Senate Public Affairs Committee Hearing Set
Building on the already successful efforts to tier the chiropractic profession and add drugs to the scope in the State, Senate Bill 471 states that it provides for a Certified Advanced Practice Chiropractic Physician to prescribe and administer dangerous drugs and to perform certain other procedures while defining “Chiropractic Medicine.” Several sections of the practice act would also be amended for purposes of the law.
Of serious concern is the removal of the prohibition on surgical interventions and the addition of narcotics, opiates, depressants and stimulants to the scope of practice of the so called “Advanced” chiropractors.
Senate Bill 471 would also provide for “Advanced” chiropractors to obtain a “prescription certificate” that would allow them to prescribe, administer and dispense legend drugs or controlled substances included in Schedules III through V of the Controlled Substances Act. These include narcotics, opiates, depressants, stimulants and other dangerous and addictive drugs.
According to Stephen Perlstein DC, a so called “Advanced” chiropractic physician in New Mexico, he will be the expert witness for the bill as he has been for all of the Advanced Practice bills. In a letter being circulated where Perlstein is encouraging supporters of drug prescribing for chiropractors, he states that in order for chiropractors to be considered Primary Care Physicians they need to be able to prescribe drugs. Stating that those opposed to prescriptive authority for chiropractors “cannot see beyond their outdated dogmatic ideologies” Perlstein argues that the public has no problem with chiropractors developing a new identity through the use of drugs.
Chiropractors have been sending letters to the Senate Public Affairs Committee as well as signing on line petitions in support and opposition to the chiropractic drug bill.
Interestingly, both the petition opposed to the bill and the petition in support of the bill contend that chiropractors are primary care providers. The only difference between the petitions deals with the drug issue. In fact, the petition in support of SB 471 makes no mention of drugs but focuses solely on chiropractors as primary care physicians. Besides the drug issue, SB 471 seeks to solidify and expand chiropractors’ role as primary care physicians.
The problem is that chiropractors are not currently fully trained as primary care providers and cannot offer the full spectrum of primary care in order to qualify as such. Chiropractors are more appropriately considered Portal of Entry providers meaning that they can receive patients without referral and then manage the patient within their field of specialty similar to the way an optometrist or podiatrist manages their patients.
Primary Care has the following attributes:
- ACCESSIBILITY
- CONTINUITY
- COORDINATION
- COMPREHENSIVENESS
- ACCOUNTABILITY
While chiropractors fulfill some aspects of these responsibilities, those they do fulfill are the same as those required of a PORTAL of ENTRY provider. To be considered a PRIMARY CARE provider then one must fulfill the COMPREHENSIVE nature of that responsibility.
It is believed that most chiropractors are simply confusing the two terms and that this confusion is being exploited by those groups and individuals who want to be considered primary care providers for purposes of increasing access within third party pay systems. Strangely enough this includes even some elements within the more conservative, traditional “straight” chiropractic community.
Making matters even more confusing is that chiropractic schools, the Council on Chiropractic Education, the American Chiropractic Association, the International Chiropractors Association and numerous other trade groups within chiropractic contend that chiropractors are already trained as primary care providers. However, through this Bill the State of New Mexico is saying that chiropractors need several more years of clinical training to be considered a primary care provider and National University of Health Sciences seems to agree based on their presentation at the last New Mexico State Board meeting.
It is also interesting, and may be a reflection of the sad state of affairs regarding chiropractic market share, that some chiropractors wish to be considered primary care physicians while medical doctors are staying away from that field in droves. Primary Care Providers are the lowest paid of the medical providers but have the MOST RESPONSIBILITY due to the attributes listed above -especially comprehensiveness of care. So, in essence some chiropractors and their trade groups are fighting to be paid less to work harder and have more responsibility.
