Doctor Title

[docpowers]

I am a Licensed Chiropractic physician in Virginia. I plan to go to PA school. In virginia and many other states a chiropractor is a portal of entry Physician. We can do physicals, order Lab tests, X-Rays, DME equipment, braces, etc. We cannot prescribe drugs or do surgery. When I become a PA will I be called Doctor since I already can do most of the same things a medical doctor can do. I have my own NPI number and I believe the group I would work for would recieve full reimbursement instead of 85% for a PA.

[NewtonsApple]

Maybe you should just get your MD or DO, sounds like being referred to as doctor is very important to you.

[andersenpa]

You can check the state regulations through the AAPA but most are explicit about identifying yourself as a PA if you are working in that capacity. I have known DCs who went on to be PAs and worked in ortho/sport med practices where their PA and DC lines are blurred, so there you may have a case, but if you are working as a PA and not practicing chiro then it would be hard use the term Dr.

Same as any academic or non-allopathic clinical Dr using the title.

 

PAs have NPI numbers as well as you probably know.

There are incident to rules that allow 100% billing but I wasn't aware of one which utilizes a doctorate degree to grant 100% of the physicians fee schedule.

[docpowers]

The reason I am not applying to MD school is that I am 55 years old

[docpowers]

It id very possible that the hospital that I will work for will allow me to perform chiropractic adjustments also

[docpowers]

Becoming a chiropractor is very intense.The first 2 years is identical in the basic sciences as med school. So, yes I have earned that title

[CJKitty]

You certainly have earned that title, but if you are hired as a PA and working as a PA then you will have to identify yourself as such. Check your local state laws, usually they are very specific about having a visible badge with title, etc. Of course lots of patients don't know/don't care about the difference between a PA and an MD and may call you "doc" without you even saying anything. However, I certainly know nothing about working with dual liscences or performing chiropractic duties under the job title of PA, so I will leave that to the working professionals. :)

[NewtonsApple]

I don't think anyone was saying that you did not earn the title or questioned the intensity of your degree. I was saying that from your post, it seems a title is important to you. Personally I feel it to be irresponsible and misleading to call anyone Doctor without an MD or DO in a hospital setting without immediate clarification, a major problem I have with the DNP agenda.

[bradtPA]

Practicing as a chiro when you are a PA can also be problem. Your scope of practice as a PA is derived from the scope of practice of your supervising physician, not your DC license. This should not be considered a shortcut allowing you to be a DC with prescriptive authority. Maybe Anton Cherry will see this post and answer it fully for you, he is one of the PA/DC folks that occasionally answer questions on this forum.

[lzypanda]

We had a couple lectures from the physician assistant committee and they've mentioned that you can't perform chiro services if your sp's scope of practice doesn't cover it. If you perform those chiro services and your sp is a cardiothoracic surgeon or something.. I think there might be a serious problem there. I think this is state dependent, so be sure to check the pac website to make sure your don't get a lawsuit on your hands.

[physasst]

Practicing as a chiro when you are a PA can also be problem. Your scope of practice as a PA is derived from the scope of practice of your supervising physician, not your DC license. This should not be considered a shortcut allowing you to be a DC with prescriptive authority. Maybe Anton Cherry will see this post and answer it fully for you, he is one of the PA/DC folks that occasionally answer questions on this forum.

 

THIS....and please stop comparing DC school to MD/DO school, it is not the same. It comes off as defensive. DC school is not easy, 2 of my friends are DC's including one who works with the US Cycling Team, but I know (from previous conversations) that they would say that it is not an even comparison.

 

As far as NPI's, PA's have this as well, but you will be reimbursed as a PA, there is no "hybrid" model in the Medicare reimbursement formula. If you are working as a PA, you had better check your institutions policy, and state law, but many will not let you use the title "Doctor" if you are functioning as a PA. There is quite a deal of concern over misrepresentation of healthcare providers, and in fact, the physician community has introduced the "Truth and Transparency" Act twice into Congress. It has died both times in committee, but the states and institutions are picking up on this, and many are already creating their own policies and rules.

 

To be clear, this should not be considered a "shortcut" to prescribing as a DC. If that is your concern, you may want to consider NP school, as they can function more independently in many states, although I am not 100% sure about Virginia.

