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The Student Loan Mess:
Why Chiropractic Is in Trouble
Timothy A. Mirtz, D.C.
The default rate for student loans is much higher among chiropractors
than it is among graduates of any other health profession, Chiropractic
leaders would like you to believe this situation exists because
the loan program is flawed and reflects "discrimination"
against their profession. The simple truth, however, is that
the default rates signify that the profession itself is in deep
The Federal Health Education Loan (HEAL) program was enacted
under Public Law 94-484 and took effect in October 12, 1976.
In 1981, Public Law 97-35 made chiropractic, health administration,
and clinical psychology students eligible to borrow up to $12,500
per year for four years. In 1992, Congress raised the the maximum
graduate students could borrow in federal loans from $11,500
to $18,500. Of this amount, $8,500 is available as a subsidized
Loan on which the government pays interest while the student
is in school. The remaining $10,000 is available through an unsubsidized
Stafford loan, on which interest starts to accrue immediately.
Borrowers obtain these loans through private lenders or directly
from the federal government. Private lenders aggressively market
their own loan programs to graduate students typically with rates
pegged to the 91-day Treasury bill plus 2.4 to 3.25 percentage
points while one is in school and rising to 2.85 to 3.5 points
after graduation .
From fiscal year 1978 through 1998, the HEAL program insured
loans to over 156,000 borrowers and was a big help to chiropractic
schools and their students. But as time went on, it became clear
that the default rate of chiropractic graduates was very high.
By 1991, taxpayers had lost an estimated $3.6 billion on bad
student loans, and the Bush Administration recommended dropping
chiropractic from the HEAL program . Congress did not do this
, but increasing debt (from $10 million in 1987 to $42 million
in 1992) stimulated the Department of Health and Human Services
to release the names of defaulters with the hope that public
humiliation would pressure them into paying. Many media outlets
responded by portraying the defaulters as "deadbeats, but
some defaulters were portrayed sympathetically. In St. Charles,
Missouri, for example, the local newspaper issued these contrasting
The U.S Attorney's office is looking for two "deadbeats"
in St. Charles County who have defaulted on more than $200,000
in student loans. "We consider them deadbeats, even though
they are professionals and graduates of chiropractic colleges,"
said Eric Tolen, assistant U.S.attorney .
A former chiropractor turned high school teacher who is deep
in debt to the government because of student loans said his experiences
have taught him valuable lessons. "I'm in my boat, and I
want others to stay out of it. It almost like a prison sentence
-- a lifelong prison sentence." The prison sentence Scott
Pinkham referred to is the debt he owes the US government for
student loans he used to finance his education at Logan College
of Chiropractic in Chesterfield, Missouri. Pinkham said he passed
his chiropractic board exam in September 1987 and became partners
with a man who was still a student and whose father was willing
to finance the start-up of a practice. "This gentleman financed
my practice on the premise that I would get an office up and
running so that his son could them join me as a 50-50 partner
upon graduation," Pinkham explained. Pinkham said the practice
opened in July 1988, but that after his partner graduated in
April, 1989, the partnership fell apart. "After practicing
together for one month, father and son suddenly decided the practice
could not support two doctors. At that point, the father called
in my loan for $120,000. My family and I were devastated, and
despite several more attempts to make it in practice, I have
never recovered financially." Since he was hired as a teacher
at Francis Howell North in 1991, Pinkham said he has received
numerous awards, including Teacher of the Year for 1992-1993.
"A deadbeat would not pour his heart and soul into his family,
his neighbors and his students," Pinkham said .
