Trends report

More chiropractors are reporting a slightly better income than the previous year, according to results of the 2017 annual Canadian Chiropractor Practice Trends survey.

Nearly 60 per cent of survey respondents saw their income increase in 2016, compared to about 51 per cent who reported higher income the year before. The number of those who reported a drop in their income remained the same at around 15 per cent.

Some 446 chiropractors participated in this year’s Canadian Chiropractor Practice Trends study – an annual survey of Canadian chiropractors to gain insights on trends and issues affecting the profession.

More than 35 per cent of respondents reported more than $200,000 in gross revenue in 2016. However, when taxes and other expenses are factored in, the majority (36 per cent) reported a net income ranging from $50,000 to $90,000.

The highest earners – those who reported a net annual income of $200,000 and above – make up less than nine per cent of respondents.

Most of the respondents (56 per cent) are between the ages of 40 and 59. Majority in this age group (31.6 per cent) earned between $50,000 and $99,000 in 2016. Most of those who reported more than $200,000 in net income (nearly 70 per cent of them) also belong in this age group, according to the survey.

Majority of the women (47.5 per cent) earned between $25,000 and $75,000 in net income. Among male practitioners, on the other hand, 35 per cent earned between $50,000 and $100,000 in 2016.

Aside from patient billing, chiropractors report receiving other sources of income. Product sales remain the top source of supplemental income at 36 per cent, followed by income from clinic/office space rental. Nearly 40 per cent, however, say they have no other sources of supplemental income outside of clinical practice.

Although 51 per cent of chiropractors do not plan on making any significant purchase or upgrade in their practices, some are looking into purchasing office furniture (19 per cent), practice management software and/or electronic health record systems (17.5 per cent), new chiropractic table (17 per cent), and laser therapy equipment (10 per cent). Some have also indicated they are looking at spending on marketing and/or practice management consulting services (18 per cent).

Forty-three per cent plan on spending up to $10,000 on purchases and upgrades this year, while 40 per cent do not plan on making any big purchase for the practice this year.

Practice profile
Sixty-eight per cent of respondents (303) are male, of which 36 per cent are aged 40 to 49. Of the 143 female respondents, 43 per cent are in this same age group. Nearly half (48 per cent) of all respondents are from Ontario, 26 per cent are from British Columbia and 11.5 per cent are from Alberta.

Majority of respondents (76 per cent) have been in practice for at least 10 years, with the majority (41 per cent) practicing for more than 20 years.

Chiropractors in multidisciplinary practices make up more than 60 per cent of practitioners, with the majority (43.5 per cent) working with allied health practices such as RMTs and naturopaths. Only a small number of practices (7.4 per cent) are working in the same clinic with medical doctors. Nearly 12 per cent, however, are in a multidisciplinary clinic with both medical doctors and other allied health practitioners. Thirty per cent are solo practices, while 20 per cent are in group practice with other chiropractors.

This trend of high number of practices in multidisciplinary practices is true across many Canadian provinces, except Manitoba and Quebec, where the majority (80 per cent in both provinces) are either in solo practice or group practice with other chiropractors only.

Thirty per cent of chiropractors see between 50 and 100 patients in a typical week, while 24 per cent would see up to 150 patients per week. There is not much change in the length of time a chiropractor spends in clinical practice when comparing data from the previous year. Seventy-two per cent of DCs spend between 21 and 40 hours a week in clinical practice.

Only 17 per cent overall spend less than 20 hours per week in practice. However, some provinces tend to like their short workweek more than others. In B.C., while 34 per cent have a 21- to 30-hour workweek, 23 per cent work less than 20 hours in a typical week. Ontario has a similar trend, with 20 per cent working 20 hours or less, while 35 per cent are in clinic 31 to 40 hours a week.

More than half of Alberta chiropractors are working at least 40 hours a week, while less than eight per cent maintain a lighter schedule of 20 hours or less.

Challenges
Despite getting patient referrals from medical doctors, some chiropractors believe the public and the medical community still have a low trust rating for DCs.

In the previous survey (2016), 23 per cent reported receiving up to 30 patient referrals from medical doctors in 2015. However, in the current survey “low trust-level from the public or medical community” was cited as the biggest challenge facing chiropractors today.

