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Is Physical Therapy or Chiropractic Medicine worth the time and money?

From what I've learned, both physical therapy and chiropractic medicine require years of school. Tuition is pricey and school takes up a lot of your time. Is it really worth all that effort to become a PT or a DC?
#medicine #physical-therapist #medical-education #physical-therapy #doctor #chiropractor #chiropractic-medicine #kinesiology #college #major #medical #hospital

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Susie’s Answer

Great question, Darren. I can only speak to the PT part of the question. I have been a PT for nearly 30 years -starting out with a Bachelor's (back then we could practice with just the 4-year college degree), then adding a Masters (2 more years) and a transitional doctorate (completed in 18 months). Now, all PT graduate students in the USA go straight through to a doctorate in PT, or a DPT, which is typically 7 full years of study. 4 years of college, and 3 years of DPT school. It is intense and costly, yes, and I will be paying off student loans for many years. Even so, I would 1000% do it all over again to become a PT! I am so grateful for the opportunities my career has provided me- I am continually learning- and now I get to teach as well. I can't speak to the flexibility of being a chiropractor, but as a pediatric PT I can work in so many different settings: schools, clinics, hospitals, neonatal units, home-based care, and adaptive sports. I can sub on weekends at the local hospital as well. I work primarily with children, but PTs work with patients from birth (in NICUs) all the way to end of life care. Nearly every clinic and hospital in my area is hiring at the moment, so I don't think PTs will soon be in a position where there are too many of them to meet the needs of most communities. Most of us work for a salary or hourly rate, for a facility or school district, but certainly you could open your own practice or go solo, similar to the independent practice model used by many chiropractors. Hope that answered your question, Darren.
Thank you comment icon So all PTs are DPT (7 years of education) plus the orthopedic rehabilitation is another 4000 hours (2 years of supervised instruction at 40 hours per week). The end result is if someone wants to become a PT OCS they get 9 years of expert training vs a DC who has 8 years of weak, nonevidence-based training and a field of similarly-trained DCs. This is a no-brainer. PT OCS is the way to go for a bright future, the best training and best prospects. Allen Botnick DC CNIM
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Ross’s Answer

As a recent chiropractic graduate (2020) I’ve been thrilled with my experience. Yes, student loans are a lot but if you are wanting to go into physical medicine chiropractic and physical therapy are best options. No other medical professional will be as hands on and have as large of an influence in healing than these.

As a chiropractor, most of the time you will be operating in a private practice setting. I’ve had the fortune of being a staff physician at the local hospital as well as the medical provider for the local high school sports teams. Research is starting to catch up and prove how valuable manual therapy and manipulation of joints is when it comes to managing pain. Both professions provide a huge service and neither is going away any time soon.
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Allen’s Answer

Chiropractic is a big "No" as the field is nonevidence based and contains primarily pseudoscience (treatment of nonexistent vertebral subluxations) and has been surpassed by the evidence-based OCS physical therapist who is the recognized expert in musculoskeletal rehabilitation. OCS physical therapists are required to have 4,000 hours of supervised training in rehabilitation while chiropractors have none required for the DC and CCSP and only 100 hours unsupervised for their highest certification the DACBSP.

Also, OCS PT assistants can do much more than DC assistants so if a PT wants to open their own practice they can probably make about as much money as a DC while doing less direct patient care in repetitive tasks (ie. teaching patient exercises) so it is a much more fulfilling job. If you are serious about getting great results and helping people OCS PT is the way to go. I know that chiropractic incomes may be tempting (average $120k/yr for self employed in all regions) as they are business owners and give a great sales pitch for the field but keep in mind that any chiropractor who is evidence-based will be swimming against the tide in the field where they will always be shunned by other DCs who use quackery. They will also struggle to make as much money as they would if they were an OCS PT with higher qualified PT assistants or the nonevidence-based DCs.

In fact, 50% of chiropractic graduates end up leaving the field within 5 years and are stuck with their student loan debts that they never pay off. You can find many good articles about chiropractic problems on Chirobase.org.