The HEAL program ended in 1998. Today, chiropractic education
is funded by a privatized version called ChiroLoan, which began
in 1992 . As far as I know, its default rates have not been
publicly revealed. I have inquired several times but received
The Department of Health and Human Services maintains a list of defaulted HEAL
borrowers which identifies the defaulters and provides several
statistical analyses. As of February 6, 2003, the site included
the following figures:
|Life Chiropractic College
|Los Angeles College of Chiropractic
|Palmer College of Chiropractic
|Cleveland Chiropractic College (KC)
|Life Chiropractic College - West
|Logan College of Chiropractic
|Palmer College of Chiropractic -
|Cleveland Chiropractic College (LA)
|Texas Chiropractic College
|New York Chiropractic College
|National College of Chiropractic
|Southern California College of Chiropractic
|Parker College of Chiropractic
|Western States Chiropractic College
|Northwestern College of Chiropractic
Total, clinical psychology
Total, public health
Total, health administration
Total, veterinary medicine
The data indicate that the percentage of chiropractic students
defaulting vastly exceed the percentage of students from other
disciplines. Other data indicate that, over the years, the percentages
of defaulters who had declared bankruptcy or were reportedly
disabled were also much higher among chiropractors .
Efforts at "Spin Control"
In 1993, ACA executive vice president Jerome McAndrews, D.C.,charged
that the loan crisis reflected discrimination against chiropractors
and issued a special report in response to the federal government's
crackdown of HEAL defaulters . According to McAndrews, the
reasons for the high default rate were:
- Higher tuition costs at chiropractic colleges; medical schools
have lower tuition because of research grants.
- Licensing exams for chiropractors are given out of phase
with graduation dates.
- Medical students are eligible for the Health Professions
Student Loan whereas chiropractors are not.
- Medical doctors have developed large group practices. New
medical graduates have better opportunity for employment. Chiropractors,
on the other hand, have to develop lines of credit and open solo
- Chiropractors have faced "the long term consequences
of medicine's illegal boycott." ACA believes that despite
the chiropractic legal victory, chiropractic's reputation has
been harmed thus it takes a chiropractor longer to build a successful
- Chiropractors have to buy expensive x-ray equipment (total
cost of $36,000) when chiropractors could have easily referred
to hospitals for such services.
None the above reasons involves "discrimination":
- Chiropractic tuition rates are high because when student
loans became available, the schools raised their rates accordingly.
Life University, for example, tripled its tuition rate between
1990 and 1995 . Moreover, the cost of attending medical school
is generally higher than the cost of going to chiropractic colleges.
- The timing of licensing exams represents a failure of the
chiropractic community to welcome new graduates. Some chiropractors
believe this is done for anti-competitive reasons. As noted by
Robert Ward, D,C.:
A number of state boards . . . make it impossible for many
graduates to become licensed until after the grace period has
expired, effectively nullifying the loan grace period. Policies
like these greatly increase the likelihood of financial failure
and default, and apply tremendous pressure to the new doctor
to do anything, however, unethical, to generate income. In the
absence of a clear rationale for the existence of restrictive
policies by state boards, it is likely that such policies exist
solely to protect the business interests of established doctors
by restricting competition from an influx of new graduates .
- Medical students may be eligible for different loan options
because after graduation they can meet the needs of underserved
areas. They can prescribe medications, give inoculations, deliver
babies, perform surgery, and provide many other health services
that are needed more than spinal manipulation. Moreover, chiropractors
who are philosophically opposed to standard medical care, including
medications and vaccinations, are even more unsuitable for primary-care
practice. Thus the lack of federal subsidy is due to chiropractic's
shortcomings and not bias within the medical community.
- Most chiropractors are solo practitioners because chiropractors
vary widely in philosophy and practice styles.
- The "We haven't recovered from the AMA boycott"
argument is another ploy used to justify chiropractic failures.
The AMA's antichiropractic campaign took place more than 25 years
ago when chiropractic was completely mired in quackery. The average
doctor's opinion of chiropractors is based on their disdain for
"subluxation" theory and the bad experiences their
patients report to them.
- Most hospitals and private radiologists are willing to provide
x-ray examinations for chiropractic patients. But many chiropractors
prefer to buy their own machines because (a) x-ray exams can
be very profitable and (b) medical radiologists will report as
normal many films on which chiropractors see "subluxations."
Some chiropractic leaders have charged that the HEAL program
was flawed because it initially did not include a credit check
Chiropractic Incomes Are Falling
Most insurance companies don't knowingly pay for "maintenance
care" in which the chiropractor keeps the patient coming
back to have "subluxations" diagnosed and treated.
