The New York State Board for Chiropractic serves as the regulatory body for chiropractic in New York and serves in an advisory capacity to the Board of Regents. There are over 50 different state boards that the Office of the Professions has established through the New York State Education Department. The primary role of these state boards is to protect the public by ensuring that complaints that are filed by consumers are investigated and dealt with fairly and in an unbiased nature. These complaints can be quite varied and can range from scope issues, boundary violations, fraud and any other aspect of unethical practice.
They are all across the spectrum but I would say some of the more common complaints recently have to do with advertising. Many advertisements claim that the D.C. has a special treatment that no one else has or guarantees a cure. Treating conditions that are out of scope and bait and switch are also common.
This has been brought up at some of our board meetings. Although no one can be sure why this is occurring, some thoughts were that other states have more favorable scopes of practice, better reimbursement rates, lower taxes and an overall better economy than NY.
Well, on this matter I cannot speak for the entire board so I will only give you my personal opinion. As you know, every state has its own defined scope of practice. This is a legal definition of what is expected of the D.C’s in a given state in terms of standards of care and responsibilities. Over the years these standards and expectations from entities such as the legal system, insurance industry, our chiropractic education, the general public as well as other areas, have changed. When you take those changing responsibilities and juxtapose them with our chiropractic philosophy, there can be some controversy about what is and is not within our scope. In New York for example, our scope is predominantly subluxation based. If you are of the belief that you treat only subluxations then you might view the scope as quite broad. On the other hand many times when questions come into the board, by definition, we have very little room for leeway to allow for the changing times. Some examples of the things we can’t do are standalone extremity adjusting, standalone physical exams and urine dip-sticks.
Here is an example of what I was referring to above. Just recently, because of the way our scope laws are worded, the State Education Department has determined that our patient examination process is basically to determine whether or not a person is a candidate to become a chiropractic patient based on the subluxation. Period. The DOT exams have many other aspects to them that we are competent to do and have been trained to do but are not allowed to do in New York because of the way our scope is written.
Again, from my personal standpoint our scope of practice laws need updating. With only a few changes, the basic language in our scope hasn’t changed in over 50 years. At the same time, health care delivery and expectations are completely different than they were 50 years ago. I’ll give you a couple of examples. There are still a fair number of D.C.’s that take their own x-rays. So let’s say you have a female patient of childbearing age that you feel needs x-rays and she is not sure if she may or may not be pregnant. Wouldn’t it be nice to be able to do an in office urine test to determine if she were pregnant? Would that not be ethical, professional and in line with expected standards? We could do this 30 years ago as students in chiropractic college but the way our law is written, we cannot do in office urine dip tests. I’ll go back to the DOT for the second example. We as a profession are all the time complaining about what little exposure we get to show the public what we have to offer and can do as chiropractors. It has been estimated that three to four million DOT exams will be performed each year. That’s a lot of people potentially walking into a D.C’s office who otherwise might not have done so. These exams are complete, thorough and uniform throughout the country. What a great way for a person who may never have been in a chiropractor’s office to get exposed to chiropractic. Unfortunately, the DOT ship has sailed and New York is not on board because of the way our scope law is written.
You know, we already have a number of professions that have prescriptive rights and aren’t doing such a good job with it. Do we really need another profession with that ability in the mix? One of the reasons I became a chiropractor was that I was drawn to the drug free approach to health care. I believe there is a time and place for medicine and I personally feel the practice of it should be left to those who specialize in it.
Unity. I have had conversations with people who are in a position to help our profession who say they know that if they wait long enough regarding chiropractic issues, the issue will eventually go away because there is a good chance that internal dissention will cause the issue to implode. The recent data show that there are over 4,500 registered resident chiropractors. I don’t know the exact numbers but I would say the majority of those D.C.’s do not belong to either state organization. To me that says one of two thing: 1. Many D.C.’s are apathetic and or feel alienated about the process of service back to the profession. Or 2. Neither group has their finger on the pulse of what this “silent majority” feels is important. That being said I would like to acknowledge the good work both state associations have done over the years. However it’s no secret to any of us that when two groups represent one profession those in government simply do not know who to listen to. Joint ventures are great but the fact remains that is still not unity and those joint venture can easily fracture. Who would have guessed how the landscape of healthcare delivery has changed in just the last 5 years. Along with those changes we have seen many limitations and cutbacks to the care we deliver. Other opportunities have opened up, but we as a profession are not in a position to take advantage of them.
The charge for the board is to protect the public. The board is advisory to the Board of Regents. If a consumer has a complaint, they contact their local Office of Professional Discipline (OPD). In turn the OPD would contact a board member for an opinion about the complaint. In doing that, members of the board have a good working knowledge of the state laws governing chiropractic in N.Y.. Every day the state board office receives many calls from all types of entities asking questions and handling complaints. These questions concern any aspect of practice. The board primarily deals with regulatory and discipline issues and we are required to make decisions based on the language of the present rules and regulations. The Board is in a unique position to see that our education does not always equate with our scope. The staff of the board office also services the dentistry board and the optometry board. With a staff of four including the executive secretary, it is a very busy office.