Chiropractic 2025:

Scenario 2: Hard Times & Civil War
Scenario Highlights
■■ The period from 2013 to 2025
becomes difficult for most of
American health care. Millions of
people enroll in high-deductible
catastrophic care plans, and
everybody is trying to pay as little as
necessary. Only clear and compelling
value can sustain chiropractic
practices, but the scarce evidence
base for chiropractic hurts DCs.
■■ For the public, the most visible
part of the chiropractic field is the
civil war waged by focused-scope
chiropractors against the broadscope
chiropractors’ efforts to
expand practice rights.
■■ The variability in quality and
outcomes among solo and small
practice practitioners causes DCs
to be overlooked by ACOs and
PCMHs. Once these ACO systems
are set and standardized, it becomes
too difficult to create change. A lowquality/low-cost
chiropractic industry
grows and provides care that
sometimes harms people in highly
publicized cases. Only some DCs are
lucky enough to practice in the right
communities or on integrated teams.
■■ The bleak outlook for the profession
and the unpromising return on
investment lead prospective
chiropractic students to opt for other
career pathways that provide them
with greater financial stability. Many
chiropractors are driven from the
field.
Imagine:
Chiropractic 2025: Divergent Futures
Drs. Lee and Wayne have had their shared chiropractic practice for eight
years. After working as associates for four years each, they had spent
two years establishing their joint practice, and had done reasonably well
in their third year. Each had his own patients, some insured and some
paying cash. Both belonged to chiropractic networks. While they did not
like the fee discounts or the practice restrictions, they appreciated the
flow of patients that came to them by this route. On the last Thursday
of each month, they met at noon for lunch before seeing patients at 2
PM. Typically, they reviewed cases, considered any learning or research
they had encountered, and discussed office management questions.
However, this Thursday was different. It would be their last as a joint
practice. Demand had dropped off as another recession hit in 2015.
Another round of Medicare cuts in fee-for-service payments and the
growth of low-cost subluxation-only chiropractic franchises with $30
adjustments made it harder to make a living. The supply and demand
for chiropractic services in their community used to be well balanced,
but now a growing number of chiropractors were setting up shop there
even while demand dropped. Some of their DC colleagues joined ACOs
and PCMH teams that were growing in their communities, and one
chiropractor even had her practice acquired by an ACO. But neither
Dr. Lee nor Dr. Wayne had reached out to the decision-makers in these
integrated care organizations, nor had they established an electronic
health record system in their practice that would have allowed them
to track and report their patients’ health outcomes. In the absence of
hard data, they had to rely on the local consumer rating groups where
patients posted provider ratings online, which some chiropractors
manipulated by soliciting positive ratings from friends and relatives.
While Drs. Lee and Wayne were proud of the care they gave patients,
more and more of their patients had been going longer between visits.
Others only came in for emergencies like severe and/or episodic back
or neck pain. At the same time, networks kept fees and the number of
visits low. Under these conditions, they simply could not maintain their
practice. At their last Thursday lunch, Drs. Lee and Wayne compared
notes on their plans for what was next. Dr. Wayne had decided to ramp
up his efforts and pursue the expanded practice rights the state allowed
for chiropractors. Dr. Lee had seen the demise of their practice coming
and had chosen another path – to become a physician’s assistant. He had
already begun his studies online and would spend part of the next year
at PA school in-person.
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