Serving Chiropractors and Their Patients


Just days before the close of the legislative session, the State Senate’s Committee on Health and Human Services granted a public hearing on the controversial legislation introduced by the Wisconsin Chiropractic Association (“WCA”) to allow chiropractors to become “Primary Spine Care Physicians” (PSCP”). By the time their testimony was completed, it became readily apparent that each of these WCA presenters actually began to expose the fundamental problems or “challenges” which chiropractors face that have nothing to do with dramatically altering the scope of practice by creating the PSCP. With no chance for passage during this current legislative session, invitations to speak were extended to selected state organizations who are on record as either supporting or opposing the legislation.  It did not go unnoticed by the senators in attendance in the small hearing room, that only the WCA appeared in support of the proposed law; while multiple speakers from various organizations spoke in opposition; including the Chiropractic Society of Wisconsin (“CSW”), Wisconsin Academy of Family Physicians, Hospital Association, Medical Society, Physical Therapy Association, and Society of Anesthesiologists.

While those in opposition echoed consistent themes which focused upon the inadequacies of the educational requirements, likelihood of public confusion over scope of care, and potential patient health risks; it was interesting to listen to the arguments advanced by the four speakers who were selected to speak on behalf of the WCA.  Each of the WCA speakers presented their own unique perspective for advancing this legislation which would address the “problems” they each felt existed with the current chiropractic scope of practice in treating “spinal related disorders”.  By the time their testimony was completed, it became readily apparent that each of these WCA presenters actually began to expose the fundamental problems or “challenges” which chiropractors face that have nothing to do with dramatically altering the scope of practice by creating the PSCP.

First to speak was the current president and primary policy proponent from the WCA, Dr. Rodney Lefler.  He generally asserted that current care for spinal disorders is “not patient centered” and that there is virtually no patient care protocol to treat patients with these types of problems.  He then went on to provide an elaborate and extended hypothetical on the extensive travel time, inconvenience associated with treatment delays, and personal cost for patients who have to visit a multitude of practitioners to treat a disorder, such as a “slipped disc”.  His solution: expand the scope of care to a PSCP who would have all the “tools” needed to care for the spinal disorder in one location, including the ability to prescribe opiates.

The choice of this speaker to recommend that type of solution is most ironic since Dr. Lefler actually works for an integrated, multidisciplinary practice where a patient with a spinal disorder can actually seek all the care they need (or choose to obtain) from multiple doctors who are practicing collaboratively in one, simple location.  For those who actually know of his professional background as a provider in a “medical practice”, this WCA speaker failed to explain that a broad spectrum of “tools” are already available from the differing types of health care provider which the patient chooses to seek out, but that the patient often faces of the real problems of an insurance industry which discourages chiropractic care and  non-collaborative physicians who do not understand or value the benefits of early chiropractic intervention.

Next up for the WCA was a young chiropractor, Frankie Amarillas of Fitchburg, who sent out nothing more than a mixed message about what his patients are truly seeking in care from his office.  At several times, he mentioned that “patients don’t want drugs” and that “most patients seek natural care”.  However, he then submitted that he would like the “option” as a PSCP to do a variety of treatment protocols at his office rather than refer patients to a hospital or other providers.  Once again, this WCA speaker actually highlighted an integral problem facing the profession that will only be enhanced by the proposed law: a growing percentage of the public which would only be confused, rather than educated and accommodated, in their search for true wellness care from the appropriately trained chiropractor.

The third speaker for the WCA was Dr. Jason Mackey, a successor in the venerable, multi-clinic offices of Luedtke, Storm, and Mackey located throughout the Madison area. This chosen speaker for the WCA spoke of the “evolution of the profession” and need to have the PSCP who is “better able” to serve patients.  By failing to recognize the new and expanding (what some would even call “evolving”) trend of hospitals and medical clinics towards integrative wellness care as an effective avenue of patient treatment, this speaker also misplaced the need for the legislation by ignoring the real problem resulting from chiropractic’s failure to adequately compete with the medical community’s promotion of “complementary alternative medicine”.

The last WCA speaker was a bit of an “unknown” until you became familiar with his background.  The WCA reached into the world of academia to call upon Professor Clyde Jensen, a non-chiropractor, from Portland.  Incidentally, the surprising presence of this researcher led one of the Senators to promptly ask whether he was “paid for his testimony”.  Little did the Senate Committee know that Jensen was once affiliated with the University of Western States, one of the few chiropractic colleges which supports the legislation. In any event, he was apparently asked to provide an over-arching philosophical commentary on the legislation based on his years of research on “intraprofessional comparisons”.  He also seemed to assert the benefits for patients of “collaborative care” without specifically connecting it to the new legislation.  In failing to make that connection, this speaker inadvertently recognized the problem of an increasingly competitive health care industry consisting of therapists and other providers who will be more than happy to intrude into the holistic traditions of chiropractic if chiropractors do not advance the distinct nature of their profession.

With the objective of advancing the PSCP as a means of addressing a perceived scope of practice problem, the speakers for the WCA legislation actually highlighted the real problems underlying the profession which arise out of a scope of recognition problem:  A failure of recognition by insurers who overly control the course of patient care, a failure of recognition by alternative providers as to the benefits of chiropractic care, a failure on the part of the public to recognize reliable information on the distinct benefits of chiropractic treatment, and  a failure of the profession to recognize the strength it has in unifying against a competitive medical care industry which seeks to redefine true wellness care.  It was inspiring that one of the last speakers at the hearing from the physical therapy association suggested that P.T.’s and D.C.’s should actually have greater access to entry level care, including even that of the emergency room, as a means of providing better, overall patient care. This is the type of “forward thinking” strategy which chiropractors may want to consider in the future in order to address real problems facing the profession.