DCs voice their opinions on doctor of chiropractic schools, recommendations, debt, business training, and possible changes to the model
The 2nd annual Chiropractic Economics schools survey of U.S. doctors of chiropractic couldn’t have come at a more urgent time in July for chiropractic students, doctor of chiropractic schools and universities. The fall semester questions loomed about on-campus classes vs. virtual classes, or a combination of the two, and other unknowns.
Last year’s survey results
This time last year we unveiled the initial school survey results revealing how DCs in the field felt about their alma maters, the quality of education and preparedness they received, and also how they felt about recommending doctor of chiropractic schools they did not attend. The results were eye-opening, showing a greater need for DCs to be advocates recommending students to chiropractic, especially amidst the growing shadow of a predicted DC (and MD) shortage on the horizon.
Now 2020 and the onset of COVID-19 have swung the chiropractic college conversation to one of survival. Chiropractic Economics spoke with university administrators, students and new DCs in the field about dealing with COVID-19, and how they think the economics of chiropractic need to change — especially in regard to business training and student debt.
2020 doctor of chiropractic schools survey feedback
This year’s survey showed how important chiropractic college promotion, marketing and branding remain to institutions, as 79% of DCs responding said they would recommend a chiropractic college to students that they did not attend, up 6% from last year.
While business/financial training and education is rising at chiropractic institutions, as you’ll read from administrators we spoke with, this year 43% of doctor of chiropractic respondents in our Schools Survey rated the college they attended as “poor” (28%) or “worst” (15%) in regard to business preparation.
Of respondents, 78% said they would recommend chiropractic as a profession, 2% down from last year, while the 12% who said they would not recommend chiropractic to students shared concerns mostly centering on student debt vs. earnings potential, the cost of a DC education, and poor business preparation. Anonymous comments from the survey included:
- “Most of the graduates are having trouble doing business. Schools should focus more on how to do business when they graduate.”
- “High student loan cost as compared to salary coming out of school. My student loans increased by nearly $75,000 in five years after graduating.”
- “Can’t make enough money to pay loans back with such a high interest [rate] on a chiropractor’s income.”
Chiropractic colleges and debt assistance
Veteran chiropractors among our survey respondents noted that 20 years into their respective careers, for many debt was still an issue, and that chiropractic colleges needed to bear more of the responsibility to arm graduates with financial knowledge and assistance. Reaching out to colleges, we found that some are doing just that.
“University of Western States College of Chiropractic provides personal finance and debt counseling to students while they are enrolled and after graduation,” says UWS President Joseph Brimhall. “The university also provides support for students and graduates by connecting them with mentors or other practitioners in the field, information on internships and job opportunities, and facilitates practice opportunities with practicing chiropractic physicians and other health care professionals.”
Sherman College of Chiropractic has taken another approach with a business curriculum that also addresses student debt.
“Implemented in 2015 and continuously updated, Sherman College’s distinctive Graduation Plus 10 (G10) business curriculum not only provides the necessary skills for new graduates’ success as practitioners and entrepreneurs, but it also provides a game plan for eliminating student loan debt and building prosperity within the first 10 years after graduation,” says Sherman Chief Operating Officer/Chief Financial Officer Karen Canup, MBA, CPA. “The college also educates students about federal programs available following graduation, such as income-based repayment plans and loan forgiveness programs.”
Sherman is currently implementing a four-phase reopening plan, where if the outcomes, data and information gathered support it, will result in the fourth phase of resuming live classes on campus in late September 2020, according to Canup.
“Based on government recommendations, guidance from the CDC and an abundance of caution, Sherman College has begun the return to campus with some new safety measures and operational changes,” she says.
Texas Chiropractic College also responded that they work with a financial aid management company, requiring all students to perform entrance and exit counseling, and offering financial literacy to trimester 3 and 7 students each trimester. They also have a monthly financial aid e-newsletter for students, and an update on debt for each student every trimester. Cleveland University-KC, which will use a hybrid on-campus and remote approach this fall, in addition to student and parent aid counseling embeds four formal business courses within the curriculum, along with workshops in business training and other opportunities.
New grads, current students on dealing with debt
DCs new and experienced in the field, along with current students, shared their experiences of dealing with their student debt load, and how they would like to see industry and doctor of chiropractic schools changes to address debt and payback options.
“Like many chiropractors, I went on income-based repayment and will expect a huge tax bomb in 20 years when the loan is forgiven,” said recent graduate Noah Volz. “This drives me to learn more about finances and to hire coaches and accountants who can help me.”
Michaela Edwards, the new president of the American Black Chiropractic Association and a 2009 graduate of Logan University, says higher education needs to change to better support chiropractors to make money directly out of school.
“So many chiropractors graduate from a DC program not fully ready to practice with all of the necessary tools in place,” she says. “Without being able to go straight into practice upon a short time from graduating, such as waiting for board exams, new DCs are unable to work to their potential in order to pay their living expenses and their student debt.”
Edwards said her efforts to consolidate debt hindered her business prospects.
