Chiropractic Education in Transition: How Will Our Chiropractic Colleges Survive?

"We tend to overestimate the changes we can make in the short term, but underestimate the changes we can make in the long term." - anonymous

The stage is set for some dramatic changes in chiropractic education:

• There are three new U.S. chiropractic colleges in the offing: Florida State University in Tallahassee (enrollment in fall 2002); Marycrest International University, Denver, Colorado (classes to begin Aug. 15, 2000); and a Palmer College facility in Port Orange, Florida (the goal is to have a plan and presentation in time for the Oct. 12-14 Palmer Board of Trustees meeting).

• National College of Chiropractic becomes the National University of Health Sciences on September 1, 2000. Northwestern College of Chiropractic is now part of Northwestern Health Sciences University (NHSU), whose colleges include the Minnesota Institute of Acupuncture and Herbal Studies, an integrative health and wellness program, and a professional school of massage.

• The Association of Chiropractic Colleges (ACC) admits that enrollment is down an average of 15 percent over the last two years.

• There are new opportunities for teaching foreign students at U.S. chiropractic colleges.

• There are rumors of substantial faculty layoffs at several U.S. chiropractic colleges.

• There is a continuing effort to move North American chiropractic colleges from private institutions to public universities.

What's happening at the chiropractic colleges should come as no surprise, considering the impact of managed care and a growing interest in "alternative care." The chiropractic profession in the U.S. has been under pressure to change for over a decade. This has been a time of tough decisions for individual doctors of chiropractic and the institutions that produce them. Eventually, we all knew the effects would filter down to our chiropractic colleges. The chiropractic colleges have some tough decisions to make. Some of these decisions will be advantageous, while others will be prompted strictly by survival.

While the decisions made by our colleges may be frightening for some, they drive the impetus for needed growth and development. Given that change is an opportunity to make things better, what goals should dictate these decisions? Should we focus on short-term goals (survival)? What decisions can we make to affect the long-term growth of chiropractic in North America?

The future is never easy to predict, and even harder to control. Technology, public opinion and chance have a way of thwarting the "best laid plans." The best long-term decisions for our chiropractic institutions may not be the most popular ones.

There is much to consider here. According to one study on "alternative medicine," chiropractic provides over 30 percent of the services that fall under this category, more than any other profession or form of care.¹ Should our profession become more eclectic and offer patients other forms of alternative care? Can doctors of chiropractic effectively deliver other forms of alternative care?

Meanwhile, physical therapists, osteopaths and some MDs are trying to supplant the chiropractic adjustment with "medical manipulation." There is the argument that the DC should concentrate on being the best adjusters, rather than just another alternative care provider. Shouldn't DCs strive to keep chiropractic "pure" and remain a distinct profession? Isn't this what has made chiropractic so successful for the last 105 years?

Entwined in this debate are substantial economic realities. The ability to be successful ultimately applies enormous pressure on doctors to adapt their practices to what the public wants and what they can make money doing. The same pressures and economic realities are felt at the chiropractic colleges. As noted earlier, some colleges are expanding their programs to offer broader choices in health care professions.

Chiropractors in over 100 other countries are watching to see what direction the profession takes in the U.S. Will they learn more from our successes or from our mistakes?

Back to the original questions: How will our chiropractic colleges best survive (and perhaps even thrive) in these tumultuous times? Will some of them fail? Granted, the colleges that make the best decisions will be the ones with the most promising futures, but what are the best decisions? The best decision for one chiropractic college may be the worst decision for another. If the best decisions were clear, they would be easy to make.

While we all have opinions on the best course of action, this is a time when we should give leeway to our chiropractic colleges. Let's not be too quick to judge their decisions. It may take a few years to discover the potential of some of those tough decisions - decisions which may propel chiropractic into an exciting future.

Reference

1. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC. Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998;280:1569-1575.

DMP Jr.