This won't matter for unethical students who don't care about ripping patients off but if you eventually want to be in an evidence-based field you can be proud of and contribute to then chiropractic is not for you. You will find yourself likely having to self-learn differential diagnosis and evidence-based rehabilitation but this is impossibly difficult to do on your own without supervised instruction in these subjects. It will be the hardest for graduates of the straight programs (ie. Life University, Sherman) but even at mixer programs (ie. Logan, NorthWestern), which cover differential diagnosis better, students are in a losing proposition due to the deficit of competent supervised rehabilitation instructors. Also, as a DC trying to do evidence-based care you will always be on your own and have to tolerate the mainstream chiropractic quackery to avoid being a target. So it is incredibly isolating. The other DCs will hate you for not supporting their quackery and will call you names like mixer and sell-out. This is how bad it is.

Red Flags that Chiropractic is a Bad Field

A big tip-off that a field is bad is a lack of improvement. This is why you see chiropractic colleges still teaching methods like "Hole-in-one" aka Toggle Recoil (1890s), Gonstead (1930s) and Sacro-Occipital technique (1920s). These techniques are known to use inaccurate biomechanical systems yet students are still tested on them on their national board exams.

Another big tip-off of a health scam are unsupported claims that a procedure helps most problems (ie. with chiropractic claims that manipulation raises immunity, removes nervous system interference and helps a wide range of health problems).

Another big red flag is that chiropractic students don't even respect their instructors, they say things like, "those who can't do...teach." At evidence-based schools (ie. dentistry, physical therapy) it is an honor to teach and they are highly selective because they want only the best professionals teaching but low-quality schools and professions like chiropractic do the opposite. Attending a chiropractic college is nothing more than an expensive diploma mill taught by incompetent faculty.

Don't put yourself in a losing situation, just avoid chiropractic and get an OCS PT certification. If you can't get into physical therapy then find a good school in another field that you have an interest and aptitude in, and has a good future outlook.

Also, be careful about the US Government's Occupational Outlook Handbook as it is promoting fields as having more credibility and a better outlook than is actually warranted.

Here is a representative chiropractic clinic that has an emphasis on rehabilitation with chiropractors from a mixer-type program (New York Chiropractic College) where you would be getting the best instruction in primary care and the owner has a diplomate in chiropractic orthopedics so it is a good representation of the upper tier of the field. From a job ad the owner of the clinic "is a Chiropractic Orthopedist, Chiropractic Neurologist and Functional Medicine Practitioner" yet he has no credentials in rehabilitation. (https://tinyurl.com/bdhejz3c) In fact, none of the chiropractors have any credentials in rehabilitation yet they market themselves as treating these types of injuries. Note how even the mixer-type chiropractors push subluxation care. Here they are using a subluxation poster to sell manipulation treatments (aka adjustments) as a false cure for osteoarthritis which is a common sales pitch that is used to justify never-ending maintenance care (care beyond maximum medical improvement).
https://www.activespineandjoint.com/results

Allen recommends the following next steps:

