The longer I serve in chiropractic, the more convinced I become that our colleges are our strongest vehicle for driving the profession forward and helping more people gain access to vitalistic care. Because we're creating the next generation of practitioners, we have the potential (and responsibility) to educate doctors who will play a larger role in wellness and neurological care.
But the milieu in which we operate is changing dramatically and we have to change with it or – even better – ahead of it. The following key trends are impacting chiropractic education today, and providing both challenges and opportunities to advance the profession.
Massive Open Online Courses (MOOCs)
You may not yet be familiar with MOOCs, but they are coming and they represent a sea change in education delivery. Harvard, Stanford, the University of California-Berkeley and a growing number of other elite universities are now offering some of their most popular courses online for free. MOOC stands for Massive (as in enrolling tens of thousands) Open (to anyone) Online (web-based only) Courses.
MIT really changed the game last spring when it offered (through MITx, its online teaching initiative) the popular Circuits and Electronics class as an MOOC; 146,000 eager students signed up. While "only" about 7,800 students made it all the way to the final exam, that figure is not far off from nearly the whole of chiropractic college enrollment across the country.
We don't yet know the impact MOOCs will have, and how far and quickly they will spread. But the trend warrants significant study to assess the impact of top schools providing courses that might typically have been completed at a student's "home" institution; and to look for opportunities to fill a unique niche based on our particular strengths.
For instance, every year thousands of students take first-year, basic science courses in traditional classrooms all across the country. The courses are faculty- and resource-intensive with small class sizes, laboratory facilities and the physical presence of both the teacher and students. Could our chiropractic colleges possibly work together to offer a first-class basic science MOOC for our own students with a unique vitalistic emphasis?
We might even market a health care career prerequisite degree with a vitalistic emphasis to students interested in becoming nurses, physical therapists and medical doctors as one way to bridge the understanding gap between chiropractic and other health care professions, while also expanding the inquiry pool for chiropractic students.
MOOCs have the potential to transform higher education and address some of the key issues universities face today, including shrinking budgets, rising costs, and protests over soaring tuition and student debt. Which brings me to my next point: the cost of education.
Educational Costs and Gainful Employment
Pressure is steadily growing for colleges and universities to prove the benefits received by graduates in terms of their ability to enter their intended field. Much of this pressure stems from the for-profit education sector, where these institutions have been harshly criticized for enrolling students who either do not persist to degree obtainment or are unable to find gainful employment upon program completion.
The issue is a big one for all colleges, and a critical one for our profession. The average chiropractic student leaves our institutions with $150,000 in debt. That is a very tough way to start out in practice. And individuals who do not meet their goals in practice are highly unlikely to recommend their profession to others.
There are many things impacting the rising cost of a college education: from student expectations for expensive amenities to the cost of compliance with an ever-growing body of state and federal regulations, to the huge investments we must make today in campus technologies. However, none of that is an excuse for doing nothing while we watch the constantly rising costs that seriously impact a student's ability to repay college loans and get started in practice on the right foot.
We have to find ways to manage the cost of chiropractic study and help graduates succeed in practice. Some things we might consider include pooling our resources more frequently in terms of recruiting efforts across all chiropractic colleges, exploring joint purchasing arrangements, creating alumni networks that provide critical support to new graduates, and using online technology or even MOOCs. Which again, leads right into my next point: educational outcomes.
Measuring Our Success
Higher education is changing dramatically from tracking hours spent in a seat in a classroom to measuring outcomes produced by the educational effort. Today's prospective students, the federal government, private funding sources and potential employers all want to know if students have mastered the skills for success, not just if they've logged the time spent working on them.
We are moving toward more outcomes-based curricula within our courses, but at the same time we need to transition to outcomes-based measures for our graduates. We need much more detailed data on issues such as how long it takes for new graduates to establish a practice, how long until their practice hits break even, time required to pay back student loans, and levels of satisfaction in practice. Just as prospective students in traditional four-year colleges have for years inquired about "placement rates" of graduates, chiropractic students have a right to expect specific data on the success of the alumni who have come before them.
Collecting data like this, however, requires additional investments in manpower and often technology, as well as a willingness of graduates to share information candidly.
Non-Medical Integrated Wellness
Although change is hard and practitioners are wary of further restrictions on reimbursement and practice autonomy, one of the most exciting aspects of federal health care reform is that it's moving in our direction. Even if the impetus is cost-containment, the thinking of health policy leaders is still moving away from a high-tech disease treatment model to a prevention and lifestyle approach.
During Life University's 4th annual Octagon Conference last year, which focused on helping the profession better understand the Patient Protection and Affordable Care Act, many speakers referenced the fact that, even under the best circumstances, our national investment in health care only increases life expectancy by 10 percent.
The most significant potential in health care reforms lies in a massive shift of resources to behavioral and wellness changes that will both improve health and save money. Of course, the sick will still receive needed care, but if we focus more on keeping well people well, and how to get the marginal folks up into wellness, our nation will dramatically change how it invests its health care dollars.
The motivation might be dollars and cents, but the impact will show up in increased investment in services that truly promote health, which is chiropractic's sweet spot. Of course, to play a larger role in wellness care, chiropractors have to be prepared to function as part of a non-medical-based integrated team that may include midwives, alternative practitioners and, when necessary, responsible MDs. Admittedly, that is best done during the education process.
Our colleges must revise curricula and clinic expectations to provide greater understanding of and access to a diverse range of health care providers. Likewise, we need to open our doors to colleagues in other disciplines to help them better understand our unique role. National health care and appropriate referral relationships will only exist where practitioners have grown to know, understand and respect their colleagues, and not think of other providers as the enemy.
Advancing Technology
It's happening in every field and it's no different in chiropractic. Our students arrive at our campuses completely comfortable with technology and expecting us to deliver fully wired buildings, Wi-Fi across campus, online coursework, lecture capture that enables 24/7 access to information, and electronic patient records. They expect to run their lives and practices from their smartphones and might even consider a traditional phone call a strange interruption.
The implications for engaging young people with the chiropractic profession are significant. Practicing chiropractors are still a critical source of student referral into the profession, and your role in reaching out to students via e-mail and social networking is key to getting them connected to chiropractic. Your practice website and blog may be key resources for their early education about what chiropractic is and about a career in the profession.
On our campuses we are striving every day to meet students' voracious demands for the latest technology. In the field, practicing chiropractors and our professional organizations need to consider how to most effectively use technology to reach the next generation of chiropractors.
With so many diverse challenges and opportunities heading straight for our profession, this is an especially good time to take a leadership role in intra- and interprofession collaboration. Prospective chiropractors want to engage with a dynamic profession in constant communication and dialogue with its own members and with other health care providers focused on helping people maximize their performance.
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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A central challenge in creating our identity is that chiropractic is a method of care, not a technique or procedure. This is an important concept for us to promote. Our patients are treated with lifestyle modification, exercise, nutritional supplements, diet and a whole-body approach to accelerate the natural healing process. We are not simply CMT providers.
The results of a global survey released late last year (2023) unveiled some startling findings among medical and nursing students. The “Clinician of the Future: 2023 Education Edition” surveyed 2,212 students, of which 446 were in the United States, from 91 countries.
