“Chiropractors have no legal right to engage in the practice of medicine, and allowing them to do so undermines the purposes of the Texas Medical Practice Act; which are, in part, to set requirements for those who wish to practice medicine, thereby safeguarding patients who receive medical care,” the TMA lawsuit says. “[A] chiropractor’s license does not entitle that person to practice medicine, and any law that permits him or her to do so is unconstitutional.”
In 2006, the Texas Medical Association (TMA) sued the Texas Board of Chiropractic Examiners (TBCE) to block the board’s allowance of manipulation under anesthesia (MUA) and needle EMG by chiropractors. The TMA maintains that chiropractors have no business conducting procedures which constitute the clinical and legal practice of medicine. Recently, a judge ruled in favor of the TMA, stopping chiropractors from utilizing these two procedures in the state of Texas.
I wholeheartedly agree. In fact, I would like to thank the TMA for stepping up and taking a stand for chiropractic and medicine. They are separate and distinct, not one and the same.
The chiropractic profession has suffered from a case of identity crisis for a long time. Are we chiropractors? Or are we personal trainers? Nutritionists? Physical therapists? Physiotherapists? Second-rate osteopaths? Physicians?
Seriously, what the heck are we? If I didn’t know what chiropractic is, I would be confused, too. In fact, I do know what it is, and many times I’m still confused.
In all reality, this professional identity crisis boils down to one simple truth:
It’s all about the money to many chiropractors.
Why else would our professional associations fight for overreaching scopes of practice? Why else would the schools teach so much medical diagnosis and so little chiropractic? Because the majority of our profession is dictated by what the insurance industry will pay us. That’s why.
Some Background on Third-Party Payers and Chiropractic
Chiropractors made a lot of money during the 1980s, mainly off of the insurance companies. It was not uncommon for chiropractors to bill an insurance company for an adjustment and three to four therapies/modalities in one visit. It was also not uncommon for those therapies/modalities to never take place… meaning a lot of chiropractors committed insurance fraud.
This would often result in chiropractors making anywhere from $200-$300 per visit per patient… all paid by insurance. Factor in the explosion of numerous practice management groups and high-volume offices, and you’re talking about million dollar practices galore. It should come as no surprise then that the 80s were considered the heyday of money-making in chiropractic.
In the 1990s, insurance companies got smart and realized chiropractors were abusing them. They tightened up reimbursement requirements. They also stopped reimbursing for multiple therapies per visit.
Now it’s uncommon for an electrotherapy/modality to be billable beyond the first two weeks of an acute/subacute condition. Even then, a chiropractor can’t expect to make much from, let’s say, 15 minutes of Hi-volt.
Because of this, chiropractors have had to change the way they practice. That change has developed into much more active care. This means the patient performs the actions, as opposed to passive care, where the doctor performs the actions.
It’s very common to walk into a chiropractic office nowadays and think you’ve entered 24-Hour Fitness. Exercise balls, Thera-bands, floor mats, and weight-lifting machines are as common as an adjusting table, if not more so.
This is because insurance companies will pay for active rehab. Once the patient’s two weeks of reimbursement for Hi-volt is up, the chiropractor can then switch them to six weeks of rehab and still get paid.
The Next Phase of the Chiropractic Scope of Practice
Considering the chiropractic organizations (ACA, TCA, etc.) are supposedly looking out for our best interests in expanding our scope of practice, why not add some procedures to the chiropractic scope so we can once again make a lot of money from insurance companies? Let’s make the two-thousand-teens the new heyday of chiropractic, right?
Things like MUA and needle EMG can help us chiropractors do that, or so it was thought.
Manipulation Under Anesthesia (MUA)
MUA was done quite often by osteopaths and MDs up until the 1950s. It lost traction mainly because of complications arising from anesthesia. Ironically, MUA started making a comeback in the 1990s, primarily because of chiropractors.
Needle Electromyography (EMG)
Needle EMG is the practice of placing needle electrodes into a muscle and measuring whether the nerve to that muscle is firing or not. It is used primarily to differentiate between neuropathies and myopathies.
Are MUA and Needle EMG in the Best Interest of the Chiropractic Patient?
Sedating a patient and then bending/forcing their joints beyond a normal range of motion is not in the best interest of the patient; not as far as a vitalistic approach to health care known as chiropractic is concerned. MUA is simply a ploy for chiropractors to make a lot of money to pretend they are practicing real medicine.
Don’t believe me? I went hunting for MUA certifications and this is what I found:
“The MUA Certification course teaches chiropractic professionals all the techniques and skills they need to immediately implement MUA techniques into practice in order to rapidly build and expand your patient base to achieve the rapid growth, revenue generation and phenomenal patient results that has made MUA the most effective pain management technique available in America today.”
Notice how patiet results came in third behind rapid growth of your patient base and revenue generation?
In case you need more evidence about what the real incentive is for chiropractors, here are a few of the benefits for the practitioner, as found on that same webpage:
* Practice as little as 2 hours a day
* No overhead expenses
* Treat 6 patients a week
* Increase your income by 4-5 figures per week
No overhead, only 6 patients a week, and increase your weekly income by $1,000-$10,000 minimum? Sounds like pie in the sky to me.
Let’s move on to needle EMG.
My understanding is that I got myself into six-figure debt learning characteristics of various pathologies, neuropathies and myopathies included, in order to diagnose them.
If that’s the case, why in the world would I need access to needle EMG as a chiropractor? Do my patients really need me sticking needle electrodes into their muscles to know they have carpal tunnel syndrome or peripheral neuropathy?
According to Preston Fitzgerald, Sr. D.C., “The EMG is helpful all right, but not the gold standard. A careful clinical examination… is the gold standard.”
So why not get paid for a careful clinical examination AND a needle EMG? Even though you know the patient’s diagnosis after a case history and exam, why not tack a needle EMG onto their bill? Insurance will pay for it, so what’s the harm?
The harm is that MUA and needle EMG are not chiropractic. They are medical procedures. Including these two procedures within the chiropractic scope of practice is money driven, not patient driven.
Where does that money come from? You guessed it. Insurance companies.
We are not medical doctors, we are chiropractors. We need to leave medicine to the MDs and get better at chiropractic. The schools need to start teaching their students some adjusting skills beyond the flying seven, which most newly-graduated chiropractors can’t even perform. The schools need to tone down the medical education and leave that to the medical students.
I can’t tell you how many times I’ve heard chiropractors complaining that physical therapists are manipulating patients and that MDs are allowed to take weekend courses on manipulation. But chiropractors are allowed to do exercise rehab, modalities, and therapies just like physical therapists do. And in Texas, they’ve tried to do MUA and needle EMG just like the MDs. Once again, what’s good for the goose is good for the gander.
If we don’t get back to the basics, our profession will shrink significantly when physical therapists eventually become doctors. That will happen by 2020. When it does, people won’t go to chiropractors for neuromusculoskeletal conditions such as low back pain or neck pain. They will go to Doctors of Physical Therapy (DPT). DPTs will be respected by society and supported by MDs, whereas chiropractors, because of the horrible job of marketing the profession has done since its inception, will still only be left with their negative name equity.
Who do you think will be allowed to perform MUA and needle EMG then?