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University:

M kronlm s

International

3 0 0 N Z E E B R O A D . AN N A R B O R . Ml 4 8 1 0 6
18 B E D F O R D ROW , L O N D O N W C1R 4 E J. E N G L A N D

7907415
ULRICH# SANFORD SELWYN
AN INVESTIGATION OF CURRENT CONTINUING
EOUCATION PRACTICES AND PERCEIVED
p o s t - d o c t o r a l n e e d s o f c h i r o p r a c t o r s IN THE
STATE OF MICHIGAN,
MICHIGAN STATE UNIVERSITY# PH .D .#

UrtvmJw

a Mkxonbrts
IntWTVtttonAl

w o n

. m i H O A o , a n n A n B o a .w itR io o

©

1978

SA N F O R D SELWYN UL R IC H

ALL RIGHTS RESERVED

1976

AN INVESTIGATION OF CURRENT CONTINUING EDUCATION
PRACTICES AND PERCEIVED POST-DOCTORAL NEEDS OF
CHIROPRACTORS IN THE STATE OF MICHIGAN
By
Sanford S. U lrich

A DISSERTATION
S u b m itte d to
Michigan S t a t e U n i v e r s i t y
1n p a r t i a l f u l f i l l m e n t o f t h e r e q u i r e m e n ts
f o r t h e degree o f
DOCTOR OF PHILOSOPHY
Department o f A d m i n i s t r a t i o n and H i g h e r Education
1978

ABSTRACT
AN INVESTIGATION OF CURRENT CONTINUING EDUCATION
PRACTICES AND PERCEIVED POST-DOCTORAL NEEDS OF
CHIROPRACTORS IN THE STATE OF MICHIGAN
By
Sanford S. U lr ich

Purpose o f t h e Study
The p urpose o f t h i s s t u d y was t o o b t a i n , In an a n a l y t i c a l
m anner, s p e c i f i c I n f o r m a t io n from and about t h e Michigan c h i r o p r a c t o r
w i t h two o v e ra l l m a j o r o b j e c t i v e s :
1.

To d e t e r m i n e what t h e p r e s e n t c o n t l p u1ng e d u c a ti o n
p r a c t i c e s a r e f o r t h e d o c t o r o f ch1 r o p r a c t l c 1n
this s ta te .

2.

To d e t e r m i n e the c u r r e n t pe rc eived p r o f e s s i o n a l educa*
t1on n e e d s and I n t e r e s t s o f t h e s e p r a c t l t l o n e r s .
Procedure

This s t u d y was designed p r i m a r i l y on des c r l p t l v e r e s e a r c h
m etho d s.

A q u e s t i o n n a i r e was t h e In stru m en t de / e l o p e d which sought

a nsw e rs t o the s t a t e d o b j e c t i v e s .

The survey 1 n st r u m e n t was mailed

t o 100 p e rc e n t o f t h e l i c e n s e d r e s i d e n t p r a c t1 t|f o n e r s o f c h i r o p r a c t i c
i n Michigan.

A u s e a b l e response o f 45 p e rc e n t ivas v a l i d a t e d a s a

r e p r e s e n t a t i v e sample o f the t o t a l Michigan ch1 r o p r a c t l c p o p u l a t i o n
by t h e c l o s e c o r r e l a t i o n o f two s i m i l a r a r e a s o F r e c e n t c h i r o p r a c t i c
I n q u i r y , as r e p o r t e d by t h e Michigan Department o f P u b lic H ealth and

S anford S. U lric h
a s found in t h i s s u r v e y .

T his s tu d y was l i m i t e d t o I n - s t a t e l i c e n s e d

d o c t o r s o f c h i r o p r a c t i c and did not In clu d e l i c e n s e e s p r a c t i c i n g
e ls e w h e r e .
In a d d i t i o n t o t h e socio-economic p r o f i l e and some s t a t i s t i c s
on p r a c t i c e * t h e surv e y a d d r e s s e d t h e e d u c a t i o n a l background o f t h e
p r a c t i t i o n e r s and t h e i r p e r c e i v e d needs f o r c o n t i n u i n g p r o f e s s i o n a l
education.

The q u e s t i o n n a i r e answers were coded and q u a n t i f i e d p r i o r

t o a n a l y s i s by e l e c t r o n i c d a t a p r o c e s s i n g equipment.
Major Findings
The f o l l o w i n g c o n c l u s i o n s app ear t o be j u s t i f i e d on t h e b a s i s
o f the f i n d i n g s o f t h i s s t u d y :
1.

Current p o st-g rad u a te learning a c t i v i t i e s a re lim ite d to

t h e mandatory r e q u i r e m e n ts f o r annual r e l i c e n s u r e .

All o t h e r con­

t i n u i n g e d u c a ti o n 1s o b t a i n e d 1n a s e l f - d i r e c t e d manner when a c o u rs e
1s b ro u g ht t o t h e a t t e n t i o n o f t h e d o c t o r v i a t h e p r o f e s s i o n a l media
o r by d i r e c t m a l l .

A tten d a n ce 1s th en s u b j e c t t o t h e p e r c e i v e d

Importance o f t h e c o u r s e , tim e and t h e l o c a l e where g i v e n .
2.

The p r a c t i t i o n e r s have I n d i c a t e d an awarenes s and a degree

o f p r e f e r e n c e f o r c e r t a i n s u b j e c t s which r e l a t e t o c h i r o p r a c t i c
practice.

In d e sce n d in g o r d e r o f I n t e r e s t , t h e y p r e f e r I n s t r u c t i o n

1n advanced x - r a y I n t e r p r e t a t i o n , m a n i p u l a t i v e t e c h n i q u e s , p r a c t i c e b u i l d i n g p r o c e d u r e s , s p o r t s h a za rd s and management o f a t h l e t i c
I n j u r i e s , and p r a c t i c a l c l i n i c a l psychology.
3.

C h i r o p r a c t o r s would l i k e t o review n e u r o l o g i c a l t e s t s ,

o r t h o p e d i c t e s t s , p h y s i c a l exam in atio n p r o c e d u r e s and l a s t l y , t h e c ase
h i s t o r y work-up.

S an fo rd S. U lric h
4.

In d e c l i n i n g o r d e r o f Im porta nce, t h e r e s p o n d i n g DCs

a p e r c e i v e d need f o r seminars on:
a.

H e a l t h I n s u r a n c e claims and r e s p o n s i b i l i t i e s o f t h e
DC In t h i r d p a r t y payment c l a i m s .

b.

N e u r o lo g i c a l I m p l i c a t i o n s o f d i e t a r y d e f i c i e n c i e s and
r o l e o f n u t r i t i o n a l management 1n t h e c h i r o p r a c t i c
practice.

c.

D i f f e r e n t i a l d i a g n o s i s o f back and neck p a in syndromes.

d.

Trauma e f f e c t s on body j o i n t s .

e.

O rth o p ed ic d i s a b i l i t y e v a l u a t i o n and Impairment
rating.

f.

N e u r o lo g i c a l concept o f c h i r o p r a c t i c and I t s c u r r e n t
s c ie n tif ic status.

g.

L a t e s t advances 1n r a d i o g r a p h i c te c h n o lo g y .

h.

E volving concepts 1n K1nes1o1og1cal B1omechan1cs.

1.

I n n o v a t i v e th era p y and R&D a t c h i r o p r a c t i c c o l l e g e s .

j.

V i s u a l i z a t i o n in c l i n i c a l and p a t h o l o g i c a l anatomy.
Su g g e s tio n s f o r F u r t h e r Research

1.

R e p l i c a t e t h i s s tu d y In t h r e e y e a r s t o d e te r m i n e p o s s i b l e
changes 1n t h e p e r c e p t i o n s o f Michigan c h i r o p r a c t o r s
r e g a r d i n g t h e importance o f c o n t i n u i n g e d u c a t i o n 1n t h e i r
professional liv e s .

2.

R e p l i c a t e and expand th e stu dy t o I n c l u d e comparisons
w ith c o n t i n u i n g c h i r o p r a c t i c e d u c a t i o n programs o f
other s ta te s .

3.

R e p l i c a t e t h i s s t u d y t o In clu d e comparisons w i t h t h e
c o n t i n u i n g e d u c a ti o n p e r c e p t i o n s o f t h e needs In o t h e r
health professions.

4.

I n v e s t i g a t e t h e c o n t i n u i n g e d u c a t i o n p r e f e r e n c e s based
on s e x , e t h n i c o r i g i n , f am ily background and s i m i l a r
v a ria b le s f o r the ch iro p ra ctic p ro fessio n .

ACKNOWLEDGMENTS

The w r i t e r g r a t e f u l l y acknowledges t h e s u p p o r t and encourage­
ment o f t h e many f i n e pe o p le who c o n t r i b u t e d t o t h e s u c c e s s f u l com­
p l e t i o n o f t h i s endeavor.

S p e c ia l a p p r e c i a t i o n 1s extended to Dr.

Walter S c o t t , committee chairman, whose c o n t i n u a l encouragement and
s u p p o r t guided me o v e r t h e u n f a m i l i a r and o f t e n rough s p o t s o f t h i s
research e f f o r t .
S i n c e r e thanks 1s a l s o e x te n d ed t o Dr. Donald N ic kerso n , Dr.
Howard Hickey and Dr. James McKee o f t h e d o c t o r a l g uidance committee
f o r t h e i r v a l u a b l e a d v i c e and I n s i g h t s d u rin g t h e program.

A

sp e c i a l thanks 1s due t o Dr. Marcia Ca rlyn f o r h e r generous a s s i s t a n c e
with t h e s t a t i s t i c a l p ro ce d u res o f t h e s t u d y .
A p p r e c i a t i o n 1s e x p r e s s e d f o r t h e encouragement o f Dr.
Charles S i p e s , a c o l l e a g u e , who s h a r e d t h e w r i t e r ' s c oncern s during
h i s r o l e as both p r a c t i t i o n e r and r e s e a r c h e r .
S i n c e r e g r a t i t u d e 1s e x te n d e d t o Ms. V i r g i n i a Wiseman f o r
h e r ad v ic e and encouragement w h i l e p a s s i n g th rou g h t h e maze o f p a p e r ­
work Involved in p u r s u i n g t h e d o c t o r a l program.
F i n a l l y , I am d e e p l y and e t e r n a l l y t h a n k f u l f o r t h e c o n s t a n t
I n s p i r a t i o n , s a c r i f i c e s and s u p p o r t g iv e n me by n\y w i f e , S a r e t t a ,
w i t h o u t whose t o l e r a n c e and u n d e r s t a n d i n g I c o u l d n o t have completed
t h i s work.
11

TABLE OF CONTENTS
Page
LIST OF TABLES................................................................................................................. vi
LIST OF APPENDICES

.............................................................................................

VIi

Chapter
I.

THE P R O B L E M .............................................................................................

1

Need f o r t h e S t u d y ................................................................................
2
2
Purpose o f t h e S t u d y .........................................................................
S i g n i f i c a n c e o f t h e Study ..................................................................
3
Research Q u e stio n s ................................................................................
3
Development o f t h e P r o f e s s i o n and Conceptual Framework .
4
Modern C h i r o p r a c t i c Education
.....................................................
5
6
Continuing P r o f e s s i o n a l Education...... .............................................
'Scope o f P r a c t i c e ' I n f l u e n c e on Continuing E d ucation
.
9
Proposed New L ic e n s e Renewal C r i t e r i a ........................................
9
D ive rg e nt Concepts 1n C h i r o p r a c t i c P r a c t i c e ..............................
11
Determining t h e Wishes o f t h e M a j o r i t y
..................................
11
D e f i n i t i o n o f Terms ................................................................................
13
Overview o f t h e Study .........................................................................
16
Format o f t h e D i s s e r t a t i o n ................................................................... 17
II.

SELECTED REVIEW OF THE LITERATURE...... .............................................

19

Se lf - A ss e s sm e n t Surveys
..................................................................
20
Government Agency R e p o rts ..................................................................
20
R e le v an t Do ctoral D i s s e r t a t i o n s .....................................................
22
O ther L i t e r a t u r e Germaine t o t h i s Study ....................................
25
Continuing C h i r o p r a c t i c E ducation Programs 1n O th e r
S t a t e s ........................................................................................................... 25
Summary..................................................................................................................32
III.

RESEARCH DESIGN AND PROCEDURES

.....................................................

35

I n t r o d u c t i o n .............................................................................................
35
Framework o f t h e Study .........................................................................
36
P r e l i m i n a r y Pro c edu re s .........................................................................
37
Questionnaire Construction
............................................................
39
A d m i n i s t r a t i o n o f t h e Survey ............................................................
40
S t a t i s t i c a l T r e a t m e n t ................................................................................ 41
Summary................................................................................................................. 43
111

C h a p te r
IV.

Page
PRESENTATION AND ANALYSIS OF THEDATA.................................................. 44
44
I n t r o d u c t i o n .............................................................................................
Summary
.......................................................................................................... 73

V.

SUMMARY, CONCLUSIONS. IMPLICATIONSAND RECOMMENDATIONS

.

74

74
I n t r o d u c t i o n ............................................................................................
Purpose o f t h e S t u d y .................................................................................74
Review o f t h e L i t e r a t u r e ...................................................................
75
Design o f t h e S t u d y ....................................................................................... 77
Fin d in gs o f t h e S t u d y .................................................................................77
C o n c l u s i o n s ....................................................................................................81
...............................................
83
I m p l i c a t i o n s and Reconmendations
Recommendations f o r F u r t h e r Research ........................................
84
R e f l e c t i o n s ....................................................................................................84
APPENDICES........................................................................................................................87
SELECTED BIBLIOGRAPHY

.........................................................................................

1v

117

LIST OF TABLES
Table

Page

1.

Composition o f Michigan DC P r a c t i t i o n e r s by Age Group

.

2.

S i z e o f Community Where C h i r o p r a c t o r P r a c t i c e s

3.

Importance 1n Choosing P r a c t i c e L o c a t i o n .............................

46

4.

Annual P r a c t i c e Income f o r Michigan DCs ...................................

47

5.

How C h i r o p r a c t i c P a t i e n t s a r e Obtain ed

...................................

48

6.

P r o f e s s i o n a l R e f e r r a l o f P a t i e n t s ................................................

49

7.

Health Counseling Given t o P a t i e n t s

..........................................

50

8.

How Treatment Progress 1s D e t e r m i n e d ..........................................

51

9.

S e l f - R a t i n g o f P r a c t i t i o n e r ' s S k i l l s ..........................................

52

10.

Attendance a t P r e p r o f e s s l o n a l C o l le g e s

...................................

53

11.

Where Po st-G radu a te Work was Taken

..........................................

53

12.

What Po st-G rad uate Course Work was Taken

13.

S u b j e c t s Which P r a c t i t i o n e r s Want t o Review

14.

Subjects P referred f o r I n s tr u c tio n

15.

S u b j e c t s 1n Which Seminars a r e D e s i r e d

...................................

56

16.

Where Education Courses Should be Held

...................................

57

17.

Who Should P r e s e n t Courses

..............................................................

58

18.

When Should Courses be Given

19.

P r e f e r e n c e f o r Length o f Seminars ................................................

59

20.

P r e f e r r e d Location o f C l a s s e s

60

. . .

............................
.

.

.

.

..........................................

. . .

.......................................................

v

45
45

54
55
55

58

T able

Page

21.

Post>Graduate Courses Taken In Orthopedics 1n R e la ti o n
t o Community S i z e ......................................................................................62

22.

P r a c t i t i o n e r ' s D e sire to Review Orthopedic T e s t s f o r
P a t i e n t Examination in R e la ti o n t o Community Siz e .

23.
24.

.

63

P r a c t i t i o n e r ' s D e sire f o r I n s t r u c t i o n 1n C l i n i c a l
Psychology 1n R e la ti o n to Community Size ...........................

64

P r a c t i t i o n e r ' s D e sire f o r I n s t r u c t i o n 1n P r a c t i c e
Build ing Procedures 1n R e la ti o n t o Community S i z e

.

.

65

25.

Post-G raduate Courses Taken 1n R e la ti o n t o Age Group .

.

66

26.

P r a c t i t i o n e r ' s D e sire t o Review Work In Continuing
Education 1n R e la ti o n t o Age Group.......... .................................

67

P r a c t i t i o n e r ' s D e sire f o r I n s t r u c t i o n 1n Continuing
Education 1n R e l a t i o n t o Age Group
.................................

68

Where Post-Graduate Work was Taken 1n R e l a t i o n t o
Income G r o u p ................................

69

27.
28.
29.

Post-G rad u ate Courses Taken 1n R e l a t i o n t o Income Group

30.

P r e f e r e n c e 1n Seminar S u b j e c t s in R e l a t i o n t o Income
Group
......................................................................................................... 71

31.

Location P r e f e r e n c e f o r Taking Courses 1n R e la ti o n
t o Income G r o u p ...................................................................................... 72

v1

.

70

LIST OF APPENDICES
Appendix

Page

A. L e t t e r and L i s t o f O f f i c i a l s o f Each S t a t e
O r g a n i z a t i o n R e p r e se n tin g C h i r o p r a c t i c ...........................

88

B.

L e t t e r Authorizing S t a t i s t i c a l In v estig atio n .

97

C.

P r a c t i c e Opinion Survey L e t t e r and Form

D.

P r a c t i c e Opinion Survey R e s u l t s

E.

DC D i s t r i b u t i o n 1n Michigan D i s t r i c t s

F.

L e t t e r o f T r a n s m i t t a l and Q u e s t i o n n a i r e Forms

G.

Follow-up L e t t e r t o Q u e s t i o n n a i r e

vl 1

.

.

.

............................

99

................................................

101

...................................
.

.

103

.

106

.........................................

115

CHAPTER I
THE PROBLEM

Many p u b l i c and p r i v a t e a g e n c ie s have e x p re ss ed concern with
t h e q u a l i t y o f h e a l t h c a r e d e l i v e r e d t o t h e p u b l i c by p r a c t i t i o n e r s
o f a l l segments o f th e h e a l i n g a r t s .

This concern has been I n cr e as ed

r e c e n t l y w ith the emergence o f a s t r o n g , m i l i t a n t consumer I n t e r e s t
In h e a l t h c a r e and a p r o l i f e r a t i o n o f m a l p r a c t i c e s u i t s a g a i n s t
h e a l t h p r o f e s s i o n a l s and h o s p i t a l s f o r a l l e g e d n e g li g e n c e o r Incompe­
tence.

In a d d i t i o n , an a f f l u e n t s o c i e t y which can now a f f o r d more

h e a l t h c a r e and I n c r e a s e d worker I n su r a n c e co v erag e through u n io n /
management c o n t r a c t e f f o r t s may have c o n t r i b u t e d t o a g r e a t e r p u b l i c
demand f o r a s u p e r i o r h e a l t h c a r e d e l i v e r y system.
T r a d i t i o n a l l y , most p r o f e s s i o n s have done t h e i r own p o l i c i n g
o f members.

Now t h e p u b l i c 1s q u e s t i o n i n g t h i s a b i l i t y o f a p r o ­

f e s s i o n t o c o n t r o l t h e q u a l i t y o f I t s members' o u t p u t 1n b e h a l f o f
t h a t public.

This t r e n d 1s most n o t i c e a b l e 1n t h e h e a l t h f i e l d .

The

p u b l i c wants a s s u r a n c e t h a t h e a l t h c a r e p r o v i d e r s no t o n l y m a i n t a i n
t h e i r knowledge and s k i l l s a s de monstrate d when f i r s t a c q u i r i n g t h e
l i c e n s e t o p r a c t i c e , b u t t h a t t h e y a r e a l s o keeping c u r r e n t on new
I n f o r m a t io n and t e c h n o l o g i c a l changes 1n t h e i r f i e l d .
^S y s te m a tic Competency S u r v e i l l a n c e In Health Personnel
L i c e n s u r e , O f f i c e o f H e alth and Medical A f f a i r s , Lansin g, Michigan
A p r i l ! 977.

2
Need f o r t h e Study
A s e a r c h o f t h e l i t e r a t u r e on c o n t i n u i n g p r o f e s s i o n a l edu ca­
t i o n I n d i c a t e s t h a t r e l a t i v e l y l i t t l e has been done by t h e c h i r o ­
p r a c tic co lleg es o r the various professional a s s o c ia tio n s to discover
t h e t r u e p o s t - d o c t o r a l l e a r n i n g needs o f t h e p r a c t i t i o n e r 1n t h e
field.

This 1s u n d e r s t a n d a b l e s i n c e t h e r e 1s such a v a r i a n c e 1n

's c o p e o f p r a c t i c e ' as d e f i n e d In each S t a t e t h a t t h e c o l l e g e s c a n ­
n o t p o s s i b l y u n d e rt a k e t h e huge t a s k o f a c q u a i n t i n g them selv es w ith
t h e s p e c i f i c e d u c a t i o n a l needs 1n each I n d i v i d u a l p r a c t i c e a r e a .
The p r o f e s s i o n a l a s s o c i a t i o n s have had few s e l f - a s s e s s m e n t
su rv e ys made and t h o s e few have n o t a d d r e s s e d t h i s p a r t i c u l a r phase
o f t h e d o c t o r ' s ongoing e d u c a t i o n .

Indeed, t h e emphasis has been on

demographic, soc io-economic and p r a c t i c e p r e f e r e n c e s t a t i s t i c s w i t h
some a l l u s i o n t o e d u c a t i o n a l background.

I t a p p e a r s t h a t s t u d i e s 1n

c o n t i n u i n g c h i r o p r a c t i c e d u c a ti o n a r e long overdue when compared w ith
t h e advances made by t h e medical p r o f e s s i o n 1n t h i s a r e a o f c o n s i d e r a ­
tio n .2
Purpose o f t h e Study
There 1s c u r r e n t l y no unifo rm , s y s t e m a t i c program f o r con­
t i n u i n g e d u c a ti o n o f t h e c h i r o p r a c t o r a t t h e n a t i o n a l o r s t a t e
levels.

I t 1s t h e r e f o r e t h e purpose o f t h i s s t u d y , a l t h o u g h l i m i t e d

t o DC r e s p o n d e n t s 1n t h e s t a t e o f Michigan, t o p r e s e n t a d e s c r i p t i o n

2B. V. Dryer, " L i f e t i m e Learnin g f o r P h y s i c i a n s : P r i n c i p l e s ,
P r a c t i c e s , P r o p o . j l , " J ou rna l o f Medical E d u c a t i o n , P a r t 2, June
1962.

3
o f the c u rre n t post-doctoral learning p r a c tic e s o f the S t a t e 's doctors
o f c h i r o p r a c t i c and t h e i r p e rc eiv e d needs f o r c o n ti n u i n g p r o f e s s i o n a l
education.
S i g n i f i c a n c e o f t h e Study
Analysis o f th e r e s e a r c h r e s u l t s 1n t h i s d e s c r i p t i v e s tu d y
may I n d i c a t e the method o r methods by which th e c h i r o p r a c t i c p r a c ­
t i t i o n e r s can b e s t meet t h e i r p e rc eiv e d e d u c a tio n a l needs and th us
more e f f e c t i v e l y d i s c h a r g e t h e i r o b l i g a t i o n s In p r a c t i c e .

This

would p e rm it them t o :
1.

Upgrade t h e i r e x p e r t i s e 1n d r u g l e s s p r o c e d u r e s , with
due re ga rd t o I n d i c a t i o n s and c o n t r a - i n d i c a t i o n s .

2.

In c r e a s e a n d / o r r e f i n e a l l r e l a t e d t ec h n iq u e s k i l l s .

3.

I n c r e a s e t h e i r e f f e c t i v e n e s s as primary h e a l t h
care providers.

4.

Expand t h e i r knowledge o f t h e broad h e a l t h f i e l d .

5.

Promote b e t t e r communication with o t h e r h e a l t h c a r e
practitioners.

This study may a l s o s t i m u l a t e s i m i l a r I n v e s t i g a t i o n s 1n
o t h e r s t a t e s f o r t h e u l t i m a t e b e n e f i t o f t h e h e a l t h c a r e consumer
as well as t h e p r o f e s s i o n .
Research Questions
R e s u l ts o f t h i s stud y may a l s o p r o vid e answers t o some
im p o r tan t q u e s t i o n s f o r t h e p r o f e s s i o n In Michigan:
1.

In what p r o f e s s i o n a l a r e a s a r e DCs n o t I n t e r e s t e d ?

2.

Are c h i r o p r a c t o r s I n t e r e s t e d 1n a d d i t i o n a l s c i e n c e
degre es?

4
3.

Where would Michigan p r a c t i t i o n e r s p r e f e r t o a t t e n d
c l a s s e s 1n c o n t i n u i n g p r o f e s s i o n a l e d u c a t i o n , when
and f o r what l e n g t h o f time?

4.

Should t h e c o n t i n u i n g e d u c a t i o n c o u r s e s l e a d to
specialty c e rtific a tio n ?

5.

Who should b e a r t h e c o s t o f c o n t i n u i n g e d u c a ti o n
programs?

6.

Have p a s t e d u c a t i o n a l c o u r s e s g iven f o r r e l l c e n s l n g
r e q u i r e m e n t pu rpo se s been e f f e c t i v e In upgrading
t h e DCs* p r o f e s s i o n a l competence ( I n t h e i r o p i n i o n ) ?

7.

Are Michigan c h i r o p r a c t o r s s a t i s f i e d w ith t h e ty pe
and q u a l i t y o f c o n t i n u i n g e d u c a t i o n c o u rs e s as now
p r e s e n t e d f o r l i c e n s e renewal p urposes?
Development o f t h e P r o f e s s i o n and
Conceptual Framework

W e b s t e r 's New C o l l e g i a t e D i c t i o n a r y (1977) d e f i n e s C h ir o ­
p r a c t i c as "a system o f h e a l i n g which ho lds t h a t d i s e a s e r e s u l t s
from a l a c k o f normal n e rv e f u n c t i o n and which employs m an i p u l a t io n
and s p e c i f i c a d j u s t m e n t o f body s t r u c t u r e s ( as t h e s p i n a l c o lu m n ) . 11
The C h i r o p r a c t o r 1s a p r a c t i t i o n e r o f t h a t h e a l i n g system.
The p r i n c i p l e s upon which C h i r o p r a c t i c 1s founded a r e
d i f f i c u l t to tra c e .

The o r i g i n o f s t r u c t u r a l a d ju s tm e n t o f t h e human

body 1s l o s t 1n a n t i q u i t y , b u t e a r l i e s t r e c o r d s I n d i c a t e t h a t manlpu3
l a t l o n was used 1n China, c i r c a 2700 BC.
A n c i e n t E g y p ti a n s , Greeks, J a p a n e s e as well a s North and
South American I n d i a n s , and P o l y n e s i a n s , employed "back-walking" and
o t h e r m a n i p u l a t i v e p r o c e d u r e s as h e a l i n g a g e n t s 1n t h e i r r e s p e c t i v e

S.
C ity , Florida:

Homola, B o n e s e t t l n g , C h i r o p r a c t i c and C ultlsm (Panama
C r i t i q u e P r e s s , 1963).

5
cultures.

" B o n e - s e t t e r s " o f England and o f Europe were h i g h ly

s u c c e s s f u l w ith t h e i r m an i p u l a t iv e p r a c t i c e s , bu t were scorned
p u b l i c l y by orthodox medicine a s being u n q u a l i f i e d 1n the b a s i c
c li n i c a l sciences o f th a t era .
Although t h e " l a y i n g on o f hands" was p r a c t i c e d f o r many
c e n t u r i e s , th e founder o f C h i r o p r a c t i c 1n 1895, D. D. Palmer, wrote
in an e a r l y tex tbo o k:

" I am not t h e f i r s t person t o r e p l a c e

v e r t e b r a e , but I do cla im t o be t h e f i r s t t o r e p l a c e d i s p l a c e d
v e r t e b r a e by using th e spinous and t r a n s v e r s e p r o c e s s e s as l e v e r s
. . . and t o develop t h e philo sophy and s c i e n c e o f C h i r o p r a c t i c . " 4
Modern C h i r o p r a c t i c Education
C h i r o p r a c t i c , a s a p r o f e s s i o n 1n t h e h e a l t h f i e l d w i t h an
5
acc ep ted d o c to r a l d e g re e , has made g r e a t s t r i d e s 1n I t s e l g h t y - t h r ee
y e a r old h i s t o r y toward g a in i n g p u b l i c a c c ep tan c e on a p a r with
o t h e r groups 1n t h e h e a l t h f i e l d .

Full p a r i t y , however, w i l l no t be

achieve d u n t i l both t h e p u b l ic and th e ' s c i e n t i f i c community1 a r e
made aware t h a t the e d u c a ti o n a l l e v e l o f t h e c h i r o p r a c t i c p r o f e s s i o n
now compares f a v o r a b l y with t h a t o f t h e o t h e r h e a l t h groups.
S o c i o l o g i s t William J . Goode6 e x p r e s s e s t h e op in io n t h a t as
a s o c i a l r e a l i t y o n l y f o u r g r e a t person p r o f e s s i o n s —law, m edicine,
4

D. D. Palmer, The S c ien c e, A rt and Philosoph y o f C h i r o p r a c t i c
( P o r t l a n d : Oregon P r i n t i n g P r e s s , 1910; r e p u b l i s h e d , 1966J.
5W. E e l l s , Academic Degrees (Washington, D.C.:
o f E d ucation, 1960), p. 169.

