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Chiropractic Scope of Practice, Competency Evaluation and Licensure

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Chiropractic Scope of Practice, Competency Evaluation and Licensure Cynthia Vaughn, D.C. Introduction Purpose of this presentation will be to: Provide an overview of ... – PowerPoint PPT presentation

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Title: Chiropractic Scope of Practice, Competency Evaluation and Licensure


1
Chiropractic Scope of Practice, Competency
Evaluation and Licensure
  • Cynthia Vaughn, D.C.

2
Introduction
  • Purpose of this presentation will be to
  • Provide an overview of the legal scope of
    practice for Doctors of Chiropractic
  • Outline the testing procedures that ensure
    clinical competency
  • Describe state licensure requirements and
    disciplinary procedures

3
Preamble
  • Primary Care versus Primary Contact versus
    Direct Access
  • These three terms have different meanings to
    different people, yet for all practical
    purposesmean the same thing.

4
Definition of Primary Care
  • The provision of integrated, accessible health
    care services by clinicians who are accountable
    for addressing a large majority of personal
    health care needs, developing a sustained
    partnership with patients, and practicing in the
    context of family and community.
  • - Institute of
    Medicine

5
Primary Care
  • Regardless of misconceptions, Doctors of
    Chiropractic provide all the components of that
    definition since they
  • Provide integrated, accessible health care
    services
  • Are clinicians accountable for addressing a large
    majority of personal health care needs
  • Develop a sustained partnership with patients
  • Practice in the context of family and community
  • Nevertheless, this presentation will use the
    terms Primary Contact and/or Direct Access

6
Chiropractic Scope of Practice
  • Other than a few isolated exceptions, all 50
    States and the District of Columbia
  • Authorize DCs to perform physical examinations,
    diagnostic imaging, laboratory studies and
    physiotherapy modalities.
  • Require DCs to diagnose
  • Require DCs to refer when indicated
  • Permit DCs to serve as primary contact, direct
    access providers. (ALL 51 jurisdictions)

7
Chiropractic Scope of Practice
  • Other than a few isolated exceptions, all 50
    States and the District of Columbia prohibit
    Doctors of Chiropractic from
  • Utilizing Prescriptive Medications
  • Performing Surgery

8
Testing Measures That Ensure Clinical Competency
  • National Board of Chiropractic Examiners (NBCE)
  • Established 1963
  • Four Parts Physiotherapy SPEC
  • Parts I, II and III accepted by all 51
    jurisdictions
  • Part IV accepted by 46 jurisdictions

9
NBCE Examinations Part I Written Examination
  • Six Basic Science Subjects
  • General Anatomy
  • Spinal Anatomy
  • Physiology
  • Chemistry
  • Pathology
  • Microbiology Public Health
  • Implemented in 1965

10
NBCE Examinations Part II Written Examination
  • Six Clinical Science Subjects
  • General Diagnosis
  • Neuromusculoskeletal Diagnosis
  • Diagnostic Imaging
  • Principles of Chiropractic
  • Chiropractic Practice
  • Associated Clinical Sciences
  • Also implemented in 1965

11
NBCE Examinations Part III
  • Written Clinical Competency Exam
  • Case History, Physical NMS Examination
  • Roentgenologic Examination
  • Clinical Laboratory and Special Studies
  • Diagnosis
  • Chiropractic Techniques
  • Supportive Techniques
  • Case Management
  • Implemented in Fall of 1987

12
NBCE Examinations Part IV
  • Practical Examination
  • Objective Structured Clinical Examination (OSCE)
    methodology
  • Standardized patients
  • Trained examiners
  • X-ray Interpretation and Diagnosis
  • Physical Exam and Case Management Skills
  • Chiropractic Technique
  • Implemented in 1993

13
NBCE Examinations - PT
  • Physiotherapy Examination
  • Case History and Examination
  • Physiotherapy Modalities
  • Indications, contraindications and Applications
    of Modalities
  • Therapeutic Exercise and Rehabilitation

14
NBCE Examinations - SPEC
  • Special Purposes Examination for Chiropractic
    (SPEC)
  • Used by state licensing boards for licensure by
    endorsement or for license reinstatement after
    suspension or revocation.
  • Computerized exam designed to assess
    practitioners in clinical areas encountered in
    general practice.

15
Credibility of NBCE Exams
  • Widespread acceptance by state licensing boards
  • Adhere to the American Psychological
    Associations Standards for Educational and
    Psychological Testing and the American
    Educational Research Association
  • Validity and reliability scores

16
State Licensing
  • Licensing is required for Doctors of Chiropractic
  • in all 51 US jurisdictions (state law)
  • and on federal military bases (DOD policy)
  • All 51 US jurisdictions license Doctors of
    Chiropractic to serve as primary contact, direct
    access providers.
  • 3 states (KS, IL VA) have composite licensing
    boards composed of MDs, DOs and DCs

17
State Licensing
  • Responsibility of the licensing boards
  • Protect the public by
  • Ensuring appropriate education and examinations
  • Interpreting and applying statutes and
    regulations
  • Identifying and recommending legislative
    improvements

18
State Licensing
  • State licensing boards commonly
  • Adopt the accreditation standards of the CCE
    (Chairman Reed Phillips is CCE President)
  • Require 12 24 hours of CE every year
  • Re-evaluate practitioners every 12 years during
    the license renewal process
  • Discipline DCs who do not comply with acceptable
    professional standards as codified in statute and
    regulation
  • Report violations to the national CIN-BAD
    database so other states will have information.

19
Presentation Summary
  • Doctors of Chiropractic are
  • extensively examined prior to state licensure
  • legally licensed and regulated in all 51 US
    jurisdictions
  • professionally trained in the primary care
    subjects and required to diagnose and refer when
    indicated
  • qualified to serve as primary contact, direct
    access providers
  • permitted by state law to perform a wide variety
    of conservative procedures
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