“Chiropractic is a remarkable profession with a legacy of dedicated men and women working diligently to make chiropractic universally available.
As our profession grew and matured, so did chiropractic colleges. They set the standard for what we can expect from our future doctors of chiropractic. Our responsibility is to provide the best chiropractic education possible to the men and women who entrust their future to us.”
Dr. Fabrizio Mancini, F.I.C.C., F.A.C.C.
President, Parker College of Chiropractic
What are some of the challenges now facing chiropractic colleges and students?
Here are the questions we asked:
1) Student loan defaults: do you provide advice to their students on how to manage loans effectively.
2) Decreasing enrollment: True or False
3) Quality and efficacy of the Educational programs in creating competent & successful chiropractors: Grade your School and Comment. (is practice management part of the curriculum)
4) Ongoing Improvement to curriculum to keep up with the changing needs of the patients (New Technologies being taught at the schools)
1) Student loan defaults: does your college provide advice to it’s students on how to manage loans effectively?
LCCW – Gerard Clum, D.C.
The news from Life Chiropractic College West on student loan defaults doesn’t get much better; the College’s draft cohort default rate for the latest period reported (2004) is 0.00%. The default rate in 2003 was 1.3% for chiropractic education in general and 4.5% for the entire program. Over the past five years the Life West default rate has averaged 1.3% compared with a profession-wide default rate of 1.5% and a national average of 4.5%.
That being said, Life West has an active and multi-layered approach to student borrowing, student debt management and graduate follow-through with respect to student loan obligations. The simplest strategy is also the most cost-effective strategy: Borrow ONLY what you NEED, understand that you can borrow well in excess of basic needs and avoid doing so at every turn. The second piece of advice to be aware of the “miracle of compounding” and do everything you can to accelerate payments to lower your overall cost of borrowing over time. The third tidbit is also a critical one; attend to your loan payback as closely as you paid attention to receipt of the money in the first place.
NUHS – James Winterstein, D.C.
National University of Health Sciences has a very capable and active financial aid staff. We have for many years, counseled our students regarding their use of financial aid and the requirements imposed by government on the repayment. Our default rate, which is typically under 1%, reflects this effort.
NYCC – Frank J. Nicchi, D.C., M.S.
NYCC’s default rate is .5 percent. NYCC, as is the case with all chiropractic colleges, is required by the Department of Education to provide debt management counseling to its students, and accordingly does so.
Parker – Fabrizio Mancini, F.I.C.C., F.A.C.C.
Absolutely and it works. For the past three years, Parker has maintained a student loan cohort default rate between zero (0) and three (3) percent. Approximately 90 percent of Parker students receive some type of financial aid.
Parker attracts high quality students who possess very good fundamental life skills. We help our students build on these skills by offering superior business training that encourages responsible personal and fiscal behavior. Our students learn about loan repayment, receive individualized assistance with loan repayment issues and receive strong customer service. The fine reputation of Parker graduates helps our students find quality career opportunities upon graduation that allow for timely repayment of loans.
TCC – Richard Brassard, D.C.
From entering Texas Chiropractic College (TCC) until graduation, the Financial Aid Office (FAO) is active in default management and in working with the students in Debt Management. For the last two years, TCC’s co-hort default rate has been 0%.
Entrance counseling gives students an overview of financial aid—what is available to them through Federal and State grants, regular scholarships, Federal Work Study and finally Stafford and Private Loans. We talk about how the loans affect their credit, how interest accrues on certain loans, how very rarely loans are discharged through bankruptcy and what can happen to their credit if they default on student loans.
We ask them to work with a budget to manage their funds and to determine their need and that the FAO is always open to and for them.
Students are invited to a Debt Management Seminar upon entering their third trimester. Lunch is provided for the students. They receive a history of their loan indebtedness and verbal reminders that they are only one third of the way finished toward their doctorate and will be continuing to borrow for the next seven trimesters. We encourage them to again look at their budgets. We remind them that if they use the Federal Work Study program they could reduce the amount they borrow.
We explain the different repayment options available once they go into repayment. We even talk with them about credit card debt and the importance of checking their credit history once a year. We welcome questions and remind them that the FAO counselors are always available to assist them.
