The training for chiropractors is nowhere close to that which physicians get. The closest physician, in terms of practice, to a chiropractor is a physiatrist. The physiatrist is required to have four years of medical school, 1 year of internship, and three years of residency training. Now, chiropractors will try and tell you that they somehow cram 5 years of training into 3 years. This is because they use the federal financial aid rules to define a year (1 year = 2 semesters). By this math, a physiatrist has 11 1/2 "years" of training.
Understand that, while they are properly referred to as "doctors" in practice, the DC is not generally recognized as an academic degree. There are
many teaching hospitals where a DC would not be referred to as "doctor" (there are policies stipulating who can and can't be called "doctor" to prevent confusing patients and staff). There are no institutions of higher education, other than chiropractic colleges, where a DC is an acceptable degree for admission to academic faculty. (And before everyone starts screaming about T. Yochum at Colorado, he lectures there, he is
not a professor, he is not on tenure track, and he does not hold academic rank. Nurses, paramedics, PTs and RTs hold similar positions at many schools. That doesn't make them faculty).
Additionally, chiropractic is not supported by the current literature for any condition other than idiopathic LBP. For that condition, studies have demonstrated that chiropractic is "as good as" but not better than traditional medical treatment. You should keep in mind that both chiropractic and traditional medicine are statistically only slightly better than placebo in those cases, so there is not a strong arguement for either. Read this for a bit more skeptical take on chiropractic education:
http://quackfiles.blogspot.com/2005/02/why-i-left-chiropractic.html
There are several papers out that demonstrate how ineffectively chiropractors are prepared for practice in primary care, the best of which is here:
http://www.ncbi.nlm.nih.gov/entrez/..._uids=15965408&query_hl=1&itool=pubmed_docsum
What they did was give a test to on basic primary care to three groups of chiropractic students in their final terms in chiropractic college (groups 1, 2 and 3) and one group of recent medical school graduates who had yet to start residency. The test was created by "2 DCs who also hold bachelor's degrees, 1 DC with a diplomate in radiology, a DC enrolled in the final year of a radiology residency program, and 2 MDs". It was a 100 question test broken into two 50 question sections and some description of attempts to validate the instrument for use on chiropractic students is offered by the authors. So here is what they found...
Group 1: 21 students, raw scores 32.7, % scores 65.4, SD 4.6
Group 2: 22 students, raw scores 28, % scores 56, SD 5
Group 3: 79 students, raw scores 32.1, % scores 64.2, SD 4.4
Groups 1 to 3 (combined): 122 students, raw scores 31.4, % scores 62.8, SD 4.7
Group 4: 20 students, raw scores 36.7, % scores 73.4, SD 3.3
Now, while the medical student sample size is low, the
performance of the chiropractic students is abyssmally low. 68% of all of the chiropractic students (who are very soon to enter practice) taking the test, a test designed and validated by DCs, scored between 58.1% and 67.5%?!? This is noteworthy? Yes, it is! It succinctly proves the point that DCs are very ill prepared to serve as primary care physicians. As for the medical students, 68% scored between 70.1% and 76.7%. While I would normally bristle at these data as the sample size is so small, it should be noted that the SD was the narrowest, by a considerable amount, in this group. This leads me to question the need to validate the instrument not only with chiropractic students (as was done) but also with medical students (not done in this study). These results seem to indicate a very tight "clumping" of scores in the medical student group, which may suggest that areas of the test represented material outside their scope of instruction.
Other results:
Percentage scores of all students on 5 major categories of primary care tasks
Primary care activities (% correct)
Information gathering Group 1 - 60.12, 2 - 57.04, 3 - 64.72, 4 - 76.64
Screening and prevention Group 1 - 35.72, 2 - 27.09, 3 - 38.93, 4 - 63.10
Other diagnostic procedures Group 1 - 66.94, 2 - 57.64, 3 - 65.83, 4 - 74.34
Counseling and education Group 1 - 69.05, 2 - 75.00, 3 - 87.74, 4 - 95.24
Management of acute/chronic conditions Group 1 - 65.71, 2 - 57.04, 3 - 64.69, 4 - 73.01
By these data, chiropractic does not perform information gathering or screening and prevention well at all.
