The chiropractic profession has been undergoing a revolution of sorts over the past decade.
Many have suffered the effects of managed health care and the Affordable Care Act, two developments that have been widely frustrating. That said, new opportunities have also presented themselves.
One major opportunity that arose is related to Department of Transportation physical exams. This is a great opportunity for the profession, and one that many doctors have embraced. DOT physical exams have been a real boon, both professionally and economically, for those who participate in performing these physicals.
Broadening your scope
With the enhanced awareness created by DOT exams, there is now a growing interest by chiropractors across the country in performing other occupational services for workers of all types, not just truck drivers. One in particular is also mandated by the federal government, and is in as much demand as DOT physical exams.
If your state allows you to perform a DOT physical (the only states that do not are New York, Michigan and Washington), you should have no limitation in providing medical clearance for respirator use and ancillary services associated with respirators such as spirometry (pulmonary function testing), medical surveillance exams and respirator fit testing.
A large target market
As mentioned, the use of respirators is mandated by the federal government for those performing certain tasks. The Occupational Safety and Health Administration (OSHA) as far back as 1971 mandated the use of respirators as part of a Respiratory Protection Program that must be adopted by industries where workers are exposed to defined environmental hazards.
The standard law that governs this type of personal protective equipment is 29 CFR 1910.134 (titled “Respiratory Protection”). This law was updated in 1998 to more widely expand who can be involved with respirator medical clearance, to include physicians and other licensed health care professionals (OSHA uses the acronym PLHCP). This includes chiropractors.
How many workers use respirators on the job? OSHA estimates that more than 5 million workers use respirators, with more than 1.3 million employers required to supply respirators to their employees.
Medical clearance to use a job-related respirator is required anywhere from yearly to every five years. This is based on a number of factors, including the age of the worker and overall health status identified in OSHA’s Respirator Use Questionnaire Form (which must be completed annually).
Medical clearance can be as simple as reviewing the form and providing clearance, or as detailed as performing a clinical exam on the worker and, where needed, obtaining clearance from treating providers. It often involves pulmonary function testing (spirometry). Because there are relatively few PLHCPs who are familiar with respirator medical clearance, the opportunity here for chiropractors is even greater than that for performing DOT physical exams.
Respirators are used in vast numbers across many types of industries, from tool and dye plants to the maritime industry to landscaping companies, from hospitals to glass manufacturers to the automotive industry and more.
Add to this the requirement to perform annual “fit testing” for workers who use respirators (a process that ensures the respirator fits the worker properly), a service that can be provided by the doctor’s staff, and the financial benefit to the chiropractor is significant. Fit testing must also be performed if there is a change in the weight of the user, a change in job description or type of respirator used, and this must be conducted for all respirators used by the worker (many use two or more). The number of fit tests required is greater than the number of medical clearance evaluations conducted.
Spirometry and surveillance exams
Additionally, although it is not required by OSHA, the worker will most often have pulmonary function testing (spirometry) along with medical clearance, to obtain baseline values when they initially begin using a respirator and to monitor respiratory function based on the answers to the evaluation questionnaire.
If you can perform spirometry as part of conducting medical clearance exams, you’ll find it to be a significant benefit. It does require additional training and certification from the National Institute for Occupational Safety and Health (NIOSH), however, to perform this testing. Spirometry training is available all over the country and certification is inexpensive.
Medical surveillance exams are also part of respirator protection and present an additional opportunity for the chiropractor. These exams are required for workers exposed to specific respiratory hazards such as asbestos and silica. Although most can only be performed by medical physicians, there are four that can be provided by PLHCPs—including chiropractors.
The next question relates to guidance and regulations. Despite the fact that OSHA has not developed specific guidance, others have. It comes from NIOSH and the American College of Occupational and Environmental Medicine (ACOEM). This guidance is organized in a similar way as that for DOT physical exams.
There is a standard protocol in place for a review and possible clinical examination, and the types of accommodations that can be recommended to ensure safety. Disqualification for the use of respirators is extremely rare because of the ease in accommodating the user. Understanding the medical guidelines and methods of accommodating the user is imperative to successfully performing these evaluations.
Up until now, the only training that existed for PLHCPs was provided by ACOEM, a medical organization that doesn’t offer membership to chiropractors—only MDs and DOs can join. Recently, though, training for DCs has been developed and is now available.
This training is similar to that required for DOT physical certification, both in its organization and classroom time. It is different in that it is not mandated (like that required by the National Registry of Certified Medical Examiners (NRCME), and there is no certification requirement to perform these exams. Anyone with the requisite knowledge can perform respirator medical clearance.
Additional training is also available to DCs and their staff who want to offer other services typically associated with medical clearance for respirator use. There’s training for the aforementioned pulmonary function testing (spirometry), and training performing respirator fit testing and respirator surveillance exams is also available.
If you are looking to expand on your current DOT business, or wanting an additional cash-based service to complement what you already provide in your practice, respirator medical clearance is an easy add-on, and will significantly boost your bottom line. There is increasing interest and demand from businesses and industry across the country for this service. The time to get involved is now.
David Thorpe, DC, has provided occupational services to businesses throughout the Northeast. He is board certified in occupational health and is president of the American Chiropractic Board of Occupational Health. He was the lead trainer for the ACA/TeamCME DOT physical training course, and has developed a national respirator medical clearance and fit testing training program for chiropractors. He can be contacted at 541-276-7062 or through teamcme.com.