In a medical world that involves a wide variety of drug prescriptions and invasive treatments, chiropractors belong to a healing profession that requires a doctorate degree and a license to practice before an individual can provide non-invasive services to patients. The future of the chiropractic profession continues to advance with mounting research, increasing public interest, and a growing population which currently has more access to health insurance. However, prospective chiropractic students must also weigh the cons associated with this career field.
The chiropractic profession has been affected by years of preconceived notions and mistrust lingering from a lack of understanding and a reputation for over treating patients. Although increased research is constantly demonstrating the validity of the profession and the benefits of seeing a chiropractor, students also travel an educational road paved with potentially high student loan debt and difficulties initially breaking into the industry. The following information will touch upon the overall cost versus the rewards of pursuing a chiropractic school education:
One of the most significant concerns for a prospective student is the amount of money it costs to pursue the necessary training and education to become a chiropractor. In the United States, the average tuition cost paid for attending a chiropractor school for four years is approximately $120,000. However, the total cost that a student is responsible for involves much more than just the ‘sticker price’ of college tuition.
Beyond the tuition cost of a chiropractor school, students must also pay for other education-related expenses, such as books, lab fees, equipment, activity fees, insurance for clinical work experience, and technology fees. Additionally, students must pay for room and board (or off-campus housing), transportation, and other personal living expenses.
Total education costs vary for students on a case-by-case basis, and figures are often affected by a range of factors that include the following:
* Location of School: Since prospective chiropractor students have a limited number of schools to attend (currently 15 institutions accredited by the Council on Chiropractic Education), many must figure in the cost of relocating to a state that offers a degree program. In addition to relocation fees, some schools are situated in regions with an overall lower (or higher) cost of living which also plays a part in the overall costs associated with obtaining a chiropractor degree.
* Method of Funding: Those who secure scholarships and grants to help fund their chiropractor education face a better ROI (Return on Investment) than students who borrow the bulk in the form of government loans which come with the added cost of interest.
“A chiropractic degree is very expensive as all of the schools are tuition-driven, private institutions, and there are not a great number of scholarships or grants or other support for the students,” says Dr. Shawn Allen, DC, of The Joint Chiropractic. “Many schools have branched out beyond chiropractic education into physical therapy or massage as a way to stay open and to continue to provide a quality medical education for the chiropractic programs.”
“That said, being a chiropractor is usually a passion for most chiropractors and the expense of the schooling is the price that is necessary,” he adds.
In the end, a chiropractor school graduate is not only responsible for paying back the loans taken out to fund the pursuit of an advanced degree, but also repay the cost associated with his or her undergraduate studies. Many are faced with an average debt of $150,000. Therefore, the starting salaries for new graduates and median annual wages ($66,160) for the occupation as a whole are considered low – when compared to the lingering debt and time it takes a chiropractor to train and earn his or her degree.
Chiropractors undergo four to five years of postgraduate education in order to obtain a Doctor of Chiropractic (D.C.), and qualify to become licensed to practice in the United States. Completion of three years (or at least 90 semester hours) of undergraduate education is the minimum requirement needed to apply to chiropractic school, which means graduates are expected to have completed at least 7 years of education before earning the proper credentials of a chiropractor.
As part of their professional training, chiropractor students incorporate a minimum of a one-year clinical-based program centered on administering real-time patient care. In its totality, the American Chiropractic Association (ACA) cites that the average curriculum involves the completion of at least 4,200 hours of classroom, laboratory and clinical experience.
Upon graduation, some chiropractors pursue postgraduate programs that lead to certification and other credentials which enhance their appeal to potential employers and the public. The programs involve additional training in specialty areas, such as pediatrics or orthopedics. It is not uncommon to see a chiropractor school graduates later earn a master’s degree in a related subject (like sports rehabilitation or nutrition), which helps expand their level of expertise and the services they may offer patients.
There are also a few D.C. programs that offer a dual-degree option that allows students to earn a master’s degree in a second subject while fulfilling their D.C. training.
“One challenge [chiropractic school graduates face] would be the escalating costs of receiving a chiropractic education,” says Dr. George Rabito, a National Board Certified and licensed chiropractic physician, who works at Hamilton Holistic Wellness Center in Hamilton, NJ.
