The Evolution of the Idaho Chiropractic Profession
ADVANCED PRACTICE
DCs Return to a Former Dual Credentialed Status
Laurence V. Hicks
John F. Kressler
DC, ND, DO
ND, MB, ChB, BAO
In 2015, the National Board of Chiropractic Examiners (NBCE) conducted The Practice Analysis of Chiropractic, estimating that there were 349 practicing chiropractors in Idaho.
For more up-to-date figures, contact the Idaho Board of Chiropractic Physicians.
On September 1, 2019, Montecalvo and I reported about Idaho’s experience with an advanced chiropractic scope of practice in an article in The American Chiropractor) In the paper, we posited that it has been the long-held belief of the authors that a profession must be free to determine the course of its own destiny. Now, we report on what has occurred in the subsequent evolution of that profession, coupled with the interests of other learned professions.
The Idaho Chiropractic Profession Has Continued to Evolve in Scope of Practice
To help the reader appreciate how the current Idaho scope of practice came into law in 2019, it is important to look back well over a half-century. In the state of Idaho, the fledgling profession of naturopathy was being practiced. On April 8, 1959, David W. Smith, ND, practicing in Ada County, Idaho, was one of a few providers who had been summoned to court and charged with practicing medicine without a license.
Naturopathy had its origin in Scotland, promoting a natural diet and exercise with avoidance of tobacco and overwork. The term naturopathy was coined in 1895 by John Scheel and purchased by Benedict Lust, whom naturopaths consider to be the “Father of US Naturopathy.”
Lust defined naturopathy as a broad discipline rather than a particular method and included such techniques as hydrotherapy, herbal medicine, and homeopathy, as well as eliminating overeating, tea, coffee, and alcohol. Lust founded the American School of Naturopathy in New York in 1902.
Early on, chiropractic schools incorporated naturopathic principles into their curricula and awarded ND degrees to graduating doctors of chiropractic during the graduation, resulting in a period of rapid growth for naturopathy. In the 1940s and 1950s, a broadening in the chiropractic scope of practice laws beyond “hands on the spine, manipulation only” led many chiropractic schools to cease issuing ND degrees, although many chiropractors continued to practice naturopathy.2
In Idaho during the 1950s, the legal system recognized naturopathy as a system of physical culture and drugless treatment of disease by methods (including manipulative treatments) to simulate or assist nature, as a system of treating disease.3
In the Smith case, the judge ruled that a:
... calling may not be prohibited unless it is inherently injurious to the public health, safety, or morals, or unless it has a tendency in that direction. Here the respondent... holds himself out as a practitioner of the recognized branch of the healing art designated naturopathy.
If the naturopath is limited in his practice to the use of a system ofphysical culture and drugless treatment by methods supposed to stimulate or assist nature, or to the use of physical forces such as air, light, water, heat, massage, and other similar simple materia medica, the system cannot be inherently injurious or have a tendency in that direction.4
In Idaho, this judge-promulgated Smith decision has subsequently been the legal basis permitting naturopathy practice.
Subsequent to that decision, it was an obvious conclusion that the Idaho naturopathic profession would grow to around 100 active NDs. They were predominantly composed of holders of chiropractic degrees and traditional naturopathic providers. Other parties interested in natural health care soon joined and included some DOs, MDs, dentists, and podiatrists.
Graduates of naturopathic schools accredited by the Council on Naturopathic Medical Education (CNME) desiring to practice in Idaho joined the local ranks. However, CNME graduates were soon interested in a scope of practice broader than what the Smith decision provided and pushed for legislative activity. This led to two separate naturopathic practice laws being enacted.
The group representing the CNME chose to designate themselves by the initials NMD, and they became regulated th ough Idaho statutes under the Allied Health Advisoiy Board to practice naturopathic medicine.5 The eclectic group became regulated under the Idaho Board of Naturopathic Health Care (IBNHC).6
The IBNHC currently registers or licenses a varied aggregation of practitioners, primarily composed of chiropractic physicians and traditional naturopathic providers. Other regulated professionals include the prior licentiates of medicine, osteopathic medicine, dentishy, podiahy, nursing practice, and pharmacy.
