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Oversupply of Chiropractors and Reduced Income Impact California

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ChiroACCESS Editorial Staff



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August 16, 2010

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Based upon an August 2010 study of California chiropractors, 20 to 25% are leaving practice within ten years of graduation.  The authors believe that an oversupply of chiropractors and decreased income are two of the many factors that contribute to the exodus.  From 1970 to 1998 there was an increase in the number of active California licenses from 4,274 to 11,637.  Supporting the oversupply issue the authors note that “The 170% growth rate in chiropractors during the study far exceeds the 65.1% increase in residential population.”

Other regional studies in North America document the direct impact of supply on income.  A study of Canadian chiropractors in Ontario shows that accompanying a substantial increase in the number of chiropractors there was a dramatic drop in income.  The research discovered a 50% drop in income from $97,892 annually in 1992-1993 to only $48,900 in 2002-2003.  The exact income of U.S. chiropractors is difficult to know because many of the surveys capturing that information are no longer administered and there are questions relating to the reliability of some that still are used.  Overall the data that does exist suggests a decline in both gross and net chiropractic incomes without adjusting for inflation.  

More information on the income of chiropractors can be found here: Practice Economics: How Much Do Chiropractors Make?

The attrition rate of licensed chiropractors in California: an exploratory ecological investigation of time-trend data.  [LINK]

Chiropr Osteopat. 2010 Aug 12;18(1):24. [Epub ahead of print]

Foreman SM, Stahl MJ.

BACKGROUND: The authors hypothesized the attrition rate of licensed chiropractors in California has gradually increased over the past several decades. "Attrition" as determined for this study is defined as a loss of legal authority to practice chiropractic for any reason during the first 10 years after the license was issued. The percentage of license attrition after 10 years was determined for each group of graduates licensed in California each year between 1970 and 1998. The cost of tuition, the increase in the supply of licensed chiropractors and the ratio of licensed chiropractors to California residents were examined as possible influences on the rate of license attrition.

METHODS: The attrition rate was determined by a retrospective analysis of license status data obtained from the California Department of Consumer Affairs. Other variables were determined from US Bureau of Census data, survey data from the American Chiropractic Association and catalogs from a US chiropractic college.

RESULTS: The 10-year attrition rate rose from 10% for those graduates licensed in 1970 to a peak of 27.8% in 1991. The 10-year attrition rate has since remained between 20-25% for the doctors licensed between 1992-1998.

CONCLUSIONS: Available evidence supports the hypothesis that the attrition rate for licensed chiropractors in the first 10 years of practice has risen in the past several decades.

Attrition from emergency medicine clinical practice in the United States.  [LINK]

Ann Emerg Med. 2010 Aug;56(2):166-71. Epub 2009 Dec 24.

Ginde AA, Sullivan AF, Camargo CA Jr.
Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA.

STUDY OBJECTIVE: We estimate the annual attrition from emergency medicine clinical practice.

METHODS: We performed a cross-sectional analysis of the American Medical Association's 2008 Physician Masterfile, which includes data on all physicians who have ever obtained a medical license in at least 1 US state. We restricted the analysis to physicians who completed emergency medicine residency training or who obtained emergency medicine board certification. We defined attrition as not being active in emergency medicine clinical practice. Attrition was reported as cumulative and annualized rates, with stratification by years since training graduation. Death rates were estimated from life tables for the US population.

RESULTS: Of the 30,864 emergency medicine-trained or emergency medicine board-certified physicians, 26,826 (87%) remain active in emergency medicine clinical practice. Overall, type of attrition was 45% to non-emergency medicine clinical practice, 22% retired, 14% administration, and 10% research/teaching. Immediate attrition (<2 years since training graduation) was 6.5%. The cumulative attrition rates from 2 to 15 years postgraduation were stable (5% to 9%) and thereafter were progressively higher, with 18% having left emergency medicine clinical practice at 20 years postgraduation and 25% at 30 years postgraduation. Annualized attrition rates were highest for the first 5 years postgraduation and after 40 years postgraduation; between 5 and 40 years, the rates remained low (<1%). The overall annual attrition rate from emergency medicine clinical practice, including estimated death rate, was approximately 1.7%.

CONCLUSION: Despite the high stress and demands of emergency medicine, overall attrition remains low and compares favorably with that of other medical specialties. These data have positive implications for the emergency physician workforce and are important for accurate estimation of and planning for emergency physician workforce needs. 2009 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Economic and resource status of the chiropractic profession in Ontario, Canada: a challenge or an opportunity.  [LINK]

J Manipulative Physiol Ther. 2008 Feb;31(2):104-14.

Mior SA, Laporte A.
Division of Research, Canadian Memorial Chiropractic College, Toronto, Canada.

OBJECTIVE: Chiropractic is one of the most frequently sought nonphysician provider groups. Despite its apparent recognition, the profession faces numerous challenges, including the economic reality of an increasing supply within a market of questionable demand. This paper evaluates the chiropractic manpower status in Ontario, Canada.

METHODS: Data collected from administrative and education databases, insurance billing data, and population health survey data between 1990 and 2004 were analyzed.

RESULTS: Between 1990 and 2004, the total number of chiropractic registrants in Ontario doubled, with an average annual rate of growth of about 5.4%; however, recent data suggest that the number of nonpracticing chiropractors is increasing, whereas the number of new registrants is decreasing. The rate of applications to a chiropractic institution rose sharply and peaked in 1996-1997, thereafter declining but leveling off in 2002-2003. Despite the continued growth in the number of practicing chiropractors, the utilization of chiropractic services among the Ontario population has remained relatively stable, resulting in a decline in the average net annual incomes adjusted for inflation to 2002 dollars.

CONCLUSIONS: Our results support previous reports projecting an oversupply of chiropractors and suggest that the chiropractic profession in Ontario is in long-run oversupply. Competition from other providers, changing population demographics, and the recent loss of public funding for services may present significant future challenges to current practitioners. Opportunities related to participation in multidisciplinary environments and accessing unmet population health needs may contribute to influencing the demand for chiropractic services. A concerted effort by professional and educational institutions is required.
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1 Comment on:

Oversupply of Chiropractors and Reduced Income Impact California

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Re:Oversupply of Chiropractors and Reduced Income Impact California

by drbryan   (8/17/2010 4:12:15 PM)
Now that a problem has been established, we should find the root cause and then we will see a solution.  I see over saturation as just part of the problem, otherwise our solution would be to get the new graduates to move to less serviced areas.  I believe there are other factors just as important to understand such as poor business practices, something we are not taught in school.  I am in an area that could be considered well saturated, however the recent decline in my business I believe is directly related to two main factors: 1) recession, it has hit hard in my area and I meet prospective patients every day that would come in if they had a way to pay for services rendered, & 2) My reimbursement rate the past 2-3 years from insurance companies has dropped from 60% of billed services to 40% of billed services, this is without an annual fee increase not to mention the continual increase of cost of doing business.