In addition to navigating the costs associated with a chiropractic education, there are several other obstacles and disadvantages that prospective students must address when deciding on pursuing this particular career path. The following hardships represent some of the primary concerns related to students thinking about becoming a chiropractor:
Limited Number of Chiropractic Schools: In addition to rising tuition costs, prospective students also face a limited number of options for obtaining their education. The U.S. Bureau of Labor Statistics noted that in 2012, there were 15 Doctor of Chiropractic programs accredited by The Council on Chiropractic Education found on 18 different campuses.
A Demanding Curriculum: According to the American Chiropractor Association (ACA), those who graduate from chiropractic school undergo a rigorous education in the healing sciences, which is comparable to that of medical doctors. In some areas, the ACA says chiropractors receive a more intense education than medical physicians in regards to coursework in physiology, anatomy, rehabilitation, and nutrition.
Difficulties Getting Started in the Field: “Many chiropractors quickly learn after graduation that finding satisfying employment or success as a solo practitioner is difficult,” says Dr. Allen.
After graduation, the opportunities for chiropractors to practice without going into business for themselves is scarce, and according to Dr. Allen, “chiropractic school prepares you for the clinical aspects, but it really doesn’t place much focus on areas such as how to manage employees or how to market yourself and your business.”
The BLS reported that most chiropractors in 2012 worked in a solo or group practice with around 37 percent being self-employed; while a small number of professionals were employed in doctors’ offices and hospitals. Those interested in establishing a chiropractic business must pay additional expenses and upfront costs to set up an office.
Chiropractors generally earn significantly less early on in their careers. After becoming an owner of a private practice, or partnering up with others, the potential to earn a greater income usually does not follow until a chiropractor has spent time building a healthy client base.
“In most other fields you have the opportunity to learn the ropes from a more experienced co-worker,” says Allen. “That doesn’t often happen with chiropractic.”
Dr. Ehren Doty, DC, owner and clinic director of AZ Body Mechanics in Phoenix, AZ, mentions that ‘being successful in the healthcare industry” is a hardship that many chiropractic school graduates face.
“Being a doctor is easy,” says Dr. Doty. “Making a living at it is something else.”
“Most new graduates have no idea what is waiting for them when they are ready to hang out their shingle,” he adds.
This is why Dr. Allen believes the field is more accepting of franchise models, like the one offered at The Joint Chiropractic, which allows chiropractors to be in business for themselves, but not by themselves. Allen works for a company that uses a cash, non-insurance model, which eliminates the hassles of dealing with insurance companies, and allows chiropractors to devote their time to taking care of patients while still reaping the benefits of an attractive cash flow and earnings potential.
The Challenges of Private Practice: Although owning a business and becoming self-employed allows a chiropractor to reap the benefits of a more flexible schedule and work hours, a private practice also comes with its own unique set of obstacles and hardships.
Dr. Stephen Gubernick, DC, of The Joint Chiropractic, says there are not many job opportunities that pay much in the field, and launching a chiropractic business is often difficult. He mentions that gaining additional experience, improving skills, gaining a reputation within the community, building a practice (and making it successful) are all common hardships faced by chiropractic school graduates.
“You get out of school armed with all this knowledge about how the body works, and with this burning desire to help people,” he says. “But then the reality hits: How do you get started?”
“You may know all about anatomy, but do you know how to market that knowledge effectively,” asks Dr. Gubernick. “Do you understand how to keep the books, or work with insurance companies, or hire and keep good people?”
“Those are all challenges many of us face after graduation.”
Dealing with Insurance Companies: The success and demand for chiropractic treatment is also interconnected with a patient’s ability to pay for services – either directly with cash, or through health insurance. Dr. Rabito notes that changes taking place in the health insurance industry ultimately affect the way chiropractors are reimbursed.
Therefore, with an increasing number of insurance plans now covering chiropractic services to varying degrees, many chiropractors must learn how to submit the proper paperwork and communicate with insurance companies in order to get paid.
