“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?
Not chiropractors.
{ 20 comments }
I’ve always been in the same boat as you about both of these procedures, but not too long ago I spoke with a DC who is certified in MUA and I’m not so sure now. It’s not as if the DC is doing the anesthetic, and they’re basically doing what they would normally do on a patient who isn’t knocked out. The point of it is to do it on patients who have serious injuries that have not had success with any other methods. Given the choice of MUA or suffering, I think it’s good there are people out there who can do it.
On principle, I can see where it seems like a stretch, but when you look at the procedure and take away the visceral reaction to it, it’s hard to see how MUA is much different from adjusting someone who is bedridden, a baby, etc. It’s definitely not something I’d want to do or have done, but LIKE ANYTHING ELSE, if the person who is practicing it is ethical, they’ll have an ethical practice.
The guy you showed is some marketing goofball. Texas Chiropractic College has (had? maybe now) a MUA certification program, so I’d be more apt to look at that program than an internet marketing guy’s when making judgments about MUA. Sort of like how we never think it’s fair to look at some PM group’s website and then blast the profession for it.
Steve,
It is not possible to do “what they would normally do on a patient who isn’t knocked out”, as what the chiropractor “normally” does is introduce a force into the body that is utilized by the innate intelligence of the body to alter the physiology in a constructive manner. By taking the intelligence of the body out of the equation (via anesthesia), it is no longer a chiropractic adjustment. It is an outside-in, medical procedure.
Herb, unfortunately, that is a pretty esoteric way of looking at things. That same philosophy is utilized by medipractors who say, “It doesn’t matter if you’re specific on the bone or which line of drive you use because it doesn’t matter…” and I think 99% of people reading this blog probably disagree with that. It’s kind of like if you go to court and say, “I didn’t shoot that lady, the gun shot her.”
Regardless of that, though, I do see how the intent of MUA (braking up adhesions) and the intent of chiropractic (removing interference in the form of subluxations) are very different. If you look at it that way, MUA is more of a PT procedure, but then if you apply that rule I’d 95% of what DC’s are doing across the board isn’t really chiropractic, sadly.
The chiropractic adjustment IS a toggle recoil. Toggle refers to the “Toggle joint. An elbowlike joint composed of two arms pivoted so that a force applied to their hinge to straighten them produces an outward force at the ends.” Recoil is the body’s Innate Intelligence reaction to the force applied to it by the chiropractor’s thrust. Putting someone under anesthesia would hinder Innates ability to make a correction of the vertebral subluxation. If 95% of chiropractors are practicing physical therapy without a license, that still does not make it right. Most chiropractors have an inferiority complex and make up for it by trying to be medical doctors. This has resulted in laws forcing chiropractic students to take medical classes a being subjected to 6 figure debts. The chiropractor either has to become unethical or not be able to pay this debt off. I hope the real chiropractors will stand up for chiropractic, or else there may not be a chiropractic profession.
I knew this post would create some good comments. Thanks for posting this Brandon.
Its not Chiropractic Its for Chiro’s that can’t make it in Chiropractic or they want quick cash
Thanks Brandon
Sorry – I find this idea disgusting!!! No wonder people hesitate to take their children to a chiropractor – the boundaries have well and truly been crossed here. This reminded me of medical practices of old where they had to hold the patient down to “do stuff to them”. It is easy to see why the lay public have a fear of Chiropractors – they think this is what Chiropractors do!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
I think everyone in this blog seems to forget that even MD s DOs have tons of debt adn are also looking out to throw medical procedures that are unnecessary to their patients to bill insurance companies. Chiropractors who are unsuccessful are those who keep looking at what others do to achieve success, because they can’t. Therefore waste time trying to bash what others can do that they can’t for themselves. The traditional chiropractic approach to health is ridiculous if you want to remain a straight chiropractor is because you know the money you can make is huge by lying to patients without doing any work for your patients, kind of being a quack. But I think this is worst you dont need chiropractic debt to be a quack you can do that on your own.. However, those chiros who attempt to include medical procedures in their practices are at least in a good respectful position with their patients, doing what is best to heal.
