| The question to be asked at the end of an educational step is not, 'What has the student learned?' but, 'What has the student become? -- James Monroe |
What do the students of chiropractic education learn, and how does their expanded knowledge relate to what they become in practice? What effect do the standards set by the Council on Chiropractic Education (CCE) -- everything from the pre-admission requirements to the final graduation requirements -- have on the prospects of a graduate becoming a successful practitioner? Is chiropractic education, as currently constituted, adequate? Should our standards be higher or lower?
History teaches us that these questions have been previously debated in chiropractic.
Dr. Wassersug, in "The case against chiropractic,"1 finds fault with chiropractic on three points:
- Chiropractic has low educational standards.
- The practice methods of chiropractic are based upon a fixed concept of disease and its remedy (cultist in nature).
- There is no scientific proof of the demonstrable worth of chiropractic methods in practice.1
Do these accusations offend you? Isn't this just another biased attack designed to discredit the chiropractic profession, and thereby deny chiropractors their right to care for patients chiropractically? C.O. Watkins, DC, expresses this sentiment: "The criticisms are familiar ones which we have heard many times from intelligent laymen who were our friends. They are damaging criticisms because, unfortunately, they are largely true."2
Dr. Wassersug published his observations in 1950. Would his statements, if published today, garner the same commentary from Dr. Watkins as they did nearly fifty years ago? Has chiropractic education improved since the 1950s? I believe the answer would be an undeniable yes. Chiropractic education has improved in many ways in the last half-century.
Resistance to Raising Standards
There is, however, an underlying tension within chiropractic education that never seems to settle. I propose to let history describe this tension. In 1917, the Universal Chiropractors' Association (UCA), led by B.J. Palmer, opposed state licensure. Palmer feared such regulation would lead to allopathic control of the profession.
Echoing B.J.'s position, UCA counsel Morris stated:
"Then your standards [of education] keep out new men, new women, from coming into the state. Now what happens when you do that? ... there is many a chiropractor today practicing in the field who, if he had to spend as much time to qualify himself for the practice of chiropractic as he would have had to spend for the practice of medicine, would have chosen medicine, because he would have looked at the 'culture' side of the thing, the 'social' side of the matter, the 'position' side of it. They want to be called 'Doctors.'"3
The UCA opposition to licensure eventually caved in, but B.J. remained strong in the opinion that examining boards should be composed exclusively of chiropractors (not mixers), and the educational standards to be adhered to were those of the Palmer School.
The Palmer School Standard
According to Keating, the UCA created a "model bill" in conjunction with B.J.'s "cleaning house" policy and the formation of the first National Board of Chiropractic Examiners (no relation to today's NBCE), to be introduced in states where chiropractic statutes had not yet been enacted. The model bill called for boards of examiners composed exclusively of chiropractors, and for a maximum training period of eighteen months, the length of the Palmer School program. In 1917, B.J. also organized the International Association of Chiropractic of Schools and Colleges (IACSC) in an effort to legitimize his educational standards.4
There was opposition to B.J.'s standard-setting organization. F.W. Collins and F.W. Allen of the Mecca College of Chiropractic in Newark, New Jersey, organized the Associated Colleges and Schools of Chiropractic (ACSC) in 1917.5 The National School of Chiropractic, under the leadership of W.C. Schulze, MD, DC, took opposition to the 18-month standard. Dr. Schulze believed that 18 months of training should be a minimum rather than a maximum standard. In response, B.J. expressed the following:
"Any chiropractor who plays to the higher educational qualifications, either willingly or unwillingly, knowingly or unknowingly, deliberately or unconsciously, plays the medical man's game just as he plays it and does just what the medical man wants done; except the chiropractor does it against his own and saves the medical man the trouble of doing it for himself."and:
"Chiropractic education has reached that period in its growth where more time would mean something more than chiropractic subjects, as it is even now. The P.S.C. is compelled to teach chemistry and bacteriology, both of which are entirely foreign subjects to chiropractic. We could ably cut the three years of six down two months if we didn't have these subjects. Veritably, it can be said that three years of six right now is slightly too long to teach and make proficient and competent chiropractors. Having graduated 80% of the surviving practitioners in the field, I think I ought to know and I think they can agree upon their results.
