The Wisconsin Chiropractic Association (WCA) is the driving force behind the introduction of a bill to create a new health care profession to be known as "primary spinal care practitioners."1 This is the apparent culmination of significant effort that began when "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 (PSCP) initiative to WCA members and the public."2
According to the bill's authors, Wisconsin Senator Frank Lasee and Representative Joe Sanfelippo, "[T]his bill creates a new type of health care provider in Wisconsin called the Primary Spine Care Practitioner (PSCP) designed to address the growing burden of spine related disorders and the overuse of prescription drugs in Wisconsin. The Primary Spine Care Practitioner would be a new practice act governed by the Medical Examining Board available to licensed chiropractors who meet the educational and clinical training requirements."3
The bill includes rights and privileges for primary spinal care practitioners not currently enjoyed by doctors of chiropractic. In addition, the bill:
- "[E]stablishes a licensure program for primary spinal care practitioners to be administered by the Spinal Medicine Affiliated Credentialing Board, which is created in the bill and attached to the Medical Examining Board.
- "[D]efines 'spinal medicine' in relevant part as the integration and application of the practice of chiropractic and the practice of medicine and surgery, both as defined under current law, that is limited to conditions of the spine and the musculoskeletal, neuromuscular, and nervous systems.
- Provides that "a licensed primary spinal care practitioner has authority to prescribe and administer prescription drugs."4
In a letter to association members, WCA Executive Director John Murray stated: "For the past three years, the leadership of the WCA has been discussing how chiropractors through additional training and clinical excellence can better serve their patients and play a greater role in the integrated, team based health care model evolving in Wisconsin." (Emphasis added) The letter goes on to describe the WCA's effort "to pursue the development of an expanded scope of practice for chiropractors ... The result is a new practice act called the Primary Spine Care Practitioner (PSCP)."5
Murray also announced that "the Medical College of Wisconsin and the Wisconsin Chiropractic Association are in initial discussions to form an academic partnership to develop an accredited Master's Degree known as the Primary Spine Care Practitioner (PSCP) that would be only available to chiropractors. The rationale behind potentially partnering with the Medical College of Wisconsin is to develop a chiropractic specific program that builds on your doctoral level training in highly effective, conservative care, but add training in other evidence informed, patient centered interventions. The PSCP Master's would require 500 hours of clinical training in evidence informed interventions. This additional education will allow chiropractors to have the skills to work independently as well as in the team based, integrated care model." (Emphasis added)
An article in the local Journal Sentinel provides additional clarity: "Chiropractors would have to complete an accredited master's program and 500 hours of clinical training to become primary spine care practitioners. They would be licensed by the Wisconsin Medical Examining Board and the Chiropractic Examining Board." In the same article, Rod Lefler, DC, president of the Wisconsin Chiropractic Association, "estimated that 10% of the state's roughly 2,000 chiropractors might be interested in getting additional training and becoming primary spine care practitioners."6
According to Dr. Gene Yellen Shiring, chair of the WCA Government Affairs Committee, "[T]raditional chiropractic offices could integrate a Primary Spine Care Practitioner into their practice and manage cases from a conservative perspective, coordinate interventions, order advanced special studies and procedures and achieve better patient outcomes."7 (Emphasis added)
The language used in much of the information provided by the WCA reveals the association's perceived superiority of the primary spinal care practitioner health care profession. As emphasized above, these include the ability to "better serve their patients," "achieve better patient outcomes" and "allow chiropractors to have the skills to work independently as well as in the team based, integrated care model." (See "Creating Our Own Competition" for a further discussion of this issue.)
An email from the bill's authors notes, "[Th]is bill would grant an expanded scope of practice to chiropractors who become PSCP's that would include the ability to order advanced imaging, the ability to order advanced studies, procedures and the ability to proactively manage over-the-counter medications and pharmaceuticals."3 (Emphasis added)
What still isn't clear to anyone is the point of all of this effort. As the Journal Sentinel article points out, "[Th]e shortage of primary care physicians in Wisconsin ... is limited to rural areas. The state also has a growing number of nurse practitioners and physician assistants who provide primary care."
In the same article, Jay LaGuardia, DC, president of the Chiropractic Society of Wisconsin, notes: "No one in the public is clamoring for chiropractors to be able to prescribe medications." And Joseph Kerschner, dean of the school of medicine at the medical college where the WCA hopes the PSCP master's degree will be offered, adds, "We are not advocating for the chiropractors to have this enhanced role."6
This all leaves too many unanswered questions, including the following:
- Why is the WCA leadership spending so much of its members' resources to create a new health care profession that will compete directly with the chiropractic profession for the potential benefit of only 10 percent of its members?
- How does the current WCA leadership hope to represent two competing professions when meeting with legislators, third-party payers and the public?
- How long before nurses, physician's assistants, physical therapists and others are able to take coursework to become PSCPs?
- Being educated by the Medical College of Wisconsin and governed by the Medical Examining Board, what's to keep the new PSCP from becoming a medically controlled profession?
- Legislative Analysis: The PSCP Proposal. Wisconsin Chiropractic Association; analysis by Legislative Reference Bureau.
- 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.
- E-mail from Senator Frank Lasee and Representative Joe Sanfelippo on Feb. 5, 2016, regarding "Co-sponsorship of LRB 3787/1 – Re: Creation of Primary Spine Care Practitioner."
- State of Wisconsin 2015-2016 Legislature LRB−3787/1.
- WCA Executive Director Dr. John Murray's letter to the membership.
- Boulton G. "Medical College of Wisconsin Would Consider Master's for Chiropractors." Journal Sentinal, Feb. 9, 2016.
- "WCA Announces Support for Legislation Creating Primary Spine Care Practitioner." WCA press release, Feb. 5, 2016.