A Brief Review of Chiropractic Educational Programs and Recommendations for Celebrating Education on Chiropractic Day

Abstract

Objective

The purpose of this article is to provide an overview of the growth of chiropractic education globally and a chronological list of current training programs. Another purpose is to provide exemplars of enduring programs and offer suggestions for how chiropractic practitioners may celebrate education on Chiropractic Day, which is September 18.

Discussion

Chiropractic education has transformed considerably over the past 125 years, and there are now 52 programs globally. We consider the 5 longest-existing chiropractic programs and propose hypotheses for what may have contributed to their durability. In addition, we offer ideas and opportunities for how chiropractic practitioners may focus on chiropractic education when celebrating the founding of the profession.

Conclusion

Since its inception, chiropractic education has expanded around the world and continues to develop. Recognized accreditation agencies and testing organizations are ensuring that standards of education are established and maintained internationally. With innovation, international collaboration, and a commitment to continuous professional development, the future of chiropractic education is bright. We urge chiropractic practitioners from all over the world to celebrate these accomplishments on Chiropractic Day.

Introduction

For decades, chiropractic practitioners have recognized Chiropractic Day on September 18 as the day to celebrate the founding of the chiropractic profession.^1,2 During this time, chiropractic practitioners learn about, share, and recognize the many contributions of the chiropractic profession to their patients and the public.^1,3 In addition to various aspects of chiropractic (eg, clinical art, research and science, philosophy, principles and practices), chiropractic education is another facet that may be celebrated on Chiropractic Day.

Chiropractic education has grown substantially over the past 125 years. Since 1897 when the first chiropractic students matriculated, numerous schools have been established in various world regions. These programs are important because they contribute to the future global chiropractic workforce. Whether someone is a student learning to become a chiropractic practitioner or is an alumnus fortifying knowledge and skills to stay current in practice, education is an essential component of the chiropractic profession.

The establishment of early chiropractic education programs allowed chiropractic to become the profession that it is today. Reviewing how far education has come and where it is now can help us to celebrate Chiropractic Day. At present, there is no catalog of the extant educational programs and their years of inception. Therefore, one purpose of this article is to provide an overview of the growth of chiropractic education globally and a chronological list of current training programs. Another purpose is to provide exemplars of enduring programs and offer suggestions for how chiropractic practitioners may celebrate education on Chiropractic Day.

Discussion

Daniel David Palmer began practicing health care in Davenport, Iowa in the 1880s and initiated the chiropractic profession by the mid-1890s. The day that D. D. Palmer declared as the day that chiropractic began was September 18, 1895.^1,2 After this, he established a school so that others could learn how to “practice and teach” chiropractic.^4,5

The first chiropractic program was incorporated in 1896 (Fig 1).⁶ “Palmer's School of Magnetic Cure” would later change its name to “Palmer's School of Chiropractic” after the term “chiropractic” was created in 1896 by Reverend Samuel Weed for the founder, D. D. Palmer.⁷ The incorporation of the school allowed D. D. Palmer to teach and establish clinics and schools in other locations. Graduates from the first chiropractic school established their practices and quickly developed their own schools.^8,9 These programs helped to nurture chiropractic as an emerging profession in the United States (US) in the early 1900s.

Fig 1.

Top and bottom sections of the incorporation notice for the Incorporation of Palmer's School of Magnetic Cure, dated June 26, 1896.⁶ Included on the board are Daniel David Palmer (board president), his wife Villa T. Palmer (married, 1888) listed as board secretary, and D. D. Palmer's younger brother Bartlett D. Palmer (born 1854) as vice president. B. D. Palmer should not be confused with D. D. Palmer's son, B. J. Palmer, who was born on September 14, 1882, and was only 13 years old at the time this notice was published in the Quad-City Times (Davenport, Iowa) on July 23, 1896. The first classes started in 1897. The school's name would change to Palmer's School and Infirmary of Chiropractic and move to the 841 Brady location in 1905, and then in 1921, become the Palmer School of Chiropractic. The legal notice for the name change was published in the Quad-City Times (Davenport, Iowa) in April 1921.⁷

Much like the medical schools throughout the 1800s, the earliest chiropractic programs were short, lasting only several months. D. D. Palmer's original chiropractic training program lasted 3 months but quickly expanded to 9 months.¹⁰ In 1906, after D. D. Palmer sold his school in Davenport to his son, Bartlett Joshua Palmer, the program was expanded to include anatomy, physiology, pathology, in addition to diagnosis and chiropractic adjusting.¹⁰ After this, training programs continued to grow in length and content.

