Education and the Chiropractic Profession
By Reed Phillips, DC, PhD
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.Arguments for and against varying levels of standards are replete throughout our first century. What is most amazing is how the elements of the arguments have remained relatively consistent. The following historical prospective sheds light on the roots of our lack of internal consensus regarding educational standards for chiropractic education. Perhaps our journey through time will also shed light on the fruits of a solution to this problem.
Dr. Wassersug, in "The case against chiropractic,"1 finds fault with chiropractic on three points:
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:
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:
B.J.'s attitude toward education is further stated by Keating:
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:
Even field practitioners were concerned and dismayed over the profession's reluctance to lift the source of the river to a higher level:
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:
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.
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:
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.)
Reed Phillips, DC
Click here for previous articles by Reed Phillips, DC, PhD.