Chiropractors, also known as doctors of chiropractic or chiropractic physicians, diagnose and treat patients whose health problems are associated with the bodyís muscular, nervous, and skeletal systems, especially the spine. Chiropractors believe that interference with these systems impairs the bodyís normal functions and lowers its resistance to disease. They also hold that spinal or vertebral dysfunction alters many important body functions by affecting the nervous system and that skeletal imbalance through joint or articular dysfunction, especially in the spine, can cause pain.
The chiropractic approach to healthcare is holistic, stressing the patientís overall health and wellness. It recognizes that many factors affect health, including exercise, diet, rest, environment, and heredity. Chiropractors provide natural, drugless, nonsurgical health treatments and rely on the bodyís inherent recuperative abilities. They also recommend changes in lifestylein eating, exercise, and sleeping habits, for exampleto their patients. When appropriate, chiropractors consult with and refer patients to other health practitioners.
Like other health practitioners, chiropractors follow a standard routine to secure the information they need for diagnosis and treatment. They take the patientís medical history, conduct physical, neurological, and orthopedic examinations, and may order laboratory tests. X rays and other diagnostic images are important tools because of the chiropractorís emphasis on the spine and its proper function. Chiropractors also employ a postural and spinal analysis common to chiropractic diagnosis.
In cases in which difficulties can be traced to the involvement of musculoskeletal structures, chiropractors manually adjust the spinal column. Some chiropractors use water, light, massage, ultrasound, electric, and heat therapy. They also may apply supports such as straps, tapes, and braces. Chiropractors counsel patients about wellness concepts such as nutrition, exercise, changes in lifestyle, and stress management, but do not prescribe drugs or perform surgery.
Some chiropractors specialize in sports injuries, neurology, orthopedics, pediatrics, nutrition, internal disorders, or diagnostic imaging.
Many chiropractors are solo or group practitioners who also have the administrative responsibilities of running a practice. In larger offices, chiropractors delegate these tasks to office managers and chiropractic assistants. Chiropractors in private practice are responsible for developing a patient base, hiring employees, and keeping records.
Chiropractors work in clean, comfortable offices. Their 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.
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.
Chiropractors held about 49,000 jobs in 2002. Most chiropractors are in 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.
Many chiropractors are located in small communities. There are geographic imbalances in the distribution of chiropractors, in part because many establish practices close to chiropractic institutions.
All States and the District of Columbia regulate the practice of chiropractic and grant licenses to chiropractors who meet 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 boards require at least 2 years of undergraduate education; an increasing number are requiring a 4-year bachelorís 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.
To maintain licensure, almost all States require the completion of a specified number of hours of continuing education each year. Chiropractic associations and accredited chiropractic programs and institutions offer continuing education programs. Specialty councils within some chiropractic associations also offer programs leading to clinical specialty certification, called ďdiplomateĒ certification, in areas such as orthopedics, neurology, sports injuries, occupational and industrial health, nutrition, diagnostic imaging, thermography, and internal disorders.
In 2003, 16 chiropractic programs and 2 chiropractic institutions in the United States were accredited by the Council on Chiropractic Education. Applicants are required to have at least 90 semester hours of undergraduate study leading toward a bachelorís degree, including courses in English, the social sciences or humanities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelorís degree, which may eventually become the minimum entry requirement. Several chiropractic colleges offer prechiropractic study, as well as a bachelorís degree program. Recognition of prechiropractic education offered by chiropractic colleges varies among the State boards.
During the first 2 years, most chiropractic programs emphasize classroom and laboratory work in basic science subjects such as anatomy, physiology, public health, microbiology, pathology, and biochemistry. The last 2 years stress 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.
Chiropractic requires keen observation to detect physical abnormalities. 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.
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.
Job prospects are expected to be good for persons who enter the practice of chiropractic. Employment of chiropractors is expected to grow faster than the average for all occupations through the year 2012 as consumer demand for alternative healthcare grows. Chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery. As a result, chiropractic care is appealing to many health-conscious Americans. 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. The rapidly expanding older population, with its increased likelihood of mechanical and structural problems, also will increase demand for chiropractors.
Demand for chiropractic treatment also 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. Increasingly, chiropractors must educate communities about the benefits of chiropractic care in order to establish a successful practice.
In this occupation, replacement needs arise almost entirely from retirements. Chiropractors usually remain in the occupation until they retire; few transfer to other occupations. Establishing a new practice will be easiest in areas with a low concentration of chiropractors.
Median annual earnings of salaried chiropractors were $65,330 in 2002. The middle 50 percent earned between $44,140 and $102,400 a year.
Self-employed chiropractors usually earn more than salaried chiropractors. According to the American Chiropractic Association, in 2000, the average income for all chiropractors, including the self-employed, was about $81,500 after expenses. 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. Self-employed chiropractors must provide for their own health insurance and retirement.
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2004-05 Edition,
Chiropractors, on the Internet at
(visitedJuly 09, 2004).