NPs working with chiropractors

cfinesse19 · Oct 5, 2015

If you didn't provide the service you shouldn't be signing the notes. If the patient comes back with a problem and decides to sue, the lawyer is going to come after YOU because your name is on the note. The chiropractors I worked with for that short time were soooo shady! They basically just wanted to use us NPs for our prescriptive authority. I lasted 2 wks and still had My RN job to fall back on until I found another NP job. You worked wayyyyyyyyy too hard for this degree to jeopardize it. Run fast!

Joebird21 · Oct 5, 2015

Yay for chiropractic pseudoscience!

I'll stick with being a skeptic......

crazynurselady · Oct 6, 2015

OK so, I spoke with the chiro about his crazy note idea. He tried to act as if I didn't understand. So I told him I didn't and asked him to please explain it to me so I could. He gave me some double talk about ICD-10 and I told him that didn't have anything to do with how he was trying to get me to sign his notes under my name. I told him to please show me something in black and white that is from a legitimate source that states that this is the way for him to do his notes. I told him to go to the CMS site and find something to prove that this is legit or we could just go ahead and call Medicare ourselves and ask. I told him that I am not comfortable with this note plan and that maybe this is not the right place for me to be. He said he understood my asking. Then after a few more words, he started to walk out of my office and on the way out he said somewhat under his breath, "maybe this isn't the place for you." I just ignored it and let him walk out. But what I really wanted to say was "Hey, I'm right here. Why don't you look at me in the face if you have something you want to say." So I started getting my things together thinking that maybe that meant I was fired. I sat there and waited for lunch time because I was done seeing patients but he wasn't quite yet. Once the patients were gone, he came back to my office again. This time he was very pleasant. He told me I was right and that he was doing it wrong. Then he started telling me how much he likes working with me and how the patients like me, etc. I was pretty disgusted to say the least. But I just smiled and pretended that I was listening and that I cared. He is likely scared that I am going to report him. He went and changes all the notes back to his name. Needless to say, I am still looking elsewhere for employment. I can't get out of there fast enough. I even went ahead and took most of the few things that I had there home. This way I can just run out fast when the time comes. I still have to ask them about what levels they are billing under so that I can make sure that it is correct. I'm sure it isn't. On the bright side, I did get a couple of calls from places that I applied to. One is much closer and will hopefully their head guy will call me for an interview. The office manager called me yesterday and I called her back today because I'm not at work on Tuesdays. The other place wanted someone with ER and urgent care experience already, so I'm out of luck. But my fingers are crossed and I still have several other aps out there.

chiro13 · Oct 6, 2015

Interesting discussion, I'll throw in my .02. I'm a chiropractor, but am going back to school to get RN and then ultimately on to FNP.

I read a lot in the chiropractic journals and magazines etc...and there are a lot of coaching programs popping up that teach chiropractors how to "integrate" NP's into their practices. Why? Billing. It's all about the $...nothing more. Chiropractors don't get paid poo from insurance companies...goes down every year. By adding an NP they can bill new services and better codes and get paid more...

Would I ever work with a chiro as an NP? Never! Run! And I am a chiropractor...but I'm sure there are better "settings" for a NP to practice vs a chiropractic office.

As far as the pseudoscience debate above...eh...I've adjusted over 60,000 spines in the past 12 years. Have helped a ton of patients. It definitely has a place in healthcare. For me personally, I'm sick of the "business" side of things. Less then 3% of the country sees a chiropractor. The public opinion of the profession is terrible...and I'm sick of going to bed each night wondering where that next new patient is coming from. It has become 95% sales / marketing...5% doctoring. Not what I went to school for...therefore I'm getting out!

crazynurselady · Oct 6, 2015

Thank you chiro13 for your comments. You being a chiropractor yourself and saying this, says it all. And it's true about the business end. We see new patients there but mostly the same people who are coming for maintenance for their neck and back pain. I hope I find something soon or may just have to quit and be jobless. Haha. I hope not.

lhflanurseNP, APRN · Oct 7, 2015

To follow-up, I recently received records on a new patient from an integrated MD/DC practice. I was quite amazed to see the notes. Even though the DC signed off on his notes, there was a place for the MD to "seal" the charts! From what I can tell, this is blatant fraud...the MD did not oversee the DC, nor was the MD involved in the actual treatment given by the DC. How in the world can he think he will be able to bill and collect? He has a concierge practice, but knowing this particular MD...I would bet that he is still submitting to insurance as well.