One respondent notes some public misconceptions about chiropractic: “Most people think that all chiros just crack backs. They don’t know what we do and why we do it and why it is important to them. People also need to know that there are many ways that we treat the spine – many different techniques.”

Other challenges cited by chiropractors in the survey include:

• Competition from physiotherapists and other manual practitioners
• Increasing rent and overhead expenses
• Hiring the right people
• Bad PR/negative media coverage
• High cost of running a practice
• Too many chiropractors/low utilization rate

One respondent cites, “Lack of research evidence supporting the efficacy of SMT (spinal manipulative therapy) or other manual therapy modalities, which makes me feel like the profession as a whole needs to re-evaluate the standard of care practice, and whether chiropractors should be at the forefront of treating health conditions with exercise medicine, which would increase trust and utilization among medical practitioners and the public.”

Question on expansion
Survey respondents were asked to provide their thoughts on the current debate in the profession around expansion of chiropractic scope of practice to potentially include limited prescription rights.

Chiropractors are narrowly split between those in favour (47 per cent) and those who oppose (37.4 per cent) the move to give chiropractors the ability to prescribe medications on a limited capacity. Fifteen per cent responded “not sure, need more information” on the question.

Here are some comments from the respondents offering their perspectives on the issue.

“Expanding into limited pharmaceuticals will drive the profession into lower and lower utilization. After several years of relying on them, chiropractors will no longer have the skills to walk people through acute episodes (stay around long enough) to get into corrective care. It will be the absolute kiss of death. It will also kill our brand. For over a century, we have been the profession for people to turn to when drugs failed to help or are not one of the patient’s options. We will lose on both fronts.”

“With the upcoming legalization of cannabis I feel we need to be educated and allowed to prescribe medical cannabis as we are treating conditions that can be helped by this product.”

“Again, let’s stop getting in bed with the MDs, keep our uniqueness, keep our philosophy pure. Let’s develop more standardized care protocol between all chiropractors.”

“I know it would be helpful to a small percentage of my patients when they are very acute. Also, many here do not have MDs and so would have to access emergency department or hospital walk-in clinic in my small town. But I do not want to be seen as allopathic in anyway.”

 “If there was better interprofessional collaboration there would not be a need for chiropractors to prescribe for MSK conditions as the patient’s MD would be involved in care and they would be better suited for such prescriptions on a collaborative case. In addition, patients need to know there are non-pharmaceutical options for their care and in many instances there are nutraceutical that could be better utilized. The bigger problem is what insurance companies will reimburse for, which becomes symptom masking and not health care.”

“I was speaking with a young naturopath and he uses his rights to prescribe people to stop taking certain medications. This would be great to be able to do.”

“Yes, but would have to prove knowledge in pharmacotherapy, biochemistry and dosage. This could be done with a board exam or mandatory education to achieve this designation.”

“We need to improve the caliber of adjusting skills in the profession, not prescribing drugs to mask symptoms. Chiropractors should be addressing the cause of the health problems.”

“It would provide us as practitioners the ability to better aid the patient and reduce a vast amount of burden from the medical system in redundant visits to multiple practitioners.”

“Patients benefit from short-term use of muscle relaxants and pain killers. Prescription rights speed the process to get these products to patients for short-term use. I am aware of the negatives around this subject and can see both sides of the argument, but I think on the whole it is a positive for the patients we serve and the profession.”

“Prescriptions mean you are treating symptoms not systems. Chiropractors can get to the root cause of issues naturally, unlike any other profession on the planet. If you decide to prescribe medications what are you doing it for? Opiates pose a health crisis right now – you want to be part of the problem or part of a solution?”

“Set aside our philosophies, and views on prescriptions for a second. From a business perspective alone allowing for this expansion of scope for the right to prescribe when needed ONLY will solidify our profession as the go-to doctors for MSK cases. Our knowledge, exam skills, etc., far exceed our medical colleagues. This scope expansion would only help our practices not hinder it. In addition, those who choose to prescribe may and others have the option not to.”

View full 2017 survey results here.