U.S. O f f i c e

6W. Goode, " T h e o r e ti c a l Lim its o f P r o f e s s i o n a l i z a t i o n , "
paper p r e s e n t e d a t 1960 meeting o f t h e American S o c i o l o g i c a l A ssoc ia ­
tion.

6
t h e m i n i s t r y , and u n i v e r s i t y t e a c h 1 n g -- c a n r e a c h t h e h ig h l e v e l s o f
f u l l p r o f e s s i o n a l i s m w i t h "such t r a i t s a s c o h e s i o n , commitment t o
norms o f s e r v i c e , p e r c e n t a g e o f numbers rem aining 1n t h e p r o f e s s i o n
th r o u g h o u t t h e i r l i f e t i m e , and o t h e r s . "

U n f o r t u n a t e l y , he does n o t

c o n s i d e r D e n t i s t r y , P o d i a t r y , C h i r o p r a c t i c o r Optometry 1n th e same
category o f professionalism .
Although P r o f e s s o r Goode's c o n c l u s i o n s a p p e a r somewhat b i a s e d
(he i s a u n i v e r s i t y p r o f e s s o r ) , t h e d e s c r i b e d t r a i t s a r e c e r t a i n l y
g o a l s f o r any p r o f e s s i o n t o a c h i e v e .

In r e g a r d t o t h e c h i r o p r a c t i c

p r o f e s s i o n , an obvious approach t o answer I t s c r i t i c s i s t o I n s t i t u t e
a p p r o p r i a t e p o s t - d o c t o r a l t r a i n i n g f o r upg rading th e p r a c t i t i o n e r ' s
e x p e r t i s e , u sin g programs s i m i l a r t o t h e e x c e l l e n t ones a v a i l a b l e t o
t h e medical p r a c t i t i o n e r .

A d d i t i o n a l l y , 1 t must be o bvious t h a t t h e

r a p i d o b s o l e s c e n c e o f knowledge 1n t h e s c i e n t i f i c and h e a l t h f i e l d s
p l u s Improvements r e s u l t i n g from ongoing r e s e a r c h mandate t h e c on­
t i n u i n g e d u c a t i o n o f a l l h e a l t h person n el t o a s s u r e competency 1n
s e r v i n g t h e h e a l t h needs o f t h e p u b l i c .
C on tin u in g P r o f e s s i o n a l E ducation
C on tin uing e d u c a t i o n 1n t h e h e a l t h f i e l d has been p r a c t i c e d
i n Michigan f o r many y e a r s on a v o l u n t a r y b a s i s , u s u a l l y by members
of a p a rtic u la r association.

Such e d u c a t i o n was a l s o l e g i s l a t i v e l y

mandated f o r c h i r o p r a c t o r s s i n c e 1933, when f i r s t l i c e n s e d , 7 and 1s
now a r e q u i r e m e n t f o r most o f t h e o t h e r Michigan h e a l t h p r o f e s s i o n a l s .
7M1ch1gan C h i r o p r a c t i c Act 145 o f 1933, 338.154 [MSA 1 4 . 5 9 4 ] .

7
Although c o n s i d e r e d v i t a l t o t h e p r o f e s s i o n by many d o c t o r s
o f c h i r o p r a c t i c , t h e r e 1s c u r r e n t l y no s t a t e w i d e e f f o r t t o p ro v id e a
c o n t i n u i n g e d u c a t i v e program f o r t h e p r a c t i t i o n e r .

The r e a s o n s f o r

t h i s s i t u a t i o n a r e m a n i f o ld , but a few o f t h e more notew orthy ones
w i l l j u s t i f y t h e s t a t e m e n t made.
D i f f e r e n c e s 1n c h i r o p r a c t i c c o l l e g e c u r r l c u lu m s have con­
t r i b u t e d t o a l a c k o f c o n fo rm ity 1n t h e t h i n k i n g and b e h a v i o r o f t h e
members o f t h i s p r o f e s s i o n .

According t o t h e p a r t i c u l a r c h i r o p r a c t i c

c o l l e g e a t t e n d e d , t h e y e a r o f g r a d u a t i o n and a d m i t ta n c e t o p r a c t i c e
by l i c e n s u r e , and perhaps pe rs o nal t r a i t s , t h e c h i r o p r a c t o r has
developed h i s own unique s t y l e o f p r a c t i c e , w i t h i n t h e l i m i t a t i o n s
s e t by t h e c u r r e n t s t a t e law.

I t 1 s , t h e r e f o r e , a lm o s t a s common t o

r e c e i v e d i f f e r e n t t r e a t m e n t from any given number o f c h i r o p r a c t o r s
a s 1 t 1s t o r e c e i v e t h e p r o v e r b i a l d i f f e r i n g o p i n io n s on a p a t i e n t ' s
h e a l t h problem from as many medical p r a c t i t i o n e r s .
Co n tin uing p r o f e s s i o n a l e d u c a t i o n f o r t h e D.C. ( d o c t o r o f
c h ir o p r a c tic , c h iro p ra c to r, c h iro p ra c tic physician), outside o f the
r e l l c e n s u r e r e q u i r e m e n t s , has o n l y r e c e n t l y become a v a i l a b l e a t some
c o l l e g e s 1n c e r t a i n s u b j e c t s , and from p r i v a t e groups o r I n d i v i d u a l s
havin g a s p e c i a l I n t e r e s t 1n promoting t h e d i s s e m i n a t i o n o f t h e i r
unique knowledge o r te c h n iq u e s k i l l s .
On a n a t i o n a l l e v e l , c o n t i n u i n g e d u c a ti o n has been documented
D

1n a r e c e n t p u b l i c a t i o n
o f DC p r a c t i t i o n e r s .
p

d e s c r i b i n g e f f o r t s t o upgrade t h e competency

The pamphlet d e s c r i b e s t h e l i c e n s u r e r e q u i r e m e n ts

C h i r o p r a c t i c , S t a t e o f t h e A r t . American C h i r o p r a c t i c
A s s o c i a t i o n , 1976, p. 16.

8
by s t a t u t e 1n most s t a t e s and by c r i t e r i a e s t a b l i s h e d by Examining
Boards 1n o t h e r s .

Programs a r e u s u a l l y conducted by S t a t e A s s o c ia ­

tions.
C o l le g e s pro v id e ongoing p o s t g r a d u a t e ( c o n t i n u i n g ) e d u c a t i o n
programs w h i l e the n a t i o n a l p r o f e s s i o n a l o r g a n i z a t i o n s ( I n t h i s
i n s t a n c e t h e American C h i r o p r a c t i c A s s o c i a t i o n ) have programs 1n
several s u b je c ts leading to s p e c i a lt y c e r t i f i c a t i o n .

These upg rading

c o u r s e s a r e v o l u n t a r y and a r e g iven both on and o f f campus.
The v a r i o u s s t a t e annual c o n v e n t io n s o f t e n r e q u e s t c o l l e g e
pers onnel from t h e t e a c h i n g s t a f f , e i t h e r D.C.s o r Ph.D.s 1n
s p e c i a l i z e d s u b j e c t s , t o a d d r e s s t h e a t t e n d e e s f o r t h e e d u c a ti o n a l
p o r t i o n o f t h e c o n v e n t io n .
Technique c o u r s e s a r e g iven by some I n d i v i d u a l d o c t o r s who
may have developed a s p e c i a l r e f i n e m e n t 1n t h e m a n i p u l a t i v e f i e l d .
This has l e d t o m a n i p u l a t i v e s p e c i a l i z a t i o n by some D.C.s 1n a
c e r t a i n t e c h n i q u e , a p p l i c a t i o n o f which may y i e l d q u i c k e r , e a s i e r o r
a more permanent r e s o l u t i o n o f t h e h e a l t h problems p r e s e n t e d .

L ast,

and c e r t a i n l y very p o p u l a r , a r e a number o f m o t i v a t i o n a l c o u r s e s
o f f e r e d t o t h e p r a c t i c i n g d o c t o r s e e k i n g a h i g h e r socio-ec onomic
l e v e l In h i s o r h e r community.
D e s p i t e t h e a v a i l a b i l i t y o f t h e s e commendable c o u r s e s , d i s ­
c u s s i o n s h e ld w ith Michigan c h i r o p r a c t o r s seem t o I n d i c a t e t h a t t h e
s e l e c t i o n o f f e r e d o r t h e tim e and p l a c e where t h e coursework I s
s ched u led does n o t f u l f i l l t h e p a r t i c u l a r needs o f Michigan c h i r o ­
p ractic p ra c titio n e rs.

I t t h e r e f o r e a p p e a r s t h a t such programs w i l l

9
have t o be t a i l o r e d t o t h e Michigan d o c t o r s ' p e r c e i v e d needs a s
d e r i v e d from t h i s I n v e s t i g a t i o n .
♦Scope o f P r a c t i c e * I n f l u e n c e on
C ontin uing Education
I t 1s s i g n i f i c a n t t h a t t h e c h i r o p r a c t i c p r o f e s s i o n has grown
a t a d i f f e r e n t pace In each s t a t e and r e c e i v e d t h e b l e s s i n g s o f
l i c e n s u r e a t d i f f e r e n t t im e s .

With Kansas and North Dakota as the

f i r s t s t a t e s t o r e g u l a t e t h e p r a c t i c e o f C h i r o p r a c t i c 1n 1913,
t h e l a t e s t and l a s t o f t h e f i f t y s t a t e s t o l i c e n s e D.C.s was
L o u is ia n a 1n 1975.

The scope o f p r a c t i c e and t h e r e q u i r e m e n ts f o r

c o n ti n u e d l i c e n s u r e a l s o v a ry from s t a t e t o s t a t e , a c c o r d i n g t o t h e
s tr e n g th o f c r i t i c s o f th e c h ir o p r a c t i c pro fessio n (seeking to l i m i t
t h e scope o f p r a c t i c e ) and t h e d e d i c a t i o n and a g g r e s s i v e n e s s o f
I n d i v i d u a l , p o U t l c a l l y - k n o w l e d g e a b l e c h i r o p r a c t o r s 1n t h a t s t a t e .
Proposed New L ic ense Renewal C r i t e r i a
A major concern f o r t h e p r o f e s s i o n 1s t h e a p p a r e n t a t t e m p t
o f a f e d e r a l agency t o a s s u r e c o n t i n u e d competence o f a l l h e a l t h
q

care providers.

in

Most I n t e r e s t i n g 1s t h e c o n t e n t o f a r e c e n t

H e a l t h , Education and Welfare (HEW) sub- com mittee r e p o r t .

One

recommendation c o nce rn in g c o n t i n u e d competence o f t h e p r a c t i t i o n e r
states:

9DHEW, 1971, Report on L i c e n s u r e . P u b l i c a t i o n No. (HSM)72-11.
H ealth Manpower L i c e n s u r e ,
Publica

10
C e r t i f i c a t i o n o r g a n i z a t i o n s , l i c e n s u r e boards and p r o f e s s i o n a l
a s s o c i a t i o n s a r e ur ged t o a d o p t r e q u i r e m e n ts and p r o ce d u r es
which w i l l a s s u r e c o n t i n u e d competence o f h e a l t h p e r s o n n e l .
T his o b j e c t i v e should be accomplished 1n l i e u o f u sing
c o n t i n u i n g e d u c a t i o n as t h e s o l e r e q u i s i t e f o r l i c e n s u r e
renewal. 1 T
The Department o f HEW's proposa l w i l l und oubtedly r e s u l t 1n
some h e a t e d c o n t r o v e r s y on S t a t e s ' r i g h t s v e r s u s Federa l government
r i g h t s on c r e d e n t i a l 1 n g s t a n d a r d s b u t e v e n t u a l l y , w ith such c o n f l i c t s
r e s o l v e d , some ty pe o f e x am ina tio ns on c o n t i n u i n g p r o f e s s i o n a l e du ca ­
t i o n w i l l become t h e c r i t e r i a f o r p e r m i t t i n g l i c e n s e renew al.

T his

a n t i c i p a t e d outcome 1s an a d d i t i o n a l r ea so n f o r I n v e s t i g a t i o n o f t h e
c u r r e n t c o n t i n u i n g e d u c a ti o n e f f o r t 1n Michigan and d i s c o v e r i n g t h e
p e r c e i v e d l e a r n i n g needs o f t h e D.C.s so as t o I n c r e a s e t h e i r s k i l l s
and competence 1n p r a c t i c e .
Another concern f o r t h e Michigan c h i r o p r a c t i c community 1s
t h e as y e t u n s e t t l e d r e v i s i o n t o t h e Michigan P u b lic Health Act
(House B111 4070) where each h e a l t h p r o f e s s i o n ' s scope o f p r a c t i c e
1s bein g upda ted and r e d e f i n e d .
I t 1s I n t e r e s t i n g t o n o t e t h a t t h e American Board o f Family
P r a c t i c e (composed o f g e neral p r a c t i t i o n e r s o f m e d ic in e ) r e q u i r e s
b o th s t u d y and e x am in atio n s f o r I t s members t o r e t a i n t h e i r c e r t l f l 12
c a tio n annually.

^DHEW, 1976, C r e d e n t i a l I n g H ealth Manpower, p. 12.
^ " T e s t i n g t h e G . P . s , " Newsweek, November 8 , 1976.

11
D iverg ent Concepts In C h i r o p r a c t i c P r a c t i c e
Another f a c e t o f t h e problem which must be a d d r e s s e d , 1 f t h e
c o n ti n u i n g e d u ca tio n needs o f t h e Michigan c h i r o p r a c t o r s a r e t o be
d i s c o v e r e d , 1s th e d e f i n i t i o n o f c h i r o p r a c t i c p r a c t i c e and I t s con­
c e p t i o n by t h e p r a c t i t i o n e r s 1n th e s t a t e .
(Greek:

The term " C h i r o p r a c t i c "

c h e l r , hand and p r a k t l c o s , p r a c t i t i o n e r ) 1s n o t uniformly

d e f i n e d 1n e very s t a t e and I t s c o nce p tio n v a r i e s even w i t h i n a s t a t e ,
as 1n Michigan.
There a r e two sch oo ls o f th o u g h t, and p r a c t i c e , 1n t h e
ch iro p ractic profession.

One ( c a l l e d ' s t r a i g h t ' ) 1s u l t r a ­

c o n s e r v a t i v e and ad h eres s t r i c t l y t o t h e t e a c h i n g s o f th e f o u n d e r ,
D. D. Palmer, who m anipulated by hand only t h e v e r t e b r a e o r segments
o f t h e human sp in e t o achiev e c o r r e c t i o n o f h e a l t h d e f e c t s .

The

o t h e r ( c a l l e d ' m i x e r ' ) 1s more l i b e r a l 1n I t s views and employs a l l
n a t u r a l methods o f h e a l i n g , e x clu d in g drug m edica tio n and I n c i s i v e
su r g e r y .

These two s c h o o l s o f t h o u gh t have c r e a t e d a dichotomy o f

o r g a n i z a t i o n s a t t h e n a t i o n a l and many s t a t e l e v e l s .

Such d i s ­

s e n sio n w i t h in t h e p r o f e s s i o n has r e s u l t e d 1n d u p l i c a t i o n o f
o r g a n i z a t i o n a l f u n c t i o n s and d i l u t e d I t s s t r e n g t h 1n r e l a t i o n s h i p s
with t h e L e g i s l a t u r e and t h e ' s c i e n t i f i c community.'
Determining t h e Wishes o f t h e M a j o r it y
Since t h e r e a r e v a r i o u s co nce p ts o f c h i r o p r a c t i c modes o f
p r a c t i c e 1n Michigan, t h e d e t e r m i n a t i o n o f t h e wishes o f t h e m a j o r i t y
o f t h e D.C.s was c o n s i d e r e d a p r e r e q u i s i t e f o r a formal stud y o f t h e
c o n ti n u i n g e d u c a tio n needs o f t h e p r o f e s s i o n .

A 1976 Opinion

Survey

13

I n d i c a t e d t h a t t h e m a j o r i t y (75 p e r c e n t ) o f t h e Michigan

c h i r o p r a c t o r s wished t o p r a c t i c e l i k e the second school o f thought
( t h e ' m i x e r s ' ) and t h a t t h e p r a c t i c e o f 'm a n i p u l a t i o n o f t h e sp in e
by hand o n l y ' ( t h e ' s t r a i g h t s ' ) 1s co nfin ed t o r e l a t i v e l y few (6
percent) of the c h iro p ra c to rs.
Although a d ju stm ent o f t h e s p i n e 1s s t i l l employed as t h e
b a s i s o f a l l c h i r o p r a c t i c t r e a t m e n t , a m a j o r i t y o f t h e D.C.s 1n
Michigan, and e ls e w h e re , have broadened t h e i r view o f p r a c t i c e mode
t o In clu d e t r e a t m e n t o f a l l n e u r o - m u s c u l o - s k e l e ta l problems by
m a n i p u l a t i o n , g i v e n u t r i t i o n a l co u nselin g and use v a r i o u s o t h e r
n a tu r a l methods o f t r e a t m e n t , o u t s i d e t h e realm o f drug m edica tio n
14
and o p e r a t i v e su r g e r y .
Based on t h e outcome o f th e Opinion Survey, I t was now
p o s s i b l e t o d e sign a comprehensive survey In strum ent which a d dressed
t h e p e rc e i v e d needs o f t h e m a j o r i t y o f p r a c t i t i o n e r s 1n Michigan and
w i l l h o p e f u l l y l e a d to t h e f o r m u la ti o n o f a uniform, 1n-depth
c o n ti n u i n g p r o f e s s i o n a l e d u c a ti o n program.
The non-un1form exposure o f t h e D.C. 1n t h e p a s t t o many o f
th e s u b j e c t a r e a s c o n sid ere d a 'm u st' by t h e s c i e n t i f i c community
has given r i s e t o many 1 n t e r - p r o f e s s 1 o n a l m is c o n c e p t i o n s , e . g . , t h e
medical p r o f e s s i o n ' s u nf a v o ra b le view o f t h e c h i r o p r a c t o r ' s
13

(Lansing:

S.
U l r i c h , Opinion Survey o f Michigan C h i r o p r a c t o r s
Michigan S t a t e C h i r o p r a c t i c A s s o c i a t i o n , 11976).

^ C h i r o p r a c t i c C o l l e g e s . Foundation f o r C h i r o p r a c t i c
Education and Research and Council on C h i r o p r a c t i c Edu cation,
1976.

13
e d u c a t i o n a l background.

A p e ru s a l o f t h e s u b j e c t m a t t e r c u r r e n t l y

t a u g h t a t two c h i r o p r a c t i c I n s t i t u t i o n s , ^ 5 *

a lt h o u g h s u p p o r t i n g

op posing DC o r g a n i z a t i o n s and p h i l o s o p h i e s , w i l l d i s p e l Ideas o f
I n s u f f ic ie n t professional tra in in g .

Also, a g l a n c e a t t h e c o n ti n u i n g

e d u c a t i o n o f f e r i n g s o f one o f t h e c o l l e g e s ^ should f u r t h e r e a s e
c o n ce rn s 1n t h i s r e s p e c t .

The outcome o f t h i s I n v e s t i g a t i o n , by

i n c l u s i o n 1n t h e l i t e r a t u r e o f t h e h e a l t h p r o f e s s i o n s , w i l l hope­
f u l l y I n f l u e n c e both t h e p u b l i c and t h e a l l i e d h e a l t h p r o f e s s i o n s
in a p o s i t i v e manner.
D e f i n i t i o n o f Terms
Bonesetters
M a n ip u la to r s o f t h e bony segments o f t h e human s p i n e
including a r t i c u l a r d i s t o r t i o n s .

Although l e a r n e d e m p i r i c a l l y

( " T h e i r methods have been passed on from f a t h e r t o son as f a m i ly
is
secrets")
t h e a r t was h i g h l y developed by a n c i e n t Greeks and has
been p r a c t i c e d 1n Europe up t o t h e p r e s e n t t im e .

^ B u l l e t i n (D avenport, Iowa:
1975-1976), pp. 56, 57.
^ B u l l e t i n (Lombard, I l l i n o i s :
C h i r o p r a c t i c , 1976-1977), pp. 42-69.

Palmer C o lle g e o f C h i r o p r a c t i c ,
Natio nal C o lle g e o f

^ R e g i s t r a t i o n Form, "C ontinuing E d ucation Courses Schedule:
1976-77," N a t i o n a l - L i n c o l n School o f P o s t - G r a d u a te E d u ca tio n ,
D i v i s i o n o f National C o lle g e o f C h i r o p r a c t i c , Lombard, I l l i n o i s .
18
E. S c h l o tz and 0 . C y r l a x , M a n ip u la tio n P a s t and P r e s e n t
(London: ttn. Helnemann Medical Books, 197 5), pp. 2S-38.

14
C hiropractic
One acc ep ted d e f i n i t i o n i s "a system o f h e a l i n g which holds
t h a t d i s e a s e r e s u l t s from a l a c k o f normal n erv e f u n c t i o n and which
employs m an ip u latio n and s p e c i f i c a d ju stm ent o f body s t r u c t u r e s (as
19
t h e sp in a l column)."
Continuing Education f o r t h e
Health P r o f e s s i o n s
"Continuing e d u ca tio n c o n t r i b u t e s d i r e c t l y to meeting th e
l e a r n i n g needs o f p r o v i d e r s and I n c r e a s e s t h e i r a b i l i t y t o perform
20
more e f f e c t i v e l y in t h e d e l i v e r y o f s e r v i c e s . "
Manipulation ( C h i r o p r a c t i c )
Also c a l l e d spin a l a d ju s tm e n t , m a n i p u la tio n 1s t h e r e p l a c i n g
o f su bluxate d ( p a r t i a l l y d i s l o c a t e d ) v e r t e b r a e "by t h e a p p l i c a t i o n
o f a d e f i n i t e t h r u s t by t h e hands o f t h e c h i r o p r a c t o r In c o n t a c t
with t h e su b lu x a te d v e r t e b r a . "

21

S c i e n t i f i c Community
A c o n fu s in g term i n d i c a t i n g t h a t "each g e n e r a t i o n o f
s c i e n t i s t s r e c e i v e s more t h a n a t e c h n i c a l t r a i n i n g .
19

R a th e r , they

Webster*s New C o l l e g i a t e D i c t i o n a r y ( S p r i n g f i e l d , Mass.:
G. & C. Merrlain C o ., 1977), p. 95.
20
F o s t e r i n g th e Growing Need t o Learn (Syracuse, N.Y.:
Syracuse U n i v e r s i t y f o r bepartment o f Hea)th 7 Education and Welfare,
Pu blic Health S e r v i c e , 1974), p. 171.
21
W. Blron; B. Wells; and R. Houser, C h i r o p r a c t i c P r i n c i p l e s
and Technic (Chicago: National College o f C h i r o p r a c t i c , 1939J,
p. 349.

15
a r e e f f e c t i v e l y s o c i a l i z e d by o l d e r s c i e n t i s t s I n t o a moral and
22
I n t e l l e c t u a l community o f s c i e n t i s t s . "
On t h e o t h e r hand,
"usages such a s s c i e n t i f i c community . . . ten d t o be m etaphorical
23
e f f o r t s t o convey a kind o f psy c h o lo g ic al u n i t y . "
Although used
b r o a d l y t o I n d i c a t e t h e I n t e l l e c t u a l , s c h o l a r l y , e r u d i t e , knowledge­
a b l e and w e l l - e d u c a t e d I n d i v i d u a l s 1n a s o c i e t y , 1 t Is a l s o o f t e n
misused by w r i t e r s and sp e ak e rs wishing t o Impress an audience with
t h e v a l i d i t y o f a s t a t e m e n t , such a s "The s c i e n t i f i c community does
( o r does n o t ) a g re e w i t h . . . ."
Self-assessment
An e v a l u a t i o n made by an i n d iv i d u a l o r group o f h i s o r t h e i r
background, q u a l i f i c a t i o n s , s t a t u s 1n th e community o r o t h e r
a t t r i b u t e s which may be s e l e c t e d f o r review and comparison w ith a
norm o r o t h e r s t a t i s t i c .
Spinous Proces s and
transverse Process"
One spinous and two t r a n s v e r s e p r o c e s s e s p r o j e c t from the
v e r t e b r a l a r c h l i k e spokes from a s h i p ’s c a p s t a n .

They a f f o r d

a ttac h m en t t o muscles and a r e t h e l e v e r s t h a t h e l p t o move t h e
vertebrae:

22

J . McKee, I n t r o d u c t i o n t o Sociology (New York: H o lt,
R i n e h a r t and Winston, 1969), p. 503.
23
N. Smelzer, Sociology: An I n t r o d u c t i o n (New York: John
Wiley and Sons, 1973 ), p. 74.

Functions:

Parts:

Movement

Spinous pro ce ss
T r a v e rs e pro ce ss

P rotection

V e r te b r a l a rc h
Foramen (opening f o r
passage o f s p i n a l cord)

Support

*1

Body

Cross-section
Typical V erte b ra

V e rte b rae
The 33 bony segments* each s e p a r a t e d from t h e o t h e r by a
c a r t i l a g i n o u s di sc * comprising the human s p i n a l column.
Overview o f t h e Study
Continuing p r o f e s s i o n a l e d u c a ti o n f o r t h e Michigan c h i r o ­
p r a c t i c d o c t o r s has an Involved and c o n t r o v e r s i a l p a s t .

Aside from

mandatory a t t e n d a n c e a t a two-day e d u c a ti o n a l c o nfe renc e f o r annual
r e l l c e n s u r e , t h e r e 1s no uniform plan f o r c o n s i s t e n t l y upgrading
t h e p r a c t i t i o n e r s 1 knowledge and s k i l l s In t h e i r p r o f e s s i o n .

17
This stu d y i s l i m i t e d t o th e p o p u la tio n group re p r e s e n te d
by a l l th e l ic e n s e d Michigan c h ir o p r a c t o r s o f re c o r d .

S ta tistic a l

d ata was g a th e r e d and analyzed to g iv e comprehensive In fo rm a tio n on
Michigan DCs In c lu d in g e d u c a tio n a l backgrounds, p e rc e iv e d needs f o r
v a rio u s c o u rs e s o f s tu d y , and what t h e i r I n t e r e s t s a r e In c o n tin u in g
p r o f e s s io n a l s tu d y .

I n c id e n ta l demographic and socio-econom ic d a ta

were o b ta in e d f o r use In c r o s s - t a b u l a t i n g s t a t i s t i c a l o u tp u t.
The I n v e s t i g a t i o n may c o n c e iv a b ly le a d to new o r a d d itio n a l
s t u d i e s o f th e Michigan c h i r o p r a c t o r and m ight s t i m u l a te s i m i l a r
s t u d i e s 1n o t h e r s t a t e s .

The stu d y 1s n o t Intended to be f i n a l ,

b u t r a t h e r a path to encourage f u r t h e r e x p lo r a ti o n .
Format o f th e D i s s e r t a t i o n
In C hapter I th e t o p ic 1s In tro d u c e d , th e problem and I t s
s i g n i f i c a n c e 1s d e s c r i b e d , and th e n a tu r e and b o u n d aries o f th e
stu d y a r e s t a t e d .

An overview and d e f i n i t i o n o f term s 1s g iv en .

In C hapter II th e R elevant l i t e r a t u r e and c l o s e l y r e l a t e d
s t u d i e s a r e review ed.

The r e s u l t s o f p re v io u s I n v e s t i g a t i o n s In

t h i s a r e a a r e examined.

The m ajor f i n d in g s o f th e l i t e r a t u r e review

a r e th e n summarized.
In C hapter I I I th e s t r a t e g i e s and sam pling m easures used 1n
th e I n v e s t i g a t i o n a re p r e s e n te d .

A t t e n t i o n 1s drawn to th e sou rce o f

d a t a , s e l e c t i o n o f th e su rv ey In stru m e n t, and th e o r g a n i z a t i o n and
p r e s e n t a t i o n o f th e d a t a .

A r a t i o n a l e 1s given f o r t h e framework

o f th e d e sig n t o be d e s c r i p t i v e r a t h e r th a n p r e d i c t i v e In n a tu r e .
The d esign Is th e n summarized.

18
In C hapter IV th e d i s p l a y and a n a l y s i s o f t h e d a ta a re
p re se n te d .

A t t e n t i o n 1s fo cu sed on th e r e s e a r c h problem posed In

C h a p te r I .

The d a ta a r e d is p la y e d and a n a ly z e d 1n such a manner as

t o y i e l d r a t i o n a l answ ers to th e problem .

Data sunm arles a r e th en

fu rn ish ed .
In C h apter V a summary o f th e procedures* r e s u l t s , c o n c lu ­
s i o n s and recommendations 1s p r e s e n te d .

A d isc u ssio n se c tio n

I n c o r p o r a te s c e r t a i n views o f th e r e s e a r c h e r In c lu d in g i m p l i c a ti o n s
fo r fu tu re research .

Appendices o f r e f e r e n c e Items as th e y a ppear

1n t h e c h a p te r s a r e p re s e n te d .

CHAPTER II
SELECTED REVIEW OF THE LITERATURE

The a v a i l a b l e l i t e r a t u r e was r e s e a r c h e d f o r In fo rm a tio n on
c h i r o p r a c t i c s t u d i e s , e s p e c i a l l y 1n th e a re a o f c o n tin u in g p r o ­
f e s s i o n a l e d u c a tio n .