The 1910 report by Abraham Flexner “Medical education in the United States and Canada; a report to the Carnegie Foundation for the Advancement of Teaching” pushed for reform in medical education.¹¹ Chiropractors also saw the need for improvements in chiropractic programs. B. J. Palmer campaigned for a minimum of 18 months of instruction and standardization of curricula, and other chiropractic educators promoted even longer programs.¹⁰ By 1919, chiropractic programs were 3 years, 6 months.⁸

In its first decades, the chiropractic profession grew in popularity across America resulting in an upsurge in the number of chiropractic schools. By 1920, there were at least 79 chiropractic schools in the US, and that number grew over time.^9,12, 13, 14 However, many of these either did not survive or were consolidated into larger institutions.¹⁰ And, possibly because the chiropractic profession was still emerging, no educational programs existed outside of the US at this time.

In the 1940s, education continued to improve, however, there was no US federal recognition of chiropractic institutions, which was the likely result of lobbying and legal pressures from rival health professions.¹⁰ This made the chiropractic profession vulnerable to attacks from these competing professions and negatively affected student enrollment. Chiropractic education leaders worked to transform chiropractic education “to include longer curricula of 4 years, more uniform entrance standards, and the conversion of the schools from for-profit to non-profit institutions.”¹⁰ By converting chiropractic schools into larger, financially sound, nonprofit colleges, the quality of the curricula, faculty, and facilities improved. For example, efforts from the National College of Chiropractic resulted in the first federally recognized program in 1945.⁸

As the popularity of chiropractic rose, marketplace competition also increased in the US. In the 1950s and 1960s, coordinated efforts were made by organized medicine to contain and eliminate the chiropractic profession.¹⁰ One of the components of the American Medical Association (AMA) propaganda program was to attack chiropractic education. This elimination objective was known as “The Iowa Plan.” This plan recommended the containment of chiropractic schools, stating, “Any successful policy of ‘containment’ of chiropractic, must necessarily be directed at the schools. To the extent that these financial problems continue to multiply and to the extent that the schools are unsuccessful in their recruiting programs, the chiropractic menace of the future will be reduced and possibly eliminated.”^15,16 The AMA's efforts to thwart the advancement of chiropractic education created a struggle over many decades for the chiropractic profession, including vigorous opposition to the chiropractic profession receiving state or federal recognition for accreditation.

The 1960s and 1970s were transformative years for the chiropractic profession. Despite multiple internal and external obstacles, chiropractic educators continued to improve their programs and to develop the infrastructure needed to support the profession. For example, Dr Joseph Janse, president of the National College of Chiropractic, contributed to leading collaborative efforts to create the National Board of Chiropractic Examiners, Council on Chiropractic Education, and eventually "the creation of our leading journal of science and scholarship - Journal of Manipulative and Physiological Therapeutics (JMPT)."¹⁷ The National Board of Chiropractic Examiners, established in 1963, became the body to administer the chiropractic qualifying examinations, which also became the licensing examination for many states.¹⁰ These accomplishments elevated the quality and status of chiropractic education.

As improvements continued throughout chiropractic education in the 1960s, the number of enduring programs expanded (Fig 2). This growth seems to coincide with the successful recognition of chiropractic practice in most states of the US through licensure and legalization of the practice of chiropractic.¹⁸ By 1965, 94% of US states and territories allowed chiropractic practitioners to practice legally, which is an important consideration for education programs and their graduates. As well, at this time there was an increase in the number of chiropractors fighting back against restrictions. Lawsuits were filed by chiropractic practitioners against organizations that were trying to limit or forbid chiropractic practice, and chiropractic associations that were traditionally competitive were working together on projects to advance the profession.^15,19 A more united front from within the profession and the establishment of the legal practice of chiropractic may have bolstered the education programs. These efforts may have raised the legitimacy of chiropractic in the eye of the public, which could have increased the number of students considering chiropractic as a career.

Fig 2.

Number of chiropractic degree–granting programs that are currently (2022) in existence. The dashed trend line shows the change in growth rate of chiropractic programs before and after the mid-1960s.

