Avoid practicing beyond your scope of practice

Patients around the world are increasingly seeking out doctors of chiropractic for more and more of their health and wellness care. They are beginning (although just beginning) to realize that chiropractic is NOT only for low-back pain.

In response, DCs are offering a wider range of services. Many are using their knowledge and training in nutrition to help advise patients on diet and nutritional supplementation. Others are helping patients to adopt healthy living practices.

But some doctors are going a step further and offering services that are beyond their state's scope of practice. This puts them at risk of violating state statutes, makes them more vulnerable to board discipline, and potentially increases their exposure to lawsuits. It also may leave them without malpractice coverage for the specialty activity.  Professional liability policies typically cover only those services and/or diagnostic procedures that are specifically included within the individual's state Chiropractic Scope of Practice definition and create a claim or chiropractic incident.

Each state, through its licensing laws, defines what services chiropractors may legally provide patients in that state. The laws differ greatly, from those that specify only the correction of subluxations by adjustment, to those that permit acupuncture and various therapeutic modalities.

According to one survey, more than 50% of the responding licensing boards “allow chiropractors to order or perform clinical lab procedures, conduct components of a routine physical exam, examine the female pelvis, perform rectal exams, and conduct electromyographic, electrocardiographic and nerve conduction studies. More than 80% can perform a variety of X-ray procedures, use thermography, administer a vascularizer (Doppler) and order CT or MRI studies. More than 90% of the respondents permit chiropractors to employ some form of physiotherapy, adjust soft tissue or extremities, supplement with vitamins and conduct impairment ratings.” (JMPT, 1995, Jan;18 (1):16-20.)

Normally, the laws are quite detailed and explicit and there’s little argument over what the law permits. For instance, the Nebraska scope of practice law states that:

"The practice of chiropractic is defined as being one or a combination of the following, without the use of drugs or surgery: (1) The diagnosis and analysis of the living human body for the purpose of detecting ailments, disorders, and disease by the use of diagnostic X-ray, physical and clinical examination, and routine procedures including urine analysis; or (2) the science and art of treating human ailments, disorders, and disease by locating and removing any interference with the transmission and expression of nerve energy in the human body by chiropractic adjustment, chiropractic physiotherapy, and the use of exercise, nutrition, dietary guidance, and colonic irrigation. The use of X-rays beyond the axial skeleton shall be solely for diagnostic purposes and shall not expand the practice of chiropractic to include the treatment of human ailments, disorders, and disease not permitted when the use of X-rays was limited to the axial skeleton."

While the law does not mandate that all DCs provide every service permitted by law (that is, a Nebraska DC does not HAVE to offer dietary guidance or colonic irrigations) no doctor is permitted to provide services not specified in the law --  insurance policies will not cover any services not specified in the law.

In recent years, some doctors of chiropractic have expanded their practices into many areas that are not covered by state statutes – everything from cellulite treatment to hair removal!  Without getting into any philosophical discussions about the role of chiropractic in health care, it’s important to point out that any lawsuits arising from these “extra-scope services” are not covered by malpractice insurance policies since they are not deemed to be a “chiropractic procedure” that would thus give rise to a covered “chiropractic incident.”

Before adding any new service to your practice, protect yourself by checking with your board to determine if the new procedure is within your state’s definition of Chiropractic Scope of Practice.