Significant Points

• Job prospects should be good.
• Chiropractors must be licensed, requiring 2 to 4 years of undergraduate education, the completion of a 4-year chiropractic college course, and passing scores on national and State examinations.
• About 44 percent of chiropractors are self-employed.
• Earnings typically are relatively low in the beginning but increase as the practice grows.

Nature of the Work

Chiropractors, also known as doctors of chiropractic or chiropractic physicians, diagnose and treat patients with health problems of the musculoskeletal system and treat the effects of those problems on the nervous system and on general health. Many chiropractic treatments deal specifically with the spine and the manipulation of the spine. Chiropractic is based on the principle that spinal joint misalignments interfere with the nervous system and can result in lower resistance to disease and many different conditions of diminished health.

The chiropractic approach to healthcare focuses on the patient's overall health. Chiropractors provide natural, drugless, nonsurgical health treatments, relying on the body's inherent recuperative abilities. They also recognize that many factors affect health, including exercise, diet, rest, environment, and heredity. Chiropractors recommend changes in lifestyle that affect those factors. In some situations, chiropractors refer patients to or consult with other health practitioners.

Like other health practitioners, chiropractors follow a standard routine to get information needed to diagnose and treat patients. They take the patient's health history; conduct physical, neurological, and orthopedic examinations; and may order laboratory tests. X rays and other diagnostic images are important tools because of the chiropractor's emphasis on the spine and its proper function. Chiropractors also analyze the patient's posture and spine using a specialized technique. For patients whose health problems can be traced to the musculoskeletal system, chiropractors manually adjust the spinal column.

Some chiropractors use additional procedures in their practices, including therapies using heat, water, light, massage, ultrasound, electric currents, and acupuncture. They may apply supports such as straps, tape, braces, or shoe inserts. Chiropractors often counsel patients about health concepts such as nutrition, exercise, changes in lifestyle, and stress management, but chiropractors do not prescribe drugs or perform surgery.

In addition to general chiropractic practice, some chiropractors specialize in sports injuries, neurology, orthopedics, pediatrics, nutrition, internal disorders, or diagnostic imaging.

Many chiropractors are solo or group practitioners who also have the administrative responsibilities of running a practice. In larger offices, chiropractors delegate these tasks to office managers and chiropractic assistants. Chiropractors in private practice are responsible for developing a patient base, hiring employees, and keeping records.

Work environment. Chiropractors work in clean, comfortable offices. Like other health practitioners, chiropractors are sometimes on their feet for long periods. Chiropractors who take X rays must employ appropriate precautions against the dangers of repeated exposure to radiation.

Chiropractors work, on average, about 40 hours per week, although longer hours are not uncommon. Solo practitioners set their own hours but may work evenings or weekends to accommodate patients. Like other healthcare practitioners, chiropractors in a group practice will sometimes be on call or treat patients of other chiropractors in the group.

Training, Other Qualifications, and Advancement

Chiropractors must be licensed, which requires 2 to 4 years of undergraduate education, the completion of a 4-year chiropractic college course, and passing scores on national and State examinations.

Education and training. In 2009, 16 chiropractic programs in the United States were accredited by the Council on Chiropractic Education. Applicants must have at least 90 semester hours of undergraduate study leading toward a bachelor's degree, including courses in English, the social sciences or humanities, organic and inorganic chemistry, biology, physics, and psychology. Many applicants have a bachelor's degree, which may eventually become the minimum entry requirement. Several chiropractic colleges offer prechiropractic study, as well as a bachelor's degree program. Recognition of prechiropractic education offered by chiropractic colleges varies among the States.

Chiropractic programs require a minimum of 4,200 hours of combined classroom, laboratory, and clinical experience. During the first 2 years, most chiropractic programs emphasize classroom and laboratory work in sciences such as anatomy, physiology, public health, microbiology, pathology, and biochemistry. The last 2 years focus on courses in manipulation and spinal adjustment and provide clinical experience in physical and laboratory diagnosis, neurology, orthopedics, geriatrics, physiotherapy, and nutrition. Chiropractic programs and institutions grant the degree of Doctor of Chiropractic (D.C.).

Chiropractic colleges also offer postdoctoral training in orthopedics, neurology, sports injuries, nutrition, rehabilitation, radiology, industrial consulting, family practice, pediatrics, and applied chiropractic sciences. Once such training is complete, chiropractors may take specialty exams leading to "diplomate" status in a given specialty. Exams are administered by chiropractic specialty boards.

Licensure. All States and the District of Columbia regulate the practice of chiropractic and grant licenses to chiropractors who meet the educational and examination requirements established by the State. Chiropractors can practice only in States where they are licensed. Some States have agreements permitting chiropractors licensed in one State to obtain a license in another without further examination, provided that their educational, examination, and practice credentials meet State specifications.

Most State licensing boards require at least 2 years of undergraduate education, but an increasing number are requiring a 4-year bachelor's degree. All boards require the completion of a 4-year program at an accredited chiropractic college leading to the Doctor of Chiropractic degree.

For licensure, most State boards recognize either all or part of the four-part test administered by the National Board of Chiropractic Examiners. State examinations may supplement the National Board tests, depending on State requirements. All States except New Jersey require the completion of a specified number of hours of continuing education each year in order to maintain licensure. Chiropractic associations and accredited chiropractic programs and institutions offer continuing education programs.

Other qualifications. Chiropractic requires keen observation to detect physical abnormalities. It also takes considerable manual dexterity, but not unusual strength or endurance, to perform adjustments. Chiropractors should be able to work independently and handle responsibility. As in other health-related occupations, empathy, understanding, and the desire to help others are good qualities for dealing effectively with patients.

Advancement. Newly licensed chiropractors can set up a new practice, purchase an established one, or enter into partnership with an established practitioner. They also may take a salaried position with an established chiropractor, a group practice, or a healthcare facility.

Job Outlook

Employment is projected to grow much faster than average. Job prospects should be good.

Employment change. Employment of chiropractors is expected to increase 20 percent between 2008 and 2018, much faster than the average for all occupations. Projected job growth stems from increasing consumer demand for alternative healthcare. Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive healthcare practices. Chiropractors who specialize in pediatric care will be in demand as chiropractic spinal treatment is very gentle and children enjoy subsequent visits. The rapidly expanding older population, with its increased likelihood of mechanical and structural problems, also will increase demand for chiropractors.

Demand for chiropractic treatment, however, is related to the ability of patients to pay, either directly or through health insurance. Although more insurance plans now cover chiropractic services, the extent of such coverage varies among plans. Chiropractors must educate communities about the benefits of chiropractic care in order to establish a successful practice.

Job prospects. Job prospects for new chiropractors are expected to be good, especially for those who enter a multi-disciplined practice, consisting of, for example, a chiropractor, physical therapist, and medical doctor. Multi-disciplined practices are cost effective and allow patients to remain in-house. Should a patient be referred to a medical doctor, they may use the "in-house" doctor or one of their own choosing. Chiropractors usually remain in the occupation until they retire and few transfer to other occupations, so replacement needs arise almost entirely from retirements. Establishing a new practice will be easiest in areas with a low concentration of chiropractors.