Monday, November 4, 2013

Doctors of Chiropractic Receive Extensive, Demanding Professional Education on Par with MDs and DOs

Chiropractors like to claim that their education is equivalent to the MD curriculum, with statements such as this:

source: http://www.healthandchiropractic.com/chiropractic/chiropractic-facts

The chiropractor and marketer Ron Grisanti has published a widely-reproduced article, Educational Requirements for Admission to Medical and Chiropractic College, and for the MD Degree (Doctor of Medicine) and DC degree (Doctor of Chiropractic) in which he claims
The educational requirements for the MD degree (doctor of medicine) are often exaggerated, and that of the DC degree (doctor of chiropractic) underestimated. Here, actual requirements for each degree are compared....

...clearly shows that compared to medical colleges, chiropractic colleges require more courses for admission and more classroom hours for graduation. 
Grisanti then lists comparative admissions requirements:


Clearly the chart alleges that aspiring chiropractic students are better-educated that aspiring medical students, even for prestigious programs such as the medical schools of Harvard and Stanford.  This is a footling claim, both Harvard and Stanford medical schools require an undergraduate degree from an accredited four-year university.   For example, to graduate with a BS in chemistry from Stanford University a student is required to complete a least a competency in a non-English language, take courses in rhetoric and writing, and satisfy other general education distribution requirements. In any case, according to Wyatt (2005), only "seven states currently require a baccalaureate degree before granting a chiropractic license".

Further, a 1997 study found that chiropractic students were the least academically qualified of all the medical professions surveyed.


(Aside: it would be interesting to repeat the study in the current educational climate.)

Grisanti then lists classroom hours for chiropractic students and medical students, drawn from a "Parker College study".  (I have not been able to find a proper citation for this study.)


Grisanti concluded, "It should be apparent.... that in general, the chiropractic student has a more extensive classroom education and practical training in these areas, particularly in diagnosis, than the medical student."

There are two small problems.  First is that those hours cannot be verified, as the "Palmer College study" cannot be found.  Another small problem:  chiropractic students lack both clinical training while in school, and post-doctoral training. As Ralph E. Gay MD, DC wrote, "The weakest part of chiropractic education is the clinical post-doctoral period...there is no requirement for an internship or residency prior to licensure as there is in medicine and osteopathy."

In 2005, Wyatt et al. wrote (emphasis added)
In general, the first four to five academic terms are spent studying basic sciences while also learning the basics of spinal examination and treatment. Terms five through eight are spent in clinical classes such a diagnostic imaging, clinical neurology, physical examination, geriatrics, pediatrics, case management and the like. In addition, it is during these terms that students refine their diagnostic and treatment skills for the management of joint diseases, primarily of the spine. 
Currently, internship (more correctly externship) in the chiropractic profession is a one-year undergraduate endeavor, while it is a three to five year post-graduate program in medical and osteopathic training, including residency training.... In addition, clerkships are routine in medical training, while they are not in chiropractic schools, although some chiropractic schools have had clerkship programs for students in lower terms.... Our cumulative observations suggest that the obvious contrast in numbers of patient encounters in a chiropractic externship, when compared to a medical/osteopathic internship, are sadly disconcerting from the perspective of the volume and variety of patient exposures. Post-graduate residencies are available to chiropractors, but residency-based training is not currently a requirement, or even commonplace, the exception being diagnostic radiology training leading to diplomate status.

In  "Chiropractic Education for Primary Care", Harriet Hall at the Science Based Medicine Blog expands on how much medical education and training happens in the post-doctoral setting of internship and residency:
Traditional Education of MDs The 4 years of medical school are very different from those of a chiropractic school. When I was a student, the first two years were spent in classrooms and labs studying gross anatomy, physiology, pharmacology, pathology, biochemistry, histology, neuroanatomy, microbiology, immunology, embryology, and other meaty science subjects. In the 3rd year, students moved into the hospital wards, rotating through internal medicine, surgery, pediatrics, OB/GYN, psychiatry, neurology, radiology, emergency medicine, etc. 4th year clinical rotations involve a higher level of responsibility and include electives. Most of the clinical experience is with seriously ill hospitalized patients, but students also get some outpatient clinic experience.

