Filed under: a chiropractic podcast, chiropractic 101, education | Tags: a chiropractic podcast, Anchor Chiropractic, chiropractic, chiropractic college, chiropractic education, chiropractic training, Chiropractor, continuing education, Dr. Thomas Lamar, health, Kingston, Kitsap, medical school
Title: The Educational Makeup of a Chiropractor
Episode Number: 002
Host: Dr. Thomas Lamar
Show Date: 01/15/2010
Run Time: 27:57
Description: Ever wonder what it takes for a chiropractor to hang his or her shingle out? And how does it compare to a medical doctor? Dr. Lamar gives listeners a peak “under the hood” of the educational makeup of a chiropractor.
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Dr. Lamar’s chiropractic education newspaper article: “A Chiropractor’s Education Never Ends!“
Coulter, et al. A comparative study of chiropractic and medical education.” Alternative Therapies in Health and Medicine. Sep;4(5):64-75. 1998. (Here’s another summary of it).
Valahos K, Bond M. Knowledge of musculoskeletal medicine at undergraduate and postgraduate levels. Australasian Musculoskeletal Medicine. May 2002:28-32. (sorry, I can’t seem to find an abstract online to link to. Here is a listing of this article from the Austrialian Association of Musculoskeletal Medicine, and here is an article written about the subject). [Update: My apologies, it seems that the "Australasian Musculoskeletal Medicine" journal was a bogus journal - ghost written by a pharmaceutical company and not peer reviewed. The subject matter of the article regarding inadequate musculoskeletal competency levels in graduating medical student was the real deal however. Here is a link to another journal, the Irish Journal of Medical Science, (which is not bogus) that reviews the same subject].
Taylor, et al. Interpretation of abnormal lumbosacral spine radiographs. A test comparing students, clinicians, radiology residents, and radiologists in medicine and chiropractic. Spine. May 1995. 15;20(10):1147-53.
Does your podcast listening schedule need a little backbone? If so, then maybe it’s time to schedule an appointment with your podcast chiropractor, Dr. Thomas Lamar.
Spinal Column Radio, episode number two.
Coming up on Spinal Column Radio — The Educational Makeup of a Chiropractor
[intro theme music]
And welcome back to another exciting and information packed episode of Spinal Column Radio. My name is Dr. Thomas Lamar, chiropractor and Dad of six. And this is the podcast that gets you to think…. to think about your health in a whole new way. We’re the podcast for your backbone… the podcast with backbone. Who knew that spinal education could be this much fun?
If you haven’t done so, we’d like to invite you to visit our podcast website at spinalcolumnradio.com, where you can learn more about us, podcasting in general, and can access the show notes for this episode. And of course You can also leave comments and ask questions. Additionally, you can shoot me an email at DrLamarATspinalcolumnradio.com (that’s D-R-L-A-M-A-R -ATspinalcolumnradio.com) and I’ll do my best to include it in a future show.
[transitional sound effect]
Many wonder but few really know…. Just what kind of education does the typical chiropractor possess? And how does it compare to, say, a medical doctor?
It’s a great question and one worth talking about.
Health care education, in general, has taken tremendous strides forward over the past century in its quality and quantity — especially with the implementation of licensure and accrediting agencies.
If you were a prospective chiropractic student — let’s say — in 1898, you would have one school to choose from — taught by the founder himself, D.D Palmer. And it was three months long, and it would set you back about $500. (Actually that was a decent sum of money back then).
Today in 2010, you have 31 chiropractic colleges to choose from (18 in the US, 2 in Canada, 6 in Australasia, and 5 in Europe). With the required undergraduate courses, it would take you 9 years, and would ring in a tuition (not counting undergraduate, or extras like books) of about $75,000.
You know, an interesting little tidbit that I picked up in my research for this podcast was that 5 of the first 15 chiropractic graduates of our profession were actually medical doctors! Kind of interesting when you consider the opposition that the medical profession had against us in the beginning (and perhaps still does today… but it is getting better). One of the students, Andrew Davis, who after completing Palmer’s chiropractic school, had three degrees after his name: MD, DO, and DC.
Now, I’m basing this episode on an article that I authored on the chiropractic educational subject back in 1997. With 13 years passing since its appearance in the newspaper, you can imagine that some of the information might be a bit dated. With our revisiting this subject here on SpinalColumnRadio, I’ve done my best to update it as much as possible. By the way, you can read the original article on SpinalColumnBlog.com… Check out the show notes for a link to it. Just look for the newspaper icon.