S ev eral e v a l u a t i v e s t u d i e s were found 1n th e

form o f s e l f - a s s e s s m e n t su rv e y s by s t a t e and n a tio n a l c h i r o p r a c t i c
a s s o c i a t i o n s and some r e p o r t s from government a g e n c ie s .

These a r e

review ed in t h e f i r s t p a r t o f th e c h a p t e r .
E x te n siv e r e s e a r c h o f d o c to ra l d i s s e r t a t i o n s d i s c l o s e d t h a t
few s t u d i e s have been made In t h e a r e a s o f c o n tin u in g p r o f e s s i o n a l
e d u c a tio n .

However, th o s e d i s s e r t a t i o n s having some r e le v a n c y to

p o s t - d o c to r a l l e a r n i n g 1n t h e h e a l t h f i e l d a r e review ed .
The rev iew o f th e l i t e r a t u r e uncovered a c o n s i d e r a b le number
o f te x tb o o k s on m a n ip u la tiv e p r o c e d u r e s , c h i r o p r a c t i c and o s t e o ­
p a t h i c , w h ile c o n tin u in g e d u c a tio n I t s e l f has many t e x t s d e v oted t o
t h i s emerging branch o f t h e e d u c a tiv e f i e l d .

T h is l i t e r a t u r e ,

I n c lu d in g some j o u r n a l s and p e r i o d i c a l s germ alne t o t h i s s tu d y ,
have been l i s t e d and a p p e a r 1n t h e Appendices.
Correspondence w ith each o f th e o t h e r 49 s t a t e c h i r o p r a c t i c
a s s o c i a t i o n s r e q u e s te d In fo rm a tio n on planned e d u c a tio n a l programs
and which had been o f f e r e d 1n t h e p re v io u s f i v e y e a r s .
th e r e p l i e s by t h e s t a t e ( a s r e c e i v e d ) I s g iv e n .
19

A listin g of

20
Several h e a l t h and n o n - h e a lth r e l a t e d p r o f e s s i o n a l a s s o c i a ­
t i o n s were c o n ta c te d f o r t h e i r views and c u r r e n t a c t i v i t i e s In con­
t i n u i n g e d u c a tio n .

T h e ir r e p l i e s a r e summarized and l i s t e d .

The

c h a p t e r sunmary I n d i c a t e s th e m ajor f i n d in g s and r e l a t i o n s h i p t o th e
form o f Research Design and P ro c ed u re s adopted 1n C hapter I I I .
S e lf-A ssessm en t Surveys
A s t a t i s t i c a l I n v e s t i g a t i o n o f " C h i r o p r a c ti c In North
C a ro lin a " was made f o r th e North C a ro lin a C h i r o p r a c ti c A s s o c ia tio n
In 19 7 4 .1

Demographic, so cio -eco nom ic and c h i r o p r a c t i c u t i l i z a t i o n

s t a t i s t i c s f o r t h e s t a t e a r e g iv e n , u sin g a q u e s t i o n n a i r e as t h e
I n v e s t i g a t i v e In s tru m e n t.

As w ith o t h e r su rvey s o f t h i s t y p e , con­

t i n u i n g e d u c a tio n 1s n o t a d d re ss e d d i r e c t l y .
The American C h i r o p r a c t i c A s s o c ia tio n sp onsored a stu d y In
1975

2

on th e e n t i r e c h i r o p r a c t i c p r o f e s s i o n 1n t h e U nited S t a t e s .

Although th e stu d y In c lu d e s p r e - p r o f e s s i o n a l and p r o f e s s i o n a l
e d u c a tio n s t a t i s t i c s , p o s t - g r a d u a t e e d u c a tio n d a ta 1s n o ta b le by
I t s a b sen c e.
Government Agency Reports
The Comprehensive H e alth P lanning Council o f C en tral
M a s s a c h u s e tts , 1n c o o p e ra tio n w ith th e Holy C ross C o lle g e S p e c ia l
S tu d ie s Department made a s tu d y as p a r t o f t h e i r 1972-1973 Work
^C h i r o p r a c ti c In North C a r o lin a : A S t a t i s t i c a l I n v e s t i g a t i o n
(R a le ig h : North C a ro lin a C h i r o p r a c t i c A s s o c i a t i o n , August 1974).
2
Survey and S t a t i s t i c a l Study o f th e C h i r o p r a c ti c P r o f e s s io n
(Des Moines, Iowa: American C h i r o p r a c t i c A s s o c i a t i o n , March 1975).

21

Program on th e " U t i l i z a t i o n o f C h ir o p r a c tic In C e n tra l Massachu­
s e tts ."

The r e s e a r c h e r made some I n t e r e s t i n g o b s e r v a tio n s :

By f a r th e most la u d a b le f e a t u r e o f c h i r o p r a c t i c e d u ca tio n
1s th e o p p o r tu n ity (and req uirem en t In most s t a t e s ) f o r
c o n tin u e d p o s t- g r a d u a te e d u c a tio n f o r annual l i c e n s e
renew al. T his 1s one a s p e c t o f medical e d u c a tio n which
should be r e q u ir e d o f a l l prim ary p r o v id e rs o f h e a l th
serv ices.
F urtherm ore, he s t a t e s :
The f i n a l a re a o f l i t e r a t u r e I n v e s t i g a t i o n 1s concerned
w ith th e c h i r o p r a c t o r as a member o f th e h e a lth c a r e team.
I t i s th e Inad eq u acies 1n t h i s a re a which g iv e s Impetus to
t h i s s tu d y . Four prev io u s s t u d i e s by th e Department o f
H e alth , Education and W elfare, th e Royal Commission, the
S ta n fo rd Research I n s t i t u t e and th e N ational A dvisory
Commission on H ealth Manpower, w h ile r e l a t i v e l y w ell done,
a r e n o t p a r t i c u l a r l y o b j e c t i v e . T h e ir f i n d i n g s , a s well
as c o rre sp o n d in g c h i r o p r a c t i c r e b u t t a l s , cannot be taken
a t f a c e v a lu e . Each s i d e has perso nal b i a s s t r o n g l y
r e f l e c t e d 1n t h e i r p r e s e n t a t i o n o f f a c t s and th e c o n c lu sio n s
based on them .3
On c o n tin u in g e d u c a tio n program s, he found a l l th e c h i r o ­
p r a c t o r s p a r t i c i p a t i n g t o some e x t e n t 1n a d d it i o n t o f u l f i l l i n g
l i c e n s e renewal re q u ire m e n ts .

S p e c ia lt y programs a t c h i r o p r a c t i c

c o ll e g e s were a tte n d e d 1n such a re a s as Roentgenology, C h ir o p r a c tic
O rthopedics and Biomechanics.
A r e p o r t t o th e Michigan L e g i s l a t o r s was Iss u e d by th e
Michigan O f f ic e o f Health and Medical A f f a i r s under d a te o f
February 23, 1977.4
3

K. J . Soprano, U t i l i z a t i o n o f C h i r o p r a c ti c in C en tral
M a ss a c h u se tts, a r e p o r t o f th e Comprehensive H ealth Planning
Council o f C e n tra l M a ss a c h u se tts, A pril 1974.
4
C hiro p r a c t i c : A R eport t o t h e Michigan L e g is la t o r s
(Lansing: O f fic e o f Health and Medical A f f a i r s , February 23,
1977).

22
R e feren c e s a r e made In th e r e p o r t t o th o s e s t u d i e s which th e
M a ss a c h u se tts r e s e a r c h e r (s e e f o o t n o te 3» C hap ter I I ) l i s t e d a s
being s t r o n g l y b i a s e d , as w ell a s to a number o f m edical p u b l i c a t i o n s .
The o n ly r e f e r e n c e to c h i r o p r a c t i c e d u c a tio n i s a d e s c r i p t i o n o f
p a s t and c u r r e n t t r a i n i n g programs in le n g th o f tim e , f a c u l t y - t o s t u d e n t r a t i o s , f a c u l t y academic background, and s i m i l a r com parisons
o f t h e m edical p r a c t i t i o n e r ' s and th e c h i r o p r a c t o r 's p r o f e s s i o n a l
p rep a ratio n .
The c o n c lu s io n s and recommendations a r e :
U n til a d d i t i o n a l r e s e a r c h can document t h e b a s i s and
e f f e c t i v e n e s s o f c h i r o p r a c t i c t r e a tm e n t so t h a t s p e c i f i c
l i m i t a t i o n s can be p la c e d on i t s a p p r o p r i a t e u s e s , I t 1s
recommended t h a t no changes be made 1n th e Michigan scope
o f p r a c t i c e a s d e fin e d 1n Act 145 o f 1933, a s amended.
The Michigan Department o f P u b lic H e alth Is s u e d a report** in
1977 which 1s an assem blage o f a "minimum c o re s e t o f e s s e n t i a l
d a ta . . . f o r each o f s e v e r a l components o f h e a l t h in form a­
t i o n . . . ."

The d a ta was c o l l e c t e d by means o f a q u e s t i o n n a i r e

w ith th e p r e s e n te d d a ta t a b u l a t e d and d e s c r i b e d , w ith o u t o p in io n
o r Inference.

C o n tin uing c h i r o p r a c t i c e d u c a tio n 1s n o t Inclu ded

1n t h e q u e s t i o n n a i r e o r r e p o r t .
R e le v an t D o c to ra l D i s s e r t a t i o n s
The D i s s e r t a t i o n A b s t r a c t s I n t e r n a t i o n a l were c o n s u lte d f o r
s t u d i e s under such h eading s a s a d u l t , c o n tin u in g e d u c a ti o n , c h i r o ­
p r a c t i c , o s t e o p a t h i c , h e a l t h , biom echanics and m a n ip u la tio n .

The

l i c e n s e d H e alth O c c u p a tio n s , Michigan C h i r o p r a c to r s 1976
(L ansin g: Michigan Department o f P u b lic H e a lth , A p ril 1977).

23
se a rc h Included th e p e rio d o f 1861 to and In c lu d in g Nay 1978 and
y i e l d e d th e fo llo w in g r e l e v a n t d i s s e r t a t i o n s :
1.

John C. B arton6 re p o r te d a 25 p e r c e n t respo nse to h is

q u e s t io n n a ir e but c o n sid e re d 1 t an I n d i c a ti o n o f "a h y p o th e tic a l
group o f Ohio p h y s ic ia n s who have an I n t e r e s t 1n t h e i r c o n tin u in g
e d u c a tio n . . .

Major c o n c lu sio n s were t h a t th e c o n tin u in g

medical e d u c a tio n needs o f responding p h y s ic ia n s a re w idespread and
c o ver a l l th e c l i n i c a l management c o n d itio n s a d d re sse d 1n th e s tu d y .
The a re a s r e q u i r i n g th e g r e a t e s t e d u c a tio n a l a t t e n t i o n were d i s c lo s e d
(which d i f f e r markedly from th e c h i r o p r a c t i c a r e a s o f I n t e r e s t ) .
Group d isc u ssio n * rea d in g medical j o u r n a l s and a tt e n d i n g
medical sem inars sponsored by lo c a l medical s o c i e t i e s were found to
be t h e i r prim ary e d u c a tio n a l methods.

O ther t r a i n i n g a id s such as

audio ta p e re c o rd in g s and r e c o r d s , l i b r a r y a r t i c l e s and medical
sem inars sponsored by n a tio n a l medical o r g a n i z a t i o n s a re a v a i l a b l e
to th e p h y s ic ia n , b u t a r e n o t used.

Responding p h y s ic ia n s exp ressed

a d e s i r e f o r programmed I n s t r u c t i o n , group d i s c u s s i o n , medical t e l e ­
v i s i o n , computer a s s i s t e d I n s t r u c t i o n and video ta p e re c o r d in g s .
2.

Eugene K. Horton7 I n v e s t ig a te d p ro c e ss I n t e r e s t and

e d u c a tio n a l commitment b u t m ajor emphasis was focused on c o n te n t
In tere st.

P h y s ic ia n s , n u rse s and a l l i e d h e a l th personnel a t s i x

6J . C. B arton, "Needs f o r Continuing Medical Education as
P erceiv ed by S e le c te d Ohio P h y s ic ia n s " (Ph.D. d i s s e r t a t i o n , Ohio
S t a t e U n i v e r s i ty , 1971), 32/05-B , p. 2808.
7E. K. Horton, " I n t e r e s t s o f P ro f e s s io n a l Groups 1n Con­
ti n u i n g Medical Education" (Ph.D. d i s s e r t a t i o n , U n iv e r s ity o f Utah,
1972), 32/10-B, pp. 58-79-5880.

24
V eterans A d m in is tra tio n h o s p i t a l s were q u e s tio n e d .

Data comparisons

I n d ic a te d d i f f e r e n c e s and s i m i l a r i t i e s among th e p r o f e s s io n a l g ro u p s,
and th e h i g h e s t and lo w e st c o n te n t I n t e r e s t s a r e d is p la y e d .
o

3.

James B. Cowle

s t a t e s t h a t th e most s i g n i f i c a n t f in d in g

o f h i s stu d y 1s t h a t r e s e a r c h e r s should re-exam ine t h e i r I m p l i c i t
assum ption t h a t c h i r o p r a c t i c should be la b e le d 'd e v i a n t b e h a v i o r . 1
He n o tes t h a t " R a th e r th an being a r e l a t i v e l y pow erless I n d i v i d u a l ,
th e c h i r o p r a c t o r , la b e le d a s d e v ia n t 1n s o c i e t y a t l a r g e , 1s shown to
p o ssess c o n s id e r a b le s o c i a l power In ways h e r e t o f o r e unexam ined."
He b e lie v e s h in d ran c e o f I t s p r o f e s s io n a l Image 1s due to the
r a d i c a l l y unique e x p la n a tio n o f th e cause and n a tu r e o f d i s e a s e and
th e I n t e r n a l c o n f l i c t o v e r p h ilo s o p h ie s o f p r a c t i c e .
g
4. David S. S te in r e p o r t s t h a t th e medical p r o f e s s io n has
been p lan n in g c o n tin u in g e d u c a tio n programs through th e medical
sc h o o ls s in c e th e enactm ent o f mandatory c o n tin u in g medical educa­
t i o n req u ire m e n ts by th e s t a t e f o r annual r e l l c e n s u r e .

Medical

e d u c a to rs a re concerned o v e r th e many hours s p e n t in t h e s e programs
which a p p a re n tly f a l l to produce marked change 1n p h y s ic ia n s k i l l o r
knowledge.

The t r a d i t i o n a l s h o r t c o u rse program has been q u e stio n e d .

C onclusions were t h a t a d u l t e d u c a tio n p r i n c i p l e s a r e more a c c e p ta b le
Q

J . B. Cowle, "An Ethnography o f a C h i r o p r a c ti c C l i n i c :
D e f in i t io n s o f a D eviant S i t u a t i o n " (Ph.D. d i s s e r t a t i o n , M is s is s ip p i
S t a t e U n i v e r s i ty , 1974), 35/08-A, pp. 5527-5528.
g

D.
S. S t e i n , "The Continuing Medical Education S h o rt Course:
A Comparison o f A d ult Education and T r a d i ti o n a l Education Approaches
t o Program Planning" (Ph.D. d i s s e r t a t i o n , U n i v e r s i ty o f M ichigan,
1976), 3 7 /1 0 , p. 6220-A.

25
th an th e t r a d i t i o n a l approach 1n th e I n s t r u c t i o n a l fo rm a t.

The

r e s e a r c h e r I d e n t i f i e d such d e s i r a b l e elem ents as s o l i c i t i n g program
c o n te n t In p u t from th e le a r n e r * u s in g a c t i v e methods o f l e a r n i n g and
s o l i c i t i n g program and d i a g n o s t i c feedback from th e p h y s ic ia n group.
5.

James B. B a t t l e s 10 p r e s e n t s an Id ea l c o n tin u in g educa-

t l o n system a s a f l e x i b l e , m u l t i - o p e r a t i o n a l system which can s e r v e
a l l members o f th e h e a l th c a r e team s im u lta n e o u s ly .

I t would f u l f i l l

b oth p e rc e iv e d and a c tu a l needs a r i s i n g o u t o f p a t i e n t c a r e d a t a .
The Id e a l system 1s a g e n e ra l model which th e r e s e a r c h e r c o nclud es
1s a t t a i n a b l e and would p e rm it h e a l th p r o f e s s i o n a l s t o I n t e r a c t on
In n o v a tiv e methods 1n h e a l t h c a r e , t r a n s f e r r i n g In fo rm a tio n by
means o f " v a r io u s I n s t r u c t i o n a l m o d a l i t i e s . "
O ther L i t e r a t u r e Germaine t o t h i s Study
A l i s t i n g o f th e t e x tb o o k s , j o u r n a l s and o t h e r p e r i o d i c a l s
on c o n tin u in g e d u c a ti o n , c o n ti n u i n g p r o f e s s i o n a l e d u c a tio n and on
th e h e a l t h s c i e n c e s Inv olved 1s p r e s e n te d a s th e S e le c te d B ib lio g ra p h y
appended t o t h i s d i s s e r t a t i o n .
C o n tin u in g C h i r o p r a c t i c E ducation Programs
~in O th e r S t a t e s
The v a rio u s s t a t e a s s o c i a t i o n s were c o n ta c t e d in 1976 (s e e
Appendix A) f o r In fo rm a tio n I n c lu d in g t h e i r c o n tin u in g e d u c a tio n
program s.

The fo llo w in g s ta te m e n ts a r e e x c e rp te d from th e r e p l i e s

o f th o s e resp o n d in g :
^ ° J . B. B a t t l e s , "A Design Study f o r C o n tin u in g H ealth
P r o f e s s io n a l E ducation" (Ph.D. d i s s e r t a t i o n , Ohio S t a t e U n i v e r s i ty ,
1976), 3 7 /1 1 , p. 6B96-A.

26
A rizona
Every y e a r a t th e s t a t e c o n v en tio n 1n A rizona t h e r e
1s a plann ed e d u c a tio n a l program. This y e a r ' s theme
was P r e v e n tiv e M edicine. Also tw ic e a y e a r th e
a s s o c i a t i o n o f f e r s th e Goodheart Seminars w ith Dr.
G oodheart, and th e E rh a rd t X-Ray S em inars, once a
month.
C a lifo rn ia
C a l i f o r n i a C h i r o p r a c ti c A s s o c ia tio n (CCA) and o u r
s u b o r g a n i z a ti o n , H ealth S e rv ic e s F ou n d atio n , a r e
a c t i v e l y sp o n so rin g sem in ars th ro u g h o u t th e y e a r .
Some o f t h e s e a re t o meet r e l i c e n s i n g re q u ire m e n ts
and o t h e r s a r e s p e c i a l t y ty p e s . Our c o n v e n tio n s
have h i s t o r i c a l l y Included l i c e n s e renewal program
mlng.
Colorado
A c o u rs e on S p o rts I n j u r i e s and K in e sio lo g y . Our
S pring Seminar and Convention c o n s i s t o f l e c t u r e s on
n e u r o l o g i c a l , o r th o p e d ic and k in e s io lo g y exam ination
o f th e p a t i e n t ; s u b l u x a ti o n ; low back c o n d i t i o n ; body
c a s t i n g ; lumbar s u p p o r t s ; m a l p r a c t i c e ; s p in a l r e s e a r c h
by Colorado S t a t e U n i v e r s i t y ; anatomy; Dr. Suh r e s e a r c h
a t C olorado S t a t e U n i v e r s i t y ; d e t e c t i o n , c a r e and
management o f p o s tu r a l d e f e c t s ; d i a g n o s i s ; c l a s s i f i c a ­
t i o n and t r e a t m e n t o f lumbar d i s c p r o t r u s i o n s and
p r o l a p s e s ; p e rs o n a l involvem ent—g r a s s r o o t s p o l i t i c s
and o t h e r t o p i c s such a s a u r e c l l l o th e r a p y and
d e v elo p in g tom orrow 's p r a c t i c e , today.
Delaware
T here a r e no e d u c a tio n a l programs p lann ed f o r 1976.
No programs have been o f f e r e d In t h e p a s t f i v e y e a r s .
F lo rid a
Usual se m in ars and c o n v e n tio n s .
Hawal1
Technique se m in a rs . . . ACA c o n v e n tio n .

27
In d ian a
M ostly N e u ro lo g ic a l‘ O rth o p ed ic o r i e n t e d programs
o rg a n iz e d th roug h t h e C h i r o p r a c ti c C o lle g e s ( u s u a l l y
N ational C o lle g e ) and some p o l i t i c a l a n d /o r In su ra n c e
sem inars a s th e y deem n e c e s s a r y a n d /o r a p p r o p r i a t e .
Iowa
O rth o p ed ic s and X-Ray.
Kentucky
A s s o c ia tio n p r e s e n t s a th r e e - d a y e d u c a tio n a l sem inar
y e arly .
L o u is ia n a
None (p lan ned f o r 1976 o r o f f e r e d 1n th e p a s t f i v e
y ears).
Mary!and
In A pril 1976 we had a tw o-day sem inar t a u g h t by Dr.
James W. Cox o f N atio nal C o lle g e . T opic was D ia g n o s is ,
C l a s s i f i c a t i o n and T reatm ent o f th e Most Common
Causes o f Low Back P a in . We have been fo llo w in g t h e
programs a s sponsored by t h e v a rio u s sc h o o ls f o r many
y e a r s and w ill c o n tin u e t o do so.
M innesota
M innesota law d i c t a t e s t h a t o u r D .C .s must have f i v e
(5) m o nitored h o u rs p e r y e a r o f c o n tin u in g e d u c a tio n .
We p ro v id e t h e s e r e q u i r e d e d u c a tio n a l hours a t o ur
annual C onvention. However, we p u t se m in a rs on
th ro u g h o u t th e b a la n c e o f t h e y e a r [ o f which] some
hours can be a p p li e d tow ard t h e re q u ire m e n t f o r
l i c e n s u r e . O ther e d u c a tio n a l sem in ars a r e p u t on
th ro u g h o u t t h e y e a r f o r C.A.s ( c h i r o p r a c t i c a s s i s t a n t s )
a s well as se m inars s t r i c t l y f o r t h e D.C.s 1n t h e way
o f o f f i c e management, c o n tin u in g e d u c a tio n 1n c h i r o ­
p r a c t i c , e t c . We u s u a l l y I n v i t e a l l non-members a t an
Increased r e g i s tr a ti o n fee r a te .

28
M issouri
Six r e g io n a l sem inars p lu s '77 c o n v e n tio n . Same
form at in '7 5 - '7 6 . Only c o n v en tio n p r e v i o u s ly .
Nebraska
E d u catio n al programs: 1974 Convention and sem inar:
Dr. James F. Lee, " C e rv ic a l-D o rs a l Spine" and "Lumbo­
s a c r a l S p in e ," Dr. Frank Hoffman, " C l in ic - L a b o r a to r y
E v a lu a tio n s in R e la tio n t o C h i r o p r a c t i c P r a c t i c e , "
Mr. Henry R o t h b l a t t , A tto r n e y , " C h ir o p r a c to r as a
Medical C h i r o p r a c t i c E x p e rt" ; 1975 Convention and
Seminar: Dr. A. L. S c h u ltz , "E x tre m ity A d ju s tin g and
S u p p o rtiv e C a re ," Dr. Paul W hite, "A pplied K in e s io lo g y ."
1976 Convention and Seminar: Drs. Arnold and Groves,
"Neurology A pplied 1n Everyday P r a c t i c e , " Dr. James
E is e n , " D e te c tio n and P re v e n tio n o f C ong enital
A no m alies." We a l s o have a s p r in g sem in ar and b u s in e s s
m eeting and o f f e r 6 hours o f c r e d i t toward l i c e n s e
renewal f o r sem inar a tt e n d a n c e . The 1976 s p e a k e r was
T. A. Vonder Haar o f th e U n i v e r s i t y o f M issou ri a t
S t . Louis on I a t r o g e n i c D is e a s e .
New J e r s e y
Our e d u c a tio n a l programs a r e worked 1n as p a r t o f
Columbia [ c h i r o p r a c t i c ] C o l l e g e 's c o n tin u in g e d u c a tio n
program.
New York
The NYSCA [New York S t a t e C h i r o p r a c t i c A s s o c ia t io n ]
p r e s e n t s an e x te n s i v e e d u c a tio n a l program t o t h e members
each y e a r b o th d u rin g th e y e a r and a t c o n v e n tio n . Our
y e a r runs from J u l y 1 t o May 31 and t h e r e f o r e o u r 1975
program has n o t y e t been o f f i c i a l l y fo r m u la te d . For
y o u r In fo r m a tio n , however, e n c lo s e d p l e a s e f i n d m a t e r i a l s
r e l a t i v e t o t h e 1975 program.
North C a ro lin a
E nclosed 1s a C a le n d ar o f Events o u t l i n i n g o u r program
f o r 1976. We have no r e c o r d s a d eq u a te t o p ro v id e you
w ith programs o f f e r e d 1n t h e p a s t f i v e y e a r s .

29
Worth Dakota
Our s p r i n g c o n v en tio n which 1s m andatory f o r renewal
o f l i c e n s e (o r tw elve hours a t a p o s tg r a d u a te c o lle g e *
sp onsored c o u rs e ) was w ell a tt e n d e d . T h is y e a r o u r
s p e a k e r was Dr. Lemolne de Rusha who spoke on
C h i r o p r a c t i c te c h n iq u e .
Oklahoma
V ariou s sem inars a r e o f f e r e d by th e A s s o c ia tio n a t
f r e q u e n t I n t e r v a l s d u rin g each c a l e n d a r y e a r , I n c lu d in g
such s u b j e c t s a s a c u p u n c tu re , In s u r a n c e , comprehensive
h e a l t h p la n n in g , e t c .
Oregon
The o n ly planned e d u c a tio n a l programs by th e OACP
[Oregon A s s o c ia tio n o f C h i r o p r a c t i c P h y s i c i a n s ] a r e
t h e annual s t a t e c o n v e n tio n s . With t h e e x c e p tio n o f
an o c c a s io n a l E d u catio n al Council sem inar . . . a l l
e d u c a tio n a l programs a r e planned th ro u g h th e P o s tG radu ate Department o f W estern S t a t e s C h i r o p r a c t i c
C o lle g e .
Pennsvlv anla
We I n i t i a t e d a s e r i e s o f p o s t - g r a d u a t e sem in ars
d u rin g th e y e a r 1976 which we p la n t o c o n tin u e I n t o
1977. These se m in a rs a r e now a c c e p te d a s c r e d i t f o r
l i c e n s e renewal 1n many s t a t e s .
Rhode I s la n d
Due t o t h e f a c t t h a t we now have a c o n tin u in g e d u c a tio n
b i l l , th e S t a t e s o c i e t y w i l l be sp o n so rin g some educa­
t i o n a l s e m in a rs. Because o u r s t a t e 1s so sm all we do
n o t have a s t a t e c o n v e n tio n . What we do 1s p a r t i c i p a t e
1n t h e New England C h i r o p r a c t i c Convention each y e a r .
We w i l l h o s t t h e c o n v e n tio n 1n th e y e a r 1980. In t h e
p a s t f i v e y e a r s we have sp o nso red e d u c a tio n a l se m inars
f o r o u r members e s p e c i a l l y 1n X-Ray p ro c e d u re and
d iag n o sis.

30
South Dakota
. . . [ f o r ] 1977 a t l e a s t 10 hours w ith Dr. P e te r
M artion o f P.C.C. (Palmer C ollege o f C h i r o p r a c t i c ) .
Texas
A comprehensive Med1care-Med1ca1d Seminar J u l y 24-25;
tw elve hours o f C h ir o p r a c tic Board o f Examiners
approved l e c t u r e s a t o u r annual convention June 10-1112. There were workshops in Spinal B1o-Mechan1cs and
A t h l e t i c I n j u r i e s . We have numerous e d u c a tio n a l p ro ­
grams, none p a r t i c u l a r l y unique enough t o p o i n t t o .
Vermont
One p e r y e a r a t Spring Convention. P a s t 5 y e a r s same
one in c o n ju n c tio n w ith th e New England Convention.
V ir g in ia
We have undertaken a c o n tin u in g e d u c a tio n program on
a q u a r t e r l y t o t r i - a n n u a l b a s i s 1n 1976 . . . r o e n t ­
genology, d i s c - r e l a t e d problem s, In su ran ce r e l a t i o n s
and h a n d lin g . All a r e weekend programs.
Wisconsin
Educational programs f o r th e WCA [W isconsin C h ir o p r a c tic
A s s o c ia tio n ] members a r e : Roentgenology, a d j u s t i n g
te c h n iq u e s , n u t r i t i o n , c h i r o p r a c t i c r e s e a r c h , c h i r o ­
p r a c t i c ph ilo so p h y , o f f i c e p r a c t i c e p ro c e d u re s , such as
r e c o rd keeping and e x p e r t w itn e s s testim o n y . The programs
o f th e l a s t f i v e y e a r s have g e n e r a l l y been along th e s e
areas.
Wyoming
1975, Dr. West; 1976, Dr. G reenaw alt.
N ote:

The s t a t e s o f C o n n e c tic u t, Kansas, Tennessee and

Washington s e n t 1n d e s c r i p t i v e m a te r ia l about t h e i r e d u c a tio n a l
programs f o r 1976 a n d /o r th e p re v io u s f i v e y e a r s .

