Are Chiropractors Qualified to Function As Primary Care Physicians?
Chiropractors have many of the attributes of primary care providers and often describe themselves as such. Others say that chiropractic has more of the attributes of a limited medical profession similar to dentistry or podiatry. In this paper I will try to answer the question: Are Chiropractors Qualified to Function As Primary Care Physicians? I will use resources such as admission requirements to Chiropractic schools and general educational path and requirements for some one to become a chiropractor. Then based on this information I will try to draw a conclusion.
Ever since D.D. Palmer founded the first chiropractic school there was much misconception about the profession of chiropractic. It did not matter that people preferred chiropractic to the so-called allopaths in the early part of the 20th century. The American Medical Association was set to literally wipe out the Chiropractic profession. With publication of the Flexner report this was almost accomplished. Chiropractors had to literally fight for recognition and under some circumstances chose jail to protest the bias against their profession (Keating, C., 2005). Chiropractic profession went underground so to speak.
Lately the chiropractic profession has flourished again, under seemingly less than ideal conditions. A big boost to chiropractors was the success in an antitrust lawsuit against the AMA (Keating, C., 2005). This seemed to boost the chiropractic profession, but also new research seemed to indicate that chiropractic is actually a valuable tool in the treatment of some ailments (Bronfort, Evans & Haas, 2005). With this new research, a renewed trust by the public in chiropractic care one must ask the question: Are Chiropractors Qualified to Function As Primary Care Physicians?
Let us start the quest to answer this question by examining general education requirements of NY Chiropractic College and University of Michigan Medical School. U of M has the following minimum subject requirements. Chemistry, 8 semester hours, 3 semester hours of Biochemistry, 6 semester hours of Biology, 6 semester hours of Physics, 6 semester hours of English Composition and Literature, 18 semester hours of Non-science subjects (www.med.umich.edu).
NY Chiropractic College lists the following minimum requirements. 12 semester hours of Chemistry, 6 semesters of Biology, 6 semester hours of Physics, 6 semester hours of English, 3 semester hours of psychology, and 15 semester hours of social sciences and humanity (www.nycc.edu). It seems that the minimum entry requirements are pretty similar; actually, chiropractic college requires one more credit hour of Chemistry. This might be surprising to some people, since public perception still radiates towards the adage that Chiropractors are not real doctors and get their degree through mail correspondence (Keating, C., 2005).
Now we need to examine the actual college experience. U of M has a four year curriculum, after which one can sit for the Doctoral exam and then get going with the residency. Residency requirements start at a minimum of one bring bringing up the total of the doctoral candidate’s education requirement to five years of academics (www.med.umich.edu). The Chiropractic doctoral degree requires at least 15-week trimesters (three years and four months, total) of full-time resident study, including a clinical internship (www.nycc.edu). This equates to five years of academic study, the same as the above U of M doctoral student.
Let us now examine some of the subject matter studied in the two chosen colleges. Here is a listing of total hours spent at NYCC chiropractic program. Anatomy 585 hours, Biochemistry 75 hours, Physiopathology 345 hours, Microbiology and Public Health 120 hours, Diagnosis 525 hours, Diagnostic Imaging 270 hours, Clinical Laboratory 75 hours, Associated Studies 165 hours, Chiropractic Philosophy 135 hours, Chiropractic Technique 615 hours, Ancillary Therapeutic Procedures 90 hours, Clinical Practice Issues 75 hours, Clinical Experience and Outpatient Services 1,320 hours, Total Core hours 4,380 hours with an additional 225 hours of Elective Courses. This is a grand total of 4,605 course hours (www.nycc.edu).
