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Chiropractic Key Facts

ACA – Chiropractic Key Facts

Chiropractic
  • There are 77,000 Doctors of Chiropractic (DCs) in the United States who are required to pass a series of four national board exams(1)  and be state licensed.(2)  
  • Roughly another 3,000 DCs work in academic and management roles.
  • There are approximately 10,000 chiropractic students(3)  in 18 nationally accredited, chiropractic doctoral graduate education programs(4)  across the United States with 2,500 Doctors of Chiropractic (DCs) entering the workforce every year.(5)
  • An estimated 40,000 chiropractic assistants (CAs)(6)  are in clinical(7)  and business management roles for chiropractic practices across the United States.
  • It is estimated that Doctors of Chiropractic (DCs) treat over 27 million Americans (adults and children) annually.(8)
  • Doctors of Chiropractic (DCs) are educated in nationally accredited, four-year doctoral graduate school programs(9)  through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship,(10)  with the average DC program equivalent in classroom hours to allopathic (MD) and osteopathic (DO) medical schools.(11)
  • Doctors of Chiropractic (DCs) are designated as physician-level providers in the vast majority of states and federal Medicare program. The essential services provided by DCs are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Departments of Veterans Affairs and Defense, Federal Employees Health Benefits Program, Federal Workers’ Compensation, and all state workers’ compensation programs.(12)

 

Patient Satisfaction/Clinical Effectiveness

  • Chiropractic outperformed all other back pain treatments, including prescription medication, deep-tissue massage, yoga, pilates, and over-the-counter medication therapies.(13)
  • Doctors of Chiropractic (DCs) are the highest rated healthcare practitioner for low-back pain treatments above physical therapists (PTs), specialist physician/MD (i.e., neurosurgeons, neurologists, orthopaedic surgeons), and primary care physician/MD (i.e., family or internal medicine).(14)
  • Doctors of Chiropractic (DCs) provide a patient-centered, whole person approach to health care marked by greater interaction and better communication, resulting in consistently higher patient satisfaction ratings than medical doctors.(15)
  • Doctors of Chiropractic (DCs) are utilized by all 32 National Football League teams(16)  in optimizing the functionality, endurance and overall conditioning of professional football players in the treatment of neuromusculoskeletal strain injuries, including neck pain, low back pain, strains to hamstrings and quadriceps, and whiplash injuries.
  • With prescription pain drug abuse now classified as an epidemic(17)  in the United States and the number of spinal fusions soaring 500% over the last decade,(18)  the essential services provided by Doctors of Chiropractic (DCs) represent a primary care approach for the prevention, diagnosis and conservative management of back pain and spinal disorders that can often enable patients to reduce or avoid the need for these riskier treatments.
  • Injured workers with similar injuries are 28 times less likely to have spinal surgery if the first point of contact is a Doctor of Chiropractic (DC), rather than a surgeon (MD).(19)
  • A recent study showed that treatment for low back pain initiated by a Doctor of Chiropractic (DC) costs up to 20 percent less than when started a MD.(20)
  • Chiropractic care has an excellent safety record.(21)   This should be viewed in the context of other treatments for back pain such as steroids,(22)  pain medications(23)  and surgery.(24)  As a result, Doctors of Chiropractic (DCs) pay malpractice premiums at significantly lower rates than allopathic doctors (MDs).(25)
  • The Doctor of Chiropractic (DC) collaborative, whole person-centered approach reflects the changing realities of health care delivery, and fits well into Accountable Care Organization (ACO) and patient-centered, medical home (PCMH) models bringing greater clinical efficiency, patient satisfaction and cost savings.(26)
  • A systematic review in 2010 found that most studies suggest spinal manipulation achieves equal or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up.(27)
  • The American College of Physicians and the American Pain Society jointly recommended in 2007 that clinicians consider spinal manipulation for patients who do not improve with self-care options.(28)

References

[1]  National Board of Chiropractic Examiners (NBCE) www.NBCE.org. Accessed December 2013.

[2]  Federation of Chiropractic Licensing Boards (FCLB) www.FCLB.org Accessed December 2013.

[3]  Association of Chiropractic Colleges, www.acc.org. Accessed December 2013.

[4]  Council on Chiropractic Education (CCE) www.cce-usa.org is the agency certified by the U.S. Department of Education to accredit doctoral graduate school programs who offer Doctor of Chiropractic (D.C.) degree; Accessed December 2013.

