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Virginia Board Of Veterinary Medicine

The ACA conducted a veterinary chiropractic survey toward the end of 2000 to estimate the profession's interest in veterinary chiropractic, gather information on available chiropractic veterinary education, and get a sense of related state legislation and statutes. Surveys were sent to 183 ACA delegates, alternate delegates, state associations, and chiropractic colleges. The overall response rate was 40.98 percent.

Interest in Veterinary Chiropractic

On a scale from one to ten, the median rating for interest in veterinary chiropractic in the chiropractic community, as a new chiropractic marketplace, and as curriculum addition or postgraduate course was low average (4.5; 4.5 and 4.6 correspondingly). (Table 1) (In the state of Montana, however, high interest in veterinary chiropractic has led to proposed legislation that would require DCs to be certified animal adjusters.)

Sixty-five percent of respondents said interest has grown over the past two to three years, based on an increase in the number of veterinary chiropractic programs advertised, and because several doctors were asked to adjust patients' animals. Twenty-five percent of respondents, however, said interest was flat.

Veterinary Chiropractic and State Board Laws

Sixty percent of respondents reported that DCs are not permitted to practice on animals. (Table 2) In addition,

* Six said that by state law, chiropractic must treat human disorders.

* While some chiropractors in some states work alongside veterinarians, the state boards do not like it.

* One commented that doctors of veterinary medicine (DVMs) in his state have effectively blocked DCs from treating animals.

* Some commented that they have treated many animals themselves, or that they know DCs who do.

Twenty-three percent of respondents reported that DCs can practice veterinary chiropractic in their states. However, six doctors stated that DCs must have a referral, approval, or prescription from a DVM. In Alaska, DCs can practice veterinary chiropractic, but cannot legally charge for it. In West Virginia, chiropractic may be performed on animals, but services cannot be called "veterinary."

When asked whether DCs in their state are permitted to treat non-human animals by statute, 56 percent answered no, 16 percent yes, and 28 percent could not answer the question. (Table 2)

* Several respondents emphasized that it is not permit- ted because DC practice acts refer to treating human conditions only.

In Hawaii, DCs treating animals are considered to be practicing veterinary medicine without a license.

In California, however, the state board's interpretation of the law allows chiropractors to treat non-human animals.

* In Oregon, chiropractors are allowed to administer animal services with authorization of a licensed veterinarian.

In addition, 31 percent of the respondents reported that in their states, DCs couldn't treat animals even under direct supervision of a DVM. (Table 2) One doctor commented that it can be done only on a private basis, where all liability is assumed by the pet owner, the DC, and the DVM. Thirty-two percent stated that DCs could perform services to animals under supervision of the DVM in their states.

* One doctor emphasized the direct supervision, as the DVM assumes responsibility and liability.

* Three respondents indicated that the supervision is "indirect"-- upon referral or prescription, and, in one state, the DVM must be available by phone. Thirty-seven percent didn't know whether chiropractic treatment of animals under supervision of a DVM was permitted in their states.

Is It Time for a Change?

Is there enough interest in the chiropractic community at this time to pursue a change in the scope of practice act to allow DCs to treat animals? Table 3 shows that 57 percent say no; 23 percent would like to see a change; and 20 percent want more discussion.

* Five doctors said their state associations are trying to determine interest in this subject.

* Two doctors commented that those who treat animals are very interested in the change of practice act scope, but they are not the majority.

* One respondent said a change in the scope of practice would be impossible without national sanction by veterinary associations.

Twenty percent of respondents were undecided about whether ACA should seek greater participation for DCs in non-human animal treatment, 33 percent feel the ACA should pursue this opportunity, and 47 percent said no. (Table 4)

* Five doctors said a larger national survey should be done.

* Three felt ACA should devote its efforts to strengthening the profession's position in the human health care marketplace.

* One person felt ACA should prevent American Veterinary Medicine Association (AVMA) from closing the future option of veterinary chiropractic to DCs.

* One doctor noted that interest would follow if instruc- tion were available, reimbursement probable, and private practice allowed.

