Whether you are a skilled chiropractor guiding patients toward health or a high-powered CEO steering a company, true leadership, at its core, is the commitment to a meaningful mission and the creation of a strategic plan that enables your team to bring that vision to life. To reach your destination, you must first know where you are.
Even Google Maps cannot provide directions without a starting point. Yet identifying where you truly stand is often the most difficult task. Specialists, in particular, are prone to tunnel vision, which blinds them to critical variables. With only a partial understanding of your present reality, how can you possibly create a viable strategic plan?
The chiropractic profession stands at a crossroads: one path leading toward the future we have always envisioned, and the other toward decline. As an entrepreneur, I consider myself a pragmatic optimist, though that may not always be apparent since I often highlight potential challenges.
My intention is not to dwell on the negatives, but to create clarity. Only by facing reality can we make sound decisions. Some of what follows may be uncomfortable to hear, and I ask the reader’s grace as I present these challenges – not to discourage, but to illuminate a path toward a brighter tomorrow.
Where We Stand: A Perfect Storm
So, where are we as a profession? Chiropractic today faces a perfect storm: political hurdles, financial pressures, shifts in education, declining student enrollment, tightening financial aid, and evolving public perceptions. These converging forces represent both our greatest threat and our greatest opportunity. Still, good leadership never presents problems without solutions. With that in mind, I also outline actions that can tip the scales in our favor.
The Education System
Chiropractic’s popularity is at an all-time high. We are the doctors of the people and patients increasingly seek alternatives to medication, particularly for musculoskeletal conditions. For many, chiropractic has become the natural and obvious choice.
Public demand has never been stronger, and many chiropractors have experienced record growth, expanding their practices only to face the harsh reality of being unable to find associates. A chiropractic headhunter recently shared that there are four job openings for every available chiropractor. If the profession is in such demand, why are there so few chiropractors in the marketplace?
One major reason is declining school enrollment. Two decades ago, approximately 15,000 chiropractic students were enrolled in the U.S.; today, that number is closer to 10,000. Students are the future of our profession, and shrinking enrollment suggests contraction rather than growth.
If public demand is rising, why are fewer students pursuing a career in chiropractic? Part of the answer lies in broader trends. Enrollment in higher education overall has declined, and because graduate programs depend on undergraduate pipelines, chiropractic schools have felt the effects. But this is not the only explanation.
Veteran chiropractors often ask students, “What’s your story? Why did you become a chiropractor?” In years past, answers often included dramatic accounts of healing and transformation. Increasingly, however, students are entering chiropractic school without ever having received an adjustment.
Before dismissing this, consider: Do we expect aspiring engineers to have life-changing engineering story, or do we simply accept that they were good at math? Likewise, students entering chiropractic without a personal miracle story may reflect something positive – our profession is becoming a mainstream, a respected career path, on par with medicine.
Still, prospective students are pragmatic. With limitless online resources, today’s undergraduates research their options thoroughly. They quickly learn that while chiropractic can be rewarding, financial success is far from guaranteed.
According to government data, the average chiropractor earns about $70,000 annually, while the average debt load exceeds $300,000. Even though many chiropractors earn far more, especially practice owners, students see the published averages and weigh the risks. For those uninterested in owning a clinic, the outlook appears even less appealing.
Tuition inflation compounds the problem. In higher education, costs have risen dramatically, often detached from actual inflation. Students are treated like commodities, with lenders footing ever-larger bills. The days of working a summer job to cover tuition are long gone; today, two semesters can cost $30,000-$50,000.
Student Loans
Not long ago, Grad PLUS loans were meant for special situations: older students supporting families or those pursuing learning opportunities abroad. Today, most chiropractic students must max out these loans simply to pay tuition and living expenses.
The result is an unsustainable system: graduates burdened with debt they cannot realistically repay. Many rely on income-based repayment and hope for eventual loan forgiveness. This cycle has fueled loan defaults, straining the system to the point that Grad PLUS loans are scheduled for elimination in 2026. While this will devastate chiropractic schools financially, the truth is that the system has long been unsustainable.
Further student loan restrictions are likely, perhaps limiting loans by field of study or institutions with high repayment default rates. If that happens, chiropractic education risks becoming accessible only to the wealthy, forcing many schools to close their doors.
Insurance Reimbursement
We’ve all heard the phrase, “Chiropractors eat their young.” It refers to the harsh treatment of associates who are overworked and underpaid. While stories vary, a key driver is stagnant insurance reimbursement.
Rates have not increased in over 20 years and in many areas have declined, even as expenses have soared. Many established chiropractors want to pay associates more but simply cannot afford to. Yet when possible, they should feel obligated to do so and to encourage associates to repay their student loans.
While chiropractic care saves the healthcare system money, this benefit is recognized only in budget-based systems, such as the VA or self-insured employer programs. Traditional hospitals, whose primary goal is to maximize billing, have little incentive to reduce costs. In fee-based hospitals, physicians may receive the equivalent of 5%-10% of their annual collections.
At current reimbursement levels a busy chiropractor would collect about $400,000 a year and if they were compensated similarly, an associate might earn only $40,000 annually, which is clearly unsustainable.
Some chiropractors promote abandoning insurance in favor of a cash-based system, but such models are impractical in impoverished areas or within national healthcare systems. The reality is that our healthcare system is insurance-based, and we must function within that framework. While cash models may sometimes generate higher income, B.J. Palmer never intended chiropractic care to be reserved only for the wealthy.
Editor’s Note: In part 2, Dr. Short explores the path forward for the chiropractic profession.
