Chiropractic 2025:

Introduction
Chiropractic 2025: Divergent Futures
Where will the chiropractic profession in the United States be 12 years from now? This Chiropractic 2025: Divergent
Futures report by the Institute for Alternative Futures (IAF) presents scenarios that provide four different answers
to that question. The 2025 scenarios reflect the opportunities and challenges for chiropractic in the U.S. given our
assessment of developments within both the chiropractic field and the broader context of health, science, technology,
and society. The scenarios invite deliberation about which futures are more likely and which are more preferred by
chiropractors.
Viewed from 2013, the future of chiropractic remains fascinating and uncertain. Chiropractic as a uniquely American
invention has persisted and grown worldwide despite organized suppression. In fact, chiropractic has become a
global force. More and more countries, including Denmark and Switzerland, are granting legal recognition for
the practice of chiropractic, and accept the profession as a member of government-sponsored health care delivery
programs. There are now more schools of chiropractic located outside the United States than within it. Chiropractic
has also become a recognized and accepted health profession at the World Health Organization. International
educational standards are being adopted across various accreditation agencies. Regulatory bodies are working to
remove the impediments to practitioner mobility between jurisdictions. Chiropractic research is advancing as well in
the U.S. and in countries around the world.
The entrepreneurial spirit of chiropractors, fractures within the chiropractic community, and isolation from and
oppression by organized medicine have all left chiropractors largely independent and separated from health care
provider systems. As chiropractors were included in health insurance coverage in the 1980s, chiropractors enjoyed a
brief period of relatively unrestricted, well-paid patient visits and many earned high incomes. However, a tightening
of both reimbursement levels and allowable visits followed. With the rise of managed care in the 1990s—and later
managed access to chiropractic services—chiropractors have seen their incomes, on average, fall further. Now,
with the implementation of the Patient Protection and Affordable Care Act of 2010, “value” is being redefined
and measured in new ways; primary care is shifting from largely solo and small group physician practices to
multidisciplinary teams; and provider organizations are shifting from fee-for-service to bundled payments, risk
sharing, or capitation. These are among the major changes in health care that chiropractic is facing.
Differences among chiropractors are also important. There is great diversity of practice styles and philosophies
within the chiropractic profession. For this report, we will use an awkward but serviceable division of chiropractic
into three communities (defined more specifically in Appendix 2): focused-scope, middle-scope, and broad-scope
chiropractors. While there are differences within each of these, critical parts of chiropractic’s future will be shaped by
how each community evolves and interacts with the other two.
About 10% of chiropractors (“broad-scope”) focus on primary care or specialties dealing with a range of conditions
beyond the spine. Many in this latter group want to broaden their practice rights further to include prescribing rights.
They have been trying for years to do so and in 2013, it appears they may win this battle in a few states.
At the other end of the spectrum, 10-15% of chiropractors (“focused-scope”) correct subluxations in the spine to free
the body’s self-healing capacity. Some argue that they do not “treat conditions” but only fix problems with the spine
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