Think You're a Chiropractic "Physician"? Not According to the American Medical Association

It has been more than 40 years since the AMA first initiated efforts to "contain and eliminate" the chiropractic profession as a recognized health care service in the United States. Formed in November 1963, the Committee on Quackery - originally called the Committee on Chiropractic, interestingly enough - existed as an official organization until 1974. Although its efforts were ultimately unsuccessful, the committee's activities are believed to have delayed the full integration of chiropractic into the health care marketplace for several years.

Despite the Wilk outcome, chiropractic inclusion in various government programs, and increasing referral and practice relationships between DCs and MDs, the AMA seems bent on continuing its anti-chiropractic ways. At its recent House of Delegates meeting in Chicago, the AMA approved Resolution 232, which advocates the use of state legislation to make it a felony for any non-MD/DO to misrepresent themselves as a "physician."

Before being amended, the resolution actually advocated a much stricter policy, reserving the terms "Doctor," "Resident" and "Residency" for medical doctors and select others. The original resolution, introduced on April 30, 2008 (in advance of the HOD meeting) by the Illinois delegation, stated:

Whereas, Certain specialty societies recognize that many allied health care professions have improved their educational standards and incorporated doctorate designations in their training programs; and

Whereas, Many nursing schools have re-titled their training program as a Residency and their students as Residents, despite the traditional attribution of these titles to medical doctors and their training programs; and

Whereas, The growing trend of this title encroachment is of concern because patients will be confused when the titles of Doctor, Resident and Residency are applied to non-physicians who hold non-medical doctorates or to non-physicians in training; there be it

RESOLVED, That our American Medical Association adopt that the title "Doctor," in a medical setting, apply only to physicians licensed to practice medicine in all its branches, dentists and podiatrists (New HOD Policy); and be it further

RESOLVED, That our AMA adopt policy that the title "Resident" apply only to individuals enrolled in physician, dentist or podiatrist training programs (New HOD Policy); and be it further

RESOLVED, That our AMA adopt policy that the title "Residency" apply only to physician, dentist or podiatrist training programs (New HOD Policy); and be it further

RESOLVED, That our AMA serve to protect, through legislation, the titles "Doctor," "Resident" and "Residency." (Directive to Take Action)

The amended text of Resolution 232, proposed by AMA Reference Committee B (which had received the original resolution) and adopted at the HOD meeting (June 14-17), reads as follows:

RESOLVED, That our AMA advocate that professionals in a clinical health care setting clearly and accurately identify to patients their qualifications and degree(s) attained, and develop model state legislation for implementation.

RESOLVED, That our AMA supports state legislation that would make it a felony to misrepresent oneself as a physician (MD/DO).

ACA President Glenn Manceaux, DC, said the resolution only serves to discount the education of non-MD health professionals and will stifle competition within the health care marketplace. "The members of our association are deeply concerned about the AMA's most recent attempt to undermine the legitimate education and training of doctors of chiropractic, as well as other health care providers. It is not the role of organized medicine to regulate the titles and terminology used by other providers; it is the responsibility of federal and state legislators to bestow the title of 'physician.' As a trade association, the AMA is clearly overstepping its bounds."

The ACA, heavily involved in opposing the AMA and its resolutions against chiropractic, is concerned that supporters of the resolution are acting in their own self-interest at the expense of consumers. The fear is that this new resolution could jeopardize the interreferral relationships many allied health providers - including doctors of chiropractic - have developed with their MD colleagues.

The ACA also was quick to make this observation: "[U]nder federal statute, all doctors of chiropractic are considered physicians in Medicare ... and are legally deemed chiropractic physicians in an overwhelming majority of states."

Other health care provider groups, such as the American Association of Nurse Anesthetists and the American Optometric Association, have formed coalitions to defeat AMA-initiated resolutions and legislation that seeks to limit alternative health care providers. The PARCA Coalition consists of a group of 800,000 non-MD providers "committed to quality, cost-effective care, and ensuring patients have options in the delivery of such care." The Coalition for Patients' Rights (CPR) consists of 35 organizations representing a variety of licensed health care professionals. The latter group was formed as a result of the Scope of Practice initiative passed by the AMA in 2006, which was designed to limit patient choice of health care practitioners. The ACA is a member of both PARCA and CPR.

"At a time when health care costs are soaring, Americans deserve nothing less than an efficient health care system in which the contributions of all types of health care providers work in tandem to best meet the needs of our patients," Dr. Manceaux said.