Source Dynamic Chiropractic
by Kent Greenawalt
The future is a topic that is top of mind to everyone. When the future comes up in conversations, words that are generally associated with it are technology, improvement and growth.
I strongly believe there is a need for action to be taken to assist in enrollment efforts. Obviously what is being done now needs to be tweaked or even fundamentally changed. To fill this need, I felt it was essential to create a nonprofit organization, the Chiropractic Education Foundation. The foundation was founded in order to develop chiropractic education and support the Association of Chiropractic Colleges (ACC) as it decides what actions need to be taken.
The health professions’ education systems are increasingly competitive and the marketplace is changing. The demographic pool of students is changing as well. The ACC saw these changes taking place and formed an Enrollment Task Force to examine these issues. Dr. Brian McAulay, executive vice president and provost of Life University, is the chairman of the task force, which will focus on bringing forward a plan to address the issue of declining enrollment and implement dramatic actions that need to be taken. This is an exciting project that will yield new and specific information about our student recruitment needs.
The Enrollment Task Force and the ACC wanted expertise in recruitment efforts in order to execute a successful plan. They sent out a request for proposals to a number of marketing firms with experience in this field. The ACC winnowed the responses to three marketing firms that were interviewed by the entire ACC Board, and initiated a contract with the Widmeyer Group.
To allow the initial research and development to occur, Foot Levelers and Standard Process each donated $50,000 to the Chiropractic Education Foundation to support efforts for an enrollment campaign. Funds from the foundation will be used to retain the Widmeyer Group to do the underlying data development and collection.
In order to develop an enrollment marketing plan, chiropractic education needed to assess today’s student population, the extent of chiropractic’s student prospect pool, and have concrete information to advance the marketing plan. Initial plans include interviewing prospective students, current students and alumni to gather facts about their attitudes and perspectives on chiropractic education.
Foot Levelers and Standard Process funded the mechanism that will evaluate the vital information gathered from the research and market testing, so informed decision-making can occur. The data collected is important not only to create a marketing effort, but also to advance chiropractic.
The Chiropractic Education Foundation anticipates that this campaign will expand public and prospective student knowledge and understanding about chiropractic. The various stakeholders in this profession recognize the importance of chiropractic education. It is the lifeblood of a successful profession. Without a strong enrollment and continuous stream of new doctors, this profession will die on the vine.
According to Richard Brassard, DC, current president of the ACC and president of Texas Chiropractic College, “This undertaking was fully supported by the ACC member institutions and they have pledged to help advance this project with their cooperation and support.” And in speaking with me, David O’Bryon, ACC executive director, shared, “The entire chiropractic education community is behind this much-needed campaign.”
I am very encouraged with the assertiveness of many college presidents to recognize the issues and their willingness to do things differently to address the problems. I have already seen significant steps taken – steps that would have been unheard of a few years ago. Now is the time to keep that momentum and build a strong campaign that the entire chiropractic community supports.
“We all need to do a better job of selling a chiropractic career to a community of potential students. We recognize that we need to all be in this together,” said Gary Cuneo, chief operating officer of the Foundation for Chiropractic Progress. “We do believe that a coordinated campaign and the willingness for colleges to work together, and maybe do things outside of the box, will change the enrollment dynamics in chiropractic education. f we discovered anything from our highly successful [FCP] campaign, it’s that this profession can accomplish anything when we work together. We hope to inject this same attitude in chiropractic education.”
One easy way for you to contribute is to actively recruit students. In his 2004 article, “State of the Profession: Chiropractic Colleges in the United States,” Donald Petersen Jr., publisher of Dynamic Chiropractic, makes a profound statement:
“So, why are fewer students enrolling in U.S. chiropractic colleges? I believe it may have to do with our attitude. One of the primary reasons people enter chiropractic college is because they are encouraged to do so by their doctor of chiropractic. They visit their DC and become enthralled with chiropractic because of what it did for them or someone they know. They see chiropractic as an opportunity to care for people. When their doctor sees their interest, they recommend a chiropractic college.”
Think of the day you decided to be a part of chiropractic. What helped you make the decision? Why do you love what you do every day? I challenge you to do your part to make an impact and explain to young people, or people wanting a career change, why becoming a chiropractor is such a rewarding life journey. Chiropractic changes people’s lives; let’s do our part to keep chiropractic college enrollment strong.