"Three years of six will be the chiropractic course from now on. I never have said and don't see how I honestly could say that the P.S.C. will ever have a longer course than three of six. It isn't in the nature of the past nor present facts to see it at any time in the future. And foreseeing futures has been my one longest suit, as our history ably shows."6
B.J.'s attitude toward education is further stated by Keating:
"And there was the developer's well-known attitudes about college education. It was his father's bias; and B.J., the 10th-grade drop-out, carried it with him throughout his career as head of the world's largest chiropractic school. Indeed, a serious dispute between B.J. and son Dave revolved around the latter's intent to pursue studies at the University of Pennsylvania. B.J.'s scorn for university training also paralleled his belief that organized medicine's ever-rising education standards were a ploy to keep the lower classes of society out of the professions and in a servile status. Palmer suggested that he'd rather train a plumber to be a chiropractor than a "college man," because the latter required a de-medicalization of thinking before he could learn chiropractic. `Education equals constipation,' he insisted, and most colleges, he believed, filled their pupils with useless theories that ill-prepared them for the practical realities of modern life."7
While the Palmer School lobbied to set the educational standard at 18 months (the length of time required to complete the "doctor of chiropractic" degree), they continued to offer a "chiropractor" degree as part of a 12-month program into the 1920s. Tuition for the two programs was $300 and $250 respectively.8
The National College Standard
The debate over the value of education raged between B.J. and the Palmer School, and A.L. Forster, MD, DC; William C. Schulze, MD, DC; and W.A. Budden, DC, ND, of the National College of Chiropractic and Western States College of Chiropractic. Dr. Schulze, as quoted by Keating:
"... first and foremost, and to be brutally frank about it, we are, as a profession, not well-enough educated. We have drilled into too large a number of our people such fallacies as, 'Get the idea and nothing else matters,' when we are all, more-or-less, slowly admitting what we should have known all the while, namely, that a river cannot rise higher than its source ... But first of all we must recognize, as a profession, that the thing which is holding us back or pulling us down is our own lack of education, generally speaking. ..."9
Even field practitioners were concerned and dismayed over the profession's reluctance to lift the source of the river to a higher level:
"... I have known the heads of certain schools who actually go so far as to say that they prefer as students the blank, unlettered, unlearned and untrained minds, as they usually make the best chiropractors, knowing full-well the impossibility of getting trained minds to follow their foolish philosophies. This is not fiction, but a fact. Could anything be more disgusting or preposterous! That is what is killing us, this seeming encouragement of ignorance. The public, as it expresses itself through the magazines as it has done of late and will continue to do until we have some sort of respectable unity in our ranks, is concerned for the most part over the vain babblings of those who say that there is no need of chemistry, physics, physical diagnosis, pathology or anything of the sort; that there is no need of quarantine or health laws; that there is no need of license or regulation; that there is no need of other doctors; that there is no need of observing any kind of rule or regulation, divine or otherwise, with regard to health, so long as you take adjustments; that there is no need of having a diseased appendix operated; that it is not necessary to get plenty of good food, rest, fresh air and sunshine and the like in connection with adjustments in order to get well; that adjustments will cure everything from corns to lice; that this is no good, ad infinitum, ad nauseam, and then some, that makes us the laughing stock of scientific men and the public at large."10
B.J.'s State Board Strategy: The Control of Education
By 1920, attempts to settle upon an educational standard among the schools were failing. Variations in educational programs and state licensure requirements were immense, ranging from the Palmer School's "3 years of six months each" as a maximum, to the National College's position of 18 months as a minimum. B.J. and the UCA embarked on a novel approach to achieve their standards. In a meeting of representatives from the state boards of examiners in eleven states, the following was proposed:
"Whereas, it appears that the educational requirements in the various states having laws governing the practice of chiropractic are so widely at variance;"Whereas, some state laws require a three-years course of six months each, or more or its equivalent, others require a three-year course of nine months each, while others have intermediate requirements;
"Whereas, the non-uniformity of laws governing the practice of chiropractic tends to create confusion between the various schools and colleges of chiropractic to establish a uniform course of education to meet the requirements of different state chiro Laws.
"Whereas, there is a federation of chiropractic schools and colleges who have adopted a standard course of study of three years of six months each; and,
"Whereas, this federation of chiropractic schools and colleges maintain and consider that the course of three years of six months each of sufficient length of time to produce capable and competent Chiropractors, due to the fact that the course of chiropractic study is devoted primarily to the study of subjects that bear directly on the science of chiropractic and does not include the extended study of materia medica, surgery and kindred subjects,
"Now, therefore, be it resolved by the undersigned representatives of the following state boards of chiropractic examiners, assembled in conference at Davenport, Iowa, on the 23rd day in August, 1919, that it is the agreed consensus of opinion that a uniform course of study of three years of six months each is of sufficient length, and should be adopted as the standard of education to be required by all states now having laws governing the practice of chiropractic, and be it further resolved that a standard educational requirement of a course of study of three years of six months each should hereby be adopted as a standard for future chiropractic legislation."11
B.J. also created a National Board of Chiropractic Examiners (NBCE, not the same NBCE as today) at the 1921 lyceum in Davenport in an effort to inspect the chiropractic colleges to ensure compliance with straight chiropractic guidelines. Between the influence of the NBCE, the International Association of Colleges and Schools of Chiropractic (IACSC), the UCA and the 11 state boards of chiropractic examiners, B.J. sought to drive the "mixers" from the profession and control legislation and licensing.
