I attended the Federation of Chiropractic Licensing Board's (FCLB) 86th Annual Education Congress in San Antonio, Texas this year because the FCLB was announcing an important new educational initiative – a national certification program for chiropractic assistants – similar to a program we have in my own state of Maryland.The program is designed for CAs who provide or assist patients with their physical therapy. It will certify that they are adequately trained and award them the title "Certified Clinical Chiropractic Assistant" (CCCA) or "triple CA." According to FCLB executives, the program is of vital importance, and if you ask me, long overdue.
Chiropractic is the last of all health care professions to employ assistants who are not universally trained, certified, registered, licensed or regulated. In the 10 states with any language in their statutes regarding chiropractic assistants, training requirements range from none at all to over a thousand hours.
According to Donna Liewer, FCLB president, the organization decided to take action after hearing that a number of major insurance carriers were deliberating whether they would continue to reimburse chiropractors for services provided by unregistered assistants. Insurance carriers answer to underwriters or accreditors, who demand they require anyone touching a patient to be credentialed.
The FCLB suggested a program of certification or registration rather than full licensure, which would have required that each state open their regulations to the legislative process and possibly take years to accomplish. If that had happened, doctors would have been faced with the dilemma of providing therapy without an assistant, providing therapy without insurance reimbursement, or eliminating the provision of therapy altogether.
When I began practice in 1982, there were no rules when it came to the employment of a chiropractic assistant. I could hire anyone and they could do anything. It's a scary thought, really. How confident would patients have felt had they known the assistant applying their electrical stimulation or ultrasound had no professional training in that regard? What if they realized my assistant was an unregistered employee who just a week earlier had dropped out of high school? Let's face it: Would anyone be comfortable with a doctor's assistant working on a family member without some type of formal training and certification?
Around 1982, the Maryland Chiropractic Association and Maryland State Board of Examiners worked together to change our regulations, allowing CAs to become "registered chiropractic assistants." They felt, and rightly so, that our patients would be safer and receive better care if our assistants received the appropriate training and could demonstrate they were competent.
Our new regulations required every CA to have a high-school diploma, CPR certification and 103 board-approved hours in the subjects of anatomy, physical therapy, terminology, jurisprudence, and risk management. They also needed 520 hours of in-service training with a licensed chiropractor before they could sit for the state board's examination and receive their certification.
Chiropractors panicked. What would this cost? Where would CAs receive their training? Would they pass the certification exam? Would they be willing to take the courses? How long would it take to complete the certification process? Would it be more difficult to hire a CA, and would they demand a higher salary once they were registered? After the dust had settled, we found that having trained, state-registered CAs was one the best things that could have happened to our practices. And now that the rest of the country is about to start scrambling to get their CAs registered, we know we did the right thing.
Our CAs were proud of their knowledge and certification. For many, it was the first time they'd actually understood what they were trying to accomplish with the therapies. They not only knew how to set up and adjust the therapies they were applying, but they also understood their indications and contraindications.
The CAs could answer their patients' questions, which made them feel so much more important and valuable to the practice. The sense of professionalism this gave them was astounding. They actually sounded and acted like professional assistants. In fact, they knew their therapy so well, the doctors they worked for started brushing up on their knowledge. Staff turnover reduced and morale improved because they were personally invested. What other position would allow a high-school graduate to receive a certificate from the state they could be proud of? All of our fears were for naught.
The FCLB didn't create the CCCA program on its own; it enlisted the help of college postgraduate departments, experts from the field and regulators from states with existing programs. It is also drafting sample language to help states create their regulations.
The NBCE has the expertise and credentials to satisfy accreditors. Its online test will be ready this fall, and in the meantime, a number of online education providers are gearing up to deliver the training. The training and exam will consist of four primary subjects: foundational knowledge, patient safety procedures, documentation, and boundaries / ethics. Unlike our program here in Maryland, assistants will need far fewer hours to sit for the exam, requiring only 24 hours of instruction and just 300 in-service hours.
For the past 20 years, my assistants have all been trained and registered under our state's certification program. For the past two years, I've assisted my association, helping switch its live CA training program to online. Last year, our CAs were able to take 80 of their required hours completely online, taking quizzes as they go to prepare for the exam. The results of the last exam were just announced, and I am proud to say only one of our students had any trouble passing.
I encourage all chiropractors to embrace the triple CA program. I can say from firsthand experience with confidence: this is a positive step in the right direction.
For an overview of the certified clinical chiropractic assistant (CCCA or "triple CA") program including draft clinical competencies, visit www.fclb.org/ChiroAssistants.aspx.
Dr. Richard Schmitt is a 1982 graduate of New York Chiropractic College, director of Atlast Health Care Centers of Maryland, past president of the Maryland Chiropractic Association and founder / CEO of CE4You, an online continuing-education provider. To see what an online CA program is like, check out the MCA's online CA certification program at http://ca.ce4you.com/mca.