I think the reason for “the decline effect in chiropractic” is that so many other practitioners are competing for the same market. TCM/OMD’s, PT’s/DPT’s, AT’s amd Massage Therapists are all going for the same patients and some like PT’s are networked within the powerful orthodox medical community much better which gives them advantage.
Simply put, the market is saturated and schools won’t see greater enrollments until that changes.
The question is how can the market change.
It’s suggested in this article that knowledge about chiropractic will help? Really? I think potential students know the situation about chiropractic and choose more lucrative and/or secure career paths. Treating musculo-skeletal pain conditions and doing wellness care just has too many non-chiropractic players in the market.
Chiropractic probably needs a serious overhaul and some former chiropractic schools seem to be going in that direction.
The other option is recruiting and penetrating more into foreign markets. Countries that don’t have much in the way of anything like chiropractic maybe another source of both school and professional expansion.
The US market will likely be stagnant for still quite a while.
The same issue exists in Canada. We’ve seen our market share decline and have all seen a drop in patient volumes. What puts chiropractors at a disadvantage is that we can’t decide what we want to be, neuromusculo-skeletal specialists or alternative practitioners, and this confuses consumers.
Hi John,
Yes, I’ve heard that is the case. A DC friend of mine that practiced in Edmonton went off to get his Naturopathic Doctor degree in Arizona. I guess that states laws allow a very wide scope of practice for ND’s. He wants the degree for a broader scope and has the ability to practice in that state.
You bring up the neuromusculoskeletal specialist or alternative practitioner issue. I think there maybe a problem with this dichotomy itself and a better conceptual scheme or categorization is needed.
One problem with the neuromusculoskeletal specialist category is that all those other disciplines are targeting that market as well. My guess is that’s why there is so much competition with chiropractors.
The alternative practitioner category has it’s problems, in chiropractic that could mean just “adjusting subluxations” which just doesn’t “cut it” anymore since the competitors I mentioned do similar but maybe call it something else. Also, it’s not clear whether other techniques that do not “adjust the spine” don’t have similar effects.
This is an interesting challenge that everyone can do some brainstorming on. It may require novel approaches or ideas and watching developments across the globe in health care could provide an answer.
Thanks.
The attitude of the Chiropractic Colleges has always driven me nuts. When enrollment is down they will accept ANYONE with a pulse. I was shocked and dismayed when I saw the caliber of some of my classmates. Many had had their admission pre-requisites waived. I can confidently say that there is no way in hell that some of those kids survived post-graduation. Now they have huge loans and lack the skill set necessary to pay them off. Several are still there plugging away at their degree with small hope of success.They started when I did and I graduated years ago. Chiro school for 6 years? Really? Essentially they have been robbed. They never should have gotten in to begin with. The admission dept knew it but the school needs the dough. Tuition driven education has been and will continue to be a disaster for the profession I love until we get our act together and become included in larger university systems.
This problem isn’t unique to chiropractic but is endemic in the American educational and free market system.
All kinds of colleges exaggerate or misuse statistics that show a college degree means a better standard of living. What they don’t tell you is that only applies to certain degrees. The rest waste both time and increase their debt while getting other degrees. They then wind up in a job they probably would have got without the degree or one where there is no big pay difference. There standard of living is worst with a college degree.
Also a huge over-inflation of college tuition is happening nation wide. This is probably a bubble that’s going to burst. Here is a article on the sad situation, “Why Tuition Always Goes Up at American Universities” by Bob Samuels:
http://www.huffingtonpost.com/bob-samuels/why-tuition-always-goes-u_b_462906.html
With regards to chiropractic, it maybe student qualifications but I think a lot of it has to do with competition and saturated markets.
Mark, the market got saturated by pumping out too many (poor quality) students. Every time graduation rolls around on a Chiropractic College campus, our piece of the pie gets a little bit smaller. Every time they accept a unqualified student, our profession runs the risk of them doing something ridiculous in practice that reflects poorly on all of us. My concern is that at some point the supply of chiropractors exceeds the demand for chiropractic. The state of affairs in California is a perfect example.
