The Journal of Manipulative and Physiological Therapeutics has published the results of a study that examines the practice characteristics of chiropractors and the type of care DCs provide during a typical patient visit.
In the study, researchers set out to obtain data on chiropractors and patient visits in two states - one in the Northeast, one in the West, both with "intermediate" scopes of practice - that they felt would "maximize representativeness" of the chiropractic profession as a whole. After reviewing each state's scope of practice, the researchers interviewed 205 chiropractors (104 in Arizona, 101 in Massachusetts) by telephone. All participating chiropractors answered questions about their demographic, training and practice characteristics. In addition, all DCs who reported at least 60 patient visits in a typical week were invited to participate in a patient visit survey, as was a sample of DCs who had between 30 and 59 weekly patient visits. Data on chiropractors and chiropractic patients were then analyzed and compared to findings from previous studies of chiropractic practice in the United States.
Characteristics of the Practicing DC
Demographics. The average age of a practicing chiropractor in both states was nearly identical (42.0 in Arizona, 43.0 in Massachusetts). Seventy percent of the DCs in Massachusetts were male, compared to 81 percent in Arizona.
Practice settings. More than two-thirds of all DCs in both states reported operating a solo practice. Ten percent of chiropractors in Arizona, and 11 percent of chiropractors in Massachusetts, worked in a multidisciplinary group setting. Among those working in multidisciplinary settings, DCs in Massachusetts most commonly practiced with massage therapists (9 percent); Arizona chiropractors most commonly practiced with medical doctors (8 percent) and massage therapists (6 percent). The vast majority of patient visits occurred in an office setting (Arizona, 96 percent; Massachusetts, 90 percent).
Typical workweek. Chiropractors in Arizona had a slightly higher number of patient contact hours (30.1) and patient visits (101.4) in a typical workweek compared to DCs in Massachusetts (29.1 hours and 86.9 patient visits, respectively). Interestingly, 12 percent of Arizona chiropractors reported making at least one visit per week to a patient's home.
Managed care income. Only 19 percent of Massachusetts DC and 14 percent of Arizona DCs reported deriving at least 50 percent of their annual income from managed care sources. Thirty-one percent of Arizona's chiropractors (and 10 percent of Massachusetts DCs) reported receiving no income from managed care.
Training and experience. Palmer College of Chiropractic (Davenport) appeared to be the source of most chiropractors' education; 24 percent of Arizona DCs and 27 percent of Massachusetts DCs reported having been trained at Palmer. The number of years in practice was similar among both states (11.7 years in Arizona, 12.9 years in Massachusetts). A healthy minority of Arizona chiropractors (17 percent) reported holding licenses in another field besides chiropractic, with the most frequent being physical therapy and acupuncture. In Massachusetts, only 4 percent of the DCs indicated that they held licensure in another health care field.
Characteristics of the Chiropractic Patient
Demographics. The average chiropractic patient in both states was roughly the same age as the DC treating them (46.1 in Arizona, 44.7 in Massachusetts). More than half of chiropractic patients in both states were female.
Referrals and reasons for treatment. Approximately 85 percent of chiropractic patients in both states either self-referred to a chiropractor for care or were referred by a friend. Referral from a medical physician accounted for 7 percent of patient visits in Massachusetts and 4 percent of patient visits in Arizona. Between 81 percent and 89 percent of visits were by patients the DC had seen previously, approximately 90 percent of whom had been seen previously for the same problem.
Not surprisingly, low back pain was the most common reason patients sought chiropractic care (44 percent in Massachusetts, 41 percent in Arizona). Other common reasons for chiropractic care included neck/facial pain, wellness and headaches.
Diagnosis and treatment. In both states, chiropractors often performed a variety of procedures to determine a diagnosis and treatment plan. Spinal examination was performed during 80 percent of patient visits to Massachusetts DCs and 79 percent of Arizona DCs. Other common diagnostic procedures included soft tissue examination (56 percent in both states) and orthopedic examination (41 percent in Arizona, 30 percent in Massachusetts). Interestingly, in 12 percent of visits to Arizona chiropractors (and 10 percent of visits to Massachusetts chiropractors), no clinical evaluation was performed.
In terms of treatment procedures, the most common procedure was the spinal adjustment, which was provided during more than 80 percent of patient visits in each state. Manual high-velocity manipulation, particularly Diversified procedures, accounted for the majority of adjustments. Instrument adjusting was used during approximately 20 percent of patient visits.
In addition to adjusting the spine, several other techniques were employed by chiropractors during patient visits, including soft-tissue techniques, hot/cold packs, electrical stimulation, and trigger point therapy. Specific rehabilitation procedures were administered in between 20 percent and 26 percent of patient visits.
Prior/concurrent care. In 17 percent of patient visits in Arizona and 18 percent in Massachusetts, chiropractors reported that their patient was receiving medical treatment for the same condition. In 15 percent of Arizona visits and 26 percent of Massachusetts visits, the chiropractors indicated that they had discussed care of the patient with another health care provider.
Outlook for the Profession
In their discussion of the results, the authors noted some limits to their survey compared to those performed by the National Board of Chiropractic Examiners, the American Chiropractic Association and other organizations. For instance, the survey was conducted in only two states, whereas surveys from the NBCE and ACA are conducted on a national basis. In addition, the researchers noticed "regional variations in specific diagnostic and therapeutic preferences," which may have been caused by differences in scope of practice and/or training. On the other hand, the authors observed that the response rates to their survey were higher than those of the NBCE and ACA, and that their survey "was much briefer" than that used by the NBCE.
Nevertheless, the information derived from the study appears "consistent with the findings of previous studies" and provides important background information on chiropractors and chiropractic patients. This data, the authors believe, "may be of interest to chiropractic leaders and education planners for professional development purposes." As they note in their discussion:
"Chiropractic leaders, trade groups, and academics should find these results of interest, as there continues to be internal debate about the role chiropractors play, or should play, in drugless primary care and triage roles. Recent actuarial reports suggest that increased use of chiropractic is associated with lower utilization or substitution for other health care services. Identifying the most appropriate roles for chiropractors within conventional delivery settings and rational approaches to the coverage for chiropractic services should be priorities for further research."
Reference
- Mootz RD, Cherkin DC, Odegard CE, et al. Characteristics of chiropractic practitioners, patients, and encounters in Massachusetts and Arizona. Journal of Manipulative and Physiological Therapeutics Nov-Dec 2005;28(9):645-653.
Michael Devitt, senior associate editor.