Learn about the OCS PT certification https://www.ptprogress.com/orthopedic-clinical-specialist-ocs/
Learn about the many controversies in chiropractic. https://quackwatch.org/chiropractic/general/
Learn about the high HEAL loan default rate among chiropractors. https://quackwatch.org/chiropractic/edu/loan/
Learn about how the US Government supports chiropractic misinformation https://quackwatch.org/chiropractic/edu/ooh_2010/
Thank you comment icon I do not disagree with your interpretation entirely. While there are plenty of charlatans in the field, there are plenty of DCs trying to abide to an evidence based protocol of helping with acute/chronic neck and low back pain with clear efficacy in the AMA'S own research of manipulative medicine. DCs do very much tend to be more entrepreneural and as a result, can utilize corny or ethically unsound sales pitches. This is wrong, but there are plenty of practitioners who just want to help individuals with their mechanical pain. Depending on which research you decide to settle your paradigms around, you'll get a spectrum of results from chiropractic being just as efficacious to PT for the same musculoskeletal condition to both chiro and PT being non-efficacious entirely. Colin Mermey
Thank you comment icon Actually, I have experience with both chiropractic and OCS PT as a patient. I had numerous times where DC treatment failed but OCS worked consistently (neck radiculopathy, whiplash rehabilitation). Chiropractic is nowhere on the same level as OCS PT. Your comment misrepresents and minimizes the number of chiropractors who support evidence-based practice. It also hides the lack of willingness for reform. If chiropractors were serious about their profession they would have reformed it years ago. There is no will in the field to reform it and all they care about is marketing and public relations to maintain a good image. Rehabilitation is an optional side subject that is neither required nor well-regulated and a lot of low back pain resolves on its own no matter what you do. Allen Botnick DC CNIM
Thank you comment icon I also have anecdotal work experience in integrative clinics with a heavy focus on rehab and orthopedics. It has been some of my most positive experiences, but like yours, it is still indeed anecdotal. Woo practitioners, while the probable minority of the profession, are the most vocal and tend to hold seats of authority have become comfortable operating in ambiguity within the outdated elements of the field. I don't foresee this changing either. It is also my opinion the future does not lie in chiropractic, but I'm hesitant to put all my chips in a niche diplomate of PT where the evidence still does not favor it. In the meanwhile, helping people get out of pain *who desire to get out of pain in a viable, non invasive vector* remains an ethical solution as long as no harm is done. Colin Mermey
Thank you comment icon In 2017 only 29% of chiropractic practices were multidisciplinary where the DC works with PTs and MDs and tend to de-emphasize vertebral subluxations (https://tinyurl.com/yj5na3ws). The remainder of most DCs support treating questionable "vertebral subluxations" that are basically diagnostic mirages, are unreliable to diagnose and have no bearing on patient outcomes (2004, https://tinyurl.com/yckn82v2). So this isn't a minority of the profession. According to the chiropractic scope of practice defined in State law if you go into chiropractic then treating subluxations is what you are trained to do, not treat back pain and other musculoskeletal disorders (though chiroprators misattribute this to subluxation) and this is what is tested on in chiropractic board exams. Allen Botnick DC CNIM
Thank you comment icon Would you base non integrative chiro models as subluxation based practitioners then? If so, I could see why you think the vast majority are subluxation based. A newer poll of 10% of randomly selected chiropractors were asked what type of practice they identify themselves as undertaking. Slightly over 50% were non-subluxatuon NMS practitioners with only about 25% affiliating themselves as subluxation based (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491397/) While I tend to agree that 50% is not enough for field cohesion, it doesn't seem that "straight" chiro is the vast majority. Also, the apparent variety of wild west practice paradigms out there also cause detrimental issues with true interdisciplinary work and being taken seriously. Colin Mermey
Thank you comment icon Half of the schools are straight (subluxation) and half are mixer (subluxation but limited to musculoskeletal problems) but there is still a lack of proper training in rehabilitation. They can think they are competent but that doesn't make it so. Honestly I don't care what style of practice they choose. I care whether they are evidence-based and have adequate training and experience to treat real problems in an effective manner that isn't going to harm the patient through misdiagnosis, delayed diagnosis or unnecessary neck manipulation giving them a stroke. In the current chiropractic profession we know that they aren't trained properly and lack the experience. This isn't going to change. The US government is setting these kids up for failure and it needs to be stopped. Allen Botnick DC CNIM
Thank you comment icon Chiro schools are private institutions, aside from licensing and accreditation boards, I'm not entirely sure what the US government is doing incorrectly in this scenario. Conversely, chiro schools can be quite predatory and misleading in what they can offer to their prospective students at an incredibly high sticker price. What did you end up doing when you decided to veer away from the profession? Or did you hone a particular adjacent specialty? Colin Mermey
Thank you comment icon I quit practice because I wasn't taught proper differential diagnosis at Life University (straight program), though I was quite good at soft tissue techniques from classes in trigger point therapy and reading cross friction massage but any medical massage person can train to do this) and earned a certification in intraoperative neuromonitoring (CNIM). I'm currently disabled though and miss working at this. Chiropractors can advance in neuromonitoring to DABNM but are limited because neurologists are the recognized experts, not DABNMs. DABNM chiropractors must be signed off by a MD for billing. which is similar to nurse practitioners. This is why it is important for students to make good choices when deciding what degree to get. Allen Botnick DC CNIM
Thank you comment icon DABNM and CNIMs are limited in pay. One can make around $150k/yr as a DABNM but this doesn't compare to a neurologist and many low-end CNIM jobs don't pay well ($75k/yr). $60k starting and $150k/yr at four years isn't worth it considering all the training you have to do and you can make near that with no extra training as a chiropractor. I can't see people paying their student loans off with this scheme. For our audience here the best advice is just to avoid chiropractic and do the OTC PT if they want to work as experts in rehabilitation with patients. Allen Botnick DC CNIM
Thank you comment icon No arguments there. While I try to not come off as the "doom and gloom," jaded chiro, it's all kind of true. I've usually made it a point to steer all but the most ardent, chiro-minded students away from the profession. Fascinating with the CNIM cert. I'll have to look in to it. I've been trying to course correct and study for the MCAT after being out of school for over 10 years. It's difficult, but hopefully not too late to jump back in to. Good luck out there. Colin Mermey
Thank you comment icon Thanks Colin. I think most chiropractors believe they are doing the right thing but also lack the data to see all the sides of what is going on. Especially how well the PT OCS profession has developed itself into an effective care system and how obsolete chiropractic has become since it is based on an outdated model (the 1900s Manual Medzin model of treating lesions that have been proven not to exist). As for the U.S. government, I fault the economists at the Occupational Outlook Handbook for relying on biased chiropractic sources to portray an overly optimistic view of chiropractic prospects that is factually wrong. This is what the Quackwatch/Chirobase.org article covers. Overall chiropractic is a massive time and money-draining dinosaur that needs to be put out of its misery. Allen Botnick DC CNIM
Thank you comment icon Unfortunately, the stupid Outlook handbook was one of the variables that assisted in my eventual decision to become a chiro as well. I had no idea it was a government sanctioned publication though. Sad to hear that. It's a hell of a hard lesson to learn post factum, but that's why we're on these student question boards now, lol. Colin Mermey
Thank you comment icon Exactly. Several years ago I wrote to the Occupation Outlook Handbook and they never changed anything except perhaps to remove any way to contact them to correct articles so I think it's more about advertising for colleges than a source of reliable information about professions. Caveat emptor here, buyer beware. Students must really dig and follow the precautionary principle to avoid the trap of damning themselves into lifetime indebtedness for an essentially worthless degree that leads nowhere. Allen Botnick DC CNIM
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Colin’s Answer

