Analysis of the Chiropractic Section of the
2010-11 Occupational Outlook Handbook

Stephen Barrett, M.D.


The chiropractic section of the 2010-11 edition of U.S. Department of Labor's Occupational Outlook Handbook presents an overly optimistic picture to students faced with one of the most important decisions they will ever make. Here is a line-by-line analysis of the document with my comments in brackets.


CHIROPRACTORS

Significant Points

Nature of the Work

Chiropractors, also known as doctors of chiropractic or chiropractic physicians, diagnose and treat patients with health problems of the musculoskeletal system and treat the effects of those problems on the nervous system and on general health. Many chiropractic treatments deal specifically with the spine and the manipulation of the spine. Chiropractic is based on the principle that spinal joint misalignments interfere with the nervous system and can result in lower resistance to disease and many different conditions of diminished health. [The above statements are misleading overgeneralizations based on the false notion that spinal problems are an underlying cause of disease. Instead of simply parroting what chiropractors say, the Handbook should warn prospective students that the field is riddled with false beliefs and that this problem may ultimately destroy the chiropractic profession.]

The chiropractic approach to healthcare focuses on the patient's overall health. Chiropractors provide natural, drugless, nonsurgical health treatments, relying on the body's inherent recuperative abilities. [This is a backward way of saying that chiropractors have a very narrow range of treatments and therefore that there are very few conditions they should attempt to treat.]They also recognize that many factors affect health, including exercise, diet, rest, environment, and heredity. [All health professions do that.] Chiropractors recommend changes in lifestyle that affect those factors. So do other health professions. But the relevant question is whether their recommendations are appropriate. The vast majority of chiropractors who give nutrition advice make inappropriate recommendations to use dietary supplements and other products.] In some situations, chiropractors refer patients to or consult with other health practitioners. [The relevant question is whether they do this enough. The answer is no.]

Like other health practitioners, chiropractors follow a standard routine to get information needed to diagnose and treat patients. They take the patient's health history; conduct physical, neurological, and orthopedic examinations; and may order laboratory tests. [The relevant question is whether they do this properly. A large percentage of them do not. In fact, some chiropractors do not believe they should diagnose patients.] X rays and other diagnostic images are important tools because of the chiropractor's emphasis on the spine and its proper function. [Many chiropractors take too many x-rays, and some take full-spine films that have little or no genuine diagnostic value.] Chiropractors also analyze the patient's posture and spine using a specialized technique. For patients whose health problems can be traced to the musculoskeletal system, chiropractors manually adjust the spinal column. [There are many types of "spinal analysis." Most have not been validated, and most lead to recommendations for treatment that is inappropriate.]

Some chiropractors use additional procedures in their practices, including therapies using heat, water, light, massage, ultrasound, electric currents, and acupuncture . They may apply supports such as straps, tape, braces, or shoe inserts. Chiropractors often counsel patients about health concepts such as nutrition, exercise, changes in lifestyle, and stress management, but chiropractors do not prescribe drugs or perform surgery. [Most chiropractors are not qualified to counsel patients about nutrition or stress management. Many—perhaps 50%—prescribe worthless homeopathic products.]

In addition to general chiropractic practice, some chiropractors specialize in sports injuries, neurology, orthopedics, pediatrics, nutrition, internal disorders, or diagnostic imaging. [This statement might lead students to think that chiropractic specialization is analogous to medical or dental specialization. It is not. Chiropractic neurologists and orthopedists are probably better qualified than the average chiropractor to diagnose conditions within their scope, but there is nothing special about the treatment they offer. "Chiropractic pediatrics" is not a legitimate field because no childhood diseases are within chiropractic's scope. Moreover, most chiropractors who treat children do unnecessary spinal manipulation and advise parents against immunization .]

Work Environment

Chiropractors work in clean, comfortable offices. Like other health practitioners, chiropractors are sometimes on their feet for long periods. Chiropractors who take X rays must employ appropriate precautions against the dangers of repeated exposure to radiation. [Such procedures do not protect patients from the widespread practice of taking too unnecessary x-rays.]

Chiropractors work, on average, about 40 hours per week, although longer hours are not uncommon. Solo practitioners set their own hours but may work evenings or weekends to accommodate patients. Like other healthcare practitioners, chiropractors in a group practice will sometimes be on call or treat patients of other chiropractors in the group. [Jobs for new graduates usually pay poorly, are hard to get, and typically require unethical patient recruiting.]

The average workweek is about 40 hours, although longer hours are not uncommon. Solo practitioners set their own hours, but may work evenings or weekends to accommodate patients. [Most chiropractors are solo practitioners. Jobs for new graduates pay poorly, are hard to get, and typically require unethical patient recruiting.]

Chiropractors analyze the patient's posture and spine and may manually adjust the spinal column. [Whether they do this appropriately is not addressed.]