Respondents at state associations and chiropractic colleges were fairly equally divided between "yes," "no," and "don't know" on the issue of their willingness to sponsor or conduct postgraduate courses in veterinary chiropractic. (Table 5). Some conditions mentioned included changing the scope of practice, making sure courses were held at reputable locations, sponsorship by ACA, and providing an evidence-based, national, scientifically supportable curriculum. The main reason for absence of interest, brought up by four respondents, was that state statutes prevent it.

Do We Need to Protect Our Turf?

As Table 6 shows, 60 percent of respondents reported resentment toward entry of the AVMA into the field of manual manipulation and use of the term "chiropractic" in animal treatment. The majority, 71 percent, believe the profession should take measures to prevent the use of the term "chiropractic" for manual manipulation on non-human animals.

Table 6 also shows that 47 percent of respondents felt that their attitude toward the use of the term "chiropractic," as applied to treatment of non-human animals, would be different if DCs were permitted by statute to practice on animals.

Is Cooperation Possible?

Assuming accommodation can be achieved, the majority, 93 percent of respondents, felt that DCs could/would work cooperatively or co-treat with DVMs. (Table 7) Only four percent felt that cooperation with DVMs is impossible for chiropractors: "DCs would feel restricted and inferior to another health care provider, while DVMs would be in a role of a gatekeeper."

If co-treatment or cooperation could not be achieved, 61 percent of respondents still felt that DCs could/would work "under the direct supervision" of a DVM.

(Table 7) Twenty-eight percent were strongly opposed to the idea of treating animals under direct supervision of a DVM.

Research and Education

Sixty-three percent of respondents felt that limited funds should be used for research of veterinary chiropractic effectiveness. (Table 8)

* Three doctors said this will also prove the value of chi- ropractic in treating human conditions, as it will remove human subjectivity (the placebo effect).

* One doctor believed that this would help some states to open opportunities for DCs in treating animals.

Thirty-two percent opposed the idea of veterinary chiropractic research.

* Ten doctors said it's "not because it is not worthy of investigation, but since research dollars are so scarce, they should be directed to human outcome studies."

* One commented that research should be possible only after the place of DCs in the treatment of animals has been assured.

The survey showed that doctors of chiropractic are only vaguely aware of veterinary chiropractic programs and courses. Only 48 percent of respondents knew that such courses exist. Forty-three percent knew of none at all. * Twenty doctors have received materials or seen adver- tisements of some programs, but couldn't recall details.

* One doctor felt that since such courses are not sponsored by a chiropractic college, the value of the education is suspect.

* Five people mentioned the 150-hour "Options for Animals" certification course by AVCA. One DC took the "Options for Animals" course and commented that it is the best one available.

* Four people named the Veterinary Orthopedic Manipulation (VOM) course with William Inman, BS, DVM, CVCP, as the instructor.

* Also mentioned were courses by Carl DeStefano, DC, and Garry L. Dulgar, DC. The latter works with many DVMs on animal treatment in many states.

One state association discouraged members from taking courses because chiropractic animal treatment is in violation of state law and the association felt "attending the courses would only give impetus to illegal practices."

As Table 9 shows, 57 percent of respondents felt that a 100- to 120-hour postgraduate course for doctors of chiropractic (as recommended by the ACVA) would not be sufficient to develop competence in treating animals.

* Five respondents suggested a requirement of 200- to 400-hour postgraduate programs.

* Five respondents added that human and animal diseases and physiology are significantly different. Considerably more training would be required.

* Six respondents thought that 100 to 120 hours would help achieve basic animal treatment safety, but not competence. * Three respondents emphasized that the level of com- petence sought by DCs should be comparable to that of DVMs because consumers would need absolute confidence in the DCs' expertise.

* One doctor suggested a diplomate program for those who choose to "specialize" in this area.

* Two respondents felt that if chiropractors want to treat animals, they should get a degree in veterinary medicine.

A smaller group, 25 percent, felt that 100 to 120 hours of training should be enough to perform chiropractic treatment on non-human animals. Two doctors felt the treatment would be very limited. Two respondents added that they had experience with treating animals. One used applied kinesiology surrogate, and the other used the Activator.

Four respondents pointed out important aspects involved in animal adjusting that would determine the length of the course:

* To learn the anatomical variants of facet angles

* To determine sufficient hands-on time plus a distinction between small and large animals

* To develop knowledge of when to refer to a DVM

* To provide education on the liabilities and business aspects of animal treatment.

