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How can chiropractic become a respected mainstream profession? The example of podiatry

September 2008
Chiropractic & Osteopathy 16(1):10

DOI:10.1186/1746-1340-16-10

Source
PubMed

License
CC BY 4.0

Authors:

Donald R Murphy

Brown University

Michael J Schneider

University of Pittsburgh

David R Seaman

Logan University

Stephen M Perle

Health Sciences University

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The chiropractic profession has succeeded to remain in existence for over 110 years despite the fact that many other professions which had their start at around the same time as chiropractic have disappeared. Despite chiropractic's longevity, the profession has not succeeded in establishing cultural authority and respect within mainstream society, and its market share is dwindling. In the meantime, the podiatric medical profession, during approximately the same time period, has been far more successful in developing itself into a respected profession that is well integrated into mainstream health care and society. To present a perspective on the current state of the chiropractic profession and to make recommendations as to how the profession can look to the podiatric medical profession as a model for how a non-allopathic healthcare profession can establish mainstream integration and cultural authority. There are several key areas in which the podiatric medical profession has succeeded and in which the chiropractic profession has not. The authors contend that it is in these key areas that changes must be made in order for our profession to overcome its shrinking market share and its present low status amongst healthcare professions. These areas include public health, education, identity and professionalism. The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise. Several lessons can be learned from the podiatric medical profession in this effort.

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Assessing research culture and capacity amongst faculty at a North American chiropractic institution: an explanatory mixed methods study

Article

Full-text available

Nov 2024

Background Research enables a profession to establish its cultural authority, validate its professional roles and ensure ongoing improvement in the quality of its academic programming. Despite the clear importance of research, a mature research culture has eluded the chiropractic profession. A fostering institutional culture that enables, values, and supports research activity is essential to building research capacity. Our study aimed to collect information about the existing research capacity and culture at the Canadian Memorial Chiropractic College (CMCC) and explore the views, attitudes and experiences of faculty members regarding research. Methods We conducted a sequential explanatory mixed methods study with quantitative priority between April and July, 2023. Quantitative data were collected using the Research Capacity and Culture (RCC) tool. Survey results guided the qualitative data collected from four faculty focus groups with varying levels of research experience. Quantitative data were analyzed using descriptive statistics by domain and stratified by research education and workload. The qualitative data were thematically analyzed and then integrated with the quantitative results to provide deeper meaning to the results. Results The faculty survey response rate was 42% (59/144). Attributes at the organization or department level were consistently rated as either moderate or high; however, research skills at an individual level were more variable and influenced by factors such as research workload and highest research-related academic qualification. Qualitative focus group data were categorized under four themes: institutional factors, resource allocation, career pathways and personal factors. Lower scores for survey items related to mentorship, research planning and ensuring faculty research career pathways, as well as the identified workload and time-related barriers (e.g., other work roles and desire for work/life balance) for engaging in research were supported by each of the four themes. Research motivators included keeping the brain stimulated, developing skills and increasing job satisfaction. Conclusion The quantitative and qualitative information in this study provides a baseline evaluation for RCC and identifies key factors impacting RCC at the CMCC. This information is critical for planning, developing, implementing, and evaluating future interventions to enhance research capacity. Ultimately, these efforts are aimed at maturing the research culture of the chiropractic profession.

The best aspects of being a chiropractor

Article

Apr 2021
J Can Chiropract Assoc

Objective: The aims of this study were to determine the best aspects of being a chiropractor from the practitioners' perspective and to determine job satisfaction among respondents. Methods: An anonymous online survey was distributed to members of the chiropractic profession from August to September 2019. The survey included 25 statements regarded as being "a positive aspect of being a chiropractor." Results: Three hundred and sixty-nine chiropractors responded. Respondents believe that the best aspects of being a chiropractor are that chiropractors can reduce pain, help move or build strength, flexibility, and power in patients. In addition, chiropractors 'being trained to diagnose' and 'being able to transform peoples' quality of life' were highly scored. Job satisfaction overall was rated as high (median score of 9/10). However, there are some aspects that are not highly regarded as best aspects by the profession such as the respect of the public and other health professionals.