“Many chiropractors have difficulty dealing with insurance companies’ rules and policies,” says Dr. Allen. “And if you don’t submit claims or perform other tasks the way the insurance companies want it done – which differs from company to company, by the way – it can delay payment which hurts your cash flow.”
High Student Loan Default Rates: A list maintained by the Health Resources and Services Administration (HRSA) keeps track of Health Education Assistance Loan (HEAL) borrowers who are in default, and chiropractic colleges have demonstrated much higher default rates than other types of schools that train health care professionals.
For example, the total number of chiropractic defaults reported in 2012 was 499, while the total defaults cited from other schools was 945, which meant that chiropractic graduates represented 52.8 percent of all defaults for that year.
Threat of Bankruptcy: Chiropractors who default on their student loans and are unable to build and advance their private practice are at risk of losing their business and ‘going bankrupt.’ Other factors also come into play, as mentioned in the Arizona Chiropractic Society News, which cited that insurance company denials resulted in “hundreds of Arizona chiropractors closing their doors and many filing for bankruptcy.”
Negative Image: Chiropractors and the work they do are part of a largely misunderstood field plagued by preconceived notions of over treatment. As with all employment fields, corruption and unsavory business practices have damaged the overall perception of the occupation. Surveys and Gallup Poll results show that public perception of chiropractic compares unfavorably with mainstream medicine in regards to honesty and ethics.
“Chiropractic school graduates may find hardships with communicating the message of natural healing,” says Dr. John Lloyd, DC, of The Joint Chiropractic. “Chiropractic care is often considered alternative to mainstream care and it will require tremendous skill from the chiropractor to learn how to communicate the message of chiropractic in a format the general public understands.”
It is also not uncommon to find chiropractor graduates who have become disillusioned due to rising debt, and are also vocal about expressing dismay in the way some practitioners run their business or encourage others to follow suit. In his piece, Why I Quit Chiropractic, Allen J. Botnick, D.C., recounted negative experiences with chiropractor school and employers – ranging from calling his training “a system of strict rules and harsh punishments” to noting a number of “chiropractic institutions that encourage (or fail to discourage) unethical practices.”
Potential Burnout: Chiropractors are also susceptible to becoming burned out, especially when they lose motivation to practice and ‘feel stuck’ within their profession. Those who suffer burnout are more likely to stop marketing their business, cease trying to advance their education, and struggle to find happiness within their practice.
“What’s scary is that burnout is not exclusive to DC’s in practice for 20+ years; I have observed this phenomenon in frustrated docs who have been in practice 5 years or less,” wrote Tom Necela, DC, CPC, CPMA, in his piece titled, Three Investments You Need to Make in Your Chiropractic Practice, in which he urges chiropractors to ‘do something different” to stay motivated, ‘get out of a rut,’ and continue to grow a practice.
While the chiropractor field seems saddled with a variety of hardships and career obstacles, there are plenty of gratifying aspects related to the profession that attract individuals looking for an occupation associated with promoting the health and well-being of others, such as:
Valuable Knowledge Gained: “For me, the largest reward has been the ability to improve health in a natural way and make changes that positively impact people’s lives,” says Dr. Gubernick.
“Many think chiropractic is mostly about pain,” he adds. “While that is definitely a factor, and one of the main reasons people seeks out a DC initially, it is so much more than that.”
“It is really about improving health in general so patients can lead the type of active lives they want to lead instead of being limited by what their bodies allow,” says Dr. Gubernick. “Additionally, the knowledge gained during school regarding lifestyle and the ways to eat, move and think has been invaluable not only to the patients I treat but my family as well.”
The Potential to Earn a Decent Salary: In May 2012, the U.S. Bureau of Labor Statistics cited the median annual wage for chiropractors as being $66,160, with the top 10 percent of chiropractors earning more than $142,950.
High Job Growth Rate: Since chiropractic care involves nonsurgical methods of treatment, an increasing number of people are showing interest in pursuing a chiropractor’s assistance. The U.S. Bureau of Labor Statistics identifies the profession as having a potential high job-growth rate – expected to grow 15% between 2012 and 2022. Escalating interest in the field also means chiropractors can expect to find more employment opportunities within hospitals and clinics.