I graduated from a “straight college” back in the 1990′s and was a straight chiropractor for the first 5 years.
I have since received my certification in nutrition, became QME qualified and MUA certified here in California. Why? Having multiple disc problems myself and being athletic, traditional adjustments were minimality effective due to the amount of guarding and scarring. After an MUA program and rehab, I am 70% better.
Who better to perform MUA other than chiropractors trained and certified ? Is there abuse, sure much like any profession there are always the few. But, as a functional approach to soft tissue creep, the correction I have found to be bar none, the least invasive as well as curative. Please, review the proper applications and requirements.
I’m glad you got help. However, I completely disagree with you. MUA has no place in Chiropractic. In fact it’s simply bastardized Chiropractic. It shouldn’t even contain Chiropractic in the same sentence. Anesthesia is never the safer or better option. This is the type of thing that leads our profession down the slippery slope of pushing for the recently failed HB 127 in New Mexico. We are a DRUGLESS profession, an alternative to medicine. Do you think men like Herbert Reaver went to jail 12 times, sacrificing his reputation and sanity, so you could manipulate a completely drugged up patient in a hospital? Or so chiros in New Mexico can prescribe low level narcotics and get their certification in Advanced Practice, completely trashing the very definition and heart of their profession?
WHUH ? “…definition and heart of the profession?…” so,…our profession has to stay in the 19 century ? are you still driving that AMC Pacer ?
We are NOT a “drugless” profession. Not only do our patients take drugs, but we utilize botanicals and vitamins that have drug-like effects, and the issue as to whether or not they are ‘drugs’ is just a semantics, turf, and legislative issue, not a biochemistry issue.
I also disagree with the earlier posts about chiro’s desire to expand scope of practice for the purpose of $$. Nothing could be further from the truth. Many of us “expansionists” spend enormous amounts of $$ on additional education, licensing and certification fees, equipment, etc… without any guarantee of recovery of those investments.
So what drugs are you prescribing? Seriously if you utilize those things that’s fine, but don’t call it Chiropractic. Chiropractic is Chiropractic, not botanicals, or drugs, or vitamins, or anything else. Prescribing botanicals, drugs, or vitamins is an allopathic approach aka alternative medicine. Chiropractic is not allopathic in nature. It is not a treatment for anything. That’s the problem too many Chiropractors don’t take the time to understand. You can take Chiropractic into the 21st century as you obviously think you are doing, but there is already a group of health care professionals that do what you do and are more respected by the medical community… they are called osteopaths… maybe that would have been a better career choice for you?
The question is not if these procedures/tests “have a place in chiropractic”. I believe the question you are posing is should chiropractors be performing MUA’s and nEMG’s. The only determining factor is what each state deems “within the scope” of chiropractic. Everything else is individual opinion. Fortunately, individual opinion does not make law. Collective opinion does. Unfortunately in politics, $$$ sometimes bests collective opinion, but that is a different topic.
Any practitioner should perform whatever he/she deems necessary to assist the patient in achieving their individual health goals, which vary patient to patient. A chiroopractor should never allow themselves to be limited by anothers beliefs or opinions. I know chiropractors who don’t take radiographs because they don’t feel that is chiropractic. I know others who do not refer for MR studies because they believe that is not chiropractic, or others that sell more vitamins than perform adjustments, but would never consider a diagnostic test because to them that is not chiropractic. Some chiropractors go as far as to claim that the chiropractic technique they perform is better than other techniques. Or if modalities are utilized. It is shameful when some practitioners try to impose their individual opinions on others and degrade them based solely on their personal beliefs. History has shown this to be a dangerous path.