Diagnosing Vertebral Artery Dissection: Commentary on the 2014 Mattox Case Report

Article

Full-text available

Jun 2024

Steven Brown

Research shows no convincing evidence to support a causal link between cervical spine manipulation (CSM) and cervical artery dissection (CAD). Researchers have proposed that a belief in a causal link may have significant negative consequences such as numerous episodes of litigation. The objective of this study was to review 10 malpractice cases for evidence of unnecessary litigation due to a belief in a causal link between CSM and CAD. A Google Scholar Case Law search from 1989 to 2024 was conducted to identify the 10 most recent English-language reports of malpractice cases involving an allegation that CSM caused CAD. Although our objective was to review 10 cases, only 9 cases were found. In all cases, causation of CAD by CSM was not supported by the evidence. In 4 out 9 cases reviewed, causation of stroke by CSM was supported by the evidence. In all 9 cases reviewed, failure to diagnose an existing CAD was more likely than not but was not alleged. We conclude that belief in a causal link between CSM and CAD does have negative consequences such as unnecessary litigation. In all 9 cases reviewed, allegations of failure to diagnose an existing CAD would have been more likely to result in a settlement without need for a trial.

“So that life force, to me, is that expression of intelligence through matter”: A qualitative study of the meaning of vitalism in chiropractic

Article

Aug 2022

Research question What do chiropractors mean when they speak about vitalism? Theoretical framework and context Vitalism forms a controversial part of the philosophical basis of chiropractic. However, the precise meaning of vitalism in the profession today is not clear. Methodology Qualitative research design Sample selection Eighteen key informant chiropractors selected by purposive sampling from eight countries Data collection Semi-structured interviews Analysis and interpretation Thematic analysis based on descriptive phenomenology Main results To many participants, vitalism meant the chiropractic concept of innate intelligence, a guide to a good life, and an essence of the identity of chiropractic. To other participants, vitalism meant healthy lifestyle, an obsolete and unscientific doctrine which hindered the profession’s progress, part of unethical practice styles, or an autopoiesis-based neo-vitalism. This study provides the first empirical data specifically on a group of chiropractors’ understandings of the meaning of vitalism. This data confirmed the contents of much of the opinion-based literature for and against vitalism in chiropractic. Given the debate within chiropractic over vitalism, specific areas for future research are recommended. Key words: vitalism, chiropractic, qualitative research, phenomenology, philosophy

Suicide prevention, public health, and the chiropractic profession: a call to action

Article

Full-text available

Dec 2021

Background Suicide is a major public health concern that has wide-reaching implications on individuals, families, and society. Efforts to respond to a public health concern as a portal-of-entry provider can reduce morbidity and mortality of patients. The objective of this commentary is a call to action to initiate dialogue regarding suicide prevention and the role the chiropractic profession may play. Discussion This public health burden requires doctors of chiropractic to realize current strengths and recognize contemporaneous deficiencies in clinical, research, and policy environments. With this better understanding, only then can the chiropractic profession strive to enhance knowledge and promote clinical acumen to target and mitigate suicide risk to better serve the public. Conclusion We implore the profession to transition from bystander to actively engaged in the culture of suicide prevention beholden to all aspects of the biopsychosocial healthcare model. The chiropractic profession’s participation in suicide prevention improves the health and wellness of one’s community while also impacting the broader public health arena.

The conventional identity of chiropractic and its negative skew

Research

Full-text available

Apr 2022

Phillip Ebrall

Objective: To discuss the professional identify of chiropractic as evident in the profession's literature. Methods: Structured literature review followed by a pragmatic historical narrative of found artefacts. Results: The literature appears vague regarding chiropractic's identity. Discussion: The literature does allow a broad determination that the identity of chiropractic is uni-modal gathered around the founding premise of DD Palmer with an informed prediction of a left-skewed, negative distribution of concessional chiropractors representing no more than 30% of all. It appears this minority becomes more dogmatic as it concedes elements of conventional identity and adopts extreme evidence-based musculoskeletal medicine to become a sect of about 0.2% of all. About 70% of chiropractors identify with subluxation in an evidence-informed context and I call this representation the conventional chiropractic identity. Conclusion: The identity of chiropractic may now be described as conventional when its practitioners adhere to the profession's founding precepts, or concessional when it modifies or ignores these. The majority of the profession can be considered conventional. (J Contemporary Chiropr 2020;3:111-126)

Evaluation of United States chiropractic professional subgroups: a survey of randomly sampled chiropractors

