Success in claiming the physician title, linked to privilege, status and particularly third party payment - some insurers will only cover certain services if provided by a “physician” – figured heavily in an October 2, 2009 mailing to members from the American Chiropractic Association (ACA). The ACA credited its hard work for insuring that the title stayed in the language defining the Federal Employee Benefit Plan. Blue Cross Blue Shield, which manages the plan, attempted to demote chiropractors to a status as “other health care providers.” (6)

While the chiropractic field is fiercely divided over its naming, with many adamantly opposing the use of the term “chiropractic medicine” (preferring “chiropractic”), resistance can diminish if more income opportunity is associated with a more medical positioning. A federal lobbyist for the field recently shared his view that opposition is waning as physician status is increasingly a component of the chiropractic medical profession’s Congressional agenda.

“Certified advanced practice chiropractic physicians” in New Mexico and an “entry-level doctorate” for AOM

A place the chiropractors are watching is the state of New Mexico which drew a good deal of attention at the ACA’s fall 2009 national conference. Chiropractors in New Mexico passed legislation this year that establishes the category of “certified advanced practice chiropractic physician.” This category, distinguished from chiropractor and requiring additional education and certification, is defined as having “prescriptive authority for therapeutic and diagnostic purposes as authorized by statute and stated by the board .” (7) The ACA has named a task force to look into this development.

For licensed acupuncturists, over the last decade roughly a half-dozen schools have begun offering small, accredited, clinically-focused Doctor of Acupuncture and Oriental Medicine programs which allow graduates to use D.A.O.M. after their names and “Doctor” in their title. But the big push will be around the profession’s movement toward an “entry level doctorate” from the current Master’s level of basic education.  In the spring of 2008, the Council of Colleges of Acupuncture and Oriental Medicine endorsed this direction. The physician question will certainly follow – and may yet pop-up in anomalous, legislated re-definitions such as created the Acupuncture Physician category in Florida.

The AMA’s push-back in its Scope of Practice Partnership campaign

These changes have not gone un-noticed by the American Medical Association. In 2006, the organization formed its Scope of Practice Partnership to battle against scope expansions into its turf from a huge array of fields, including nurses, optometrists and psychologists, as well as licensed DCs, MDs and LAcs. A recent analysis of state legislative issues the AMA was watching in 2009 found that 24 of 154 related to these 3 fields. Often the AMA interest was in opposing the licensing of “naturopathic physicians” and a cluster of others were against expanded prescriptive authority for NDs and DCs. (8)

The AMA’s view is supported by the 2008-2009 version of occupational titles published by United States Department of Labor. The stern clarity of the language is hardly aligned with actual use in the various States that make up these United States: “There are two types of physicians: M.D.—Doctor of Medicine—and D.O.—Doctor of Osteopathic Medicine.” (9)  This faulty language must be reassuring to the leaders of the AMA’s Scope of Practice Partnership campaign – positively a pacifying thumb-sucker of a throw-back to some remembered good old days when the MDs we unchallenged by other upstart “physicians.”