Chiropractic is at last a legalized profession in Thailand and 18 chiropractors recently were granted the first licenses to practice there.
Editorial Staff
Full-time chiropractic doctors have practiced in Thailand for almost 15 years, primarily in the capital city of Bangkok. Despite treating thousands of Thai people, the expatriate community and foreign tourists, these pioneer chiropractors had been practicing without benefit of a legally licensed profession. Occasionally, foreign chiropractors would visit Thailand on a working vacation or sabbatical from their homelands and practice temporarily. Technically, all practiced outside the law - until now.
"We appreciate all their historical contributions in helping start the profession on its way to legalization here," said Dr. Oat Buranasombati, a Los Angeles College of Chiropractic graduate and current president of the Thailand Chiropractic Association (TCA), the official national member association affiliated with the World Federation of Chiropractic (WFC).
According to Dr. Buranasombati, "The profession evolved here out of the efforts of many people over the years. Some DCs were even arrested, and that was not too long ago." One of those arrested was Dr. Don Nakaya-Nielsen, one of the first chiropractors to establish an ongoing practice in Bangkok, a practice that is still the largest in the country. Dr. Don, a Cleveland Chiropractic College - Los Angeles graduate and former world-champion kickboxer (MuayThai kickboxing is the national sport of Thailand), opened one of the first chiropractic clinics and several of the chiropractors in Bangkok passed through his office before starting off on their own. He also brought his former instructor and friend, the legendary Ronald J. Watkins, DC, to Thailand at the twilight of his career so he could finish his days adjusting the Thai people in Bangkok and in the resort city of Pattaya. (See "Chiropractic in Pattaya, Thailand," Dynamic Chiropractic, Aug. 16, 2002.) Dr. Watkins also was arrested briefly and released, as was Dr. Teerasak, vice president of the TCA.
Dr. Rand Baird, well-known as a chiropractic college public health instructor, hospital privileges expert and DC columnist, knew both Dr. Oat and Dr. Don from his days as their teacher in chiropractic college, and at times was called upon to help resolve conflicts and encourage compromises. Dr. Baird chairs the WFC Public Health Committee and the WFC appointed him as its special ad hoc rep to Thailand for the purpose of assisting the TCA and the Thailand Ministry of Public Health (MoPH).
When the Thai MoPH asked the TCA to nominate an international advisor for coordinating efforts and to serve later as a licensing examination administrator, the WFC and Dr. Carl Cleveland III, president of the Cleveland Chiropractic Colleges, both nominated Dr. Baird. The WFC regional representative, Dr. Bruce Vaughan of Hong Kong, concurred. Among the key Thai officials and their staff members from the MoPH, Drs. Pakdee, Tares, Wisit, Tewan, Supachai, and Chief Minister Dr. Mongkul all shared their expertise with the chiropractic reps. (Thai surnames are multi-syllabic and quite difficult for Westerners to pronounce. Fortunately, it is a Thai custom to call doctors by their first names, as has been done here.)
"The WFC strategy in Thailand and other developing countries beginning chiropractic is to work with the country's national association and help develop indigenous resources. The local DCs must play the major role, and our WFC role was to work with and through our member association, the TCA," said Dr. Baird. "Dr. Oat and his TCA officers and members were a great national resource."
Dr. Baird visited Thailand 17 times from 2000-2007, meeting with ministry officials and working with the TCA and even unaffiliated DCs. As co-chair of the WFC delegation to the World Health Organization (WHO), Dr. Baird also met several times with Thai MoPH officials in Geneva during the World Health Assemblies each May. Mr. David Chapman-Smith, secretary-general of the WFC, Dr. Baird and other WFC leaders also worked with WHO officials on a document that eventually became the 2005 publication WHO Guidelines on Basic Training and Safety in Chiropractic, which was eagerly embraced by the Thai government in establishing standards.
Finally, after years of efforts marked by reviews of chiropractic scientific and legal articles from all over the world, progressions, regressions and obstructions, shuffling among key players within the Thai government, and political upheaval, in August 2006 the Thailand Ministry of Public Health issued formal recognition to chiropractic as a legally licensed health care provider profession in Thailand with a delineated scope of practice. The profession itself was legally established at last.
The next major task was to actually license the individual practitioner by comprehensive examination. Test eligibility was restricted to applicants holding a DC degree from a recognized chiropractic college program (with a one-time exception allowance granted to one DC program - McTimoney College). No residency was required for Thai nationals, but for foreigners, a three-year accumulated residency was mandatory. All credentials had to be submitted and verified, which were time-consuming tasks for both applicants and the MoPH.
Early on, the Thai government made the decision that there would be no "grandfathering" and that all candidates for initial licensure would have to pass a competitive exam consisting of four parts spread over two days:
Basic sciences exam of 100 questions emphasizing anatomy, physiology and pathology, with the questions submitted by an 18-member Subcommittee of Healing Arts representing all the health care professions in Thailand.
Chiropractic sciences exam with 50 clinical questions submitted by local chiropractors and their organizations, and 50 practical questions obtained by special arrangement from the National Board of Chiropractic Examiners (NBCE) and the International Board of Chiropractic Examiners (IBCE), which also generously provided invaluable technical advice and guidelines for test administration.
Hands-on technique and X-ray practical portion including live mock patients on whom to demonstrate adjusting and chiropractic exam and instrumentation procedures (four examiners, the two American DCs and two Thai MD board-certified orthopedists and medical school professors).
