Chiropractic + Naturopathic Doctor

B.C. chiropractors seek expanded scope of practice

Mari-Len De   

Features Collaboration Profession

Dr. Dean Greenwood makes a case for chiropractors as primary spine care provider at the recent BCCA Chiropractic Convention

VICTORIA – Chiropractors in British Columbia are working toward legislation that will further expand their scope of practice, including the ability to order diagnostic imaging for patients.

The B.C. Chiropractic Association (BCCA) has been engaging the provincial legislature and the Ministry of Health for better integration of the profession into primary and community health care.

At the association’s recent annual general meeting, BCCA president Dr. Jay Robinson said association executives have met with members of the legislative assembly to explore ways that chiropractic can help solve some of the province’s health-care challenges.


“We’re at one of those points where we’ve been interacting with governments, we’re starting to ask for things that chiropractors have never had,” said Robinson in an interview with Canadian Chiropractor magazine. “We’re starting to integrate better into the health-care system, and we now have a very strong case to be able to be players in the health-care system.”

Top on the BCCA’s legislative agenda is widening the chiropractic scope of practice to allow DCs to prescribe diagnostic imaging for patients. This, Robinson said, will help patients get the right care they need at the right time. Chiropractors in Alberta, Ontario and Newfoundland currently have authority to order x-rays and certain diagnostic imaging in varying degrees and limitations.

Currently in B.C., patients need to get a referral from their medical doctor to get any diagnostic imaging done. This could mean a patient who’s had an injury or suffering from musculoskeletal pain, for example, would have to wait weeks to get appropriate treatment. Few who are willing to pay out of pocket to get x-ray right away could get the right care quicker, but the majority would prefer the government pick up the tab on this health-care service, Robinson noted.

“It’s the patient that’s been disadvantaged out of this,” he said. “If (chiropractors) refer the patient directly for x-ray, they can go that day or the next day, the result comes back, then they go back to the chiropractor – if it’s applicable – and they get treated. They are getting treated within a couple of days instead of a couple of months.”

Having the ability to refer directly for imaging would also help take some of the load off the medical doctors, who are already quite overwhelmed with patient visits, the BCCA president added.

Members of B.C.’s legislative assembly were generally receptive to the chiropractic cause, according to Robinson, adding the government is increasingly becoming aware of the need for more collaboration among health-care providers to increase efficiencies in the health-care system and promote effective patient-centred care.

Meeting the minister
The association executives hit a snag, however, when they met with B.C. Health Minister Terry Lake. Robinson said the meeting was to obtain the minister’s support for expanded scope of practice for chiropractic and increasing chiropractic involvement in the health-care system.

Lake’s “less-than-hospitable” reaction was unexpected.

“He didn’t want to hear about it, and didn’t want to talk about it,” Robinson said, “and suggested that we have to find answers other ways.”

Lake, a veterinarian by profession, has told BCCA officials he has a “bias,” according to Robinson, but the minister provided no further clarification.

The minister’s office has since reconnected with the BCCA and relayed that the “minister regrets his comments” and is willing to meet with the BCCA again, Robinson reported. No word yet on when that next meeting would be.

Canadian Chiropractor has contacted the health ministry’s office and attempted to get clarification from Lake about what transpired at the meeting with the BCCA, particularly on his reported “bias” statement. As of this writing, the minister was unavailable for interview.

The minister’s office, however, provided a response to Canadian Chiropractor’s inquiry, in which it called Lake’s encounter with the BCCA officials a “productive meeting.”

“The Minister did meet with the association earlier this year. They had a productive meeting; however, there are currently no plans at this time to extend MSP coverage to chiropractic care,” the statement said.

Despite the surprising reaction from the health minister, chiropractors in B.C. are not discouraged. “We have had good relationships with health ministers in the past. We expect to have good relationships in the future.”

Robinson is confident that with the increasing support from government and others in the health care sector – inside and outside of B.C. – the chiropractic profession will move forward with its goal of better integration into primary care.

Case for spine care
One important role chiropractors can play in an interprofessional primary care setting is as spinal care provider, according to Vancouver chiropractor Dr. Dean Greenwood, citing this expertise is currently an urgent health care need. Greenwood was one of the speakers at the BCCA’s annual chiropractic convention.

One in eight people suffer from a spinal disorder and musculoskeletal disability is on the rise, Greenwood said. “Conventional medicine is not adequately addressing the needs of patients.”

“With an aging population, there is urgent need for further research to better understand spinal pain,” he told conference attendees, adding the B.C. Medical Association has expressed support for efforts to enhance multidisciplinary care in the province to address the health care needs of the aging population.

Greenwood, who is co-founder of the Vancouver Spine Care Centre, urged chiropractors to consider pursuing additional education and advanced learning to further increase chiropractors’ credibility as spinal care experts. In addition to his doctor of chiropractic degree, Greenwood also has a Master of Science in Advanced Clinical Practice from National University Health Sciences, and is a fellow of both the U.S. Academy of Chiropractic Orthopedists and Canada’s College of Chiropractic Orthopedists.

“Clinical expertise and professional authority are essential (for chiropractors) to be included in integrated spinal care,” Greenwood stressed.

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