New Mexico chiropractors are moving closer to their dream of becoming primary care physicians.  Not by dint of having actually passed the medical school admissions test, graduation from medical school, passing board exams and completing 3 years of residency, where they would learn how to care for patients in clinical settings. No, not by a long shot. 

New Mexico chiropractors, with certain qualifications we'll get to in a minute, could do the following if a new Senate Bill passes:

prescribe, administer, inject and dispense dangerous drugs that are used in a standard primary care practice.

The bill would except only Schedule I and II controlled substances. 

They are attempting to do this by legislative fiat, not education and hard work. Which is how chiropractors typically do things. Want to detect and correct the non-existent chiropractic subluxation? Get all 50 states to pass chiropractic practice act allowing it.  Want to be paid by insurers for your services, even though you are known for pseudoscientific diagnoses and treatments?  Get the state legislatures to mandate insurance coverage. 

 Thanks to the legislature, New Mexico chiropractors can already call themselves chiropractic "physicians."  They currently enjoy limited prescription privileges if they become "advance practice" chiropractors. In keeping with their affinity for pseudoscientific treatments, the advanced practice chiropractor can prescribe and administer bioidentical hormones, glandulars and herbal medicine, among others.

If the listed substances are given by injection, they have to be approved by the chiropractic board. If the chiropractor wants to administer other drugs by injection, or "dangerous drugs" as defined by state law, or controlled substances, they have to be on a formulary approved by the pharmacy board and the medical board.  It appears the medical doctors and pharmacists weren't willing to go along with the charade that chiropractors are somehow qualified to prescribe.  The current formulary looks pretty slim. 

For some advanced practice chiropractors, taking 90 hours of classes and passing a test was sufficient. New requirements went into effect, however, requiring a "postgraduate degree in a clinical specialty" from an accredited institution. Since we can be pretty certain few educational institutions want to take on granting "postgraduate degrees" to chiropractors, we can be confident these "accredited institutions" are, and will remain, chiropractic schools.  

This year, they want even more from the legislature. Senate Bill 376 would create two levels of advanced practice.  Level ones could do everything the advanced practice chiropractor can now do and more.  He would be able to prescribe "dangerous drugs," as defined by state law, in accordance with rules passed by the chiropractic board. The board would have to collaborate with the pharmacy board in making the rules, but the pharmacists wouldn't have to sign off on them.  The medical board is nowhere in sight in this process. 

A level two chiropractor could prescribe, dispense, inject and administer prescription drugs used in primary care practice except for Schedule I and II controlled substances. Only level ones can become level twos, which requires additional training consisting of 

an organized program of medically supervised clinical rotation from an [accredited] institution of higher education or professional school . . . that consists of clinical and hands-on instruction of no fewer than six hundred and fifty hours . . .

By comparison, a family practice residency is 9,000 - 10,000 hours. This 650 hours must include "primary care case management."  At the end this clinical rotation, the supervising MD, DO, certified nurse practitioner or level two chiropractor has to make a "declaration" that the chiropractor has "successfully completed the prescribed clinical experience." 

See anything about an exam? No? Me either.

Let me offer a prediction about how this will all come down if the bill passes.  I doubt medical, osteopathic or nursing programs are going to allow chiropractors to participate in their clinical training without being forced to. (But I could be wrong.)This may well happen with the VA, as Congress has already forced them to take on chiropractors. Otherwise, chiropractic schools will simply create their own clinical training programs and employ MDs, DOs or nurse practitioners until they have enough level twos to take over to take over at least some of this work.

But what about the chiropractic scope of practice in NM? Does it include primary care?  They've thought about that one too.  Currently, the scope of practice is defined in traditional "correcting subluxations" terms, with "prescribing and administering" the previously mentioned bioidentical hormones and the like to "assist in the healing act."  This bill would change the practice of chiropractic to "chiropractic medicine" and expand their scope of practice to include

diagnosis and treatment of a condition for which the chiropractic physician has been educated and trained. 

In other words, leave it to the chiropractic schools to decide what chiropractors can do. And if you'd like some idea of the type of "primary care" services chiropractors could offer, look no further than this, um, exciting procedure NM chiropractor Bill Doggett hoped to offer if a similar bill passed during a previous legislative session:

using a proprietary technique, the growth factors in platelet-rich plasma (PRP) are extracted from that blood sample and injected into an area near the clitoris and into a the [sic] area of the upper vagina that is most important for the sexual response (the O-Spot) using a patent-pending procedure.

The bill's first stop, in the Public Affairs Committee, got a "do pass" recommendation with amendments.  Level twos would need a enter into a collaborative practice agreement with an MD, DO or nurse practitioner in order to prescribe and inject dangerous drugs. This includes a plan for consultation and referral, protocols for prescribing, and chart review.  After five years, the collaborating doctor or nurse practitioner can attest that the chiropractor successfully completed the collaboration and the chiropractor is off the hook.  I fear that chiropractors will simply be able to locate doctors or nurse practitioners of the "integrative" persuasion who will be all too willing to sign off.