MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Chiropractic may be nonsense, but it nevertheless earns chiros very good money. Chiropractors tend to treat their patients for unnecessarily long periods of time. This, of course, costs money, and even if the treatment in question ever was indicated (which, according to the best evidence, is more than doubtful), this phenomenon would significantly inflate healthcare expenditureIt was reported that over 80% of the money that the US Medicare paid to chiropractors in 2013 went for medically unnecessary procedures. The federal insurance program for senior citizens thus spent roughly $359 million on unnecessary chiropractic care that year.

Such expenditure may not benefit patients, but it surely benefits the chiropractors. A recent article in Forbes informed us that, according to the US Bureau of Labor Statistics’ Occupational Outlook Handbook, the employment of chiropractors is expected to grow 12% from 2016 to 2026, faster than the average for all occupations.

According to the latest data from the Bureau Occupational Employment Statistics, as of 2017, the average income of an US chiropractor amounts to US $ 85,870. However, chiropractors’ salaries aren’t this high in every US state. The lowest average income (US$ 45 000) per year is in the state of Wyoming.

Below you’ll find a breakdown of where chiropractors’ incomes are the highest.

1 Rhode Island $147,900
2 Tennessee $122,620
3 Connecticut $113,130
4 Alaska $106,600
5 Colorado $99,350
6 New Hampshire $99,330
7 Nevada $99,140
8 Delaware $97,650
9 Massachusetts $96,110
10 Maryland $95,190

 

These are tidy sums indeed – remember, they merely depict the averages. Individual chiropractors will earn substantially more than the average, of course. And there are hundreds of websites, books, etc. to teach chiros how to maximise their cash-flow. Some of the most popular ‘tricks of the chiro trade’ include:

  • maintenance therapy,
  • treatment of children,
  • making unsupported therapeutic claims,
  • disregarding the risks of spinal manipulation,
  • selling useless dietary supplements.

Considering the sums of money that are at stake, I am beginning to understand why chiropractors tend to get so nervous, often even furious and aggressive, when I point out that they might be causing more harm than good to their patients.

Its the money, stupid!

 

35 Responses to Chiropractic: it’s the money, stupid!

  • @ Edzard

    Are you confusing mean averages with median averages? Your statement of “These are tidy sums indeed – remember, they merely depict the averages. Individual chiropractors (exactly half of the total, to be precise) will earn substantially more than the average, of course”.

    This statement would be correct if the figures you state were referring to median figures. They do not, the figures you have compiled show the mean annual wage.

    The median salary for a chiropractor in the states is $68,640 (https://www.bls.gov/ooh/healthcare/chiropractors.htm#tab-5)

    In comparison the median salary for a physical therapist is $86,850 (https://www.bls.gov/ooh/healthcare/physical-therapists.htm#tab-5)

    I think an interesting point for chiropractors are the difference in earnings between the bottom 10% ($34,550) and the top 10% ($144,730), especially when compared to physical therapy. This level of inequality shows a profession in trouble and would indicate that there should be suspicions of how the top 10% of chiropractors are earning some of their income.

  • Sorry, I should have included that most if not all income distributions are skewed – therefore the median figure is more accurate than the mean figure.

    • This is an easy mistake to make and a nice example of the importance of having a good understanding of statistics when trying to interpret data (e.g. from a clinical trial).

      In this case we have a few chiropractors who earn a lot more than their peers, skewing the distribution so that it does not follow a normal curve, and resulting in a mean which is a lot higher than the median and therefore less representative of the profession as a whole.

      Survival figures can also follow a skewed distribution, which is why median survival is usually quoted in scientific papers. However, I don’t think I have ever seen the word “median” used in the popular press. Inasmuch as most journalists seem to understand the concept of an average, I am guessing that they mainly have the mean in mind without any thought to distribution. I have no idea how this applies to their readers.

      When it comes to cancer patients wanting to know what future they face, oncologists often quote median survival figures from clinical trials without really explaining what these mean. If, say, an expected survival is two years, that means that after two years half the group will be dead, but the other half will still be alive, and some may live much longer than that. I think this is probably the reason we see testimonials saying “my doctors only gave me six months to live, but I have been doing natural quantum ozone therapy now with the organic energy diet for five years now and I have never felt better”.