 

Your scope of practice, AND prescribing privileges are derived from your supervising physician. You cannot use them independently, and in order to function as a PA, you would likely have to give up doing adjustments, UNLESS you work with a DO in a setting like Family Medicine, where they may be doing adjustments as well.

 

You should be proud of your degree and your title. I am completing my doctoral as well, but would never consider using mine in the clinical setting. Of course mine is in healthcare policy and research. I will use my title when dealing with Congress, and in the research setting/publications, which is my eventual goal, but my point is, that you have to be careful when you are straddling two fields as it sounds like you are trying to do. VERY CAREFUL clarification of which role you are in, and how you are functioning is paramount. Or you may find yourself in a pool of hot water.

[physasst]

Here's some more info for you, a link to the Virginia Medical Board site, with regulations there:

 

http://www.dhp.state.va.us/medicine/medicine_laws_regs.htm

 

You'll note, that under 18VAC85-50-40, Chiros cannot serve as supervising providers, so another Chiro which would be performing adjustments CANNOT serve as your supervising doc, which might limit your ability to continue to provide chiropractic services.

 

Also, 18VAC85-50-101 in section C, it clearly states that you can ONLY provide those services that are "within the scope of practice and proficiency of the supervising physician".

 

Also, 18VAC85-50-110 clearly states that the physician is responsible for all prescriptions written by the PA, and that all patients being seen for a chronic illness be seen by the supervising physician no less than every fourth visit.

 

18VAC85-50-115...well, just read the whole section. Rather important. Especially the part about "identification showing clearly that he is a physician assistant".

 

IT was interesting to see that Virginia still requires any prescription written by a PA to have the SP's name and phone number on the Rx as well. We finally got rid of that regulation a few years ago in Minnesota.

[docpowers]

Thank you for your information. I realize no one was questioning my credentials. But as far as chiro school is concerned, I was only speaking of the first 2 years of basic sciences being identical to med school. The last 2 are totally different. There are several DO's in my area. But it looks like I will just have to open an after hours clinic for chiro. I don't want to quit chiropractic as it is very helpful to avoid giving drugs when not necessary. The two combined fields will provide better care to my patients. I thank everyone for there information.

[NewtonsApple]

 

Also, 18VAC85-50-110 clearly states that the physician is responsible for all prescriptions written by the PA, and that all patients being seen for a chronic illness be seen by the supervising physician no less than every fourth visit.

 

 

 

I have seen a PA for my back for the past 3 years (2-3 visits/yr) and have yet to see a doc. I asked about this and was told it is rarely followed, however, it seems to me that you do open yourself to liability if it is not followed.

[LESH]

I have seen a PA for my back for the past 3 years (2-3 visits/yr) and have yet to see a doc. I asked about this and was told it is rarely followed, however, it seems to me that you do open yourself to liability if it is not followed.

 

Wide open - especially if there is a case with a poor outcome and lord forbid lawyers are involved.

[physasst]

I have seen a PA for my back for the past 3 years (2-3 visits/yr) and have yet to see a doc. I asked about this and was told it is rarely followed, however, it seems to me that you do open yourself to liability if it is not followed.

 

It depends on the state, if it is in Virginia, then yes, they are opening themselves up to considerable liability. In Minnesota, we do not have that requirement. Although at Mayo, where I work, all patients MUST see a physicain on their initial visit to the clinic, and no less than once every five years if they are being managed for a chronic illness. So, even though the state does not regulate this, my institution does.

 

Virginia's laws seem okay, mildly restrictive when compared to Minnesota, but certainly within the mean.

[docpowers]

If you have been seeing a PA or Medical doctor for that long and they have not come up with a logical reason for your problem. Then you need to see a chiropractor. I Know that you can be given muscle relaxers for a period of time and if a misalignment is involved, it will sometime go back in place by itself. But if it persists such as your case then it would be wise to see a chiropractor. I have had patients that have had back trouble for years and been given a ton of pain killers. And just one visit with one adjustment have had tremendous relief. I could go on with many stories. Check it out.

[physasst]

And we could also discuss the 1 stroke, and at least 3 separate carotid dissections that I have seen in my career secondary to chiropractic manipulation. Chiropractic care can help with musculoskeletal back pain, although, the idea of intersegmental repositioning, and the need for xrays has been debated even among chiropracters.

