The first chiropractic college was founded in 1897 by Daniel David (D.D.) Palmer in Davenport, Iowa.
At first named the “Palmer School and Cure,” it was the source of the first professional chiropractors, some of whom went on to found other colleges. In the span of about 50 years, chiropractic schools evolved to encompass laboratories, X-ray facilities, research departments, and by the latter part of the 20th century, most were fully accredited by the Commission on Higher Education, the Council on Chiropractic Education (CCE), and similar national bodies that ensure rigorous standards of education. In other cases, already-established colleges and universities added chiropractic degree programs to their curricula.
In looking at the state of chiropractic education today and where it’s headed, it should be noted that today’s chiropractic colleges are not fundamentally different from any other professional schools—and they face the same challenges. Being medical schools, nearly all of them require prospective students to have completed three to four years of college education, with at least half of that focused on life and physical sciences.
By the time a student graduates with a doctorate in chiropractic, he or she possesses approximately the same knowledge as a medical doctor, with a more specialized understanding of anatomy, physiology, biochemistry, and radiology. Although viewed as working outside or alongside mainstream medicine, chiropractors are the third largest group of medical practitioners, after doctors and dentists.
Personality and emphasis
Although the schools are fairly uniform in their prerequisites for admission and content of their coursework, each has the imprint of its founder in terms of focus and philosophy. Some colleges pride themselves on their lineage and hew closely to the principles established by D.D.
Palmer and his son, Bartlett Joshua (B.J.) Palmer. These tend to stress the primacy of the adjustment and role of subluxations in health care. And some colleges are preparing their students to work as “mixers,” teaching multiple modalities and viewing traditional chiropractic with more of a historical interest. The rest fan out somewhere amid this spectrum.
Prospective students have a lot to weigh in assessing a school. If their parents are chiropractors—which is often the case—they may have a strong inclination to study at their mom or dad’s alma mater. Location, amenities, reputation, philosophy, graduation and job placement rates, cost of tuition, and relationships with other medical institutions are all salient factors.
You might think that students at college have similar worries and anxieties, and to an extent they do. Yet if you speak with administrators and student leaders, a more nuanced picture emerges.
According to Joseph Brimhall, DC, president of the University of Western States, students need to start making plans early for what they want to pursue after graduation, “Whether that is practice, additional education, a residency, or other opportunities, they should start making plans while they are in school.” The sooner they commit to their future direction, the better they can prepare and maximize their time.
Yet they’ll need to make these decisions while juggling the problems that virtually every college student faces. Christopher Cassirer, ScD, MPH, the president and CEO of Northwestern Health Sciences University, notes that most students face common concerns. “One is that while they’re very excited and satisfied with the quality of their clinical education, they don’t have the business skills needed when they graduate. And they are acquiring a significant amount of debt, which will be a concern for them after they graduate.”
Jennifer Razey is a student at National University of Health Sciences, and the national executive chair of the Student American Chiropractic Association. She’s now in the eighth trimester of her program, and is active in student associations. As Razey sees it, a student’s most pressing concerns tend to change over the course of time. “I think it depends where you’re at in the program; in the beginning you’re trying to get through classes and not seeing the light at the end of the tunnel.”
But now, as she’s getting closer to graduation, she’s thinking about whether she’ll want to be an associate DC, in private practice, or taking a position at a hospital. “And debt is something that’s always on our minds,” she says. “It’s a rising concern for any student—where student loan repayment is actually going.”
This is similar to the observations of Michael Mestan, DC, EdD, MS, president of New York Chiropractic College. “Under the surface, they’re anxious, they have their practices to worry about, wondering ‘Where am I going to go, what am I going to do?’ And these concerns grow more prominent the closer they get to graduation.”
Preparing for takeoff
In light of the issues students grapple with, administrators work to get them focused on success while there’s adequate time to prepare. Dennis Marchiori, DC, PhD, is the chancellor and CEO of Palmer College of Chiropractic. “We ask students, ‘Where are you going? How do you want to practice?’ We get them to consider strategic questions and a plan as early as possible. We focus them on the real challenges they’ll be facing.”