31
R e p lie s from th e a s s o c i a t i o n s r e p r e s e n ti n g h e a lth and non*
h e a l th r e l a t e d p ro fe s s io n s , a re p re s e n te d 1n summary form as In d ic a te d
below:
H ealth R elated F ie ld s
A.

Michigan Health O f f i c e r s A s s o c ia tio n .
F i f t y hours c o n tin u in g medical e d u c a tio n f o r MD
annual r e l l c e n s u r e .

B.

Michigan Dental A s s o c ia tio n ,
Continuing e d u c a tio n s e s s io n s a t annual m eetings
o n ly .

C.

Michigan V e te r in a r y Medicine A s s o c ia t io n .
L ec tu re ty p e m eetings f o r r e l l c e n s u r e . S t a te s
" r e q u ir e d a tte n d a n c e 1s n o t th e answer to In su rin g
competency." V e te r in a ry m edicine c o n tin u in g educa­
t i o n Is now on a v o lu n ta r y b a s i s o n ly . "Must
Improve m o tiv a tio n —n o t l e g i s l a t e . "

D.

Michigan Nurses A s s o c ia t io n .
S t a f f developm ent, formal c o n tin u in g e d u c a tio n f o r
p o s t- g r a d u a te c e r t i f i c a t i o n 1n a n u rsin g s p e c i a l t y
and Informal e d u c a tio n on an I n t e r m i t t e n t b a s i s .
A non-degree p o s t- g r a d u a te program on p e d i a t r i c
n u rsin g Is given a t th e U n iv e rs ity o f Michigan.

E.

Michigan Q ptom etrlc A s s o c ia t io n .
Must have 12 hours c o n tin u in g o p to m e trlc e d u c a tio n
f o r annual r e l l c e n s u r e . T h irty -o n e a d d i t i o n a l s t a t e s
have s i m i l a r re q u ire m e n ts . The A s s o c ia tio n sponsors
fo u r c o n tin u in g e d u c a tio n sem inars o f 12 hours each.
Local o p to m e trlc s o c i e t i e s a l s o spo nsor such se m in a rs.

F.

Gerontology I n s t i t u t e o f th e U n iv e rs ity o f M ichigan.
O ffe rs r e s i d e n t i a l I n s t i t u t e s and workshops a s con­
t i n u i n g p r o f e s s io n a l e d u c a tio n .

32
Non-Health R e la te d F i e ld s
A.

Funeral D i r e c t o r s A s s o c ia tio n .
Convention s p e a k e rs a t 1, 2 , 3 and 5 day program s.
B ehavioral s c ie n c e and management.

B.

I n s t i t u t e o f C o n tinuing Legal E d u c a tio n .
L e c tu re s and d i s c u s s i o n s , c a s e c i t a t i o n s , s a l i e n t
p o i n ts o f law and p r a c t i c a l a p p l i c a t i o n s . All
v o lu n ta r y .

C.

American I n s t i t u t e o f A r c h i t e c t s .
Have one and two day l a b o r a t o r i e s , s tu d y g u id e s ,
c a s s e t t e s and review o f A r c h i t e c t u r a l P e r i o d i c a l s .
All v o lu n ta r y .

D.

American I n s t i t u t e o f C e r t i f i e d P u b lic A c c o u n ta n ts.
L e c tu r e s , c a s e s , panel group d i s c u s s i o n s , workshops
o f one and two d a y s. A ll v o l u n ta r y .
Summary

The s e l f - a s s e s s m e n t su rv e y s p o i n t o u t th e need f o r more
em phasis on d a ta g a th e r in g 1n c o n tin u in g p r o f e s s i o n a l e d u c a tio n
a r e a s and th e v a r i e t y o f s u b j e c t s t h a t can be made a v a i l a b l e t o
u p d a te th e knowledge and s k i l l s o f th e p r a c t i t i o n e r .
D octoral d i s s e r t a t i o n s r e l e v a n t t o t h i s stu d y w ere n o t a l l
Illu m in a tin g .

B a r to n 's Ohio P h y s ic ia n s su rv e y 1s s u s p e c t because o f

t h e low re s p o n se o f 25 p e r c e n t , y e t 1 t Is I n t e r e s t i n g t o n o te t h a t
c e r t a i n I n s t r u c t i o n a l methods a r e made a v a i l a b l e , b u t a r e n o t used
by th e p h y s i c ia n s , I n d i c a t i n g th e need f o r t a i l o r e d program s.
C ow le's s tu d y 1s I n t r i g u i n g 1n t h a t th e 'd e v i a n t ' l a b e l i n g by th e
American p u b l ic 1s re c o g n iz e d a s r e q u i r i n g a re -e x a m in a tio n by
r e s e a r c h e r s stu d y in g t h i s p r o f e s s i o n .

S t e i n ' s com parison o f t h e

33
a d u l t and t r a d i t i o n a l e d u c a tio n a p proaches I s o f I n t e r e s t .

While

s h o r t c o u rs e s v i a t h e t r a d i t i o n a l approach had l i t t l e l e a r n in g
Im pact, a d u l t e d u c a tio n p r i n c i p l e s a r e more a c c e p t a b l e and p r e ­
sumably b e t t e r r e t a i n e d .

B a t t l e s ' d e s ig n model I s unique bu t more

I n t e r e s t i n g would be a r e p o r t o f th e s u c c e s s f u l a p p l i c a t i o n o f t h i s
system .
The l i t e r a t u r e In t e x tb o o k s , p e r i o d i c a l s and magazines
e x p re s s a u th o r v ie w p o in ts , some f o r and some a g a i n s t c h i r o p r a c t i c as
a p r o f e s s i o n a l group.

Much work I s needed by u n b ia s e d b e h a v io ra l

s c i e n t i s t s t o e v a l u a t e p ro s and cons o f oppo sing f a c t i o n s 1n th e
h e a l t h f i e l d , and s u g g e s t means o f r e s o l v in g t h e d i f f e r e n c e s .
The c o n tin u in g e d u c a tio n programs r e p o r t e d by t h e v a rio u s
s t a t e a s s o c i a t i o n s I n d i c a t e l i t t l e homogeneity 1n t h e i r approach t o
th is su b je ct.

The l a r g e r p o p u la te d s t a t e s seem t o have th e more

a g g r e s s iv e program s.
M edical, o s t e o p a t h i c , c h i r o p r a c t i c , o p to m e trlc p r a c t i t i o n e r s
r e q u i r e a number o f hours o f c o n tin u in g p r o f e s s i o n a l e d u c a tio n to
s a t i s f y annual r e l l c e n s u r e re q u ire m e n ts .

O ther h e a l t h team w orkers

do n o t y e t r e q u i r e t h i s mandatory t r a i n i n g .

In d ic a tio n s a re th a t

f e d e r a l a g e n c ie s may r e q u i r e , 1n th e p u b l ic I n t e r e s t , a feedback v ia
exam inatio n r a t h e r th a n mere expo sure t o c o n tin u in g e d u c a tio n c o u rs e s
fo r r e llc e n s u r e to p r a c tic e a h e a lth p ro fe s s io n .
N o n-health r e l a t e d p r o f e s s i o n s have some e x c e l l e n t programs
1n c o n tin u in g e d u c a tio n .
t o a s s o c i a t i o n members.

These v o l u n ta r y programs o f f e r new knowledge
The p o s s i b i l i t y o f compulsory a tte n d a n c e a t

34
t h e s e c o u rs e s Is rem ote s i n c e th e p u b l ic I n t e r e s t I s n o t a t s t a k e as
w ith h e a l t h - r e l a t e d p r o f e s s i o n s .
In C h ap ter I I I t h e s t r a t e g i e s and sam pling m easures a r e p r e ­
sen ted .

The s o u r c e s , s e l e c t i o n o f th e su rv e y In stru m e n t and a

r a t i o n a l e g iven f o r th e framework o f th e d e sig n I s fo llow ed by a
sunmary o f t h i s c h a p t e r .

CHAPTER I I I
RESEARCH DESIGN AND PROCEDURES
I n t r o d u c t io n
The prim ary purpose o f t h i s s tu d y 1s t o I n v e s t i g a t e th e
c u r r e n t c o n tin u in g e d u c a tio n p r a c t i c e s and p e rc e iv e d p o s t - d o c t o r a l
l e a r n i n g needs o f c h i r o p r a c t o r s 1n Michigan.

To a c h ie v e t h i s , a

number o f r e s e a r c h q u e s tio n s have been s e l e c t e d , which In c lu d e :
1.

In what p r o f e s s i o n a l a r e a s a r e DCs n o t I n t e r e s t e d ?

2.

Are c h i r o p r a c t o r s I n t e r e s t e d 1n a d d i t i o n a l s c ie n c e
d e g re es?

3.

Where would Michigan p r a c t i t i o n e r s p r e f e r t o a t t e n d
c l a s s e s 1n c o n tin u in g p r o f e s s i o n a l e d u c a ti o n , when
and f o r what le n g th o f tim e?

4.

Should th e c o n tin u in g e d u c a tio n c o u rs e s le a d to
sp e c ia lty c e r tif ic a tio n ?

5.

Who should b e a r t h e c o s t o f c o n tin u in g e d u c a tio n
programs?

6.

Have p a s t e d u c a tio n a l c o u r s e s , g iv e n f o r r e l l c e n s l n g
re q u ire m e n t p u rp o s e s , been e f f e c t i v e 1n upgrading
th e DCs1 p r o f e s s i o n a l competence (1n t h e i r o p in io n ) ?

7.

Are Michigan c h i r o p r a c t o r s s a t i s f i e d w ith th e ty p e
and q u a l i t y o f c o n tin u in g e d u c a tio n c o u rs e s a s now
p r e s e n te d f o r l i c e n s e renewal p u rp o se s?

T h is c h a p t e r d e s c r i b e s th e r e s e a r c h d e sig n and d e l i n e a t e s t h e
p ro c e d u re s used 1n c o l l e c t i n g , com piling and a n a ly z in g t h e d a t a .
In clu d e d 1s a d e s c r i p t i o n o f th e p o p u la tio n s t u d i e d , d e f i n i t i o n o f
35

36
th e sample s e l e c t e d and a d is c u s s io n o f th e prim ary In stru m en t
employed.

The a d m i n i s t r a t io n o f the Instrum ent and I t s s t a t i s t i c a l

tr e a tm e n t a r e e x p la in e d .
Framework o f th e Study
The d esign o f t h i s I n v e s t i g a t i o n 1s based upon d e s c r i p t i v e
r e s e a rc h methods b u t n o t l i m i t e d s o l e l y to such methods.

The survey

a s a form o f e d u c a tio n a l r e s e a r c h uses l o g i c and s t a t i s t i c a l p ro ­
cedures f o r a n a ly z in g th e d a ta o b ta in e d , as opposed to su rveys made
j u s t f o r s y s te m a tic d a ta c o l l e c t i o n . ^
The stu d y was conducted by o b ta in in g demographic, s o c i o ­
economic and e d u c a tio n a l d a ta and o p in io n s from Michigan l i c e n s e d
re s id e n t c h iro p ra c to rs.

I t I s b e lie v e d th e s e d a ta co u ld b e s t be

a c q u ire d through d e s c r i p t i v e r e s e a r c h methods w ith th e d e sig n and
use o f a q u e s tio n n a ir e as th e su rvey In stru m e n t.

This form a s th e

main I n v e s t i g a t i v e Instru m en t was deemed most p r a c t i c a l s in c e th e
c h i r o p r a c t i c d o c to r p o p u la tio n 1s r e l a t i v e l y s m a ll, under 1000, and
c o n t a c t w ith a 100 p e rc e n t sample would prove r e l a t i v e l y In ex p e n siv e ,
tim e -s a v in g , promote e a se o f com pletion and subsequent t a b u l a t i o n ,
and 1s "a method f o r d is c o v e r in g f r u i t f u l problem a re a s f o r f u t u r e
2
In v e s tig a tio n ."
There a r e some l i m i t a t i o n s t o th e use o f th e q u e s t io n n a ir e
In c lu d in g p r e j u d i c e t o com pleting a form, Im personal1zat1o n,
^W. R. Borg and M. D. G a l l , E ducational Research (2nd e d . j
New York: David McKay Company, 1971), p. 1 8 /.
2
D. R. B erdle and J . F. Anderson, Q u e s tio n n a ire s : Design and
Use (Metuchen, N . J . : The Scarecrow P r e s s , I n c . , 1974), p. 20.

37

p o s s i b i l i t y o f a low response* and o t h e r f a c t o r s .

However, th e

a l t e r n a t i v e s were weighed and found Im p ra c tic a l f o r th e purpose o f
t h i s stu d y .
P re lim in a ry Procedures
Since t h e r e Is an acknowledged v a ria n c e in p r a c t i c e b e l i e f s
among th e c h i r o p r a c t i c d o c to r s , 1t appeared lo g ic a l to f i r s t d e t e r ­
mine how th e m a jo r ity o f DCs 1n Michigan would l i k e to p r a c t i c e .
T his would o u t l i n e th e p aram eters f o r th e I n v e s t i g a t i o n o f p o s t ­
d o c to r a l d e s i r e s and p e rc e iv e d needs o f th e rank and f i l e p r a c t i ­
t i o n e r s and I n d i c a te w hether th e y a r e being met by c u r r e n t e d u c a tio n a l
programs.
The Michigan S t a t e C h ir o p r a c tic A s s o c ia tio n (MSCA) 1s th e
l a r g e s t p ro f e s s io n a l group r e p r e s e n ti n g th e Michigan p r a c t i t i o n e r .
They w ere, t h e r e f o r e , c o n ta c te d a s a m ajor re s o u rc e e n t i t y (se e
Appendix B).

A sim ple one-page q u e s t io n n a ir e was d e v ised and s e n t

to e very r e s i d e n t S t a t e - l i c e n s e d c h i r o p r a c t o r o f re c o rd (se e
Appendix C).

The p r a c t i t i o n e r was asked to s e l e c t one o f fo u r

c h o ic e s given as t o how he o r she would l i k e t o p r a c t i c e 1n Michigan.
The r e q u e s t o f t h i s m in i-su rv e y approach ( s e e Appendix D)
i n d ic a t e d t h a t a m a j o r it y (75 p e r c e n t) o f M ic h ig a n 's c h i r o p r a c t o r s
would p r e f e r t o p r a c t i c e by employing a l l d r u g le s s methods a n c i l l a r y
t o m a n ip u la tiv e p ro c e d u re s , but e x clu d in g drug m e d ica tio n and
o p e r a t iv e s u rg e r y which a r e both 1n th e domain o f o t h e r h e a lth
p ro fessio n s.

38
The p e rc en ta g e resp o n se (70 p e rc e n t o f th e t o t a l number o f
l i c e n s e e s In c lu d in g members o f th e MSCA, th e m in o rity group Michigan
C h ir o p r a c tic Council [MCC], and th e uncommitted d o c to r s ) ap p ears t o
confirm se v e ra l f a c t o r s (as advanced by a few c h i r o p r a c t o r s during
a r e c e n t d i s c u s s i o n ) which could In flu e n c e th e high r a t e o f r e t u r n s :
a.

A b a s ic c u r i o s i t y to a s c e r t a i n what th e av erage DC

p r a c t i t i o n e r s r e a l l y b e li e v e th ey should be p e rm itte d t o p r a c t i c e ,
s in c e many a re t r a i n e d f a r beyond what th e p r e s e n t p r a c t i c e s t a t u t e
p e rm its them t o do.
b.

The c u r r e n t c o n tr o v e r s i a l I s s u e as t o how l e g i s l a t o r s

w ill r e a c t t o th e many b i l l s in tro d u c e d by v a rio u s segments o f th e
p r o f e s s i o n , each adamant 1n t h e i r views on what th e y c o n s id e r th e
p ro p e r scope o f p r a c t i c e .
c.

C h ir o p r a c tic p r a c t i t i o n e r s , l i k e o t h e r h e a l th p r o f e s ­

s i o n a l s , a r e c o n s t a n t l y bombarded w ith l i t e r a t u r e from many com­
m erc ia l and 1 n tra p ro fe s s1 o n a l s o u rc e s —a l l w ith a f i n a n c i a l axe t o
g r in d .

The Opinion Survey re q u e s te d one s e l e c t i o n w ith o u t s o l i c i t i n g

funds o f any kind and r e q u ir e d l i t t l e e x p e n d itu r e o f tim e o r e f f o r t
f o r th e busy p r a c t i t i o n e r .

The uniqueness o f such an approach

a p p a r e n tly had I t s n o v e lty e f f e c t and c o n t r i b u t e d to th e high
re sp o n se .
d.

The s i m p l i c i t y o f th e d e v ised su rv e y In s tru m e n t, r e q u i r i n g

a s i n g l e c h o ic e , d i f f e r e d from th e usual b a rra g e o f q u e s t io n s —some
o f which may be c o n sid e re d a s to o personal o r o f f e n s i v e t o th e
re c ip ie n t.

39
Comments re c e iv e d w ith t h i s o p in io n su rvey were most I n t e r e stln g .

Many p r a c t i t i o n e r s e x p re sse d t h e i r f e e l i n g t h a t th e scope

o f p r a c t i c e should be commensurate w ith th e t r a i n i n g re c e iv e d by th e
In d iv id u a l d o c to r , e s p e c i a l l y 1 f follow ed by a q u a li f y in g exam ination
1n th e s u b j e c t and p r e f e r a b l y g iven o r m onitored by th e Michigan
S t a t e Board o f C h ir o p r a c tic Examiners.

T his I n d ic a te d an awareness

t h a t f u r t h e r l e a r n i n g , through Continuing E d ucation, may be th e key
to e v e n tu a lly In c re a s in g th e p e rm itte d scope o f p r a c t i c e , w h ile
upgrading c u r r e n t p r o f e s s io n a l e x p e r t i s e .
To avoid a p o s s ib l e charge o f b i a s , no s i g n i f i c a n c e was
a tta c h e d t o th e p e rc e n ta g e s 1n r e p o r t i n g them t o a l l th e H c e n s e s s
nor were I n t e r p r e t a t i o n s made o f th e few comments r e c e iv e d .

The

100 p e rc e n t sampling o f a l l r e s i d e n t c h l r o p r a c t l c e l i c e n s e e s reduced
th e p o s s ib l e e r r o r t o an a c c e p ta b le minimum.

O u t - o f - s t a t e h o ld e rs o f

Michigan l i c e n s e s were bypassed due to th e I n t e n t o f th e q u e ry ,
l im i te d t o r e s i d e n t s o f M ichigan.
Q u e stio n n a ire C o n stru c tio n
A fiv e - p a g e q u e s t io n n a ir e (se e Appendix F) was d e sig n ed 1n
f o u r p a r t s t o g a th e r th e o p in io n s and a t t i t u d e s o f th e l ic e n s e d
r e s i d e n t Michigan c h i r o p r a c t o r s so as t o o b t a i n a p r a c t i t i o n e r
p ro file .
The f i r s t p a r t a d d re s s e s th e socio-econom ic s t a t u s , t h e
second 1s concerned w ith p r a c t i c e s t a t i s t i c s , th e t h i r d reviews
th e d o c t o r s ' e d u c a tio n a l background and th e f o u r t h s o l i c i t s t h e i r
views on c o n tin u in g p r o f e s s i o n a l e d u c a tio n .

40
R e l i a b i l i t y g e n e r a l l y r e f e r s t o th e a b i l i t y o f th e e m p iric a l
In stru m en t to measure c o n s i s t e n t l y , and v a l i d i t y b e a rs on
th e a b i l i t y o f th e In stru m en t to t r a n s l a t e In to se n so ry e m p iric a l o p e r a t io n s t h e d e f i n i t i v e c h a r a c t e r i s t i c s o f the
c o n c e p t.3
To t e s t th e I n s tru m e n t, th e f i v e D i s t r i c t (se e Appendix E)
p r e s i d e n t s , th e MSCA p r e s i d e n t , v i c e - p r e s i d e n t and la y d i r e c t o r com­
p r i s i n g the A s s o c i a t i o n 's Board o f D i r e c to r s reviewed t h e q u e s tio n ­
n a ir e p r i o r to d i s t r i b u t i o n .

The consensus was t h a t 1 t conveyed

th e same meaning t o a l l c o n s i s t e n t l y ( r e l i a b i l i t y ) and e l i c i t e d t r u e
resp o n ses r e l e v a n t to In form ation wanted ( v a l i d i t y ) .
A d m in is tra tio n o f th e Survey
As t h e r e a r e 850 l ic e n s e d c h i r o p r a c t i c p r a c t i t i o n e r s In th e
S t a t e o f M ichigan, a 100 p e rc e n t sam pling o f th e DC p o p u la tio n was
fe a sib le .

T his would e li m in a te o r minimize e r r o r s due t o random

sampling as f o r a l a r g e r t a r g e t p o p u la tio n .

I t was a l s o planned to

u t i l i z e th e f a c i l i t i e s o f th e s t a t i s t i c a l departm ent a t Michigan
S t a t e U n iv e rs ity u sin g computer a s s i s t a n c e t o o b t a i n th e optimum
r e s u l t s from th e d a ta o b ta in e d .
In A pril 1977 th e comprehensive q u e s t io n n a ir e was m ailed to
each o f the l i c e n s e d DCs 1n M ichigan.

A s t a t e h e a lth manpower survey

and an MSCA l e g i s l a t i v e su rv e y , both s e n t t o DCs 1n th e f i r s t
q u a r t e r o f 1977, may have c o n tr i b u te d t o th e slow re s p o n se .

A

fo llo w -u p l e t t e r (se e Appendix G) was t h e r e f o r e s e n t two weeks l a t e r .
One month a f t e r t h i s m a i l in g , f u r t h e r a c c e p ta n c e o f completed
O

W. M. D o b rln e r, S ocial S t r u c tu r e s and Systems ( P a c i f i c
P a l is a d e s , C a l i f . : Goodyear P u b lish in g C o ., 1969), P- 43.

41
q u e s t i o n n a i r e s was h a l t e d and a s y s te m a tic a n a l y s i s w ith computer
a s s i s t a n c e was begun.

To v a l i d a t e th e re s p o n se (N * 386 o r 45

p e r c e n t ) a s being a r e p r e s e n t a t i v e sample o f t h e t o t a l Michigan
c h i r o p r a c t i c p o p u l a t i o n , a c o r r e l a t i o n was so ugh t between two s i m i l a r
a r e a s o f I n q u i r y , as r e p o r te d 1n A pril 1977 by th e Michigan D ep art­
ment o f P u b lic H ealth (MDPH) and a s found 1n t h i s su rv e y .

(The

c l o s e c o r r e l a t i o n 1s s e l f - e v i d e n t . )

I.

Michigan DC P o p u la tio n —by Age Groups:
MDPH (T able 2)
Up t o 34
35 t o
45 t o
55 t o
Over 65

II.

years
44
54
64
years

T h is Survey
27.0%
22.4
1 7 .6
18.4
1 1.4

27.6%
2 4.4
1 9.2
17.4
10.4

G eographical Area o f P r o f e s s io n a l E d u c a tio n :
MDPH (T able 4)
41.7%
2 4 .9
15.1
6 .0
4 .0

Palmer C o lle g e o f C h i r o p r a c t i c
N ational C o lle g e o f C h i r o p r a c t i c
L in c o ln C o lle g e o f C h i r o p r a c t i c
Logan C o lle g e o f C h i r o p r a c ti c
O th e r S t a t e s and Canada

T h is Survey
40.2%
27.9
17.5
3 .4
5.1

S t a t i s t i c a l T reatm ent
The fo llo w in g s t e p s were ta k e n 1n coding and q u a n ti f y in g
in fo rm a tio n p r i o r t o a n a l y s i s by e l e c t r o n i c d a ta p r o c e s s in g e q u ip ­
m ent:

42
1.

Answers from each o f th e q u e s t io n n a ir e r e t u r n s were

t r a n s f e r r e d by hand to m ac h in e -rea d ab le s c o rin g s h e e t s (two s h e e ts
per re p ly ).
2.

The sc o rin g s h e e ts were then o p t i c a l l y scanned and t h e

d a ta a u to m a t i c a ll y punched I n to c ard s (two c a rd s p e r r e p l y ) .

The

keypunch 1s 100 p e rc e n t v e r i f i e d .
3.

S t a t i s t i c a l Package f o r th e Social Sciences (SPSS)

programs were w r i t t e n to a n aly ze th e d a ta w ith th e a p p r o p r ia te
sta tistic s.
4.

A PNC (Problem Number Card) was o b ta in e d f o r th e Michigan

S t a te U n iv e rs ity (MSU) C ollege o f E d ucation . 1n o r d e r to run th e
programs on th e CDC 6500 Computer a t th e MSU Computer C en ter.
5.

Programs were run and p r i n t o u t s o b ta in e d .

6.

A n a ly sis o f th e p r i n t o u t d a ta w ith in each su b s e c tio n

o f th e survey In stru m en t was made and t a b l e s and graphs c o n s tr u c te d
f o r e a se o f p re s e n tin g In fo rm a tio n .

In fe re n c e s were then drawn from

th e r e s u l t s o b ta in e d .
Ch1-square

A n a ly sis was used t o t e s t th e r e l a t i o n s h i p

between two o r more c a t e g o r i c a l v a r i a b l e s having a s e t o f expected
f r e q u e n c i e s , e . g . , Age v e rs u s Income.
One-way A n a ly sis o f V ariance (ANOVA) was used f o r comparing
one c a t e g o r i c a l and one co n tin u o u s v a r i a b l e , e . g . , Income v e rsu s
T o tal Hours Worked p e r Week.
In both c a s e s , alp h a ■ .05 was used t o t e s t s i g n i f i c a n c e .

43
S u rm a r y

In th e p r e s e n t c h a p te r th e r e s e a r c h s e t t i n g has been b r i e f l y
d e s c r ib e d and th e p ro ce d u res used to c o l l e c t , compile and a n aly ze
th e d a ta have been d e l i n e a t e d .

The p o p u la tio n was d e fin e d w ith an

e x p la n a tio n o f th e sample s e l e c t e d .

The c h o ic e o f th e survey

In s tru m e n t, a q u e s t i o n n a i r e , was defended.

The type o f re s e a r c h

stu d y and th e d a ta a n a l y s i s te c h n iq u e s were j u s t i f i e d .
In C hapter IV th e d a ta w ill be o r g a n iz e d , p re s e n te d and
a n aly ze d .

In C hapter V th e summaries w ill be c o l l a t e d , c o n c lu sio n s

drawn, I m p lic a tio n s d is c u s s e d and s u g g e stio n s f o r f u t u r e r e s e a r c h
p r e s e n te d .

CHAPTER IV
PRESENTATION AND ANALYSIS OF THE DATA
I n tr o d u c tio n
The purpose o f t h i s c h a p te r 1s to p r e s e n t th e f i n d in g s o f
th e stu d y .

In o r d e r to I n v e s t i g a t e th e c u r r e n t c o n tin u in g e d u ca tio n

p r a c t i c e s and p e rc e iv e d le a r n in g needs o f Michigan d o c to r s o f
c h i r o p r a c t i c , some d a ta d e riv e d from each p a r t o f th e q u e s tio n n a ir e
should be examined.

P a r t I has some Item s having a b e a rin g on th e

background o f th e p o p u la tio n being I n v e s t ig a te d .
Answers t o Item # (1 -1 ) o f th e q u e s t io n n a ir e determ ined th e
ages o f t h e resp o n d en ts w ith in t e n - y e a r age sp a n s.

Note t h a t 52.0

p e rc e n t o f th e Michigan p r a c t i t i o n e r s a r e between 25 and 44 y e a r s o f
age, 10.4 p e rc e n t a r e o ver 65 y e a r s and o n ly one p e r c e n t a r e under
25 y e a r s o f age.

The m a j o r it y a r e t h e r e f o r e 1n th e e a r l y and m iddle

age b r a c k e t o f a d u lth o o d , w ith many y e a r s o f p r o f e s s i o n a l l i f e ahead
o f them b e fo re th e t r a d i t i o n a l 65 y e a r r e t i r e m e n t age I s reached.
This c o n s t i t u t e s a prime p e rio d f o r c o n tin u in g p r o f e s s io n a l educa­
t i o n — I f th e p ro p er m o tiv a tio n 1s s u p p lie d (se e T able 1 ) .
Item # (1 -2 ) I n q u ir e s I n to t h e s i z e o f th e community where
th e d o c to r p r a c t i c e s .

Except f o r th e 31.2 p e rc e n t o f th e DCs

p r a c t i c i n g in communities o v e r 100,000 and th e 6 .9 p e rc e n t 1n
communities under 2000, t h e r e 1s a lm ost an even d i s t r i b u t i o n o f DCs

44

45
TABLE 1 . --C om position o f M ichigan DC P r a c t i t i o n e r s by Age Groups
Item # ( 1 - 1 ) .
Age Group

P e rc e n t o f DCs

25 - 34 y e a rs

2 7 .6

35 - 44

24.4

45 - 54

19.2

55 - 64

17.4

Over 65

10.4

Under 25

1.0

TOTAL

100.0

p r a c t i c i n g everywhere 1n M ichigan.

