The Role of the Institution in Developing the Next-Generation Chiropractor: Clinician and Researcher

Flanagan and Giordano1 have offered a useful model of institutional function (their Figure 1) which illustrates the role that research (and more generally, scholarship) can and ought to play within schools of chiropractic. As well, they have touched upon 2 (perhaps the most important) factors which have inhibited the development of research climates within our institutions: “philosophy” and poverty. A word about each seems in order.

Dogma masquerading as philosophy is an old tale in the profession2., 3., 4. and continues to be manifest within chiropractic in several ways. These range from the widely disseminated, public commitment by college leaders5 to inadequately tested constructs (eg, “subluxation-syndrome”),6 to instructors who insist that clinical research is unnecessary or deleterious because chiropractic is based on vitalistic premises,7., 8. to those elements within the college community and wider field who argue that “we already know” chiropractic works9 and that the primary purpose of research in chiropractic is to determine basic science mechanisms of presumed effectiveness or “how and why chiropractic works so well.” Given the dearth of investigational skills, output, and skeptical attitudes within so many of our faculties,10., 11., 12., 13., 14., 15., 16., 17., 18., 19. the sequestering of researchers and clinician-researchers within research departments may have the paradoxical effect of encouraging the attitude that investigation and scholarship are trivial and esoteric activities for pointy-headed nonclinicians and thereby help to perpetuate uncritical attitudes and dogma.

Underpinning the dogma and scarcity of research skills are the financial limitations of the American chiropractic colleges. Very heavy tuition dependence has been the basic economic dynamic of chiropractic education in the United States since BJ Palmer established the financial formula for training chiropractors in the early years of the last century. An unpublished report in 1978 indicated that at the typical, private, free-standing American chiropractic institution, 75% or more of funding for operational budgets derives from tuition 20., 21. and the lowest tuition dependence of any American chiropractic college that I have ever heard of is 62% (electronic communication with J.F. Winterstein, May 17, 2002). The consequences of this reality are devastating, although seemingly unrecognized (or at least, not often publicly discussed). Heavy tuition dependence impacts who can be hired (eg, instructors vs scholars), how the faculty will be employed (eg, teaching vs investigation), and who will be enrolled as a student (almost anyone who meets the Council on Chiropractic Education's minimal prerequisites and can pay the hefty tuition). The best of intentions (and there are certainly chiropractic institutions which would like to raise the caliber of scholarship within their communities) has not been able to overcome this poverty and its intellectual consequences.

The grapevine suggests that the derailed effort to establish a state university–based college of chiropractic in Florida may be back on track. Although it may be unfair to pin too many hopes on this still nonexistent institution, the project might provide the context in which Flanagan and Giordano's model could be implemented. A tax-supported school of chiropractic would presumably be much less tuition-dependent. Competitive salaries and greatly reduced teaching loads could attract the talent and provide the faculty time needed to place the research mission on an equal footing with the goal of training doctors. With lessened need for tuition revenue, much greater selectivity in admissions augurs well for a better crop of chiropractors down the road. And we might expect that the university environment itself could be a factor in encouraging a more critical orientation to all things chiropractic.

I commend the authors for illustrating the potential role of research within chiropractic education and wish them well in their efforts to implement the model.