Employment

Chiropractors held about 49,100 jobs in 2008. Most chiropractors work in a solo practice, although some are in group practice or work for other chiropractors. A small number teach, conduct research at chiropractic institutions, or work in hospitals and clinics. Approximately 44 percent of chiropractors were self-employed.

Many chiropractors are located in small communities. However, the distribution of chiropractors is not geographically uniform. This occurs primarily because new chiropractors frequently establish their practices in close proximity to one of the few chiropractic educational institutions.

Training, Other Qualifications, and Advancement

Education and training. In 2009, 16 chiropractic programs in the United States were accredited by the Council on Chiropractic Education. Applicants must have at least 90 semester hours of undergraduate study leading toward a bachelor's degree, including courses in English, the social sciences or humanities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelor's degree, which may eventually become the minimum entry requirement. Several chiropractic colleges offer prechiropractic study, as well as a bachelor's degree program. Recognition of prechiropractic education offered by chiropractic colleges varies among the States.

Chiropractic programs require a minimum of 4,200 hours of combined classroom, laboratory, and clinical experience. During the first 2 years, most chiropractic programs emphasize classroom and laboratory work in sciences such as anatomy, physiology, public health, microbiology, pathology, and biochemistry. The last 2 years focus on courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, neurology, orthopedics, geriatrics, physiotherapy, and nutrition. Chiropractic programs and institutions grant the degree of Doctor of Chiropractic (D.C.).

Chiropractic colleges also offer postdoctoral training in orthopedics, neurology, sports injuries, nutrition, rehabilitation, radiology, industrial consulting, family practice, pediatrics, and applied chiropractic sciences. Once such training is complete, chiropractors may take specialty exams leading to “diplomate” status in a given specialty. Exams are administered by chiropractic specialty boards.

Licensure. All States and the District of Columbia regulate the practice of chiropractic and grant licenses to chiropractors who meet the educational and examination requirements established by the State. Chiropractors can practice only in States where they are licensed. Some States have agreements permitting chiropractors licensed in one State to obtain a license in another without further examination, provided that their educational, examination, and practice credentials meet State specifications.

Most State licensing boards require at least 2 years of undergraduate education, but an increasing number are requiring a 4-year bachelor's degree. All boards require the completion of a 4-year program at an accredited chiropractic college leading to the Doctor of Chiropractic degree.

For licensure, most State boards recognize either all or part of the four-part test administered by the National Board of Chiropractic Examiners. State examinations may supplement the National Board tests, depending on State requirements. All States except New Jersey require the completion of a specified number of hours of continuing education each year in order to maintain licensure. Chiropractic associations and accredited chiropractic programs and institutions offer continuing education programs.

Other qualifications. Chiropractic requires keen observation to detect physical abnormalities. [Chiropractic "vision" also seems to entail the ability to find alleged "subluxations" that only chiropractors can see.] It also takes considerable manual dexterity, but not unusual strength or endurance, to perform adjustments. Chiropractors should be able to work independently and handle responsibility. As in other health-related occupations, empathy, understanding, and the desire to help others are good qualities for dealing effectively with patients.

Advancement. Newly licensed chiropractors can set up a new practice, purchase an established one, or enter into partnership with an established practitioner. They also may take a salaried position with an established chiropractor, a group practice, or a healthcare facility. [Few "healthcare facilities" hire chiropractors.]

Employment

Chiropractors held about 49,100 jobs in 2008. Most chiropractors work in a solo practice, although some are in group practice or work for other chiropractors. A small number teach, conduct research at chiropractic institutions, or work in hospitals and clinics. Approximately 44 percent of chiropractors were self-employed.

Many chiropractors are located in small communities. However, the distribution of chiropractors is not geographically uniform. This occurs primarily because new chiropractors frequently establish their practices in close proximity to one of the few chiropractic educational institutions.

Job Outlook

Employment is projected to grow much faster than average. Job prospects should be good.

Employment change. Employment of chiropractors is expected to increase 20 percent between 2008 and 2018, much faster than the average for all occupations. Projected job growth stems from increasing consumer demand for alternative healthcare. [These are chiropractic claims, but there's no good evidence to support them. The percentage of Americans who use chiropractors is less than 10% and has not been growing. I believe that the field is overcrowded. The 2002 Occupational Outlook Handbook made a similar claim that did not turn out to be true.] Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery, chiropractic care is appealing to many health-conscious Americans. [These words may be appealing, but there's not much evidence that chiropractors do a good job of lifestyle counseling. Most people see them for backaches.] Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive healthcare practices. [Accepted by who?] Chiropractors who specialize in pediatric care will be in demand as chiropractic spinal treatment is very gentle and children enjoy subsequent visits. [This statement is preposterous because there is no scientific evidence or logical reason to believe that "chiropractic spinal treatment" can benefit children. In addition, chiropractors receive almost no clinical training in pediatrics.] The rapidly expanding older population, with its increased likelihood of mechanical and structural problems, also will increase demand for chiropractors. [It's not clear how much these problems can be helped by chiropractic care.]