I'm not going to post the data on all individual "subcategories of management of acute and chronic conditions". Suffice it to say that group four handily out performed all of the other groups in every area except one:
Musculoskeletal (% correct) Group 1 - 71.04, 2 - 56.95, 3 - 54.75, 4 - 48.02
(but group four did outperform the others in neuro!:
Neurological (% correct) Group 1 - 78.1, 2 - 61.67, 3 - 78.99, 4 - 82.86)
My most significant concern on their methodology is this - the test was given to medical students about to enter residency training and to final term chiropractic students about to enter practice (presumably). Now, the article acknowledges a gap, but that gap
should only
grow as the medical students have at least three years of training remaining. Also, no attempt was made to identify what area of medicine the MD students were entering. I would argue that given the latitude to self direct fourth year cirricula to a certain degree, students heading into primary care would likely outperform a random sample from all medical students on this examination as they would have more training in this area than the "average" medical student.
Lastly, the conclusions (from the abstract) do not match the data. It is not "noteworthy", in a positive sense, that chiropractic students about to enter the workforce score abyssmally low on a test of basic primary care skills. Comparing them to MD graduates with at least three years of training remaining is comparing apples and oranges. And even given the disparity in time remaining in training, the MD students quite significantly outperformed the chiropractors. This paper completely demonstrates what I have been saying since I started coming to this forum. Chiropractors are not equipped to act as primary care physicians.
Now chiropractors
love to quote this study:
http://www.ncbi.nlm.nih.gov/entrez/...t_uids=9801210&query_hl=5&itool=pubmed_docsum and it's follow-up
http://www.ncbi.nlm.nih.gov/entrez/..._uids=15687152&query_hl=3&itool=pubmed_docsum as "proof" that MDs are not adequately trained in NMS complaints, and that chiropractors are. Before you buy into this realize the following -
chiropractors were not given the test in either study! We have no idea how badly they would have bombed it. But we do know from the article above: J Manipulative Physiol Ther. 2005 Jun;28(5):336-44. Assessment of knowledge of primary care activities in a sample of medical and chiropractic students. Sandefur R, Febbo TA, and Rupert RL. that three groups of chiropractic third year students, when given a test on musculosketal pathology, scored 71.04%, 56.95%, and 54.75% respectively. So much for the greater musculoskeletal training.
And, the arguement is spurrious on its face. The articles on allopathic musculosketal pathology training were studies designed specifically to call for additional training for all physicians in musculosketal pathology. There is no question that the current medical school cirriculum is overloaded. The call for extended training in many subjects has been going on for years. Unlike in chiropractic where all of medicine AND all of chiropractic can be learned in three calendar years.
Given the collaborative medical model (remember that unlike chiropractors, MD/DOs do not believe we know everything nor do we believe we can treat everything) a properly treated patient presenting to a primary care physician for treatment of a musculosketal issue will be referred to another physician. Patients are best served by receiving care from a health care provider with more musculoskeletal training - an orthopedic surgeon or a medical PM&R physician.
BTW - the practicing orthopods ALL passed the test and were used as controls!
The last problem is that you need to remember that there are, within chiropractic, at least three distinct groups, each of whom have a very different vision of chiropractic - especially in regard to it's scope. There are "straight" chiropractors who hold dear the principles of Palmer and the belief that nervous system dysfunction holds the key to most health problems. Then there are the "mixers" who agree that there is little scientific basis for most of Palmer's theories, but who feel chiropractic is a useful modality for treatment neuro/muscular/skeletal problems. Then there are the "psuedo-mixers" who hold on to Palmer's theories and try and expand them through "new" and decidedly non-medical practices. These folks are often very "anti-medicine" and truly believe that the "Rosetta Stone" to all of health lay within their grasp. Each of these groups is "entrenched" in the profession and have resist standardizing the profession in any vision but their own. These groups infight so much that it is impossible to even define chiropractic care anymore because the care you will recieve will vary so greatly based on which "camp" your practitioner comes from.
- H
