Golden Reflections, Modern Realities
By Joseph Keating Jr., PhDAn institution was approaching its 50th anniversary and had just completed one of its first self-studies (perhaps its first), an important step down the path toward federally recognized accreditation. Among the school's ambitious goals during that period was the erection of an in-patient facility. The administrative dean of the college reported that:
"Three years ago, the regents, alumni, faculty, administration and representatives of the profession reached a solid agreement that in addition to the purchase of the property now occupied by the college, we would require the building of a training hospital adjacent to the campus ... The practical training of the future doctors ... can only be further improved through hospital experience, where the student can follow the progress of in-patients ... We agreed that the site for the hospital should be given first and urgent priority. We are in accord that the second step should be the buying of the college site, to be followed by the building of the hospital. To brush this work aside as so much day-dreaming would be to do something less than justice to the careful and thoughtful work of many people. This general plan and program imposed on all concerned a responsibility to give serious consideration to the future of the college. That the obligation was not taken lightly I can vouch, and I would pause here to express deep appreciation to the members of the regents, the alumni, the faculty and the profession who labored so earnestly and generously to advance our plans to the present state of development."1
To complement its own self-scrutiny, the institution also employed several educational consultants with impressive credentials from some of the nation's leading universities. The consultants constituted the "dean's committee," and were authorized to prepare their own parallel but independent report on the institution.
"On this matter of financial support of the college I was happy to see the following as part of the report being prepared by the aforementioned dean's committee. A nonprofit specialized, technical institution financially dependent upon tuition is nowadays in no position to expand or improve its facilities unless additional sources of revenue are available. Colleges that depend solely upon tuition for their support very likely face extinction in this era of inflationary finances. The committee therefore feels strongly that the continuation of a sound, progressive, educational program will not be assured until there is economic security ..."1
Once Upon a Time ...
The college in question relied almost exclusively (70-90%) on the jargon of higher education) it was overwhelmingly tuition-dependent for its operating budget. The institution had no endowment from which it could draw money for improvements. (An endowment is a fund wherein the principal is never touched, but interest or dividends may be used once a pre-determined size of the principal has been achieved.) As a consequence, this school, like other institutions lacking endowments2,3 or other significant, non-tuition revenue sources, necessarily accepted almost every student who met the minimum admissions requirements and was able to pay the requisite tuition. There was little or no competition for admission among prospective students. Indeed, the only competition that seemed to take place was among the admissions departments of the other colleges within this institution's orbit. It was confidentially acknowledged4,5 among this and similar schools that a sizable proportion of inferior students were essential to the profession's training enterprise:
"In order to have an income for survival, each school must have sufficient enrollment for student tuition to cover operating expenses. In order to have such an enrollment the schools must enroll some poorer students, by the law of averages ... the upper one-third of the students are usually very good and the school is proud of that group. The next one-third must be classed as fairly good and are still a credit; however, the lower one-third must be considered as an "endowment." If the profession could provide the schools with the needed "endowment" then the enrollment could be curtailed and screened to a much greater degree. The schools would be much happier if this could be done."5
Of course, a variety of ways and means of generating larger operating budgets were considered, such as:
The school under consideration in this paper was not unmindful of the devastating effect that lack of selectivity in admissions can have upon an institution. When only the intellectual cream of the student crop are admitted to a college, the level of instruction can be sophisticated. But if a broad range of students are admitted to a school, a much lower level of discourse, teaching and grading must be adopted, or else a significant proportion of the student body will be set up for failure. And if students fail (or fear they will fail), then they drop out or seek admission elsewhere, which means tuition loss for the school that failed to accommodate them. Lack of selectivity in admissions tends to drive down the academic quality of a teaching institution.