Maine Chiropractor, do you have data to support that view?
I got a look at an analysis that William Meeker, D.C., MPH did from BLS data for California and the percent Chiropractors per population didn’t account for the decline effect. Bill was of the view that it was more competitors at the practice level and he mentioned that competitor activity at the political scope level reflects this move into markets which chiropractors typically address.
One problem I see with your notion of unqualified students flooding the market then leaving the market is that there should be a different curve to the income data. Maybe I’m wrong and maybe there are some studies that show something different.
The attrition rate of licensed chiropractors in California: an exploratory ecological investigation of time-trend data
Stephen M Foreman, Michael J Stahl Chiropractic & Osteopathy 2010, 18:24 (12 August 2010)
http://chiromt.com/content/18/1/24
The population of California increased 65% from 1970-1998. The number of chiropractors increased 170% during that same period.
Thank you Maine Chiropractor.
This looks like an interesting study and it’s different from what I saw because the time frames are not the same. I can’t disclose specifics since the study I saw was private and for institutional use only but the time frame was up to 2009/2010 and over at least the last 10 years.
In any case, it still comes down to saturation from competition.
I agree with many of the conclusions in the discussion section but need to read this study more closely to see how the “quality of students” determines attrition.
Was it education alone or entrepreneurial and small business skills besides competition that effected attrition?
In any case, it looks like we are finally getting some more accurate data about the real “failure rates” in chiropractic.
It’s a discussion that our profession needs to have. We’ve been avoiding it for far too long. I can give you an anecdote from my personal experience where I went to chiropractic school. A particular faculty member was relating her experiences to me regarding doing admission interviews for the college. She was called into the vice presidents office and reprimanded for how many she deemed unacceptable for admission. The end result, she has never been allowed to do another interview and all of the students that she said should not get in, did in fact get accepted.
this profession is dying. every chiro knows it but no one wants to admit it. either we go the way of the DO or face extinction. it’s time we all faced reality. i for one left chiroville after 2 long miserable years of practice to become a PA……..and never looked back.
DC2PA
I respectfully disagree
I don’t know what percentage of students fail in practice after successfully jumping thru all the hoops, but we all know it happens. I knew I wasn’t going to work as someone’s apprentice, so I had to face the hard times of low income while I grew my practice.
And all I can say with certainty is…it was worth the effort. Anyone who is a new grad who is thinking about new cars, or a new house BEFORE working at least 3-5 years is kidding themselves. Delusional. If you aren’t willing to crawl before you walk, then you’re not properly motivated to be a DC. For me, it’s a calling as much as a profession. It’s NOT a job.
why? why does it have to be like that? why after all the studying we did, all the suffering we did, all the spinal screenings we did, all the volunteer work we did, all the money we put into our education, all the years we dedicated to this profession, all the slave labor we do as associates, all the sacrifice we do, do we have to crawl first to become a successful DC? who says we have to do this? BJ Palmer? management gurus? you?……why can’t new DC’s be rewarded with a stable job to provide for their families or even themselves after graduation? no other health profession does this to their new grads!!!
Frank Responds:
DC2PA,
I hate to say this, but you suffer from magical thinking. Having a Degree does NOT entitle someone to an income… working and providing high quality services over time does.
Name any job where someone starts at the top (or near the top) when all they have to offer is book-learning and *some* clinical interactions at school?
Frank
I agree with Frank. Think about MD’s…they go through more years of school, then years of residency with ridiculous hours for practically no money, then possibly a fellowship before they are even on their feet…then comes the pay off. If you don’t have a passion for learning and helping people then of course its not worth all the time and effort. If that is the case then get a job in business. I don’t know how anyone can expect to graduate as an MD, DC, Dentist or any doctor and be making the big bucks right after. Everyone knows its tough and takes years to build a practice…as it is in ANY profession when starting your own business.
Interesting… I am unfamiliar with how comments work on this site, but I find it strange that some unknown person is ‘commenting’ on DC2PA’s remarks within his own post. Is it Dr. Painter that is responding? I cannot tell.
I agree- no degree guarantees anything, but it would be nice if students were not routinely lied to about their prospects upon graduation (similar to how for-profit law schools seem to be working). MD’s get poorly paid residencies where they learn the real tools of their trade, while we get poorly paid associateships where we learn how to market (usually through fear) and not how to care for people. It is the rare position that leaves a young Chiropractor a better doctor than when he started there.