In 1974, after decades of effort, the Council on Chiropractic Education was recognized as the accrediting agency for chiropractic education by the US Office of Education.^8,20 This recognition meant that chiropractic students were eligible for federal student loans. In the same year, the fight to legalize chiropractic in all regions of the US finally came to a close when the last state in the US (Louisiana) legalized the practice of chiropractic.¹⁰

In the mid-1970s a small group of chiropractors filed an antitrust lawsuit against the AMA. This eventually resulted in the 1987 decision by US Federal Judge Susan Getzendanner that concluded, “the American Medical Association and its members participated in a conspiracy against chiropractors in violation of the nation's antitrust laws.”²¹ This lawsuit raised awareness that the AMA and its collaborators had been suppressing chiropractic education, research, and practice for nearly a century.²¹

Yet even though chiropractic educators were working in an oppressive environment for nearly 90 years, they gained ground to advance chiropractic education. The chiropractic leaders, practitioners, and educators, who were fighting to improve the profession for the entire 20th century are commended and recognized for their persistence and devotion. Were it not for them, chiropractic would not exist as a profession. Thanks to the dedication of the educators of the 20th century, chiropractic programs grew and helped to firmly establish the profession around the world in the 21st century.

Chiropractic Education Around the World

Fifty years passed after the founding of the profession before the first chiropractic degree granting program was established outside of the US. The Canadian Memorial Chiropractic College began in Canada in 1945.²² However, chiropractic education was limited to North America for nearly 2 more decades.

In 1965, the first European chiropractic institution opened: the Anglo-European College of Chiropractic (now named AECC University College) in Bournemouth, United Kingdom. Following this, further expansion in the United Kingdom led to a current total of 5 programs. Other European chiropractic programs were established in Denmark, Sweden, France, Spain, and Switzerland. In Africa, university-based programs in Durban and Johannesburg were established. Six programs have evolved in the Pacific region, with 5 in Australia and 1 in New Zealand. Latin America has seen expansion of chiropractic education since 2000, with programs established in Brazil and Chile. The Asian region has established programs in Japan and Malaysia. In the Eastern Mediterranean region, Bahçeşehir University opened a chiropractic program in Istanbul, Turkey.

As of 2022, chiropractic education has expanded worldwide to include 52 programs in the following locations around the world: Australia, Brazil, Canada, Chile, Denmark, France, Japan, Malaysia, Mexico, New Zealand, Puerto Rico, South Africa, Spain, Sweden, Switzerland, Turkey, United Kingdom, and the US, as listed on the World Federation of Chiropractic website.²³ Figure 3 shows a chronological list of current training programs.

Fig 3.

Timeline of the founding of institutions with chiropractic degree–granting programs in existence as of 2022.

In the US, which currently has the largest global population of chiropractic practitioners,^24,25 a doctor of chiropractic degree is required to practice. The US educational requirements have increased in the past several years. Today's American chiropractic program candidate must complete the equivalent of 3 academic years (90 semester hours) of undergraduate study at an institution accredited by an agency recognized by the US Department of Education. Applicants must have a cumulative grade point average of at least 3.0 on a 4.0 scale for the 90 hours, which must include a minimum of 24 semester hours in life and physical science courses. Entrance criteria also include education in other topics, such as social sciences and humanities and other coursework deemed relevant by the chiropractic training program for students to successfully complete the curriculum. ²⁶

While not mandatory for entrance into all US chiropractic programs, some require a bachelor's degree.²⁷ Approximately two-thirds (67%) of US chiropractic practitioners surveyed in 2019 possess bachelor's degrees, with a higher percentage (78%) of chiropractic practitioners under 40 years of age holding a bachelor's degree.²⁷ The number of US doctors of chiropractic with other additional graduate degrees is growing. Approximately 6% have master's degrees, and 7.0% have doctorates in nonchiropractic fields. Possession of a master's degree is higher (14%) amongst doctors of chiropractic under 40 years of age.²⁷ Once accepted to a chiropractic program, students are required to take 4 200 hours or more of course work, comprising 4 to 5 academic years. For a training program to be accredited in the US, there is a defined minimum number of curricular topics that must be taught.²⁶

Each world region has different approaches to educational requirements to matriculate into training programs, requisites of those programs, and qualifying examinations.²⁸ The number of years to obtain a professional degree to practice chiropractic has grown considerably since the profession began in 1895 (Fig 4).^24,25 Various accreditation agencies have developed around the world to maintain standards for most chiropractic curricula. In some global jurisdictions, university accreditation serves to address qualifications for graduates.²⁸

Fig 4.

Examples of regional sources that describe the combined years of education required to practice chiropractic in the 4 countries/regions with the largest number of chiropractic practitioners according to World Federation of Chiropractic workforce estimates in 2017.^24,25

Longevity of the Earliest Chiropractic Programs

The 5 institutions with the longest-running chiropractic degree granting programs are the following:

• •Palmer College of Chiropractic (1897)^13,29,30
• •University of Western States (1904)^31,32
• •National University of Health Sciences (1906)33, 34, 35, 36, 37, 38
• •Texas Chiropractic College (1908)^39,40
• •Southern California University of Health Sciences (1911)⁴¹

Changes in these curricula have accommodated the growth of student needs and campus facilities for over 100 years. Figures 5 to 9 show prior and present images of these longest-running chiropractic programs. These exemplars show the visual changes over time to the symbols and buildings of these institutions. However, the success of an institution requires more than its campus. We consider here, based upon our personal knowledge, what may have contributed to their longevity.