Entering their seventh trimester, the students receive a mandatory invitation to attend a Debt Management Seminar luncheon. At this seminar, they again receive a history of their student loan indebtedness and are reminded that there are still three trimesters to complete before graduation. We encourage them to look over their debt and to talk with us about any concerns.
We hold exit counseling a few days before graduation and again explain repayment options, deferments, forbearance and the importance of keeping their lender(s) aware of any address or phone changes. We talk about possible changes in their financial situation and possibly not being able to make payments. We explain that they should always contact their lender(s) to discuss this and what can be done to keep them from being delinquent and to help keep them from defaulting on any loans.
We remind them that the FAO is always here—even after graduation—to assist them in any way possible.
2) Enrollment: Is it Decreasing? True or False
LCCW – Gerard Clum, D.C.
The facts speak for themselves, the profession has seen a notable decrease in enrollment that started in the late 1990s and has continued through Fall 2004. Data from the Association of Chiropractic Colleges indicates that the maximum enrollment in the 1990s was 15,398 seen in Fall 1996. Conversely enrollments thereafter began to decline and reached their lowest point in Fall 2004 with a profession-wide enrollment decrease of 36% to a total number of 9,811. The 2005 data indicates a slight upward trend in enrollment to once again in excess of 10,000.
NUHS – James Winterstein, D.C.
Enrollment in the chiropractic degree program has remained steady for the past three years and at the present time is on the increase for fall of 2006.
The reasons range from the impact of managed care on health care at all levels and in particular chiropractic care, to a shift in demographics, to the September 11 tragedy which resulted in a dramatic change in international student enrollment to the decline in interest in health care as a career option in general. Like all trends, these factors are modulating on a regular basis.
NYCC – Frank J. Nicchi, D.C., M.S.
The enrollment picture at NYCC is stable.
Parker – Fabrizio Mancini, F.I.C.C., F.A.C.C.
Enrollment at Parker College remains steady. We purposely set 950 as a cap on our enrollment to provide the best education based on the capacity of our current facilities. The enrollment cap has enabled us to raise our admission index. We can select the more academically prepared students, which traditionally translates into a higher likelihood of success.
Parker College instituted the enrollment cap after carefully considering facility usage, class size, faculty to student ratio and clinic student distribution, as well as other factors.
TCC – Richard Brassard, D.C.
Enrollment at Texas Chiropractic College has been consistent over the past several years. Although there seems to be a decrease in the total number of students being admitted to chiropractic schools nationwide, here at TCC our enrollment has remained constant. Our student to faculty ratio is approximately 13:1, and we strive to manage our enrollment in order to keep the ratio at this optimal level, allowing our institutional environment to be family oriented and student friendly. This, coupled with our new, technologically advanced educational facility, provides a strong basis for our enrollment management plan.
3) Quality, Efficacy and Ongoing Improvement: Grade your School and Comment. (Is practice management part of the curriculum?)
LCCW – Gerard Clum, D.C.
One of the goals of Life Chiropractic College West is to see that our graduate in 2006 will be better prepared than our graduate of 2005. The issue of quality assessment and continuous improvement are at the heart of the academic process and also at the heart of the accreditation process. Life Chiropractic College West, like all of the chiropractic colleges and programs, is constantly evaluating its efforts, methods, procedures and planning in order that they accurately reflect the external environment and its attendant opportunities and threats.
An area of considerable frustration for every chiropractic program is related to the subject of practice management skills. Some programs view this as a critical part of the professional education of the chiropractor while others view it as something beyond the capacity of the chiropractic institutions and programs to adequately address. Like many things, the reality is likely somewhere in the middle. This is the perspective we have taken at Life Chiropractic College West. We present the fundamentals of the business of practice with content ranging from business planning to office procedures. It is our intention to provide our students with a background that will allow them to make good business decisions with respect to their professional life, but not to provide them with the details of that professional life. We help them sketch the tree, the leaves are their responsibility.
NUHS – James Winterstein, D.C.