The real training begins after graduation, when students get to put their learning into practice. They assume primary responsibility for patients, under supervision. I did what was called a “Rotating 0” internship, designed to provide a broad foundation before entering a specialty. I rotated through internal medicine, surgery, OB/GYN, pediatrics, and electives (neurology and ENT). Most of my time was spent on the hospital wards, but I also worked in outpatient clinics and in the ER. The experience was intensive, with call every 3rd night. This meant working all day, all night, and the following day for a total of 32+ hours straight, followed by a day when we worked 9-10 hours and got to go home in the evening. In my case, my training was interrupted by an Air Force assignment as a General Medical Officer, and after that I spent 2 years in a 3-year residency in Family Practice (my internship counted for year 1). Residencies are where doctors get their training in a specialty, with graduated responsibilities as the program proceeds. At 3 years, the family practice residency is one of the shortest; a surgery residency typically lasts 5 years, a neurosurgery residency 7 years. In some cases, a residency is followed by a fellowship in a subspecialty, such as gastroenterology or child psychiatry. Rigorous exams are required at various stages of training and for board certification in a specialty.
....
Chiropractic education
Chiropractic education is much less rigorous. Class time is taken up by many hours of training in manipulation technique like “toggle,” and “cervical technique,” palpation, and “subluxation” analysis; and for subjects like financial management and practice management. They don’t get any experience caring for seriously ill hospitalized patients. There is no internship or residency. 
Summary:
I think it is clear: chiropractic education is in no way as rigorous or as extensive as that required of MDs and US-trained DOs. In other words, chiropractors are not equipped by their education to opine on any medical matters other than the management of low back discomfort.

Sources 

Coulter I, Adams A, Coggan P, Wilkes M, Gonyea M. (1998) A comparative study of chiropractic and medical education. Altern Ther Health Med. 1998 Sep;4(5):64-75. http://www.ncbi.nlm.nih.gov/pubmed/9046456

Deardorff J August 4 2009, A Medical Doctor's view of Chiropractic Health Care (Interview with Ralph E. Gay, MD, DC) http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/08/a-medical-doctors-take-on-chiropractic-care.html

Doxey TT, Phillips RB. Comparison of entrance requirements for health care professions. J Manipulative Physiol Ther. 1997 Feb;20(2):86-91, http://www.ncbi.nlm.nih.gov/pubmed/9046456 

Hall H October 13, 2013 Chiropractic Education for Primary Care  http://www.sciencebasedmedicine.org/chiropractic-education-for-primary-care/

Hodges BR, Cambron JA, Klein RM, and Madigan DM,(2013) Prevalence of nonmusculoskeletal versus musculoskeletal cases in a chiropractic student clinic. Journal of Chiropractic Education: Fall 2013, Vol. 27, No. 2, pp. 123-127. doi: http://dx.doi.org/10.7899/JCE-13-101

Grisanti R >Educational Requirements for Admission to Medical and Chiropractic College, and for the MD Degree (Doctor of Medicine) and DC degree (Doctor of Chiropractic) (no date)http://www.yourmedicaldetective.com/drgrisanti/mddc.htm


Wyatt LH, Perle SM, Murphy DR, Hyde TE The necessary future of chiropractic education: a North American perspective Chiropr Osteopat. 2005; 13: 10. Published online 2005 July 7. doi:10.1186/1746-1340-13-10

4 comments:

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  2. Chiropractors do 408 hours study in "diagnosis" whereas medical doctors only do 113.

    Tell me then why doctors diagnose a broad range of conditions, and chiropractors seem to only ever see subluxations?

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  3. Fellowship will be the launching pad to the rest of your career, and as such, fellowship personal statements should focus on the future as opposed to what you have already accomplished. osteopathic neurology residency personal statement

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