Fig 6.

University of Western States was developed from a consolidation of programs; the earliest (Marsh School and Cure) began in 1904. Then: logo of the Pacific College of Chiropractic (top left) and building ca 1920 (top right), which was one of the precursor schools. Now: University of Western States in Portland, Oregon, (bottom) offers a chiropractic program in addition to other health professions degrees and certifications (historical photos with permission from the Joseph C. Keating, Jr historical collection).

Fig 7.

National University of Health Sciences began in 1906. Then: early logo (top left) and building of the National College of Chiropractic with Dr Joseph Janse (president, 1945-1983), standing on the steps (top right). Now: the National University of Health Sciences in Lombard, Illinois, offers an integrated primary health care chiropractic medicine program in addition to other health profession degrees (photos contributed by author R.L.S. with permission from the National University of Health Sciences).

Fig 8.

Texas Chiropractic College was founded in 1908. Then: an early version of the college crest (top left) and building in San Antonio, Texas (top right). Now: the Texas Chiropractic College is located in Pasadena, Texas (historical photos with permission from the Joseph C. Keating, Jr historical collection).

Fig 5.

Palmer College of Chiropractic, Davenport, officially began in 1897. Then: early calling card (top left) and building (top right) of the Palmer School of Chiropractic. Now: the Palmer College of Chiropractic campus in Davenport, Iowa (photos contributed by author M.J.T. with permission from the Palmer College of Chiropractic).

Fig 9.

Southern California University of Health Sciences, which began as the Los Angeles College of Chiropractic in 1911. Then: the early version of the Los Angeles College of Chiropractic seal (top left) and one of the buildings circa 1911 (top right). Now: the Southern California University of Health Sciences includes the Los Angeles College of Chiropractic program in addition to programs for other health profession degrees and certifications (historical photos with permission from the Joseph C. Keating, Jr historical collection).

These first 5 chiropractic programs are still thriving and each is unique. Each program is in a different region of the US. Each has a varied yet valuable approach to chiropractic; thus, each program has its own strengths to offer. They have overcome countless challenges during the past 100+ years. We suggest that the influences for their success may include the following:

• •Passionate and charismatic leaders started the programs and set the course for what the institutions would become in the future.
• •Each program serves a different geographic location, which may make it more feasible for prospective students to seek out a chiropractic education in those areas.
• •Members of the alumni associations support their alma maters, donating funding and support events and programs.
• •The institutions’ governing boards and leadership guide and support the financial and academic success of the programs.
• •Strong academic programs prepare graduates to successfully pass credentialing boards and exams and to practice the art and science of chiropractic as recognized health care providers.
• •The programs facilitate knowledge, skills, and attitudes to succeed in practice using ethical business practices.
• •The programs adapt to changing demands from regional, national, and professional accreditation standards.
• •Administrators develop and refine the programs based on best practices in higher education and health care education.
• •Administrators are flexible and able to adapt to changing stakeholder demands.
• •Faculties adapt to the changing expectations of updated pedagogy methods and the use of educational technologies.
• •Faculties contribute to new knowledge through research, scholarship, and publications and obtain research and grant/funding.
• •Faculty members come from diverse backgrounds and instill a love for the chiropractic profession in students and graduates.
• •The programs are based on science but also instill students with a sense of enthusiasm for and pride in their profession.
• •Members of campuses engage in outreach and relationships with their communities.
• •The institutions collaborate with other institutions and professions and demonstrate interprofessional camaraderie.
• •The public recognizes that these programs have a longstanding presence and, through their programs and graduates, have contributed to improving the health of the public.

Certainly, there may be other reasons why these earliest of chiropractic programs continue to endure. This list may include some of the key ingredients for academic leaders to consider as they safeguard their programs to persevere for the next 125 years.

