Chiropractic 2025:

Chiropractic 2025: Divergent Futures
access, with emphasis on care for headaches, back pain, and neck pain. Or, DCs could contribute as PCPs who
also deliver care to patients seeking help for non-musculoskeletal conditions, and as providers of diagnostic and
therapeutic prevention and health promotion services, including evidence-based diet and exercise counseling. 176
Chiropractors can provide effective care for back and neck conditions that prove challenging to primary
care providers. The FCP explains that care for patients with headaches, back pain, and neck pain is currently
“fragmented,” 177 so improved coordination and cooperation will benefit these patients significantly. These conditions
are highly prevalent in the United States. Two of the most frequently experienced non-migraine headaches are
cervicogenic and tension-type headaches. 178 The Duke University Evidence-Based Center found that spinal
manipulation is effective for the treatment of these headaches. 179 The second-most common reason for patients
to visit a MD is back pain, and two-thirds of people will experience neck pain in their life. 180 Chiropractic care
has frequently proven effective against these conditions. 181 In fact, the American Pain Society and the American
College of Physicians released guidelines for low back pain (LBP) acknowledging spinal manipulation to benefit
patients with chronic, acute, and sub-acute LBP. Their guidelines endorsed spinal manipulation as the sole nonpharmacologic
approach that is effective against chronic and acute LBP. 182
The FCP points out that DCs have a unique opportunity in rural populations, as their patients are more likely to
present with non-musculoskeletal complaints. 183 DCs may serve as a first point of contact with the health system
in these areas especially, and the consistent high levels of satisfaction with chiropractic care may help strengthen
the relationship between DCs and their patients in these localities. 184 This has been the case in South Dakota, for
example, where DCs provide a broad range of services, particularly in rural areas, and their activities complement
the services offered by MDs and PCPs. 185 Going further, the FCP has recently partnered with URAC, a nonprofit
health care accreditation and education organization, to conduct a pilot project that seeks to provide an opportunity
for the chiropractic profession to articulate its role and validate its significance in improving costs, clinical
186, 187
efficiency, and overall patient outcomes.
A study authored by Gaumer et al. in 2001 reinforces the argument for including DCs in primary care teams.
Gaumer et al. evaluated and assessed, by importance and frequency, almost 200 activities that “constitute
primary health care.” 188, 199 The authors used two U.S.-based panels, one composed mostly of allopaths (the
“interdisciplinary” panel with 60% MDs) and the other composed mostly of chiropractors. Both panels agreed
that 92% of the nearly 200 activities were primary care activities. 60% of those activities were performed with
similar frequency in both chiropractic and medical offices. The interdisciplinary panel felt that MDs were not
needed at all or needed infrequently in 53% of the primary care activities (particularly the activities that were
categorized under “information gathering,” “screening/prevention,” “counseling/education,” “injuries/trauma,”
“musculoskeletal,” “ear, nose, and throat,” “pulmonary,” “gastrointestinal,” “dermatologic,” “behavioral,” and
“special populations”); that 31% of the activities needed some MD involvement (particularly for activities
categorized under “ophthalmologic,” and “genitourinary”); and that only 16% needed MD involvement all or most
of the time (particularly activities that were categorized under “neurologic,” “infections,” and “cardiovascular”). The
panel of DCs claimed to need MDs more often, as they did not perceive themselves as able to do some primary care
activities, such as invasive diagnostic procedures, treating for sexually transmitted diseases, treating glaucoma, and
treating cellulitis. More recently, a 2008 Canadian study found that integrating DCs into primary care teams yielded
positive, successful, and cooperative results. 190
The PCMH is likely to evolve into the Community-Centered Health Home (CCHH) that provides patient-centered,
coordinated and effective care, but also assesses community conditions and understands how to advocate for
population health or community health. 191 This parallels the pursuit of the Triple Aim as the standard for quality
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