ICA Recommends Keeping Primary Care Physician Language in New CCE Standards

Foundation for Vertebral Subluxation
ICA Recommends Keeping Primary Care Physician Language in New CCE Standards

Wants Term Re-Defined as Direct Access

According to a Press Release by the International Chiropractors Association (ICA) they have submitted comments to the Council on Chiropractic Education (CCE) in regards to the CCE’s proposed new Standards.

In addition to the expected concerns surrounding the addition of an adjusting Meta-Competency that considers terms such as subluxation/articular dysfunction and adjustment/manipulation synonymous, the ICA surprised the conservative, traditional faction of the chiropractic profession by suggesting that the CCE keep the terms related to primary care and physician (primary care chiropractic physician) in the Standards and simply re-define them to mean only “direct access”.

According to the ICA Press Release:

“ICA is concerned that the use of terms such as primary care and primary care chiropractic physician be clearly defined in the context of chiropractic practice and consistently applied in the Standards. Primary care simply means direct access, without referral."

In its comments the ICA recommended that the following definition be added to the Glossary: 

"Primary care chiropractic physician: A direct access, doctor level health care professional qualified to serve as the patient's first point of contact within the health care system, without referral from any other professional.” 

According to ICA Vice President Steven Welsh:

"The inclusion of a sound definition will help avoid misrepresentation of what is actually meant and limit expansive and inappropriate interpretations in the direction of medicine and medical procedures," said Dr. Welsh. 

Unfortunately, despite the wishes of the ICA to re-define what primary care actually means, the concept is well entrenched within health care and means much more than direct access. The proper term for direct access is portal of entry provider.      

The ICA’s support of primary care language in relation to chiropractic is in stark contrast to comments regarding the primary care language submitted by the International Federation of Chiropractors and Organizations.


According to a Press Release from the IFCO, the IFCO objected to the use of those terms because many, if not most procedures termed “primary care” as commonly defined, are not within the scope of chiropractic practice in any jurisdiction.  

These include, by example, family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs.  

There are conflicting definitions of primary care and primary care physician.  Under the WHO definition, for example, primary care must include a number of services, such as the provision of drugs and vaccines, which are outside the scope of chiropractic practice, and incompatible with chiropractic practice. The IFCO recommended that the term “Primary Care” be removed from the document.  In addition, IFCO recommended that the term “primary care chiropractic physician” be replaced with “doctor of chiropractic” and that the term “Primary Health Care” in the Glossary be removed.

The embrace of primary care by the ICA is just one more confusing policy position held by the organization. As an example, just recently the ICA passed a resolution that chiropractic was “non-therapeutic” and pledged to “aggressively oppose” efforts to include terms like “medicine” paired with chiropractic to describe the unique service offered by chiropractors.

Any notion that the CCE would entertain re-defining primary care to mean “direct access” only is patently absurd considering the decades long fight the CCE and the Chiropractic Cartel have engaged in to expand the scope of chiropractic to include the practice of primary care. A fight in which they have been largely successful. Every chiropractic college on the planet currently trains chiropractors as primary care providers and not a single program does so in the context of “direct access” only.

Even the very Meta-Competencies that are contained within the CCE standards prescribe a course of education leading to the graduation of a primary care provider.   

It is speculated that the ICA wants to continue its newly formed close relationship with the CCE which began when the ICA shocked the profession by endorsing them just prior to the hearing the CCE had before the US Department of Education (USDE) in December 2013 to consider whether or not to continue the USDE’s recognition of the CCE.  

With the submission of these comments the ICA can say they tried to do something about the primary care issue without actually making an argument against it. This will appease the CCE as well as ICA constituents who fear the loss of insurance reimbursements, ability to declare care as medically necessary and other third party issues that they believe will be lost if they are not considered “physicians” or called primary care providers.   

Foundation for Vertebral Subluxation