By Allen Axenfield, DC
Perhaps you are a recent graduate from a chiropractic college. Perhaps you are a highly experienced chiropractor. Either way, you may be thinking about the possibility of practicing abroad.
The idea of helping sick and injured people get better with chiropractic makes a lot of sense to you. You feel like you have the potential to be a professional chiropractic ambassador or pioneer
Well, before you pack up your tools, charts, and portable adjusting table, and start globe trotting, it would be in your best interest to first do your due diligence and know the rules and regulations and current chiropractic climate in the country of your choice.
In recent years, I have worked abroad and visited chiropractors or spoken with chiropractors in Europe, Asia, Central America, and South America. Practices ranged from modest two story walkups with one treatment table to very modern, professionally decorated offices with highly technical patient education, lighting, sound, and expensively imported, high-end treatment tables. The majority of the chiropractors demonstrate a high degree of integrity and professionalism.
Chiropractic and the titles chiropractor, DC, or its equivalent fall into the following categories:
1.) Fully legal
2.) Somewhat legal
3.) Not illegal
Use the Internet to determine where the country of your interest falls on the above list.
Also, if you wish to work abroad, there are other very important considerations including work and residence permits or visas, housing, cost of living, transportation costs, health insurance, emergency air flight home, and various and sometimes confusing cultural considerations.
Communication and language skills are extremely important when considering working abroad. For some chiropractors, being conversant or fluent in the host’s country is not an issue. For others it could be a major challenge. Having the opportunity to live in a non-English speaking country and learning the local language is a rewarding experience with lasting value. Being able to communicate and having the ability to explain the chiropractic story is essential.
I know of one chiropractor who would walk around with a plastic model of the spine anxious for anyone to ask a question while enjoying a coffee at a cafe. Communicating chiropractic around the world could be the sum total of:
- Local language chiropractic patient information posters (I have seen good ones in Dutch, Spanish, French, German, and Italian).
- Verbal language
- A demeanor to talk to everyone to spread the chiropractic story
- Body language
- Hand signs (lots of folks around the world talk with their hands)
In Europe there are those who claim to be chiropractors without having undergone a formal chiropractic education. Whether it was a weekend seminar taught in haste or simply using variations of the chiropractic name, like “chirotherapist,” there are unlicensed and un-credentialed people “competing” with chiropractors.
There are also nonchiropractors and chiropractic “schooling” of educated and noneducated people in what they think is chiropractic. Fortunately, two new recognized schools of chiropractic are available to students in Spain.
The worst situation I am personally aware of is “nonchiropractors” operating and directing a “chiropractic mill” with no regard for chiropractic, the chiropractors, or the patients. It might not surprise you to learn these lay people have a practice style called “high volume.” There is nothing wrong with a properly run high-volume practice, especially when it is not being compared with a “fabriek” (factory).
Now, 115 years since the rediscovery of chiropractic, there is a certain understanding and acceptance of chiropractic in the U.S. Outside the U.S., people are curious and want to look for alternatives to allopathic care. Hands on treatments and programs of care make sense to many Europeans and Asians.
But the understanding of chiropractic is still fragile and subject to certain political and professional criticism.
It is important, therefore, that chiropractic expands in the world with the right people and for the right reasons.
So how can you avoid the pitfalls?
You probably will be able to recognize questionable people by the way they use the Internet to lure chiro
practors to their countries and practices. They take delight in using chiropractic college and noncollege classified Web sites offering things like:
- Work permits
- Language lessons
- Housing (I know of one doctor who was placed in a very substandard room for which he eventually paid even though he thought it was part of his remuneration)
- Health insurance (of course charged to the Doctor)
- Great pay (way too vague)
- Other perks (with no intention of providing what was promised)
Keep in mind that in life when you are offered something that sounds too good to be true, it usually turns out to be a hoax.
Two other important considerations you should be aware of:
- Taxes. Yes, income taxes are an extremely important issue in the European Union (EU). Make sure your employer provides proof in writing that your taxes are being paid. Also, find out from a good accountant your tax liability as a U.S. citizen working abroad.
- Liability/malpractice insurance. While Europeans are not overly litigious, you should have a current policy in hand.
When I was employed in Germany and found out my taxes were not being paid,
I had to hire an attorney. My taxes were paid. Then when I found out there was no insurance for me, I resigned.
One U.S. college Web site I am aware of issues a warning under Employment Opportunities Outside (the) United States that reads:
“Important! Please note: New graduates have had experiences with unscrupulous doctors advertising for associates or listing practices for sale in foreign countries. Be cautious. Always do background checks and get personal references (including current and former employees) when applying to work for someone in another country. Be responsible for obtaining your own “Work Permit.”
I would like to see this caveat posted on all chiropractic college Web sites that publish outside the U.S. or international classifieds.
Should you have any questions or comments concerning any of the above information feel free to contact Allen Axenfield, DC at firstname.lastname@example.org.
The views and opinions in this article are those of Allen Axelfield, DC, not those of Chiropractic Economics, however, you can provide comments or insight on Chiropractic Economics’ Facebook page, www.ChiroEco.com/Facebook.