      • Cancer survival – or NON survival – estimates for any unique patient only serve to give ‘comfort’ and satisfaction to the GP or Consultant – which leaves the cancer suffer to stew in chemotherapy that all the while is damaging their immune system and reducing their quality of life. Typical examples of useless statistics include: The average UK family has 2.1 children. I am waiting with eager anticipation to encounter 0.1 of a child. Statins are said to significantly improve life expectancy over a 10 year period for anyone over the age of 50, even if they are in perfectly good health! This is yet another nonsensical statistic that is touted by idiots such as Prof Sir Rory Collins. When will we move on to Common Sense Medicine? Not in our lifetime unfortunately.

  • EE…”It was reported that over 80% of the money that the US Medicare paid to chiropractors in 2013 went for medically unnecessary procedures.”

    Did you even read the original report to see how they determined what was “medically unnecessary”?

    What does the more recent Medicare report say? Do you even know?

  • Are those figures gross or net considering most chiropractors are self employed?

    How about the number of hours worked? As the USBLS states “Chiropractors may work in the evenings or on weekends to accommodate patients.“

    Forbes? Really? They can’t even hyperlink to the correct page.

  • Excellent post. You can’t fault a person for trying to make a living (especially after being duped into becoming a faux doctor) but since only 12% of Chiroquackers operate a “cash-only” business (Chiropractic Economics Dec 2018) that leaves MOST rich or poor DCs defrauding public and private insurance companies…as do virtually all PTs. That’s the problem. So-called “manual-therapy” and “gizmo-therapy” but especially the utterly arcane, magician-based DC brands are entrepreneurial-theatrics masquerading as healthcare. IF it was 99% “cash-only”…and drop the faux-Doctor….it would be acceptable to most critics. It could be exactly like any religion…an elaborate con job, attracting and coddling people with self-limiting conditions and gullible personalities.

    • “…an elaborate con job, attracting and coddling people with self-limiting conditions and gullible personalities.”

      But yet…

      “For treatment of patients with acute low back pain, the guidelines recommend reassurance on the favourable prognosis and advice on returning to normal activities, avoiding bed rest, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids for short periods.”

      https://link.springer.com/article/10.1007%2Fs00586-018-5673-2

      • For which advice a chiropractor is not needed

        • Is a MD needed for most of these cases? Are NSAIDs needed? Are opioids needed?

          • the guidelines suggest exercise combined with NSAIDS and/or manual therapy. An MD prescribes NSAIDS and weak opiods and can also advise about exercise. A physio can advise about exercise , perform manual therapy and in some cases prescribe weak opioids. So what do we need a chiro for?

          • The public is free to choose their provider. In my area it’s about 2 to 3 weeks to see a PT. About the same to see a MD. Those providers tend to have higher costs than Chiropractors. NSAIDs have the potential for serious AE and some even question their appropriateness for acute MSK conditions. PTs cannot interpret imaging thus requiring outside reports and guidance. Chiropractors tend to take a more wholistic approach, taking into account lifestyle, ergonomics, exercise, etc.

            So, with nonspecific MSK conditions, why go to a MD or a PT?

  • How about dealing with the fact that EE conclusion isn’t even supported by the references he used in his blog.

    or that he doesn’t even follow his own rule….

    “Please remember: if you make a claim in a comment, support it with evidence.”

    all this blog appears to be is another lame attempt to discredit an entire profession using references that are out of date, irrelevant or the incomplete reporting of facts.

    but maybe that’s the best he can do.

  • Re over 80% of the money that US Medicare paid to chiropractors in 2013 going for medically unnecessary procedures, I understand that Medicare only pays for manual manipulation of the spine to correct subluxations. Is anyone able to confirm this? If true, why does it remain unchallenged?

    With regard to commercial health insurers, it’s worth noting what Prof. Ernst commented in a previous post, i.e. they

    “…could even be more competitive, progressive and ethical by telling their customers that they took better care of their money than the competition by not paying for ineffective treatments”

    Ref: https://edzardernst.com/2018/06/why-do-insurance-companies-pay-for-ineffective-treatments/

    • BW…” I understand that Medicare only pays for manual manipulation of the spine to correct subluxations. Is anyone able to confirm this? If true, why does it remain unchallenged?”

      Yes, that is true.

      It has/is being “challenged”.

