The United States Chiropractic Workforce: An alternative or complement to primary care?

Matthew A Davis,William B Weeks,Todd A Mackenzie,Ian D Coulter,James M Whedon

doi:10.1186/2045-709x-20-35

Abstract

BackgroundIn the United States (US) a shortage of primary care physicians has become evident. Other health care providers such as chiropractors might help address some of the nation’s primary care needs simply by being located in areas of lesser primary care resources. Therefore, the purpose of this study was to examine the distribution of the chiropractic workforce across the country and compare it to that of primary care physicians.MethodsWe used nationally representative data to estimate the per 100,000 capita supply of chiropractors and primary care physicians according to the 306 predefined Hospital Referral Regions. Multiple variable Poisson regression was used to examine the influence of population characteristics on the supply of both practitioner-types.ResultsAccording to these data, there are 74,623 US chiropractors and the per capita supply of chiropractors varies more than 10-fold across the nation. Chiropractors practice in areas with greater supply of primary care physicians (Pearson’s correlation 0.17, p-value < 0.001) and appear to be more responsive to market conditions (i.e. more heavily influenced by population characteristics) in regards to practice location than primary care physicians.ConclusionThese findings suggest that chiropractors practice in areas of greater primary care physician supply. Therefore chiropractors may be functioning in more complementary roles to primary care as opposed to an alternative point of access.

Highlights

In the United States (US) a shortage of primary care physicians has become evident
Population characteristics and practitioner supply In both univariate and multiple variable Poisson regression models, population characteristics were more strongly associated with the supply of chiropractors than with that of primary care physicians (Figure 3)
We found greater than a 10-fold variation across the country in the supply of chiropractors, a higher concentration of chiropractic services than expected in the Midwest, and a lower one in the South which collaborates with a Chiropractors Primary Care Physicians (A)

Summary

Introduction

In the United States (US) a shortage of primary care physicians has become evident. In the United States (US) health care policymakers continue to be concerned about the ability of the primary care workforce to meet the future primary care needs of an aging and expanding population. Only primary care physician supply [4] appears to be related to improvements in population health outcomes [6]. To meet the nation’s future primary care needs, it might be reasonable to expand the scope of practice of ancillary practitioners such as nurse practitioners and physician assistants. There is concern that the number of new graduates from nurse practitioner and physician assistant programs is not keeping pace with the required needs to mitigate future primary care physician shortages [7]. There is evidence that physician assistants are providing more specialty care [8,9]

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