Based on its actions over the past 15 years (review the sidebar in the app version of this article), controversy and the Wisconsin Chiropractic Association seem to go hand in hand. The latest controversy: "the WCA Board of Directors – at a special meeting on August 7, 2014 – voted unanimously to release a white paper outlining the Primary Spine Care Physician initiative to WCA members and the public."1 The white paper outlines many aspects of what a "Primary Spine Care Physician" (PSCP) should be able to do, but ultimately concludes:
"To be more effective at managing care, reduce the burden on primary care and decrease referrals to specialists, Wisconsin should expand the scope of practice for chiropractors trained as PSCPs to include limited prescription rights and the ability to perform some minor procedures. To obtain the appropriate training necessary for an expanded scope of practice, we propose a program similar to that required of nurse practitioners and physician assistants, who also have prescription authority in Wisconsin. This program would build upon the doctoral level training chiropractors already possess."2
The position taken by the WCA has spawned a number of critics, including Russell Leonard, former longtime WCA executive director, who stepped down in 2012.3 On Sept. 25, 2014, Leonard sent an e-mail to a "core group of chiropractors" openly criticizing the WCA white paper. The 2,656-word document leveled many probing questions and points of contention at the white paper's authors. In his conclusion, Leonard warned:
"[T]here is an entire discussion that needs to occur regarding the tactics to be used to control the discussion of this topic, the opposition to the proposal, and legislation that may result from these discussions.
"The initial town hall meetings may not have engendered much opposition; however, the most stridently opposed members will not attend a town hall meeting. How those individuals, the Wisconsin Medical Society, and the Wisconsin Hospital Association are neutralized may well determine the fate of the legislation and the WCA itself."4
Leonard's warning may already have shown merit. According to Jay LaGuardia, DC, president of the Chiropractic Society of Wisconsin (CSW), "There is a grassroots movement in Wisconsin that is turning the tide to toward the CSW. Chiropractors feel betrayed and abandoned by the WCA and are tired of the failed vision that has resulted in member distrust."
One such doctor is former WCA member Dr. Brian Dittmann, now a member of the CSW. According to Dr. Dittmann, "The WCA has done wonderful things for Wisconsin. And while it was hard to leave after 19 years, I don't want any associations with drugs; it is not congruent with the chiropractic philosophy. The more incongruency you have within a system, the more likely it is to fail. Drugs and surgeries are not healthy behaviors, they are sickness behaviors and don't result in health, only the treatment of sickness. When the WCA came out with their initiative, I knew I had to leave and go with the CSW, who is more in line with my philosophies."
The WCA offered a different perspective when we posed the following questions to the board:
Q: What is your primary motivation for advocating the expansion of chiropractic practice rights in Wisconsin?
A: "The Wisconsin Chiropractic Association is a big-tent association that strives to represent the views of all chiropractors regardless of practice philosophy or business model. The WCA Board of Directors is committed to hearing all voices who wish to expand the tools available to Wisconsin chiropractors while providing the best care possible for patients. This conversation involves looking at a number of scope issues ranging from acupuncture to nutritional supplements, homeopathy, integrated case management of spine-related disorders and limited prescriptive rights. WCA members across the state have expressed a strong interest in exploring the merits of scope expansion that could include many, if not all of these additional clinical tools with appropriate training. The WCA Board of Directors is doing its job by engaging members in this important discussion."
Q: What do you say to doctors who feel the white paper is in direct opposition to the fundamental "no drugs, no surgery" principle of chiropractic?
A: "The Wisconsin Chiropractic Association has a deep respect for the history of the chiropractic profession and is very serious about listening to opinions from all across the ideological spectrum. There is a growing voice within the WCA membership and from chiropractors across the nation who believe that the time is now to have the conversation about expanding the chiropractic scope of practice in a way that chiropractors can truly own spine care the way other health care professionals own eye care (optometrists), oral health (dentists) and foot care (podiatrists)."
Q: How are you addressing potential member mistrust from those who may take issue with the association's ongoing vision?
A: "The WCA strives to inclusively represent the views of all Wisconsin chiropractors. As a member-driven association, the WCA Board of Directors is comprised of practicing chiropractors who are elected by the membership to represent their views. An issue as significant as scope expansion is a great opportunity for WCA members to engage in a meaningful discussion with their board members and make their opinions known. The WCA Board of Directors will make an informed decision on the extent of scope expansion it will pursue based on membership input."
As the battle lines are drawn, the public is beginning to take notice of the discord. An Oct. 31, 2014 article in the Wisconsin State Journal notes: "The American Chiropractic Association supports a ‘drug-free approach to health care,' but hasn't taken a position on the Wisconsin proposal, spokeswoman Lori Burkhart said. The Virginia-based International Chiropractors Association opposes the Wisconsin proposal.
"Four of the nation's chiropractic schools have weighed in. Atlanta-based Life University and Davenport, Iowa-based Palmer College of Chiropractic oppose the proposal. National University of Health Sciences, in Lombard, Illinois, and University of Western States, in Portland, Oregon, support it."5
References
- Primary Spine Physician Initiative. Introduction: What Is the Primary Spine Care Physician Initiative? By John Murray, WCA executive director.
- Lefler RK, et al. Filling the Shortage of Primary Care Health Care Providers in Wisconsin: The Primary Spine Care Physician, A New Class of Health Care Provider. Wisconsin Chiropractic Association Policy White Paper, 2014.
- "Wisconsin Executive Director Leaves Well-Paid Position." Dynamic Chiropractic, July 1, 2012. WCA 990 earning statements showed that Leonard was paid "an average income of more than $580,000 per year" which is more than three times what the Wisconsin governor makes.
- Email from former WCA Executive Director Russell Leonard commenting on the association's white paper, Sept. 25, 2014.
- Wahlberg D. "Proposal Would Let Chiropractors in Wisconsin Prescribe Drugs." Wisconsin State Journal, Oct. 31, 2014.
- "Wisconsin Chiropractic Association and its Director Agree to Settle FTC Charges of Price Fixing." Dynamic Chiropractic, May 1, 2000.
- Devitt M. "Wisconsin Chiropractic Association Sues State Over Testing Change." Dynamic Chiropractic, July 28, 2003.
- "WCA Exec. Guilty of Frivolous Lawsuit." Dynamic Chiropractic, July 2, 2005.
- Petersen D. "History Repeating Itself in Wisconsin?" Dynamic Chiropractic, June 1, 2013.
- Crownfield P. "Say Goodbye to the Wisconsin State Exam?" Dynamic Chiropractic, June 15, 2013.