We began our Ethical Practice Management program for our DC students about 15 years ago. This is partially didactic using on campus faculty and also practicing faculty who are brought in on a seminar series basis. Part of the program involves preparation of a practice development plan and in general seems to have worked well. Coding and insurance relations are a significant part of the educational process. Our surveys reveal that 96% of our graduates are in practice – I would give us an “A” on that basis.
There is little doubt in our minds that the education of chiropractic students must change. Practice is not just about back pain and spinal adjusting any more. The quantity of knowledge has expanded very rapidly, so there must be greater education in the area of genetics and physiology, for example. Meanwhile, our chiropractic medicine department has markedly increased the instruction in various aspects of kinetic chain analysis and related methods of care. New soft tissue procedures, Kinesiotaping, and rehabilitation are all part of the curriculum today.
NYCC – Frank J. Nicchi, D.C., M.S.
Based on exit surveys of alumni who have been out of school for 3, 5, and 7 years respectively, the quality and efficacy of NYCC’s education program would warrant an “A,” evidenced by the fact that 94 percent of our graduates who have been out of school for 3, 5, and 7 years respectively, continue to practice chiropractic. Additionally our graduates’ annual income are ahead of net averages. When one combines these facts with our relatively low student loan default rate, one easily discerns an overall picture of successful graduates.
NYCC is committed to chiropractic’s increased availability for all patients through integration, academic excellence, quality patient care and professional leadership.
Parker – Fabrizio Mancini, F.I.C.C., F.A.C.C.
Parker College continues to provide innovative instruction and we are proud of our many efforts to stay on the forefront of chiropractic education. Parker students learn successful practice management skills through the Parker College curriculum and Parker Seminars. Our students leave as prepared, competent, and exceptional doctors of chiropractic and successful business owners.
TCC – Richard Brassard, D.C.
Creating competent and successful chiropractors is not only the mission of Texas Chiropractic College, but it is also a requirement for continued accreditation with the Council on Chiropractic Education (CCE). Accreditation is based on standards set forth by the Council on Accreditation (COA) of the CCE. These standards demand that the Doctor of Chiropractic Program provide students with the necessary instruction and opportunities to observe, acquire, and practice under supervision, the attitudes, knowledge and skills in the areas of: history taking, physical examination, neuromusculoskeletal examination, psychosocial assessment, diagnostic studies, diagnosis, case management, chiropractic adjustment, emergency care, case follow-up and review, record keeping, doctor-patient relationship, professional issues, wellness, ethics and integrity.
Practice management is a significant component of the Clinical Sciences curriculum at Texas Chiropractic College in preparing its graduates for clinical practice. A five-credit, 75-hour course in business law, practice management, and insurance is offered during a student’s eighth trimester. The course includes legal aspects of setting up a chiropractic practice, jurisprudence, legislative issues, and writing a business plan. The course also includes materials on effective office procedures, practice management, and business skills. In addition, students learn all aspects of insurance billing, third party payers, CPT and ICD-9 coding, filing techniques, and documentation. During internship in the outpatient clinic, students rotate through the clinic’s business office to gain practical knowledge of office management and patient billing/collections. Interns on preceptorship programs gain valuable experience from exposure to business offices in private and group practices.
4) New Technology: Is there ongoing Improvement to curriculum to keep up with the changing needs of the patients?
LCCW – Gerard Clum, D.C.
This is perhaps one of the most exciting areas for Life Chiropractic College West. In 2000 we occupied our new campus in Hayward, California. The campus was designed with a technology emphasis and related structural preparedness for greater technology application in chiropractic education and practice.
Soon thereafter, we became the most-wired campus in chiropractic with power and data to the desktop in every classroom where this was feasible. The next step involved campus-wide Internet accessibility on a wireless basis. This was accomplished and today there is wireless connectivity in every section and corner of the campus.
In 2003 we began a conversion from film-based radiography to computed radiography. This was accomplished by the end of 2003 and we are presently increasing our capacity through the inclusion of digital radiography technology for use in the classroom and the Health Center. Life Chiropractic College West was the pioneer in the use of computed radiography in chiropractic education worldwide and we will once again pioneer the application of digital radiography in chiropractic education on a worldwide basis.
