCE Exams • Widespread acceptance by state licensing boards • Adhere to the American Psychological Association’s Standards for Educational and Psychological Testing and the American Educational Research Association • Validity and reliability scores

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

17. State Licensing Responsibility of the licensing boards: Protect the public by – • Ensuring appropriate education and examinations • Interpreting and applying statutes and regulations • Identifying and recommending legislative improvements

18. State Licensing State licensing boardscommonly – • Adopt the accreditation standards of the CCE (Chairman Reed Phillips is CCE President) • Require 12 – 24 hours of CE every year • Re-evaluate practitioners every 1–2 years during the license renewal process • Discipline DCs who do not comply with acceptable professional standards as codified in statute and regulation • Report violations to the national CIN-BAD database so other states will have information.

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