Journal of Manipulative and Physiological Therapeutics
Review of literatureChiropractic—primary care, neuromusculoskeletal care, or musculoskeletal care? Results of a survey of chiropractic college presidents, chiropractic organization leaders, and Connecticut-licensed doctors of chiropractic
Introduction
In recent years, it has largely been the impression of government, private industry policymakers, many health care professions, the general public, and some within the chiropractic profession itself that chiropractic practice is not primary care and should be utilized for the treatment of neuromusculoskeletal or musculoskeletal conditions only.1, 2 Consequently, this impression, especially within the third-party payment system, may deter the health care consumer from choosing chiropractic as a naturally based discipline of primary care. Others, however, do consider the training and clinical practice of the doctor of chiropractic (DC) to constitute primary care.3, 4, 5, 6
A review of mission statements of chiropractic colleges accredited by the Council on Chiropractic Education (CCE), European Council on Chiropractic Education, Council on Chiropractic Education-Canada, and Australian Council for Chiropractic and Osteopathy reveals, additionally, that these institutions are preparing students to render primary care (Table 1). 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 This is consistent with the CCE's stated purpose27 and established standards of chiropractic education and practice.28
According to the Bylaws of the Connecticut Chiropractic Association (CCA), its objectives include:
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To maintain the science of chiropractic as a separate and distinct healing arts profession.
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To protect in every way not contrary to the law, the philosophy, science and art of chiropractic, and the professional welfare of its members.
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To serve as an official spokesman for and representative of the chiropractic profession in the state of Connecticut.29
A plan for the future of chiropractic in the state of Connecticut, established by the CCA in 1998, includes 4 primary strategies of development. One strategy, “To increase access to the patient population”, includes the objective, “...achieving direct access to patients, equitable payment for services provided and protection of the scope of practice in Connecticut.”30
To this end and on inquiry regarding the CCA position on the issues of the DC as a primary care or neuromusculoskeletal care provider, an Ad Hoc Committee on Chiropractic Scope of Practice was formed in January 1999.
The committee's objectives were to:
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Study the terms primary care, primary care provider (clinician, physician) (PCP), neuromusculoskeletal care, neuromusculoskeletal care provider (clinician, physician), musculoskeletal care, and musculoskeletal care provider (clinician, physician).
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Analyze the chiropractic scope of practice in Connecticut according to state statutes.
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Determine how the clinical practice of chiropractic relates to the legal scope of practice and these terms.
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Formulate a CCA position statement on the role of chiropractic practice in Connecticut as primary care and/or neuromusculoskeletal care and/or musculoskeletal care.
The committee felt an established CCA position statement on these issues would be essential for the CCA to fulfill its mission, objectives, and strategic plan, and to further the chiropractic profession in the eyes of government, private industry, and the public.
Section snippets
Methods
A Medline, Chiropractic MANTIS Database, and Congressional Information Services Code of Federal Regulations search were performed for the terms primary care, primary care provider (clinician, physician), neuromusculoskeletal care, neuromusculoskeletal care provider (clinician, physician), musculoskeletal care, and musculoskeletal care provider (clinician, physician). The literature obtained was distributed by the chairman for review by committee members. Articles were chosen which would offer
Literature review
The American health care system is presently undergoing a dramatic transformation. Whether the current trend in utilization of naturally based treatment alternatives is due to disenchantment with allopathic medicine or renewed interest in vitalistic health care,42, 43, 44, 45 increased accountability of all health care disciplines will inevitably ensue. Moreover, in the midst of the confusion, a current issue in chiropractic's own evolution involves taking itself to task to establish a unified
Discussion
Based on this study, including primary care definitions, the definition of chiropractic, education, licensure, intraprofessional consensus, and clinical practice, the CCA Ad Hoc Committee concluded the Connecticut-licensed DC is qualified to provide primary care.
Conclusion
The committee set out to apply the terms primary care, neuromusculoskeletal care, or musculoskeletal care to the practice of chiropractic, particularly in Connecticut. The evidence supports chiropractic as a primary care profession and the Connecticut-licensed DC as qualified to provide primary care. The study also revealed the DC's interest in providing neuromusculoskeletal or musculoskeletal specialty care. It was very clear that health care consumer/patient choice is very important, if not
Acknowledgements
We extend our gratitude to the 1998-1999 CCA Board of Directors for recognizing the necessity of this study and authorizing the formation of the Ad Hoc Committee. Malcolm Doyle and Marge LaCroix were instrumental in helping this project run smoothly; we appreciate their assistance. We thank Sheryl Horowitz, PhD, for her guidance in preparing and reviewing the surveys.
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