In New Mexico, legislation in 2008 and 2009 gave DCs with additional education and training in pharmacology and medication administration rights to perform procedures outside of chiropractic’s common scope of practice. “Advanced Practice (AP)” chiropractic, in one form or another and by other names, has existed in the US for several decades.
These AP DCs, who have an additional chiropractic license, are able to prescribe prescription pain management medications, perform injection procedures such as prolotherapy, utilize homeopathics and analgesics, as well as prescribe topical hormones, one of which is testosterone, requiring a DEA 3N license, which we have been eligible to obtain. Other states, notably Utah, Idaho and Oklahoma, have the right to perform IV nutritional infusion.
All of this is a departure from traditional chiropractic without giving up what has been traditional for more than a century.
Scope expansion
Why, you might ask, have some DCs wanted to expand their scope of practice beyond the boundaries that traditionally define chiropractic? The answer is straightforward.
Although chiropractic has always used the simplistic interpretation of the non-utilization of drugs and surgery as its hallmark, we do have the training that acts as a foundation and a stepping stone toward providing non-traditional services that clearly benefit our patients. This allows us, with additional education, to raise the bar and practice to the top of that education. The fear among DCs who adhere to a strict philosophy of what chiropractic has always been is, by going beyond the traditional ways, we will lose our identity.
The question of identity
Which brings us to a question: What is our identity? Is chiropractic a healthcare profession that does not use drugs and surgery in its healing methods? Or is it a healthcare profession that uses natural methods and sometimes pharmaceuticals to achieve healthcare goals?
Perhaps the distinctive feature should be what chiropractic is rather than what it is not. Perhaps the chiropractic adjustment is the paramount entity that should define us and that should be the primary treatment method above all else. Perhaps chiropractic can be inclusive for the health and well-being of our patients. Perhaps we can maintain the standards of chiropractic, with the adjustment being the primary method of treatment, and use other modalities that benefit our patients. We do use many other modalities, such as supplementation, physical therapy, even weight loss regimens. Why not medication when it is warranted? Who better to use medication judiciously than the chiropractic profession?
Pharmaceuticals are not bad. It is the use of them exclusively and excessively that is problematic. We in New Mexico have been prescribing pain management medications and topical hormonal treatments for almost 20 years with a high ratio of patient compliance and excellent, predictable results. We have been able to step up and provide treatments to enhance our practice value as physicians.
Practitioner shortages
The physician and primary care physician shortage is especially acute in New Mexico. Our patients suffer long appointment wait times, have an older physician population andrank low in number of physicians per capita in the US. We are aware this is happening all across the country. AP chiropractic physicians in New Mexico and other atypical scope DCs in other states provide needed services more accessibly than the orthodox route does, especially in pain management and hormonal and nutritional imbalances.
When only medication is the treatment of choice in healthcare, the patient suffers from being denied the entire scope of procedures that are more natural and helpful. One could argue we should stick with our narrow scope and let others stick with theirs. Yet the past nearly 20 years have shown use in New Mexico patients understand the good you do and they do not necessarily care if you adhere to a strict philosophy. When I prescribe judiciously a muscle relaxant to assist the adjustment to do its work effectively, the prescription is short-term and the results show the prescription acted as a modality assisting the main mode of treatment, the chiropractic adjustment. Many DCs I have met don’t believe you can combine the two. I know you can, and we have a wonderful track record to prove it.
What’s your scope?
Practicing like this is not for everyone, in the same way some DCs do not like to use ultrasound or incorporate lasers or use weight loss programs or put patients on decompression tables. We all have our personal preferences and tolerances; therefore, we are all quite different. But we all do have one thing in common: the chiropractic adjustment in whatever way we do it. That is the first treatment, but it needn’t be the last.
Final thoughts: Future plans
We in New Mexico have plans for the future of AP chiropractic. We will be introducing legislation that will expand our scope to create an additional category of Advanced Practice, designated as APC1 and APC2.
APC1 will be a reintroduction of the original APC program that sunset over a decade ago. To obtain APC1 licensing, a licensed DC in New Mexico will have to take approximately 100 hours of additional training as outlined in the first paragraph of this article. To obtain APC2 licensing, additional education and training including 500 hours of hands-on didactic rotations in a primary care setting will be required. APC2 DCs will have plenary licensure as primary care providers.
I encourage readers to look up the statutes and rules for New Mexico, Oklahoma, Utah and Idaho and discover how each state in its own way has expanded traditional chiropractic. We recognize that this profession can be multi-faceted while not losing our core identity, the chiropractic adjustment.
David W. Peer, DC, APC, graduated from New York Chiropractic College (now Northeast College of Health Sciences) in August 2000. His postdoctorate certifications include Certified Chiropractic Sports Physician (November 2004) and New Mexico Advanced Practice Certification (September 2009). Peer is the founding owner of Heights Chiropractic and Sports Medicine in Albuquerque, New Mexico. He has been practicing full-time for 25 years. He is a Past President of the New Mexico Chiropractic Association and is the current New Mexico Chiropractic Association Political Action Committee Chairman. He can be reached at doctorpeer@hotmail.com.
Stephen Perlstein, DC, APC, FAADEP, FICC, CIR, is a September 1981 graduate and founding student and board member of Palmer College of Chiropractic West. He is a Past President and former PAC Chair of the New Mexico Chiropractic Association, as well as the Past President of the Academy of Advanced Practice Chiropractic Medicine. He was one of the authors of Advanced Practice Legislation (2008-2009) and the expert witness for that legislation. He can be reached at info@spchiro.net.