cayenne06, MSN, CNM · Oct 7, 2015

As far as the pseudoscience debate above...eh...I've adjusted over 60,000 spines in the past 12 years. Have helped a ton of patients. It definitely has a place in healthcare. For me personally, I'm sick of the "business" side of things. Less then 3% of the country sees a chiropractor. The public opinion of the profession is terrible...and I'm sick of going to bed each night wondering where that next new patient is coming from. It has become 95% sales / marketing...5% doctoring. Not what I went to school for...therefore I'm getting out!

Here's my question though. Do you subscribe to the subluxation theory?

chiro13 · Oct 8, 2015

I don't have time to get into a debate...thanks though...

lhflanurseNP, APRN · Oct 8, 2015

cayenne06...subluxations are the "meat" of the coding for chiropractors. Many of the "straight" schools still cling to the idea that EVERYTHING wrong with a person is related to a "subluxation" in the neck or lower back. Many DCs graduating from more progressive programs identify health problems as well as back issues. Are some tied together...think about your anatomy/physiology. It is known that various nerves generating from certain spinal areas affect certain organs. The key is being open to the fact that while a manipulation may help, it is certainly the "cure all". Medicine and chiropractic/osteopathy need to realize that there needs to be a blend (holistic) approach to helping patients. Chiropractic and osteopathic medicines encourage further in-depth research to chronic disease where as "tradition" modern medicine tends to treat the symptom only. Just my thoughts from experience working with DCs and DOs in functional/integrative medicine.

cayenne06, MSN, CNM · Oct 11, 2015

I don't have time to get into a debate...thanks though...

A good chiropractor can be as vital to the health care team as a PT or physiatrist. The problem is that the chiropractic profession is based on the magical idea of subluxation (not to be confused with actual subluxations) being the root of all health problems, and thusly all ills can be managed by the appropriate vertebral adjustment.

Science based chiropractors who specialize in back care are not easily distinguishable from the overall quackiness of the chiropractic profession. Either chiropractic needs to accept science based medicine and assume a specialty role in back care, or the science based chiropractors who limit their scope to the appropriate application of physical manipulation for musculoskeletal issues need to distance themselves from the profession. You cannot practice science based medicine if your care is based in a pretend "theory."

chiromed0 · Oct 27, 2015

Well, I'm a couple of months from being an NP and I was a practicing chiro for 10 years. The last three years as an RN in ICU. For those that aren't chiro's...pipe down a little. You don't know the education and background a chiro has to have to "just crack backs" so give a little respect. I have found NOTHING in my NP program that is

as demanding except clinicals. NP programs comparitively are weak, especially in basic sciences. There are none. Having said that, clinically chiro's are weak in both their diagnosis, understanding of treatment and evidence based medicine.

They are great at "talk medicine" but have precious little, real world understanding, and most have never seen real pathology face to face. Part of it isn't their fault, they are sold a bill of goods in school that just is not real world.

On the other hand would I ever work for chiro's again. He// NO! As business owners they have proven to be dishonest with patients and insurers time & time again. I understand the pressures on them, believe me! But the "business" of crackin' backs is bovine feces. Medicine isn't perfect either and I've seen that, too. Chiropractic seems to have made a profession out of professing the benefits of spinal manipulation without ever proving it. It's that "selling of the spine" that gets the dirty looks from anyone with any

common sense.

Would I work with them again? Yes. In the right environment nobody is better at spinal manipulation than a D.C.. I work with PT's and D.O.'s and sorry, they just don't compare. Now, that is a narrow focus but I think that's fair. Chiro's are just guilty of not knowing what they don't know and I say that with experience. Nursing is much harder than chiropractic but chiropractic education is much harder than anything in nursing. So, in a nutshell...run don't walk away from working for chiro's--there is not much good to be gained from it. However, if you get the chance work with them and you'll probably enjoy a good peer to peer relationship, if kept in scope.

sauce · Oct 27, 2015

Ive heard chiro school is pretty tough esp on the anatomy parts.