One question I am often asked is: is a chiropractor a doctor or asked to explain the difference between a Medical Doctor (MD) and a Doctor of Chiropractic(DC). While there is a great deal of overlap in the subjects that are taught to both MDs and DCs, there are many important differences. The biggest difference to pay attention to is the fact that both DC’s and MD’s are on this spectrum called health. One is at the health end of the spectrum and the other at the disease end. There is value to each profession as they are experts of ‘their’ end of the spectrum. The essential training of chiropractors is to see how to be healthy and that of MD’s is to see how to get rid of the disease. I always say to my patients who ask me what medications to take, to go to their MD’s and that I am not the expert in that. MD’s have had hours and hours of pharmacology (the study of meds) while I have had hours and hours of nutrition. MD’s should not give any nutrition advice just like DCs should not give any medical advice. Now with that said, let’s get into the specifics 🙂
Education – Do Chiropractors go to medical school?
Chiropractors complete an undergraduate degree, which is often in either biology, chemistry, or kinesiology and must include many of the same prerequisites as MDs including Biology, Chemistry, and Organic chemistry. Following completion of their undergraduate degree, future chiropractors must be accepted into a CCE accredited chiropractic program where they will complete approximately 4900 instructional hours in chiropractic education over the course of approximately 4 years. Chiropractic students must complete over a year of clinical internship while in school and are required to perform hundreds of adjustments while being supervised by a licensed Chiropractor. Many DCs also complete a rotation working in a chiropractic office outside of school prior to graduation. During this internship, student chiropractors learn the everyday logistics of running a chiropractic practice in addition to performing exams, taking x-rays, educating patients, performing adjustments, and managing patient cases.
Following the completion of a 4-year undergraduate degree, often in a heavy science-based major, and always including pre-requisite courses in the same subjects such as Biology, Chemistry, and Organic chemistry, those wishing to be MDs begin the ultra-competitive process that is medical school applications. Following acceptance to an accredited medical school, MDs complete 4 years of schooling entailing approximately 4700 instructional hours followed by 3-4 years of hospital internship and residency. At that time MDs choose to either go into general practice or choose a specialty for which they must complete anywhere from 3-5 more years of fellowship. MDs complete all of their clinical training in hospitals, seeing and doing everything from severe trauma to labor and delivery and everything in between.
MDs have the option of training to be either a general or specialized surgeon, practicing as a general practitioner (often called family doctors or internists) or choosing to specialize in one of more than 120 particular areas of specialized medicine such as pediatrics, neurology, obstetrics and gynecology, dermatology, cardiology, infectious disease, psychiatry just to name a few. Specializing in a particular area of medicine requires further training and time, some fellowships require anywhere from 4-8 more years of training after the completion of internship and residency.
DCs also have the option of choosing to specialize in a certain area of chiropractic. Most DCs who choose to pursue further chiropractic education in the form of certifications or diplomats in one of the 14 sub-specialties acknowledged by the American Board of Chiropractic Association continue to offer chiropractic care for a variety complaints as well as for wellness care.
One huge main area of difference is that whereas a medical education covers hundreds of hours and in-depth training of general surgery, emergency medicine, and pharmacology, chiropractic education entails hundreds of hours and in-depth training in chiropractic analysis (motion palpation), kinesiology which is the study of human movement, and chiropractic adjusting techniques.
Each chiropractor has his/her own approach to delivering a chiropractic adjustment. There are approximately 200 different chiropractic techniques and while some of these techniques overlap and some have been studied more than others, this means there is certainly more than one way to analyze and adjust a spine. ‘Cracking’ the spine is not the only way to get adjusted you know!
Not all chiropractic colleges teach every technique, and not every chiropractor knows all 200 techniques. The way a chiropractor chooses to analyze and adjust patients is often based on individual preferences as well as individual strengths and weaknesses. For example, I do not adjust a 300lb linebacker the same way I adjust a newborn baby and a 6’5” 250lb chiropractor does not adjust the same way as a 4’11” 100lb DC chiropractor would.
Are Chiropractors licensed and regulated?
Licensing for both MDs and DCs requires the passing of certain licensing exams. MDs are required to take the notorious United States Medical Licensing Exam (USMLE) which is a three-step examination and pass it in order to receive a license to practice medicine in the USA. DCs must pass all 4 parts of the National Board of Chiropractic Examiners (NBCE) licensing examination. The 4th part of the NBCE exam qualifies a DC for licensure in 48 states (there are 2 states requiring state board exams as well as a large number of states that call for DCs to have also passed an addition NBCE exam on Physical Therapy in order to obtain a license in that state).