The Future of Animal Chiropractic

Seventy-one percent of respondents felt that chiropractic care of non-human animals should be pursued as a new marketplace for future chiropractic practitioners:

* Five doctors mentioned that consumers are asking for it. In states where statutes allow it, there are DCs who practice chiropractic almost exclusively on non-humans.

* Two respondents think that veterinary chiropractic can serve to further demonstrate the effectiveness of chi- ropractic.

* Seven respondents felt it important to set responsible standards and work in close cooperation with the veterinary profession.

* Three respondents felt that even though animal chiro- practic does represent a new marketplace for the profession, other priorities would need to be achieved first -- i.e., managed care reimbursement.

Nineteen percent did not feel that animal chiropractic should be perceived as a new marketplace for the profession. The major concern was that treating animals would produce a negative impression on the chiropractic profession for "abdicating our responsibilities to expand our knowledge and treatment of human problems" (one respondent). Another doctor asked, "Do we really want to be a one-stop profession? Bring your cat, dog, cow, horse; we treat it all. Decide what you want to treat and treat it. It seems a bit hypocritical that we need all the hours of human physiology, anatomy, chemistry, but only 100 to 120 hours to start treating a variety of anatomical structures."

Finally

The last survey question welcomed comments or suggestions to help ACA determine if the interest of the profession in veterinary chiropractic is sufficient to pursue the association's involvement. These draw a composite image:

* Chiropractic treatment of animals is a rapidly growing field, very popular in rural areas (e.g., Montana, Hawaii, Utah, North Dakota). A lot of animal species are treated -- domesticated animals (cats, dogs), farm animals (cows, horses), and wild animals (bears). Several respondents treat animals and/or know of DCs who work primarily on animals. According to them, animals have responded well to chiropractic treatment. * At present, the majority of DCs know little about this topic. Twelve respondents strongly felt that only a nationwide survey of DCs -- rural practitioners in particular -- state licensing boards, and chiropractic college students could estimate the interest of the profession.

Several doctors suggested that the ACA should start by checking state practice acts and targeting states where animal adjusting is allowed. By achieving success in those states, they believe the interest of the profession on the whole would be generated.

* Three doctors emphasized the necessity of cooperation with the veterinary profession because DCs lack DVMs' expertise in the area of non-human anatomy and physiology. Besides, as one respondent pointed out, "orthopedic manipulation of the spine and extremities of non-human patients is an area of therapeutics which has very little research to support its efficacy."

* Meanwhile, said four doctors, chiropractors must remain focused on the responsibilities of treating humans, pointing out that DCs haven't "yet effectively marketed our services to humans -- more than 25 percent of the human population have not utilized chiropractic services."

* Six respondents felt that ACAs resources should be directed, instead, toward equitable reimbursement for chiropractic care and standardization of diplomate programs: "When the public learns that the chiropractic profession claims 'expertise' based on a 100-hour course and compares us to the medical profession that not only has much higher standards but also re-certification requirements we lose credibility and market share."

* Three respondents commented that while it's too early for ACA to delve into veterinary chiropractic, this should be revisited in five to ten years. Several doctors expressed the need to keep control over the terms "manipulation" and "chiropractic," and keep abreast of the changes in the field. One respondent mentioned that more and more laypeople are performing manipulation of animals, e.g., at rodeos. One doctor strongly felt that the use of the Activator on large animals should be discouraged.

What interest there is in this topic is strong. The Montana State Association is actively involved in working with the state legislature to allow chiropractors to treat animals. ACA delegates from several states inquired about survey results because they wanted to discuss them at their state associations' board meetings. A representative from a chiropractic college claimed that the college "would support a scientifically oriented, evidence-based program in veterinary chiropractic." Several doctors, including the first DC credentialed by the U.S. Equestrian Team at the Olympic Games and one of the few DCs certified by AVCA, offered their help in gathering information. Several people referred us to doctors specializing in the area of veterinary chiropractic.

The ACA is very thankful to Dr. Edward L. Maurer for his invaluable expertise and help in conducting the survey and to all those who took time to fill out the survey and share their knowledge and views with is.

Copyright American Chiropractic Association Apr 2001
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