Chiropractic Medicine

An Ethnographic Study

Robert Hartmann McNamara

From its very beginning, chiropractic medicine has faced challenges about the scientific validity of the treatment and the credibility of its practitioners. Since those early years, many of these criticisms have remained, but legislation, licensure, and litigation have created an environment where chiropractic care is allowed in all 50 states, and licenses are required of all chiropractors who wish to practice medicine.

The implementation of the Affordable Care Act has changed the way insurance companies provide reimbursement for services by medical providers. With a greater emphasis on administratively documenting how and in what ways a particular form of treatment actually improves a patient’s health, coupled with a greater level of restriction on the types of services medical providers can offer without justification and authorization, many medical providers, including chiropractors, have had to re-examine the services they provide and how they operate.

This study attempts to explore the life of chiropractors in light of all the historical and current changes taking place within the medical profession. It also seeks to understand the external and internal threats posed to chiropractors, with an eye towards understanding how and in what ways the future of medicine will impact the chiropractic profession. Despite the projected growth of job opportunities for chiropractors between 2014 and 2024, which, according to the U.S. Department of Labor is occurring at a much faster than average trajectory than other professions (U.S. Department of Labor Statistics, 2015), given the costs involved in completing chiropractic training (which can exceed $200,000) coupled with the low salary (recent data from the U.S. Department of Labor Statistics shows that the median salary for a chiropractor is $64,440 per year), along with the challenges of sustaining an individual practice (most chiropractors are self-employed in solo practice), these obstacles are formidable ones. This is particularly true in light of the recent development of large chiropractic chains such as the Joint, that offer spinal and neck adjustments at a fraction of the cost of a traditional provider.

This ethnographic study consisted of systematic observation and interviews of 40 chiropractors in South Carolina from Fall 2016 to Fall 2017. Additionally, interviews were conducted with staff members, patients, and other medical providers, such as physicians, physical therapists, massage therapists, and representatives from the insurance industry about their understanding and experiences with chiropractic medicine. Phone interviews were also conducted with seven deans and provosts at chiropractic colleges around the country. In total, over 100 interviews and informal conversations occurred during the course of the project. All identifiers of participants and chiropractic colleges in the study were removed to ensure anonymity. Instead, pseudonyms were created that were known only by the author of the study. Additionally, data from the South Carolina Department of Labor, Licensing and Regulation was obtained to document changes in the number of chiropractors who are no longer in practice in the state between 2016 and 2017.

Lexington Books

Pages: 274 • Trim: 6⅜ x 9

978-1-4985-9140-9 • Hardback • November 2018 • $117.00 • (£90.00)

978-1-4985-9141-6 • eBook • November 2018 • $111.00 • (£85.00)

Subjects: Social Science / Human Services, Social Science / Health Geography, Social Science / Medical Sociology, Social Science / Sociology of Education, Education / Teaching Methods & Materials / Health & Sexuality

Chiropractic Medicine

An Ethnographic Study

Hardback

eBook

Summary

From its very beginning, chiropractic medicine has faced challenges about the scientific validity of the treatment and the credibility of its practitioners. Since those early years, many of these criticisms have remained, but legislation, licensure, and litigation have created an environment where chiropractic care is allowed in all 50 states, and licenses are required of all chiropractors who wish to practice medicine.

The implementation of the Affordable Care Act has changed the way insurance companies provide reimbursement for services by medical providers. With a greater emphasis on administratively documenting how and in what ways a particular form of treatment actually improves a patient’s health, coupled with a greater level of restriction on the types of services medical providers can offer without justification and authorization, many medical providers, including chiropractors, have had to re-examine the services they provide and how they operate.

This study attempts to explore the life of chiropractors in light of all the historical and current changes taking place within the medical profession. It also seeks to understand the external and internal threats posed to chiropractors, with an eye towards understanding how and in what ways the future of medicine will impact the chiropractic profession. Despite the projected growth of job opportunities for chiropractors between 2014 and 2024, which, according to the U.S. Department of Labor is occurring at a much faster than average trajectory than other professions (U.S. Department of Labor Statistics, 2015), given the costs involved in completing chiropractic training (which can exceed $200,000) coupled with the low salary (recent data from the U.S. Department of Labor Statistics shows that the median salary for a chiropractor is $64,440 per year), along with the challenges of sustaining an individual practice (most chiropractors are self-employed in solo practice), these obstacles are formidable ones. This is particularly true in light of the recent development of large chiropractic chains such as the Joint, that offer spinal and neck adjustments at a fraction of the cost of a traditional provider.

This ethnographic study consisted of systematic observation and interviews of 40 chiropractors in South Carolina from Fall 2016 to Fall 2017. Additionally, interviews were conducted with staff members, patients, and other medical providers, such as physicians, physical therapists, massage therapists, and representatives from the insurance industry about their understanding and experiences with chiropractic medicine. Phone interviews were also conducted with seven deans and provosts at chiropractic colleges around the country. In total, over 100 interviews and informal conversations occurred during the course of the project. All identifiers of participants and chiropractic colleges in the study were removed to ensure anonymity. Instead, pseudonyms were created that were known only by the author of the study. Additionally, data from the South Carolina Department of Labor, Licensing and Regulation was obtained to document changes in the number of chiropractors who are no longer in practice in the state between 2016 and 2017.

Details

Lexington Books

Pages: 274 • Trim: 6⅜ x 9

978-1-4985-9140-9 • Hardback • November 2018 • $117.00 • (£90.00)

978-1-4985-9141-6 • eBook • November 2018 • $111.00 • (£85.00)

Subjects: Social Science / Human Services, Social Science / Health Geography, Social Science / Medical Sociology, Social Science / Sociology of Education, Education / Teaching Methods & Materials / Health & Sexuality

Author

Robert Hartmann McNamara is professor of criminal justice at The Citadel, The Military College of South Carolina.

Table of Contents

Preface

Acknowledgments

Chapter One: Introduction and Methods

Chapter Two: History of Chiropractic Medicine

Chapter Three: The Cast and Setting

Chapter Four: Scope of Practice

Chapter Five: The Joint

Chapter Six: Chiropractic Colleges

Chapter Seven: Health Care Reform

Chapter Eight: Conclusion

Reviews

Based on the existing research literature and empirical evaluation, this book sheds light on an industry that has long existed in the shadows. It answers questions that many of us have asked, and in doing so is an extremely useful work that should be read by anyone considering chiropractic treatment and others interested in better understanding health care. McNamara’s research-based approach is refreshing as he overcomes various obstacles in assembling a comprehensive account of an industry that has operated without much scrutiny.
— Ronald Burns, Texas Christian University

McNamara is a fine story teller, and in many ways, gives us a wealth of information on the scientific merits of chiropractic medicine. Even though we are left at times distressed by some of the findings, the book is compulsively engaging.

McNamara writes with lucidity, passion, and keen knowledge; he engages our collective conscience in a way that helps us understand the world of chiropractic medicine. This book is a dynamic study of a relatively unknown profession.
— Terry Williams, The New School for Social Research

Chiropractic Medicine

An Ethnographic Study

Robert Hartmann McNamara

Chiropractic Medicine

An Ethnographic Study

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