I have multiple offices and personally care for patients who are interested in wellness care, family care and injury care. I utilize modalities when I feel it is necessary to help those who want to achieve pain relief. I do not use them for wellness patients (by the way, ice packs are considered modalities). I perform radiographs in my office. I refer for MR’s when warranted. Remember, chiropractors are not excluded from standard of care, even if you are a cash practice. If you care for any pain syndromes at all, you enter into the realm of medical standards and are responsible to act accordingly. I personally perform nEMG/NCV on patients that have differential diagnoses. I perform SMUA and extremity joint MUA on patients that I feel would benefit and have met all criteria. I sell very little vitamins. I carry a good fish oil and joint supplement. I am licensed in multiple states and follow the scope of each state. I do what it takes to do my best to help each patient achieve their health or condition goals within the scope of chiropractic. I believe that if DD Palmer who was also interested in magnet therapy, BJ Palmer who pioneered chiropractic xray or as he called it “spinography” and who patented the NCM (Neurocalometer) and who used the “latest technology” that the times had to offer had lived today they would be utilizing all that was available under the “scope” of chiropractic to assist their patients reach their goals. I believe DD and BJ would be on the cutting edge of technology and procedure. I believe that they would not stand for any chiropractor not doing the same. And that, my fellow chiropractors is MY individual opinion.
Yes B.J. Palmer would have utilized all the newest and latest technology. But to say he would have done it under a broad scope is not correct. B.J. Palmer did everything he did to prove the subluxation’s existence, it’s effects, and how Chiropractic could affect the nervous system positively. He had no regard for modalities or anything that wasn’t chiropractic being called chiropractic. Yes, everyone has the right to practice how they want, and yes chiropractors can do various things under their respective state’s scope, but MUA, needle EMG , and vitamins are not chiropractic. You can’t look up chiropractic in the dictionary and see as the definition “the use of vitamins, exercise, modalities, needle EMG, and MUA.” I personally feel that if people want to do those things, they ought to have just gone to school to become an osteopath, because there is really no difference in that and how most chiropractors practice..
I agree. Those you mentioned are not chiropractic. But as chiropractors we are able to perform them in almost all states. Which means that most chiropractic boards find them to be useful to chiropractic care. These where not readably available in the time of BJ so we can only surmise of what he would have utilized or not. As far as osteopathy, I may be mistaken but I don’t believe osteopaths diagnose and treat the vertebral subluxation complex. As a chiropractor I do many times everyday. I remove nerve interfence which restores proper nerve function which allows the body to heal itself. As does any chiropractor who performs their version of the chiropractic adjustment with innate purpose and care. Do osteopaths do that? The answer is no. Whatever else we offer our patients is up to us as practitioners. Chiropractic scope has expanded and grown and most of us have grown with it. To suggest that we have chosen the wrong profession is an insult and extremely pretentious in my opinion. But that is your opinion and you are entitled and welcome to it.
No osteopaths don’t remove vertebral subluxations. They did, however, start doing MUA along with orthopedic surgeons back in the 1930s. Sure what I say may be pretentious and insulting, but logically speaking, as chiropractors, who are separate and distinct in the health care paradigm, why do something that was originated by osteopaths way back when? MUA is a medical/osteopathic procedure and therefore doesn’t and shouldn’t have a place in chiropractic. That’s the source of my comment up above. To me, chiropractic is about performing an adjustment to reduce the vertebral subluxation and allow the Innate intelligence the opportunity heal the body as it was intended. Manipulations don’t do that. Manipulating a fixated joint to induce movement is far different than performing an adjustment on a subluxated vertebra. Manipulating any joint while someone is under anesthesia completely interferes with Innate Intelligence due to perception of pain and quantity of mental impulses being distorted by the anesthesia.
