Scope of Practice and Responsibilities of the Chiropractic Physician
Domain 2: Scope of Practice and Responsibilities of the Chiropractic Physician
This domain tests what a North Carolina chiropractic physician may lawfully do, when to refer, and how to supervise staff. The scope is defined by statute and Board rules, not by office custom.
Core rules
- Chiropractic practice centers on analysis of the neuromusculoskeletal system and correction of vertebral subluxations and articular dysfunction by adjustment or manipulation.
- Chiropractic physicians may perform physical examinations, order and interpret diagnostic imaging and laboratory tests when indicated, and use adjunctive physiotherapy modalities permitted by Board rule.
- They do not prescribe legend drugs or perform surgery; conditions requiring those services must be referred.
- Referral is required when findings exceed the licensee’s scope, competence, or available diagnostic tools, and when red flags suggest serious pathology.
- Chiropractic assistants may perform delegated tasks only under the supervision and training allowed by Board rules; the licensee remains responsible.
Worked example
A 58-year-old presents with new low back pain plus saddle anesthesia and urinary retention. The correct response is urgent referral for emergency evaluation, not a trial of manipulation. Reasoning: these are red flags for cauda equina syndrome; adjustment could delay diagnosis. Document the findings, the referral, and the advice given.
Traps that cost marks
- Equating chiropractic physician with a medical physician who can prescribe.
- Adjusting first and referring only if the patient fails to improve despite red flags.
- Letting an assistant perform manipulation or make clinical decisions.
- Failing to document informed consent and the rationale for care.