Broad-scope and disaffected straight practitioners responded by forming the American Chiropractic Association (ACA -- not the same ACA of today) in 1922. The ACA raised the standard for chiropractic education above the Palmer minimum, organized a research bureau and sought independence from the influence of the "schools" by not allowing any officer in the ACA to be a member of any college faculty.
Historical Lessons
B.J. opposed raising educational standards above the curriculum set by the Palmer School. He argued that expanded education would not produce better chiropractors and would prevent many (of the less educated) from entering the profession. In fact, he preferred to do away with any education beyond what was defined by him as "chiropractic." He used his political influence to create a federation of colleges, a national examining board, a national association and a collective of state licensing boards to prevent the profession from lifting standards above his mandated maximum.
As we ponder the continuing tension that strains the contemporary unity of our profession, I find a twist of irony. As the Council on Chiropractic Education (CCE) strives to increase professional educational standards above the 60 hours of college credit and a minimum 2.25 GPA currently required, there is opposition in the ranks:
- Some argue that increased standards would prevent the less fortunate from obtaining a chiropractic education (echoes of B.J.).
- Others argue that additional requirements do not equate to better or more successful graduates (echoes of B.J.).
- The colleges are split over their willingness to implement increased standards (as in 1920).
- The national board has been successful in implementing four parts of its standardized examination, with part IV becoming accepted as requirement for licensure in nearly half the states (far more successful than the NBCE of B.J.).
- The national associations are split over increasing educational standards. The ICA allows "school men" to serve as officers (like B.J. and the UCA), while the ACA requires "school men" who have traditionally been given a break on membership dues to pay full-fare if they wish to hold office.
- Finally, it is the federation of chiropractic licensing boards that is standing firm in support of increased standards (the exact opposite of the 1920s).
The irony is that where B.J. used influence over state boards to minimize standards, it is the state boards of today who are leading the charge to raise the standards. Thus, after 70+ years of debate, the argument has shifted from the length of chiropractic education (18 months vs. 24 months) to pre-matriculation requirements (60 credit hours and a 2.25 GPA vs. 90 credit hours and a 2.5 GPA, or even a bachelor's degree and a 3.0 GPA).
The Issue of Educational Standards
The fundamental issue continues to revolve around education. How much post-high-school education is needed to train doctors of chiropractic: one, two, four, or six or more years of college? What level of entrance performance should be considered adequate: 2.25, 2.5, 3.0 or a 4.0 GPA? Which subjects should be included in the curriculum? Should the established standards form the total framework of our educational requirements or serve as a foundation from which additional growth and development could be pursued? Do we need a two-tiered program: the chiropractor (minimum standards) and the doctor of chiropractic (attainment beyond the minimum)?
These are difficult questions that many organizations in the profession wrestle with. There are multiple answers based on one's perspective. While the correctness of the answers is important, the failure of the profession to find the answers has tarnished our social and political reputation. Patients still love the care they receive at the hands of their doctor of chiropractic, but why must chiropractic struggle for parity with other physicians in programs funding health care? Whether managed care, insurance, military or government health benefits, the profession continues to be the last to gain full access.
Perhaps we would do well as a profession to answer the questions regarding the effectiveness of our educational programs and the effect of our educational standards on the future doctors of chiropractic.
(A note of gratitude for the readily accessible material from Dr. Keating's book, B.J. of Davenport, from which I have drawn profusely.)
References
- Watkins CO. The case against chiropractic. J Calif Chiro Assoc Sept. 1950, pg. 19.
- Ibid.
- Keating JC. Courtrooms & legislative halls. In: B.J. of Davenport, the Early Years of Chiropractic. Assoc. for the History of Chiropractic, Davenport, Iowa. 1997, pg. 120.
- Ibid, pg. 121-122.
- Ibid, pg. 172.
- Ibid, pg. 123.
- Ibid, pg. 158.
- Ibid, pg. 161.
- Ibid, pg.177-78.
- Ibid, pg. 179.
- Ibid., pg. 181.
Reed Phillips, DC
Whittier, California
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