Chiropractic Care

U.S.Census data for establishments in both the employer and non-employer categories demonstrates consistent historical net increases in both the numbers of group and independent chiropractic establishments. This trend is expected to strongly continue into 2015. See table below:

Comparative Statistics for the United States: Years 2002 and 199
Employer and Nonemployer Statistic

1. Employer Statistics		Establishments (number)	Receipts/ Revenue ($1,000)	Annual Payroll (1,000)		Paid Employees for pay period incl. March 12 (number)
Offices of Other
Health Practitioners	2002	104,413	38,110,483		13,768,023		495,571
(NAICS 6213)	1997	88,886	28,282,299		10,456,729		406,589
Offices of Chiropractors	2002	34,359	9,390,288		2,769,757		112,367
(NAICS 621310)	1997	30,487	6,570,083		1,886,173		91,700

2. NonEmployer Statistics

Offices of Chiropractors		2002	22,523	1,275,613
(NAICS 621310)		1997	18,607	861,023

Sources: U.S. Census, 2002 Economic Census. Health Care & Social Assistance – Industry Series, Ambulatory Health Care Services and U.S. Census, 2002 Economic Census. Nonemployer Statistics. Health Care & Social Assistance

Patient Demographics Complementary and Alternative Medicine (CAM)
According to an NCCAM publication, CAM use was greater among a variety of population groups:

• Including women
• those with education beyond high school
• those who had been hospitalized within the past year

former smokers
According to the findings in this survey, the 10 most commonly used CAM therapies and the approximate percentage of U.S. adults using each therapy were:

Management

Office Startup Considerations

Expenditures for the startup of a new practice vary widely depending on building or remodeling needs, square footage, geographical location, fixtures, etc. Estimates range from $20,000 to $100,000. One 1996 archived article from The Chiropractic Resource Organization⁵includes the following calculations: Build-out costs average at $50 per square foot. A $50,000 cost for a 1,000 square foot office space included construction of walls, doors, ceiling, carpet and paint. Adjusted for inflation, the initial $50,000 estimate has increased to just over $62,000.

Additional startup expenses besides the operations budget include living expenses before the office opens and enough money to sustain the practice until a positive cash flow is realized.

Expenses

Office operations expenditures for a chiropractic business are typical of other health practitioners. The 8^thAnnual Salary and Expense Survey by Chiropractor Economics⁶ captured respondent information regarding business expenses and comparing 2004 and 2005. The findings are reflected in the table below:

Expenses as % of Total Business Expenses Reported

Business expenses	2005 (%)		2004 (%)
Advertising/marketing	11.0	11.9
Business supplies	11.4	10.9
Computers/software	3.5	3.2
Staff training	2.5	—
Continuing education/professional travel	4.8	4.7
Equipment leases	8.3	7.3
Malpractice insurance	3.7	2.7
Office space	26.5	27.6
Professional services (CPAs, etc)	4.6	3.2
Business loans	19.2	17.0
Diagnostics	4.4	11.7
Totals	100.0	100.0

Source: 8^th Annual Salary and Expense Survey. Chiropractor Economics. 2005.

Services

Chiropractors most often offer body manipulation, utilizing a wide variety of techniques. However, by providing an even greater number of convenient services, today’s chiropractor places patient needs first by providing innovative in-house services. Based upon a holistic approach to each patient’s individual treatment, chiropractors are clearly diversifying by offering many of the following popular therapies: physical therapy, nutritional counseling, weight management, acupuncture, and homeopathy. Additionally, patient exercise and massage are also readily available in offices of chiropractors.

Profile

Eighty-three percent of practitioners work full time. Eighty percent own their practices; 8% are contractors; 8% are partners; and 1% are employees. Twenty-three percent describe their practice as a specialty; 28% describe it as a general practice; and 47% describe it as both. Thirty-seven percent of practitioners report an annual income in excess of $200,000 and 41% reported an annual income between $80,000 and $200,000.

