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Who Will Govern Chiropractic?
Throughout the history of chiropractic in the United States, and now on the world frontiers of our profession, our fundamental goal was and continues to be the legal establishment of chiropractic as a recognized, doctor level health care profession. There are very few left among us who can remember the celebration when this state or that finally enacted a licensure law, but the legislative enactment of chiropractic authorities and obligations remain perhaps the greatest triumph for chiropractic. Today, we see communities in nations around the globe working within their national political processes to secure the legal standing we enjoy in the US, Canada and many other nations.
Inherent in legal recognition is the coding into law and regulations the exact definitions and parameters of practice. While we all disagree on some of the details from time to time, licensure laws and regulations have provided a solid pole against which we can measure activities in our practice, and to which we can look for protection and support when challenged by any entity, be it a third-party payment agency or other professionals.
There is, however, a dark cloud emerging in this arena that should be of grave concern to all doctors of chiropractic, everywhere. This is the emergence of aggressive entrepreneurial organizations that are presenting themselves in the marketplace as “regulators” of chiropractic procedure and utilization. They contract with insurance carriers and self-insured plans on the promise of reducing utilization and costs, and then proceed to seek to dictate new, economically driven, and advantageous terms of practice that run the gambit from drastically limiting the taking of x-rays to limiting the number of visits to sometimes ridiculously low levels, even for complicated cases. Claiming a credibility to which they are not entitled, they sometimes show up before regulatory boards with claims and assertions that are so far beyond established chiropractic norms and practice parameters that the profession needs to question whether these organizations are, in fact, seeking to usurp the unique authority of the state legislatures in the United States to regulate the professions and the trades.
We should be outraged, indeed, we must be outraged at any organization that acts to place our doctors in conflict with their obligations under state law, or cynically calls recognized activities and procedures “unethical” as a lever to serve their economic interests.
The level of interference with quality patient care that these organizations are engaging in represents a grave crisis for chiropractic and one that cannot continue if we are to maintain our independence as clinical decision-makers, and to maintain the quality of care we are obligated ethically and legally to provide every patient. The International Chiropractors Association (ICA) has studied the operations and the impact of such groups on the profession and on quality patient care, and we are poignantly aware of the frustration felt throughout the profession. We have watched the flurry of lawsuits against such organizations, and continue to encourage and support all responsible legal action aimed at curbing these abuses. We are also aware of the financial drain this approach inevitable causes, and have a real concern that because these groups and their insurance industry clients have far deeper pockets that the chiropractic profession, can we afford to pursue this means of remedy to a successful conclusion, even on a limited basis?
This is a bitter conflict, with hundreds of millions of dollars at stake, and fundamental questions of quality of care and professional independence on the line. With so much at stake, we need to take the widest possible look at potential solutions. Indeed, we need to consider who else is having their authority usurped, and work to draw those parties into the debate. A gifted strategic thinker once observed, “In conflict, no matter on what level, whether it be within the family or between nations, all you need to do to win is to expand the scope of the conflict in a direction favorable to yourself.” I believe that there are situations so egregious, and so outside the realm of even common sense, that the chiropractic profession can legitimately make the claim that these organizations are acting on a level that only government can act. In these cases, chiropractic doesn’t need to file lawsuits. We need to file charges.
The law exists to serve and protect. As one of ICA’s legal advisors is fond of observing, “The law is a shield, not a sword.” Chiropractic needs to look to the law for protection, on both the state and federal level. ICA has, on many occasions, employed a strategy of taking specific concerns to members of state legislatures, and presented documents that demonstrate how a private organization is seeking to act in a manner reserved to the legislature and only the legislature. We have then used the good offices of those legislators to contact the state attorney general and demand a cease and desist action, on the basis that only the legislature can determine the scope and parameters of the health professions.
As some of us may remember from our civics classes in school, the reserve clause of the US Constitution reserves exclusively to the states the regulation of the professions and the trades. On a federal level, protections exist to defend both the public and individual actors in private business from coercive, predatory and other illegal practices through the US Department of Justice and Federal Trade Commission, among other agencies.
Enough is enough. The bullying has to stop. We can most effectively act to use the law to defend our rights and those of our patients by drawing into these issues the civil powers which are also being infringed upon in highly questionable ways. We can never raise enough legal action money to solve these abuses. But we all pay taxes and maybe the time has come to put our tax dollars to work in our and our patients defense.
ICA is seeking to launch a profession-wide dialogue to determine if the time has come to seek these protections. This is serious business and as such requires serious, responsible dialogue. What do you think? ICA wants to know. Contact us via e-mail at chiro@chiropractic.org. We will listen, and we will respond.
International Chiropractors Association
ICA’s OPPOSITION TO “PACE” REMAINS UNCHANGED The International Chiropractors Association (ICA), reflecting what the Association believes to be the position of the vast majority of doctors of chiropractic in active practice in the United States, continues to oppose the implementation of the so-called “PACE” program being promoted by the Federation of Chiropractic Licensing Boards (FCLB). Despite an on-going dialogue with some of ICA’s leaders, and a few modifications in language and procedure, the basic nature of the “PACE” initiative remains unchanged. ICA has called for the complete abandonment of the initiative. The institutionalization of the administration and control of an educational function directly related to the re-licensure of practicing Doctors of Chiropractic in an organization of non-elected individuals is a dangerous precedent. The promulgation of any rules or regulations, directly or indirectly related to the process of re-licensure, should be subject to the open public processes of legislation and rulemaking. These processes are only available within the jurisdiction of the states or the federal government. The long term potential for abuse of an extra-legal means of influencing the practice of chiropractic far outweighs the short term benefit of centralized administration. “PACE” represents an unnecessary, unregulated, undemocratic and inherently unaccountable new layer of control on a profession already under heavy pressure. Despite assurances from “PACE” spokespersons of the good intent of the program, ICA has no confidence in the ability of any non-governmental organization, especially one comprised of self-selected individuals who have a long history of promoting one chiropractic paradigm, to the exclusion of others, to fairly and responsibly execute a control function that can only rightfully reside in the hands of the states. Among ICA’s top concerns are:
ICA recognizes the reluctance of those individuals who have devoted so much time and effort, which ICA does not doubt has been well intended and in good faith, to consider abandoning the “PACE” project. There are, however, no circumstances under which the “PACE” concept can be made palatable to the doctor in the field. The lack of any credible mechanism of accountability alone is sufficient grounds for ICA to call for its termination. ICA has an obligation to present its position clearly and emphatically. That position, that “PACE” is simply not in the chiropractic profession’s best interests, has been developed after careful study of all aspects of the project. It is not the product of any misunderstanding or lack of data, nor should the discussions with ICA members in previous years be represented (or misrepresented) as ICA approval, assent or encouragement. ICA urges all state chiropractic board representatives, educational institutions, independent educators and postgraduate councils to reject the “PACE” initiative.
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