Yes, I was directed here from the Chirotalk thread you obliquely reference. Feel free to use phantom responses to my post which include petty Ad Hominem attacks.
In Canada MD’s practices are full within a few months of hanging out their shingle and they stop accepting new patients. This is a virtual certainty. Chiropractic is much more like opening a new business where the early years are difficult to get through.
DrBacon,
Yes, I do add comments, occasionally nested at the end of a posted comment, to maintain continuity. In the future I’ll add a sig to make it more clear.
I saw your posting on the chiro-talk site because WordPress automatically tracks all incoming traffic. We do not “edit” people’s comments. They sink or swim of their own accord.
I don’t know where you went to school. Are you saying that all the staff who taught you fed you inaccurate information? What exactly did they tell you?
I respectfully disagree that MDs learn “all the tools of their trade” during residency, because if that were true, Freedman would never have published The Adequacy of Medical School Education in Musculoskeletal Medicine or any of the other follow-up articles.
I also worked in a hospital lab for 6 months, and was frequently surprised by how often an MD or DO would call down to ask a low-paid Tech what a positive test meant? My immediate question to the Tech (since I was so naieve) was…”if the doctor didn’t already know what the test was for and what it meant, why did they order it in the first place?” Our diagnostic lab class used Fischbach’s A Manual of Laboratory and Diagnostic Tests, and a copy of that text should be sitting in every doctor’s office, and at every hospital nursing station.
Finally, DrBacon, I’m curious why a doctor would choose an e-mail handle like Dead Suburbanite? That name doesn’t inspire much confidence. Is my straightforward question what you meant by “petty Ad Hominem attacks”?
Dr. Painter: Thanks for clearing that up- I was confused as to who was adding comments to others posts. Good to see that no editing is occurring as well.
I believe most schools lie to their students, usually through false data like average salaries or inflated usage statistics. Still, buyer beware. And I am sure you could start a whole new thread dedicated to shoddy associateships and it would be overflowing.
Thanks for the links- while I dislike attacking other practitioners to make ourselves look better, these are at least related to what we do. Still, pointing out the ‘weakness of modern medical education’ does not change chiropractic education (for better or worse), nor does it change how many chiro’s practice, using questionable diagnostic and treatment techniques, and (typically) poor patient management.
But how does this help? It seems like you are arguing that chiro’s should be the front line provider for back pain, but then you run smack into the philisophical divide that has haunted us for so long, and that debate never goes anywhere.
I have known many excellent, evidence based chiro’s that have worked very hard to do what’s right and best for their patients, and they have taught me a lot. Most of these, however, have been around for some time. New doc’s are fighting an uphill battle and are not gaining traction.
As for my fake name and dubious email, I am obviously trying to maintain anonymity and do not use these in daily work life.`
DrBacon
It sounds like you have spent some time considering issues in (some?) chiropractic school curricula. When I hear a statement like “most schools lie to their students“, I can’t help but wonder where you gathered that data. We know (fer sure, fer sure) we’d hear very different stories from a failed student and a successful doctor who graduated in the same class.
You are welcome to write on that topic for our Blog, as long as you can document those claims (to the extent you can). Hopefully there are other sources of information besides the self-referential op-ed editorials of Dr. Botnik. Compelling though they may be, opinion is distinct from fact.
Why do you consider my editorial “End Medical Mis-Management of Musculoskeletal Complaints” an attack on medicine? I believe it’s a straight forward report of materials easily found in the biomedical literature. Don’t you realize how their lack of knowledge contributes to unnecessary surgeries and ineffective treatment? And don’t you realize how that contributes to the spiraling costs in health care?
If MDs hadn’t been snowed under by their national association for decades, they would have been much more likely to refer unresolved patients to a DC, and everyone would benefit. As it is, I see a lot of angry patients…ones who wonder why their MD wasted their time and money with useless nostrums, when I should have been at their “beck and call”. A doctor who refers to help his patient is a hero, whereas one who hangs on, and then fails them look like a loser to the patient. Who’s fault is that?