Forty percent of practitioners have been in practice for 6 to 10 years; 34% for 11 to 15 years; and 14% for longer than 16 years.⁷

Outlook

While dialog continues on traditional vs. alternative medical philosophies, the general outlook is good for growth in the chiropractic arena. According to the Bureau of Labor Statistics (BLS), employment of chiropractors is expected to grow faster than the average for all occupations through the year 2014. Growth in this sector mirrors demand by the increasingly health-conscious consumer who seeks alternatives to prescription drugs and invasive surgical procedures.⁸ Research studies finding objective, positive results of chiropractic diagnosis and treatment have contributed to improved awareness and acceptance of this field. The growing health-associated back, neck and joint ailments of the elderly will also contribute to the demand for chiropractic expertise.

Benefit coverage of chiropractic care is an important trend and continues to increase. Currently, coverage is offered in Medicare, Medicaid, Federal Employees Health Care Benefits Programs, Federal Workers’ Compensation, Departments of Defense and Veterans Affairs, approximately three quarters of employer health programs and all state workers’ compensation programs.

Forecasted Supply of Chiropractors in the United States through 2015

	2000	2005	2010	2015
Number of chiropractic colleges	16	17	18	20
Graduates per year	3,800	3,400	3,700	4,000
Estimate of Licensed Chiropractors	69,000	74,000	80,000	87,000
Estimate of Practicing Chiropractors	59,000	63,000	68,000	74,000

Source The Future of Chiropractic Revisited 2005 – 2015. Institute for Alternative Futures, 2005. p. 13.

Associations

Council on Chiropractic Education – https://www.cce-usa.org Federation of Chiropractic Licensing Boards – https://www.fclb.org International Chiropractors Association – https://www.chiropractic.org American Chiropractic Association – https://www.acatoday.org

Sources

¹ Manipulative and Body-Based Practices: An Overview. NCCAM Publication No. D238. October 2004. <https://nccam.nih.gov/health/backgrounds/manipulative.htm>

² National Center for Complementary and Alternative Medicine, National Institutes of Health Publication, National Advance Data, Vital and Health Statistics, Number 343 + May 27, 2004. <https://www.cdc.gov/nchs/data/ad/ad343.pdf>

³ Coulter ID, Shekell PG. A Profile of Chiropractic in North America. Chiropractic in North America: a descriptive analysis. Journal of Manipulative and Physiological Therapeutics (JMPT). Feb 2005; 28(2):83-9. <https://www.chiropracticresearchreview.com/crr/article.php?id=1364>

⁴ Institute for Alternative Futures, The Future of Chiropractic Revisited 2005 – 2015. Alexandria, Virginia, 2005, © The Institute for Alternative Futures. <>

⁵ Whitney, John T., D.C. Scratch Startup, The Chiropractic Resource Organization, Chiropractic Tools, July 4, 1996. <https://www.chiro.org/newDCs/ScratchStartup.html>

⁶ 8^th Annual Salary and Expense Survey. Chiropractor Economics. Vol. 5, Issue 6, April 29, 2005. <https://www.chiroeco.com/article/2005/issue6/S&ESurvey05.pdf>

⁷ Coulter ID, Shekell PG. A Profile of Chiropractic in North America. Chiropractic in North America: a descriptive analysis. Journal of Manipulative and Physiological Therapeutics (JMPT). Feb 2005; 28(2):83-9. <https://www.chiropracticresearchreview.com/crr/article.php?id=1364>

⁸ Occupational Outlook Handbook, 2006-07 Edition. <https://www.bls.gov/oco/ocos071.htm>

McCann J, Phillips RL, Green LA, Fryer GE. Chiropractors are not a usual source of primary health care. American Family Physician. June 2004. <>

Military Chiropractic Service. Military Medical Technology Online Edition. Vol. 9, Issue 7, October 28, 2005. <https://www.military-medical-technology.com/article.cfm?DocID=1220>

This material is based upon work supported by the U.S. Small Business Administration. Any opinions, findings, conclusions or recommendations are those of SBDCNet and do not necessarily reflect the views of the U.S. SBA. The SBA funds this U.S. Small Business Administration (SBA) Grant. SBA’s funding is not an endorsement of any products, opinions, or services. All SBA funded programs are extended to the public on a non-discriminatory basis.