“Student debt has negatively affected my debt-to-income ratio which has, in turn, significantly negatively impacted my ability to obtain a commercial or business loan to build a clinic,” she says. “Before I was able to consolidate my loans, my monthly payment was more than all of my monthly living expenses combined.”
Casey Rogers, a recent graduate and now chiropractic resident at the Bruce W. Carter VA Medical Center in Miami, Fla., found his solution to student debt by working with the U.S. Department of Veterans Affairs.
“My professional goal has always been to provide services for the VA,” he says. “A major benefit of federal service is 120-month federal loan forgiveness. As a newer DC graduate, I was fortunate enough to match with a VA residency, and I plan to stay within federal employment as my career progresses.”
A believer in loan forgiveness for the future of U.S. health care is Alli Totzke, national chair of the Student ACA (SACA) of the American Chiropractic Association.
“DCs don’t usually qualify for most student loan forgiveness options, including those designated for health care professionals,” she says. “One in particular that we have advocated to include chiropractors in is the National Health Service Corps (NHSC), which gives providers the opportunity to work in an underserved area in exchange for student loan forgiveness. The sponsor of the bill to have chiropractors included in NHSC retired from Congress, so ACA plans to reintroduce the bill in the next congressional session.”
Survival mode for DC schools
COVID-19 mitigation, preparation and testing is expensive. This preparation for on-campus schooling in 2020 is in addition to the cost of ramping up or establishing a virtual learning infra-structure for all courses. Doctor of chiropractic schools that are forced through state safety measures or outbreaks to go all-virtual could then miss out on room and board fees that make up a large part of colleges’ incomes, as state support for many institutions has dwindled over the years.
Larger doctor of chiropractic schools have larger endowments to carry them through tough times. Smaller schools have smaller endowments, or little to no endowments, and will be challenged to serve their constituents the longer the pandemic keeps students off-campus.
Even before the pandemic, higher education “was in many ways being held together by prayers, Band-Aids, international students and a lot of debt,” said Mitchell Stevens, an associate professor of education at Stanford, speaking to the New York Times. “What the pandemic creates is a kind of existential challenge to so many colleges and universities and business-model presumptions. That’s an opportunity for fairly radical rethinking.”
The student COVID testing challenge
Another large-school advantage will be on-campus medical programs, health programs and labs for quick on-campus COVID testing and results, and the ability to enact contact tracing to mitigate spread. Small schools without the testing and tracing capacity will likely have to depend on outside labs, where results can take so long that they are useless to controlling the virus spread.
Many large doctor of chiropractic schools with medical facilities and labs are hopeful they will be able to process COVID tests and provide results within 1-3 days. Many schools, including chiropractic colleges and universities, were still in the process of putting together their COVID mitigation plans at the time of this printing, but the University of California-Berkeley is one such large school that shared their plan for student safety.
UC-Berkeley will test all students residing on campus within 24 hours of their arrival at no cost, a test that originated in their campus genomics research lab. Students must then stay in their dorms 7-10 days, leaving only to pick up designated meals or use the bathroom. They are tested during this time, and if positive they will be isolated in a dorm for positive-testing students. After this period students will be tested at least twice a month.
Unhelpful to overall mitigation, say critics, is each college and state enacting their own safety protocols, with most referencing the CDC’s “Interim Considerations for Institutions of Higher Education Administrators for SARS-CoV-2 Testing.” The CDC states, “These CDC considerations are meant to supplement — not replace — any federal, state, local, territorial, or tribal health and safety laws, rules, and regulations with which IHEs (institutes of higher education) must comply. Implementation should be guided by what is feasible, practical, and acceptable, as well as tailored to the needs of each community.”
Finding the path forward
As Stanford’s Stevens said, COVID-19 likely keeping students off-campus this fall will be an extreme financial challenge for universities and colleges, but also “an opportunity for fairly radical rethinking.”
“Government debt repayment programs for DCs working in underserved areas would help to increase the number of clinics in those communities,” the ABCA’s Edwards says. “And preparing chiropractors to start work quickly upon graduating [by moving board exams earlier]. Oftentimes, new DCs find themselves in limbo after graduating because they still have to study for boards in addition to finding the money to complete them while making a living as well.”
Cash-strapped students need the ability to practice sooner after graduation and to be compensated for serving in-need communities. Addressing student debt and additional business and entrepreneurial education are issues not just for students. The same issues are passionately voiced in our schools survey by current practitioners demanding change for the betterment of chiropractic as a whole.
Going forward, schools must most likely adjust to a combination of on- and off-campus learning. On-campus is not only where the institutions pay their bills, but where students, polls show, want to be, to experience the coveted social aspect of college. A poll of 21,000 students in May-July by Niche, a website that reviews colleges for prospective students, showed that 78% of students say they find in-person classes appealing this fall, while 10% found it unappealing, and 12% were unsure.
“We really don’t deal well with uncertainty,” said Joshua Kim, director of online programs and strategy for the Dartmouth Center for the Advancement of Learning who authored the popular article “15 Fall Scenarios” for Inside Higher Education. “No one knows how this will play out.”
Rick Vach is editor-in-chief of Chiropractic Economics and can be reached at firstname.lastname@example.org.