Under this regulatory schema, traditional naturopathic providers and pharmacists are currently registered as naturopathic doctors with a more limited scope of practice, while all others become licensed NDs, with a broader scope of practice. The Idaho Legislature adopted the Rules of the IBNHC, IDAPA 24.40.01, and these rules became effective on July 1, 2024.
While registered naturopathic doctors gained regulatory access automatically because of the inherent virtue of the Smith decision, all other previously designated professionals were required to complete a continuing medical education (CME) program consisting of 160 clock hours in an ND curriculum, and chiropractors were additionally required to complete a 45-clock hour CME activity in Principles of Pharmacology.
For MDs and DOs, this CME course did not affect their inherent scopes of practice, but it did provide them with necessary knowledge in pharmacognosy, homeopathic remedies, acupuncture, and traditional Chinese herbal medicine, etc. Interestingly, the dentists and podiatrists completing the ND curriculum become enabled for the first time ever to enjoy an “anatomically unlimited” primary care scope of practice.
Most importantly, the DCs, representing the greater faction of potential N.D. licentiates, are now endowed with the authority under a broadened scope of practice with new licensed naturopathic doctor credentials. This de novo scope of practice, clarified by DOPE counsel, Russ Spencer, JD, before the Board of Pharmacy (BOP) on December 19, 2024, indicated the statutory codifications allow DC-derived licentiates under the IBNHC to “order, obtain, and administer Legend drugs7 and sell proprietary (OTC) medicines.”
Under this new regulatory paradigm, prior scope of practice parameters is derived from consideration of the chiropractic physicians delineated “non-certified” clinical nutrition practice as follows:
700. CLINICAL NUTRITION CERTIFICATION (CNC) AND PRACTICE. 01. Non-Certified Clinical Nutritional Practice. Clinical nutritional methods as referenced in Section 54-704(1), Idaho Code, include, but are not limited to, the clinical use, administration, recommendation, compounding, prescribing, selling, and distributing non-prescription vitamins, minerals, botanical medicine, herbals, homeopathic, phytonutrients, antioxidants, enzymes and glandular extracts, and durable and non-durable medical goods and devices. Nothing herein shall allow any deviation from Section 54-704(3), Idaho Code.8
Additional to the prior advanced scope of practice (CNC) for DCs defined under this section provided a statutory basis to offer an expanded practice provision. Here we read:
708. CLINICAL NUTRITION FORMULARY: Chiropractic physicians certified in clinical nutrition may obtain and independently administer... the prescription drug products listed in this chiropractic clinical nutrition formulary and subject to the provisions hereof. (3-28-23) 01.
Chiropractic Clinical Nutrition Prescription Drug Formulary
Prescription drug products that may be used by chiropractic physicians with clinical nutrition certification are limited to the following: (3-28-23) a. Vitamins: vitamin A, all B vitamins, and vitamin C; (328-23) b. Minerals: ammonium molybdate, calcium, chromium, copper, iodine, magnesium, manganese, potassium, selenium, sodium, and zinc; (3-28-23) c. Fluids: dextrose, lactated ringers, plasmalyte, saline, and sterile water; (3-28-23) d. Epinephrine; and (3-2823) e. Oxygen for use during an emergency or allergic reaction. (3-28-23) 02... obtained only from a source licensed under Chapter 17, Title 54, Idaho Code, that is a wholesale distributor, a manufacturer, a pharmacy, compounding pharmacy, or an outsourcing facility and from no other source.8
Pursuant to clarification of the prior chiropractic CNC statutory language, DOPE legal counsel informed the BOP that all previously licensed DCs currently under licensed ND status may also “order, obtain, and administer Legend drugs,” in addition to prior breadth of practice described under the CNC.7
All candidates must complete the 160 CE credit/clock hour program ND curriculum course covering various topics germane to natural health care practice, and are demarcated into 13 modules as follows:
• Module 1: Naturopathic Physical Medicine (12 hours)
• Module 2: Physical Diagnosis and Clinical Syndromes (14 hours)
• Module 3: Pharmacognosy Part I (12 hours)
• Module 4: Pharmacognosy Part II (12 hours)
• Module 5: Pharmacognosy Part III (12 hours)
• Module 6: Homeopathic Material Medical Part 1(12 hours)
• Module 7: Homeopathic Material Medical Part II (12 hrs)
• Module 8: Homeopathic Material Medical Part III (12 hours)
• Module 9: Acupuncture and Oriental Medicine (14 hours)
• Module 10: Traditional Chinese Medicine (12 hours)
• Module 11: OTC Medications (12 hours)
• Module 12: Laboratory Medicine (12 hours)
• Module 13: Mental Health (12 hours)
Each module is accompanied by an exam and must be passed with a grade of at least 80%. All modules must be passed to complete this program.9
Interested chiropractic physicians and other parties may inquire for further information by emailing the Professional Development Academy at [email protected].