The Ability to Help Others: “There are pros and cons in every profession,” says Dr. Doty. “I think that the ability to practice a non-invasive, effective form of treatment through chiropractic care is very rewarding and far [outweighs] any possible downside.”
Dr. Gubernick agrees that the human factors associated with a career in chiropractic work increase the level of gratification that chiropractors feel towards the profession. “It is difficult to compete with the rewards that come from making adjustments that help a patient avoid surgery or seeing babies’ ear infections vanish, or the letters from patients who have gotten off addicting pain medication as a result of the work we have done with them,” he says.
“For me personally, by becoming a chiropractor I fulfilled a lifelong dream,” says Dr. Allen.
“In general, the reward of seeing a patient experience improved quality of life is worth all the difficulty in becoming a chiropractor,” he adds. “If you can help reduce or eliminate someone’s pain, or help patients lead a healthier and more active lifestyle overall, there’s a lot of satisfaction in that.”
The Ability to Provide Specialized Services: In some parts of the U.S., there are acute shortages of chiropractors, meaning the opportunity to set up a potentially prosperous private practice in various areas, as well as offer communities specialized services, is high.
Personal Growth: “Chiropractic suits my personality well and affords me the ability to get paid to help people, work with my hands, and communicate a principle in which I believe,” says Dr. Lloyd. “It also allows me the ability to be in control of my success as a self-employed business owner.”
Dr. Lloyd adds, “The biggest benefit however is that chiropractic has shown me how to live an innate-based lifestyle and provided me with opportunities to grow as a human being.”
Dual Role as Educator and Healer: “This degree opens up the ability to communicate with patients about the amazing healing potential of the human body and re-engage the patient with the knowledge that the body can improve through natural means,” says Dr. Lloyd. “In some cases, we can help those put years of dependence on drugs behind them.”
“In others, they are able to do things that they thought were beyond them, which lets them live their lives the way they prefer,” he adds. “We help patients get in tune with their own bodies and its miraculous healing powers.”
Flexible Schedule: Self-employed chiropractors often enjoy the luxury of setting their own work schedule, and although most are employed full time, around 1 out of 3 worked part time in 2012. To serve patients that work during the week, chiropractors may also hold hours in the evening or on the weekends.
Some of the best approaches a potential chiropractic student can take to get the most out of their education, minimize their overall debt, find employment, and run a successful private practice include the following suggestions:
Thoroughly Investigate the Profession: “When considering the chiropractic profession, I would highly recommend that students obtain information directly from a chiropractor, not base their decision solely upon information they have reviewed on the Internet,” says Dr. Rabito. “Communication with a chiropractor, even a visit to a chiropractic office, will provide a much more realistic insight into the profession.”
Dr. Botnick pointed out that career handbooks and literature related to the chiropractic field often originate from chiropractic organizations themselves, and tend to speak favorably to a fault about the profession . Encountering no negative information about the field creates unrealistic expectations of what it’s like to be a chiropractic student and graduate.
Enter the Career Field for the Right Reasons: “You really need to be passionate about pursuing a career as a chiropractor; you should want to go into the field because you have a goal of providing healing care for patients above all else,” says Dr. Allen. “Not for the prestige of being called neither “Doctor” nor the expected financial gains.”
Research All Options for Financial Assistance: “I would recommend that students contact the Financial Aid office of the schools that might be of interest to them to determine what loans, grants and aid is available to them to minimize the overall cost of their education,” says Dr. Rabito.
College scholarships, work-study programs, and state-specific grants that do not have to be paid back can help soften the financial burden associated with tuition costs. A range of merit-based options are available, as well as financial assistance that caters to students who fit a certain criteria, such as scholarships for women or veterans. The American Chiropractic Foundation (ACF) also awards various scholarships to qualifying students on a yearly basis.
Take Business Classes: “I feel the most beneficial thing a student can do when in school is to take as many business classes as possible,” says Dr. Doty. “This will provide a huge head start when deciding to open a business.”
Join a Professional Association: Chiropractors may also benefit from joining professional associations, such as the American Chiropractor Association or the International Chiropractors Association, to learn more about the profession, explore educational opportunities, and network.