T his should be c o n s id e re d when

determ in in g where c o u rs e s a r e to be given (se e T able 2 ).
TABLE 2 . —S iz e o f Community Where C h ir o p r a c to r P r a c t l c e s - Item # ( 1- 2 ).
Community P o p u la tio n Size
Over 100,000

P e rc e n t o f Responding DCs
31.2

5,000 to

10,000

14.7

25,000 t o

50,000

13.1

50,000 t o 100,000

12.0

2,500 t o

5,000

12.0

10,000 t o

25,000

10.1

Under 2,500
TOTAL

6 .9

100.0

46
Items # (1 -8 ) to (-1 3 ) ask f o r th e Importance o f s e v e ra l
f a c t o r s In choosing th e p r a c t i c e l o c a t i o n .

The most Im portant

c o n s i d e r a ti o n s were th e p e rc e iv e d need f o r t h e i r s e r v i c e s and the
f i n a n c i a l p r o s p e c ts .

B e t t e r s e r v ic e s a re th e d i r e c t outcome o f

a d d it i o n a l e d u c a tio n and th e f i n a n c i a l p ro s p e c ts In c r e a s e as a
c o r o l l a r y o f re n d e rin g b e t t e r s e r v i c e .

I t would t h e r e f o r e seem t h a t

th e d o c to r s would be e a g e r t o f u r t h e r t h e i r e d u c a tio n as a means o f
e v e n t u a l l y a ch iev in g th e s t a t e d g o a ls (se e Table 3 ) .

TABLE 3 . — Importance 1n Choosing P r a c t i c e L o ca tio n — Items # (1 -8 )
through ( 1 -1 3 ) .

Very Im portant

P e rce n t
o f DCs

R e la ti v e ly Unimportant

P e rce n t
o f DCs

Need f o r DC S e rv ic e s

4 9 .5

Cl1mate

73.4

F in a n c ia l P ro sp ec ts

39.4

E s ta b lis h e d P r a c t i c e

68.9

Family T ies

26.5

R e c re a tio n a l Environment

55.8

E s ta b lis h e d P r a c t i c e

19 .5

Family T ies

51.9

R e c re a tio n a l Environment

1 7.3

Need f o r DC S e rv ic e s

22.4

F in a n c ia l P ro sp e c ts

20.5

8 .9

C lim ate
TOTAL*
*

P ercen tag es do n o t add up to 100.0 because o f o v e rla p p in g
c o n d it i o n s .

Item # (1-1 4) sought t o d eterm in e th e annual p r a c t i c e income
f o r Michigan DC p r a c t i t i o n e r s .

The l a r g e s t number (2 5 .9 p e rc e n t)

e arn between $50,000 and $100,000 p e r annum g r o s s .

Of t h e 8 1 .9

47
p e rc e n t o f th e c h i r o p r a c t o r s who e a rn o v e r $ 20,000 p e r annum,
2 2 .9 p e r c e n t earn between $35,000 and $5 0,000; 2 1 .8 p e rc e n t e a rn
between $20,000 and $35,000 and o n ly 10 p e r c e n t e a rn l e s s th an
$20,000 ( p o s s ib l y b e g in n e rs o r r e t i r e e s ) .

A pproxim ately 8 p e r c e n t

o f th e respondees f a i l e d t o answer t h i s q u e s tio n which I s s u r p r i s i n g
s i n c e Income has always been a s e n s i t i v e s u b j e c t w ith p r o f e s s i o n a l s
In th e h e a l t h f i e l d and a g r e a t e r p e rc e n ta g e o f o m ission s was
e x p e c te d .

I t a p p e a rs t h a t th e c o s t o f f u r n i s h i n g c o n tin u in g educa­

t i o n t o th e m a j o r i t y o f c h i r o p r a c t i c p h y s ic ia n s would n o t be a
problem ( s e e T able 4 ) .

TABLE 4 . —Annual P r a c t i c e Income f o r Michigan DCs--Item # ( 1 - 1 4 ).
Annual Income

P e rc e n t o f DCs

$50,000 t o $100,000

2 5 .9

$35,000 t o

$50,000

22 .9

$20,000 t o

$35,000

21.8

Over $100,000

11 .3

$ 10,000 t o

10.0

$ 20,000

TOTAL*
★
P e rc e n ta g e s do n o t add up t o 100 p e r c e n t b ecause some
resp ond ees t o t h e q u e s t i o n n a i r e o m itte d answ ering t h i s q u e s t io n .

P a r t I I d e a l s w ith in fo rm a tio n r e l a t e d t o t h e c h i r o p r a c t o r 's
o ffic e p ra c tic e .

Item # (2 -1 4 ) a sk s how t h e p a t i e n t s a r e o b ta in e d .

The m a j o r it y (9 5 .9 p e r c e n t) r e p o r t t h a t p a t i e n t s a r e p ro cu re d

48
through o t h e r p a t i e n t r e f e r r a l s and a l a r g e p e rc e n ta g e (4 2 .5
p e rc e n t) I n d i c a te t h e i r s come from p erso nal c o n t a c t , 40.7 p e rc e n t
from wa1 k - 1ns and o nly 28.2 p e rc e n t from o t h e r h e a lth p r o f e s s i o n a l s .
A p p a ren tly , w ith o u t membership on a h o s p i t a l s t a f f , exposure v ia
TV programs and o t h e r I n d i r e c t means o f a d v e r t i s i n g , th e c h i r o ­
p r a c t i c p r o f e s s io n depends h e a v ily on r e f e r r a l s and personnal com­
m unication t o o b ta in t h e i r c l i e n t e l e .

T his 1s a n o th e r a re a where

I n t e r p r o f e s s i o n a l c o n ta c t m ight break down th e b a r r i e r s s e t up by
s e l f - c e n t e r e d p r o f e s s io n a l o r g a n i z a t i o n s 1n th e h e a lth f i e l d (s e e
T able 5 ) .

TABLE 5 . —How C h ir o p r a c tic P a t i e n t s a r e O btained— Item # (2 -1 4 ) .
P e rc e n t R eporting

Methods
P a t i e n t R e fe rra l

95.9

Personal C ontact

4 2 .5

Walk-1ns

4 0 .7

From O ther H ealth P r o f e s s io n a l s

28.2

TOTAL*
^ P e rc e n ta g e s do not add up to 100 p e r c e n t because o f o v e r­
lap p in g c o n d it i o n s .

Item # (2-15) p e r t a i n s t o p r o f e s s io n a l r e f e r r a l s o f p a t i e n t s .
I t app ears t h a t more p a t i e n t s a r e r e f e r r e d o u t t o DCs and o t h e r
h e a l t h p r o f e s s i o n a l s th a n a r e re c e iv e d by t h e r e f e r r i n g p r a c t i t i o n e r .
The g r e a t e s t d i s p a r i t y 1s 1n th e p e rc e n ta g e s o f r e f e r r a l s t o MDs and

49
DOs v e rs u s r e t u r n r e f e r r a l s from t h e s e o t h e r h e a l t h p r o f e s s i o n a l s —a
r a t i o o f ro ug hly two t o one.

T h is p o i n t s up t h e need o f more I n t e r ­

p r o f e s s i o n a l communication and a tte m p t a t harmony, c o n c e iv a b ly t o
be g a in e d by means o f c o n tin u in g e d u c a tio n f o r th e c h i r o p r a c t o r t o
upgrade h i s competency and e d u c a te th e o t h e r p r o f e s s i o n s on th e
c h i r o p r a c t i c s p h e re o f e x p e r t i s e so t h a t no t h r e a t o f c o m p e titio n
w i l l mar th e r e l a t i o n s h i p s w i t h in th e h e a l t h f i e l d ( s e e T able 6 ) .

TABLE 6 . - - P r o f e s s i o n a l R e f e r r a l o f P a t i e n t s — Item # ( 2 - 1 5 ) .
P e rc e n t

R e fe rre d t o

R e f e r r a l s from:

P e rc e n t

O th e r DCs

5 8 .7

O th e r DCs

61.1

MDs

7 1 .8

MDs

3 8 .6

DOs

5 2 .8

DOs

2 7 .7

O ther Health P r o f e s s i o n a l s

4 8 .2

O th e r H ealth P r o f e s s i o n a l s

3 3 .9

TOTALS
* P e rc e n ta g e s do n o t add up t o 100 p e r c e n t because o f o v e r
la p p in g c o n d i t i o n s .

Item # (2 -1 7 ) r e f e r s t o t h e amount o f h e a l t h c o u n s e lin g g iven
to p a tie n ts .

A p p a re n tly , o n ly 0 .6 p e r c e n t o f t h e p r a c t i t i o n e r s

f a l l t o g iv e some m easure o f h e a l t h c o u n s e lin g .

The 'av erag e* 1s

a d m i t te d ly a vague term b u t 1t can be ta k e n a s t h e 'u s u a l* amount
o f cou nsel tim e g iv e n t o p a t i e n t s d u rin g th e c o u rs e o f t r e a t m e n t .
S in c e 3 8 .6 p e r c e n t I n d i c a te d t h a t 'a g r e a t amount' o f c o u n s e lin g

50
was given t o t h e i r p a t i e n t s , 1t ap p ears t h a t th e measure o f h e a lth
c o u n se lin g 1n tim e and c o n te n t could well be th e b a s i s o f f u t u r e
r e s e a r c h (se e Table 7 ) .

TABLE 7 . —Health Counseling Given to P a t i e n t s - - I t e m # (2 -1 7 ) .
Amount

P e rc e n t

Average

4 9 .7

G re at Amount

38.6

Some

11.1
.6

None a t All

100.0

TOTAL

Item #(2-18) ask s how t h e p a t i e n t ' s p ro g re s s 1s determ ined
by th e d o c to r :

8 4 .5 p e r c e n t r e p o r t t h a t th e y a sk q u e s tio n s a f t e r

t r e a tm e n t, by feedback from p a t i e n t s o r a com bination o f methods.
S ince th e rem ainder r e l y on p a t i e n t r e f e r r a l s t o I n d i c a t e t h e i r
s a t i s f a c t i o n w ith th e tr e a tm e n t, t h i s seems to c a l l f o r more educa­
t i o n 1n p ro p e r o f f i c e p ro ce d u res (se e T able 8 ).
Item #(2-1 9) q u e s tio n s how t h e q u a l i t y o f th e s e r v i c e p e r ­
formed 1s e v a lu a te d by th e c h i r o p r a c t o r .

Although t h e m a j o r it y

q u e s tio n th e p a t i e n t o n ly (4 4 .0 p e r c e n t ) , 51.1 p e rc e n t e i t h e r r e ­
examine and r e - x - r a y o r combine w ith p a t i e n t q u e s tio n in g t o e v a l u a t e
th e q u a l i t y o f t h e i r s e r v i c e s .

Less than f i v e p e r c e n t make no

q u a l i t y e v a lu a tio n which speaks well f o r th e e n t i r e c h i r o p r a c t i c
p o p u la tio n 1n M ichigan.

51
TABLE 8 . —How T reatm ent P ro g re ss 1s D eterm ined— Item # (2 -1 8 ).
Method

P e rce n t

By a sk in g q u e s tio n s a f t e r t r e a tm e n t, p lu s
P a t i e n t ' s r e p o r t on p ro g ress

33.0

By a sking q u e s tio n s a f t e r tre a tm e n t

31.1

By p a t i e n t s r e p o r tin g p ro g re ss

20.4

P a t i e n t r e f e r r a l s I n d i c a te s a t i s f a c t i o n
w ith tre a tm e n t

15.5

100.0

TOTAL

Item #(2-20 ) I n q u ir e s I n to th e p r a c t i t i o n e r ' s s e l f - r a t i n g
o f h is s k i l l s 1n v a rio u s a re a s as good, a d e q u a te , poor o r none.
Most c o n s id e r t h e i r s k i l l s 1n tr e a tm e n t (o r a d ju s tm e n t) , d ia g n o s is
( o r a n a l y s i s ) and t h e i r r e l a t i o n s h i p w ith p a t i e n t s as f a i r l y h igh.
In t h e i r s e l f - r a t i n g o f s k i l l s 1n d e a lin g w ith o t h e r c h i r o p r a c t o r s ,
w ith a t t o r n e y s , in su ra n c e companies and w ith MDs o r DOs th ey see
t h e i r s k i l l s p r o g r e s s i v e l y d e c re a se from about o n e - h a l f to onet h i r d a s good as 1n th e o t h e r a r e a s .
More communication w ith o t h e r h e a l t h p r o f e s s i o n a l s seems
I n d i c a te d a lth o u g h l i t t l e a id can be e xpected from th e r e s p e c t i v e
p ro fessio n al o rg an iz atio n s.

Seminars w ith and by members o f th e

le g a l p r o f e s s io n and th e S t a t e In su ra n c e commission should be on
th e c o n tin u in g e d u c a tio n agenda and would h e lp d is p e l t h e u n e a s in e s s
I n d ic a te d by th e DCs 1n r e p o r t i n g t h e i r s k i l l r e a c t i o n s (se e
T able 9 ) .

52
TABLE 9 . - - S e l f - R a t i n g o f P r a c t i t i o n e r ' s S k i l l s — Item # ( 2 - 2 0 ) .
S k i l l ( r a t e d h ig h )

P e rc e n t

T r e a tm e n t/a d ju s tm e n t

8 7 .6

D ealing w ith p a t i e n t s

74.3

D ia g n o sis/an a ly sis

63.9

D ealing w ith o t h e r DCs

52.2

D ealing w ith a t t o r n e y s

4 7 .0

D ealing w ith In su ra n c e companies

4 5 .3

D ealing w ith MDs/DOs

3 4 .9

TOTAL*
*

P e rc e n ta g e s do n o t add up t o 100 p e r c e n t because o f o v e r ­
la p p in g c o n d i t i o n s .

P a r t I I I 1s concerned w ith t h e e d u c a tio n a l background o f
t h e Michigan c h i r o p r a c t i c p r a c t i t i o n e r .

In Item # ( 3 - 4 ) th e le n g th

o f a tte n d a n c e a t a p r e - p r o f e s s i o n a l c o l l e g e 1s a d d re s s e d .

The

m a j o r i t y o f Michigan l i c e n s e e s had two y e a r s o f p r e - p r o f e s s i o n a l
t r a i n i n g (now m andatory f o r l i c e n s u r e ) w ith th e rem ain der having
one y e a r c o l l e g e t o a b a c h e l o r 's o r advanced d e g r e e s .

T his 1s

c e r t a i n l y n o t t h e p i c t u r e o f a p o o rly e d u c a te d group a s t o u t e d by
some v e s te d I n t e r e s t s 1n t h e h e a l t h i n d u s t r y ( s e e T a b le 1 0 ).
Item # ( 3 - 8 ) I n q u i r e s i n t o where p o s t - g r a d u a t e work was
ta k e n by th e d o c to r s i n c e r e c e i v i n g h i s D.C. d e g re e .

Most took

t h e i r work a t c h i r o p r a c t i c c o l l e g e s o r a t both c h i r o p r a c t i c and
'o t h e r c o l 1e g e s / u n l v e r s 1t i e s ' w ith a sm all p e rc e n ta g e a t o t h e r

53
TABLE 1 0 .—A ttendance a t P re p ro fe s s io n a l C o lle g e s — Item # ( 3 - 4 ) .
Length o f A ttendance

P e rc e n t

Two y e a r s

38.7

One Year

24.3

B a c h e lo r 's d e g re e

20.9

Three y e a r s

11.9

Advanced deg ree

4 .3

100.0

TOTAL

c o l l e g e s / u n i v e r s i t i e s o n ly .

A pproxim ately o n e - f i f t h o f th e sample

have n o t ta k e n any p o s t - g r a d u a t e work (presum ably d i s r e g a r d i n g th e
m andatory re q u ire m e n ts f o r r e l l c e n s u r e ) .

T his group d e s p e r a t e l y

needs th e b e n e f i t s o f c o n tin u in g p r o f e s s i o n a l e d u c a tio n ( s e e
T able 1 1 ).

TABLE 1 1 . —Where P o st-G rad u a te Work was Taken— Item # ( 3 - 8 ) .
F a c ility

P e rc e n t

At c h i r o p r a c t i c c o l l e g e s

52.6

No p o s t - g r a d u a t e work tak en

2 2 .5

Taken a t both c h i r o p r a c t i c c o l l e g e s and
o t h e r c o l I e g e s / u n 1v e r s 1t i e s

16.4

At o t h e r c o l l e g e s / u n i v e r s i t i e s
TOTAL

8 .5

100.0

54
Item # ( 3 - 9 ) a s k s what p o s t - g r a d u a t e c o u rs e work was tak e n
by th e Michigan p r a c t i t i o n e r s (based on th e u su a l c o u rs e s o f f e r e d
by th e v a rio u s c h i r o p r a c t i c c o l l e g e s ) .

The d i s t r i b u t i o n 1s shown

1n T able 12 and I n d i c a t e s a h e a l t h y I n t e r e s t In th e s u b j e c t s con­
s i d e r e d e s s e n t i a l t o th e c h i r o p r a c t o r 's a re a o f e x p e r t i s e .

TABLE 1 2 .--W hat P o st-G ra d u a te Course Work was Taken— Item # ( 3 - 9 ) .
Course

P e rc e n t

S p e c ia l C h i r o p r a c ti c Techniques

4 7 .7

Roentgenology

39.1

D ia g n o s tic Areas

35 .5

O rth o p ed ic s

31.1

O th e r p r o f e s s i o n a l a r e a s

18.7

Neurology

10.4

TOTAL*
P e rc e n ta g e s do n o t add up t o 100 p e r c e n t due t o o v e r ­
la p p in g c o n d i t i o n s .

P a r t IV c o n s i d e r s q u e s t io n s d i r e c t l y r e l a t i n g t o c o n tin u in g
c h i r o p r a c t i c e d u c a tio n o f t h e Michigan p r a c t i t i o n e r .

T ab les 13,

14 and 15 I n d i c a t e th e wide v a r i e t y o f s u b j e c t s on which th e
d o c to r s would l i k e t o re v ie w , t a k e I n s t r u c t i o n and a t t e n d
se m in a rs.

55
TABLE 1 3 .- - S u b j e c t s Which P r a c t i t i o n e r s Want t o R e v ie w -•Item # { 4 -1 ).
S u b je ct

P e rc e n t

N euro log ical t e s t s f o r p a t i e n t exam ination

52.3

O rthopedic t e s t s f o r p a t i e n t exam ination

45.1

P hysical exam in atio n pro ced ures

38.1

Work-up o f c ase h i s t o r y

26.2

TOTAL*
★
P e rce n tag e s do n o t add up t o 100 p e rc e n t due t o o v e r­
lap p in g c o n d it i o n s .

TABLE 1 4 .—S u b je c ts P r e f e r r e d f o r I n s t r u c t i o n — Item # ( 4 - 2 ) .
S u b je c t

P e rc e n t

Advanced X-ray i n t e r p r e t a t i o n

47 .4

M anipulative te c h n iq u e s

39 .6

P r a c t i c e b u i ld i n g pro cedures

3 6.5

S p o rts hazards and management o f a t h l e t i c I n j u r i e s

3 4.5

P r a c t i c a l c l i n i c a l psychology

22.5

TOTAL*
★
P e rc e n ta g e s do n o t add up t o 100 p e r c e n t due t o o v e r­
lap p in g c o n d it i o n s .

56
TABLE 1 5 .— S u b je c ts 1n Which Seminars a r e D e sired — Item # ( 4 - 3 ) .
S u b je c t

P e rc e n t

H ealth In su ra n ce c la im s and DC's r e s p o n s i b i l i t i e s

4 7 .9

N eu rolo gical I m p lic a tio n s o f d i e t a r y d e f i c i e n c i e s
and r o l e o f n u t r i t i o n a l management 1n
c h iro p ra c tic p ra c tic e

47 .2

D i f f e r e n t i a l d ia g n o s is o f back and neck p a in s

4 6 .7

Trauma e f f e c t s on body j o i n t s

39 .9

O rthopedic d i s a b i l i t y e v a lu a tio n and Impairment
ratin g

3 9.9

N eurolo gical concept o f c h i r o p r a c t i c and I t s
c u rren t s c ie n tif ic sta tu s

3 6 .0

L a t e s t advances In X-ray techn olo gy

32.9

Concepts 1n k l n e s io l o g l c a l biomechanics

30.3

Research and development a t c h i r o p r a c t i c c o l l e g e s

28.8

V i s u a l i z a t i o n s 1n c l i n i c a l and p a th o lo g ic a l anatomy

23.3

TOTAL*
*

P e rce n tag e s do n o t add up t o 100 p e r c e n t because o f o v e r ­
lapping c o n d it i o n s .

Item # (4 -4 ) asks 1 f c l a s s e s 1n p u b lic r e l a t i o n s , p u b lic
speaking and o t h e r communications s k i l l s would be d e s i r e d .
o n e - h a l f (5 3 .2 p e rc e n t) I n d i c a te d no I n t e r e s t .

Over

Item # (4 -5 ) a sk in g

f o r i n t e r e s t 1n a d d it i o n a l s c ie n c e degrees a l s o re c e iv e d ov er oneh a l f (5 4 .6 p e r c e n t ) , who I n d i c a te d no i n t e r e s t 1n such p u r s u i t .
Presum ably, DC p r a c t i t i o n e r s wish t o p r a c t i c e t h e i r p r o ­
f e s s i o n on a o n e -to -o n e b a s i s w ith t h e i r p a t i e n t s and a r e n o t

57
I n t e r e s t e d 1n a d d i t i o n a l work beyond t h e o f f i c e s p h e r e .

They a r e

a l s o u n i n t e r e s t e d 1n p u rsu in g knowledge 1n o t h e r s c i e n t i f i c f i e l d s
o u tsid e o f c h iro p ra c tic .
Item # (4 -6 ) q u e s tio n s where c o n tin u in g e d u c a tio n c o u rs e s
should be g iv e n .

The p r a c t i t i o n e r s o f c h i r o p r a c t i c a r e a lm ost

e v en ly d iv id e d among th o s e who want such c o u rs e s g iv en 1n nearby
c o l l e g e s o r u n i v e r s i t i e s and th o s e I n d i c a t i n g no p r e f e r e n c e 1n t h i s
a r e a ( s e e T able 1 6 ).

TABLE 1 6 . —Where E ducation Courses Should be Held— Item # ( 4 - 6 ) .
L o ca tio n

P e rc e n t

No p r e f e r e n c e

3 7 .8

Nearby c o ll e g e / u n 1 v e r s 1 t y

3 7 .3

At a p u b lic o r p r i v a t e f a c i l i t y

15.0

By a m u lti-m e d ia approach

1 3 .5

TOTAL*
*

P e rc e n ta g e s do n o t add up t o 100 p e r c e n t because o f o v e r ­
la p p in g c o n d it i o n s .

Item # (4 -7 ) poses t h e q u e s tio n a s t o who sh o u ld p r e s e n t
c o n tin u in g e d u c a tio n c o u r s e s .

A tw o -th ird s m a jo rity in d ic a te th a t

t h e y would l i k e any s u b j e c t q u a l i f i e d I n s t r u c t o r s , a s shown 1n
T able 17.

58
TABLE 1 7 .—Who Should P re s e n t C ourses— Item # ( 4 - 7 ) .
In stru c to rs Preferred

P e rc e n t

Any s u b j e c t - q u a l i f i e d I n s t r u c t o r s (P h .D .s , e t c . )

61.8

C h iro p r a c to r (DC) I n s t r u c t o r s o n ly

12.5

No p re f e r e n c e

25.7

100.0

Item # (4 -8 ) seek s th e DCs' o p in io n s as t o when c o n tin u in g
ed u ca tio n c o u rs e s should be g iv e n .

Most (6 2 .4 p e rc e n t) would l i k e

to have th e c o u rs e s on weekends and f o r a two-day p e rio d » according
to a m a jo r ity o f 51.3 p e rc e n t (se e T ab les 18 and 19).

TABLE 1 8 .—When Should Courses be Given—Item # ( 4 - 8 ) .
Time

P e rc e n t

Weekends

62.4

Thursdays

27.7

Evenings

17.1

Wednesdays
TOTAL*
-*
P e rce n tag e s do n o t add up t o 100 p e rc e n t due t o over
la p p in g c o n d it i o n s .

8 .3

59
TABLE 1 9 .--P re fe re n c e f o r Length o f Sem inars— Item # (4 -9 ).
P e rce n t

Time
Two days

51.3

One day

24.1

No p r e fe r e n c e

14.4

Three days

5.1

Not I n t e r e s t e d In any

3.1

Five days

1 .7

Four days

0 .3

100.0

TOTAL

Item #{4-10) gave t h r e e c h o ic e s as o p tio n s on where t h e DC
would l i k e t o a tt e n d c l a s s e s .

Of n in e c i t i e s * Lansing* D e t r o i t and

Ann Arbor were th e le a d e r s and, a c c o rd in g to 81 p e r c e n t (Item #
4-1 1) c h i r o p r a c t o r s would l i k e I n s t r u c t i o n to extend o ver a long
p e rio d o f tim e In s te a d o f f u l l - t i m e e a r l y com pletion c l a s s e s
(se e Table 20 ).
In re g a rd t o th e q u e s tio n 1n Item #(4-1 2) w hether c o n tin u in g
e d u c a tio n c o u rse s should be counted toward a s p e c i a l t y c e r t i f i c a t i o n ,
77.1 p e r c e n t were 1n f a v o r .

However, In Item #(4 -1 3 ) q u e s tio n in g

w hether th e DC would l i k e t o q u a l i f y a s a s p e c i a l i s t , 52.1 p e rc e n t
were a g a i n s t th e Id e a .
In Item # (4 -1 5 ) an o p in io n was s o l i c i t e d as t o who should
pay f o r th e c o s t s o f c o n tin u in g e d u c a tio n .

Most I n d ic a te d th e

60
TABLE 2 0 .- - P r e f e r r e d L o c a tio n o f C la s s e s - -Ite m # (4 -1 0 ) .
C ity In Michigan

P e rc e n t

Lansing

46.1

D etro it

35 .8

Ann Arbor

26.2

F lin t

23 .6

Grand Rapids

19.9

Kalamazoo

17 .6

B a t t l e Creek

12.2

Gaylord

9 .3

Houghton

4 .4

TOTAL*
*

P e rc e n ta g e s do n o t add up to 100 p e r c e n t due t o o v e r
la p p in g c o n d i t i o n s .

p r a c t i t i o n e r a lo n e should pay th e c o s t s (51.1 p e r c e n t ) , w h ile
4 2 .0 p e r c e n t would l i k e t o s h a re c o s t s w ith th e member's a s s o c i a t i o n .
The re m a in d e r, 6 .9 p e r c e n t , f e l t t h a t t h e member's a s s o c i a t i o n
sh ou ld co m p lete ly sp o n so r t h e c o u rs e s .
In answer t o Item # ( 4 - 1 6 ) , 6 6 .3 p e r c e n t b e l i e v e t h a t p a s t
e d u c a tio n a l c o u rs e s f o r r e l i c e n s i n g re q u ire m e n ts have upgraded t h e i r
p r o f e s s i o n a l com petence.

A lso , as a r e s u l t o f th e q u e s tio n 1n

Item 3 # ( 4 - 1 7 ) , 57 p e r c e n t o f th e DCs a r e s a t i s f i e d w ith ty p e and
q u a l i t y o f c o n tin u in g e d u c a tio n c o u rs e s a s now g iv en f o r l i c e n s e
renewal p u rp o se s.

I t sh o uld be n oted t h a t both o f t h e s e l a s t Item s

61
and t h e i r r e p l i e s cannot be tak e n v erbatim s in c e t h e r e I s no way to
check r e t e n t i o n o f th e knowledge Im parted a t th e c o n tin u in g educa­
tio n c la ss e s.

Examination to check such r e t e n t i o n I s th e a p p aren t

o b j e c t i v e o f such a g en c ie s as th e U.S. Department o f H e a lth ,
E ducation and W elfare and lo c a l c o o p e ra tin g h e a l t h a g e n c ie s .
Mandatory feedback a f t e r exposure to e d u c a tio n c o u rs e s may be c l o s e r
th an th e members o f the p r o f e s s io n b e lie v e p o s s i b l e .
In an a n a l y s i s o f th e p r i n t o u t d a ta from th e survey
I n s tru m e n t, a number o f c r o s s - t a b u l a t i o n s were made o f how In d iv id u a l
p r a c t i t i o n e r s 1n an Age, Community S ize o r Income group responded to
a giv en q u e s t io n .

The r e s u l t s a r e I n t e r e s t i n g 1n t h a t some were

p r e d i c t a b l e b u t o t h e r s were s u r p r i s i n g 1n t h e i r I n f e r e n c e s .
A One-Way A n a ly sis o f V ariance (ANOVA) was used f o r com­
p a rin g one c a t e g o r i c a l and one co n tin u o u s v a r i a b l e , e . g . , an Age
group v e rsu s th e Type o f P r a c t i c e Conducted.

Eleven o f th e 40

t a b u l a t i o n s and graphs o b ta in e d ap p ea r r e l e v a n t to th e purpose o f
t h i s stu d y (c o n tin u in g p r o f e s s io n a l e d u c a tio n c u r r e n t p r a c t i c e s
and p e rc e iv e d needs 1n t h i s le a r n in g a r e a o f Michigan d o c to rs o f
c h iro p ra c tic ).

These r e l e v a n t t a b u l a t i o n s a r e t h e r e f o r e d isp la y e d

in T ab les 21 thro ugh 31 w ith a p p r o p r i a te I n f e r e n c e s .

