In your recent editorial "Regulated growth? Hard questions that need to be faced" ("Report of My Findings," DC December 15, 2001, http://www.chiroweb.com/archives/19/26/12.html) you ask: "Is it time for the chiropractic profession to regulate the number of new DCs that enter the profession in the U.S.?" and "Is this a policy our chiropractic colleges should consider?" You offer medical school admissions as an example, suggesting that higher standards (and vigorous competition) enable medical schools to limit growth in the medical ranks.
To raise such questions is to address the economics of chiropractic schools in America. Since the basic formula for financing the training institutions was worked out by B.J. Palmer in the early years of the 20th century (Keating, 1997), relatively little has changed. Chiropractic colleges in the U.S. are heavily (80+%) tuition-dependent for their operating budgets, whereas U.S. allopathic schools rely upon tuition for some 5-15% of their annual operating expenses.
In the early days of the accreditation movement in the chiropractic profession, school leaders were adamant: "We cannot just give the profession the prestige and the advantages of the higher educational standard - we must ask them to become philanthropists and support it. It cannot be done on tuition fees alone" (Steinbach, 1944). Indeed, when John Nugent,DC, NCA director of education, addressed the newly formed NCA Council on Education (forerunner of today's CCE) about the need to improve the facilities for basic science instruction, the quick response from Thure Peterson,DC, president of the council, was that it "could not be accomplished without proper endowment, because college income, based upon student tuition entirely, would not be able to defray the expenses associated with such a complete program" (Minutes, 1949). Council leaders privately opined that "the lower one-third of the students in all chiropractic colleges represented the endowment for the upper two-thirds" (Minutes, 1955). In other words, chiropractic schools were forced to take students they might have preferred to turn away in order to pay the bills.
So far as I can discern, the basics of financing chiropractic-training institutions in this country have not appreciably changed in the last 100 years. And with the recognition of the CCE by the federal government in 1974, the availability of guaranteed student loans has only increased the burden faced by an expanded number of chiropractic students.
To be sure, there have been attempts to develop nontuition sources of revenue for the schools. One admirable effort was noted in Dynamic Chiropractic just a few years ago, when the Texas Chiropractic College seemed close to an affiliation or amalgamation arrangement with the state university (Elliott, 1997). It's my understanding that the New York Chiropractic College, under the leadership of its long-time president, Ernest Napolitano,DC, was able to acquire substantial funding through the New York State university system, and has built quite a nest egg. It's also my understanding that a few schools (e.g., Palmer, Cleveland) have been able to develop modest (seven-figure) endowments through contributions from alumni. As well, the National University of Health Sciences, as an institution training physicians in Illinois, receives a modest amount of capitation funds from the state.
On the other hand, we're all aware of at least one chiropractic institution, which has spent its dollars to prevent the creation of a state-university-based (and funded) chiropractic college in Florida!
None of the American chiropractic colleges, so far as I know, is in a financial position to significantly increase the degree of selectivity it might otherwise like to exercise in admitting students. Accordingly, and rather unlike medical school recruitment, the only competition for admission to U.S. chiropractic colleges occurs among the admissions directors of the schools themselves. Applicants who meet the minimum admissions requirements and can pay the hefty tuition charges will find a seat at some chiropractic college in this country. Even those schools which have upper limits for total enrollment are more likely to place an applicant on a waiting list than to turn her/him away. Nor will raising admission requirements alter the fundamental dynamic that drives this reality: chiropractic schools are supported by their students. Poverty-stricken, tuition-driven finances are the bottom line, and consequently, our admissions departments encourage weak (albeit minimally qualified) individuals to apply. The bills have to be paid.
By way of contrast, the 125+ allopathic schools in America have the luxury of turning away the majority of applicants because they don't need the money. The medical profession can afford to limit its own ranks because medical education in this country is overwhelming paid for by the public through taxes.
So, the short answer to your question is that it seems very unlikely that U.S. chiropractic schools will be willing to "regulate the number of new DCs that enter the profession in the U.S."
Joseph Keating Jr., PhD
- Elliott, Shelby M. One giant leap for chiropractic education. Dynamic Chiropractic, 5 May 1997, p. 28
- Keating JC. B.J. of Davenport: the early years of chiropractic. Davenport IA: Association for the History of Chiropractic, 1997.
- Keating JC, Callender AK, Cleveland CS. A history of chiropractic education in North America: report to the Council on Chiropractic Education. Davenport, IA: Association for the History of Chiropractic, 1998.
- Minutes of the National Chiropractic Association, Council on Education, Chicago, 5-7 January 1949 (reprinted in Appendix B in Keating, Callender & Cleveland, 1998).
- Minutes of the mid-year meeting of the National Council on Education of the National Chiropractic Association, New York, 9-11 February 1955 (reprinted in Appendix B in Keating, Callender & Cleveland, 1998).
- Steinbach, Leo J. Letter to members of the executive board of the National Chiropractic Association, 13 January 1944 (CCE Archives, #35-12-1938).