In addition to having the right mindset and preparation, students have to be excellent clinicians when they graduate, confident in their abilities. Ron Oberstein, DC, is president of Life Chiropractic College West. He notes his school’s strong focus on clinical experience. “Since the majority of graduating students will be going into practice, it is Life West’s commitment to prepare them for success. This includes having an excellent academic education and a stellar clinical experience. We feel it’s important for students to know their why in what they do, and be able to deliver exceptional care in the clinical setting.”
Oberstein also points to the practical experience students get with Life West’s preceptorship program, where students have to opportunity to study with doctors already in practice. “Our Preceptor Program is currently available to students during their last quarter of the chiropractic program (3 months). Our vision is to expand this program and make it available to students during their final two quarters (6 months). During this time, students can do all their classes online while working in the field and getting real-life experience.”
At UWS, Brimhall says the school encourages students to spend time in a variety of offices and clinics to see how other people practice. “We have, like all chiropractic institutions, internships in our own fee-based and charitable clinics, so students get exposed to different demographics, and preceptorships around the world, which students can take in their twelfth quarter. We have relationships with the VA, the DOD, and hospitals. And we’re finalizing an arrangement with Native American health centers.”
This is similar to how NYCC prepares students, too. “Success is different for each person,” Mestan notes. “In the clinical phase, there’s integration with other health care providers, so our students go through the typical outpatient care center, VA hospitals, and community health centers, and this makes them confident about working in any setting they want to work in.”
Another point raised by Marchiori is that students need to become good at on-going learning. “Traditionally, maybe it wasn’t emphasized, but today there’s a focus on students as lifelong learners, and we have to have skills to navigate that—the need for this has emerged and greatly expanded in the last few decades.” In other words, learning doesn’t stop at graduation. Arguably, that’s when it begins.
Making classes count
As you’d expect, given the cost of obtaining a degree in chiropractic it’s vital for students to make the most of their time in school. “I tell students, on their first day, to remind themselves of what brought them here,” Razey says. “Over all 10 trimesters, they can get bogged down and forget their passion for wanting to help people without drugs or surgery.”
Oberstein suggests that students work diligently at acquiring communication skills. “Regardless of the chiropractic technique one is drawn to, communication is a key factor in success. As one develops effective communication skills, their ability to educate others through communication strengthens and allows them to confidently share the benefits of lifelong chiropractic care with those they serve.”
At NWHSU, Cassirer stresses that students should develop a deep commitment to understanding chiropractic as a profession, because the health care model is changing and it’s highly likely that graduates will be working with other health care practitioners. Accordingly, students who learn to adopt leadership roles can better engage in conversations with other clinicians. “It will be hard for them to be successful if they can’t help others understand the benefits of chiropractic, and how it can help people live better lives,” Cassirer says.
In addition to these components, students need to be mindful of the entrepreneurial skills they’ll need as well. Palmer College surveys its alumni after they’ve been in the field for several years, to learn how well they prepared them for their careers. As a direct result of that feedback, they designed their business departments so that students in school get training in coding, billing, and the management side of running a practice, in addition to providing tools they can use to locate a good place to start a career. As noted earlier, not all students will go into the same type of practice after graduation, so it’s important for them to decide their career path first and then acquire the appropriate business skill sets.
“The world is changing outside the schools,” Razey says. “It’s important to stay on top of that so students can hit the ground running after graduation.”
Education in the 21st century
People who became chiropractors a decade or more ago might be surprised at how much is changing at the colleges. A number of them have become full-fledged universities, homes to multiple colleges offering degrees in health science, acupuncture, psychology, and other disciplines compatible with chiropractic and alternative health care modalities.
Brimhall notes the omnipresence of technology throughout the typical program. “Our students are required to have an iPad tablet. They’ll take almost all their tests on a tablet.” He points to the emergence of hybrid classes, which are part in-class and part online for distance learning. “We’re moving away from the big lecture and more toward small groups. Students can learn from each other too, as they bounce ideas back and forth. So some changes are pedagogical and some technological.”