 

My big beef with chiro, and my 2 friends are well aware of this, is the occasional DC who makes outrageous claims, or oversteps their boundaries. For example, I recently saw a DC advertise locally to be able to "prevent the recurrence of ear infections" and to to be able to "treat acute migraine headaches", and finally, to "reduce the risk of contracting influenza".....Not kidding. There is not a single shred of empiric, peer reviewed data to support any of these assertions. FWIW, my friends who are DC's are actually embarassed by this kind of discussion.

 

You might appreciate this thread over at SDN:

 

http://forums.studentdoctor.net/showthread.php?t=779831

[docpowers]

I completely agree. There is some wild claims. The person I was replying to had back problems not cervical problems. And of course there is the continual debate of the safety of chiro. care. But we are not going there because medicine has far to many deaths each year just on prescription drugs alone. My brother was operated on the wrong lung.There is over 200,000 adjustments of the spine done every day. But this debate could and will go on forever. My position is that I can see the benefits of both fields. I would like to see complementary medicine become the norm. But I can understand where most people in the medical field are coming from. I have been in both area's. I used to be a respiratory therapist. It's good to be exposed to different fields. I seen an episode on mystery diagnosis where a woman said she had a demon in her kidney. The doctors tried everthing they could and said she was going to die if they didn't get help. They called in an exorcist and she got better. They said it was a combination of medicine and the exorcist that saved her life.

[physasst]

I completely agree. There is some wild claims. The person I was replying to had back problems not cervical problems. And of course there is the continual debate of the safety of chiro. care. But we are not going there because medicine has far to many deaths each year just on prescription drugs alone. My brother was operated on the wrong lung.There is over 200,000 adjustments of the spine done every day. But this debate could and will go on forever. My position is that I can see the benefits of both fields. I would like to see complementary medicine become the norm. But I can understand where most people in the medical field are coming from. I have been in both area's. I used to be a respiratory therapist. It's good to be exposed to different fields. I seen an episode on mystery diagnosis where a woman said she had a demon in her kidney. The doctors tried everthing they could and said she was going to die if they didn't get help. They called in an exorcist and she got better. They said it was a combination of medicine and the exorcist that saved her life.

 

 

As a researcher, and patient myself, I only care about the evidence. If there is substantial evidence that CAM can provide superior benefits, even for some disorders we need to know this. My point was, that people who make wild claims without evidence to support their assertions, discredit their entire profession.

 

I believe in only using techniques, medications, and treatments that are based on empiric evidence and have peer reviewed data to support their use. I think that there may be some use for Chiropractic manipulation for some disorders, but that we need evidence. For example, my wife, having been frustrated with monthly migraines that seem to worsening over time (did you hear me Mike???) has tried numerous treatments. She is on medication for prophylaxis, but it hasn't helped, and ever since the birth of our daughter they seem to be increasing in frequency and severity. One of her friends recommended chiropractic, and she is trying it. I told her that I was open to the idea of trying it, but to be aware of the potential for carotid problems with cervical adjustments, and the fact that there is no real evidence to support this. She's so frustrated that she is willing to try, and I am skeptical, but supportive. If it works, great, I only want her to be happy and pain free.

 

It would seem though, that if these manipulations are effective at preventing, or reducing the occurence of migraines, that there should be a multi center, large, prospective, RCT to evaluate this. Same with Chiropractic treatment of low back pain. There is not much in the way of large, well done studies. In fact, the DC profession seems to be suffering from the same disease as the nursing profession, and in particular NP's.......by that, I mean, that there are a LARGE number of poorly designed, poorly executed, underpowered studies of small patient populations with questionable significance when trying to apply to population health.

 

SO, if you are willing, or if you should know of any, I would love to see a LARGE, well powered, well designed, rigorous study of chiropractic techniques in a comparative fashion. Heck, with the 1.2 Billion in the stimulus for CE research, there is likely some funding available for a study like that.

 

I won't disagree on the iatrogenic death rate caused by mainstream medicine. As far as the exorcist, that is comical. But there is WAY too much superstition on this planet for me.

 

I prefer data. Cold, hard data. Facts, numbers.....data. In my role as a health policy analyst and advocate, I deal with ideologues all day...and feel like banging my head into a steel wall, over and over and over and over again.