Article

Full-text available

Oct 2021
BMC HEALTH SERV RES

Background Professional subgroups are common and may play a role in aiding professional maturity or impeding professional legitimization. The chiropractic profession in the United States has a long history of diverse intra-professional subgroups with varying ideologies and practice styles. To our knowledge, large-scale quantification of chiropractic professional subgroups in the United States has not been conducted. The purpose of this study was to quantify and describe the clinical practice beliefs and behaviors associated with United States chiropractic subgroups. Methods A 10% random sample of United States licensed chiropractors ( n = 8975) was selected from all 50 state regulatory board lists and invited to participate in a survey. The survey consisted of a 7-item questionnaire; 6 items were associated with chiropractic ideological and practice characteristics and 1 item was related to the self-identified role of chiropractic in the healthcare system which was utilized as the dependent variable to identify chiropractic subgroups. Multinomial logistic regression with predictive margins was used to analyze which responses to the 6 ideology and practice characteristic items were predictive of chiropractic subgroups. Results A total of 3538 responses were collected (39.4% response rate). Respondents self-identified into three distinct subgroups based on the perceived role of the chiropractic profession in the greater healthcare system: 56.8% were spine/neuromusculoskeletal focused; 22.0% were primary care focused; and 21.2% were vertebral subluxation focused. Patterns of responses to the 6 ideologies and practice characteristic items were substantially different across the three professional subgroups. Conclusions Respondents self-identified into one of three distinct intra-professional subgroups. These subgroups can be differentiated along themes related to clinical practice beliefs and behaviors.

The prevalence of suicide prevention training and suicide-related terminology in United States chiropractic training and licensing requirements

Article

Jan 2022

Objective: To summarize the prevalence of suicide-related terminology in US doctor of chiropractic educational programs, residency programs, continuing education training, diplomate training programs, and state licensure requirements. The secondary objective was to provide next-step recommendations to enhance suicide prevention education and training for the profession. Methods: A review of public-facing electronic documents and websites occurred from April to May 2020 for doctor of chiropractic program course catalogs, residency program curriculum overviews, state licensing requirements, candidate handbooks for the chiropractic specialties, and continuing education training. Data were extracted to tables reflecting the state of suicide prevention training and suicide-related terminology. Descriptive statistics were used to report the findings. Results: Of 19 doctor of chiropractic programs, 54 relevant courses were identified. No course catalogs specifically mentioned suicide prevention education, but specific risk factor-related terminology was highlighted. For the 10 doctor of chiropractic residency programs, all required mandatory trainee training, which included suicide prevention education. Two states required suicide prevention education training as part of the state re-licensure process and are available through 4 continuing education courses. No diplomate training program handbooks included a requirement of suicide prevention education though suicide risk-factor terminology was described in some handbooks. Conclusion: The state of suicide prevention training in the chiropractic profession documented in handbooks is largely lacking and widely varied at this time. The development of profession-specific suicide prevention continuing education may be beneficial for practicing chiropractors, and suicide prevention curriculum development at the doctor of chiropractic programs may prepare future doctors of chiropractic.

The prevalence of suicide prevention training and suicide-related terminology in United States chiropractic training and licensing requirements

Article

Jan 2022

Objective To summarize the prevalence of suicide-related terminology in US doctor of chiropractic educational programs, residency programs, continuing education training, diplomate training programs, and state licensure requirements. The secondary objective was to provide next-step recommendations to enhance suicide prevention education and training for the profession. Methods A review of public-facing electronic documents and websites occurred from April to May 2020 for doctor of chiropractic program course catalogs, residency program curriculum overviews, state licensing requirements, candidate handbooks for the chiropractic specialties, and continuing education training. Data were extracted to tables reflecting the state of suicide prevention training and suicide-related terminology. Descriptive statistics were used to report the findings. Results Of 19 doctor of chiropractic programs, 54 relevant courses were identified. No course catalogs specifically mentioned suicide prevention education, but specific risk factor-related terminology was highlighted. For the 10 doctor of chiropractic residency programs, all required mandatory trainee training, which included suicide prevention education. Two states required suicide prevention education training as part of the state re-licensure process and are available through 4 continuing education courses. No diplomate training program handbooks included a requirement of suicide prevention education though suicide risk-factor terminology was described in some handbooks. Conclusion The state of suicide prevention training in the chiropractic profession documented in handbooks is largely lacking and widely varied at this time. The development of profession-specific suicide prevention continuing education may be beneficial for practicing chiropractors, and suicide prevention curriculum development at the doctor of chiropractic programs may prepare future doctors of chiropractic.