One way to try to compensate for a severe lack of selectivity in the professional school under study here elected to require two years of pre-professional, liberal arts college credits, rather than merely a high school education, as a pre-condition for admission to its program.6-8 This particular strategy will not garner the most sophisticated student body (only competition among students and selectivity in admissions can do that), but it could potentially eliminate the "lower one-third"5 of applicants. Unfortunately for the college mentioned above, when it raised its entrance standard so that only applicants with two years of liberal arts college background were eligible for admission, applicants sought their education elsewhere, at nearby competitor schools with lower entrance standards. This school found that, indeed, "the lower one-third must be considered as an 'endowment.'" Without the fiscal cushion provided by inferior students, within a few years this college was forced to lower its admissions criteria and return to accepting high school students into a doctoral program.
Not unlike contemporary U.S. chiropractic colleges, the administrative dean and his fellow planners at this old institution saw only one or a few means of overcoming the college's extreme tuition dependence. In their case, the view was that only through appeal to the profession they served (and the state professional society with which they were then closely allied) could the college free itself from the vicious cycle of tuition dependence and poverty:
"The progress has been slow, for unfortunately the initial funds must be supplied by the members of the profession, which fund will then serve as the magnet to attract monies from other sources. I say "unfortunately" because many members of our profession, not being accustomed to the thought of a non-profit ... college, refuse to accept the fact that no individual or group of individuals are financially profiting from the operation of the college ... This condition of misconception is but a sign of a young profession; it is one of the factors that slows down [the profession's] progress ... the responsibility for the future fiscal state of the college rests ultimately with the members of the profession."1
And Nowadays ...
By way of comparison, the chiropractic colleges in America today are in quite similar economic circumstances. To the best of my knowledge, none is less than 60 percent tuition dependent for its operating budget; most are at least 80 percent tuition dependent; and a few may be even more poverty-stricken. (The typical allopathic college in the United States is no more than 15% tuition-dependent for its operating budget.) And yet, after more than 100 years of financing chiropractic education almost exclusively on students' tuition dollars, a certain sense of "normalcy" or complacency has evolved. We rightly take a degree of pride in the fact that chiropractic education has evolved without significant funding from government or taxpayers,9 which is fine up to a point. But the past need not be a blueprint for the to relive it.
Planning for chiropractic education in this country often seems to assume that because we have always relied heavily on tuition dollars to meet expenses, so it must always be. Perhaps we have even come to accept as "normal" the consequences of our poverty:10 low-level criteria and lack of selectivity in admissions; low-salaried and too few faculty members; lack of time and resources for scholarly activities and scientific investigations; little readiness to compete for grants for scholarly and scientific research. Less directly, we may attribute the very high indebtedness that our graduates depart with and the difficulties they encounter in trying to establish their practices so as to pay back their loans, to the continuing ostracism that chiropractors experience. This ostracism, in turn, derives at least partly from our institutional poverty and its effects on the products we turn out: doctors and knowledge.
While there probably is a certain minimum size necessary for economic efficiency, it is my opinion that all of the chiropractic colleges in this country are too big (not too big in an absolute sense, but too large in student body in relation to available resources for training those students). If they were to maintain the size of their personnel (faculty, administrators, etc.) and facilities and cut their student bodies by 50 percent or more, a far more appropriate ratio between students and resources would be realized.
Of course, so long as the chiropractic schools continue to be so heavily tuition-dependent, this fantasy is unlikely to be realized. As it currently stands, the financing of chiropractic schools in the United States involves a vicious cycle, and we often run the loop, seeking more students to generate more revenues, with the consequence that we have the same tuition-dependent problems on a grander scale. Yes, a few chiropractic colleges have placed a cap on the size of the student body. Bravo! But the cap does nothing to lessen the fundamental problem: tuition-driven institutional poverty. And, unfortunately, there are those chiropractic schools who seem to think that ever bigger is ever better.