Well, many people are surprised to find out that the modern chiropractic schooling of today is every bit as comprehensive as medical education. As a matter of fact, in the most recent study on the subject, it was determined that the two curricula are “more similar than dissimilar.”
[transitional sound effect]
Before I go on — I have a bit of an “educational” side story here, that’s kind of behind the study that I just quoted. And Washington healthcare professionals that are listening to my podcast — first of all, welcome — but you’re going to want to pay particular attention to this. You see, many chiropractic and medical journals –and other health journals– are not widely available in their full-text formats unless you subscribe to the journal itself or visit a medical or chiropractic, or other health professional library. The study I was just quoting was out of the 1998 volume of Alternative Therapies in Health and Medicine. And it was entitled “A comparative study of chiropractic and medical education.”
Well, I don’t subscribe to this journal…… But, I remembered reading about a bit of legislation that was passed, in our great state of Washington, when most of our license renewal fees shot through the roof in 2008. There was a $25 added fee — that seemed minute compared to the hundreds of dollars in hikes that most of us experienced – that was to give certain Washington health professionals online access to a special University of Washington-run website containing healthcare journal search engines and databases .. and even access to some full-text articles.
I recall being a little miffed by it all. And, in retrospect, the $25 really is probably a very good deal for the service that is provided — but I was miffed because this was something that was forced on us and “mandated” by law. You can check it out at RCW 43-70-110. And all this happen without any input from us — at least from what I can remember. What made it even more frustrating, was that, other than the “invoice” for it, it was never really publicized to us in anyway. And our chiropractic state association was in the dark as well …. And actually, I have seen very little on it since. Well, not wanting a resource to go to waste that I am paying for — like it or not — I’m pleased to say that I feel like I got my $25 worth on it this year, because I was able to actually obtain the full-text article of this study that we’re talking about, to share with you.
So — here’s the take home — if you practice in the state of WA and you are (let me just read through this) an acupuncturist, chiropractor, clinical social worker, massage therapist, mental health counselor, naturopath, optometrist, osteopath, medical doctor, physicians assistant, osteopathic assistant, podiatrist, psychologist, or registered nurse… by government mandate, you are paying for this service….. and my guess is that you didn’t even know about it. I’ll leave you a link in the show notes for it. And I encourage you to check it out.
And, I’ll also link to the abstract, or summary version, (sorry I can’t give you the full text) of the study that I have been referring to and will be delving into momentarily.
So I apologize for the diversion — but I believe that some listeners out there, may have found this “nugget of information” well worth the price of admission here on SpinalColumnRadio.
[transitional sound effect]
Okay. So chiropractic education is very much like medical education in a lot of ways. Like other types of doctors, our education begins with a rigorous course of undergraduate studies with a heavy emphasis on the basic sciences. Most of us are now obtaining 4 year- bachelors degrees in a science, such as biology, chemistry, or physics. The fledgling chiropractic student-to-be then chooses among the 31 chiropractic colleges I touched on earlier and then embarks on a 10-trimester chiropractic education — which is essentially 5 “school years.” In addition to the extensive classroom and laboratory work, each chiropractic student must complete a period of internship (approximately 1300 hours currently at the Los Angeles College of Chiropractic — my alma mater) during which the student cares for patients under the watchful eye of their chiropractic clinician.
Following graduation, as the new doctor awaits licensing tests, he or she will then often be involved in an externship in which they assist and observe a practicing chiropractor.
In the article that I authored, I included a chart that compared the basic and clinical sciences between the two schools. But, at this point its over 20 years old — although it is pretty interesting to look at — but let’s go ahead and look at the 1998 study that was performed — which, I said, was the most recent study available (that I could find, at least) on this subject.
This study was impressive, in that not only did they compare the chiropractic and medical school curriculum, but they also conducted detailed site visits to each of the schools. The team that visited the schools consisted of a chiropractor, medical doctor, and a sociologist. Both the chiropractor and medical doctor had educational teaching backgrounds and the sociologist was also a health policy analyst.
What Ian Coulter — the author — and his colleagues found was that in terms of overall student contact hours the programs were relatively similar (chiropractors chiming in at 4826 and medical doctors 4667 hours). There were however some distinct differences in how those hours were allocated.
The easiest of these to compare were the basic sciences. Their study broke them down into six subject areas: anatomy, biochemistry, microbiology, public health, physiology, and pathology. We’ll go back up to the top here…. Anatomy, we look at chiropractic, 570 hours … medicine, 368. Biochemistry, chiropractic 150 hours… medicine 120. Microbiology, chiropractic 120… medicine 120. Public Health, chiropractic 70… medicine 289. Physiology, chiropractic 305… medicine 142. And Pathology — and this is kind of surprising — chiropractic 205… medicine 162. Now, to be fair — for the pathology one — while chiropractors might have more book time in pathology, medical doctors have far more clinical time actually observing it and all.