TABLE 21 .- P o s t-G ra d u a te Courses Taken in O rthopedics (3 -9 -1 ) in R elatio n to Community Size
(1 -2 ).
Cornnunity Size (1-2)*

0 )

( 2)

(3)

(4)

(5)

( 6)

(7)

Yes

23.1

20.0

34.5

31.6

18.4

31.1

41.0

No

76.9

80.0

65.5

68.4

81.6

68.9

59.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

26

45

55

38

49

45

(3-9-1

Total Percent
No. Respondents
In ference:

SOURCE:

117

C h iro p racto rs p r a c tic in g in l a r g e r comnunities a re more l i k e l y t o have taken p o s t­
graduate courses in Orthopedics than OCs p r a c tic in g in sm aller com nunities.

Sanford U lrich , C h iro p ra c tic in Michigan:

A S t a t i s t i c a l Survey, 1978,, Table B-11 •

Community Size:
(1)
(2)
(3)

Under 2,000
2,500 to 5,000
5,000 to 10,000

(4)
(5)
( 6)
(7)

10,000 to 25,000
25,000 to 50,000
50,000 t o 100,000
Over 100,000

TABLE 2 2 .- - P r a c t i t i o n e r 's D esire to Review O rthopedic T e sts f o r P a tie n t Examination (4 -1 -3 ) 1n
R ela tio n to Conmunity S ize (1 -2 ).
Conmunity Size (1-2)*
(4)

(5)

(6)

(7)

36.4

44.7

53.1

60.0

49.6

66.7

63.6

55.3

46.9

40.0

50.4

100.0

100.0

100.0

100.0

100.0

100.0

100.0

26

45

38

49

45

117

(1)

(2)

(3)

Yes

26.9

33.3

No

73.1

Total Percent
No. Respondents

(4-1-3)

55

o»
CO

I nference:

SOURCE:

C h iro p rac to rs p r a c tic in g in l a r g e r communities a re more i n te r e s te d in reviewing
orthop ed ic t e s t s reconmended f o r p a t i e n t examination than DCs p r a c tic in g in
sm a lle r communities.

Sanford U lric h , C h iro p ra c tic in Michigan:

A S t a t i s t i c a l Survey, 1978, Table 8—12.

*Comnunity S ize:
(1)
(2)
(3)

Under 2,000
2,500 to 5,000
5,000 t o 10,000

(4)
(5)
(6)
(7)

10,000 to 25,000
25,000 t o 50,000
50,000 t o 100,000
Over 100,000

TABLE 2 3 .- - P r a c t i t i o n e r 's D esire f o r In s tru c tio n in C lin ic a l Psychology (4-2-4) in R elatio n to
Community S ize (1 -2 ).
Comnunlty Size (1-2)*
0)

(2)

(3)

(4)

(5)

(6)

(7)

Yes

15.4

17.8

18.2

15.8

26.5

22.2

29.1

No

84.6

82.2

81.8

84.2

73.5

77.8

70.9

Total Percent

100.0

100.0

100.0

100.0

100.0

100.0

100.0

No. Respondents

26

45

55

38

49

(4-2-4)

45

117

at

-E k

Inference:

SOURCE:

C hiro practors p ra c tic in g in l a r g e r communities a re more i n te r e s te d 1n in s t r u c t i o n in
p r a c tic a l c l i n i c a l psychology than DCs p ra c tic in g in sm a ller comnunities.

Sanford U lric h , C h iro p rac tic in Michigan:

A S t a t i s t i c a l Survey, 1978, Table B-13.

♦Community Size:
(1)
(2)
(3)

Under 2,500
2,500 to 5,000
5,000 t o 10,000

(4) 10,000 to 25,000
(5) 25,000 t o 50,000
( 6 ) 50,000 t o 100,000
(7) Over 100,000

TABLE 2 4 .—P r a c t i t i o n e r 's D esire f o r In s tru c tio n in P ra c tic e B uilding Procedures (4 -2 -5 ) in
R elatio n to Comnunity Size (1 -2 ).
Cornunity Size (1-2)*
( 1)

( 2)

(3)

(4)

(5)

(6)

(7)

Yes

23.1

33.3

32.7

28.9

42.9

40.0

40.2

No

76.9

66.7

67.3

71.1

57.1

60.0

59.8

100.0

100.0

100.0

100.0

100.0

100.0

100.0

26

45

55

38

49

45

(4-2-5)

Total Percent
No. Respondents
In ference:

SOURCE:

117

C hiropracto rs p r a c tic in g in l a r g e r cocnminities a re more i n te r e s te d in p r a c t ic e b u ildin g procedures than DCs p r a c tic in g in sm a ller communities.

Sanford U lric h , C h iro p ra c tic in Michigan:

A S t a t i s t i c a l Survey, 1978, Table B-14.

*Conrounity Size:
(1)
(2)
(3)

Under 2,500
2,500 to 5,000
5,000 to 10,000

(4)
(5)
(6)
(7)

10,000 to 25,000
25,000 to 50,000
50,000 t o 100,000
Over 100,000

TABLE 2 5 .—Post-G raduate Courses Taken (3-9) in R elatio n to Age Group (1 -1 ).
(Age Group (1-1)*
( 1)

( 2)

(3)

(4)

(5)

( 6)

( - 1)

0.0

18.7

36.2

40.5

37.3

27.5

( - 2)

75.0

34.6

38.3

43.2

41.8

37.5

(-3)

0.0

3.7

10.6

8.1

17.9

20.0

25.0

29.9

33.0

36.5

44.8

40.0

(-5)

0.0

49.5

42.5

44.6

55.2

52.5

( - 6)

0.0

18.7

19.1

18.9

23.9

10.0

Percent T otals

100.0

**

**

**

irk

irk

No. Respondents

4

(3-9)***

In ference:

94

107

74

67

40

Compared w ith younger DC p r a c t i t i o n e r s , th e o ld e r c h ir o p ra c to rs a re more l i k e l y to
have taken p o st-g rad u a te courses in o rth o p e d ic s , neurology and in d ia g n o s tic a re as.

SOURCES:

Sanford U lric h , C h iro p rac tic in Michigan:

A S t a t i s t i c a l Survey, 1978, Table B-23.

it

Aqe groups:

(1)
(2)

Under 25 y e a rs
25 to 34

(3)
(4)

35 to 44
45 to 54

(5)
(6)

55 t o 65
Over 65 y e ars

itit

Columns do not add up to 100 p e rc en t due to overlapping c o n d itio n s .
Courses Taken: (-1 ) Orthopedics
[-2) Roentgenology
-3) Neurology

(-4 ) D iagnostic Areas
(-5 ) Special C h iro p rac tic Techniques
( - 6 ) Other

TABLE 2 6 .- - P r a c t i t i o n e r 's D esire to Review Work in Continuing Education (4-1) in R elatio n to
Age Group (1 -1 ).
Age Group (1-1)*
(1)

(2)

(3)

(4)

(5)

(6)

H )

0.0

22.4

30.9

27.0

28.4

22.5

(-2)

25.0

32.7

46.8

44.6

35.8

25.0

(-3)

25.0

48.6

54.3

44.6

40.3

25.0

(-4)
Percent Total s

50.0

53.3
**

62.8
**

54.1
**

44.8
**

35.0
**

94

74

67

40

(4-1)***

100.0

No. Respondents
Inference:

SOURCE:

4

107

C hirop ractors in th e 35 to 44 age group a re roost i n te r e s te d in reviewing a l l fo u r
a r e a s , e s p e c i a l l y th e orthopedic and neurological t e s t s f o r p a t i e n t examination.

Sanford U lric h , C h iro p rac tic in Michigan:

A S t a t i s t i c a l Survey, 1978, Table B-24.

*

Age groups:

(1)
(2)

Under 25 y e ars
25 to 34

(3)
(4)

35 to 44
45 to 54

(5) 55 to 65
( 6 ) Over 65 years

Columns do n o t add up to 100 p e rc e n t due t o overlapping c o n d itio n s.
^Review Work in Continuing Education:
(-1 )
(-2 )
(-3 )
(-4 )

Work-up f o r a c h ir o p r a c tic case h is to r y .
Procedures in physical examination o f ty p ic a l p a t i e n t .
Orthopedic t e s t s recommended f o r p a t i e n t examination.
Neurological t e s t s r e l a t i v e t o p a t i e n t examination.

TABLE 2 7 .—P r a c t i ti o n e r 's D esire f o r In s tru c tio n in Continuing Education (4 -2 ) in R elatio n to
Age Group (1 -1 ).
Age Group (1-1)*

(4-2)***

( 1)

( 2)

(3)

(4)

(5)

( 6)

( - 1)

0.0

35.5

40.4

41.9

38.8

50.0

( - 2)
( - 3)

50.0

58.9

47.9

47.3

40.3

27.5

75.0

44.9

41.5

28.4

19.4

22.5

(-4)

25.0

23.4

26.6

23.0

19.4

15.0

(-5)

25.0
**

41.1
**

42.6

40.5
**

28.4
**

17.5
**

94

74

67

40

Total Percent
No. Respondents
Inference:

SOURCE:

4

107

Younger c h iro p ra c to rs a re more i n te r e s te d than o ld e r DC p r a c t i t i o n e r s in in s tr u c tio n
1n advanced rad io graph ic i n t e r p r e t a t i o n , in s p o rts hazards and management o f a t h l e t i c
i n j u r i e s , and in p ra c tic e -b u ild in g procedures.

Sanford U lric h , C h iro p rac tic in Michigan:
*Age groups:

(1)
(2)

Under 25 y e a rs
25 to 34

A S t a t i s t i c a l Survey, 1978, Table B-25.
(3)
(4)

35 to 44
45 to 54

(5)
(6 )

55 to 65
Over 65 years

jflt

Columns do not add up to 100 p ercen t due t o overlapping c o n d itio n s.
t
I n s tr u c tio n Desired in Continuing Education:
p H D iv e rs ifie d M anipulative Techniques
(-2 ) Advanced Radiographic (X-ray) I n t e r p r e t a ti o n
-3 ) Sports Hazards and Management o f A th le tic I n ju r ie s
f-4) P ra c tic a l C lin ic a l Psychology
[-5) P r a c tic e -b u ild in g Procedures

TABLE 2 8 .—Where Post-G raduate Work was Taken (3-8) in R elatio n to Income Group (1 -1 ).
Income Group (1-14)*

(3-8)

( 1)

( 2)

(3)

(4)

(5)

( 6)

None taken

36.7

32.4

21.0

21.2

17.7

. 16.7

In c h ir o p r a c tic c o lleg e s

33.3

54.1

.63.0

51.8

53.1

47.6

In o th e r c o ll e g e s / u n i v e r s it i e s

13.3

5.4

7.4

12.9

10.4

0.0

In both c h ir o p r a c tic and o th e r
c o lle g e s and u n i v e r s i t i e s

16.7

8.1

8.6

14.1

18.8

35.7

**

**

**

**

**

**

Total Percent
30

No. Respondents
Inference:

SOURCE:

37

81

85

96

42

The h ig h est income group i s much more l i k e l y to have taken p ost-g rad u ate work in both
c h ir o p r a c tic and in o th e r c o ll e g e s / u n i v e r s it i e s than th e lower income groups.

Sanford U lric h , C h iro p rac tic in Michigan:
*Income Group:

(1)
(2)
(3)

Under $10,000
$10,000 to $20,000
$20,000 to $50,000

A S t a t i s t i c a l Survey, 1978, Table B-31.
(4) $35,000 t o $50,000
(5) $50,000 t o $100,000
( 6 ) Over $100,000

Columns do n ot add*up to 100 p ercen t due t o overlapping c o n d itio n s.

TABLE 2 9 .--P o st-G rad u ate Courses Taken (3-9) in R elatio n to Income Group (1 -1 4 ).
Income Group (1-14)*

(3-9)

(Vj

lz)

(3)

(4)

(5)

(6)

Orthopedics

16.7

18.9

27.2

29.4

43.8

38.1

Roentgenology

20.0

27.0

35.8

38.8

47.9

59.5

Neurology

10.0

8.1

9.9

4.7

10.4

23.8

Diagnostic Areas

16.7

13.5

33.3

37.6

38.5

52.4

Special C h iro p rac tic Techniques

30.0

35.1

46.9

52.9

46.9

64.3

**

**

**

**

**

Total Percent
30

No. Respondents
Inference:

SOURCE:

37

81

85

96

42

The h ig h e s t income DCs a re more l i k e l y to have taken p o st-g rad u a te courses in
o rth o p e d ic s, roentgenology, d ia g n o s tic a re as and sp ecial c h ir o p r a c tic techniques
than lower income c h ir o p ra c to rs .

Sanford U lric h , C h iro p rac tic in Michigan:
*Income Group:

(1)

A S t a t i s t i c a l Survey, 1978, Table B-25.

Under $10,000

(4)

$35,000 to $50,000

(2) $10,000 t o $20,000

(5)

$50,000 to $100,000

(3) $20,000 to $35,000

( 6 ) Over $100,000

Columns do not add up to 100 p ercen t due to overlapping c o n d itio n s.

71
TABLE

3 0 . —P r e f e r e n c e In Seminar S u b je c ts (4 -3 ) 1n R e la tio n to
Income Group ( 1 - 1 4 ) .
Income Group (1 -1 4 )*

[- 1 )
- 2’
-3
-4
-5

(4-3)f»

-6
-7
' *8
■-9
( - 10 )

( 1)

( 2)

(3)

(4 )

(5)

(6)

36.7

3 9.7
2 7 .0
24 .3
27.0
1 8 .9
4 5 .9
4 0 .5
32.4
54.1
**

4 5 .7
34 .6
27.2
2 3 .5
3 5.8
2 9 .6
51.9
4 3 .2
4 6 .9
5 0.6
**

3 1 .8
27.1
23.5
3 2 .9
4 1 .2
27.1
4 3 .5
4 5 .9
3 6 .5
56.5
**

4 4 .8
34.4
16.7
37.5
37.5
33.3
4 4 .8
58.3
37.5
4 6 .9

4 7 .6
54 .8
35.7
28.6
50.0
28.6
57.1
4 5 .2
52.4
38.1
**

37

81

85

96

42

20.0
10.0
2 3 .3

20.0
23.3
26.7
4 0 .0
2 6 .7
3 3 .3

T otal P e rc e n t
No. Respondents
Inference:

SOURCE:

30

21.6

The h i g h e s t Income group 1s more I n t e r e s t e d 1n
sem inars 1n ( - 2 ) , ( - 5 ) , ( - 7 ) and ( - 9 ) th an th e
low er Income g ro u p s.

Sanford U l r i c h , C h i r o p r a c t i c 1n M ichigan:
S urvey . 1978, T able B-33.

Income Group:

Under $10,000
$ 10,000 t o $ 20,000
$20,000 t o $50,000

A S ta tistic a l

$35,000 t o $50,000
$50,000 to $100,000
Over $100,000

Columns do n o t add up t o 100 p e r c e n t due t o o v e rla p p in g
c o n d itio n s.
***
Trauma e f f e c t s on body j o i n t s .
L a t e s t advances 1n r a d i o g r a p h ic te c h n o lo g y .
■2
V i s u a l i z a t i o n s in c l i n i c a l and p a th o l o g i c a l anaton\y.
[-3
Evolving c o n c e p ts 1n k l n e s l o l o g l c a l b iom echanics.
“4
N e u ro lo g ic al c o n c e p t o f c h i r o p r a c t i c and I t s c u r r e n t
[-5
sta tu s.
( - 6 ) Developments 1n I n n o v a tiv e t h e r a p y —R & D a t
c h iro p ra c tic c o lle g e s.
( - 7 ) D i f f e r e n t i a l d i a g n o s is o f low b a ck , upper back and neck
p a in s .
( - 8 ) N e u ro lo g ic al I m p li c a t io n s o f d i e t d e f i c i e n c i e s and
n u t r i t i o n a l management.
( - 9 ) O rth opedic d i s a b i l i t y e v a l u a t i o n and Im pairm ent r a t i n g .
(-1 0 ) D ealing w ith h e a l t h I n su ra n c e c la im s and DC r e s p o n s i ­
b i l i t i e s 1n t h i r d p a r t y payment c la im s .

fill

TABLE 3 1 .—Location P reference f o r Taking Courses (4-6 -1 ) in R elatio n to Income Group (1 -1 4 ).
Income Group (1-14)*
(1)

(2)

(3)

(4)

(5)

( 6)

Yes

23.3

24.3

39.5

38.8

44.8

40.5

No

76.7

75.7

60.5

61.2

55.2

59.5

Total Percent

100.0

100.0

100.0

100.0

100.0

100.0

No. Respondents

30

37

81

(4-6-1)

Inference:

SOURCE:

85

96

42

The h ig h e s t income groups a re more l i k e l y t o p r e f e r Continuing Education courses
a t a nearby c o ll e g e / u n iv e r s i ty than the lower income groups o f c h iro p r a c to r s .

Sanford U lric h , C h iro p rac tic in Michigan:

A S t a t i s t i c a l Survey, 1978, Table B-35.

♦Income Group:
(1)
(2)
(3)

Under $10,000
$10,000 to $20,000
$20,000 to $35,000

(4) $35,000 to $50,000
(5) $50,000 t o $100,000
( 6 ) Over $100,000

~

73
Summary
The purpose o f th e s tu d y was t o d e te rm in e t h e c u r r e n t s t a t u s
o f c o n tin u in g e d u c a tio n p r a c t i c e s o f th e Michigan c h i r o p r a c t o r , and
to d i s c o v e r th e p e rc e iv e d l e a r n i n g needs o f t h e s e p r a c t i t i o n e r s .
By means o f th e su rv ey In stru m e n t employed, a number o f
I n d i c a t i o n s a r e n oted 1n th e d i s p l a y s shown 1n t h i s c h a p t e r .

That

p a r t o f th e r e s e a r c h q u e s t i o n n a i r e r e l e v a n t t o t h i s I n v e s t i g a t i o n
a d d re s s e s th e age o f th e d o c to r s o f c h i r o p r a c t i c 1n t h e S t a t e , t h e i r
Income b r a c k e t s , and th e s i z e o f th e community 1n which th e y p r a c t i c e .
T h e ir modes o f p r a c t i c e a r e m a n if e s te d . I n c lu d in g a s e l f - r a t i n g c h a r t
o f t h e i r p e rc e iv e d d e g re e s o f s k i l l e x h i b i t e d In s e v e r a l p r o f e s s i o n a l
conduct a r e a s .
The e d u c a tio n a l background o f th e d o c to r s has been e l i c i t e d
In c lu d in g what p o s t - g r a d u a t e work has been ta k e n and In what e n v iro n ­
ment.

The c h i r o p r a c t o r s ' d e s i r e s and p r e f e r e n c e s 1n c o n tin u in g

p o s t - g r a d u a t e e d u c a tio n have been deduced and p r e s e n t e d . In c lu d in g
where and when th e y b e li e v e t h e c o u rs e s sh o uld be h e l d , who t h e
p r e f e r r e d I n s t r u c t o r s sh o uld be and who should b e a r t h e c o s t o f
th e e d u c a tio n .
C r o s s - ta b u l a t e d e x h i b i t s go I n t o f u r t h e r d e t a i l o f DC
p r a c t i t i o n e r s ' p o s t - g r a d u a t e work ta k e n and t h e e d u c a tio n d e s i r e d
f o r t h e f u t u r e a c c o rd in g t o age b r a c k e t , community s i z e and Income
le v e l.
C hapter V w i l l c o n ta in th e c o n c l u s i o n s , I m p li c a t io n s and
recommendations d e riv e d from t h i s r e s e a r c h s tu d y .

CHAPTER V
SUMMARY, CONCLUSIONS, IMPLICATIONS
AND RECOMMENDATIONS

I n t r o d u c t io n
T h is c h a p t e r p r e s e n t s a summary o f th e s tu d y , d i s c u s s i o n o f th e
f i n d i n g s , c o n c lu s io n s , i m p l i c a t i o n s , and recommendations g e n e ra te d from
th e d a ta a n a l y s i s .

S u g g e stio n s f o r f u r t h e r r e s e a r c h conclude th e

In v e stig a tio n .
Purpose o f t h e Study
C h i r o p r a c t i c i s a r e l a t i v e newcomer t o t h e f i e l d o f h e a l t h p r o ­
f e s s i o n s and because o f i t s r a d i c a l c o n ce p t o f th e cause and tr e a tm e n t
o f d i s e a s e has been o s t r a c i z e d by t h e o p in io n s o f c o n v en tio n a l medi­
c in e .

C o n tin uin g p r o f e s s i o n a l (DC) e d u c a tio n has been mandatory 1n

Michigan f o r f o r t y - f i v e y e a r s .

However, th e two-day compulsory a t t e n ­

dance a t an e d u c a tio n a l c o n fe re n c e f o r annual r e l i c e n s u r e poses no
un iform p la n f o r u p grading th e c h i r o p r a c t o r 's competence, a comnendable
g o a l.
The b a s ic purpose o f t h e stu d y was t o d e te rm in e t h e s t a t u s o f
c u r r e n t c o n tin u in g e d u c a tio n a l p r a c t i c e s and th e p e rc e iv e d d e s i r e s f o r
p o s t - d o c t o r a l l e a r n i n g a s e x p re ss e d by th e c h i r o p r a c t o r s o f t h e s t a t e
o f M ichigan.

When t h e e d u c a tio n a l p r a c t i c e s a r e d eterm ined and t h e

e x p re s s e d needs o b t a i n e d , a s y s te m a tic development o f an e d u c a tio n a l
74

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program f o r th e s t a t e ' s d o c to r s o f c h i r o p r a c t i c w ill be made and p r e ­
s e n te d t o t h e p r o f e s s io n f o r Im plem entation a f t e r approval by th e
a u t h o r i t i e s 1n th e p r o f e s s io n .
Review o f th e L i t e r a t u r e
The l i t e r a t u r e on c o n tin u in g p r o f e s s io n a l e d u c a tio n was found
t o be s c a r c e and n o t v ery I l lu m i n a t i n g .

In th e c h i r o p r a c t i c a r e a , some

s e l f - a s s e s s m e n t su rv ey s on s t a t e and n a tio n a l l e v e l s were done r a t h e r
well by some unbiased r e s e a r c h e r s having an a p p a r e n tly deep I n t e r e s t 1n
l o c a ti n g f a c t u a l d a ta but having l i t t l e to I n v e s t i g a t e In th e h i s t o r i c a l
background t h a t was n ot t a i n t e d by th e p r e ju d ic e s o f org an ized m edicine
and I t s a f f i l i a t e s .

The surveys made do n o t a d d re ss ed u catio n as much

a s o t h e r f a c t o r s , demographic a n d /o r socio-econom ic s t u d i e s p lu s u t i l i ­
z a t i o n s t a t i s t i c s f o r c h i r o p r a c t i c s e r v i c e s on a s t a te - w i d e b a s i s .
Doctoral d i s s e r t a t i o n s a r e a ls o r a r e to f in d on th e s u b j e c t
m a tte r r e l e v a n t to t h i s s tu d y .

A 1971 d i s s e r t a t i o n on th e p e rc e iv e d

needs o f c o n tin u in g medical e d u ca tio n o f Ohio p h y s ic ia n s reviews
a r e a s o f c l i n i c a l i n t e r e s t to medical p r a c t i t i o n e r s and l o s e s some
c r e d i b i l i t y as 1 t 1s based on a 25 p e r c e n t resp onse r a t e .

I t d oes,

however, d e t a i l v a rio u s methods o f I n s t r u c t i o n and t r a i n i n g a i d s which
some p h y s ic ia n s l ik e d and o t h e r s d i s l i k e d .

A 1974 d i s s e r t a t i o n ta k in g

a s o c io lo g ic a l approach concludes t h a t th e c h i r o p r a c t o r should n o t be
la b e le d a s a beh av io ral d e v ia n t by s o c i e t y because o f h is r a d i c a l l y
d i f f e r e n t e x p la n a tio n f o r t h e cause and remedy o f d i s e a s e .

F u tu re

r e s e a r c h e r s a r e a l s o c a u tio n e d t o re-exam ine t h e i r " la b e le d " approach
t o any stu d y 1n t h i s f i e l d .

76
Textbook and p e r i o d i c a l l i t e r a t u r e on th e h e a lth s c ie n c e s
mention c h i r o p r a c t i c 1n accordance w ith th e a u t h o r 's view point on
"accepted" h e a lth p r o f e s s i o n s .

F u tu re unbiased e v a lu a tiv e re s e a r c h

w ill h o p e fu lly r e s o l v e many o f t h e c o n f l i c t i n g o p in io n s and p r e ju d ic e s
In th e h e a lth f i e l d .
The c o n tin u in g e d u c a tio n programs re p o rte d by o t h e r c o n ta c te d
s t a t e c h i r o p r a c t i c a s s o c i a t i o n s show l i t t l e homogeneity 1n th e s u b j e c t s
covered and l i t t l e emphasis on th e Importance o f c o n tin u in g p r o f e s s io n a l
e d u c a tio n fo r t h e m aintenance and p ro g re s s o f th e p r o f e s s i o n .

T his

a p ath y may be due to th e s e s t a t e o r g a n i z a t i o n s being unaware o f th e
same In fo rm a tio n uncovered 1n t h i s stu d y on imminent I n t e r v e n ti o n by
government a g e n c ie s In to th e r e l l c e n s u r e p r a c t i c e s o f s t a t e a g e n c ie s
m o n ito rin g h e a l th s e r v i c e s .
A review o f t h e r e p l i e s r e c e iv e d from s e v e ra l h e a l t h - r e l a t e d
p r o f e s s io n a l a s s o c i a t i o n s r e v e a l s th e type o f s u b j e c t s o f f e r e d and t h e
means o f a s s u r in g the a v a i l a b i l i t y o f c o n tin u in g e d u c a tio n t o t h e i r
members.

The r e c e n t I n s t i t u t i o n o f mandatory annual r e l l c e n s u r e

req u irem en ts f o r most o f th e h e a l t h - r e l a t e d p r o f e s s io n s p r e d i c a t e th e
e d u c a tio n a l need and th e ty p e o f s u b j e c t s ta u g h t in o r d e r to s a t i s f y
th o se Imposed req u ire m e n ts f o r m a in ta in in g o r upgrading p r o f e s s io n a l
competence.

However, a review o f t h e c o n tin u in g e d u c a tio n programs

o f some n o n - h e a l t h - r e l a t e d p r o f e s s i o n s d i s c l o s e s t h a t , a lth o u g h th ey
w i l l rem ain v o lu n ta r y , such programs a r e much so ugh t a f t e r by p ro ­
g r e s s i v e members who r e a l i z e th e b e n e f i t s o f a d d it i o n a l knowledge and
ta k e advantage o f such o p p o r t u n i t i e s to advance 1n t h e i r chosen f i e l d .

77
Design o f th e Study
The d esig n o f t h e s tu d y , which was d e s c r i p t i v e 1n n a t u r e , sought
t o a n a ly z e th e p e rc e p tio n s o f Michigan d o c to rs o f c h i r o p r a c t i c r e l a t i v e
to t h e i r needs In p o s t- d o c to r a l l e a r n in g and to determ ine th e c u r r e n t
s t a t u s o f c o n tin u in g e d u c a tio n p r a c t i c e s 1n th e s t a t e .
A comprehensive q u e s t io n n a ir e was m ailed to a 100 p e rc e n t sample
o f t h e c h i r o p r a c t i c community.

The q u e s tio n n a ir e re q u e ste d th e resp o n ­

d e n t s ' o p in io n s and p e rc e p tio n o f f o u r a r e a s o f p r o f e s s io n a l p r a c t i c e :
socio-eco nom ic, p r a c t i c e s t a t i s t i c s , e d u c a tio n a l background, and con­
t i n u i n g p r o f e s s io n e d u c a tio n .

The f i r s t t h r e e a r e a s were re q u ire d to

o b t a i n a p r o f i l e o f th e Michigan c h i r o p r a c t o r to s a t i s f y th e Michigan
S t a t e C h ir o p r a c tic A s s o c ia tio n , which sponsored t h e p r o j e c t .

The l a s t

a re a was an In n o v a tiv e one tack ed on to t h e su rvey In stru m en t t o o b t a i n
r e a c t i o n s on p e rc e iv e d e d u c a tio n a l needs.

Conments were s o l i c i t e d

a t th e end o f th e q u e s t io n n a ir e .
The survey In stru m e n t was a d m in is te re d 1n A pril o f 1977 w ith
a fo llo w -u p l e t t e r s e n t two weeks l a t e r t o speed up th e slow resp o n se .
One month l a t e r was th e c u t - o f f d a te w ith 386 resp o n d e n ts o r 45 p e r­
c e n t when th e d a ta was punched on IBM d a ta p ro c e ss in g c a rd s and p ro ­
cessed by th e Michigan S t a t e U n iv e r s ity CDC 6500 computer.

Analyses

and I n f e r e n c e s o f r e l e v a n t d a ta appeared 1n C hapter IV.
F in d in g s o f t h e Study
In o r d e r t o determ ine th e c u r r e n t s t a t u s o f c o n tin u in g p ro ­
f e s s i o n a l e d u c a tio n and t h e p e rc e iv e d l e a r n i n g needs o f Michigan
c h i r o p r a c t o r s , some o f th e d a ta from each p a r t o f t h e q u e s t io n n a ir e

78
were examined.

The age b r a c k e t o f a m a j o r i t y o f th e re s p o n d e n ts i s

between t w e n ty - f i v e and f o r t y - f o u r y e a r s .

