Creating Our Own Competition

"I used to go to my chiropractor regularly, but now I go to a primary spinal care practitioner. They're like a chiropractor, only much better. They can do everything a chiropractor can do, but even more. You should try one."

This is the kind of conversation Wisconsin DCs should expect to hear frequently next year if the Wisconsin Chiropractic Association (WCA) has its way. (See "Is the WCA Trying to Create a New Profession?" in this issue.) While it may not be accurate, this is the perception that has already been created in Wisconsin. Even the bill's authors claim the profession of "primary spinal care practitioners" would have "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."

The bill will create a new profession of "primary spinal care practitioners" (PSCPs) that will be in direct competition with DCs. Many would like to promote this legislation as a live-and-let-live, you-practice-your-way-and-I'll-practice-my-way scenario, but nothing could be further from the truth. This is a new profession with a new licensing board attached to the Wisconsin Medical Examining Board. The initial degree requirement will be a doctorate of chiropractic, but the PSCP master's degree will create a new professional license that could ultimately subvert and replace chiropractic in many areas:

• Insurance Reimbursement – Many third-party payers have made consistent efforts to restrict access to doctors of chiropractic. They will now be able to direct patients to PSCPs instead, without any recourse.
• Worker's Compensation – Given a choice between a PSCP and a DC, the choice will be obvious, as the PSCP is much more medically oriented.
• Personal Injury – PSCPs could easily be seen as having greater medical credibility and thus be preferred by many over "regular" DCs.
• Legislature – The WCA has spent three years in its effort to establish PSCPs. Much of the association's information on PSCPs speaks to their perceived superiority. The WCA is lobbying hard to pass the bill that will create this new profession, even though its own president estimates only about 10 percent of Wisconsin DCs will become PSCPs. Based on all this, who are the WCA's lobbyists most likely to represent at the Capitol when there is an issue that separates the two professions?

Chiropractors in Wisconsin will eventually be forced to become PSCPs or convert to mostly cash practices as the reimbursement for chiropractic care shifts to PSCPs. New chiropractic college graduates will need to add a medical college master's degree and another 500 hours of clinical training to their education if they want to practice successfully in those states that choose to create a PSCP profession.

While the above may seem a little crazy, one must consider the source. The Wisconsin Chiropractic Association is the same WCA that:

• In 2000, "agreed to settle Federal Trade Commission allegations that [the association] orchestrated a conspiracy among WCA members to increase prices for chiropractic services and to boycott third-party payers to obtain higher reimbursement rates." The result was a settlement with no admission of guilt and no payment of penalties, but an agreement to refrain from similar activities.¹
• In 2003, filed and lost a civil suit against the Wisconsin Chiropractic Examining Board over its decision to replace the home-grown Wisconsin state exam with the Part IV exam administered by the National Board of Chiropractic Examiners (NBCE). The WCA claimed Part IV would allow "people not even minimally competent to practice being licensed by the state."²
• In 2005, was ordered to pay $100,000 in legal costs based on a ruling it had filed a frivolous lawsuit against Dale Strama, DC, a former chair of the Wisconsin Chiropractic Examining Board, for the sole purpose of "maliciously injuring" Dr. Strama by swaying chiropractors from attending continuing-education seminars sponsored by Dr. Strama's organization.³
• In 2009, lobbied heavily to return to a state chiropractic practical exam that had an incredibly low pass rate when it began to be administered in 2012. The Wisconsin chiropractic exam was eliminated in 2013 after numerous students suffered extensive financial damage.^4-6

Now this same WCA is looking to create a new, competing profession under a new medical licensing board, with a new degree provided by a medical college with which it is partnering. If successful in getting its representatives in the right places, this same WCA could end up controlling this new profession, the educational requirements and the licensing board supposed to oversee it. Even worse, it could lose control and see its new PSCP profession controlled by representatives of the medical profession. (Given the WCA's history, this is a much more likely scenario.)

As I read through the legislation, I quickly became convinced the American Medical Association (and its related state associations) will begin celebrating once they stop laughing at us. We have now confirmed that their efforts to contain and eliminate chiropractic were unnecessary. The WCA is proving we can do that all on our own.

Not happy with what you are reading? Then do something about it:

• If you are one of the more than 1,800 Wisconsin DCs not expected to become a PSCP, you need to speak up now. This is your future.
• If you are a chiropractic student hoping to practice in Wisconsin, you also should be vocal right now – or pick a different state in which to practice.
• If you are a DC practicing elsewhere and do not want to add PSCPs to the list of professions (PTs, DOs, etc.) you current compete with, you should add your voice to the effort.

Take a few moments to contact the bill's authors, Wisconsin Senator Frank Lasee and Representative Joe Sanfelippo. Please first know these two legislators are only trying to help our profession. They are not aware of the issues and have been led to believe this is a good thing for the chiropractic profession.

Send a short email (no tirades, please) to these two legislators, letting them know you believe LRB−3787/1 will not provide an added health care benefit for the people of Wisconsin; that doctors of chiropractic are already primary spinal care providers without the use of drugs; and that this bill may even result in greater use of prescription and OTC drugs, rather than less. Thank you in advance for getting involved.

• Sen. Frank Lasee (to send an email, click Sen.Lasee@legis.wisconsin.gov)
• Rep. Joe Sanfelippo (to send an email, click Rep.Sanfelippo@legis.wisconsin.gov)

References

1. "Wisconsin Chiropractic Association and Its Director Agree to Settle FTC Charges of Price Fixing." Dynamic Chiropractic, May 1, 2000.
2. Devitt M. "Wisconsin Chiropractic Association Sues State Over Testing Change." Dynamic Chiropractic, July 28, 2003.
3. "WCA Exec. Guilty of Frivolous Lawsuit." Dynamic Chiropractic, July 2, 2005.
4. Crownfield P. "Examining the Wisconsin State Exam." Dynamic Chiropractic, June 1, 2013.
5. Petersen DM. "History Repeating Itself in Wisconsin?" Dynamic Chiropractic, June 1, 2013.
6. Crownfield P. "Say Goodbye to the Wisconsin State Exam? WCA Does an About-Face." Dynamic Chiropractic, June 15, 2013.

Read more findings on my blog: http://blog.toyourhealth.com/wrblog/. You can also visit me on Facebook.