I could not find specific course hours for the U of M MD program, but found an exciting breakdown on individual years spent in medical school.M1: A first-year student will begin seeing patients within the first couple of weeks. Patient interaction through the Family Centered Experiences, longitudinal cases and clinical weeks will be woven through the pre-clinical coursework as a means to reinforce what is learned in lectures and how to practically apply it. The second year, M2: The second-year curriculum continues to be interdisciplinary and organ-system based, covering the abnormal organ systems. The doctoral student will continue to work on patient histories, physical exams and presentations with the supervision of a faculty member. The third year, M3: By the time the student reaches the third year, they will begin clerkship-based rotations in a number of departments throughout the University of Michigan Health System and will play a key role on the health care team. The clerkship rotations are designed specifically to introduce students to various disciplines and expand opportunities for career exploration. The fourth year, M4: In addition to electives and time off for residency interviews, the required fourth-year sub-internships allow the student to further explore specialties of interest and take their own patient caseload with nearly the same responsibilities as a resident. Residency directors from the top programs across the country have credited Michigan's training as the reason why their graduates transition better than most into the role of intern (www.med.umich.edu).
Thus far we have compared the career path of students wanting to be doctors or chiropractors at U of M or NYCC. The conclusion that can be drawn from this very general outline is that D.C. and M.D. have to go through five years of graduate education in order to get to their hard earned titles. It should be obviously by now, that chiropractors face the same academic challenges as doctors face when it comes time spend in college. It also should be obvious that the subject matter varies somewhat in the respective colleges due to differing guiding philosophies of these healing arts. I would venture to far from the purpose of this paper to get into a discussion how these philosophies differ.
I think we have established beyond reasonable doubt that the education of a D.C seems just as stringent as the education of an M.D. I will offer one more clue to the conclusion I have drawn thus far. During the chiropractic examination, the D.C. does pretty much the same physical examination an M.D. would do. Measuring of blood pressure, patient interview and observation of patient for other signs of degenerative or chronic disease (Pederson, 2005). I was especially impressed to learn that chiropractors are actually trained to detect skin abnormalities. Weaving everything together, I think I have made a valid argument that supports my answer to the title of this paper. I am answering this question with a resounding yes! Yes, chiropractors are qualified to function as primary care physicians, because of their extensive education and training, and more importantly, they are on the frontline, through initial exams and patient questionnaires to detect more serious disease not within their scope of practice and make a timely and specific referral to a practitioner more suitable to address a patient’s ailment. And this, I think, makes them perfect, for what I consider to be a primary care physician.
Beste Gesundheit,
Werner
References
Keating, C. (2005). A Brief history of the chiropractic profession. In S. Haldeman (Ed.), Principles and practice of chiropractic (p. 31). New
York: McGraw-Hill
—(pp.54-55)
Bronfort G., Evans R., Haas, M. (2005). The Clinical effectiveness or spinal manipulation for musculoskeletal conditions. In S. Haldeman
(Ed.), Principles and practice of chiropractic (pp. 151-161). New York: McGraw-Hill
Keating, C. (2005). A Brief history of the chiropractic profession. In S. Haldeman (Ed.), Principles and practice of chiropractic (pp.32-34). New
York: McGraw-Hill
University of Michigan. Application Process: Requirements. Retrieved April 25, 2008 from
http://www.med.umich.edu/medschool/admissions/process/requirements.htm
New York Chiropractic College. Prerequisite course requirements for D.C. program. Retrieved April 25, 2008 from
http://www.nycc.edu/Admissions_requirements.htm#1
University of Michigan. Curriculum. Retrieved April 25, 2008 from
http://www.med.umich.edu/medschool/admissions/curriculum/#years
New York Chiropractic College. D.C. program. Retrieved April 25, 2008 from
http://www.nycc.edu/AcademicPrograms_DCprogram.htm
—
University of Michigan. Your four years. Retrieved April 25, 2008 from
http://www.med.umich.edu/medschool/admissions/curriculum/#comp
Pederson P. (2005). The Clinical history. In S. Haldeman (Ed.), Principles and practice of chiropractic (pp.488-506). New York: McGraw-Hill