In 2004 Life Chiropractic College West collaborated with True MRI Inc., and the first weight-bearing MRI facility in academia in North America was installed on our campus. Through this relationship we have initiated research efforts at the College and partnered with other chiropractic programs utilizing this technology. We have also developed a senior student rotation program offering firsthand experience to our students in the use of weight-bearing MRI. Our next effort will be to develop a one-year post-doctoral fellowship in advanced imaging focusing on the application and research related to this technology.
NUHS – James Winterstein, D.C.
In addition to the physical medicine components of the education of DC students, we have added much more in the field of clinical nutrition and botanical medicine and are looking toward expansion of education in the field of pharmacology, since patients today use far more and varied drugs than at any time in the past. As physicians, our graduates must be knowledgeable in these areas of therapeutics.
The other vital aspect of student education today, is in the arena of clinical research. At National, this aspect of education is expanding rapidly with emphasis upon the “why and how” of evidence based medicine.
When I attended chiropractic college in the mid sixties, I was required to earn 180 credit hours for graduation. Our students today must earn a minimum of 246 credits for graduation. Clearly the educational process – both quality and quantity have expanded, but I do not think we are done. Because of the magnitude of knowledge expansion, I think regular residencies will become a necessity in the future. This process will be phased in, I believe over the next 10 to 15 years. Within the residency process will be more hospital rotations and great opportunity for collaborative learning.
In my estimation, schools that are not looking to educational expansion will not be able to continue far into the future. The health of society is changing and despite the great interest in complementary and alternative medicine, there is evidence that the population is becoming less healthy. The declining health is related to lifestyle, in great measure, and I can think of no better physician to address these needs than the well-educated chiropractic physician who can bring a broad and minimally invasive approach to optimizing health. This great need must be addressed by broadening and extending chiropractic education. If we don’t see this need and this opportunity, I believe we will see a decline in our profession as others move in to take an ever-increasing share of back pain patients, which for many decades represented the chiropractic physician’s bread and butter.
National is up to the challenge and we welcome it as we look to the future, not as a large chiropractic institution, but as a university that offers the kind of educational quality that will be required for success in the challenging world of health care delivery – a university that offers a culture in which inter-professional collegiality is valued and promoted as we continue to expand our program offerings to include naturopathic medicine, acupuncture, oriental medicine and massage therapy.
NYCC – Frank J. Nicchi, D.C., M.S.
The most striking change in NYCC’s curriculum is its current emphasis on integrative care. NYCC’s on-campus integrative health center exposes students to healthcare therapies that include chiropractic, nutrition, mental counseling, massage, dyslexia training, medicine, acupuncture and Oriental medicine.
Many chiropractors would agree that the true “art” of chiropractic, as distinguished from its philosophy and science, is something that comes through practical hands-on experience. The first step begins when students are introduced into real-world practice situations and are able to treat a wide variety of conditions. NYCC has made every effort to forge relationships with distinguished healthcare facilities that accomplish this end.
Other colleges are likely to implement NYCC’s successful “hub and spoke” patient outreach model. Throughout the New York State, for example, NYCC reaches out to a cross-section of a region’s patient population through a system of central hubs and connecting health facility satellites. The “hubs” are NYCC’s integrated health centers, located in Seneca Falls, outside Buffalo, and Long Island. They serve as central cores for the “spokes.” Each center has a wide variety of spoke opportunities, including scoliosis screenings at local high schools, participation at sporting events, and speaking at local health fairs.
NYCC’s success resides, in large part, in its various internship relationships with renowned healthcare institutions. These include the National Naval Medical Center in Bethesda, Md.; State University of New York at Buffalo and Farmingdale; and Salvation Army sites throughout the state. In Rochester, N.Y., NYCC collaborates with the Monroe Community Hospital (with an emphasis in geriatric care); Lifetime Care (an organization that provides home care, hospice services, and support for caregivers); Mercy Outreach Center and St. Joseph’s Neighborhood Center (multidisciplinary clinics for low income populations.) In addition, students intern at Clifton Springs Hospital for diagnostic imaging rounds.