There's a few variables to take in to account here. All chiropractic schools are private institutions and will be more expensive than public, state-funded schools. While there are most certainly private schools that offer D/PT as a degree, you could potentially come away with an education in physical therapy with less student loan debt if you applied and were accepted as an in state tuition based student. By and large, the salary for PT 's tend to be a bit higher than a chiros if you end up wanting to work for a hospital system or for a private clinic. If you are more entrepreneural, chiropractic is pretty open ended with how much you can make if you open up your own place and keep the bills low. PTs can also do this, though some states like Missouri limit direct access to patients more notably than others and can affect your bottom line if you don't have a reliable patient referral source. PTs tend to have less of a problem getting referrals from other healthcare providers so it may just balance out anyway.

Again, much of this depends on how you want to help people and interact with them. I've worked as a chiropractor in facilities alongside physical therapists and I've been incredibly happy to talk to and learn from them. I've actually seen the best patient outcomes when both a chiro and PT work together to treat the same patient than separately. Good luck and hope that helps.
Thank you comment icon Chiropractic is not "open ended" with how much you can make. The top is around $120,000 per year in all areas. This is only $40,00 more per year than what a chiropractor who is an employee makes. But what you really aren't considering is that for most of the areas PTs have a huge advantage in the scope of what physical therapy assistants can do versus chiropractic assistants. DC assistants are very limited where they can only put a hydrocolator pack on someone whereas PTAs can teach patients exercises and more. So an OCS certified PT could do very well with a few PTAs who are doing much of the care that a comparable DC would have to do themselves. This is a huge time savings. Allen Botnick DC CNIM
Thank you comment icon Again, I agree and disagree. If you as the treating chiropractor are "above board," you will probably be bringing home about 120k or so in individual practice. Unfortunately, I have seen chiros bringing in much much more than this per year with shadier business practices. It also depends on reimbursement per state and thus the "open ended" comment. I'm on my 10th year and am currently seeking a transition out. Definitely not as advertised, but credit where credit is due is important. Colin Mermey
Thank you comment icon My preference is for the PT OCS if they are available due to the standardization and superior training. A DABSP or CCSP DC would be a last resort but it would be a risk I would try to avoid and I would have to scrutinize their recommendations carefully. A person would have the best chance of success with the PT OCS. As a caveat, general PTs do a poor job at complex orthopedic rehabilitation also. Rehab is simply a complex practice and requires good training to do well and the PT OCS is the field that gets it right consistently. They are the experts here. Allen Botnick DC CNIM
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