Life University President Opposed to Tiering
Georgia Chiropractic Council Calls for Investigation
Colorado Introduces Legislation

Several months after National University of Health Sciences announced its first graduating class of Advanced Chiropractic Physicians other chiropractors and groups are starting to speak out.

In an article published in the February/March issue of Today’s Chiropractic Lifestyle, Dr. Guy Reikeman, President of Life University states that “Tiering would take us back into fragmentation and disharmony” and says "I am opposed to tiering because I believe it’s healthy to accommodate a broad diversity of opinions within the profession and that those opinions and practice styles can be effectively managed under one chiropractic umbrella.”

Reikeman adds that the strongest proponents of tiering “…are often those who practice or educate at the most extreme philosophical ends of chiropractic and truly believe there are two professions in our midst.”

In a resolution rejecting the introduction of professional tiering, injections and prescription drugs into chiropractic the Georgia Chiropractic Council sharply denounced such activity, and stated it is opposed to any national certifying examination. It has been reported that the National Board of Chiropractic Examiners plans on developing such certifying exams. 

The GCC further called for “…an investigation into the use of the American Chiropractic Physician Credentialing Center (ACPCC), a subsidiary of the American Academy of Chiropractic Physicians, as a "nationally recognized credentialing agency" for the purposes of certifying qualifications to practice medicine.”

The whole tiering thing has a long history in the profession but the most recent drive for this started in the late 90’s and early part of 2000 with the launch of the Journal of Chiropractic Medicine. One particular issue worth reading to bring you up to speed on where the profession is headed is the:

Volume 1(4); Fall 2002 issue. 

Strength in diversity: Professional and legislative opportunities in primary care by the recognition, defining and promotion of the licensure of chiropractic medical education, competencies and skills
Reiner G. Kremer
J Chiropr Med. 2002 Fall; 1(4): 139–148. Published online 2002. doi: 10.1016/S0899-3467(07)60028-7.   

Those more medically oriented chiropractors who are supportive of tiering have been attempting to portray the outrage regarding this latest move towards a formal splitting of the profession as much ado about nothing. Others have said it’s just an isolated event in one state and why make a big deal about it. Those folks should watch carefully what’s happening in Colorado.

The Colorado bill HB 1216:

"Concerning the off site administration of medications by persons authorized to inject medications pursuant to the Pharmacy Practice Act"

orginally included the following language:
  
DEVELOP BY RULE A SPECIFIC FORMULARY OF NUTRITIONAL REMEDIAL MEASURES THAT MAY BE ADMINISTERED BY A TRAINED CHIROPRACTOR TO FACILITATE AND MAKE ADJUSTMENT AND MANIPULATION IN THE TREATMENT OF NEUROMUSCULAR-SKELETAL CONDITIONS MORE EFFECTIVE. THE FORMULARY SHALL INCLUDE VITAMINS B, C, AND D; CHONDROITIN SULFATE; GLUCOSAMINE HYDROCHLORIDE; SALINE; DEXTROSE; LIDOCAINE; PROCAINE; HOMEOPATHIC PREPARATIONS; SARAPIN; AND EPINEPHRINE.

This language is no longer contained in the current version of the bill.

According to the article in Today's Chiropractic, Dr. Michael Brown - the President of the New Mexico Chiropractic Association - says as many as 19 other states are studying New Mexico's legislation and more than half the chiropractors enrolled in the advanced certification courses are from outside New Mexico.

Similar to the false idea that this is isolated, some have expressed that the leadership within the chiropractic colleges believe we can address philosophical differences without tiering - the President of National seems to have some other ideas about that and we have yet to hear from the Association of Chiropractic Colleges on this issue.

Those within the more conservative faction of our profession should remember the story of the frog and the scorpion when such attempts to placate us are made.

See below for more reading and information on this issue.

As always I look forward to your feedback, comments and suggestions.

Matthew McCoy DC, MPH
matthewmccoy@comcast.net
Editor – Journal of Pediatric, Maternal & Family Health - Chiropractic
http://www.chiropracticpediatricresearch.net

Additonal Links and Reading on the Tiering Issue 

• Foundation for Vertebral Subluxation Statement on Tiering
• Federation of Straight Chiropractors & Organizations Statement on Tiering  
• Dr. Christopher Kent - Drugs, Chiropractic and Boiled Frogs
• The ICA Working Group Looking Into Tiering
• Dr. Don Harrison - Tiering of the Chiropractic Profession - Geuss Who's Behind This?
• Link to New Mexico Statute
• Proposal would allow practitioners to dispense meds, give injections
• American Academy of Chiropractic Physicians
• National University of Health Sciences Press Release
• Masters Degree in Advanced Chiropractic Practice Course Descriptions