Let's determine if a) there are needs justifying more colleges and b) how well the needs for more colleges are being or will be met. From this, we ought to be able to draw some rational conclusions.
I postulate several needs for chiropractic educational institutions:For the perpetuation of the philosophy, science and art - the culture of the chiropractic profession: Without the continuous genesis of new life-blood, attrition and aging would decimate and eventually eliminate the chiropractic profession. The art and the belief systems may continue, but more likely as folklore rather than as a profession.
For the preservation of current and past knowledge and the discovery of new knowledge for the profession and patients: The aim of knowledge is wisdom, not certainty. Educational institutions become the caretakers and purveyors of professional wisdom and bear the burden of providing the infrastructure upon which the profession examines itself through investigation and research.
For the preparation of the next generation of the profession: Typically conceived as training practitioners, we must not exclude the next generation of teachers, administrators, politicians, researchers and policy makers. Very few enter the "city" of chiropractic professionalism by way of the "back door" or over the city wall. The "gates" to the city are its educational institutions.
For the maintenance and enhancement of the status quo: This includes areas of continuing education and lifelong learning of current practitioners, protection and expansion of current practice rights, recognition and improvement of third-party payers and inclusion into government-sponsored programs.
For providing service to the communities in which the schools reside and the patients whom they serve
This list, by no means all-inclusive, provides a justification for the presence of educational institutions, but it does not answer the question of how many educational institutions we need. The question is how well these needs are being met by the existing institutions - a daunting challenge.
The perpetuation of a culture: I submit that the educational institutions in the chiropractic profession do a good job of perpetuating a culture. In fact, each institution seems to produce a culture of its own, whether it be the Palmer, National, Sherman, or LACC culture. While all the cultures have similarities, there are many unique and distinct differences. I cannot say if this is good or bad, but it does beg the question, "Do we need more?" Will two more institutions, with slightly different spins on their particular blends of chiropractic culture, benefit the profession as a whole?
Preservation of current knowledge and the generation of new knowledge: Current institutions are repositories of library holdings and archives. Most libraries do an adequate job of maintaining their holdings, but most archives are neglected and fall into disrepair. New institutions will likely have little need and precious few resources to dedicate to the preservation of their history and may not do any better than existing institutions.
On the other hand, new knowledge presents an opportunity. While the existing institutions recognize the need to foster strong, active research programs, not enough has been accomplished in this arena. If a new educational institution had the resource base to support a vigorous research agenda, it would be a boon to the profession; if not, it would seem wiser to consolidate the resources of several institutions into a single research effort.
Training the next generation: To varying degrees of quality and proficiency, all institutions are contributing to the ranks of the practitioner. Given current utilization rates and the effects of managed care, it could be conceded that the "village square" is saturated. Optimists and opportunists look to changing the market or enlarging the village square, and by doing so will increase the need for more practitioners. Current institutions have contributed little to expanding the marketplace. It's not likely that additional institutions will improve the situation.
The production of nonpractitioner members of the profession has fallen largely to the institutions. Except for national and international associations, nonpracticing members of the profession affiliate with the educational institutions. There are some entrepreneurial individuals who manage well by extracting their livelihoods from the practicing members of the profession.
While new institutions will provide a place for the growing cadre of nonpracticing members of the profession, the question arises, "Will they do any better at training the nonpracticing professional? Who will train the next generation of administrators, teachers, researchers and policy makers?" The colleges have not focused well on training these people. Will two new schools improve the situation?
Maintenance and enhancement of the status quo: While not considered to be politically astute, educational institutions do carry political clout. When organized properly, they can be an effective voice in legislative matters, especially when they team up with their state and national associations. Adding two new voices to this "choir" could strengthen their volume and perhaps augment their harmony.
Service to the communities and patients: I believe that all chiropractic educational institutions, including any new ones, do now or will provide a significant amount of free or low-cost care to the patients they serve. Institutions also bring additional commerce to their local communities and with other vendors.
A broader perspective of "service" could be that of higher education in general. The academy has a dilemma. There has been a shift from preparing students to be "good citizens" to a focus on preparation for the job market. Students have become consumers or customers. Faculty has become discipline-bound professionals, and more and more administrators are expected to be successful fundraisers. The academy has been overtaken by the "corporate" thinkers. What does higher education, and for that matter chiropractic education, contribute to civic life? How is chiropractic education preparing its graduates to serve in civic responsibility? Beyond our own special needs as a profession and the added value we bring to the lives of our patients, what do we as a profession, as educational institutions and as individuals immersed in society, contribute to the overall good of the society in which we exist?
Whether there are two new chiropractic educational institutions or 20, there will be advantages and disadvantages. I think the number of chiropractic educational institutions is a lesser issue. Survival is hinged to service. Think of the words of President John Kennedy: "Ask not what your country can do for you - ask what you can do for your country." A plea to all my professional colleagues is similar. Survival of the chiropractic profession is more dependent upon how well we serve our communities than how well our communities serve us.
President, Los Angeles College of Chiropractic
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