Chiropractic scope of practice is dictated by individual state law. In other words, each state has a chiropractic board which licenses chiropractors in that state and, along with state legislatures, develops the state’s laws regarding chiropractic care. Though there are states lobbying for chiropractors to be able to prescribe medication, the majority of chiropractors believe that prescribing medication would not be in line with the philosophy of chiropractic and do not want to have prescription rights. Currently, there are NO states in which chiropractors are allowed to prescribe medication and I personally like to see it that way. To me, there is a fundamental conflict that comes with DC’s practicing medicine. I can only imagine how some DO’s (Doctor of Osteopathy) must feel given that they started to also be into the natural course of health and not disease experts. Politics has its hands in every aspect of life for sure.
A matter of perspective- How is chiropractic care different?
MDs are trained to focus on disease (symptom based care) rather than focusing on the person, determining and treating the cause. That isn’t to say MDs don’t search for and treat the causes of various issues. Of course they do. However, their care tends to be more symptom based and their approaches tend to lean more toward treatments including prescription medication and surgery. For example, medical doctors usually treat a complaint such as sciatica with either over the counter or prescription pain medication and possibly a referral to a physical therapist. You can read about my blog on the difference between PT’s and DC’s as well. A patient presenting to a chiropractor’s office with sciatica will be asked to provide a detailed history of the complaint and any similar complaints, a detailed examination including motion palpation and orthopedic and neurological exams and in my practice, because my focus is Brain-based Neurology and Posture and Developmental Kinesiology, also have that portion of assessment as a part of their initial exam, all in an effort to uncover and resolve the root cause.
What do chiropractors do?
This is how I look at it!!!
After my complete exam to include assessment of Brain-based neurology and Posture and Developmental Kinesiology, I also look into the lifestyle that is contributing to the problem including workplace AND how the patient sleeps. EVERYTHING matters and impacts your health. Nutrition is a part of you and should be addressed. There is too much to focus on so every visit becomes the opportunity for learning more about health and healthy living. Here is an example of what we may talk about! Of course, utilizing different treatments for the pain that brings most patients to the office is a different story. As much as Chiropractic focus is on health, most patients don’t seek care to improve their health until they are in pain. That is when educating them on the importance of health BEFORE pain is crucial. I always say that most major health issues don’t start with pain. Diabetes, high blood pressure, even cancer are great examples to think about. Just because you are pain-free does not mean you are healthy!!
DCs believe that the body has the potential to heal and maintain optimal health when presented with the right conditions. In their approach to treating the body as a whole, chiropractors recognize the importance emotional health plays in health and healing. Our practice offers Emotional Freedom Technique (EFT) for instance as a self-applied methodology to identify and resolve negative emotions and thought patterns contributing to physical symptoms.
Think of an MD more as a firefighter working against time to put out a blazing fire while striving to maintain as much of the structure as possible. The chiropractor is then the contractor who comes in after the fire has been put out to find the cause of the fire and rebuild the structure. The Chiropractor will take time to try identify the root cause of the issue while working with the structure to rebuild, recode, and eliminate the risk of future fires. In keeping with this analogy, Chiropractors are also great at providing support when working to build a safe, well-maintained structure from the ground up or identifying and resolving issues before fire breaks out.
Can Chiropractors work in hospitals?
MDs have the option to work in either hospital or non-hospital settings. The vast majority of Chiropractors practice in private practices though the first DC working at a hospital was hired in 1989 right here in California. According to the National Board of Chiropractic Examiners, only about 3.6% of DCs hold staff privileges at a hospital. Though the majority of chiropractors who do work in hospitals are not employed by the hospital, they have attending rights which means that they have the right to see and adjust a patient at that particular hospital. Chiropractors are actually becoming more common at Veterans’ Affairs (VA) hospitals with licensed chiropractors on staff at over 70 VA hospitals across the country working alongside neurologists, physical therapists, and orthopedic surgeons.
My role as your doctor- Is chiropractic more than treatment for back pain?
The word Doctor comes from the Latin word docere which means “to teach.” As a DC, in my role as a teacher, I place a huge priority on patient education. If you are a patient at the office, you know exactly what I am talking about. I have my YouTube channel which has over 190 videos I have put out at the time of writing this blog. I believe in teaching my patients about their bodies, about their nervous systems, about the ways in which their choices affect their health. I strive to help my patients regain their control over their lives and their health, putting them back in the driver’s seat and helping them to trust in their bodies’ capacity for health and healing when presented with the right conditions. Armed with knowledge, understanding, and support patients often feel they are able to make a difference in the course of their health and to me, that is one of the greatest aspects of chiropractic care and one of the best chiropractic benefits.