Managed-care programs, which strive to eliminate unnecessary
care, try to avoid practitioners who provide unnecessary services.
Chiropractic schools have been turning out more new chiropractors
than are needed. As a result, the field is overcrowded, inflation-adjusted
chiropractic incomes have been falling, and new graduates can
have a very difficult time earning a living.
In 1994, Stephen Seater, executive director of the Foundation
for Chiropractic Education and Research, stated:
On an average day, the FCER staff talks to about 50 practicing
chiropractors. These doctors are telling us more and more frequently
that their practices are down, some by as much as 50%! And time
and time again, the villain is managed care. In areas where managed
care is growing rapidly, it is systematically cutting out most
In 1997, Michael Pedigo DC, a former president of the International
Chiropractic Association and the ACA stated:
Are there too many DC's in today's market? The primary reason
we hear more doctors expressing concerns that the colleges are
graduating what they consider to be too many doctors is that
most practices across the country are seeing fewer patients and
being paid less per visit than just a few years ago. I hear figures
like the average practice is down 30 to 40% and income is down
40 to 50%. Adding to that new doctors graduating with $80,000-$100,000
in student loans and inability to join some managed care groups
until they have been in practice for three years, and you have
an environment that is even more difficult for these new doctors
to succeed .
from the U.S. Department of Commerce indicate that the total
reported net income for chiropractic offices and clinics rose
from $6.56 billion in 1992 to $7.68 billion in 1998, which is
about 2.8% per year. Since the number of practicing chiropractors
has been increasing, and taking inflation into account, these
figures show that real chiropractic income has been decreasing
steadily. In 2001, Donald Petersen, editor of Dynamic Chiropractic,
The number of phone calls and emails we receive from new DC's
is on the increase. Many are questioning why they can't seem
to be able to make a living in their chosen profession. They
graduate with high hopes, but also with the heavy burden of a
substantial student loan debt, and are facing a very challenging
health care marketplace. . . .
Are these recent graduates just whining about the challenges
that have always faced new DC's or are they serious issues that
threaten the growth and success of our profession? Are we avoiding
talking about the tough issues? If so, how much is our avoidance
hurting us? 
The Bottom Line
The chiropractic loan default rate signifies an immense problem.
The chiropractic profession is overcrowded; average chiropractic
income has been falling; and new graduates who wish to practice
ethically may be unable to earn a living. Yet chiropractic leaders
suggest that loan defaults reflect individual failures rather
than problems that are professionwide. I believe that the main
chiropractic trade organizations do not wish to admit the truth
because it would undermine their public relations efforts. The
bottom line is that students who are considering chiropractic
as a career should think seriously about doing something else.
- Berman N. Facing 20 years of debt. Money Magazine 24(11):109-114,
- Schools facing dismissal from loan program. Associated Press,
Aug 24, 1993.
- Last minute action by Congress saves HEAL program. ACA/FYI,
- Watson F. Two local chiropractors named on deadbeat list.
St. Charles Journal, March 26, 1995.
- Watson F. Former chiropractor in debt to government says
he learned lessons. St. Charles Journal, May 28, 1995.
A boon to students and colleges. Dynamic Chiropractic 14(9):21,
- Federal Health Education Assistance Loan Annual Report Fiscal
Year 1995, Bureau of Health Professions.
- McAndrews J. HEAL update: ACA says correction of inequities
will allow DC's to pay up. ACA Update, Sep/Oct. 1993:11-12.
Sid and chiropractic make the front page: Life's founder/president
is subject of revealing 2-part series in Atlanta Journal.
Dynamic Chiropractic 14(3):26, 1996.
- Ward R. Restrictive
policies by some boards. Dynamic Chiropractic 13(24):29,
- Seater S. FCER
Forum: Warfare requires new directions. Dynamic Chiropractic
- Pedigo MD. Too
many DCs, not enough, what to do? Dynamic Chiropractic 15(12):17,
- Petersen DM. Regulated
GROWTH? Dynamic Chiropractic 19(26):12, 2001.
Dr. Mirtz practices chiropractic in Eudora, Kansas.
This article was posted on April 23,
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