VONT: What Did We Actually Gain?
If Texas chiropractors want to understand the potential consequences of scope expansion, we do not have to look very far.
We have already been here before.
The history of VONT provides an important lesson about what can happen when the profession seeks to expand or clarify its scope of practice.
What began as a dispute over a particular procedure ultimately became a much larger legal battle over the boundaries of chiropractic practice—including whether nerves could be included within the chiropractic neuromusculoskeletal system.
The result was years of legal uncertainty, significant expenditures of time and money, and the very real possibility that existing chiropractic authority could be challenged or lost.
Scope Expansion Does Not Occur in a Vacuum
When chiropractors move into an area that other professions consider part of their established practice, the result can be a legal challenge.
Once that challenge begins, the question may no longer be limited to the new procedure being sought.
The underlying statutory and regulatory foundation supporting chiropractic practice can become part of the dispute.
That is precisely what happened with VONT.
The VONT litigation lasted roughly a decade. During that time, the profession faced the possibility of losing not only the authority surrounding VONT, but broader language involving the inclusion of nerves within the chiropractic neuromusculoskeletal framework.
Ultimately, the Texas Supreme Court upheld important aspects of the Board’s authority, including the inclusion of associated nerves within that framework.
That was an important outcome.
But there is another fact that Texas chiropractors should consider.
According to the evidence presented to the Texas Supreme Court, the TCA represented that only two Texas chiropractors had completed the regulatory process to obtain authorization to perform VONTafter the Board authorized the procedure.
Think about that.
A decade of litigation.
Significant public and professional resources.
The possibility of losing existing scope involving nerves.
And, at the time of the Supreme Court case, only two chiropractors had completed the authorization process for the procedure at the center of the dispute.
The point is not that the VONT fight was meaningless.
The Supreme Court decision ultimately preserved important aspects of chiropractic scope, and that matters.
The point is that the cost and risk of scope expansion can be vastly greater than the apparent benefit of the individual procedure itself.
That is the lesson we should carry forward.
Are We Prepared to Do It Again?
This brings us back to needle EMG.
The question is not whether needle EMG has clinical value. It can.
The question is whether adding another procedure to the chiropractic scope is worth potentially exposing the profession to another prolonged scope-of-practice battle.
It is easy to look at a new procedure and see only the opportunity:
Another tool.
Another service.
Another source of revenue.
Another thing chiropractors are allowed to do.
But the VONT experience reminds us that the consequences can be much broader.
Every scope expansion creates another legal boundary that may eventually have to be defended.
Every new boundary creates another opportunity for a competing profession to challenge us.
And every legal challenge carries the possibility that the fight will involve more than the procedure that started it.
That is what happened with VONT.
The profession did not simply fight over one procedure. The fight ultimately reached the much larger question of whether nerves could be recognized within the chiropractic neuromusculoskeletal system.
We should not forget that lesson.
The Question We Should Be Asking
The question is not:
“What else can chiropractors do?”
The question is:
“What do we need to do to protect the scope we already have?”
Before expanding the scope of practice, we should ask what we are actually gaining—and what we are willing to risk to obtain it.
Texas chiropractic does not need another VONT.
We should learn from our history rather than repeat it.
And perhaps the most important question of all is this:
Is what we are seeking actually worth the risk to the scope we already have?
