Chiropractic schools have largely dodged school closings, but the toughest years are ahead with ever-increasing chiropractic school cost
PRE-COVID, COLLEGES AND UNIVERSITIES WERE FACING A NUMBER OF ISSUES ALREADY, caused by a decline in boarding fees, high chiropractic school costs, and students delaying their freshman year or opting for stay-at-home learning.
More than 600 higher education institutions closed or merged across the U.S. from 2014-20, according to data from the National Center for Education Statistics, and while chiropractic institutions have largely been spared, financial issues linger, with new challenges around the bend.
A chiropractic snapshot
The 2023 Chiropractic Economics Schools Survey, circulated at the end of last year, saw respondents who graduated in 1958 all the way up to current students who will walk the stage in 2025.
This year’s doctors’ of chiropractic responses to the annual survey showed a drop in DCs who would recommend chiropractic in the current economic climate, a drop in DCs who would recommend a school other than their alma mater, but a good sign in yet another rise in the number of dedicated “industry cheerleaders.”
After a rise last year, DCs recommending chiropractic schools to prospective students dropped to 82%, a three-point fall. More than 43% of DCs responded that they would recommend chiropractic schools other than the ones they attended, showing that chiropractic colleges need to continue to promote their programs above the competition and reach out to prospective new students rather than simply rely on alumni recommendations.
The “industry cheerleader index,” or chiropractors who recommend chiropractic to five or more students a year, rose to 22%, a 1% increase over 2022.
Current and coming struggles
In addition to COVID, many higher education institutions were struggling prior to 2020 due to demographic declines in the number of high school students, the ever-increasing chiropractic school cost, and institutions engaging in tuition discounting practices that eat at their bottom lines.
High inflation has currently increased college cost the most over the last 10 years, along with producing labor shortages that have resulted in wage inflation. Public funding for colleges that ramped-up during COVID are declining or have stopped.
According to Moody’s Investors Service and Forbes:
- College cost is increasing 4-6% per year, substantial compared to the 3-4% of the last 10 years
- Inflation means higher prices for low-income households and less money for tuition
- Federal COVID relief totaled about $77 billion for institutions and students, much of which has been spent
- At least 25% of private colleges are now running at deficits
- At the largest and most prolific public institutions, expenses have outpaced revenues during the last three years
- Nearly 20% of students are now enrolled in a mostly-online program
- 40% of colleges and universities have fewer than 1,000 students
“Colleges are not going to come out of this period and return to ‘business as usual,’ as too much has changed in the way we do business and the priorities of students,” said economist Lucie Lapovsky, former president of Mercy College, speaking to Forbes.
Schools that haven’t cut costs are those having trouble dealing with enrollment declines, fixed costs such as tenured faculty, and debt payments for financing buildings, some of which stand empty or formerly housed students.
“To me the issue is not, ‘Will colleges be forced to close?’ but rather how many will close and over what time period,” wrote Richard Vedder, an economist who studies higher education. “Will it be 500? 2,000? Will it largely happen in the next five years, or 10 years or more? I am not certain about the details, but the broad contours of the forthcoming changes seem pretty clear.”
EY-Parthenon, Ernst & Young’s global strategy consulting arm, outlined three risk factors in a 2016 report, “Strength in Numbers,” that are impacting colleges today:
- Offering high discount rates
- A dependence on tuition for more than 85% of revenue
- Having an endowment that covers less than a third of expenses
The margins are razor-thin for small colleges that see enrollment declines. According to Education Dive, the most vulnerable schools in coming years will be small institutions in the rural Northeast and Midwest, where the biggest declines of students will occur.
“All to say that it’s not that hard to paint a picture of how 25% of existing institutions — be it 550 non-profit and public four-year institutions or 1,100 degree-granting institutions — close, merge or declare bankruptcy in the years ahead,” writes Michael B. Horn of Forbes.
A broken DC business model?
Experts agree that a general realignment of higher education has begun, and with ever-increasing chiropractic school cost and limited returns compared to medical doctors, chiropractic education will be no exception.
From the 2023 Chiropractic Economics Schools Survey, comments explaining not recommending chiropractic repeatedly included cost of schooling, insurance restrictions, cost/benefit ratio, and poor insurance and Medicare reimbursement.
