The United States Chiropractic Workforce: An alternative or complement to primary care?

Abstract

BackgroundIn the United States (US) a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation’s primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians.MethodsWe used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types.ResultsAccording to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson’s correlation 0.17, p-value < 0.001) and appear to be more responsive to market conditions (i.e. more heavily influenced by population characteristics) in regards to practice location than primary care physicians.ConclusionThese findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access.

Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain

“…We found evidence to support previous findings that a higher supply of chiropractic care is correlated with PCP supply, 8 suggesting the 2 services are located in similar areas. In this study, however, we found stronger associations between the 2 services (potentially because we removed inactive providers).…”

“…This finding is not surprising considering the chiropractic profession began in the Midwest (specifically in Davenport, Iowa, which had the highest supply of chiropractors of all HRRs). 8,26,27 Given that the supply of physicians in general exhibits a different pattern, 28 it may raise questions about the role of chiropractic care in improving access to care (particularly in rural locales). Previous studies have examined the potential role of chiropractic care in improving access to care.…”

“…7 Currently, there are an estimated 75,000 chiropractors across the country practicing predominately in privately owned offices and clinics. 8 In the United States chiropractors are registered providers who participate in many state Medicaid programs, most private health care insurances, and the Center for Medicaid & Medicare Services (CMS). 7,9,10 National Medicare spending on chiropractic care has increased substantially in recent years: from $466 million in 2006 to approximately $700 million in 2011.…”

“…A recent study found some evidence that chiropractors may locate in areas with higher PCP supply. 8 Given that the supply of chiropractic care and PCP services may be positively correlated, important questions pertaining to the potential indirect effects of chiropractic care on PCP workload, simply by virtue of being located in the same areas, are raised. If chiropractic care is merely additive (ie, patients use chiropractic care in addition to medical services 16,17 ), elimination of the benefit could save the system as much as $700 million.…”

Beyond spinal manipulation: should Medicare expand coverage for chiropractic services? A review and commentary on the challenges for policy makers

“…Commonly covered services include evaluation and management services, physical therapy modalities, radiographs, and some laboratory services 2 . Davis et al 3 estimated that there were 74,623 licensed DCs in the United States in 2006; and in that year, chiropractic physicians provided 18.6 million clinical services under Medicare Part B at a cost of $420 million 4 . Overall spending for chiropractic care in the United States totaled more than $5.9 billion in 2006 5 …”