Chiropractic 2025:

Scenario 1: Marginal Gains, Marginalized Field
Imagine:
Chiropractic 2025: Divergent Futures
Should she go on to become a chiropractor? Alice Hughes is a third year college student, and she took the summer
months this year to figure it out. She asked her campus pre-health adviser if the school maintained any relationships
with local chiropractors. They did not, but the advisor recommended that she shadow a physical therapist, nurse
practitioner, or physician assistant, and gave her a list of local providers who were open to student shadowers. He
noted that these other careers offered similar opportunities for hands-on care and one-on-one relationships between
providers and patients. Moreover, he said, she would have much better
career prospects with any of those than with a doctor of chiropractic
Scenario Highlights
■■ The multiple identities in the
chiropractic field of 2013 persist to
2025. While health care reform leads
to major changes, no community
inside the chiropractic field
significantly changes its position.
■■ Income among DCs continues to
vary widely. Most remain in solo
and small group practices, trying
to hold their own in the face of
low-cost wholesale providers
of chiropractic care, constraints
imposed by insurance networks, and
the systemic reorganization of health
care delivery.
■■ One out of every six chiropractors
becomes involved in a Patient-
Centered Medical Home (PCMH)
or Accountable Care Organization
(ACO), and chiropractic becomes
more accepted among other
providers and by the public.
■■ The challenging job outlook for the
majority of current and prospective
chiropractors hampers the growth
of the profession over the decade
leading to 2025.
degree. Alice used the list to set up full-day shadowing experiences
with each type of provider. However, she decided first to shadow a
chiropractor, Dr. Morrison, to whom Alice’s mother had taken her after
a sports injury. When the day came, Alice met Dr. Morrison at her office
in the small group practice where she saw patients four days a week.
On Wednesdays, Dr. Morrison practiced as part of a local primary care
medical home (PCMH) team. In between patient visits that Alice got to
observe, Dr. Morrison talked to her about the daily realities of making
a living in chiropractic, especially as a woman chiropractor and young
mother. A good number of chiropractors, like her, had been invited to
practice at least part-time in integrated care systems after studies had
confirmed the cost-effectiveness of DC-initiated care as compared to
MD-initiated care. Some chiropractors were able to work full-time
and served as spinal health experts on primary care teams or provided
screening and triage for patients with neuromusculoskeletal problems.
Most of these had become employees of the PCMH/ACO systems.
These chiropractors made a good income and enjoyed benefits like
paid maternity leave and vacation. New chiropractors needed to get
experience before they could compete for PCMH jobs. This usually
meant becoming an associate with an existing practice or in one of those
low-cost wholesale provider networks that had many in the profession
up in arms. Either way it meant accepting a relatively low income for
a few years. Dr. Morrison noted that in some communities new DCs
could build successful solo or small group practices. Regardless, having
a strong entrepreneurial spirit was essential. As for herself, Dr. Morrison
confessed, she wished she had reached out sooner to the primary care
team that she had wanted to join originally; then perhaps she could have
beaten out the physical therapist that the medical director picked for the
full time position there.
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