According to the 1992 issue (Volume 4) of the FACTS Bulletin (Foundation for the Advancement of Chiropractic Tenets and Science), there are 49,144 doctors of chiropractic in the United States. The average DC serves 5,100 members of the U.S. population.
According to an article entitled "Seeing the Rainbow" appearing in the January 4, 1993 issue of the American Medical News (AMN), there are approximately 615,000 MDs in the U.S. They each serve 410 people. By the year 2020, the number is expected to exceed 800,000.
In 1963, 46 percent of all MDs (approximately 128,000) were considered "primary care". The rest are some kind of specialists or subspecialists. Today, only 30 percent (183,000) are primary care providers. Less than 15 percent of third year medical students are expected to practice as primary care physicians1.
According to another article in the same issue of AMN, "HMOs - the most cost-effective U.S. delivery organizations - have more than 50% primary care physicians, as do the national systems in Canada and Great Britain." This dichotomy is summarized in a recent report by the Bureau of Health Professions' Council on Graduate Medical Education which listed as finding number 1: "The nation has too few generalists and too many specialists."1
It is in this environment that the chiropractic profession must define itself. And these definitions CANNOT be merely on paper.
Are we specialists?
Should our numbers be added to the 432,000 MD specialists and subspecialists?
Where should those who are currently planning America's national health care program position chiropractors and chiropractic care?
Or are we generalists?
Could chiropractic be the solution to the obvious primary care shortage facing this country?
Can we prove our ability to serve as portal of entry providers?
These are the issues that medicine is wrestling with, and they have 615,000 doctors. With our 49,000, we don't have the luxury of taking a "wait and see" approach.
If the chiropractic profession is comprised of both specialists and generalists, we need a way to make that known. Perhaps this is a time to look at what our chiropractic colleges are really producing.
When the United States solves the problem of the 37 million people who lack health insurance, we will face an immediate need for a large number of primary health care providers. Does that mean more chiropractic patients, or more medical schools?
Again, the challenge is before us. If we can but unite and address the issues, there is a great potential. Can we do it?
1. Sandlin N: "Are There Too Many Doctors? And Too Many Specialists?" American Medical News, January 4, 1993, pp. 6 - 7
DMP Jr., BS, HCD(hc)
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