As stated before, I agree that MUA and nEMG are not chiropractic. But also as stated before, they have been included in almost every state scope as legally and ethically performed by health practitioners including chiropractors. I don’t understand why you would so vehemently attack what other chiropractors choose to do under their license and scope. By your definition any modality should not be included in the scope of chiropractors, or as you suggest we all should be osteopaths if I use a hot or cold pack or any modality. I guess because you don’t use them and this is your blog and you don’t want your prospective patients to be disillusioned about your technique of chiropractic you feel the need to insult us. Well when you insult me you insult the majority of the profession which is sheer arrogance. You correct subluxations. We correct subluxations AND more. You see, practically ALL of chiropractic colleges and universities offer certifications in physiological therapeutics and nutrition ( even Palmer, BJ’s namesake). MUA courses and EMG courses are sponsored by chiropractic colleges. So according to you ALL chiropractic colleges ( except for possibly Sherman?) are wrong, practically all chiropractic state boards are wrong, the National Board of Chiropractic Examiners is wrong, and the majority of practicing licensed chiropractors are wrong as all of them include therapeutic modalities. Your right, I see it now. Yours is the true chiropractic. The rest of us along with the colleges , state licensing boards and National licensing institutions all should have been osteopaths. I’m done with this silly little blog. Since it is your blog, the last comment is yours. Doesn’t matter, I won’t be checking back.
I absolutely agree with everything you just said. However, besides Sherman I would add Life West and New Zealand College of Chiropractic as the only schools teaching true ChiropracTIC.
All I have to say is that I didn’t get into the chiropractic profession to bow down and worship the chiropractic god’s in a dark room with candles lit around a spinal shrine. I got into chiropractic, which is a health care profession to deliver health care to my patients. I didn’t get into the chiropractic profession for the sake of chiropractic, I got into it to help the sick get better. All this nonsense about “true” chiropractic, or “pure” chiropractic is ridiculous! I thought this was about the patient! If a patient comes in and needs treatment beyond an adjustment for their issue, I’m not going to say, “I can’t help you, you would benefit from some simple stretches and exercises along with a simple dietary change and some physiotheray, but I’m not going to help you even though I know how to because it’s not “pure”/”true” chiropractic”. If a patient has something wrong with them that can’t be efficaciously addressed with an adjustment and I don’t treat them with knowledge that I have within my scope of practice, that’s malpractice. Just like if a medical doctor doesn’t treat a patient for their illness because it’s his “opinion” that the treatment isn’t “pure” medicine, than that’s malpractice 100%. Why is it that chiropractic is the only healthcare profession that is not taken seriously? Why are we the only ones called quacks? I know the answer to that but I’m not here to start arguments. When a patient goes to the dentist with TMD, the dentist can help with prescribing certain stretches and exercises. That’s not “true” dentistry, but they still do it and don’t have stupid arguments within the dental profession about how it’s wrong. If medicine was to have yours and other “straight” chiropractors view on their profession about staying “true” to the roots, than they would still be bleeding, purging every patient that walked in the door. As I stated before, this isn’t about being “true” to chiropractic like it’s our wife and we will be committing adultry if we go beyond the adjustment, this is about THE PATIENT and what is in THEIR best interest, not ours. I got into the profession to serve mankind with my skills and knowledge of the human body, not argue and fight about what’s “true” and “pure” chiropractic. Also, I agree that MUA and needle EMG are not part of the traditional definition of chiropractic, but SO WHAT! Who cares if it’s not. This is about the patient remember. I will do everything within my power to properly treat and diagnose my patients, even if it is not “pure” chiropractic and there is nothing wrong with that. The patient comes first, not the definition of chiropractic. I’m sure your patients wouldn’t appreciate it if they knew that their DOCTOR put his personal opinions before their health and well being. I know I wouldn’t. Its these opinions about chiropractic that have made us the only health profession that wants nothing to do with the health profession. If we were to be just “Straight” chiropractors to “pure” chiropractic, we could technically get through school in 1 year and that is not doctor. It’s the rest of the knowledge we attain of the human body and how to treat it that makes us DOCTORS.
Chiropractic is unique and stands alone among all healthcare professions, or at least it should. I just don’t agree we have to medical doctors, osteopaths, or physical therapists to be a good doctor, or turn chiropractic into those things, like the CCE says we do… maybe that’s a reason the CCE received 42 complaints filed against them with the USDOE and has 1 year to correct them. But if you think chiropractic is those things, by all means go practice that way.