NUHS President Urges Response to Proposed Accreditation Changes
The current President of National University of Health Sciences Joseph Stiefel, MS, EdD, DC, is urging chiropractors that the profession is in danger of losing the designation of primary care providers and physicians under revisions to the Council on Chiropractic Education's Standards for accreditation being circulated for input until September 30, 2016.
In addition to his worries about losing primary care and physician status Stiefel also expresses his concerns that pharmacology is not addressed in the proposed Standards stating:
"Further to the issue, there is, within the profession, an undeniable and definite interest in and movement toward practice scope expansion to include appropriate use of some of the various prescriptive agents."
Stiefel states that "It would seem that there is now a concerted effort to move the Standards backward." Stiefel has gone on record as supporting the addition of drugs into chiropractic. See related story: National University Vows Support of Drug Expansion Efforts in Wisconsin.
The following statement was made when he was named President of NUHS in 2013:
Dr. Stiefel's vision for National University of Health Sciences is to continue the institution's focus on broad-scope primary care practice for its graduates, and to deepen its commitment to integrative medicine. "As our national health care landscape continues to evolve, we want to assure that our graduates are full participants in delivering a higher standard of patient care, and that they are well-prepared to be leaders in integrative health care."
Several years ago the CCE was in danger of losing its federal recognition due to its lack of inclusion and lack of consideration of differing viewpoints - especially among the subluxation centered chiropractic community. These concerns were dismissed by the International Chiropractors Association (ICA) and they bargained with the CCE in exchange for supporting them before the US Department of Education.
Now, claims are being made that the traditional, conservative faction of the profession got its way as evidenced by these proposed changes. However any such claims should be met with ridicule as much as as Stiefel's claims should be.
Despite Stiefel's assertions and the bragging of conservatives in the profession, the concept of the chiropractor as a primary care provider remains even in the revised Foreward to the Standards as follows:
"Accreditation requirements focus on student learning outcomes that prepare DCP graduates to serve as competent, caring, patient-centered and ethical primary health care professionals."
And when one reviews the Meta-Competencies it becomes perfectly clear that the CCE is still focused on training chiropractors to be broad body diagnosticians who can treat patients beyond spinal conditions.
The following is the full text of Stiefel's letter.
If you know the history of the Council on Chiropractic Education (CCE), you are well aware of the significance of Dr. Joseph Janse and his associates on the initiation and development of Standards for chiropractic education. Your alma mater has always played a vital role in educational Standard development and improvement since 1966 when National was first accredited by CCE which was then part of the American Chiropractic Association. The CCE has served the profession well through the years and its recognition by the United States Department of Education in 1974 represented a watershed event in the development of the chiropractic profession.
Since that time CCE Standards have been modified and improved in many ways, however now some proposed changes have me very concerned. It would seem that there is now a concerted effort to move the Standards backward. I think you must be aware of these proposed changes as they will significantly impact chiropractic education and will also have potentially serious consequences for practicing chiropractic physicians.
Below, I am summarizing the proposed changes to the Standards for your information. It is my hope that you will take the opportunity to respond to CCE and make every effort to have any professional organization with which you are associated to take a stand against these proposed changes. The time for response ends on September 30th of this year so your participation is needed now. Here are my concerns:
1. The term “primary care” has been completely removed from the proposed Standards. This definition of, and standard for chiropractic education has been part of the CCE Standards from 1976 until the present time. During those decades the term “primary care” has been part of the “Forward” and in later years the “Preface” of the section on education. This entire section is being proposed to be removed. If the proposed removal of the term “primary care” succeeds, DC programs will not be required to teach to the primary care level and all of those who intend to practice a broad based practice as well as all who currently practice on a broad basis will not have an “educational leg” to support their practices. I am thinking, for example of all those who have pursued the functional medicine pathway, those who practice diagnosis and internal medicine, or pediatrics or geriatrics as examples. The third party payers will have a field day as they will now have grounds to deny any kind of care that is outside the strict musculoskeletal arena and more particularly the spine care concept. Chiropractic physicians are not now, nor have they ever been “anatomically limited.” Thus, it is essential that the education of this kind of physician be broad based and comprehensive. With removal from the Standards of the term “primary care,” my concern is that legislatures and practice regulators will have a clear pathway to reducing practice rights and practice scope. Please make yourself aware of the “Primary Health Care” definition of the standard.
2. In the proposed Standards there is no mention of pharmacology which is currently taught in most of the DC programs and the failure to consider this vital aspect of practice seems particularly inappropriate at a time when the country in general and the federal government in particular have become so much more aware of the issue of overuse of opioids and antibiotics just to mention two. At a time when medications of all kinds are vastly over utilized and over-prescribed and patients of chiropractic physicians are often taking two or more medications daily, it seems totally incomprehensible that our academic programs would not be required to teach the relevant subjects. While we claim to be concerned about public health issues, we are disregarding one of the most significant by failing to educate our graduates regarding the use and abuse of pharmaceuticals. How can we communicate to patients, on the most basic level, about nutrition and supplementation or public health without knowledge of pharmacology? Further to the issue, there is, within the profession, an undeniable and definite interest in and movement toward practice scope expansion to include appropriate use of some of the various prescriptive agents – but no relevant education? Additionally, numerous states currently have statutes allowing the use of OTC drugs by chiropractic physicians. Toxicology is not the same as pharmacology and formal education is what separates the physician from the layman to give advice.
3. The term “physician,” which has been part of the CCE Standards since the beginning has been completely removed from the proposed Standards. As with the term “primary care,” the term “physician” has always been included in the Standards since 1976 as part of the “Forward” and in later years in the “Preface.” This effort, it seems to me, is the result of the influence of the members of the profession and the Council who are and have always been opposed to the use of the term “physician” which is essential for, a doctoral practitioner who is NOT ANATOMICALLY LIMITED. We are the only profession that does not have anatomical limitations except for allopathy and osteopathy and as such MUST be educated as physicians. Failure in this aspect will clearly lead to major legislative and third party payer conflicts. At least half of the states allow or specifically name chiropractic doctors as physicians and that designation is so vital when legislative or regulatory changes are made in those states because the DCs are automatically included. Illinois is a prime example and there have been many instances in which our designations as “physicians” has “saved the day” for us on a legislative or regulatory basis. I realize that some will say this is not the “business of CCE,” but the reality is that it is precisely the fact that the CCE Standards use the term that has allowed us to make the case for “physicianship" with state legislative and regulatory bodies. That leverage will be gone if the proposed Standards are approved.
4. Education in the clinical sciences in the proposed Standards is in my estimation so broad and non-committal that it could be applied to a physical therapist, or optometrist or nurse but not to a physician. There is no mention, for example of the need to teach clinical nutrition, no specifics regarding subject matter in the clinical sciences. I am sure the councilors will make the claim that the Standards are not proscriptive – they do not keep programs from teaching beyond the Standards, which has always been true, but the latitude allowed will produce so called “doctors of chiropractic” who are vastly different in their knowledge and level of clinical acumen – a multi-level profession because some programs will teach to the lowest common denominator while others will do as they have always done. Still, the graduate will have the same degree.
While many will incorrectly categorize these issues as of interest to academic institutions only, the truth is that the implications for those already in practice is genuine. Routinely, regulatory bodies ask the schools what they teach in certain subject areas so that they may define scope. How can the profession ask for full physician status within Medicare, if our own accrediting body does not recognize your education as such?
At the following URL you will find the current Standards and the proposed changes to the Standards.
I strongly urge you to review these proposals and make your case against these proposed Standards Changes.
Joseph Stiefel, MS, EdD, DC
National University of Health Sciences