February 2005

Futurists looks at chiropractic in 2015

How will chiropractic fit into the healthcare scene in 2015? That is the essential question addressed in a new special report, “The Future of Chiropractic Revisited: 2005 to 2015,” prepared by the Institute for Alternative Futures (IAF). The report was funded by NCMIC Group, Inc.

In 1998, IAF issued a major report on the future of chiropractic care in the United States. The new report is an update of the 1998 study.

The IAF team, led by IAF President Clem Bezold, PhD, includes William Rowley, MD, and Craig Bettles. IAF revisited its collection of forecasts, reviewed the 1998 report, interviewed more than 50 experts on chiropractic and related fields, attended the Florida Chiropractic Association annual meeting and experienced chiropractic care first hand.

OPPORTUNITIES

This year’s IAF report finds a number of opportunities for the chiropractic profession:

• The new chiropractic services provided to the nation’s veterans as well as inclusion of chiropractic services in the Department of Defense;

• Research possibilities focused on reinforcing the benefit of chiropractic care for neuromusculoskeletal (NMS) conditions and establishing efficacy for other conditions;

• Consumer-directed healthcare, which will provide opportunities for cost effective care;

• The possibility for greater unity and coherent communication by the profession.

CHALLENGES

The study also found a number of challenges to the chiropractic profession, some of which were addressed in IAF’s first report and some that are new:

• The divisions within the field over scope, philosophy, and evidence-based approach, making it difficult for the profession to unite on important issues;

• The rise of competition from other healthcare providers who recognize the value of the approach to healthcare provided by doctors of chiropractic, particularly spinal manipulation;

• The pressure managed care continues to place on reimbursement rates.

FUTURE SCENARIOS

IAF developed four scenarios for chiropractic in 2015, based on the challenges and opportunities it identified:

Scenario 1. Slow and steady growth of chiropractic in the care of back and neck pain;

Scenario 2. A darker future in which internal conflicts and outside pressure cause a downward spiral in chiropractic;

Scenario 3. Chiropractors pursue evidence-based practices and greater collaboration with other healthcare providers to become widely recognized specialists in neuromusculoskeletal conditions.

Scenario 4. A vanguard of chiropractors and other health professionals become “healthy-life doctors” focused on using the best available evidence combined with a lifestyle or wellness approach to prevent disease.

HIGHLIGHTS

Some of the highlights of the report include:

• In Scenario 1, IAF forecasts that the profession will grow from 74,000 chiropractors in 2005 to 87,000 chiropractors in 2015.

• Chiropractic is the largest and most well established complementary and alternative medicine (CAM) in the United States, but in practice many chiropractors are barely holistic or integrative.

• Chiropractic is still well positioned to take advantage of newfound interest in complementary and alternative care by providing more integrative care themselves, developing better interdisciplinary teams and doing more consistent referrals. But since IAF made that recommendation in 1998, DCs have done relatively little to make this integration more real.

• Patient satisfaction with chiropractic care is generally high. But it is not clear if this is from spinal manipulation or the broader aspects of chiropractic care as it is delivered, including the personal attention of the chiropractor.

IAF’S RECOMMENDATIONS

IAF’s recommendations for chiropractic include:

• Accelerate research;

• Continue to strive for high standards of practice;

• Develop greater integration with mainstream healthcare;

• Anticipate and engage consumer-directed care;

• Create greater unity within the profession;

• Enhance individual DC’s contribution to public health;

• Prepare for the future of prevention and wellness; and

• Develop geriatric chiropractic.

The full report can be accessed and downloaded at the IAF Web site, http://www.altfutures.com.

Source: Institute for Alternative Futures, http://www.altfutures.com

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