As the newly elected president of the Federation of Chiropractic Licensing Boards (FCLB), it is an honor to take on the responsibility of fulfilling our mission statement. With the advent of a year-long celebration of our 75th anniversary, we find ourselves looking ahead to special challenges and opportunities, all of which affect the entire chiropractic profession.
For those who may not be as familiar as others with the FCLB, we are a nonprofit, private association of government agencies which license and regulate doctors of chiropractic. Our growing membership includes chiropractic boards in the U.S., Canada, Australia, and Mexico.
The FCLB Board of Directors is made up of nine licensed chiropractors, five of whom represent specific geographic districts and who are elected by their peers (members of regulatory boards in those regions). Additionally, there are four officers who are elected by the membership at the annual meeting of the FCLB delegates.
While the final legal authority for chiropractic regulation is embodied in the statutes and regulations in each jurisdiction, the FCLB supports the efforts of these agencies to protect the health, safety and welfare of the public. Where promoting the profession is appropriately the responsibility of associations, public protection and promoting excellence in regulation constitute the mission of the FCLB.
Carrying out our mission places us in the center of a number of issues important to the practicing doctor, including:
CIN-BAD / Licensure List
The FCLB's Chiropractic Information Network/Board Action Databank (CIN-BAD) is on the verge of adding primary verification level credentialing information on all licensed doctors of chiropractic to its current database of public board actions and exclusions from federal reimbursements. Managed care already relies on information from CIN-BAD to meet their credentialing requirements. Adding the licensee list should expedite the credentialing of chiropractors.
Practitioner Mobility
During the past several years, the issue of improving mobility for "seasoned practitioners" without repeating the full, initial examination has become important for the federation and its member licensing boards. The FCLB task force on practitioner mobility has recommended guidelines to facilitate licensure without additional testing in other jurisdictions. These were endorsed by our member boards at the 2001 annual meeting. Key elements in the adopted resolution included five years of active practice with a clean record as verified by CIN-BAD and malpractice carriers, compliance with the jurisprudence assessment requirements, use of the NBCE special purpose exam for chiropractic where appropriate, and a personal interview option as needed. Obviously, boards will be reviewing and considering this proposal for adoption on an individual basis.
With more and more doctors of chiropractic maintaining similar educational and examination credentials, the board's focus can shift to practice performance. CIN-BAD's several databases, including public board actions and Medicare exclusions (and the list of all licensed DCs) maximizes today's electronic advantages to support expedited licensure processes.
Continuing Education
Regulatory boards face increasing demands on limited resources to review programs for continuing education credit, and chiropractic colleges find themselves trying to meet multiple jurisdictional requirements. Another FCLB task force has proposed categorizing current continuing education offerings within a framework that complies with the board's legal requirements for hours accepted toward relicensure. This emerging system would assist and simplify the program sponsors' application for recognition, and eventually help track CE participation for field practitioners. Clearly, "one size" does not fit all, and each jurisdiction would retain its current rights to approve individual programs, and to customize the FCLB program components to meet its needs.
Practice Standards
Paramount to the well-being of chiropractic patients, practice standards are an important focus for both the FCLB's practice standards committee, and our work with the Council on Chiropractic Guidelines and Practice Parameters. Recordkeeping, consistency in disciplinary guidelines, and standards of conduct for board members are several examples of the public protection aspects. As befits our status as portal-of-entry providers, a particular emphasis for the federation has always been the importance of diagnosis and examination in ensuring patient safety.
In a related effort, our task force on clinical competence is studying how to measure this area, and how it may correlate with the duties of regulatory boards.
Within the constraints of our mission (to protect the public and serve our member boards), our board of directors also takes a keen interest in other professional initiatives which impact on practice standards, such as the ACC paradigm and the HCFA lawsuit.
Organizational Structure
As we look back on 75 years of service to licensing and regulation, it is apparent that we have a stewardship obligation not only to help with issues facing individual boards, but also to continuously critique our own organizational structure. Our bylaws are currently under review to address length of terms for officers and the possibility of adding a "board executive administrator" seat to the current nine-member FCLB Board of Directors. Our first Canadian district director was elected this past year, and we are increasingly aware of the regulatory needs of chiropractic's worldwide community. Future organizational changes will no doubt be proposed to respond to this larger constituency.
The Federation is fortunate to have a dedicated board of directors. Our leadership team with whom I am pleased to serve includes DCs Richard Cole (TN), vice president; N. Edwin Weathersby (AZ), treasurer, David Brown (VA), immediate past president; Patricia Conners-Allen (AK), executive board chair and district I director; LeRoy Otto (MN), district II director; Daniel Saint-Germain (Quebec), district III director; Oliver "Bud" Smith (TX), district IV director, and Linda Steele Denham (GA), district V director. Our executive director, Donna Liewer, has been with the FCLB for over 11 years. She brings a valuable perspective which is most appreciated by the board and the other four members of our talented staff.
During the coming months, we will be addressing these and many other issues corresponding to our mission of protecting the public. I would like to extend a special invitation to the entire profession to join us in dialogue on regulatory concerns. Let us commit to keeping the health, safety and welfare of the patient at the center of all our actions.
Note: There is free access to licensure requirements on the FCLB website (http://www.fclb.org), and other information and projects.
Wayne Wolfson,DC,br>FCLB President
Orlando Florida
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
