The Chiropractic Identity

Final report of the Identity Consultation Task Force World Federation of Chiropractic ~ April 30, 2005 ~ FULL TEXT Enjoy WFC's announcement about the release of the Final Report of the Identity Consultation Task Force. The document section of the Press Release page provides access to all of the relevant the WFC documents, including a Power Point Presentation, the Survey used with the participating DCs, the Survey results, and other supporting documents. The terms of reference of the World Federation of Chiropractic’s Identity Consultation Task Force were “to direct and facilitate an inclusive and comprehensive international consultation with members of the profession and other relevant parties on the public identity of the chiropractic profession, and to then report back to the World Federation of Chiropractic with findings and recommendations.” We have completed such a consultation, important aspects of which were empanelling a diverse and representative task force with 40 members of the profession (35) and public (5); collating and reviewing past surveys of the public and the profession and other relevant research; conducting an international opinion survey of chiropractors; consulting marketing experts and representatives of other professions and the public; and reaching consensus on the principal matters arising from our terms of reference.

	Moving Towards a Contemporary Chiropractic Professional Identity Complementary Therapies in Clinical Practice 2020 (May); 39: 101105 ~ FULL TEXT Articles in this review found that chiropractors had a predominately spine-based MSK practice focus utilising a wide array of interventions. Practising chiropractors consider themselves to be primary care practitioners with a broad scope of practice not limited to MSK intervention with their care including NMS, non-MSK and organic-visceral practice approaches across multiple patient demographic groups. On the surface, at least 20% of chiropractors have an exclusive VS focus. However, from this critical literature review, it is apparent that VS is an important practice consideration for a much larger proportion of chiropractors, which may be up to 70%. Of the papers in this review, less than half examined philosophical concepts of professional identity, and most papers were centred around categorising practice characteristics and SCOP. There could be a benefit for the profession to explore deeper issues of professional identity, such as how it may change over time, or investigating potential relationships between practitioner clinical confidence, patient outcomes and professional identity.
	The Identity, Role, Setting, and Future of Chiropractic Practice: A Survey of Australian and New Zealand Chiropractic Students J Chiropractic Education 2018 (Oct); 32 (2): 115–125 ~ FULL TEXT Chiropractic students in Australia and New Zealand seem to hold both traditional and mainstream viewpoints toward chiropractic practice. However, students from different chiropractic institutions have divergent opinions about the identity, role, setting, and future of chiropractic practice, which is most strongly predicted by the institution. Chiropractic education may be a potential determinant of chiropractic professional identity, raising concerns about heterogeneity between chiropractic schools.
	A Proposal to Improve Health-care Value in Spine Care Delivery: The Primary Spine Practitioner Spine J. 2017 (Oct); 17 (10): 1570–1574 ~ FULL TEXT Spine care is an increasingly important aspect of worldwide healthcare delivery. The PSP model has the potential to dramatically improve the currently disorganized and costly process of spine care delivery, address concerns about accelerating growth of spine problems, and more efficiently use existing, highly-trained personnel in a way that indirectly expands the primary care workforce. While the model is no panacea, it holds the potential to address a tremendous need, increase efficiencies, and improve healthcare quality and outcomes of an important and expanding patient population.
	Spine Care as a Framework for the Chiropractic Identity J Chiropractic Humanities 2016 (Dec); 23 (1): 14–21 ~ FULL TEXT Surveys of the general public and chiropractors indicate that the majority of patients seek chiropractic services for back and neck pain. Insurance company utilization data confirm these findings. Regulatory and legal language found in chiropractic practice acts reveals that most jurisdictions define the chiropractic scope of practice as based on a foundation of spine care. Educational accrediting and testing organizations have been shaped around a chiropractic education that produces graduates who focus on the diagnosis and treatment of spine and musculoskeletal disorders. Spine care is thus the common denominator and theme throughout all aspects of chiropractic practice, legislation, and education globally.
	Chiropractic Identity: A Neurological, Professional, and Political Assessment J Chiropractic Humanities 2016 (Dec); 23 (1): 35–45 ~ FULL TEXT This article provides an overview of chiroractic identity from 6 points of view: (1)   concepts of manual medicine; (2)   areas of interest beyond the spine; (3)   concepts of the chiropractic subluxation; (4)   concepts of neurology; (5)   concepts of mainstream or alternative health care; and (6)   concepts of primary care, first-contact provider, or specialist.
	Spinal Health: The Backbone of Chiropractic’s Identity J Chiropractic Humanities 2016 (Dec); 23 (1): 22–28 ~ FULL TEXT The professional identity of chiropractic has been a constant source of controversy throughout its history. Attempts to establish a professional identity have been met with resistance from internal factions divided over linguistics, philosophy, technique, and chiropractic’s place in the health care framework. Consequently, the establishment of a clear identity has been challenging, and the chiropractic profession has failed to capitalize on its potential as the profession of spine care experts.   Recent identity consultations have produced similar statements that position chiropractors as spinal health and well-being experts. Adoption of this identity, however, has not been universal, perpetuating the uncertainty with which the public regards the chiropractic profession.
