Academy Voices Influence Policy
Recently WAFP and others testified regarding legislation introduced by one of the two chiropractic societies in Wisconsin. This legislation, known as LRB 2981 or as AB 260, would among other things permit chiropractors to perform pre-participation physicals for sports programs in Wisconsin schools. Many medical organizations spoke in opposition to this proposal, including the Wisconsin Athletic Trainers' Association—the individuals who are often the first ones there when something bad happens. In addition, non-medical groups were opposed, such as the Wisconsin Interscholastic Athletic Association—the organization responsible for running a safe athletic program.
WAFP is opposed as well. Below is an excerpt of my testimony in this regard:
I strongly urge you to not support LRB 2981. Here's why: General physical exams like sports participation physicals are important because they are a golden opportunity to detect subtle signs of potentially serious, life-threatening health problems in a child who probably seems, to an untrained observer, to be healthy.
What does it take to be competent to reliably find these subtle signs of potentially serious conditions? Physicians undertake 4 years of medical school and a minimum of 3 years of specialty training to become primary care doctors like family physicians and pediatricians. Along the way, we spend countless hours learning normal and abnormal human physiology, pharmacology, physical exam skills, and approaches to diagnosis and treatment—all supervised by more experienced physicians at every step. In our clinical training years (usually the 2nd two years of medical school plus 3 years of residency) we perform hundreds, if not thousands of repetitions of the heart and lung exam alone—all under supervision. This is what it takes to become a doctor who is ready and qualified to discern even the most subtle abnormalities of a child's heart when doing a physical exam to qualify them to play sports.
Beyond just the physical exam skills, to do a good job in screening a child for sports participation, we must have in-depth knowledge of pharmacology. Increasing numbers of children are on chronic medications, and these may have important implications for how the human body reacts under the stress of exertion. Here again, we spend years learning these things in the classroom, and then have thousands of supervised encounters with patients to finely hone this knowledge.
Just as my medical training does not prepare me to safely and competently perform chiropractic manipulations, a chiropractor's training does not prepare him or her to competently and safely perform a comprehensive physical examination. They are not prepared to detect the sound of wheezing in a child that may represent heretofore undiagnosed asthma; they are not prepared to hear a subtle murmur which may be the only clue that a child is a risk of sudden cardiac death; they are not prepared to make medical judgments about a further testing for a child who may have early signs or symptoms of diabetes.
If chiropractors want to be able to perform these exams competently, they need to have the same training that medical doctors are required to have. Accept anything short of that, and you are choosing to lower our long-held standards of medical training. Given their lack of training and expertise, I can't see any reason to lower these standards other than to allow chiropractors to grow their businesses. Don't risk the health of children just so chiropractors can grow their businesses. Don't fool yourself that you would be doing anything less.
This is an example of the advocacy work that your Academy does. Perhaps my voice, as President of this Academy, has some influence on matters like this. Exactly how much is difficult to judge. What I do know, however, is that hundreds of individual voices of our Academy members on issues like this WILL have influence, and that influence will be exponentially stronger than my one voice as WAFP President. Please reach out to your state legislators on LRB 2981/SB 260 and let them know what you think. Do it today.
Ken Schellhase, MD
The mission of WAFP is to promote excellence in health care and to improve the health of the people of Wisconsin through the advancement of the art and science of Family Medicine, the specialty of Family Medicine and the professional growth of Family Physicians.