Conclusion
In summation, we stipulated that it was the long-held belief of the authors that a profession must be free to determine the course of its own destiny. Now, we have returned to report that chiropractic physicians in Idaho returned to a former status when it was common for chiropractic school graduates to complete their training with dual degrees in chiropractic and naturopathy. Interestingly, DCs have joined with several other learned professionals to advance themselves with the similar interests of each while reincorporating naturopathic principles into the chiropractic view of health care.
Laurence V. Hicks is the owner of Falls Centre for Functional Medicine in Twin Falls, Idaho. He is a teacher in medicine and an assistant professor of family medicine at the Idaho College of Osteopathic Medicine in Meridian, Idaho; an adjunct assistant clinical professor at Pacific Northwest University of Health Sciences, College of Osteopathic Medicine in Yakima, Washington; and a graduate instructor at the University of Western States. He is degreed as a DC, an ND, and a DO. He is certified in family medicine, occupational medicine, and geriatrics.
John F. Kressler is the CEO of Nordic Health Solutions located in Wapwallopen, Pennsylvania. He is a registered ND in Idaho. He previously completed the rigorous Age Management Medicine educational program sponsored by Cenegenics Medical Institute in New York and went on to finish an eight-year in-resident tenure as a Cenegenics staff physician. He previously undertook schooling to obtain MB, ChB, and BAO credentials by graduating from the NUI Medical School, Dublin, Ireland, and then served a medical internship at County Cork Hospital. He is certified in lifestyle medicine and geriatrics.
References
1. Hicks L, Montecalvo N. Determining the course of chiropractic’s destiny: Idaho’s experience with an advanced scope of practice. The American Chiropractor. 2019 Sept l;41(9):26-30. Available at: https://theamericanchiropractor.com/article/2019/9/l/determining-the-course-of-chiropractics-destiny
2. Wikipedia contributors. Naturopathy. Wikipedia, The Free Encyclopedia. 2024 Oct 19. Available at: https://en.wikipedia.org/wZ index. php?title=Naturopathy&ol di d= 1251951013.
3. Merriam-Webster, (n.d.). Naturopathy. Merriam-Webster.com dictionary. Available at: https://www.merriam-webster.com/dictionary/naturopathy
4. CaseText. State v. Smith, 81 Idaho 103, 337 P.2d 938 (Idaho 1959). Available at: https://casetext.com/case/state-v-smith-4595/ case-details
5. Division of Occupational and Professional Licenses. Allied Health Advisory Board.Idaho.gov. Available at: https://dopl.idaho. gov/nmd/
6. Division of Occupational and Professional Licenses. Board of Naturopathic Health Care. Idaho.gov. Available at: https://dopl.idaho.gov/nhc/
7. Division of Occupational and Professional Licenses. Meeting agendas and minutes. Idaho.gov. Available at: https://dopl.idaho.gov/ nhc/ https://dopl.idaho.gov/bop/bop-meeting-minutes/
8. Office of the Administrative Rules Coordinator. Division of Occupational and Professional Licenses: IDAPA 14 current administrative rules. Idaho Division of Financial Management. Available at: https://adminrules.idaho.gov/rules/current/24/240301.pdf
9. CSI Workforce Development and Training. Naturopathic doctor training. College of Southern Idaho. Available at: https://workforce. csi.edu/industries/health-care/courses/naturopathic.aspx