When it came to the clinical sciences, however, it was a little harder to compare apples and apples — as they found quite a bit of difference in what was studied in each discipline, as well as how the medical schools and the chiropractic colleges actually structured their schooling.
The fairest way to compare the schools was based on the educational hours for clinical sciences.
So, if we do that, chiropractors spend — on average — 1665 hours in lecture, 715 in lab, and 1010 in clinic. Whereas medicine spends 1448 hours in lecture and 2020 hours in clinic — they have no labs. So, if we total each up — and it will be easier to compare — for the clinical sciences, chiropractors spend 3390 hours and medical doctors spend 3468 hours… About the same.
The study found that the main areas of emphasis for chiropractors — for the clinical sciences — were adjustive techniques and diagnosis. Whereas, medicine focused on diagnosis and nutrition — which actually surprised me, because I was unaware that medical doctors were receiving nutritional courses — outside of obviously of learning the major nutritional deficiencies (such as scurvy, rickets, and beriberi). But if nutrition is becoming a major part of their curriculum, this is a great sign. I’d like to see it confirmed though in some other study… or some other way. Chiropractors, by the way, we receive courses in clinical nutrition and biochemical nutritional, as well as nutritional counseling applications that we take in internship.
Because some of you may be interested, I’ve put a link in the show notes to the current course curriculum of the Los Angeles College of Chiropractic — the chiropractic college I attended. You might find it interesting.
Some of the Clinical sciences that we chiropractors learn are differential diagnosis, adjustive techniques, soft tissue techniques, orthopedics and neurology, radiology interpretation and the actual taking of x-rays, physical examination, nutrition, physiological therapeutics, pharmatoxicology, rehabilitative exercise, pediatrics, geriatrics, eye-ear-nose-and-throat, dermatology, clinical psychology, obstetrics and gynecology, emergency procedures, and research.
One of the biggest differences between the two is the amount of time that MDs must log in their residencies. Chiropractors really don’t have an equivalent to this. You see, in medicine a lot of what they learn is through experience… or as they say “see one, do one, teach one.” Well, in order for this to play out statistically, you have to be present in the hospital — a lot. In other words you have to basically live there for number of years — which varies by specialty.
In chiropractic college, well we work on each other. We’ll pair up and basically treat each other — adjusting areas that we find that need it. In medicine, you can’t really pair up with your buddy and remove each other’s spleens. But if you hang out in the hospital long enough, you eventually — by the shear number of hours you spend there — will have had the opportunity to have seen the removal of a spleen, to have removed a spleen yourself, and to have taught someone else how to remove it.
Before we put this educational study on the shelf, there was something else that I found was quite interesting. And it was found in interviews that were conducted with the medical students.
Let me read to you directly out of the study. It said:
“In our interviews with medical students, two things became clear: one, these students spend little time studying the neuromusculoskeletal system and its health-related problems, the subjects of most concern to chiropractors, and, two, they receive little or no education in alternative healthcare and no education in chiropractic care. However, we also noted in talking to medical students that they had no overt hostility to chiropractors, an attitude that had historically marked the relationship between the two professions. The position taken by these medical students was one of benign neglect — chiropractic or any alternative healthcare is not among the subjects they must learn, and thus it cannot be given a high priority. Chiropractic students, though, similarly isolated from medical students, are more likely to encounter physicians as part of their faculty. It is not uncommon for the basic-science faculty in a chiropractic school to have taught in a medical school. In addition, many basic textbooks and course articles are medical in context. The chiropractic colleges we visited carried the leading medical journals in their libraries; the reverse was not seen.”
This is very true. I recall going to UCLA’s medical library in 1991, I think it was, when I was researching the idea of becoming a chiropractor… because they subscribed to one of our leading chiropractic journals — the Journal of Manipulative and Physiological Therapeutics. Well, while they did have it, there was a note by it stating that in the future they would no longer be carrying it. So, there you go.
The study then went on to make the case that spinal manipulation has exceptional clinical value and that chiropractors perform the majority of manipulations in the United States and have the most formal education on it as well — something we talked about in Episode One. And then they laid down a highlighter worthy statement. And they said, “If evidence-based medicine is to have any real meaning in education, ignoring the evidence presented by manipulation becomes increasingly untenable.”
