Organized medicine in America has been very annoyed. The American Medical Association (AMA) and its ilk have been on a crusade to save their autonomy – especially the control of the two major tenets of clinical practice, namely diagnosis and drug treatments.
Why the Paranoia?
Well, the old joke is that even paranoids have real enemies. Yes, many organized healthcare providers are seeking expanded privileges. The AMA calls it “scope creep.”1 That would include the right to refer for current diagnostic technology, perform restricted procedures, and finally drug prescription rights, which drives the AMA types crazy.
The History of “Creep”
At this point, it might be helpful to delineate these “ancillary’ medical tribes. The oldest “creep” started in Colorado in the 1960s, with nurses wanting to be nurse “practitioners” (NP). It was the liberal ‘60s, so why not? At the same time, the physician-assistant program (PA) began, freeing physicians from the tedious task of taking vital signs. But the “creep” began.
Optometrists wanted to do minor surgical procedures around the eye, or even cataract surgery. Podiatrists started the march up the leg to the hip. The pharmacists decided they could prescribe some meds as responsibly as the medical doctors. The nurse anesthetists got tired of being paid much less than their medical superiors for doing the same procedures. The physical therapists just couldn’t get enough respect from the physiatrists, and now are “doctors” of physical therapy (DPT). The audiologists? Yes, doctors now.
Naturopaths want more than just being “natural.” Psychologists want to prescribe Prozac. Even dentists are eyeing Botox injections and other neurotoxins. (I am sure I am forgetting some other group.)
Oh yeah - chiropractic! We have always had debates about who we are, what we want to do and how far to expand our privileges under any law. It is still unsettled for us, but more of that later.
I need to make it clear that I am not denigrating any of my colleagues in the “ancillary” health professions. I have worked side by side with NPs, DPT and PAs for years. The AMA’s scope creep campaign is bragging about tactics they have used to stop the “creep,” yet surveys often point out that patient satisfaction is usually high with PAs and NPs, for example.
The drama surrounding the PAs, now called physician “associates,” is especially interesting to me. They learned something from the PTs and are promoting a new degree, Doctor of Medical Science (DMSc), so they can be called “doctor.”2 This is really setting the AMA’s hair on fire! I found a website called “The PA Doctor” with the tagline, “A New Kind of Doctor.”3 (That’s rather cheeky! What’s next: PA as brain surgeon?)
The Scope Creep Campaign in Action
In my state, Colorado, a recent bill (SB25-152) was passed that basically says, and I paraphrase, “A healthcare professional must make it clear that they are not a bonafide medical physician.” The bill goes on to insist that in a hospital environment, the healthcare worker must wear a name tag identifying what kind of provider they are.
OK, seems reasonable to me. When I was a hospital patient with hordes of provider types marching through my room, I would have appreciated some introductions. But what seemed almost comical in the new law is it actually requires that a healthcare provider must “verbally communicate” what sort of provider they are, so that no patient confuses a phlebotomist with a psychiatrist.4
After the bill passed, I received a blast email from an official source, with suggestions on how chiropractors might identify themselves to patients. “I am Dr. Jones, chiropractor” was one suggestion, in case the patient mistakenly thought they were in a proctology office. Then there is my favorite: “I’m Dr. Jones and I will be your chiropractor today.” This is the kind of introduction I would expect from a server in a restaurant, not a chiropractic office. But it’s now the law!
The Last Bastion: Prescribing
By this time, you the reader, should be aware that the AMA is dead serious about fighting “scope creep.” Its control over diagnosis is tenuous at best, considering the slow expansion of clinical duties among advanced practice types like NPs. But the control of drugs is the last bastion of being a medical physician, and they are not giving it up easily.
Where Chiropractic Stands
Every now and then, a faction of the chiropractic profession brings up the topic of DCs having prescription rights. But every time this happens, organized medicine goes berserk, lawyers-up and stomps the idea down, pronto. In my opinion, the chances of chiropractors giving drugs is as likely as a Baptist Pope in the Vatican.
We DCs have more important fish to fry just in keeping the rights we have, without losing them to a whole array of scope creepers. But our practice laws differ a lot from state to state. Compared to other health professions, this seems antiquated. Compare the more broad chiropractic laws in Illinois or Oklahoma, for example, to states with more restrictive “Ten Finger” laws.
Certainly, some homogenization of practice rights would be less confusing for our patients. Meanwhile, I will continue to be “your chiropractor today.” Just don’t get me confused with an osteopath!
References
- The Fight Against Scope Creep. American Medical Association. Read Here
- Miller A, Coplan B. “Assessing the Economics of an Entry-Level PA Doctoral Degree.”J Physician Assistant Edu, 2022 Mar 1;33:34-40.
- “A New Kind of Doctor.” https://thepadoctor.com/about/, Oct. 25, 2024.
- Colorado Dept. of Regulatory Agencies (DORA), SB25-152. Signed into law May 5, 2025.
