Chiropractic 2025:

Chiropractic 2025: Divergent Futures
An important innovation addressing the ROI issue, and implemented by a growing number of colleges, is
multidisciplinary training and the possibility to earn different degrees concurrently. Chiropractic students can
now earn a doctor of chiropractic degree along with degrees in other complementary and alternative medicines
or allopathic disciplines. Chiropractic colleges are also working to expand clinical training in diverse settings
including VHA hospitals and DoD facilities, as well as practices, clinics, hospitals, and even international settings.
Another common trait is the focus on improving the reputation of chiropractic and facilitating chiropractors’ future
integration into the U.S. health care system by encouraging research, the pursuit of degrees recognized outside the
profession, and training opportunities in integrated settings.
However, there is uncertainty regarding the extent to which the schools’ efforts will successfully maintain, much
less grow, enrollment levels over the years to 2025. How interest in chiropractic as a career, federal tuition support,
public funding for chiropractic research, clinical training opportunities, and the chiropractic school landscape evolve
depends in large part on the success of practicing chiropractors and state and federal leaders in advancing their
profession and reputation in an increasingly value-based health care system.
The scenarios play out these factors in different ways. We developed a simple model to track year-by-year changes
out to 2025. In this model, our forecast for chiropractic college enrollment in Scenario 1, is 8,000 students enrolled
in the year 2025 compared to 9,632 in 2012. This reflects the declining trend seen in the last 10 years and the
grim perspectives in ROI for young chiropractors in the first years of their practice. Given the competition from
other professions and only partial success with DCs integration into primary care, we assume this 1% decline in
the total number of enrolled students each year from 2012 to 2025. In the “hard times and civil war” Scenario 2,
many chiropractors are unemployed, there is far less integration into delivery systems, physical therapists and
other effectively compete for manipulation, and the intense battles between broad-scope chiropractors seeking
pharmaecutial prescribing rights and the philosophical chiropractors vehemently opposing them get the greatest
attention for the profession. In Scenario 2, the number of enrollments is cut in half from 2012 to 2025, going down
to 5,000 students. In Scenario 3, evidence of chiropractic’s efficacy and cost effectiveness is shown for the field
and for local chiropractors, many chiropractors are integrated into primary care and ACOs, the profession gains
cultural authority, and demand for chiropractic grows, along with favorable attention to the profession. This drives
enrollments in Scenario 3 up to 12,000 students by 2025, or a 25% growth. Finally, in Scenario 4, DCs are shown
to be effective in most settings, outcomes research and protocols dictate effective course of treatment, a large group
of self-care consumers wisely buy DC services, and research on vitalism connects the professions origins with
advancing science. This increasingly bonds the profession and attracts more health oriented patients. In Scenario 4
this keeps the number of enrollments stable from 2012 to 2025 at about 10,000 students.
In all scenarios we assume that, as chiropractic studies take an average four years and assuming that close to 10%
of students who start do not graduate, around 22.5% of the total number of students enrolled in chiropractic colleges
graduate each year.
In terms of forecasting practicing DCs, we start with a base estimate of around 55,000 practicing DCs in 2012. 40 We
forecast the number of practicing chiropractors for 2025 in each scenario by adding the chiropractors that graduate
each year to the net number of chiropractors practicing the year before. The net number of practicing chiropractors
accounts for dropouts and retirements. In Scenarios 1, 3 and 4, we assume that each year on average 2.5% of all
practicing chiropractors drop out of practice or retire due to age or financial reasons. In Scenario 2, this percentage
is 4.6% as chiropractors are in dire straits. As a result, in Scenario 2 the number of chiropractors in practice declines
by 18%, reaching 45,000 by 2025. In Scenario 1, by 2025 63,000 chiropractors are in practice (a 13% growth from
2012 to 2025). In Scenario 3, the number of practicing DCs rises by 22% to 68,000 in 2025. Finally, in Scenario 4
this number reaches 66,000, with 19% growth.
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