Review of Thai legal and ethical aspects and laws pertaining in common to all licensed health care providers.
The MoPH proudly wanted a testing process that could meet the highest international standards and indeed achieved this goal. The WFC provided international precedents and models. The Federation of Chiropractic Licensing Boards (FCLB) offered valuable consultative advice. Advice also was obtained from the IBCE in keeping with its commitment to establishing worldwide acceptance of high standards of chiropractic education and practice. Based on the foundation and experience of the NBCE, the IBCE is capable of developing standardized examinations anywhere in the world that reliably measure chiropractic knowledge, skills and attitudes. The IBCE is dedicated to helping any jurisdiction shorten the time and decrease the cost of developing an examination program that contributes to legitimizing the chiropractic profession in that country.
The initial licensing exam was scheduled to be given July 5-6, 2007, and Dr. Baird was asked to serve as principal chiropractic examiner. He selected George Le Beau, DC, renowned technique seminar instructor, and like Dr. Baird, a former faculty member at both LACC and CCC-LA, to serve as his assistant. Both DCs also helped proctor other parts of the test and advocate for the chiropractors in disputed questions. The Thai orthopedic surgeons were knowledgeable but also understanding and reasonable, resulting in removing about 13 questions that were somewhat ambiguous or had lost something key in translation. A lot of pretest anxiety was alleviated as all four examiners tried to make the chiropractors feel at ease and respected. All examinees signed disclosure and integrity statements. Terence Yap, DC, of Singapore, the WFCs new regional representative and WFC Council member, served as an international observer. The test questions were quite difficult, and some review sessions beforehand supplemented the examinees' preparation.
In preparation for the exam, Western States Chiropractic College and Life West Chiropractic College were among those graciously offering to help. Palmer College of Chiropractic, Cleveland Chiropractic Colleges and Southern California University of Health Sciences (SCU) had earlier provided international literature references, professional articles, scientific studies and legal citations, as did the WFC. The teaching clinic at SCU provided use of its facility, interns and externs under Dr. Michael Sackett, clinic director, so Drs. Baird and Le Beau could refine test questions and improve grader reliability and consistency.
To help defray the rather expensive nature of a first exam, the examinees had to pay a rather large test fee of 25,000 Thai baht (approx. $775 U.S.). By policy, all professional license exams are administered in the native national language, but a special translation was made available by the MoPH for those requesting to take the exam in English - about half of all examinees. Six professional translators including a medicolegal expert and a chief translator worked for several hours with Drs. Baird and Le Beau, who were then sequestered in a hotel with all test materials locked in the ministry building under secure conditions until the start of the exam the following day.
During a break, Dr. Le Beau adjusted one of the Thai orthopedic surgeons for a cervicothoracic and shoulder problem and also adjusted a Thai MoPH staff member for de Quervain's stenosing tenosynovitis. Both reported some immediate improvement! There was great mutual respect shown among the disciplines.
A few days after the exams, the examiners and examinees were invited to a press conference at the five-star Sheraton Grande Sukhumvit Hotel in Bangkok. TCA members and officers Drs. Oat, Teerasak, Mark Leoni and Ruj, along with Drs. Baird and Le Beau, read brief statements and their interviews were shown throughout that day and evening on all the major national TV news programs throughout the country. Awards and acknowledgements were exchanged.
Dr. Baird commented, "The professionalism and sophistication of the MoPH and its staff is the equal of any I've seen in the world, and their courtesy as hosts was incredible. I have never met such gracious people! What a thrill for me and the WFC to have been part of the chiropractic history in their country."
Dr. Oat of the TCA added, "We are very proud of what we have accomplished here in our country and thank so many chiropractic organizations around the world for their help and guidance. We look forward to a great future together."
Eighteen DCs passed all exam parts, met the residency requirement and are now licensed to practice in Thailand, with their actual license certificates to be issued at a ceremony later this year. All but one were graduates of U.S. chiropractic colleges. Twenty-three chiropractors took the test; only the four oldest DCs scored below the required 60 percent on the basic sciences portion. The WFC and Dr. Baird had earlier raised the issue that a basic sciences test would likely be prejudicial to the oldest practitioners, those furthest removed from school and test-taking, and indeed that is what happened. Fortunately, the Thai government will allow them to continue to practice until the test is given again this year. One other foreign DC who scored well was denied licensure due to a subsequent determination that the residency requirement had not been met. Grading, scoring and verification of credentials has taken months, but is now completed.
Notes
The TCA and Dr. Baird continue meeting with Thai MoPH officials and public and private university officials interested in starting a chiropractic curriculum in their schools. Discussions regarding unification of all licensed chiropractors into one national association recently resumed.
Dates for a second licensing exam in 2008, with different eligibility criteria and format, remain to be determined by the Thai MoPH. The December 2007 election and resultant government changes mean that many of the Thai MoPH officials familiar with what transpired are no longer occupying their positions and new relationships must be cultivated. Formation of a multidisciplinary regulating committee or board as a prerequisite to an independent regulatory board is pending.
Chiropractic scope of practice is good in Thailand and multidisciplinary practices are encouraged. All practices are cash practices. There are no personal injury attorneys, workers' compensation administrators, or managed care or health insurance companies to deal with. There is still a requirement that the individual facility or clinic itself must be registered under the license of one of the five older, longer-established professions, with an exception granted to hospital-affiliated clinics. Passing the chiropractor license exam and obtaining a foreigner's work permit are both required to practice.
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