There are many reasons to choose a chiropractic career.
What is Chiropractic?
The health profession of chiropractic focuses on musculoskeletal disorders, the nervous system, and how overall health is impacted. Very often, chiropractors treat neck pain, back pain, joint pain, and headaches. Practitioners are called chiropractors, chiropractic physicians, or Doctors of Chiropractic (DCs). Unlike traditional medicine, DCs use a hands-on and drug-free approach to healthcare. They can examine, diagnose, and treat patients, as well as recommend rehabilitative and therapeutic exercises, and provide counseling on diet, nutrition, and lifestyle. Chiropractors most often use a procedure called spinal manipulation or adjustment. This technique is meant to resolve hypomobile (restricted) joints by restoring their mobility. Joints may become hypomobile due to a tissue injury, such as trauma, improperly lifting, repetitive stress, and poor posture. The injured tissues become inflamed, causing pain, as a result of their chemical and physical changes. The adjustment or manipulation can alleviate the tightness and pain and allow for healing. While it is rare for a chiropractic adjustment to cause pain, some patients may have mild aching or soreness for a day or so. Chiropractors are often seen for lower back pain. DCs use clinical examinations and laboratory testing as well as diagnostic imaging to assess patients. They will refer patients who need other healthcare interventions, as needed. Sometimes DCs will co-manage care with other healthcare professionals.1
There are stringent educational requirements for chiropractors. In general, after four years of pre-med undergraduate education in “biology, inorganic and organic chemistry, physics, psychology and related lab work”, students then enter an “accredited chiropractic college”. At that point, it takes about four or five years of study, and much of the time is spend doing clinical training. This is important because chiropractic is a hands-on profession. DCs are licensed in all of the United States, and in many other countries. The training they receive is similar to medical doctor training. In fact, in the areas of rehabilitation, physiology, and anatomy, “they receive more intensive education than most medical doctors or physical therapists”. DCs need to have completed, minimally, a “one-year clinical-based program dealing with actual patient care”. The curriculum, in all, is at least 4,200 hours of laboratory, clinical, and classroom experience. Further, chiropractors need to pass their national board examinations and become licensed in the state in which they practice. There are also post-graduate programs for chiropractors for various specialty fields, such as neurology, orthopedics, occupational health, and sports injuries.2
Chiropractic Career Path
According to the American Chiropractic Association, “there are 77,000 Doctors of Chiropractic (DCs) in the United States” in roles that require board exams and state licensing, and “3,000 DCs work in academic and management roles”. There are also about “10,000 chiropractic students in 18 nationally accredited, chiropractic doctoral graduate education programs” and “40,000 chiropractic assistants (CAs).3 There are many chiropractic specialties available. The American Chiropractic Association has “nine councils, which offer 10 different diplomate programs”. Specialties include orthopedics, pediatrics, neurology, nutrition, sports physician, occupational health, chiropractic acupuncture, physiological therapeutics and rehabilitation, diagnosis and internal disorders, and diagnostic imaging (radiology). Specialties are “on the rise”, according to the ACA. Robert E. Dubro, DC, DACBOH, DABCO, compared chiropractic college completion to scuba diving certification, stating that “you learn the basics…and you know enough to be safe” but “you aren’t considered an expert until you have at least 100 hours of bottom time”. He feels, as president of the American Board of Chiropractic Specialties, that without specialty training, chiropractors lack the expertise “to treat highly chronic illnesses and injuries or specific, complex occupational, sports or traumatic injuries”. Chiropractic college alone is not enough to remain in practice. There are specialty councils and postgraduate courses to move beyond the foundation. Typically, a specialty certification requires “300-400 hours of advanced study”, along with written and practical or oral exams. Colleges and associations offer this training so that chiropractors could receive their diplomate. Specializing is meant to have the goal of being able to better treat the patient, but it could also lead to more referrals, as the chiropractor becomes known for their area of expertise.4
Chiropractic Salary and Employment
Chiropractic salaries vary. According to the Bureau of Labor Statistics (May 2014), in metropolitan areas with the highest level of employment, chiropractors earn anywhere from about $54,050 to $126,800 annually. A chiropractor in the Chicago, Minneapolis, or Denver area can expect a mean wage of $55-60K. Those in Phoenix, Atlanta, Pittsburgh, and Washington, DC will generally earn an average salary of $70-82K. Chiropractors in New York could earn nearly $95K, while those in LA make about $127,000 per year. The states with the highest employment level for chiropractors are California, Texas, Florida, Illinois, and New York.5 Chiropractic salary is impacted by many factors, including “industry, company size, location, years of experience and level of education”.6 Chiropractors can practice alone or in group practices, such as part of a clinic, wellness center, medical spa, rehabilitation center, or as a franchisee. Some accept insurance, others do not. Some have a sliding scale for payment. Various chiropractic offices offer different services, as well, such as acupuncture, massage therapy, nutritionists, physical therapists or they are partnered with other healthcare professionals. They may have a general specialty or offer family, sports, or pediatric care, for example. Location (urban, suburban, rural), also impacts employment. Chiropractors who employ specialists (massage therapist, physical therapist, acupuncturist, medical doctors, etc.) earn more money in the practice, according to a recent survey by Chiropractic Economics. In the same survey it was found that those chiropractors with more experience, the “over 60 group”, earned the highest compensation. More chiropractors practice in the suburbs than in urban or rural regions. The best earnings were reports in the South, with the Midwest coming in second, in that same study.7
Chiropractors can choose to work in a group or private practice, in a franchise or hospital, for an HMO or in a chiropractic college. Working in a private practice gives the practitioner control over earnings, hours, clients, and how the office is run. Because of the self-employment, they are also in charge of attracting clients and marketing, keeping records and maintaining standards, and staffing. There are also non-clinical aspects to the practice to consider, such as payroll and bookkeeping, web design, consultations, and more. In a group practice, these kinds of decisions are made by all of the member-owners, and in a franchise, the chiropractor uses the procedures, marketing, and name of the franchise, but only has limited ownership as a return on their investment. Chiropractors need to weigh the benefits (receiving the primary profits, setting working hours, and hiring staff) with the costs of private practice (billing and insurance, trouble with getting consistent clients, and capital expenses) when making decisions about their career paths. If a practitioner is leaving a group practice to open a private practice, they may not be able to bring their patients along, due to insurance, location, or even because of contracts with the prior medical group. It may also be a challenge to set up a new practice with insurance companies for billing. It takes a lot of capital to start a new business, which could require setting up financing or loans. For some, the freedom to choose hours, staff, and location outweigh the cons and the decision to have a private practice could lead to more “financial perks”.8
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