NYCC has also played a significant role in heightening the presence of chiropractic in the military, after federal legislation mandated chiropractic benefits for active-duty personnel at designated sites. NYCC collaborated with the Buffalo VA Medical Center, making this the first academic affiliation between the Department of Veterans Affairs and a chiropractic institution. The Buffalo VAMC was the first in the country to appoint a doctor of chiropractic to provide chiropractic services to veterans. Today, there are 28 VAMCs or Community Based Outpatient Clinics nationwide, with on-site chiropractic available to veterans on a referral basis.
These unique experiences offer valuable opportunities to student interns for developing health goals based on patients’ needs. Undoubtedly, University of Buffalo’s students will present health concerns that differ from those of chronically ill patients at Monroe Community Hospital. As NYCC prepares its students to work collaboratively with medical students, hospital staff, and other healthcare professionals, they may, in turn, encourage these professionals to collaborate with chiropractors.
Through these integrative efforts, the College has played a significant role in changing the chiropractic profession. As colleagues and patients increasingly see chiropractic interns and clinicians in hospitals and other venues formerly considered “off limits,” practitioners are decreasingly relegated as mere “neck and back” doctors, but rather health professionals who treat a broad spectrum of health concerns.
Who benefits from NYCC’s efforts at integration?—students, the profession, and, most importantly, patients.
Parker – Fabrizio Mancini, F.I.C.C., F.A.C.C.
We understand that the needs of chiropractic patients change and that health care consumers, as a whole, take a more active role in their care than in years past. Wellness is so important that it consumes most of our decisions, according to economist Paul Zane Pilzer. In fact, he projects that by 2010 an additional trillion dollars of the economy will be devoted to products and services that keep us healthy, make us look or feel better, slow down the effects of aging, and prevent diseases from developing altogether.
Parker College recognizes the growing need to prepare health and wellness specialists for the continually changing and expanding professional roles in healthcare. A Bachelor of Science in Health and Wellness is now offered at Parker College. The program provides rigorous academic studies in an interdisciplinary program to prepare men and women for many healthcare related careers.
This program is attractive to students wishing to supplement their chiropractic degree with a bachelor of science. This distinctive degree program is also a good fit for those looking at careers in corporate wellness centers, fitness settings and community and college health settings.
Parker’s Future: As we prepare for our 25th anniversary in 2007, we naturally look toward our next 25 years. Since its humble beginnings, Parker has flourished and is now a highly respected college. However, we simply cannot sit back and be satisfied to admire our accomplishments and maintain the status quo. If we do, we will be shirking our responsibilities to our profession and to all those our profession serves. Too much is at stake. We have recently adopted our Parker Mission Statement: Parker creates leaders who promote wellness care through high standards in Education, Research and Service.
Statistics show repeatedly that many health problems are preventable.
For instance, the landmark INTERHEART study included more than 29,000 people in 52 countries. That research found a combination of lifestyle changes —including stopping smoking, eating healthier diet and exercising—could lead to an 80 percent reduction in the risk of heart attacks. Imagine the impact if these lifestyle changes are combined with chiropractic care. The results can be amazing.
Wellness is and will be actively sought, taught and advocated throughout our college, clinics, research and seminars. We passionately believe we must interweave our wellness message with chiropractic. The wellness of those we serve stands in the balance.
TCC – Richard Brassard, D.C.
As demands for improvement are placed upon institutions of higher education, curriculum and educational programs will have to be routinely assessed and outcomes established for the institution to be able to continue to offer qualified students an educational program leading to the Doctor of Chiropractic Degree. Within the institution, the Department of Institutional Research assesses student performance on national board examinations, assesses faculty, staff, and students on campus climate, and assesses graduates at one, three, and five years beyond graduation on their knowledge of the CCE clinical competencies. Furthermore, TCC has established a task force to review college curriculum and syllabi for areas of deficiency and to make recommendations for improvement. The task force is currently characterizing the qualities of TCC graduates and will soon compare skill sets and attitudes of the ideal TCC graduate including the competencies of: therapeutic procedures, communication, public health, referral/collaborative care, evidence-based practice/research, quality improvement, practice management, special populations, health care informatics, and nutritional counseling.
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