With tw enty to f o r t y y e a r s

o f p r o f e s s i o n a l l i f e ahead o f them, th e m a j o r it y o f th e d o c to r s have
t h e time t o d e v o te some e f f o r t toward improving t h e i r s k i l l s and
knowledge in t h e h e a l t h f i e l d .
Except f o r t h e o n e -th 1 rd o f th e resp ond in g DCs, p r a c t i c i n g in
towns o v e r 100,000 p o p u la tio n , and th e small p e rc en ta g e in c o rm u n ltie s
u nder 2 ,5 0 0 , a l l th e o t h e r s were a lm o st e v en ly d i s t r i b u t e d around th e
sta te .

T h is c o uld be a f a c t o r o f c o n s i d e r a ti o n 1n s e l e c t i n g th e s i t e s

where c o u rs e s may be g iv e n .
The p r a c t i t i o n e r s I n d i c a te d t h a t th e most im p o rta n t re a so n s
f o r ch o o sin g th e l o c a t i o n 1n which to p r a c t i c e were th e p e rc e iv e d
need f o r t h e i r s e r v i c e s and t h e f i n a n c i a l p r o s p e c t s .

Whether o r no t

th e d o c to r s have a ch ieved t h e s e g o a l s , 1 t would ap pear t h a t c o n tin u in g
t h e i r p r o f e s s i o n a l e d u c a tio n w ill m a in ta in and Improve t h e i r s t a t u s .
In P a r t I I o f t h e s u rv e y I n s tr u m e n t, 1 t was d eterm ined t h a t
most p a t i e n t r e f e r r a l s a r e o b ta in e d from o t h e r p a t i e n t s , many through
perso n al c o n ta c t and w alk-1ns b u t r e l a t i v e l y few from o t h e r h e a l t h
p ro fe ssio n a ls.

T h is low r a t e o f I n t e r p r o f e s s i o n a l r e f e r r a l o f

p a t i e n t s 1s a s i t u a t i o n which d e s e rv e s Immediate a t t e n t i o n t o se c u re
p o s i t i v e changes v ia e d u c a tio n o f t h e o t h e r h e a l t h p r o f e s s i o n a l s .
The amount o f h e a l t h c o u n s e lin g g iv en t o p a t i e n t s by DCs i s
l a r g e b u t n o t a m ea su ra b le q u a n t i t y .

T h is Item 1n i t s e l f c o u ld be t h e

b a s i s o f r e s e a r c h f o r t h i s o r any h e a l t h p r o f e s s i o n .

The methods o f

d e te rm in in g p a t i e n t p r o g r e s s i n d i c a t e th e need f o r more e d u c a tio n 1n
c h i r o p r a c t i c o f f i c e p r o c e d u re s , v ia c o n tin u in g e d u c a tio n c o u r s e s ,

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s i n c e no c l e a r p a t t e r n emerges from th e d a ta o b ta in e d .

E v a lu a tio n o f

th e q u a l i t y o f s e r v i c e performed 1s made, by a lm o st 95 p e r c e n t o f t h e
p r a c t i t i o n e r s * by means o f q u e s tio n in g th e p a t i e n t a n d /o r re-exam in e
and re -X - ra y a f t e r th e p e rio d o f t r e a t m e n t .

T h is 1s a p o s i t i v e r e f l e c ­

t i o n on th e c on cern e x p re ssed by t h e d o c to r f o r h i s p a t i e n t .
C h i r o p r a c t o r s , s e l f - r a t i n g t h e i r s k i l l s 1n d e a lin g w ith v a r io u s
p r o f e s s i o n a l c o n t a c t s , re v e a l t h e i r l a c k o f a b i l i t y to p r o p e r l y deal
w ith MDs, DOs, In su ra n c e companies and a t t o r n e y s .

T his s u g g e s ts some

rem edial a c t i o n v ia communication and d i s c u s s i o n a t a p p r o p r i a t e sem inars
to r e s o l v e d i f f i c u l t i e s .
P a r t I I I a d d re sse d t h e e d u c a tio n a l background o f t h e Michigan
DC p r a c t i t i o n e r .

The m a jo r ity have th e r e q u ir e d two y e a r s o f p r e ­

p r o f e s s i o n a l c o l l e g e p r e p a r a t i o n w ith o v e r a f i f t h having t h e i r
B a c h e lo r 's d e g re e .

A n a ly s is o f where p o s t - g r a d u a t e work was ta k e n by

t h e DCs r e v e a l s a d i s t u r b i n g 2 2 .5 p e r c e n t who have not ta k e n any PG
work, o u t s i d e o f t h e m andatory re q u ire m e n ts f o r l i c e n s e re n e w a l.

T h is

s i t u a t i o n d e f i n i t e l y r e q u i r e s t h e a d v an tag e s t o be gained by a tte n d a n c e
a t c o n tin u in g e d u c a tio n c o u rs e s .
The d i s t r i b u t i o n o f c o u rs e work ta k e n by t h e c h i r o p r a c t o r s
I n d i c a t e s emphasis on th o s e s u b j e c t s c o n s id e r e d m ost e s s e n t i a l t o a
c h i r o p r a c t o r 's armamentarium, and bodes w ell f o r t h e i r p o s s i b l e f u t u r e
I n t e r e s t 1n p u rsu in g f u r t h e r s t u d i e s 1n t h o s e s u b j e c t a r e a s .
P a r t IV d i r e c t l y a d d re s s e s t h e p e rc e iv e d needs o f t h e DC f o r
c o n tin u in g p r o f e s s i o n a l e d u c a tio n .

T a b u la r d i s p l a y s show t h e wide

v a r i e t y o f s c i e n c e s u b j e c t s th e y would l i k e t o rev ie w , be t a u g h t o r 1n
which th e y would l i k e se m in a rs.

When and where c o u rs e s sh o u ld be

80
g iv e n , ty p e o f I n s t r u c t o r s and r e s p o n s i b i l i t y f o r th e c o s t o f t h e
c o n tin u in g e d u c a tio n a r e a d d i t i o n a l answ ers e l i c i t e d from t h e
q u e stio n s.
A n a ly sis o f d a ta by c r o s s - t a b u l a t i o n gave some I n t e r e s t i n g
Inferences:
1.

C h i r o p r a c to r s p r a c t i c i n g 1n l a r g e r communities a r e more

l i k e l y t o have ta k e n p o s t - g r a d u a t e c o u rs e s 1n O rth o p ed ic s and a r e more
I n t e r e s t e d In review ing o rth o p e d ic t e s t s recommended f o r p a t i e n t
e x a m in a tio n s th an DCs p r a c t i c i n g 1n s m a lle r comm unities.
2.
In tere sted

C h i r o p r a c to r s p r a c t i c i n g 1n l a r g e r communities a re more
1n I n s t r u c t i o n 1n

p r a c t i c a l c l i n i c a l psychology and p r a c t i c e -

b u i ld i n g p ro c e d u re s t h a t DCs p r a c t i c i n g 1n sm all com m unities.
3.

Compared w ith younger DC p r a c t i t i o n e r s , th e o l d e r c h i r o ­

p r a c t o r s a r e more l i k e l y t o have ta k e n p o s tg r a d u a te c o u rs e s 1n o r t h o ­
p e d ic s , n eu ro lo g y and 1n d i a g n o s t i c a r e a s .
4.

C h ir o p r a c to r s 1n th e t h 1 r t y - f 1 v e to f o r t y - f o u r y e a r age

group a r e most I n t e r e s t e d

In

review ing a l l s u b j e c t a r e a s , e s p e c i a l l y

th e o r th o p e d ic and n e u r o lo g ic a l t e s t s f o r p a t i e n t e x am in a tio n .
5.

Younger c h i r o p r a c t o r s a r e more I n t e r e s t e d th an o l d e r DC

p r a c t i t i o n e r s 1n i n s t r u c t i o n in advanced ra d io g r a p h ic I n t e r p r e t a t i o n ,
1n s p o r t s h a z a rd s and management o f a t h l e t i c I n j u r i e s , and 1n p r a c ­
t i c e - b u i l d i n g p ro c e d u re s .
6.

The h i g h e s t Income group 1s much more l i k e l y t o have tak en

p o s t - g r a d u a t e work 1n both c h i r o p r a c t i c and 1n o t h e r c o l l e g e s /
u n i v e r s i t i e s th a n th e low er Income group.

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7.

The h i g h e s t Income groups o f DCs a r e more l i k e l y t o have

ta k e n p o s t - g r a d u a t e work 1n o rth o p e d ic s * roentgenology* d i a g n o s t i c
a r e a s and s p e c i a l c h i r o p r a c t i c te c h n iq u e s th an lower Income c h i r o ­
p racto rs.
8.
1n:

The h i g h e s t Income group 1s more I n t e r e s t e d 1n sem inars

( a ) l a t e s t advances 1n r a d io g r a p h ic te c h n o lo g y ; (b) n e u ro lo g ic a l

c o n c e p t o f c h i r o p r a c t i c and I t s c u r r e n t s t a t u s ; (c ) d i f f e r e n t i a l
d ia g n o s is o f low back* upper back and neck p a in s ; and (d) o r t h o ­
p e d ic d i s a b i l i t y e v a l u a t i o n and Impairment r a t i n g th an t h e lower
Income g ro u p s.
9.

The h i g h e s t Income groups a r e more l i k e l y to p r e f e r

c o n tin u in g e d u c a tio n c o u rs e s a t a nearby c o l l e g e / u n i v e r s i t y than t h e
lower Income groups o f c h i r o p r a c t o r s .
Conclusions
The c h i r o p r a c t i c p o p u la tio n o f Michigan has been s t u d i e d f o r
t h e i r p e rc e iv e d p o s t - d o c to r a l l e a r n i n g needs and t h e i r c u r r e n t con­
t i n u i n g e d u c a tio n p r a c t i c e s .

As 1n any stu d y u sin g a n o n - s ta n d a r d iz e d

q u e s t i o n n a i r e t o c o l l e c t d a ta from a s p e c i f i c p o p u la tio n * c a u t io n
m ust be used 1n draw ing i n f e r e n c e s from th e f i n d i n g s .

N e v erth less,

t h e r e s u l t s o f th e stu d y I n d i c a t e s e v e r a l c o n c lu s io n s which a r e
p r e s e n te d below.

These c o n c lu s io n s a p p ly o n ly t o t h e p o p u la tio n under

stu d y i n M ichigan.
1.

The c h i r o p r a c t i c p o p u la tio n o f Michigan has responded

t o th e q u e s t io n s p r e s e n te d 1n C hapter I I I :

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a.

Over o n e - h a l f (5 2 .3 p e rc e n t) o f th e OC p r a c t i t i o n e r
resp o n d en ts I n d i c a te no I n t e r e s t 1n p u b lic r e l a t i o n s ,
p u b lic speaking and o t h e r com nunlcative s k i l l s , and o v e r
o n - h a l f (5 4 .6 p e r c e n t) have no I n t e r e s t 1n a c q u irin g
a d d it i o n a l s c ie n c e d e g re e s .

b.

Responding p r a c t i t i o n e r s p r e f e r t o a t t e n d c o n tin u in g
e d u c a tio n c l a s s e s 1n Lansing (46.1 p e r c e n t ) , a t a nearby
c o ll e g e o r u n i v e r s i t y (75.1 p e r c e n t ) , on weekends (62 .4
p e r c e n t ) , and f o r two days (51.3 p e r c e n t ) .

c.

DC resp o n d e n ts (77.1 p e rc e n t) b e lie v e t h a t t h e c o n tin u in g
e d u ca tio n c o u rs e s should le a d t o s p e c i a l t y c e r t i f i c a t i o n ,
a lth o u g h 52.1 p e rc e n t do n o t wish t o q u a l i f y as a DC
sp e c ia list.

d.

Over o n e - h a l f (51.1 p e rc e n t) o f th e d o c to rs b e li e v e th e
c o s t o f th e c o n tin u in g e d u c a tio n c o u rse s should be borne
e n t i r e l y by t h e p r a c t i t i o n e r , w ith 4 2 .0 p e rc e n t p r e f e r r i n g
t o s h a re th e c o s t w ith t h e i r a s s o c i a t i o n .

e.

Most resp o n d en ts (66.3 p e rc e n t) s t a t e t h e i r b e l i e f t h a t
p a s t e d u c a tio n a l c o u rs e s f o r r e l i c e n s i n g req u ire m e n ts have
upgraded t h e i r p r o f e s s io n a l competence.

f.

Of th e c h i r o p r a c t o r s p a r t i c i p a t i n g 1n t h e su rv e y , 57 p e r ­
c e n t a r e s a t i s f i e d w ith th e ty p e and q u a l i t y o f c o n tin u in g
e d u c a tio n c o u rs e s g iv en f o r l i c e n s e renewal p u rposes.

2.

The DCs have I n d ic a te d an awareness and t h e degree o f

p r e f e re n c e f o r c e r t a i n s u b j e c t s which r e l a t e t o what I s acc ep ted a s

83
c h iro p ra c tic p ra c tic e .

The s p e c i f i c s u b j e c t s a r e d isp la y e d 1n rank

o rd e r 1n C hapter IV t a b l e s .
3.

The respond in g p r a c t i t i o n e r s ' a p p a r e n t need f o r c o n tin u in g

p ro f e s s io n a l e d u c a tio n I s re v e a le d by th e c u r r e n t p o s t-g ra d u a te l e a r n in g
a c t i v i t i e s which a r e l im i te d t o t h e mandatory req u ire m e n ts f o r annual
rellce n su re .

All o t h e r c o n tin u in g e d u c a tio n 1s o b ta in e d 1n a haphazard

manner when and where a d v e r t i s e d 1n t h e p r o f e s s io n a l media.

A ttendance

1s p r e d ic a te d on th e d o c t o r s ' p e rc e p tio n o f t h e c o u rse Im portance to
them* th e tim e a v a i l a b l e and t h e d i s t a n c e to be t r a v e l e d .
Im p lic a tio n s and Recommendations
While t h e stu d y has c e r t a i n l i m i t a t i o n s , th e f in d in g s have
s i g n i f i c a n t meaning f o r t h e c h i r o p r a c t i c d o c to r s o f Michigan and p e r ­
haps f o r p r a c t i t i o n e r s 1n o t h e r s t a t e s o f th e union.
The fo llo w in g I m p lic a tio n s and recommendations were d e riv e d
from th e f i n d in g s o f th e stu d y :
1.

The l i t e r a t u r e review shows th e dominant r o l e and I n flu e n c e

o f medical orthodoxy on t h e th in k in g o f th e s c i e n t i f i c community and
many o f th e la y p u b lic on any and a l l a s p e c t s o f h e a lth c a r e p r o v is io n .
2.

A s e r i e s o f p r o f e s s i o n a l e d u c a tio n programs f o r t h e Michigan

c h i r o p r a c t o r should be I n s t i t u t e d (perhaps approved a n d /o r m onitored by
t h e Michigan Board o f C h i r o p r a c ti c Examiners) w ith r e f e r e n c e t o t h e
f in d in g s o f t h i s s tu d y , h o p e fu lly m o tiv a tin g th e p r a c t i t i o n e r f o r
Immediate Involvem ent 1n t h i s upgrading p ro ced u re—w ith o u t le g a l com­
p u ls io n .

84
Recommendations f o r F u rth e r R esearch
1.

R e p li c a t e t h i s stu d y 1n t h r e e y e a r s o r fo llo w in g a m ajor

r e v i s i o n 1n th e C h i r o p r a c t i c P r a c t i c e Law o f Michigan o r 1n th e
a c t i v i t i e s o f th e DHEM t o d e te rm in e what changes may have o c c u rre d
1n th e p e r c e p t i o n s o f Michigan d o c to r s o f c h i r o p r a c t i c re g a r d in g th e
Impact o r Im portance o f c o n tin u in g p o s t - g r a d u a t e e d u c a tio n on t h e i r
p ro fessio n al l iv e s .
2.

R e p li c a t e and expand t h i s stu d y t o In c lu d e com parisons

w ith c h i r o p r a c t i c e d u c a tio n a l programs e x i s t i n g o r being g e n e r a te d 1n
o th er S ta te s.
3.

R e p li c a t e t h i s stu d y t o In c lu d e com parisons w ith l i k e p e r ­

c e p t io n s o f c o n tin u in g e d u c a tio n needs 1n o t h e r h e a l t h p r o f e s s i o n s .
4.

Develop and c ondu ct an 1n-depth I n v e s t i g a t i o n o f con­

t i n u i n g e d u c a tio n I d e n t i f y i n g and comparing p r e f e r e n c e s based on se x ,
e t h n i c o r i g i n , fa m ily background and s i m i l a r v a r i a b l e s .
R e f le c t i o n s
T h is s tu d y was n o t in te n d e d t o be a d e f i n i t i v e i n v e s t i g a t i o n
o f t h e Michigan c h i r o p r a c t o r , bu t r a t h e r an e x p l o r a t o r y , d e s c r i p t i v e
tr e a tm e n t o f an i s s u e which can have a d e c id e d I n f lu e n c e on t h e f u t u r e
p ro g re s s o f a m in o r i t y h e a l t h c a r e p r o f e s s i o n .

The u l t i m a t e b e n e f i t

w i l l a c c ru e t o t h e p u b l ic which t h a t p r o f e s s i o n s e r v e s .
T here 1s a s t r o n g p o t e n t i a l f o r c o n tin u in g p r o f e s s i o n a l edu­
c a t i o n among th e members o f t h e c h i r o p r a c t i c p r o f e s s i o n 1n Michigan.
The s t a t i s t i c s d e riv e d from t h e s tu d y show a p r o f e s s i o n a l person w ith
a h a b i t o f l e a r n i n g and th e w i l l i n g n e s s t o p u rsu e c o n tin u in g e d u c a tio n

85
c o u rs e s .

However, a p athy toward In c r e a s in g knowledge and s k i l l s p e r ­

t a i n i n g to c h i r o p r a c t i c p r a c t i c e beyond th e p r e s e n t meager r e q u i r e ­
ments f o r r e l l c e n s u r e could be f a t a l o r a t b e s t extrem ely tra u m a tic
fo r th e p ro fessio n .
A review o f th e r e c e n t p u b l ic a t i o n s o f th e U.S. Department of
H e alth , E ducation and W elfare p r e s e n ts a d e f i n i t e p i c t u r e o f I n t e n t
on th e p a r t o f t h a t government agency 1n th e n e a r f u t u r e to s t r o n g l y
In f lu e n c e , 1f not a c t u a l l y m on ito r, t h e t e s t s aimed a t d is c o v e rin g th e
h e a l th p r a c t i t i o n e r ' s r e t e n t i o n o f new s k i l l s and knowledge a c q u ire d .
This would supposedly dem on strate m aintenance and upgrading o f p ro ­
f e s s i o n a l competency f o r annual r e l l c e n s u r e to p r a c t i c e the p r o f e s s io n .
I t 1s th e s i n c e r e hope o f th e r e s e a r c h e r t h a t t h i s s tu d y and
I t s f in d in g s w ill s t i m u l a te th e c o n scio u sn ess o f o t h e r c h i r o p r a c t i c
p r o f e s s i o n a l s 1n Michigan and 1n o t h e r s t a t e s t o s e r i o u s l y c o n s id e r the
p r o b a b i l i t y in th e near f u t u r e o f w r i t t e n o r o r a l exam inations becoming
mandatory on a p e rio d ic b a s i s through the In flu e n c e o f Federal govern­
ment I n t e r v e n t i o n , and t h a t they p re p a re them selves f o r such an
e v e n tu a lity .
The r e s e a r c h e r , a Michigan p r a c t i t i o n e r , app ears to be th e only
member o f h i s p ro fe s s io n who has made th e e f f o r t to stu d y h i s c o lle a g u e s
v ia t h i s ty p e o f I n v e s t i g a t i o n .

I t 1s presumed t h a t f u t u r e r e s e a r c h e r s

1n t h i s a re a o f In q u iry w ill In clu d e DCs who w i l l a ls o I n v e s t i g a t e both
o f th e c u r r e n t p r a c t i c e co n cep ts under which th e p r o fe s s io n la b o r s and,
by r e p o r t i n g t h e i r f i n d i n g s , c r e a t e a b e t t e r u n d e rstan d in g among th e
c h i r o p r a c t i c p o p u la tio n t o t r u l y u n if y and s tr e n g th e n th e p r o f e s s i o n .

86
The emergence o f a m a jo r ity o f c h i r o p r a c t i c " s t r a l g h t - m l x e r s "
1n Michigan and 1n a l l t h e U nited S t a t e s would be a h ig h ly d e s l r e a b le
outcome.

F a llin g such a tte m p t a t u n i f i c a t i o n o f th e p r o f e s s i o n , s t a t e

laws should p erm it a v a ria n c e 1n th e mode o f p r a c t i c e acco rd in g to th e
t r a i n i n g r e c e iv e d by th e In d iv id u a l p r a c t i t i o n e r .

The " s t r a i g h t "

c h i r o p r a c t o r s would o p e ra te under one l i c e n s e w hile th e "mixer" c h i r o ­
p r a c t i c p h y sic ia n would p r a c t i c e under a broader p r a c t i c e scope y e t
av o id in g su rg e ry and drug m e d ic a tio n .

E ith e r method would c r e a t e th e

n e c e ssa ry harmony r e q u ir e d f o r th e h e a lth y growth o f a needed
p ro fessio n .

APPENDICES

APPENDIX A
LETTER AND LIST OF OFFICIALS OF EACH
STATE ORGANIZATION REPRESENTING
CHIROPRACTIC

88

Michigan State
Chiropractic AsaocteUon
M )E

Lanm g M e d ian 40333

(Mn*8?S06>

(The l e t t e r shown below was sen t to the lis t e d o f f i c i a l s of
each S tate organization representing chiropractic*)

June 25, 1976

Dear S ir:
We are undertaking a self-assessm ent program which w ill hopefully
resent a more factual Image of the chiropractic profession In
Ichlgan In deliberating with s ta te le g is la tiv e members* committees*
and agencies responsible fo r s ta te health policy.

K

In gathering re la tiv e Information, we wonder whether your State
ever made such a survey and 1f you could provide us with a copy.
In any event* would you please furnish the following data from
your f ile s :
1.

What Is the to tal number of your s ta te licensed
chiropractors?

2.

What Is the current membership of your organization?

3.

Are there other s ta te chiropractic organizations and
what Is th e ir approximate membership?

4.

What educational programs are planned fo r your
membership 1n 1976 (fo r convention or a t other times)
and what programs were offered 1n the past fiv e years?

Your cooperation Is g reatly appreciated and* upon request* we will
be pleased to send you a copy of our fin al self-assessm ent survey
re s u lts.
Sincerely yours*

Kenneth 0. W ells,J).C

Sanford U lrich, D.C.
Survey Coordinator of H.S.C.A

tanMWl

89

APPENDIX A
THE STATISTICAL INVESTIGATION REQUEST
WENT TO THE FOLLOWING
June 25, 1976
1.

Mrs. Ruby B. M iddleton
E x ecutive S e c re ta r y
Alabama S t a t e C h i r o p r a c ti c A s s o c ia tio n
P.O. Box 3335
Montgomery, Alabama 36109

2.

Dr. D. E. Hampton
S e c re ta ry -T rea su re r
Alaska A s s o c ia tio n o f C h i r o p r a c ti c
1500 A i r p o r t Way
F a irb a n k s , Alaska 99701

P h y s ic ia n s

3.

M1ss Ann M. Yell1n
A s s o c ia tio n S e c r e t a r y
C h i r o p r a c ti c P h y s ic ia n s A s s o c ia tio n o f A rizona
4747 North 16th S t r e e t , S u i t e D-101
Phoenix, A rizona 85016

4.

Dr. F e l l z C a n n a t e l l a , J r .
Sec r e t a r y - T r e a s u r e r
Arkansas C h i r o p r a c t i c A s s o c ia tio n
7410 Base L ine Road
L i t t l e Rock, A rkansas 72204

5.

Mr. C h a rle s L. S tra u c h
E x ecu tiv e D i r e c t o r
C a l i f o r n i a C h i r o p r a c ti c A s s o c ia tio n
2201 "Q" S t r e e t
Sacram ento, C a l i f o r n i a 95816

6.

Mr. W alther Hanklson
E x ecu tive D i r e c t o r
Colorado C h i r o p r a c t i c A s s o c ia tio n
666 Sherman S t r e e t
Denver, Colorado 80203

90

91

7.

Dr. John D. B rlsw a ld , J r .
S ec re ta ry T reasu rer
C o n n e c tic u t C h i r o p r a c ti c A s s o c ia tio n
1457 North S t r e e t
S u f f l e l d , C o n n e c tic u t 06078

8.

Dr. John Paul Feeney,
S ecre tary
Delaware A s s o c ia tio n o f C h i r o p r a c ti c P h y s ic ia n s
183 South DuPont Highway
M idvale, Delaware 19720

9.

Mrs. Marian M. Poole
E x ecutiv e D i r e c t o r
F lo r id a C h i r o p r a c ti c A s s o c ia tio n
S u i t e 101 - Amherst B u ild in g
3203 Lawton Road
O rlan do, F lo r id a 32808

10.

Dr. Hazel C. Cotney
S ecre tary
G eorgia C h i r o p r a c t i c A s s o c ia tio n
308 West Main S t r e e t
Thomaston, Georgia 30286

11.

Dr. Kwanlln L. K. Wong
S e c re ta r y
Hawaii C h i r o p r a c t i c A s s o c ia tio n
1575 South B e re ta n la S t r e e t , S u ite 210
H onolulu, Hawaii 96814

12.

Dr. Geroge Ruddell
S ec retary
Iadho A s s o c ia tio n o f C h i r o p r a c ti c P h y s ic ia n s
2605 Willow D rive
L ew iston , Idaho 83501

13.

Mr. John P. Q u llla n
E x ecu tiv e D i r e c t o r
I l l i n o i s C h i r o p r a c ti c S o c ie ty
200 E a s t R o o se v e lt Road
Lombard, I l l i n o i s 60148

14.

Dr. V i c t o r K. F i t c h
E x ecu tiv e S e c r e t a r y
In d ian a S o c ie ty o f C h i r o p r a c t i c P h y s ic ia n s
Georgetown Square P r o f e s s io n a l B u ild in g
6605 E a s t S t a t e Boulevard
F o r t Wayne, In d ian a 46805

92
15.

Dr. D. E. McAreavy
E x ec u tiv e S e c r e t a r y
Iowa C h i r o p r a c t i c S o c ie ty
216 West P l a t t
Maquoketa, Iowa 52061

16.

Mrs. Clnda S. Vogel
E x ec u tiv e D i r e c t o r
Kansas C h i r o p r a c t o r s ' A s s o c ia tio n
3320 H a rris o n
Topeka, Kansas 66611

17.

Dr. Harold W. Evans
E xecutive S e c r e t a r y
Kentucky A s s o c ia tio n o f C h ir o p r a c to r s
P.O. Box 1117
Bowling Green, Kentucky 42101

18.

Dr. Paul J . Adams
S e c re tary -T rea su rer
L o u is ia n a C h i r o p r a c ti c S o c ie ty
1101 E a s t Slmcoe
L a r a y e t t e , L o u isia n a 70501

19.

Mr. C a r r o l l M artin
E x ec u tiv e D i r e c t o r
Maine C h i r o p r a c t i c A s s o c ia tio n
B road turn Road
S carbo roug h, Maine 04074

20.

Dr. H arold F. Carbaugh
S ec re tary -T rea su rer
Maryland C h i r o p r a c ti c A s s o c ia tio n
306 North Potomac S t r e e t
Hagerstown, Maryland 21740

21.

Dr. Paul M. Hamilton
S e c re tary -T rea su rer
M a ss a c h u se tts C h i r o p r a c ti c S o c ie ty
348 Essex S t r e e t
Salem, M a ss a c h u se tts 01970

22.

Mr. Elo1 A. Hamre
E x ecu tiv e D i r e c t o r
M innesota C h i r o p r a c ti c A s s o c ia tio n
1935 West County Road B2, S u i t e 224
S t. P a u l, M innesota 55113

93
23.

Dr. Thomas 6. Hennington
S e c re ta ry T rea su rer
M i s s i s s i p p i C h i r o p r a c ti c A s s o c ia tio n
511 West Georgia Avenue
McComb, M i s s i s s i p p i 39648

24.

Mr. John B r i t t o n
E x ecutiv e D i r e c t o r
M isso u ri S t a t e C h i r o p r a c t o r s ’ A s s o c ia tio n
P.O. Box 843
J e f f e r s o n C i ty , M issou ri 65101

25.

Mr. A lfr e d F. Dougherty
E x ecu tiv e S e c r e t a r y
Montana C h i r o p r a c ti c A s s o c ia tio n
P.O. Box 593
H elena, Montana 59601

26.

Dr. Gordon Kuether
S ecre tary
Nebraska C h i r o p r a c ti c P h y s i c i a n s ' A s s o c ia tio n
1454 C olfax S t r e e t
B l a i r , Nebraska 68008

27.

Dr. Kenneth L. Yeokum
S ecre tary T rea su rer
C h i r o p r a c ti c A s s o c ia tio n o f Nevada
618 South C e n te r S t r e e t
Reno, Nevada 89501

28.

Dr. John W. Sing
S e c re tary T reasu rer
New Hampshire C h i r o p r a c t i c R esearch A s s o c ia tio n
20 E ast Broadway
D e rry , New Hampshire 03038

29.