  • Wouldn’t “Coddling” at $45.00-$80.00 per 15minutes be tantamount to fraud? Especially when wrapped in the artifice which IS chiroquackery i.e. “you have a disordered spine or spinal-segments that only my keen, mystical education and insights can address….and keep addressing until your insurance coverage is exhausted”. Avoiding resentful-demoralization is perhaps both science-based and humanitarian at root….BUT is the potential exploitation for financial reward worth the it? MDs, PTs and RNs are well suited to take charge,explain the essence of the MSK pain-issues, coddle those in need of coddling and dissuade appointments with charlatans. And offer real-medical care and opinions when needed. Unaffiliated pseudoscientific, semi-professional “healthcare providers” just muck up the works.

    • “Wouldn’t “Coddling” at $45.00-$80.00 per 15minutes be tantamount to fraud?”

      right…

      Particularly, the average total LBP-related health care costs for patients receiving physical therapy within 3 days was $2901.78, which is significantly lower than that for patients receiving physical therapy between 15 and 28 days (⁠$4283.33) or between 29 and 90 days (⁠$6366.68).

      https://academic.oup.com/ptj/article/98/5/336/4925488

      The costs of health care for spine pain by member/episode who received chiropractic care ranged from $264 to $6,171 (mean $2,022, SD $2,332, median $712), while in comparator groups it ranged from $166 to $9,958 (mean $3,375, SD $3,481, median $1,992). In eleven (92 %) studies, health care costs were lower for patients whose spine pain was managed with chiropractic care.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4615617/

  • Does this report consider the expenses? Is this gross or net? Chiro’s have expenses too – offices expenses including employee(s), costs of supplements, insurance, rent.

    And if someone has been going to doctors and been given opioids without relief, and decided that there has to be a better way. Maybe chiropractic expenses are worth it, if they get relief. People dont keep coming back if it isnt working.

    • Actually they do – if a chiro adopts the guise of a doctor , uses the right words a patient is very likely to come back for more. Why else do chiros style themselves as doctors and adopt the jargon? Patients want to believe in health professionals and expect them to be ethical and perform only necessary treatments. Especially when it come to something as intangible as back pain. It is a relationship that should not be abused

      • In the USA the dept of education set the requirements for chiropractors to use the title of Doctor of Chiropractor, just like they did for Doctor of Dentistry and Doctor of Optometry.

        • The difference dear “DC” is that dentists and optometrists do not (normally) claim they are physicians and they (normally) do not tell their customers they can fix the most diverse non skeletal health problems by thumping their spine. If a chiropractor advertised such claims in my part of the world, his license to practice might be in peril.

          Perhaps you have not given it a thought, but USA is actually only a small part of the world, where this honorific is often based on little of substance. But it is disproportionally revered by the majority of people. I have experienced myself, how being titled “Doctor” in the US totally changes peoples attitude toward you in a positive manner.
          The most recent devaluation of the “doctor” word that I have come across in the US, is the recent invention of DNP – Doctor of Nursing Practice, which mostly seems to be bona fide postgraduate nursing specialisation but at some institutions like the U. of Minnesota can be obtained by studying Reiki, Reflexology, aromatherapy and other methods of pseudomedical entertainment.

          In most other developed countries, the title “Doctor” means a great deal more than having paid an institution for admission to a few years of inconsequential classwork.

          • Bjorn…”their customers they can fix the most diverse non skeletal health problems by thumping their spine. If a chiropractor advertised such claims in my part of the world, his license to practice might be in peril.”

            Yes, here in the USA, chiropractic is listed along with other health professions under the FTC regarding advertising. We have more liberal freedom of advertising guidelines than say health products. It is abused by some, no doubt. Thus, unless chiropractic is removed from these other professions and undergoes it’s own federal standards (unlikely) it becomes more of a state issue regarding revising rules of advertising, as needed.

            I am currently compiling the rules of each state regarding these advertising rules. Probably a fruitless effort to get uniform advertising in all 50 states, to curtail this abuse of freedom. But it gives a platform to work from.

            False, deceptive and misleading advertising is an issue I take very seriously.

            Others are taking other measures.

  • In Denmark Scandanavian countries chiropractors are throughout the medical system and hospitals.

    Chiropractors never claim to cure anything..if they do..they misguided. They know life goes better when the body works better. They know that restoring mobility restores ones independence. They know that movement of the spine is healthy for the joints and does have affects on the peripheral and autonomic nervous system. Evidence shows it has a different effects on the brain. They dont cure anything..only the body can heal.
    Chiros are not killing with opioids. One in 5 of us will die from.medical error.
    Chiros advocate looking after your spine like you do exercise eating well sleeping well brushing your teeth.
    There is a place for good chiropractic.

