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WAPA Position on AB260 and Pre-Participation Examinations (PPE)

Wednesday, July 26, 2017   (0 Comments)
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Leading health experts have grave concerns over Assembly Bill 260, mandating Wisconsin’s schools, technical colleges and UW system 2-year colleges to accept physical exams completed by chiropractors. The coalition opposing the measure includes 18 key physician organizations, other health care providers, health systems, hospitals, academic centers and other parties with a vested interest in the health and well-being of Wisconsin’s student athletes.


There are several key issues with the PPE portion of the bill:


  1. While annual physical examinations are recommended for children ages birth - 21, the rate drops dramatically as children progress through school. Therefore, securing the pre-participation evaluation is frequently the child’s only encounter with a physician or other qualified medical practitioner. Ideally this examination would take place in the medical home - the clinic where the patient receives their routine medical care by a provider who is qualified in providing all aspects of routine medical care, including the PPE.

  2. During that visit, clearance to play is just one part of the appointment. A PPE is a comprehensive medical examination.

  3. Conducting a full annual exam with the athlete’s primary care provider ensures a comprehensive evaluation for, among other things:

    1. Cardiovascular conditions
    2. Appropriate immunizations
    3. Growth and development
    4. Mental and behavioral health
    5. Laboratory tests
    6. Hearing and vision screening
    7. Anticipatory guidance related to adolescent risk-taking behaviors
    8. Health education

  4. Capturing the details of this annual visit, when conducted in the primary care provider’s office, ensures full recording of the encounter in the patient’s detailed electronic medical record. In addition, it allows the provider to have access to the patient’s medical record, leaving less room for error, less risk for missed or omitted medical information, compared to examinations performed outside the primary care office.

  5. A 2016 American Medical Association issue brief reports that while physicians complete 10,000+ clinical patient care hours (plus additional classroom and laboratory experience), chiropractors are required to only complete 4,200 hours of combined classroom, laboratory and clinical experience.

  6. Chiropractors do not have the training necessary to provide the comprehensive examination provided in the primary care provider’s office. Such evaluations clearly fall outside the established definition of chiropractic practice as described in the Chiropractic Administrative Code (see CHIR 4.03, attached).

  7. One of the key purposes of the screening exam is to screen for conditions that may be life threatening or disabling. Cardiac conditions which can lead to sudden death are rare and often difficult to detect. A comprehensive cardiovascular history and examination performed by a practitioner with thorough training in these conditions is best qualified to perform the PPE.


As physicians, other healthcare providers and other interested parties with a vested interest in the health and well being of children, adolescents and young adults in Wisconsin, we urge the State Assembly to remove sections of AB-260 that allow chiropractors to perform PPEs or other comprehensive assessments of a patient’s overall health.





Alliance of Health Insurers 

Children’s Hospital of Wisconsin 

Medical College of Wisconsin 

UW Health 

WI Academy of Family Physicians 

WI Athletic Trainers Association 

WI Council of Child and Adolescent Psychiatry 

WI Medical Society 

WI Primary Health Care Association 

American Medical Society for Sports Medicine

Marshfield Clinic Health System

Sixteenth Street Community Health Centers

UW Health - American Family Children’s Hospital

WI Academy of Physician Assistants

WI Chapter of the American Academy of Pediatrics

WI Interscholastic Athletic Association

WI Neurological Society

WI Psychiatric Association



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Davis, Lindsay. Column : Why Wisconsin Should Not Allow Chiropractors to Perform Sports Physicals . USA Today , June 29,


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