Dynamic Chiropractic – August 25, 1997, Vol. 15, Issue 18

A Forbidden Subject?

Free Market vs. Planning

By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
It isn't any secret that the medical profession faces a glut of surgeons and specialists. A number of studies have discussed the surplus of medical specialists that already exist in some regions of the country, and the projecting of those numbers growing over the next decade.

The medical schools have tried to steer more students towards general and family medicine. While this lessens the immediate burden on the medical specialties, it will create an overabundance of general practitioners down the line. Another suggestion has been to simply deny medical licenses to foreign medical school graduates. But even such an exclusionary policy would not substantially impact the problem.

Because the medical profession is either incapable or unwilling to seriously tackle this issue, the world economy will be the deciding force. As more MDs graduate from medical school and the density of their numbers increases, the competition will mount; they will begin doing whatever they have to in a vain effort to earn the kind of money they anticipated earning when they entered medical school.

With a surplus of MDs on the market, many will seek the security of becoming employees. Managed care companies, knowing they're in the power seat, will begin offering lower salaries. The average income of MDs will continue to plummet.

Some MDs will move to underserved areas of the U.S. and the world. With a little encouragement, the world population would have much greater access to medical care.

Ultimately, many MDs will be forced into the grey area of ethical medicine (maybe they're already there). To maintain their income they will encourage unnecessary diagnostic tests and care: an extra surgery here, a few more office visits there.

When a career in medicine no longer offers an attractive enough income, many more of the medical school enrollees will be less motivated by earning power and more focused on becoming a doctor and treating patients. A number of medical schools will be forced to close their doors or merge with other schools.

While this scenario may sound unsettling, it should also sound familiar. Once again the chiropractic profession is given an opportunity to learn from medicine's mistakes. The question is, will we learn or will we follow?

I don't hold any particular position about the number of DCs in the profession, or what plans this profession should make in that regard. This article is not a call to action, but a call for discussion.

Some of the comments and explanations fall into two basic categories:

Too Many DCs -- Some states are increasing matriculation standards, such as requiring bachelor degrees; others are adding "training programs" prior to licensure. The Council on Chiropractic Education (CCE) is in the process of raising the required grade point average for matriculating students. The notion is that upgrading certain requirements will result in better qualified students and fewer DCs.

Expand Our Market -- Others suggest that the only way to expand the percentage of the population under chiropractic care is by increasing the number of chiropractors. When looking at the number of DCs vs. the U.S. population, it is clear that this must happen for new graduates to succeed. Considering the trend toward wellness care, new DCs may be needed to care for an increasingly holistically aware public.

According to the latest chiropractic licensure figures published by the Federation of Chiropractic Licensing Boards (FCLB), the ratio of active chiropractic licenses vs. state populations (using 1990 census data) is one DC for 3,495 potential patients. Assuming that 10% of the population receives chiropractic care (I believe the number is closer to 15%), which equates to an average of 350 patients for every DC.

Obviously, the larger the percentage of the population that utilizes chiropractic, the greater the number of DCs needed to serve them. And yes, the more DCs in practice, the greater chance a person will discover chiropractic.

But with over 12,000 chiropractic students waiting to graduate in the next 3-4 years, it won't be too long before the ratios bring concern. While the District of Columbia currently shows a ratio of one DC for every 13,196 people, Arizona's ratio is one for every 1,525.

Being a firm believer in planning, it seems that a discussion of the issues now will provide clarity of purpose for future planning. Current DCs and graduating students can only benefit from our foresight.

Again, this is a call for discussion. Your input would be greatly appreciated. Share your thoughts and concerns in this critical area. Please send them to:

Call for Discussion
P.O. Box 6100
Huntington Beach, CA 92615
or fax:
or e-mail:
Donald M. Petersen Jr., BS, HCD(hc), FICC(h)
Dynamic Chiropractic

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