    • “Chiropractors never claim to cure anything..if they do..they misguided.”
      I agree.
      This means all those chiros who claim to treat the root cause of a disease are wrong!
      They simply exploit the public with false claims.

      • “Chiropractors never claim to cure anything..if they do..they misguided.”
        “This means all those chiros who claim to treat the root cause of a disease are wrong!”

        Only if you think treat and cure mean the same thing.

          • Here’s a paragraph from your post you’re referencing:

            “Let us assume for a minute that all these practitioners are correct in believing that their interventions are causal treatments, i.e. therapies directed against the cause of a disease. Successful treatment of any root cause can only mean that the therapy in question completely heals the problem at hand. If we abolish the cause of a disease, we would expect the disease to disappear for good.”

            You link “causal treatments” in the first sentence to a page that reads:

            “treatment [trēt´ment]
            1. the management and care of a patient; see also care.
            2. the combating of a disease or disorder; called also therapy.”

            It’s quite a leap to go from “management, care, combating disease or disorder, therapy”….to “cure, completely heal, abolish the cause”.

            Maybe you should change the link?

    • @Cameron Briggs
      It is correct that in Denmark, which is one of several countries often referred to as Scandinavian, chiropractic has a somewhat higher standing than in most other countries in this part of the world, where chiropractic is generally considered to belong to alternative medicine, even if it is regulated in some of them. There are even some of them employed in speciality clinics in some hospitals, fifteen chiropractors in all according to their own organisation. The difference is that in this part of the world, chiropractors seem to have forgotten about the historical background and work in effect as physiotherapists with an extra kitbag of manipulation methods from the classical chiropractic manual.
      You see no mention of subluxation or vitalistic nonsense being promoted by the Danish chiropractic community and there is no mention of non-musculoskeletal problems being addressed. They seem to be striving at recognition as evidence based, specialised physiotherapists.

  • Evidence? Do a quick Google search for all the drugs that have been recalled due to harmful effects.
    Why is that prescription rates change depending on how much the pharma companies spend on advertising directly to GPS..is it for the patients own good?
    Why do prescription rates vary so greatly between countries..e.g Australia 2x aa much antibiotics than UK.beccause people are different?…its for patients own good? Or orthodoxy?
    Ant deoressanta..tell me about evidence there?
    Why is it that as soon as you start imaging your chances for surgery go up drastically? Why as DrNorman Swan md points out do we end up being in a place we don’t want to be. Why are there so many reactive procedures..even discredited. Tell me about money ..plastic surgeons orthopaedic surgeons. So many spinal and knee procedures on so many people now recognized to have no evidence and harmful. It’s the money!!

    Why do so many medical universities have no or very minimal education on nutrition and exercise physiology. Dr Michael mosely points this out. Patients end up in a place they didn’t intend to be.Oxford university e.g this is not health care. Its sick care. Where is the health promotion.
    Emergency medicine is wonderful. But a lot if medical procedures and prescriptions have no evidence harmful corrupted by money.
    So there are some lamentable chiros as there are disgusting money grabbing harming medical doctors.. like any profession. And there wonderful people in each.
    Tell me about the billions if dollars wasted on ergonomic advice by pts now shown to be rubbish.
    10000 s of people killed by opioids ant deoressanta medical mistakes.
    Where is this guys balance and sense of proportion. Obviously biased. In the extreme. Plenty of evidence for chiro..plenty more coming. It takes money to research..more

    • @Cam Briggs
      When chiropractors get their act together and recall cervical manipulation due to its abysmal risk/benefit ratio, then we can begin to respect chiropractors like you, who blather tired tu quoque tropes about dangers of drugs or lack of medical school education in nutrition and so forth.
      When chiropractors stop overselling pointless maintenance manipulations we can try to respect them a bit more.
      When chiropractors stop telling tall stories of non-existent subluxation and impossible extraspinal effects of pretending to correct them (like the Danish chiro’s seem to be doing), then we can perhaps add a little bit more respect and start listening to what chiropractors wish to contribute to public health care.
      Your lame laments are not working on this audience, we have heard all this before, many times over and it has been regularly being refuted.

  • I just went to a chiro after 12 years of pain, a spinal fusion at 27,and 60 weeks of Pt then they diagnosed me with fibromyalgia- this chiro found a 20 year old neck injury that a whole bunch of doctors overlooked- now I have scoliosis- please don’t slander a profession of real healers because you don’t understand the nervous system- my evidence is the relief I feel after 4 treatments

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