Dr. Arnold E, C1anc1ul11
E x ec u tiv e S e c r e ta r y
New J e r s e y C h i r o p r a c t i c S o c ie ty
940 Avenue "C"
Bayonne, New J e r s e y 07002

30.

Dr. R. D. M itc h e ll
P resid en t
New Mexico C h i r o p r a c t i c A s s o c ia tio n
P. 0 . Box 1768
Alamogordo, New Mexico 88310

94
31.

Mr. Howard S. Davis
A d m in is tra to r
New York S t a t e C h i r o p r a c t i c A s s o c ia tio n
45 John S t r e e t
New York, N.Y. 10038

32.

Dr. Roy A. O t t l n g e r
S ecretary -T reasu rer
North Dakota C h i r o p r a c t i c A s s o c ia tio n
Box 1643 - 1300 6 th Avenue, N.E.
Jamestown, North Dakota 58401

33.

Mr. R ichard H. Zimmerman
E x ecutive D i r e c t o r
Ohio S t a t e C h i r o p r a c t i c A s s o c ia tio n
1880 Harwltch Road, P.O. Box 5581
Columbus, Ohio 43221

34.

Mr. Fred W. Woodson
E x ecutive S e c r e t a r y
C h i r o p r a c t i c A s s o c ia tio n o f Oklahoma
P. 0 . Box 4470 - Donaldson S t a t i o n
T u ls a , Oklahoma 74104

35.

Ms. B e tty Tower
A d m in is tr a tiv e A s s i s t a n t
Oregon A s s o c ia tio n o f C h i r o p r a c t i c P h y s ic ia n s
P.O. Box 20455
P o r t l a n d , Oregon 97220

36.

P e n n sy lv a n ia C h i r o p r a c t i c S o c ie ty
344 North 2 1 s t S t r e e t
Wagner B u ild in g , S u i t e 108
Camp H i l l , P e n n sy lv a n ia 17011

37.

Dr. V incent J . C a v a lla ro
S ecretary
C h i r o p r a c t i c S o c ie ty o f Rhode I s la n d
371 Broadway
P ro v id e n c e , Rhode I s l a n d 02909

38.

Dr. Max W inkler
E x ec u tiv e S e c r e t a r y
South Dakota C h i r o p r a c t o r s ' A s s o c ia tio n
108 West M issou ri
P i e r r e , South Dakota 57501

95
39.

Dr. LaDon B u tle r
S e c re ta r y
South C a ro lin a C h i r o p r a c ti c A s s o c ia tio n
4 E ast Hamilton
W IIHam ston, South C a ro lin a 29697

40.

Dr. C h arles Walker
Executive D ir e c to r
Texas C h i r o p r a c ti c A s s o c ia tio n
508 West 16th
A u s tin , Texas 78701

41.

Dr. Lee Roy Selby
E xecutive D i r e c t o r
Tennessee C h ir o p r a c tic A s s o c ia tio n
S u ite 300 C a s t i l e O f f ic e Center
1161 M urfreesboro Road
N a s h v ille , Tennessee 37317

42.

Dr. John E. CUkeman
S e c r e ta r y
Utah C h ir o p r a c tic A s s o c ia tio n
525 South S t a t e S t r e e t #10
C l e a r f i e l d , Utah 84015

43.

Dr. George 8. M cClelland, J r .
S e c re ta r y
V i r g i n ia C h ir o p r a c to rs A s s o c ia tio n
131 Huntington Lane
B lacksburg, V ir g in ia 24060

44.

Dr. C h arles McLean
S e c re ta r y T re a s u r e r
Vermont C h ir o p r a c tic A s s o c ia tio n
14 S t . Paul S t r e e t
B u rlin g to n , Vermont 05401

45.

Dr. Mike Rlsdon
S e c re ta r y T re a s u r e r
Wyoming C h ir o p r a c tic A s s o c ia tio n
1027 - 12th S t r e e t
Cody, Hyomlng 82414

46.

Mr. Del Beno
E xecutive S e c r e ta r y
Wisconsin C h i r o p r a c ti c A s so c ia tio n
222 South Hamilton S t r e e t
Madison, Wisconsin 53703

96
47.

Or. Carl D. Bartholomew
S e c r e ta r y T re a s u r e r
West V i r g i n ia C h iro p ra c to rs S o c ie ty
2409 F a i r f i e l d Avenue
B l u e f l e l d , West V ir g in ia 24701

48.

Washington C h ir o p ra c to rs A s s o c ia tio n
The Grosvenor House* S u ite 402
500 Wall S t r e e t
S e a ttle * Washington 98121

APPENDIX B
LETTER AUTHORIZING STATISTICAL INVESTIGATION

97

Michigan State
vnFOpracuc Aaaocwtion
WOE IM n m h c

Lafwig Menigan 40013

rsiri 40r-so6i

July 1, 1976

TO WHOM IT HAY CONCERN:
This le tte r w ill Introduce Dr. Sanford U lrich, S ta tis tic a l
Coordinator for the M.S.C.A., o f Eaton Rapids.
On June 26, 1976 the Board o f D irectors of the Michigan State
Chiropractic Association authorized the S ta tis tic a l Investigation
of the ch iro p ractic profession In Michigan.
Any assistan ce th a t you night give Dr. Ulrich would be g reatly
appreciated.
Sincerely,

Kenneth D. Wells, D.C.
President
KDW/bn

FanM0U

98

APPENDIX C
PRACTICE OPINION SURVEY LETTER AND FORM

99

100
J u l y 13* 1976

Dear Doctor:
You a re w ell aware o f th e many d i f f e r i n g o p in io n s on how C h ir o p r a c tic
should be p r a c t ic e d 1n th e S t a t e . We a r e a l l o f c o u rse e n t i t l e d t o our
p erso nal b e l i e f s on t h i s s u b j e c t b u t , to p r e s e n t a u n i f i e d , m a j o r it y
e x p re s s io n to th e governor and s t a t e l e g i s l a t u r e a t t h i s tim e when our
p r a c t i c e law Is 1n jeopardy* you a r e asked to p le a s e I n d i c a t e your
o p in io n on th e fo llo w in g b a s ic q u e s tio n .
Your c o o p e ra tio n 1s deep ly a p p r e c ia te d and* h o p e fu lly , th e answers
i n d i c a t i n g th e m a j o r it y o p in io n o f th e D.C.s w ill fa v o ra b ly Impress th e
l e g i s l a t i v e bodies d e l i b e r a t i n g an a dequ ate and e q u i t a b l e p r a c t i c e law
f o r C h ir o p r a c tic In M ichigan.
On th e form below check one answer and r e t u r n 1n th e e n clo se d stamped,
s e l f - a d d r e s s e d e n v elo p e, as soon a s p o s s i b l e . R e s u lts o f t h i s stu d y w ill
be found 1n b o th th e MSCA and MCC news columns.
S in c ere ly ,

Sanford U l r i c h , D.C.
S t a t i s t i c a l C o o rd in ato r
SU/bn
enc.

How Would You Like to See C h i r o p r a c ti c P r a c tic e d 1n Michigan?
1.

By hands o n ly - - s p in e only?

2.

By d i a g n o s i s / a n a l y s i s , s p in a l a d ju s tm e n t
j o i n t m a n ip u la tio n ?

3.

By d i a g n o s i s / a n a l y s i s , sp in a l a d ju s tm e n t, j o i n t
m a n ip u la tio n , p h y sic a l th e ra p y and n u t r i t i o n ?

4.

By a l l t h e above, p lu s m e d ic a tio n andsu rg e ry ?

5.

A d d itio n a l comments

_____

□
and

I— .
|___[
|— ,
1____|

____________________

S ig n a tu r e

□

APPENDIX D
PRACTICE OPINION SURVEY RESULTS

101

T abulation o f th e R esults o f th e P r a c tic e Opinion Survey o f Michigan C hirop racto rs (completed
August 16, 1976).
P re ferre d Choices

Rounded to

No.

1

34 o f 579 Useable Responses*

34
579

5 .9

6%

No.

2

42 o f 579 Useable Responses

42
579

7 .3

7%

No.

3

434 o f 579 Useable Responses

434
579

75.0

75%

No.

4

69 o f 579 Useable Responses

69
579

11.9

12%
100% (579)

579 Useable Responses (signed and choice marked)
14 Unsigned (n o t counted in r e s u l t s )
5 Unmarked (no choice made—no t counted in r e s u l t s )
598 Total Responses from 852 m a ilin g s , o r 70% r e tu r n

APPENDIX E
DC DISTRIBUTION IN MICHIGAN DISTRICTS

103

D i s t r i b u t i o n o f Michigan DCs by MSCA Regional D i s t r i c t s as o f
February 1977.
Number

D istric t

P e rc e n t

1

363

4 2 .7

2

176

20.7

3

145

17.1

4

134

15.8

5

32

3 .8

TOTALS

850 R e sid en t L icen sees

★
Do n o t add up t o 100 p e rc e n t due t o rou nding.

104

★

MSCA DISTRICTS

BiSTfiCTM

105

APPENDIX F
LETTER OF TRANSMITTAL AND QUESTIONNAIRE FORMS

106

Mchigan State
CNrapracUc Association
UOE

Lanwig Wcn^an 4SM3
( 1 1 T |* 8 7 ! 0 6 '

A p ril 1 2 , 1977

D eal D o c to r i
E nclosed you w i l l f in d a su rv ey t h a t w i l l se e k t o d e te rm in e th e p r o f i l e
o f c h i r o p r e c tio p h y s ic ia n s i n M ichigan. The p u rp o se o f t h i s su rv e y i s tv o f o ld i
1) To d e t e m i n e w here th e M ichigan C h ir o p r a c tic p h y s ic ia n
s ta n d s i n r e l a t i o n t o c h i r o p r a c t i c p h y s ic ia n s in o th e r
s ta te s .
2)

To d e te rm in e w hat k in d s o f c o n tin u in g e d u c a tio n program s
th e C h i r o p r a c tic p h y s ic ia n i n M ichigan f e e l s would be
b e n e f i c i a l t o ad v an ce th e p r o f e s s io n i n M ich ig an .

As ea c h o f you knows, t h e r e i s in c re a s e d c o n c e rn by o r g a n is a tio n s l i k e
HEM, M ichigan D epartm ent o f P u b lic H e a lth , e t c . , t o p ro v id e th e p a t i e n t w ith
th e b e s t h e a lth c a r e a v a i l a b l e . I n d ic a tio n s a r e t h a t a l l h e a l t h p r a c t i t i o n e r s
may e v e n tu a lly have t o p ro v e t h e i r co e p eten c y by p e r io d i c e x a m in a tio n s a a a
b a s in f o r renew ing t h e i r l i c e n s e t o p r a c t i c e . T h e r e f o r e , i t i s Im p o rta n t t o
make a needs a s se ss m e n t now, i n o r d e r t o p la n f o r f u tu r e grow th o f th e
c h i r o p r a c t i c p r o f e s s io n .
I n o r d e r t o g e t a su rv e y t h a t a c c u r a t e ly r e f l e c t s th e M ichigan C h ir o p r a c tic
p h y s ic ia n , i t i s Im p o rta n t t h a t each D.C. p a r t i c i p a t e . Your c o o p e r a tio n i n ­
v o lv e * co m p letin g th e e n c lo s e d form (a b o u t a 20 m in u te ta s k ) an d r e tu r n in g i t
i n th e p r e - p a ld e n v e lo p e .
A ll in d iv id u a l su rv e y s w i l l rem ain c o n f i d e n t i a l . The m a te r ia l w i l l o n ly
be u se d i n t o t a l t o r e f l e c t th e f in d in g s o f th e r e g u e s te d in f o rm a tio n . Each
c h i r o p r a c t i c p h y s ic ia n w i l l r e c e iv e a copy o f th e su rv e y o n ce i t h a s b een
c o m p leted . T h is w i l l h e lp you l e a r n how y o u r c o lle a g u e s i n M ichigan view
c h iro p ra c tic .
P le a s e d o n 't o v e rlo o k th e u rg en cy f o r p a r t i c i p a t i n g i n t h i s s f f o r t .
Your c o o p e ra tio n w i l l be g r e a t l y a p p r e c ia te d .
S in c e r e ly ,

'S a n f o r d 8 . U lr ic h , D .C .
Survey C o o rd in a to r

Mark B. VanWagonar, D.C, /
P r e s id e n t , M.S.C.A

9ba
M w M SU

107

QUESTIONNAIRE
P art I

Socio-economic p r o f i l e : ( p le a s e c i r c l e th e number o f y o u r
c h o ic e u n le s s o th e rw is e n oted)
Example:

Are you m arried ?
(1 -0 )
1 Yes

2

No

ITEM #

(1- 1)

What 1s y o ur age group?
1
2

( 1- 2 )

Under 25
25-34

3
4

35-44
45-54

5 55-64
6 Over 65

What 1s y o ur community p o p u la tio n s i z e ?
1
2

Under 2500
2500-5000

3
4

5000-10,000
10,000-25,000

5 25,000-50,000

6 50,000-100,000
7

(1 -3 )

Were you r a i s e d In th e conmunlty where you now p r a c t i c e ?
1
2

(1 -4 )

6
7

Under 1 y e a r
1-5 y e a rs

3
4

6-10 y e a r s
11-20 y e a r s

5 o v e r 20 y e a r s

How 1s C h ir o p r a c tic a c c e p te d 1n y o u r community?
1

(1 -7 )

S e rv ic e (K1wan1s, H o n s , R otary, e t c . )
F r a te r n a l ( E lk s , Masons, K.C., e t c . )
B usiness groups (Chamber o f Commerce, e t c . )
R e c re a tio n c lu b s (bow ling, g o l f , gym, e t c . )
Church ( c h o i r , Sunday s c h o o l, e t c . )
M i l i t a r y (American L egion, VFW, e t c . )
Do n o t belong t o any community o r g a n iz a tio n

How long have you p r a c t i c e d 1n y o u r p r e s e n t l o c a ti o n ?
1
2

(1- 6)

Yes
No

Do you belong to any community o r g a n i z a t i o n s ?
1
2
3
4
5

(1 -5 )

Over 100,000

F u lly

2

T o le ra te d

3

S tro n g ly opposed

How many tim es d id you r e l o c a t e s in c e s t a r t i n g t o p r a c t i c e ?

108

109
How Im p o rta n t 1n choo sing y o u r p r e s e n t l o c a t i o n was each?
Very
Im p o rtan t

Some
Im portance

(1-13 )

P e rc e iv e d need f o r DC s e r v i c e s
F in a n c ia l p r o s p e c ts
Fam ily t i e s
The c lim a te
A cq u irin g an e s t a b l i s h e d p r a c t i c e
R e c re a tio n a l environm ent

(1-14 )

In what group 1s y o u r g ro s s

annual p r a c t i c e Income?

1
2
3

4
5

1-11
( 1- 12)

Under $10,000
$10,000 t o $20,000
$20,000 t o $35,000

P art

P ra ctice S t a ti s t i c s :

(2- 1)

Do you p r a c t i c e ?
1

( 2- 2 )

In a h o m e /o ffic e com bination

W ithout any a s s i s t a n t s
With one a s s i s t a n t

3 With more th a n one a s s i s t a n t

Are you 1n p r a c t i c e ?
1
2

(2 -4 )

3
3
3
3
3
3

How do you c ond uct y o u r p r a c t i c e ?
1
2

(2 -3 )

2

2
2
2
2
2
2

$35,000 to $50,000
$50,000 t o $100,000
Over $100,000

6

In an o f f i c e o n ly

Unlmp o rtan t

Alone
With a DC p a r t n e r

How many days p e r
1
2

3 In group p r a c t i c e
4 I n c o r p o ra te d a s a PC

week do you p r a c t i c e ?

Two
T hree

3
4

Four
Five

5

T o ta l hours?
____________

(2 -5 )

What 1s th e a v erag e number o f p a t i e n t s seen p e r week?_________

( 2- 6 )

About how many new p a t i e n t s a r e seen each week?_______________

(2 -7 )

Do you t r e a t p a t i e n t s ?

1
2

( 2- 8)

Do you ta k e r o u t i n e x - r a y s b e fo re t r e a tm e n t?
1

(2 -9 )

O u tsid e o f
r e g u l a r o f f i c e hours
3 Make n i g h t c a l l s
Make house c a l l s
4
None a r e so t r e a t e d

Yes

2

No

What 1s t h e usual c h a rg e f o r an I n i t i a l exam inatio n?
$___ ___________________________

110
(2-10)

What I s th e usual c harge f o r a r o u t i n e o f f i c e

.

$
(2-11)

On p a t i e n t b i l l i n g arrangem ents?
1
2
3
4

(2-12)
(2-13)

How Is y o u r p r a c t i c e c ared f o r In y o u r absence?

3 R e f e r r a l s from p a t i e n t s
4 R e f e r r a l s from o t h e r h e a lth
p ro fessio n als

O ther DCs
MDs

3 DOs
4 O ther h e a l th

p ro fessio n als

DCs
MDs

3 DOs
4 O th e r h e a l th

p ro fessio n als

A g r e a t amount
Average

3 Some
4 None a t a l l

How do you g e t feedback from y o u r p a t i e n t s ?
1
2
3

(2-19)

By perso n al c o n ta c t
From walk-1ns

How much h e a lth c o u n selin g do you g iv e p a t i e n t s ?
1
2

(2-18)

c lo se d

Do you r e c e iv e r e f e r r a l s from?
1
2

(2-17)

3 By a n o th e r DC
4 By no one, o f f i c e 1s

Do you r e f e r p a t i e n t s to ?
1
2

(2-16)

By th e o f f i c e a s s i s t a n t
By th e DC p a r tn e r

How a r e p a t i e n t s o b ta in e d ?
1
2

(2-15)

Do th ey pay a t each v i s i t
Are th e y b i l l e d m onthly
Do you make c r e d i t arrangem ents
Do you use a c o l l e c t i o n agency

How many v a c a tio n days do you av erag e p e r y e a r? ____________

1
2
(2-14)

v isit?

Asking q u e s tio n s a f t e r t r e a tm e n t
L e t ti n g p a t i e n t s r e p o r t p ro g r e s s
By n e i t h e r , r e f e r r a l s I n d i c a t e s a t i s f a c t i o n

How do you e v a lu a te t h e q u a l i t y o f y o u r s e r v ic e s ?
1
2
3

By re-exam 1nations and r e - x - r a y s
P a t i e n t feedback by q u e s tio n in g
No q u a l i t y e v a lu a tio n made

Ill
How would you r a t e y o u r s k i l l s in each o f t h e fo llo w in g ?
Good
( 2- 20 ]

2-21
2-22
2-23
2-24
2-25
2-26

2
2
2
2
2
2
2

D 1agnos1s/analys1s
1
T re a tm e n t/a d ju s tm e n t
1
D ealing w ith p a t i e n t s
1
D ealing w ith o t h e r DCs
1
D ealing w ith MDs/DOs
1
D ealing w ith in s u ra n c e companies 1
D ealing w ith a t t o r n e y s
1

P art I I I .
(3 -1 )

Adequate

Poor

None

3
3
3
3
3
3
3

4
4
4
4
4
4
4

E ducational Background:
Did you have a n o th e r o c c u p a tio n b e fo r e C h i r o p r a c ti c ?
1

Yes

2 No

(3 -2 )

I f y e s t o above, 1n what f i e l d d id you work?_______________

(3 -3 )

Did you a t t e n d c o l l e g e b e f o r e y o u r C h i r o p r a c t i c t r a i n i n g ?
1

(3 -4 )

6
7

8
9
10
11
12

4 A B a c h e lo r 's d egree
5 An advanced d eg ree

Palmer C o lle g e o f C h i r o p r a c t i c
N ational C o lle g e o f C h i r o p r a c t i c
L in c o ln C o lle g e o f C h i r o p r a c t i c
Logan C o lle g e o f C h i r o p r a c t i c
Los Angeles C o lle g e o f C h i r o p r a c t i c
Texas C h i r o p r a c ti c C o lle g e
N orthw estern C o lle g e o f C h i r o p r a c ti c
C levelan d C h i r o p r a c t i c C o lle g e
Columbia I n s t i t u t e o f C h i r o p r a c t i c
Western S t a t e s C h i r o p r a c t i c C o lle g e
Canadian Memorial C h i r o p r a c t i c C o lle g e
O th er

When d id you g r a d u a te from y o u r C h i r o p r a c t i c c o ll e g e ?
1
2
3

( 3 -7 )

Oney e a r
Twoy e a r s
Three y e a r s

Where d i d you r e c e i v e y o u r C h i r o p r a c t i c e d u c a tio n ?
1
2
3
4
5

(3 -6 )

2 No

I f y e s , was i t f o r ?
1
2
3

(3 -5 )

Yes

B efore 1930
1930-1939
1940-1949

4
5

1950-1959
1960-1969

6
7

1970-1976
1977

Are you l i c e n s e d t o p r a c t i c e ?
1

In M ichigan o n ly

2

In o t h e r s t a t e ( s ) a l s o

112
( 3 -8 )

Have you taken p o s t - g r a d u a t e work In?
1

(3 -9 )

P a r t IV.

O rth o p ed ics
Roentgenology
Neurology

4 D ia g n o s tic a r e a s
5 S p ecial c h i r o p r a c t i c te c h n iq u e
6 O ther___________________________

Would you l i k e t o review ?
The work-up f o r a c h i r o p r a c t i c c a se h i s t o r y
P roced ures 1n p h y sic a l exam ination o f a t y p i c a l p a t i e n t
O rth oped ic t e s t s recommended f o r p a t i e n t e x am ination
N e u rolo gical t e s t s r e l a t i v e t o p a t i e n t ex am in atio n

Would you l i k e i n s t r u c t i o n 1n?
1
2
3
4
5

(4 -3 )

O th e r c o l l e g e s / u n i v e r s i t i e s

C o ntinuing P r o f e s s io n a l E d u c a tio n :

1
2
3
4
( 4 -2 )

2

Of th e p o s t - g r a d u a t e c o u rs e s ta k e n , were th e y 1n?
1
2
3

(4 -1 )

C h iro p ra c tic c o lle g e s

D i v e r s i f i e d m a n ip u la tiv e te c h n iq u e s
Advanced r a d i o g r a p h ic ( x - r a y ) i n t e r p r e t a t i o n
S p o rts h a z a rd s and management o f a t h l e t i c I n j u r i e s
P r a c t i c a l c l i n i c a l psychology
P r a c t i c e - b u i l d i n g pro ce d u res

Would you l i k e sem inars on?
1 Trauma e f f e c t s on body j o i n t s
2 The l a t e s t advances 1n r a d io g r a p h ic tec h n o lo g y
3 V i s u a l i z a t i o n s In c l i n i c a l and p a th o l o g i c a l anatomy
4 Evolving c o n c e p ts 1n k l n e s l o l o g l c a l biom echanics
5 N e u ro lo g ic al c o n ce p t o f c h i r o p r a c t i c and I t s c u r r e n t
s c i e n t if i c sta tu s
6 L a t e s t developments 1n In n o v a tiv e th e r a p y , e x p erim e n tal
I n v e s t i g a t i o n s , r e s e a r c h and developm ent a t DC c o l l e g e s
7 D i f f e r e n t i a l d i a g n o s is o f low back, up per b a ck , and
neck pain syndromes
8 N e u ro lo g ic al i m p l i c a ti o n s o f d i e t a r y d e f i c i e n c i e s and
r o l e o f n u t r i t i o n a l management 1n c h i r o p r a c t i c p r a c t i c e
9 O rth oped ic d i s a b i l i t y e v a l u a t i o n and Impairment r a t i n g
10 D ealing w ith h e a l t h In su ra n c e c la im s and r e s p o n s i b i l i t i e s
o f t h e DC 1n t h i r d p a r t y payment c la im s .

(4 -4 )

Would you l i k e c l a s s e s 1n p u b lic r e l a t i o n s , p u b l ic
and o t h e r communication s k i l l s ?
1

(4 -5 )

Yes

2

speaking

No

Would you c o n s i d e r ta k i n g c o u rs e s le a d in g t o a d d i t i o n a l
d e g r e e ( s ) in t h e s c ie n c e s ?
1

Yes

2

No

113
(4 -6 )

Where do you b e li e v e c o n tin u in g c h i r o p r a c t i c e d u ca tio n
c o u rs e s should be given?
1
2
3
4

(4 -7 )

Should t h e s e c o u rs e s be p re s e n te d by?
1
2
3

(4 -8 )

At a nearby c o l l e g e / u n i v e r s i t y
In a p u b lic o r p r i v a t e f a c i l i t y
By a m u lti-m ed ia approach n o t r e q u i r i n g formal
classroom I n s t r u c t i o n
Have no p r e fe r e n c e

C h ir o p r a c tic (DC) i n s t r u c t o r s only
Any s u b j e c t - q u a l i f i e d I n s t r u c t o r s (P h .D ., e t c . )
No p re fe r e n c e

Would

you be i n t e r e s t e d 1n ta k in g c o u rs e s on?

1 Wednesdays d u rin g the daytime
2 Thursdays d u rin g th e daytime
3 Weekends
4 Evenings. I f s o , which____________________________________
(4 -9 )

How long a sem inar would you p r e f e r ?
1 One day
2 Two day
3 Three day

(4-10 )

(4-11 )

( C i r c l e th r e e

1 D etro it
2 F lin t
3 Lansing

B a t t l e Creek
Houghton
Kalamazoo

7

8
9

Taking f u l l - t i m e c l a s s e s t o com plete c o u r s e ( s ) q u ic k e r
Extending I n s t r u c t i o n over a lo n g e r p e rio d o f tim e.

Do you b e li e v e c o n tin u in g e d u c a tio n c o u rs e s should be
counted toward a s p e c i a l t y c e r t i f i c a t i o n ?
2 No

Would you l i k e to q u a l i f y as a s p e c i a l i s t DC?
1 Yes

(4-14)

4 Grand Rapids
5 Ann Arbor
6 Gaylord

I f you had a c h o ic e , would you p r e f e r ?

1 Yes
(4-13)

Not I n t e r e s t e d 1n any

Where would you p r e f e r to a tt e n d c l a s s e s ?
c h o ic e s )

1
2
(4-12 )

4 Four day
7
5 Five day
6 No p re fe re n c e

2 No

I f y e s to above, 1n which f i e l d ? ___________________________

114
(4 -1 5 )

Should c o n tin u in g c h i r o p r a c t i c e d u c a tio n c o s t s be borne by?
1
2
3

(4 -1 6 )

Do you h o n e s tly b e li e v e t h a t p a s t exposure t o e d u c a tio n a l
c o u rs e s f o r annual r e l l c e n s u r e has upgraded y o u r competence
1n p r a c t i c e ?
1

(4 -1 7 )

The p r a c t i t i o n e r a lo n e
Shared w ith t h e member's a s s o c i a t i o n
Sponsored e n t i r e l y by t h e member's a s s o c i a t i o n

Yes

2 No

Are you s a t i s f i e d w ith th e ty pe and q u a l i t y o f c o n tin u in g
e d u c a tio n c o u rs e s a s now g iven f o r l i c e n s e renewal pu rposes?
1

Yes

2 No

(4 -1 8 )

I f n o t s a t i s f i e d , how would you s u g g e s t Improving th e
situ a tio n ?

(4 -1 9 )

Any a d d i t i o n a l c o n s e n ts you c a r e t o make?

(4 -2 0 )

Would you l i k e a copy o f t h e com pleted s tu d y r e s u l t s ?
1

Yes

2

No

APPENDIX G
FOLLOW-UP LETTER TO QUESTIONNAIRE

115

Michigan State
CNropmcllc AeeodaOon
V O C M c h g m A ii
U n * * ig M c t i e s n « B S U
< S lH « a ? -S 0 6 1

May 9 . 1977

D a a r D o c to ri

Tha r e s p o n s e t o cu e s u r v e y q u e s t i o n n a i r e on th e M ichigan c h i r o ­
p r a c t o r , a a n t o u t l a a t m onth, h a a been good t o d a t a , b u t a h lg h a r
p e r c e n ta g e o f r a tu r n * w ould ln e r a a a a t h a a c c u ra c y o f r a a u l t a r e p r e a o n tln g th a t r u a s e n tim e n ts a n d c h a r a c t a r l a t l c a o f th a s t a t e ' s
p ra c titio n e ra .
I f you hava r e tu r n e d t h a co m p leted q u e s tio n n a ir e , th a n k you
f o r y o u r t i n e and e f f o r t in p a r t i c i p a t i n g . However, I f you h av e
o v e rlo o k e d se n d in g i n t h a fo rm s p la a e e d o s o now, s o t h a t t h e s tu d y
c a n ba f i n a l i s e d and th e r a a u l t a d i s t r i b u t e d . A d u p lic a t e f o r a w i l l
be n a i l e d , o n r e q u e s t I f t h e o r i g i n a l n a i l i n g was l o a t o r m is p la c e d .
Remember, e a c h d o c t o r 's r e p l y n a k e s t h a stu d y more m e a n in g fu l and
a c c u ra te .
A gain, th a n k you f o r y o u r c o o p e r a tio n .
S in c e r e ly ,

Mark B. Van W agoner, D.C.
P r e s id e n t , MSCA

S a n fo rd s . U l r i c h , D .c
S u rv e y c o o r d in a to r

SSUigba

R w M lllD

116

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