This puts MDs in a difficult quandary. Namely as the study put it, “Is it ethical to recommend to your patients a type of therapy or therapist about which you know nothing?” Good question. And then the followed it with an equally good question: “On the other hand, is it ethical to neglect to inform your patients of a therapy that may be appropriate and beneficial for the health problem they have?”
So, how do we go about helping our neighborhood MDs through this dilemma — one word… education…. by providing those willing with information about the validity of what we do as well as our training.
Let’s return to chiropractic college here for a minute.
Once we graduate and are granted the Doctor of Chiropractic Degree — before we can actually practice though — we must have passed four separate and rigorous parts of the National Board Examination, as well as an even more difficult State Board Examination consisting of practicals, interviews, and jurisprudence in the state we’re seeking a license. Providing that all these tests are passed with proficiency, then and only then, can we commence practicing the science, art, and philosophy of chiropractic.
Oh but the learning does not stop there! Because, as with all licensed health care professionals, we chiropractors have to continue our education every year — as it is required for license renewal. Each state is different. Here in Washington a minimum of 25 hours per year is required.
Virtually every doctor attends seminars, scientific symposia, and reads professional journals to keep up with the latest research and to provide his or her patients with the best care possible.
[transitional sound effect]
Okay — well this would be a great place to wrap things up, but there is something else that I really would like to address. So I apologize as this episode is already longer than our goal of 10-15 minutes. But, that’s the beauty of podcasting!
Generally speaking, I try to stay off of the “chiropractic bashing websites.” But in my research to “freshen up” this topic for our podcast, I stumbled on one that really shone a light on the ignorance and arrogance that is out there regarding this topic of chiropractic education. Now I’ll try to limit my time on this, because I know I’m going long, but I wanted to read an excerpt of this “informational blog” that I stumbled on — and no I will not be including this in the show notes… you can search it out on your own if you are so inclined. And then I want to do is follow it up with two brief overviews on some very enlightening studies.
Okay - so this blogger writes about chiropractic versus medical education. And this is what they say:
“Chiros don’t attend medical school;” – (Logan you might want to watch my sound levels, I might get up on this) — “Chiros don’t attend medical school; they are ‘D.C.’ and not M.D….”
Well, I completely agree with that. Let’s move on.
“…But often they are called doctors”
Well, this is true… we have a “doctorate” in chiropractic…. lots of other disciplines have doctorates and are addressed as doctor as well…. We move on.
“…and this is misleading to the real MDs. MD’s education and knowledge of the human body is so far advanced over those chiros, that also take on the moniker ‘doctor.’”
Well, I’m puzzled by the perception that this blogger has that an MD’s education and knowledge of the human body is “so far advanced over those of chiros.” I’d argue that both disciplines have a vast depth of knowledge in the human body — in some areas our knowledges overlap… and in other areas they do not. Understand, we chiropractors… we don’t want to be MDs… just as the MDs don’t want to be chiropractors. The blogger writes on:
“…But that is the reason why most people think chiropractors are MDs, and I used to think so too.”
Wow. Well hopefully that’s changing… I was unaware that “most people” thought of chiropractors as MDs. I suppose that’s an educational issue. Hopefully, our efforts as chiropractors, through our educational websites, blogs, and podcasts — like this one – we can start to shine some light on this apparent misperception. Or… am I totally off base here? What do you think? Do most people think — or have the misperception — that chiropractors are medical doctors? Leave your thoughts in the comment section for this episode on our website at spinalcolumnradio.com. I’ll read on.
“…I thought they just specialized in the back. It was kind of shocking to find out the truth.”
This I can understand. and was the main thrust behind Episode One. I’ll read on.
“You will notice that there is no pharmacology, a requirement for M.D./D.O. candidates, listed in the chiropractic curriculum.”
Not entirely true. We do take about 30 hours of pharmatoxicology — my instructor was actually a pharmacist. Granted, 30 hours is not a lot, but our intent in taking this course is not so we can prescribe medication. That runs counter to the basic principles of chiropractic. We take it though, so we can understand what our patients are taking. This aids in differential diagnosis. For example, I’ve had more than one patient with musculoskeletal pain that was not responding as well as I would have hoped to my care. A review of their medications found that a cholesterol medication was being taken. One of the side effects of cholesterol medication is muscle pain. So, a trip over to their friendly MD, for a medication adjustment, and their pain subsided. …I will continue reading.
“A greater divergence also occurs when it comes to clinical training. For example, how much surgical training does a chiropractor get in school? The answer is none.”