	Analysis and Adjustment of Vertebral Subluxation as a Separate and Distinct Identity for the Chiropractic Profession: A Commentary J Chiropractic Humanities 2016 (Oct 25); 23 (1): 46–52 ~ FULL TEXT For comparison purposes, identity statements and perceptions from the various chiropractic associations and colleges, as well as from students and patients, were explored. Identity statements for chiropractic were searched in various sources such as Palmer's 1910 textbook, recent literature on viewpoints from chiropractic students and practitioners, and websites for chiropractic colleges and organizations. Palmer taught that the chiropractor's focus was on vertebral subluxation. Today, a number of chiropractic colleges and organizations continue to include the vertebral subluxation model in their instruction, with a majority of students and practitioners subscribing to the model. Conversely, a number of other colleges and organizations portray chiropractic as being essentially about the treatment of back and neck pain, which is what patients associate with chiropractic. However, settling on any particular identity for the chiropractic profession will likely be met with resistance by some, given the plethora of opinions among chiropractic professionals as to what the identity of the chiropractic profession should be. Common ground between the different factions within the chiropractic profession might be found in a unifying expression such as "functional neurology."
	Chiropractic Identity in the United States: Wisdom, Courage, and Strength J Chiropractic Humanities 2016 (Sep 15); 23 (1): 29–34 ~ FULL TEXT The various clinical specialties and independent groups in the chiropractic profession are so different in their beliefs, practice styles, and political agendas that a common identity is unlikely to be created. Areas of disagreement, including advanced practice, vertebral subluxation, and the philosophy of chiropractic, continue to separate those in the profession. Doctors of chiropractic should accept that differences within the profession will remain for the foreseeable future and that the profession should allow each group to live peacefully and supportively alongside each other.
	Chiropractic Identity, Role and Future: A Survey of North American Chiropractic Students Chiropractic & Manual Therapies 2015 (Feb 2); 23 (1): 4 ~ FULL TEXT The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.
	Chiropractic 2025: Divergent Futures Institute for Alternative Futures (2013) ~ FULL TEXT Where will the chiropractic profession in the United States be 12 years from now? This Chiropractic 2025: Divergent Futures report by the Institute for Alternative Futures (IAF) presents scenarios that provide four different answers to that question. The 2025 scenarios reflect the opportunities and challenges for chiropractic in the U.S. given our assessment of developments within both the chiropractic field and the broader context of health, science, technology, and society. The scenarios invite deliberation about which futures are more likely and which are more preferred by chiropractors.
	The Chiropractic Identity: Charting Our Future Roles Health Insights Today (September 2011); 4 (5) ~ FULL TEXT For at least as long as any living doctor of chiropractic can remember, our profession has engaged in ongoing and sometimes heated debate about the proper role of its practitioners. Should our primary or sole focus be the spine? The nervous system? Vertebral subluxation? Back and neck pain? Should we be musculoskeletal pain specialists? Complementary care generalists? Primary care physicians? Two new papers, one by Donald Murphy and colleagues in Chiropractic and Manual Therapies [1] and the other by Jan Hartvigsen and colleagues in British Medical Journal, [2] simultaneously point in the same direction—toward the role of primary spine care practitioner. The lead authors of both articles are chiropractors, Murphy from the United States and Hartvigsen from Denmark. Neither proposes the primary spine care practitioner role as the only option for DCs; both make a persuasive case that developing this role on a much more widespread basis will significantly enhance the effectiveness of the health care system’s neuromusculoskeletal (NMS) care delivery. In the process, they demonstrate why many practitioners may find work as a primary spine care practitioner attractive. To the extent that deeper integration of chiropractic is one of the profession’s primary goals, this may be one of the best vehicles for its achievement. At the very least, it’s a possibility worthy of serious examination.
	Caught in the Crosshairs: Identity and Cultural Authority Within Chiropractic Soc Sci Med. 2011 (Jun); 72 (11): 1826–1837 ~ FULL TEXT In this paper the discourse over identity and cultural authority within the profession of chiropractic in the United States has been analyzed using critical discourse analysis. As the profession struggles to construct one singular image, versions of self must be internally debated and also shaped in consideration of larger, external forces. The dilemma of remaining tied to a marginal professional status must be balanced against considerations of integration. Written texts from chiropractic journals and newspapers are analyzed in a multidimensional approach that considers the rhetorical devices and thematic issues of identity construction; the representation of various voices within the discourse (both heard and unheard); and the extent to which external pressures affect the projection of cultural authority for the profession. A heterogeneous discourse characterized by conflict was found, with discrepancies between everyday chiropractors in actual practice versus academic chiropractors and leaders particularly over the idea, practice and significance of science for the profession.
	Reflecting on 115 Years: The Chiropractic Profession's Philosophical Path J Chiropractic Humanities 2010 (Dec); 17 (1): 1–5 ~ FULL TEXT The chiropractic profession struggled with survival and identity in its first decades. In addition to internal struggles between chiropractic leaders and colleges, much of our profession's formative years were stamped with reactions to persecution from external forces. The argument that chiropractic should be recognized as a distinct profession, and the rhetoric that this medicolegal strategy included, helped to develop chiropractic identity during this period of persecution in the early 20th century. This article questions if the chiropractic profession is mature and wise enough to be comfortable in being proud of its past but still capable of continued philosophical growth.
	A Proposal Regarding the Identity of Chiropractic: Embrace the Centrality of the Spine J Chiropractic Humanities 2005 (Jun 13); 12: 8-15 ~ FULL TEXT Philosophically, chiropractic’s essence, boundaries, and purpose are oriented by the spine; practically speaking, the spine is where doctors of chiropractic apply the vast majority of their work. The author suggests that embracing the spine as the center of chiropractic identity does not limit the profession but, rather gives the public and the profession a common referent to define chiropractic’s function and value.