Cassirer observes the same trends. “The future is about using technology related to learning in a more effective way, offering a more effective education than just sitting in a classroom.” Because they’ve grown up with the internet and smartphones, today’s students are hardwired for technology to be a part of their world, and they expect this in the school setting.
Oberstein agrees: “The majority of the current student population has been accustomed to always having a computer, device and the internet at their fingertips. One of our greatest challenges, as an educational organization, is conforming and adapting to this generational mindset. This isn’t just at chiropractic colleges—college presidents from all areas of higher education are grappling with this.”
Another point Oberstein makes is the emergence of the “flipped” classroom. In past years, students had been used to sitting in large halls or classrooms and taking notes from a lecturer. Now it’s more common for the teacher to send out videos and documents for students to study beforehand. “With this model, the students have access to the class material ahead of time, have had an opportunity to review and study it in advance, allowing time in the classroom to be more interactive—it becomes a hands-on experience for them that will enhance what they’ve already digested.”
For his part, Mestan has seen technology also improve the ways students learn to adjust. Tables with force plates offer objective measurements of force depth and speed, helping students more quickly match the skills of expert adjusters. “Chiropractic education was always rigorous, but now it’s better than many other health care professions,” he says. He also notes the profound change in student demographics. “Back in the day it was mostly white males. Now there’s a shift toward people of color, diversity in gender, and students from elsewhere in the world—and this applies to faculty, too.”
At Palmer, Marchiori says the school has committed to technological improvements, but also upholds traditional tools and methods where appropriate. He’s seeing the approach of augmented and virtual reality tools, and the use of sensors for measuring and building competence in adjusting skills. “Now there are new 3D anatomy software programs, Anatomage dissection tables, etc. We have a number of them. But sometimes you get so enthralled with high tech that you fail to evaluate if it’s augmenting student learning,” he says. “We’ve found that on the whole, students prefer a mixed approach of standard, traditional anatomy, dissection and cadaver labs along with augmented high-tech approaches.”
All institutions of higher learning face similar threats and challenges as tuitions struggle to match the pace at which greater needs arise, regardless of endowments. As private colleges, chiropractic schools are unable to compete for state and federal funding the way public colleges can. And chiropractic schools have to compete with the rest for scarce NIH research grants. They also have to compete for students.
“If someone’s interested in healthcare, they have choices—they might want to be a dentist, podiatrist—deciding what profession, not what college they want to go to,” Mestan says. Another challenge is an increasing degree of accountability. Brimhall notes that 20 years ago, the stress was on the quality of educational inputs, whereas the emphasis today is on how well students demonstrate their competency and mastery of the subject matter.
The road ahead
All of the experts interviewed for this article agree that collaboration with other health care providers is the wave of the future. The successful DC of tomorrow will be comfortable working in an integrated and multidisciplinary environment. And that means they’ll need to demonstrate their value and expertise to others. “We have example after example of DCs practicing in a team setting who can diagnose things that other providers don’t see,” Brimhall says.
Other tailwinds for the profession include the rising cost of health care. This is creating more demand for conservative approaches, and more demand for wellness care that prevents chronic illness from arising. The opioid epidemic doesn’t show any sign of disappearing soon, and chiropractic’s drug-free approach to pain management is the right solution at the right time. Razey is optimistic: “Millennials are passionate about exercise and being fit. We’re becoming more patient-centered and evidence-based, and that will help us treat more patients.”
Today’s students will be the DCs of the future. They face extraordinary challenges, financial burdens, a changed reimbursement landscape, and closer and more complex regulatory and compliance guidelines. The schools are rapidly evolving to meet those demands and prepare students for rewarding and fulfilling careers. Then again, success in the medical arts has always been an exceptional achievement for every generation.
Daniel Sosnoski is the editor-in-chief of Chiropractic Economics. He can be reached at 904-567-1539, firstname.lastname@example.org, or through ChiroEco.com.