Recommendations for Chiropractic Day

Chiropractic practitioners from all over the world celebrate Chiropractic Day on September 18. Suggestions for how to celebrate Chiropractic Day have been described previously.1, 2, 3^,42,43 In addition to these traditional festivities, chiropractic practitioners should consider celebrating the advancement that chiropractic education has experienced over the past 125 years. One can make Chiropractic Day memorable by considering the following suggestions for celebrating education on Chiropractic Day:

• •Visit your alma mater's campus in person or virtually.
• •Create social media posts and tag your alma mater.
• •Join your alma mater's alumni association.
• •Participate in your alumni association activities; attend a homecoming or alumni event.
• •Participate in your alma mater's mentorship program.
• •Sponsor a chiropractic student to attend the next alumni event.
• •Learn more about the history of your institution.
• •Reconnect with faculty members and let them know how much you appreciate them.
• •Contact the human resources department for how you could contribute.
• •Engage in postgraduate education provided by your alma mater.
• •Donate to a student scholarship fund at your alma mater.
• •While completing your continuing education, learn something new about chiropractic.
• •Recommend compassionate and talented youth to consider a career in chiropractic.
• •Host local college or high school students who are interested in becoming a health care provider.
• •Provide work experience opportunities to those considering chiropractic as a career.
• •Give a presentation about chiropractic as a career at local schools.
• •Educate others in your community about chiropractic.
• •Share information about current standards of chiropractic education and the training required to graduate as a chiropractic practitioner.
• •Offer your services to underserved communities though education.
• •Display a Chiropractic Day poster that celebrates chiropractic education (Fig 10; see supplemental file for full posters/fliers that are free to download).

Fig 10.

Posters for celebrating Chiropractic Day. For full posters/fliers, please download the free supplemental file.

Many of these Chiropractic Day suggestions that celebrate chiropractic education are free or low cost. These activities may help to rekindle the value and appreciation for chiropractic and help practitioners to share that passion with others.

In 2022, we celebrate 125 years of chiropractic education and recognize with pride its accomplishments and the role that education has played in developing the profession of chiropractic worldwide. On this Chiropractic Day as we reflect on the history of chiropractic education, we urge the profession to identify trends, scan the horizon, and prepare for the coming decades.

Limitations

The information in this summary is based on the information available to us. This paper was a brief overview and was not meant to exhaustively cover the history of the chiropractic education programs. The views expressed are opinions of the authors and there may be other interpretations of these findings.

Conclusion

Since its inception, chiropractic education has expanded around the world such that there are 52 programs offered internationally. New programs have been launched in underserved regions and some universities have incorporated programs into their academic portfolios. Internationally recognized accreditation agencies and testing organizations are ensuring that standards of education are established and maintained. With innovation, international collaboration, and a commitment toward continuous professional development, the future of chiropractic education is bright. We urge chiropractic practitioners from all over the world to celebrate the accomplishments of the chiropractic profession, including the advances in chiropractic education, on Chiropractic Day.

Invitation From the Editor

Recognizing that this article only provided a brief review of the early years of chiropractic education, this leaves room for more history about other people, regions, and institutions to be documented. Chiropractic educators and historians are encouraged to prepare scholarly articles about people, regions, and institutions related to chiropractic education or other relevant events. These manuscripts are welcome for submission to the Journal of Chiropractic Humanities for consideration of publication.

Funding Sources and Conflicts of Interest

No funding sources were reported for this article. C.D.J. is the editor of the Journal of Chiropractic Humanities and the volunteer administrator of the Chiropractic Educators Research Forum. B.N.G. is the editor of the Journal of Chiropractic Education and the associate editor of the Journal of Chiropractic Humanities. None of the authors received remuneration for writing this article.

Contributorship Information

Concept development (provided idea for the research): C.D.J., B.N.G.

Design (planned the methods to generate the results): C.D.J., B.N.G.

Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): C.D.J., B.N.G.

Data processing (responsible for reporting data): C.D.J., B.N.G., R.A.B., A.F., S.A.F., M.A.K., R.L.S., M.J.T.

Analysis/interpretation (responsible for statistical analysis, evaluation, and presentation of the results): C.D.J., B.N.G., R.A.B., A.F., S.A.F., M.A.K., R.L.S., M.J.T.

Literature search (performed the literature search): C.D.J., B.N.G.

Writing (substantive contributions): C.D.J., B.N.G., R.A.B., A.F., S.A.F., M.A.K., R.L.S., M.J.T. Critical review (revised manuscript for intellectual content): C.D.J., B.N.G., R.A.B., A.F., S.A.F., M.A.K., R.L.S., M.J.T.

Practical Applications.

• •Chiropractic education has transformed over the past 125 years, and there are now 52 programs globally.
• •The 5 longest-existing chiropractic programs have similar traits that may have contributed to their durability.
• •There are many ways that chiropractic practitioners can celebrate Chiropractic Day.

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