Demand for chiropractic treatment, however, is related to the ability of patients to pay, either directly or through health insurance. Although more insurance plans now cover chiropractic services, the extent of such coverage varies among plans. [Insurance companies tend to feel negatively toward chiropractic. Much of the existing coverage is forced by state laws. 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.] Chiropractors must educate communities about the benefits of chiropractic care in order to establish a successful practice. [In other words, it is getting harder to earn a living. The difficulty is reflected in the fact that chiropractic graduates have by far the highest student loan default rates of any of the health professions. Most things that chiropractors do are not very useful. It's not clear that there is much potential demand for legitimate chiropractic services.]

Job prospects. Job prospects for new chiropractors are expected to be good, especially for those who enter a multi-disciplined practice, consisting of, for example, a chiropractor, physical therapist, and medical doctor. Multi-disciplined practices are cost effective and allow patients to remain in-house. Should a patient be referred to a medical doctor, they may use the “in-house” doctor or one of their own choosing. Chiropractors usually remain in the occupation until they retire and few transfer to other occupations, so replacement needs arise almost entirely from retirements. Establishing a new practice will be easiest in areas with a low concentration of chiropractors.

Projections Data

Projections data from the National Employment Matrix
Occupational  
   Title
SOC Code Employment 2008 Projected
Employment, 2018
Change, 2008-18
Number Percent
Detailed Statistics

Chiropractors

29-1011
49,100
58,700
9600
20
[PDF] [XLS]
NOTE: Data in this table are rounded. See the discussion of the employment projections table in the
Handbook introductory chapter on Occupational Information Included in the Handbook.

Earnings

Median annual wages of salaried chiropractors were $66,490 in May 2008. The middle 50 percent earned between $45,540 and $96,700 a year. [These numbers are nearly identical to the numbers reported by the Occupational Outlook Handbook in 2002. Because inflation has eroded the purchasing power of the dollar, they demonstrate that chiropractic salaried income has fallen considerably!]

In 2009, the mean salary for chiropractors was $94,454 according to a survey conducted by Chiropractic Economics magazine. [I suspect that the mean is higher than the median because a small percentage of very high earners skew the mean upwards. In addition, the Medical Economics survey is done by mail and it is not clear whether those who respond are a representative sample.]

In chiropractic, as in other types of independent practice, earnings are relatively low in the beginning and increase as the practice grows. Geographic location and the characteristics and qualifications of the practitioner also may influence earnings.

Salaried chiropractors typically receive health insurance and retirement benefits from their employers, whereas self-employed chiropractors must provide for their own health insurance and retirement.

THE ABOVE WAGE DATA ARE FROM THE OCCUPATIONAL EMPLOYMENT STATISTICS (OES) SURVEY PROGRAM, UNLESS OTHERWISE NOTED. FOR THE LATEST NATIONAL, STATE, AND LOCAL EARNINGS DATA, VISIT THE FOLLOWING PAGES:

CHIROPRACTORS

[The American Chiropractic Association estimated that the average income after expenses for all chiropractors in 2000 was $81,500. That was $5,000 less than the comparable figure for 1996 and $20,000 less than the comparable figure for 1989. U.S. Department of Commerce data 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. Why doesn't the Handbook put its earnings figures in proper perspective?]

Related Occupations

Chiropractors treat patients and work to prevent bodily disorders and injuries. So do athletic trainers, massage therapist, occupational therapists, physical therapists. physicians and surgeons, podiatrists, veterinarians. [There is an important difference, however. Chiropractic is based on a false theory and is riddled with quackery and pseudoscience. It would be more appropriate to compare chiropractors with acupuncturists and naturopaths.]

DISCLAIMER: LINKS TO NON-BLS INTERNET SITES ARE PROVIDED FOR YOUR
CONVENIENCE AND DO NOT CONSTITUTE AN ENDORSEMENT.

General information on a career as a chiropractor is available from the following organizations:

For a list of chiropractic programs and institutions, as well as general information on chiropractic education, contact:

For information on State education and licensure requirements, contact:

For information on State education and licensure requirements, contact:

For more information on the national chiropractic licensing exam, contact:

For information on admission requirements to a specific chiropractic college, as well as scholarship and loan information, contact the college's admissions office.

The above organizations present only a favorable view of chiropractic opportunity. Overall, the Occupational Outlook Handbook presents an overly optimistic view and fails to disclose any problems or refer readers to sources that provide a realistic view of the profession. Chirobase is the most comprehensive and accessible source of such information. Prospective students would also be wise to read Inside Chiropractic: The Patient's Handbook, by Samuel Homola, DC.]

This article was posted on July 11, 2010.

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