Specific comments included:
- “Because the student debt to earning potential ratio is too large for new graduates. Graduating with $200k-plus student loans and having the majority of jobs pay between $60-80k doesn’t work.”
- “The education is very expensive and insurance reimbursement is laughably poor. Our business education was significantly lacking.”
- “The amount of financial aid I needed to complete my degree is ridiculous. I will never pay it all unless I join up with some franchise chiro place.”
- “Reimbursement and jumping through insurance hoops does not come close to making it worth the cost of the education, and is only getting worse.”
- “We are not backed by institutions and state associations for progress. Insurance companies are allowed to abuse us.”
- “I see the young doctors struggle and not able to service the debt.”
Campbellsville University, the latest institution to unveil a doctor of chiropractic program, boasts a “new model for chiropractic education” with a 20% lower tuition than most other programs ($103,000 total tuition), featuring a rigorous business program.
“The success of a good university is not only based on the institute’s ability to graduate students, but also the success of those students after graduation,” said Trevor Foshang, DC, DACBR, and dean of chiropractic education at Campbellsville. “Although some chiropractors do well, many struggle financially and often leave the profession. … That is why we have made it mandatory for each student to complete four business courses.”
While the “business of chiropractic” has been a topic of contention among graduating DCs, and has been touted by many schools over the last few years in regard to more structured chiropractic business offerings, few if any schools have found ways to lower the cost of a Doctor of Chiropractic degree.
The current number of colleges cannot be supported
Between rising costs, shrinking birth rates and pandemics, all colleges and universities are preparing to hedge against difficult times to keep their doors open.
According to the James G. Martin Center for Academic Renewal, there is simply too little demand (and too much cost) to support the current number of colleges.
“Like two arrows, one diverging downward and one upward, the demand for college is decreasing, and the cost of college is increasing. As the arrows grow farther apart, more colleges close down,” wrote Keller Moore in September. “America’s student population is shrinking. From spring ’20 to spring ’22, college enrollment dropped by nearly 1.3 million students. This nosedive cannot be attributed solely to the effects of the coronavirus pandemic. Indeed, data from the National Center for Education Statistics show that enrollment declined during the previous nine years, as well.”
Colleges were in demand in the 1960s with a 3.7 fertility rate. In 2020, with a 1.6 fertility rate, not so much. People were having fewer children, and there were eventually fewer college-age kids to fill classrooms. Also, again, the cost. According to U.S. News & World Report, college costs rose almost 80% from 2008-22, also keeping kids out of the classroom.
Chiropractic colleges survive, and some thrive
The lone movement on the chiropractic college landscape over the last few years has been Palmer College of Chiropractic in 2022 announcing the phase-out of its San Jose, Calif., campus.
“By adjusting our on-campus offerings at our two flourishing locations, Palmer is better equipped to meet its mission of educating students in the science, art and philosophy of chiropractic today and well into the future, maintaining our role as the trusted leader in chiropractic education,” said Dennis Marchiori, DC, PhD, Palmer College chancellor and CEO.
Late last fall, Palmer subsequently announced record-high enrollment numbers at its main Davenport, Iowa, campus, and the largest enrollment at its Port Orange, Fla., campus since it opened in 2002. Life University last November announced a new partnership with Indiana University of Pennsylvania to create a pathway to an accredited chiropractic college for IUP students seeking to become chiropractors and to bring down chiropractic school cost. The Northeast College of Health Sciences, formerly New York Chiropractic College, last year celebrated 30 years with a statement on its growth and financial health, with assets of $98.6 million and liabilities of $21.3 million.
“The college’s investment portfolio of $76.9 million allows the college the flexibility to take advantage of strategic opportunities, while at the same time providing funds for the annual budget and unexpected expenditures,” college President Michael Mestan said in a press release.
In an era where chiropractic is experiencing its greatest acceptance, including integration with the U.S. military, has been designated “essential providers” during COVID and essential in fighting the opioid epidemic with non-drug care, and is increasingly included in integrated medicine operations, the profession in coming years may hinge on chiropractic school cost and the affordability, or unaffordability, of a chiropractic education.
RICK VACH (firstname.lastname@example.org) is editor-in-chief of Chiropractic Economics.