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February, 2011

The Chiropractic Future

By Brenda Duran, Senior Associate Editor

When Daniel David Palmer founded the first school of chiropractic in 1897, the goal was to teach others how to help those in need overcome various ailments by addressing subluxation.

Today, chiropractic schools find themselves at a crossroad as changing health care laws, increased patient needs and a challenging job market up the pressure on recent graduates.

If they want to survive, the schools must respond to the new realities of the 21st century, a position that puts them on the cutting edge of where the profession is going.

So what does the future look like for chiropractic practices? Where is the field headed? And what do you need to know to keep in front of the curve?

To find clues, we interviewed the current presidents of the top chiropractic schools in the country.

Common Themes

A number of common themes emerged, including a significant movement away from solo practice by young doctors just starting out in the profession. As part of this general pattern, more students are demanding, and getting, advanced degrees.

And, as several of the educators told us, a major goal now is to expand the focus of the profession so that it has a larger presence in the overall health care system within the next decade.

The Disappearing Solo Practitioner

Attempting to start a solo practice right out of school is far less common today than it once was, the college presidents told us. Instead, many of the thousands of chiropractic students entering the field every year are joining a group practice. Graduates are embracing this trend in a conscious effort to avoid debt, work with a smaller staff, and pick up new skills from experienced DCs.

Fabrizio Mancini, president of Parker College, said many graduates are getting their DC degrees at a younger age than in the past, do not have experience in business or finance and may not be able to stay financially afloat on their own, at least at first.

"We are seeing a lot of our graduates going to work as independent contractors," Mancini said. "We recommend they associate with a place where they can gain from that experience, but not stay too long."

At the National University of Health Sciences (NUHS), as many as 30 percent to 40 percent of chiropractic graduates are entering integrated or collaborative practices, said James Winterstein, the university's president.

The emergence of more DCs who are cost-sharing of X-ray equipment, reception and office staff services, as well as participating in shared marketing is a pattern that Winterstein and other administrators think will have a positive impact on the future of chiropractic practices.

"I see this more and more often and I believe this is vital to the continued viability of the profession," Winterstein said.

Gerry Clum, president of Life Chiropractic College West, agrees, noting that shared office settings are a positive trend since it not only lowers overhead among several practitioners, but also allows each practitioner greater personal and professional flexibility while maintaining a high level of practice coverage.

"In my day, a DC would find an office, equip it and begin practice. This may be a simpler way of doing things but it is a relatively inefficient approach to start-up costs and maximum utilization of physical facilities and human resources," Clum said.

By working in collaborative practices, new DCs also have the opportunity to be part of strong multidisciplinary teams that often include physical therapists, nutritionists and sometimes, medical doctors.

Winterstein notes that in order for graduates to continue to have more opportunities in these new integrative settings they will need to embrace new forms of health care delivery, which includes being on the same page as other health care colleagues from different disciplines.

"Success in these arenas is dependent upon the ability of our graduates to 'speak the language,' understand their colleagues from other professions, and explain what it is they do from an evidence-based perspective," said Winterstein. "They must be excellent diagnosticians, fine historians and outstanding examiners."

Much of that preparation begins before graduates head into these integrated practices, which has started another trend on various campuses - advanced degrees and education.

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