[docpowers]

If your wife's headaches are due to her cycle, then I doubt if chiropractic care will help her. It is worth a try and I hope it helps her. I had headaches for over 25 yrs. and chiropractic did not help. I believe mind was a hormonal issue. When we start aging our hormones change. I am 55. In the last year I have noticed that they are much less severe. I used to take an imitrex every day for 3 days out of 2 weeks. My headaches would come like clock work every 10 days to 2 weeks and last for 3 days. Now I hardly ever take one. Chiropractic will only work if there is a nerve interference. When there is pressure against a nerve due to a slight misalignment then pain will result. You do not always have pain in nerve interference. If it is slight pressure there will no pain but a decrease in nerve flow will result causing the organ that the nerve intervates to not function at a optimal level. I'm sure you know that it takes a nerve to operate properly before a muscle will function. I don't have the use of my deltoid muscle due to damage to my axillary neve. So, if there is a little pressure on that nerve then it will not function as well. I know you want to see concrete evidence about everything and I agree that that is the best if possible. Chiropractic field doesn't have the money as the medical field and can't do all the research that medicine can and that is a shame. But when you see patients that are in pain and bent over come into your office and walk out with much less pain and walking straight, that is rewarding. I hope your wife gets relief. There is a lot more to chiropractic but nerve interference is the major premis.

[docpowers]

Do not feel bad about talking to your friend. Chiropractors are used to skepticism. Anyone that has never been to a chiropractor is skeptical. When the pain leaves or greatly diminishes after an adjustment they are astonished. I just had a new patient this morning who had never been to a chiropractor. He said I hope you can help my back. When he left he said he was not hurting. The spine is meant to be flexible where all segments move in harmony. The problems come about when they dont move in harmony. Subluxation or you can call it misalignment occurs basically 3 ways. 1)trauma- that is self explanatory. You have knocked it out. 2) Chemicals- by chemicals I mean the foods we consume. Most of the foods contain preservatives or other chemicals (and I know our superior FDA always say it is not harmful due to the small amounts -I just saw the Doctors show where the host doctor said he couldn't understand why the FDA allows food coloring because it causes cancer). chemicals can be in our atmosphere or in the prescription drugs or otc drugs. 3)Emotional stress - I see alot of this today. Now, when the last 2 of these situations occur, the muscles and ligaments surrounding the spine will spasm and cause the vertebra to pull to the side of least resistance thus causing a subluxation. When this happens it will close down on the IVF where the nerve exits (you must remember that there is tissue around the nerve in the IVF so that it only takes a small amount of pressure to decrease the nerve flow to the organ it supplies). Every organ in your body must be intervated with a nerve in order for it to function. Even if there is a small amount of pressure it will decrease that flow and the organ will not function at it's optimal level. I had a chiropractor colleague who developed a severe heart arrythmia. He went to the ER just as he should have done. They performed thousands of dollars of tests. They give him some pills for his arrhythmia and they probably would have worked. When he knew he wasn't going to die, he had himself adjusted. His T4 or T5 was badly out. Right after that adjustment his heart arrhythmia was gone. He never took the first pill. Another way to have nerve interference is by degeneration of the vertebra or disc. If there is a decrease of the disc then common sense will tell you that the IVF space will also decrease causing pressure on the nerve that exits that IVF. You can also take oblique pictures to look at the IVF ports. I know many may take issue with this but this is basically how chiropractic views health. You see, if the organs are not properly supplied with nerve intervention then the whole body will suffer because the body functions as a whole. I hope that I have answered your question and please don't think I am trying to convince anyone to seek chiropractic with an acute situation. I believe there are great benefits to be derived from many fields of health care. Chiropractic is just on of those things that people have to experience.

[ventana]

I wish I had $100 for every compression fx I have seen on an elderly patient who attended chiro.....

 

I no longer recomend chiro to any of my patients.

 

Over the years I have seen to many injuries to patients as the hand of chiro care and just got tired of having patients complain that they have been in Chiro care for 6months and really don't feel any better. I have gone to chiro to try and was also unimpressed.....

 

 

as for this thread - you are a PA and when you are doing something for your SP you HAVE TO ID yourself as a PA and nothing else. If you want to continue being called a Doc then stick with chiro or go to med school but PLEASE do not be a PA.

[marilynpac]

My chiro doesn't manipulate without XRs first and tends to use the activator on the elderely patients. His practice is more busy than many of the doctors practices around the area and he has never contributed to drug abuse problems like alot of the Drs. in our area. If I have an ache or pain I go to him first...

[Joelseff]

deleted-offtopic