Chiropractic 2025:

Chiropractic 2025: Divergent Futures
Recommendations for Broad-Scope Chiropractors
■ Pursue expanded practice rights, but develop a conservative pharmacology practice that supports self-healing.
■ Develop and maintain outcomes research on all practices. If the broad-scope community is to succeed in gaining
and obtaining prescribing rights, it must frequently research and evaluate its own patient outcomes and costeffectiveness.
These data can then be compared to the results achieved by other providers with prescribing rights,
as well as to outcomes from non-prescribing chiropractors.
Recommendations for the Entire Chiropractic Community
1. Integrate chiropractic into health care systems, particularly into Accountable Care Organizations and Patient-
Centered Medical Homes.
Health care is poised to change its payment streams, shifting from fee-for-service options to integrated and capitated
streams, particularly through Accountable Care Organizations (ACOs). Patient-Centered Medical Homes (PCMHs)
are shifting primary care from solo-practice physicians to teams of providers. IAF’s scenarios envision integrated
care (capitated or risk-sharing and integrated across delivery sites and providers) comprising between 30 and 85%
of health care in 2025, depending on the scenario. To date, chiropractic has remained largely isolated from delivery
systems. However, chiropractic can and should make its way onto primary care teams and ACOs. Failing to do so
will maintain the status quo of keeping the profession isolated. The role DCs could have as the spine health leaders
on primary care teams is an important opportunity to pursue for this integration. This will require local, personal
efforts by chiropractors to establish relationships with medical directors and others who will determine which
providers will be on the primary care teams and in the hospitals.
In this integration, DCs will inevitably have to work—or contend—with physical therapists (PTs). PTs (and
increasingly doctors of physical therapy or DPTs) can and do compete with chiropractors. They outnumber
chiropractors 4 to 1 today, and the U.S. Bureau of Labor Statistics forecasts that the number of physical therapists
will grow faster than chiropractors for the rest of this decade. PTs are also already better integrated into health
systems. While scope of practice fights with PTs will persist, the competition should be on outcomes, given that both
DCs and DPTs will be seeking similar patients and/or the spine health leader role within primary care teams.
Specific strategies for chiropractors to further ensure and solidify their integration include:
Take full advantage of integration in the Veterans Health Administration (VHA) and Department of Defense
(DoD). Chiropractors have years of experience getting integrated into two major systems, namely the VHA and the
DoD. The number of sites with chiropractors needs to be expanded, and chiropractors can actively advocate for this
expansion while continuing to prove their worth through good outcomes. Research on DCs’ outcomes in the VHA
and DoD also needs to be actively communicated.
Increase the prevalence of clinical training in chiropractic education. Additional clinical experience for students
before beginning their practice is essential. Chiropractic colleges should accelerate their efforts to provide students
with clinical experience in hospitals, rehab, primary care, and other treatment settings. Community health centers are
beginning to offer such opportunities, and these options should be increased and expanded further.
Seek to practice with other types of health care providers in as many settings as possible. This includes
working in community health centers and providing pro bono care in free health care clinics and other settings.
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