Get Out in the Field: One of the hardships that new graduates face is initially building a patient roster that provides a steady stream of income.
“New clients will not simply show up,” says Dr. Lloyd. “They need to be obtained, initially, through marketing; this will require many more hours than a typical work week.”
Lloyd suggests “getting out in the community, participating in local events and finding other ways to create visibility for the practice.”
“Then, as a practice matures, new patients will be generated through referrals, reputation, and results,” he adds. “The best chiropractors are the best communicators.”
Have Patience: When Dr. Robin Ellsworth D.C. commented and shared her experiences in response to a blog post titled, Want to be a Doctor of Chiropractic? (which did not place the chiropractic field in a positive light), she advised graduates to stay persistent and determined.
Despite having $250,000 in educational financial loan debt (including both undergrad and graduate school), Dr. Ellsworth illustrated how sacrifice and patience can lead to prosperity within the field. “In 2012, I earned $26,000; in 2013, I earned $64,000; and this year 2014, so far I’ve earned $70,000,” she wrote. “Each year is better and better.”
“So if you love chiropractic which I do, in time your income will increase,” she continued. “But don’t give up just because the first 5 years suck.”
“The chiropractic degree will be worth the cost if beforehand the cost of success is understood and agreed upon,” says Dr. Lloyd. “The success of an individual in chiropractic depends entirely on the individual chiropractor.”
When asked if a chiropractic degree is ultimately worth the cost, Dr. Gubernick answered, “I can justify the cost simply based on how my education has improved the health of my family.”
“The old cliché that says “If you have your health you have everything” is very true,” he adds. “Being healthy enables you to do so much more with all the other aspects of your life, so I’m happy to be able to bring that to my family.”
“Ultimately, for those who have the ability to build their own business and make it successful, it is absolutely worth the cost,” says Dr. Gubernick.
Dr. Doty says he believes a chiropractic degree is worth the cost because the ‘healthcare industry is relatively recession proof for job security,’ but notes that graduates must be willing to work hard and stay motivated in order to reap the benefits.
“There are endless opportunities to have success in the chiropractic industry when you are motivated and passionate about what you do,” says Dr. Doty. “If you are willing to pick yourself up more times than you fall down, then there is no reason why any chiropractor can’t be successful enough to justify the cost of a chiropractic education.”
“It is not the grades and scores in biology that makes a successful chiropractor,” says Dr. Lloyd, who has recently established a chiropractic school. “The most successful chiropractors are those who understand marketing, patient communication, have great adjusting skill, and have the ability to cut across the grain and not be concerned with the opinions of others.”
“This profession is great, but it is misunderstood by a large portion of the general public,” he continues. “It will require the Doctor to continuously educate both patients and the public at large regarding chiropractic philosophy.”
“It takes a lot of work and risk to become successful; but risk comes with reward,” says Dr. Gubernick. “You have to be willing to be different and trust in what you do.”
“There’s not a chiropractor who has practiced for some time that doesn’t have a handful of miracle stories,” he says. “That makes it worthwhile.”
Dr. Gubernick says as ‘funding grows so does the research validating chiropractic [work]’, which means graduates may find increasing opportunities to treat patients in group practice settings and other work environments outside of private practice.
“There is also more interdisciplinary cooperation between chiropractors and other medical professionals, with referrals going both ways,” says Dr. Gubernick. “Now is a great time to become a leader in health and prevention.”
The elevated possibility of owing a high amount of student loan debt after finishing at least seven years of school, as well as potentially experiencing difficulties finding a job or running a successful practice, are serious concerns for a prospective chiropractic student to consider. Additionally, graduates enter a career field oftentimes met with misunderstanding and negativity by the general public.
While the motivating circumstances that ultimately drive individuals deciding to become a chiropractor are different for all involved. The majority of chiropractic professionals are typically fueled by a desire to treat medical problems by using non-invasive measures which also eliminate the use of prescription drugs. Opportunities to become employed in a wider range of work settings will continue to grow as the overall population increases, new chiropractic research emerges, and increased access to health care services remains.