The picture may seem bleak, but denial helps no one. As I said at the beginning [Part 1, February issue], only by confronting reality can we design a better future. So, how do we move forward?
The Financial Equation Must Change
In the early 2000s, graduates carried about $140,000 in debt and earned roughly $80,000 with a ratio of 1.75. Today, debt averages over $300,000, while income hovers around $70,000 with a ratio of 4.29. For chiropractic to remain viable, this ratio must return to around 2.0 or less, which we surpassed around 2005. To move to a sustainable level means increasing income, reducing education costs or ideally, both.
Benjamin Franklin once said, “There are two ways to increase your wealth: increase your means or decrease your wants. The best is to do both.” Likewise, chiropractic schools must lower student costs while simultaneously teaching them how to thrive financially. Currently, business education in most chiropractic programs is laughably inadequate. If schools want to survive, they must deliver meaningful business training and reduce tuition, no matter how difficult administrators claim that may be.
Real solutions must be on the table: cost-sharing with larger universities, expanding online courses to serve more students per instructor, eliminating programs that drain resources, rethinking physical space usage, consolidating administrative roles, and scrutinizing executive compensation. Nothing should be off-limits, and savings must be passed on to students. Practicing chiropractors also need to refer more students to schools that offer lower tuition and stronger business training, sending a message to all chiropractic programs: If you want your graduates to thrive, not just survive, set them up for long-term success.
We Must Recruit Students Earlier
With undergraduate enrollment declining nationwide, chiropractic cannot rely solely on traditional college pipelines. Outreach must begin in high schools, where science-minded students are currently being funneled toward medicine or physical therapy without exposure to chiropractic.
Thanks to the Foundation for Chiropractic Progress, chiropractic education will soon be included in career guides used by counselors, but more must be done. Programs should actively engage high-school counselors and develop dual-credit programs that create clear pathways to chiropractic careers.
Increasing Income Requires Participation and Collaboration
On the income side, all chiropractors should join a national association and demand unity in pursuit of reimbursement parity and full inclusion in Medicare. This change would be transformative, both for chiropractors and for elderly patients who desperately need access to our care. Encouragingly, both the ICA and ACA have introduced positive Medicare bills. Yet, the longstanding division between these organizations has weakened us. It is time to either collaborate or merge into a stronger, unified body.
Momentum is on our side. The current federal administration, influenced in part by Robert F. Kennedy Jr., is open to rethinking healthcare and supportive of chiropractic. There has never been a better moment for us to present a united front. But unity requires participation. Of the more than 70,000 practicing chiropractors in the U.S., fewer than 10,000 belong to either major association. If we want influence, we must show up.
The Choice Is Ours
These are challenging times and the stakes are high. We must secure better reimbursement, attract more students, reduce education costs, expand business training, and above all, unite under one chiropractic banner. If we act with clarity and courage, chiropractic can not only survive but thrive for generations to come. If we fail, or worse, do nothing, our profession will continue to shrink. The choice is ours.