You mention “questionable diagnostic and treatment technique(s)”. Tell us more.
I can’t speak for every school, but my alma mater prepared me well to diagnose to the extent necessary to protect my patients. Having worked in a pathology lab, I assure you that most of the conclusive diagnosis in hospitals is done by the pathology department, not by the average doctor working the floor. So what? That’s why hospitals have lab departments.
If medical student spent more time reviewing and integrating the meaning of textbooks like Fischbach’s A Manual of Laboratory and Diagnostic Tests, they’d be ordering a lot less unnecessary tests to do their thinking for them.
And yes, I am arguing (exactly!) that DCs should be the gatekeeper for all NMS conditions (and not just back pain, as you suggest). That’s essentially what both Manga Reports concluded, with serious evidence to back them up.
We can always resort to interdisciplinary management when required, but the literature clearly suggests that exclusive chiropractic management saves money and provides significant benefit.
If all this information was freely available to the public, new students wouldn’t struggle, and schools could tighten up their entrance requirements. As it is, they are 100% dependent on tuition and alumni for support, unlike subsidized medical schools.
John
You said: “What puts chiropractors at a disadvantage is that we can’t decide what we want to be, neuromusculo-skeletal specialists or alternative practitioners, and this confuses consumers.”
I wonder how much the public is even aware of our internal dialog, versus their massive exposure to decades of mis-information generated by Organized Medicine, and constantly reinforced by pseudo-evidence-based anti-quack websites?
I appreciate the intelligent discussion. I feel that if the chiropractors posting here could agree upon some issues, they would be better at leading our profession than our current leaders.
Missouri
Aye, there’s the rub. The ideal of Democracy is all about finding common ground for agreement, but in practice humans are still pretty weak in that regard. It’s not just a problem for our profession…look at Congress…look at our political parties…look at the world.
We need to learn to “love the bumps” in the road (as my friend Margaret says), because that’s the path we are on, and the journey is every bit as important as the destination.
Every legitimate medical journal including the journals of the AMA, the AOMA, the American Podiatric Associatopn, the American Optometric Association, and even the American Psychological Association regularly print articles critical of their respective professions including criticisms of the historical foundations and prevailing procedures of their professions.
Only chiropractic associations, and schools, continue to maintain a party line dogma and refuse to permit open debate.
If you are considering chiropractic as a career this should be a HUGE red flag.
Chiropractic science is no more scientific than Christian Science. It is in fact a cult that cannot stand up to free inquiry.
Read more: http://chirotalk.proboards.com/index.cgi?action=recent#ixzz1WF3jI9aY
Upwinger ,
I am curious why you copy, word-for-word, the writings of Allen Botnick DC from the chirotalk list, and then pass them off as your own idea(s)? Isn’t that plagiarism? Or are you the designated representative of the “great skeptic”?
If you keep up with chiropractic journals, you’ll see my profession maintains an ongoing dialog and debate about our theories and practices.
My impression, following 2 days of trying to communicate with Dr. B and the other merry members of his crew on the chirotalk list, is that there is no actual dialogue apparent on your list…it’s all lock-step agreement with the “great skeptic”, mixed in with a serious dollop of ugly inuendo, character assassination, name calling, mud-slinging and puerile behavior, reminiscent of a poorly managed inner city school yard.
I do however agree, that all chiropractic students, and those who are considering entering this profession, need to closely review websites, like the ones the “great skeptic” maintains. They will pick up several important insights:
Chiropractic has stood for 116 years, and has survived and bested viscous attacks from well-funded national professional associations. We are hearty, we are tough, and we deliver on our promise to help sick people get well without the dangers of drugs and surgery. And better than that… we don’t need your permission or approval to continue to do so!
Your feeble attempt to label my profession as a cult is most amusing, considering that it comes from the keyboard of someone who slavishly copied and pasted the words of the “great skeptic”, and then tried to pass them off as his own words. I thought THAT was the behavior of a cult. Please, correct me, if I am wrong.
This is not an ad hominum attack my friend, it’s just the plain and simple truth.
A beautifully articulated posting Frank. For some, diligently worked for evidence is never enough. For others it is a waste of time. Extremists on either side need to be shown the door. Lets get to this before the hum becomes too deafening.