Committee advises VA on chiropractor role

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Chiropractors will not become veterans' primary care professionals, but they will play a role in veterans' health care, according to recommendations sent to the Department of Veterans Affairs by its Chiropractic Advisory Committee.

On Nov. 3, the committee offered 38 recommendations to Secretary of Veterans Affairs Anthony Principi. He had appointed the committee -- six chiropractors, four other health care professionals and one public adviser -- in August 2002. Their mission: Report to Principi on the Veterans Health Administration's definitions of service to be provided and protocols governing referrals to chiropractors, direct access to chiropractic care and the scope of practice of chiropractors.

"The key here is that the VHA system is going to a primary care model system where everyone has a primary care physician and the care of the veterans is coordinated by the primary care physicians," said AAFP Past President Warren Jones, M.D., of Ridgeland, Miss., who serves on the committee.

The committee's recommendations include these:

Referral to chiropractic care requires consultation with the patient's primary care physician or another VHA professional.
Chiropractic scope of practice encompasses evaluation and care for neuromusculoskeletal conditions, such as back pain, neck pain, headache, and joint sprains and strains.
VHA will integrate chiropractic care to ensure collaboration among the chiropractor, the patient's primary care professional and other VHA health staff in planning treatment for patients with neuromusculoskeletal and other health problems.

If Principi accepts the recommendations, Jones said, it would be "a win-win situation for the veterans."

In 2002, nearly 7,800 AAFP members sent letters to lawmakers in Congress opposing a provision that would have allowed veterans to designate chiropractors as their primary care providers. The letters helped trounce that provision.

Jones said the law is clear about chiropractors working within the VHA . They can provide services, he said, but they are not to replace primary care physicians.

Offering a retrospective, Michele Johnson, legislative representative in the AAFP Government Relations Division, said, "Family physicians fought legislation a few years ago that would have classified chiropractors as primary care providers in the VHA system. Congress listened. The legislative compromise we won was the appointment of this committee. Now these recommendations include the primary care physician's referral of a patient to a chiropractor -- a successful resolution of what had threatened to be a major problem."

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