There are even a few chiropractic schools in this country that are doing the best they can to tear down the institutional barriers that have kept us apart from the state universities of the various jurisdictions. Some are approaching this ostracism from the political angle, while a few others are attempting to create the intellectual linkage between their chiropractic institutions and state-funded universities through collaboration in research and other scholarly endeavors. In relation, possibilities are growing slowly less remote not only for greater federal funding for research and chiropractic education per se, but also for greater access to the teaching hospitals of the nation. Sadly, there are still a number of chiropractic leaders who see even affiliation (never mind amalgamation) of chiropractic colleges and state.
There are other tactics that have been and/or might be further investigated in order to lessen tuition dependence for chiropractic education. A few of the chiropractic schools do receive strong economic support from their alumni. At least one school that I know of receives capitation funding from state government for the training of "physicians." Nonprofit corporations (such as chiropractic colleges) could consider establishing for-profit subsidiaries to generate non-tuition dollars. Publishing, nutritional supplies, health food, rehabilitation equipment, alternative health education (for the public), or conceivably any honorable, ethical, profit-making enterprise could be established to support a nonprofit college. Perhaps some of the business acumen to be found among chiropractic suppliers could be tapped? Perhaps some of the more successful noneducational institutions within the profession (e.g., NBCE, NCMIC) could be engaged in this area?
Chiropractic colleges can establish their own endowment funds, with contributions from alumni and friends, plus some fixed percentage of contribution from tuition revenues. This is a long-term solution to the problem of tuition dependence. And yet if any chiropractic college fifty years ago had begun to set aside $100 per month in an endowment fund, perhaps using an index stock mutual fund or something analogous as a growth vehicle, a sizable, useful nontuition income source would probably be available today. Did any of the chiropractic schools do that?
This brief list of revenue ideas can undoubtedly be expanded beyond my feeble imagination. The point here is not to generate all possible solutions to the problem of financing chiropractic education, but rather to suggest that there is a century-old problem in American chiropractic that has not been well-addressed. Indeed, the issue is rarely discussed. Some in chiropractic apparently thought that with the 1974 recognition of the Council on Chiropractic Education by the federal government, the woes of the colleges were finally behind us. Not so! The chiropractic colleges in this country are poor, and that poverty has a harmful, cascading effect upon the whole profession, if only because our schools are the breeding grounds for the profession.
We must acknowledge the problem if we are ever going to solve it.
Which Was That School?
Which school was it that wanted to build a hospital during its golden anniversary year? Which college saw its only significant alternative to tuition as reliance upon contributions from the field? Which school's laboratory was pictured above? Not that it really matters for the point of this article, but the answer can be found in reference #1.
If your interest in chiropractic history has been stimulated, then consider joining the Association for the History of Chiropractic (AHC). Founded at Spears Hospital in Denver in 1980, the AHC is a non-profit, membership organization whose goal is the discovery, dissemination and preservation of the saga of chiropractic. The AHC held its first annual Conference on Chiropractic History at the Smithsonian Institute in Washington, D.C. in 1980, and has held similar conferences each years since at various chiropractic colleges.
The AHC's 1999 Conference on Chiropractic History will be held at the University of Bridgeport, College of Chiropractic, in Bridgeport, Connecticut. Details about the upcoming conference can be obtained by contacting the college:
The AHC publishes a scholarly journal, Chiropractic History, in which chiropractors and interested observers contribute their expertise to telling and interpreting the rich lore of the profession. The journal, which is indexed in the National Library of Medicine's Bibliography of the History of Medicine, is published twice per year. Chiropractic History is distributed to all members of the AHC as a membership benefit. Membership in the AHC can be obtained by sending your name, address and check for $50 ($20/year for students) to the AHC's executive director:
If you'd like to encourage historical scholarship and preservation within the chiropractic profession, then consider making a donation, large or small, to the historical fund of the National Institute of Chiropractic Research (NICR). The NICR is a nonprofit organization committed to conducting and supporting various types of research; in most cases, contributions are tax-deductible. The NICR historical fund supports the work of chiropractic historians and of centers for the preservation of historical documents. Preparation of this paper was supported by the NICR. Please make your check payable to:
Joseph C. Keating Jr., PhD
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