Is More Scope Always Better?
When chiropractors hear the words “scope expansion,” the reaction is often predictable:
Why wouldn’t we want to do more?
More procedures mean more tools. More tools mean more options for patients. More options mean more opportunity for chiropractors.
It sounds like common sense.
But there is a fundamental point about scope expansion that every chiropractor should consider:
Adding more procedures to our scope does not automatically make chiropractic stronger.
In fact, expanding scope can make the profession more vulnerable.
Every new procedure creates another potential opportunity for competing professions to challenge our authority, another issue the Board may have to defend, and another potential battleground over the statutory definition of chiropractic practice.
What may appear to be a simple opportunity to add another service can ultimately expose the entire profession to legal challenges that have consequences far beyond that single procedure.
This is particularly important when the procedure involves an area traditionally associated with another healthcare profession.
The question should therefore not simply be:
“Can chiropractors do this?”
We should also ask:
“Should chiropractors seek to add this to our scope—and what could it cost us if we do?”
Those are very different questions.
A chiropractor may reasonably believe that needle EMG would be a useful diagnostic tool. That does not automatically mean that adding needle EMG to the scope is worth the legal, regulatory, financial, and professional risk that could accompany it.
A new procedure may benefit an individual chiropractor while creating vulnerability for the profession as a whole.
That is the part of scope expansion that is often overlooked.
We should also distinguish between clinical usefulness and necessity.
Needle EMG can provide valuable information for appropriately selected patients. It can help evaluate suspected nerve-root or peripheral nerve dysfunction. But a procedure having clinical value does not necessarily mean that the entire chiropractic profession needs to add it to its scope.
Chiropractors already have multiple tools for evaluating patients, including neurological examination and surface EMG. Needle EMG would provide additional information in selected cases, but that additional information does not automatically give a chiropractor additional treatment authority.
If an EMG demonstrates evidence consistent with an L5 radiculopathy, for example, the chiropractor has gained additional diagnostic information. The chiropractor does not suddenly gain authority to prescribe medication, perform surgery, administer injections, or otherwise practice outside the chiropractic scope.
So we should ask a very basic question:
What problem in chiropractic practice are we solving by adding needle EMG to our scope?
Is the answer that chiropractors cannot currently diagnose or manage patients within their existing scope?
Is the answer that patients are being harmed because chiropractors lack this particular diagnostic procedure?
Or is the answer simply that we can do it, and therefore we should be allowed to do it?
Those are very different arguments.
And if the primary justification is simply that needle EMG is another useful tool, we should also ask whether that benefit is substantial enough to justify the additional training, equipment, liability, regulatory requirements, payer complications, and potential legal conflict that come with expanding our scope.
Protect What We Already Have
The Chiropractic Society of Texas believes that the priority should be protecting and
strengthening the scope of practice Texas chiropractors already possess—not continually seeking additional procedures that invite unnecessary legal conflict with other healthcare professions.
A larger scope is not necessarily a stronger scope.
Sometimes the strongest position is knowing when not to expand.
The CST believes Texas chiropractors should carefully consider that principle before supporting another expansion of chiropractic scope.
And we don’t have to speculate about what can happen when scope expansion becomes a legal battle.
We have already been here before.
In our next release, we will look at the history of VONT—and what the profession actually risked, spent, and ultimately gained from that fight.
