The Diagnostic Domino Effect

There are few out there who truly understand the sacrifices of the chiropractic student. Many days we wake up before the sun rises and go to bed long after it sets. We have missed weddings of close friends, birthdays of dear relatives and more often than not relationships go neglected. Coffee is more of a religion to us than a beverage. The one thing our education requires is that we sacrifice everything for our education. Why do we fight so hard for two little letters behind our name? Diagnosis.

In 2014, JAMA published a study showing that 75% of heroin user’s first opioid use was from a prescription.1 With over 80% of the world’s prescription opioids coming from the United States, there is no question why our country has declared a War on Drugs. Wherever you practice, our chiropractic philosophy is universal: Diagnosing the root of disease is treatment, while just masking the symptoms is fraud. Losing our diagnostic right will not be a “set-back” for the profession, but rather the loss of our identity as healthcare providers.

Diagnosis is the foundation on which our patient care is built. This is the reason we students work our fingers to the bone, not just here in Texas, but across the country. In the state of Texas our right to diagnose is being threatened. In 2013, the Texas Medical Association (TMA) amended a lawsuit pertaining to our scope of practice. The TMA claimed vestibular ocular nystagmus testing (VONT) was being used to make diagnoses outside of the musculoskeletal system. On September 22, 2016 County District Judge Rhonda Hurley made the vague ruling that all diagnosis rights exceed the chiropractic scope of practice. Consequently, Texas chiropractors will no longer be point of entry into the healthcare system and lose the ability to bill insurances requiring a diagnosis code.

If this pattern continues, Texas will be the only state that will not have the right to diagnose their patients. After the fall of Texas, which state will be next in line for this Diagnostic Domino Effect? Many students, like myself, are at risk of having our hands bound by red tape instead of on those patients who are suffering.

After years of struggling, there are doctors and students across the nation who choose to ignore this burden or are ignorant of our future. As a profession we must stay informed, get involved and donate an investment towards our future. The death our profession will not be an ominous medical board working in dark alleyways, but rather the apathy found in our own shadows. Let this threat be a call to arms and not a crippling blow to the identity of chiropractic.

Currently, the Texas Board of Chiropractic Examiners (TBCE) has voted to appeal the decision made by Judge Hurley, but we still have a long road ahead. The appeals process is not cheap and the Texas Chiropractic Association is working round the clock to secure finances for the upcoming lawsuit. Even if your practice is not located in Texas, please stay informed or donate at to prevent the first domino from falling. Together we are chiropractors. Together we are diagnosticians. Together we are strong.

  1. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.

More information can be found here.

Adam Stewart is a chiropractic student member of the Texas Chiropractic Association and of the American Chiropractic Association.