Guess what? Technically this is false as well. Surgery is outside of our scope of practice…. except minor surgery is allowed in one state: Oregon. Because of this, everyone was trained in a suture technique… mind you, I would not be the one to sew you up, however, if you and I were on a desert island, and some suturing was needed… well, we could talk. The blogger goes on.
“And then comparing ‘classroom hours’ is dubious and incomplete at best. This schedule implies that ‘book’ learning stops once physicians-in-training leave the classroom. MDs must prepare and give, numerous literature searches, keeping up with assigned and independent reading and, most importantly, being responsible for knowing the full spectrum of medical and potential clinical management issues of the patient’s. They will also have to pass licensure exams that certify medical knowledge to show they are at least safe and competent. Claiming that DCs have more ‘classroom hours’ is false and made on wrong conditions and I consider the table to be inaccurate.”
I don’t’ even want to say much on this one. This comment implies that we chiropractors don’t engage in research, clinical management issues, and, oh no, independent reading. And I guess we don’t take licensure exams according to this person. Oh, I forgot this isn’t 1910 — it’s 2010!!
Okay I’m done with my rant.
Well, as I promised, Here are a couple of studies that will cripple the aforementioned blogger’s statements.
I’ll keep them as brief as possible and will supply the links in the show notes.
While we chiropractors don’t necessarily want to claim the domain of musculoskeletal pain, its an area of the body that we give most emphasis to. Approximately 80% of the body falls under the musculoskeletal system with the other 20% falling under the heart, lungs, abdomen. Make no mistake, MDs do well with this 20%. They have the potential to save lives with their knowledge and skill in this domain. But when it comes to the other 80% many of them are lacking.
Here’s a quote from a 2002 medical musculoskeletal journal: “Musculoskeletal knowledge among recent medical graduates has again been found wanting. The need for further musculoskeletal education has been established. Implementing strategies to correct the deficiency has yet to be addressed.”
In this study, a test was actually given and scored by orthopedic surgeons. The study found that the Australian interns and general practitioners, that took the test, were just as deficient as their American counterparts. This is a global problem, apparently.
There’s a whole lot more to say on this topic… I don’t have time now… look for it in a future Spinal Column Article and Radio podcast.
The other study has to do with our competency in reading and interpreting X-rays. This one came out of the medical journal Spine in 1995.
And what they did was they compared the performance of 496 health care providers in interpreting x-rays of the lumbosacral spine — basically the low back.
Compared in the study were medical doctors and chiropractors. But, in addition to that, they took the specialists, medical radiologist and chiropractic radiologists, and they put them head-to-head — and they also brought in students as well… so chiropractic students and medical students. And they wanted to see how the two disciplines compared in their ability to read and interpret X-rays. And it was pretty interesting — and I’m not going to get into all the details — … but basically they found that the test results of chiropractic radiologists, chiropractic radiology residents, and chiropractic students were “significantly better than their medical counterparts.” And interestingly chiropractors in clinical practice and medical doctors in clinical practice… were about the same.
Pretty cool study. And it’s one that I was — I remember — graduating chiropractic college when that came out.
[transitional sound effect]
Okay, let’s wrap all this up. So, what does this whole podcast mean? It means that your local chiropractor didn’t get his education from the backside of a cereal box. It means that he or she has been through the educational fire — so to speak — so that you, the patient, will be the beneficiary.
I encourage you to learn more about chiropractic. Seek out your local chiropractor. Ask questions. Because he or she is well-trained and ready to help.
[intro theme music]
Okay — that’s going to wrap up this episode of Spinal Column Radio. Thanks to my son Logan for keeping my sound levels in check and special thanks to you for listening. I encourage you to keep listening as well. Feel free to leave a comment on this episode on our website or drop us a line through our contact page.
Spinal Column Radio would like to remind you that true health comes from the inside out — not outside in. As such, the content of this podcast, along with the show notes and related links, are not intended to cure, diagnose, treat, or prevent any disease. But, instead, is meant to inform and inspire you in asking better questions regarding your health. Since the circumstances surrounding your particular situation are unique, you are encouraged to consult with a Doctor of Chiropractic — or other health care practitioner of your choosing.
Hey next time on Spinal Column Radio we’ll tackle that big $25 dollar word we chiropractors throw around: “subluxation.” Hope you’ll join us.
Until then, this is Dr. Thomas Lamar, your podcast chiropractor.
Spinal Column Radio is a production of Spinal Column Communications in conjunction with AnchorChiropractic.net. Copyright 2010.
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