De la chiropodie à la podiatrie : progression des formations à l’international

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May 2021

Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007

Article

Full-text available

Jan 2010

This report presents selected estimates of complementary and alternative medicine (CAM) use among U.S. adults and children, using data from the 2007 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). Trends in adult use were assessed by comparing data from the 2007 and 2002 NHIS. Estimates were derived from the Complementary and Alternative Medicine supplements and Core components of the 2007 and 2002 NHIS. Estimates were generated and comparisons conducted using the SUDAAN statistical package to account for the complex sample design. In 2007, almost 4 out of 10 adults had used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (17.7%) and deep breathing exercises (12.7%). American Indian or Alaska Native adults (50.3%) and white adults (43.1%) were more likely to use CAM than Asian adults (39.9%) or black adults (25.5%). Results from the 2007 NHIS found that approximately one in nine children (11.8%) used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (3.9%) and chiropractic or osteopathic manipulation (2.8%). Children whose parent used CAM were almost five times as likely (23.9%) to use CAM as children whose parent did not use CAM (5.1%). For both adults and children in 2007, when worry about cost delayed receipt of conventional care, individuals were more likely to use CAM than when the cost of conventional care was not a worry. Between 2002 and 2007 increased use was seen among adults for acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga. CAM use for head or chest colds showed a marked decrease from 2002 to 2007 (9.5% to 2.0%).

Patients Using Chiropractors in North America

Article

Feb 2002

Summary of Background Data and Objectives. Alternative health care was used by an estimated 42% of the U.S. population in 1997, and chiropractors accounted for 31% of the total estimated number of visits. Despite this high level of use, there is little empirical information about who uses chiropractic care or why. Methods. The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). Surveys collected data about the patient’s reason for seeking chiropractic care, health status, health attitude and beliefs, and satisfaction. In addition to descriptive statistics, the authors compared data between patients and chiropractors, and between patients and previously published data on health status from other populations, corrected for the clustering of patients within chiropractors. Results. More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Chiropractic patients had significantly worse health status on all SF-36 scales than an age- and gender-matched general population sample. Compared with medical back pain patients, chiropractic back pain patients had significantly worse mental health (6–8 point decrement). Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care. Conclusion. These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system.

Philosophy and science versus dogmatism in the practice of chiropractic

Article

Dec 1998

David R Seaman

The Question of Theology for Chiropractic: A Theological Study of Chiropractic's Prime Tenets

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Dec 2001

Timothy Mirtz

Chiropractic: History and evolution of a new profession

Article

Jan 1995

Herbert C. Northcott

Subluxation - the silent killer

Article

Mar 2000
J Can Chiropract Assoc

Ronald Carter

Podiatric medicine: history and education

Article

Dec 1975
J Am Podiatr Med Assoc

J E Bates

The residency in podiatric medicine. A brief historical overview

Article

Dec 1992

J Levrio

The author provides a general overview of the development of postgraduate residency training in podiatric medicine since 1956. The evolution of residency standards and requirements of the Council on Podiatric Medical Education are discussed. Integration of specialty organizations in the residency evaluation process also are reviewed. The author notes that the current positive number of entry level residency positions available to graduates of colleges of podiatric medicine may be a dubious facade in view of increasing college enrollments and the potential conversion of rotating podiatric residencies to residencies in primary podiatric medicine. He cautions the profession not to overlook these events as it considers the development of the PGY-1 concept in the restructuring of entry level residency training.

Curriculum at the Scholl College. Toward mainstream medical education

Article

Jul 1992

J H Becker

The Dr. William M. Scholl College of Podiatric Medicine in Chicago recently affiliated with a teaching hospital, the Illinois Masonic Medical Center, and used this alliance as a catalyst to effect a change in the clinical curriculum. The affiliation set up a joint venture to operate two clinics, one on Scholl College's traditional campus and one at the teaching hospital. At the hospital site, Scholl College students rotate through clinical externships in areas such as internal medicine, emergency medicine, and podiatric elective; podiatric and general medical residents assist in the tutelage of the students. At the Scholl College campus, beginning clinical students learn basic skills in a teaching clinic, then refine and further their skills in a comprehensive clinic under the guidance of faculty members. The faculty and administration at Scholl College have embraced the concept of mainstream medical education, and are striving to prepare podiatric physicians to practice 21st century medicine.

History of podiatric medical education. An update

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