Implications of prescription rights for the chiropractic profession

This article was selected by the editorial team of the Chiropractic & Manual Therapies journal as the best paper for the third quarter of 2016. The full commentary of this paper has been published and can be freely accessed online.

In a number of jurisdictions, chiropractors have developed advanced standards of practice, including the ability to order advanced diagnostic imaging as well as prescription rights for a limited formulary of medications. Recent reports indicate that a growing number of chiropractors in various other jurisdictions are also interested in expanding their scopes of practice to include such limited formulary access.

Chiropractors in Switzerland have had limited prescriptive authority since 1995, and surveys indicate that these privileges are regarded by Swiss chiropractors as a distinct advantage for both the profession and patients in that country. Despite the advances in some jurisdictions, the right to prescribe medications continues to be a contentious issue for many in the chiropractic profession.

The objective of this commentary was to examine the arguments for and against limited medication prescription rights for chiropractors, and to discuss the implications of implementing such privileges for the profession.

If limited to a musculoskeletal scope, medication prescription rights have the potential to change the present role of chiropractors within the health-care system by paving the way for practitioners to become comprehensive specialists in the conservative management of spine/musculoskeletal disorders. This is in keeping with a current move within the profession toward “rebranding” itself to align with a musculoskeletal scope of practice and a more comprehensive approach to patient care. Limited prescribing rights for chiropractors could also benefit patients and the health-care system by providing more streamlined, cost-effective care plus reduced waiting times for patients. Moreover, with such privileges chiropractors could have a positive influence on public health.

However, if the chiropractic profession wishes to expand its scope of practice to include limited prescriptive authority, necessary changes to chiropractic education and legislation must be addressed. For this, the profession could look to Switzerland where an excellent educational and legislative model for chiropractic has been developed.

Chiropractors who wish to pursue limited prescriptive authority should lobby their professional associations and regulatory bodies to engage in dialogue with like-minded politicians and third-party payers to highlight and promote the benefits of making such changes to the existing health-care system. Prior to this, discussions should take place within the chiropractic profession in order to present a uniform position on the part of the various memberships with respect to changing the profession’s scope of practice.

If such a move is to occur, it would be important that professional governing bodies, associations and respective memberships provide a united approach, perhaps initially validated after member consultation in the form of national surveys.

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Peter Emary, DC, MSc ; Taco Houweling, DC, PhD; Martin Wangler, DC, MME; Stephen Burnie, DC, MSc; Katherine Hood, DC; Mark Erwin, DC, PhD