The future of chiropractic: How can we evolve the profession?

According to 2024 data from the Federation of State Boards of Physical Therapy, the US has about 310,000 licensed physical therapists,¹ compared to the often-cited 70,000 doctors of chiropractic practicing in the US.²

Why do statistics show significantly more PTs than DCs? Both professions treat musculoskeletal conditions, yet as physical therapists increasingly integrate manual therapy and joint manipulation, the distinction between the two is becoming less clear to the public.

Many within our profession argue DCs must “own the adjustment,” meaning keep it within the scope of practice for chiropractic alone. However, as PTs refine their spinal manipulation techniques and scope-of-practice lines blur, how will DCs further differentiate themselves in a healthcare market that presents patients more choices than ever?

The future of chiropractic profession faces critical challenges

Just a few of the obstacles facing DCs today include high student loan debt, inconsistent public perception of chiropractic, a lack of standardization the field, comparatively poor insurance reimbursement and limited coverage of services.

These challenges have led to a high dropout rate among DCs, with some estimates suggesting only 50-75% of graduates remain in practice after several years.³ If retention could increase to 80% or higher, the number of active DCs would grow organically, helping fill the gap retiring practitioners leave.

But to attract more students, retain new DCs and strengthen our place in healthcare, we must address key foundational issues.

Can the future of chiropractic find unity?

One of the biggest challenges facing our profession is a lack of unity. DCs divide themselves by various techniques, philosophies and practice styles, making it difficult to present a cohesive identity to the public, medical community and health insurers.

This lack of consistency can easily create confusion. A patient with lower back pain who visits 10 different DCs will likely receive vastly different treatment from each, while a patient who sees 10 PTs will experience far more standardized care. This inconsistency makes it difficult for patients to navigate their options, challenging for medical professionals to refer their patients to DCs and easy for insurance companies to justify reduced reimbursement to DCs.

People like knowing what to expect when they visit a business, and that includes healthcare businesses. Our kids play travel baseball, and when we’re out of town we often stick with familiar franchise restaurants because we know exactly what to expect. We don’t have time to risk a long wait or an unknown menu item we might not like.

Now, imagine that same dilemma for patients looking for chiropractic care. Even as a provider, I find it difficult to find a DC in another city who practices the way I do. I look at their school, graduation year and services offered, but even then it’s still a gamble.

Medical professionals who refer patients to my practice often ask why other DCs in the area don’t practice the same way I do. This is not a good sign—consistency matters, especially in healthcare.

A patient seeking a musculoskeletal approach should be able to find a musculoskeletal-focused provider easily. Likewise, someone seeking a subluxation-based DC should be able to identify that type of provider without confusion.

Possible categorization of chiropractic care

Would DCs ever agree on one universal standard? Probably not. But could we agree on clear categories to help patients make informed choices? Possibly. I suggest the following:

• Musculoskeletal-focused. Soft-tissue therapy, spinal manipulation and corrective exercises.
• Subluxation-based. Primary focus on spinal adjustments and nervous system function.
• Upper cervical specialist. Focus on upper cervical-specific adjustments.
• Energetic and functional healing. Applied kinesiology, network spinal or other low-force techniques.
• Modality-focused. Decompression, laser, pulsed electromagnetic field therapy, shockwave or other therapies.

This structured classification could improve patient expectations, while allowing diversity within the profession. If patients and medical providers had a clear way to understand different chiropractic models, a categorical approach could help elevate the profession as a whole.

Fix the (big) financial problems

Many challenges in chiropractic stem from financial issues:

• Tuition costs have skyrocketed. Chiropractic graduates average $200K-$300K+ in student loan debt,⁴ with debt-to-income ratios exceeding 500%.
• Many new graduates struggle financially. Limited new patient flow and low insurance reimbursements restrict income potential.
• Chiropractic office owners don’t earn enough. If practice owners made their businesses more profitable, they could pay associate DCs better, increasing job retention.

My wife and I graduated with more than $300,000 in student loan debt because she earned dual degrees in chiropractic and acupuncture. Fortunately, with the right mentors, work ethic and business acumen, we were able to pay that off before I turned 30.

But many new grads aren’t as lucky. If someone graduates with $250,000 in loans and starts making $60,000 a year, their debt-to-income ratio is unsustainable.

Unlike PTs, who often work in hospitals with guaranteed salaries, most DCs must start and run their own businesses without the financial safety net of hospital or other employment.

The path forward: What needs to change?

To address the DC shortage, increase earnings and secure our place in the healthcare system, we must:

• Increase the number of new DCs by improving career opportunities and financial incentives.
• Reduce chiropractic school length and thus costs. Could we trim the curriculum to three years instead of four?
• Improve business and marketing training to make the profession more accessible and financially sustainable. Many DCs fail because they lack business skills.
• Create more employment opportunities. DCs becoming a fixture in hospital systems or medical groups could help increase career stability. They need a wider variety of employment options, not just practice ownership.
• Raise practice owner earnings, allowing them to increase associate DC salaries. If owners are more profitable, they can hire and pay better.
• Prove chiropractic care’s value to insurers. AI-powered outcome tracking could validate the future of chiropractic as a healthcare cost-saving tool and improve coverage.
• Improve public awareness and satisfy patient expectations. Categorizing DCs by services offered could help patients understand their options.

Final thoughts: We need a multi-pronged approach for the future of chiropractic

If we do nothing, the future of chiropractic professions will decline as PTs absorb more of the musculoskeletal market. More data, better business strategies and financial incentives will pave the way forward.That’s a cause everyone can rally behind.

Naota Hashimoto, DC, is the cofounder of TrackStat (trackstat.org), patient tracking software that makes it easy to attract and convert new patients while ensuring existing patients stay in your practice. It offers new ways to retain patients as well as ways for staff to communicate and schedule patients while providing you all the metrics of success.

References

1. 2024 FSBPT Census of Licensed Physical Therapists and Physical Therapist Assistants in the United States. The Federation of State Boards of Physical Therapy. https://www.fsbpt.org/Portals/0/documents/free-resources/2024%20FSBPT%20Census%20of%20Licensed%20PTs%20and%20PTAs%20in%20the%20USA.pdf. Accessed June 9, 2025.
2. Key facts and figures about the chiropractic profession. American Chiropractic Association.[News]. https://www.acatoday.org/news-publications/newsroom/key-facts. Accessed June 9, 2025.
3. Rigney CT, et al. Chiropractic profession attrition: A narrative review of studies over the past 30 years. J Chiropr Humanit. 2023;30:9-15. PubMed. https://pubmed.ncbi.nlm.nih.gov/37313265/. Accessed June 9, 2025.
4. Payne K. Chiropractic loan forgiveness vs. refinancing: Which is best? [Internet]. Student Loan Planner. January 11, 2024. https://www.studentloanplanner.com/student-loan-refinancing-chiropractors/. Accessed June 9, 2025.