[5]  Association of Chiropractic Colleges, www.acc.org. Accessed December 2013.

[6]  American Chiropractic Association (ACA) www.ACAtoday.org and Federation of Chiropractic Licensing Boards (FCLB) www.FCLB.org 2013.

[7]  Certified Chiropractic Clinical Assistant (CCCA) program.  Federation of Chiropractic Licensing Boards (FCLB), 2013.

[8]  Barnes, Bloom, Nahin. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use among Adults and Children: United States, 2007. December 10, 2008. Extrapolated to 2013 U.S. population from 2007 National Health Interview Survey (NHIS) finding that 8 percent of the adults and 3 percent of the children in the United States received chiropractic services annually.

[9]  Council on Chiropractic Education (CCE) www.cce-usa.org 2013.

[10] Meeker, DC, MPH; Scott Haldeman, DC, PhD, MD; Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine. 2002; 136(3): 216-227. http://annals.org/article.aspx?articleid=474085

[11] Coulter, Adams, Coggan, Wilkes, Gonyea. A Comparative Study of Chiropractic and Medical Education. Alternative Therapy Health Medicine. 1998; 4:64-75.

[12] American Chiropractic Association (ACA), 2013. https://www.acatoday.org/pdf/physicianstatus.pdf

[13] Consumer Reports Health Ratings Center. Back-Pain Treatments. ConsumerReports.org; July 2011.

[14] Consumer Reports Health Ratings Center. Relief for your aching back: What worked for our readers. ConsumerReports.org; March 2013.

[15] Gaumer G, PhD. Factors associated with patient satisfaction with chiropractic care: survey and review of the literature. JMPT 2006 July-Aug; 29(6):455

[16] Professional Football Chiropractic Society (PFCS) 2010 www.profootballchiros.com

[17] Unintentional Drug Poisoning in the United States. Centers for Disease Control and Prevention, 2010.  Prescription Drug Abuse. White House Office on National Drug Policy. Accessed November 2013.

[18] Whoriskey, Keating. Boom in spinal fusions questioned. Washington Post. Page 1. October 28, 2013; Rise in spinal fusion surgeries driven partly by financial incentives. Washington Post. November 13, 2013.

[19] Keeney BJ; Fulton-Kehoe D; Turner JA; Wickizer TM; Chan KC; Franklin GM; Early Predictors of Lumbar Spinal Surgery After Occupational Back Injury; Results from a Prospective Study of Workers in Washington State. Spine, May 2013; 38(11):953-64. http://www.ncbi.nlm.nih.gov/pubmed/23238486

[20] Richard L. Liliedahl, Michael D. Finch, David V. Axene, Christine M. Goertz. Cost of Care for Common Back Pain Conditions Initiated with Chiropractic Doctor vs. Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer. Journal of Manipulative and Physiological Therapeutics; November 2010; 33(9):640-643.

[21] Stevinson, MS & Ernst, MD, PhD (2002). Risks Associated With Spinal Manipulation. The American Journal of Medicine, 112(7), 566-571.

[22] Dabbs, Lauretti. A Risk Assessment of Cervical Manipulation vs. NSAIDs for the Treatment of Neck Pain. Journal of Manipulative Physiology and Therapeutics. 1995 October; 18(8):530-6.

[23] Bronfort, Evans, Anderson, Svendsen, Bracha, Grimm. Spinal Manipulation, Medication, or Home Exercise with Advice for Acute and Subacute Neck Pain – A Randomized Trial. Annals of Internal Medicine. January 2012; 156:1-10.

[24] Dekutoski, MD, Norvell, PhD,, Dettori, PhD, Fehlings, MD, PhD, & Chapman, MD (2010). Surgeon Perceptions and Reported Complications in Spine Surgery. Spine, 35(9S).

[25] NCMIC, 2013. https://www.ncmic.com/ Shaw. Avoiding Risky Business. American Chiropractic Association. Accessed December 2013. https://www.acatoday.org/

[26] Accountable Care Organizations Optimize Outcomes, Cost Savings and Patient Satisfaction with Chiropractic Care. Foundation for Chiropractic Progress. May 2013.

[27] Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (2010). NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain. The Spine Journal 10 (10): 918–940.

[28] Chou R, Qaseem A, Snow V et al. Recommendation 7. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine 147 (7): 478–91.

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