The ACA commissioned a chiropractic consultant, Christine Goertz,DC,PhD, to orchestrate the 2000 American Chiropractic Association Statistical Survey, which was conducted over the first six months of 2000. Doctors were asked to report information pertaining to the last full year in which they had data. Approximately 71 percent of respondents chose to report for 1999. The remainder reported for the last half of 1999 and the first half of 2000. As there were no significant differences between the figures presented in both reporting periods, the data were pooled. The survey was sent to a national randomly selected sample of 4,000 ACA members and 1,000 nonmembers obtained from ACA databases. The methodology used to draw the sample is consistent with that used in 1999, and it includes doctors of chiropractic that have been in clinical practice for less than five years. An overall response rate of 30 percent was achieved.
For the first time, it is possible to make a direct historical comparison between a current ACA professional survey and a previous effort. For this reason, historical data from 1997 are occasionally included for interest.
Following is a summary of demographic, practice, managed care, and income information obtained from the 2000 ACA Professional Survey:
Personal Characteristics
Gender and Age and Years in Practice
Approximately 86 percent of respondents were male. This figure is slightly lower than that reported in 1997, but consistent with what has been reported in previous ACA surveys. The average age of respondents was 45 years. The average length of time spent in chiropractic practice was 17 years, with 10 percent of respondents in practice for four years or less, and 10 percent in practice for 30 years or more.
Education
Approximately 75 percent of respondents held a bachelor's degree in addition to a doctor of chiropractic degree. Less than four percent reported having any of the following degrees: master's, PhD, MD, PT, or DO.
General Practice Characteristics
Location of Practice
The majority of chiropractic physicians (92 percent) reported that they practiced in one state only. More than one-quarter of respondents practiced in communities of between 2,500 and 24,999 people. While 47 percent of the DCs practiced in communities of less than 50,000, 53 percent are concentrated in communities with more than 50,000 people. Approximately 10 percent of respondents practiced in urban areas of more than one million residents. Most DCs (70 percent) said that they practiced in a small town or suburban setting.
Sixty-two percent of the surveyed DCs stated that their communities had "about the right number" of chiropractors in relation to demand, while 29 percent said that there were too many, and nine percent responded that the community needed more DCs. These figures are approximately the same as those found in the ACA's 1995 and 1997 surveys.
Activity Level
On average, respondents reported spending just over 43 hours per week attending to all aspects of their practices, which is consistent with 1997 figures. According to this survey, DCs spent 30 hours per week in direct patient care, eight and one-half hours documenting patient care services, and just under five hours in administration/billing activities. Interestingly, 40 percent of the doctors' office time was spent on documentation and reimbursement issues.
Principal Form of Employment
Seventy percent of those surveyed were in solo private practice, with 24 percent in group or partnership practices. Nearly three percent of respondents reported that they were employed by another DC, and less than one percent teach at a chiropractic college or are employed by a hospital or HMO. Seven percent reported that they had hospital privileges (defined as co-admitting privileges/able to treat patients in the hospital).
Patient Visits
An average of 115 patient visits per week, representing 69 individual patients, was found. Those surveyed saw approximately seven new patients per week during this reporting period.
Patient Referrals
Doctors of chiropractic referred over 27 percent of their patients to other providers, including 16 percent to medical doctors (general practitioners - 6.7 percent; orthopedic surgeons - 4.7 percent; and neurologists - 4.4 percent), 2.7 percent to physical therapists, and 3.7 percent to alternative medicine practitioners.
Conditions Treated
The vast majority of patients seen were treated for neuromusculoskeletal conditions:
There are interesting differences between the median and the mean responses pertaining to treatment of non-neuromusculosketal conditions: hypertension (mean = 2.5 percent; median = one percent); GI disorders (mean = 3.7 percent; median = one percent); asthma (mean = 2.6 percent; median = one percent); viscerosomatic conditions (mean = 4.3 percent; median = one percent).
These figures indicate that a relatively small number of DCs are responsible for treating the majority of chiropractic patients with these non-neuromusculosketal complaints. Please note that the percentage of conditions treated will add up to more than 100 percent, as one patient may be treated for more than one condition.
| Treatments | % of Patients |
| spinal manipulation therapy/adjustment | 96 |
| physiotherapeutics e.g., EMS or ultrasound | 56 |
| soft-tissue massage | 47 |
| moist heat or ice | 45 |
| nutritional counseling | 23 |
| acupuncture or homeopathy | 5 |
Office Assistants
The average number of full-time chiropractic assistants in each office is 1.5, with approximately one additional full-time equivalent (FTE) each for receptionists, insurance/billing personnel, and office managers. Other personnel include massage therapists (.69 FTE), acupuncturists (.2 FTE), and nurse practitioners or physician assistants (.2 FTE). Respondents reported that, altogether, staff spent 22 hours in patient care, 12 hours in documentation activities, and 27 hours in administration and billing activities.
Fees and Income
Sources of Revenue
Income from private insurance carriers, excluding managed care programs and automobile insurance companies, was 21 percent. The percentage of fees received from HMOs, PPOs, and automobile insurance is nine, 12, and 14 percent, respectively. Cash receipts from patients were at 26 percent. Workers' compensation accounted for seven percent of revenues, while Medicare Part B accounted for 10 percent of revenues. Medicare HMOs and Medicaid each accounted for around one percent of total revenues.
Gross and Net Income
The median gross income reported by the year 2000 was $220,000; median practice expenses were reported at $120,000; and individual net income was reported as $81,500.
Managed Care
The majority of respondents reported that they participated in managed care programs, with 13 percent involved in some type of capitated arrangement. Fifty-nine percent of respondents reported that involvement in managed care had decreased the average frequency of patient contact. Only 24 percent of respondents felt that being involved in managed care decreased the average amount of time they were able to spend with patients during each visit; however, 41 percent reported that managed care had decreased the quality of care they delivered to their patients.
Student Loans
Seventy-three percent of respondents reported getting a chiropractic college student loan while in school. The average amount borrowed was $45,836, while the average amount still owed equaled $21,989.
Patient Characteristics
Age
Respondents reported that approximately 12 percent of their patients were under the age of 16. The largest group of patients - 37 percent - was in the 17-to-44 age group, with the 45-to-64-year-old group encompassing 34 percent of patients. Eighteen percent of patients were over the age of 65.
Gender
The survey showed that 58 percent of chiropractic patients are female.
Office Equipment
X-Ray Equipment and Use
Survey respondents reported 60 percent of their new patients received x-rays, a decline from the 69 percent reported in 1997 and 75 percent reported in 1995. About 13 percent of patients were x-rayed again during the course of treatment, which is consistent with data from previous surveys. It appears that the number of new patient x-rays is declining, while the number of established patients who were x-rayed again during the course of treatment remains the same. Seventy percent of new Medicare patients received x-rays.
Computer Use
Seventy-one percent of respondents reported having access to online services in their offices, a sharp increase from 56 percent found in 1997. Similarly, use of the internet has climbed from 33 percent to 60 percent, and the use of electronic claims has gone from 34 percent to 41 percent. In addition, 68 percent of DCs reported having access to e-mail in their offices.
Patricia Jackson
Vice President
Professional Development and Research
American Chiropractic Association
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