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Almost a quarter of Americans will turn 65 or older by 2060. This remarkable shift in demographics represents the aging of the Baby Boomer generation, or those Americans born between 1946 and 1964. Accordingly, the nature of the healthcare profession is shifting to better serve this cohort, which has revolutionized how elder care and support is provided. Not only are older Americans living and working longer, but they are also changing the nature of where they age and receive care.
These shifts have resulted in significant movements and changes to the medical field, such as greater emphasis on preventive care and aging in place. Alternative medicine, particularly chiropractic, is seeing explosive growth as this generation ages and more insurance plans cover holistic care. The number of jobs in chiropractic is anticipated to grow by 4 percent between 2019 and 2029 (U.S. Bureau of Labor Statistics 2021).
Chiropractors treat (or provide preventive care) to patients who have issues or wish to manage the health of their neuromusculoskeletal system. This system includes nerves, tendons, bones, ligaments, and muscles. The field of chiropractic uses manipulations, adjustments, and supportive equipment to provide care to patients, emphasizing their spine. Chiropractors work in a variety of settings, including hospitals, clinics, offices, and home visits. A 2020 survey of 500 chiropractors conducted by Chiropractic Economics found that chiropractors saw an average of 142 recurring patients and 10 new patients each week.
There are a number of chiropractic specialties, which are slowly gaining in use as public agencies and insurance companies support the widespread use of chiropractic care techniques. The American Chiropractic Association (ABC) oversees the American Board of Chiropractic Specialities (ABCS), which recognizes and maintains standards for over twenty specialty boards and councils. These boards and councils certify specialties that range from clinical nutrition to acupuncture and internal medicine.
Those looking to specialize in an area of chiropractic must already be a licensed chiropractor, meaning they have attended chiropractic school and passed their National Board of Chiropractic Examiners (NBCE) exam. Next, they must demonstrate clinical experience in the specialization they wish to get certified in. The amount of clinical experience required differs by state and specialty, so chiropractors should take care to check with state licensing boards and the appropriate board or council for the specialty they wish to pursue.
Chiropractors may also need to take additional exams or educational coursework, depending on the specialty, and complete any license renewal requirements. While there is a lot of work that goes into specialist certification, chiropractors who pursue a specialty make an average of $134,000 annually.
For those looking to invest in their career and pursue one of many chiropractic specialties, take a look at one of the many options below.
To become a chiropractor, one must earn a Doctor of Chiropractic (D.C.) degree and a state license to practice. The U.S. Bureau of Labor Statistics states that chiropractic programs take four years to complete and require three years or more of undergraduate education to be eligible to apply for D.C. programs.
To earn a specialization, chiropractors enroll in postgraduate programs at chiropractic colleges to earn diplomate credentials in a specific area such as sports medicine, nutrition, and pediatrics.
Below is a list of common chiropractic specialties.
Acupuncture is an essential treatment technique in Chinese medicine where tiny needles are inserted in key parts of the body to treat pain, provide wellness, and even manage stress. Traditionally, Chinese practitioners sought to use this ancient technique to unlock energy passage throughout the body, whereas Western practitioners believe this treatment enhances the body’s natural painkillers and stimulates nerves, muscles, and connective tissue. As a result, patients who receive acupuncture can come from a variety of ages, medical histories, and backgrounds.
Chiropractors who have a specialty in acupuncture use needles to provide treatment in specific locations. They may manipulate the needles throughout the process and typically remove them after ten to twenty minutes, although some practitioners may leave needles in for longer.
While requirements vary by state, chiropractors can become certified in acupuncture by pursuing diplomate status through the American Board of Chiropractic Acupuncture (DABCA). This requires passage of the DABCA exam, which is offered on an annual basis and includes written and oral portions. Each state also has different clinical education and continuing education requirements. Keep in mind that not all states permit chiropractic acupuncture, so always check with the state licensing board prior to certification.
Chiropractors don’t always work in clinical settings. In fact, there’s an entire specialty dedicated to forensics, or the application of medical facts to legal proceedings and issues. A forensic professional may work with issues in one of the following areas:
- Disability determination
- Impairment rating systems
- Independent medical examinations (IMEs)
- Return to work and fitness for duty (DOT) assessments
- Fraud and abuse investigations
- Compliance issues
- Post-payment issues
- Compliance and ethics
- Informed consent and/or expert witness activities
Some of these areas include direct contact with patients, such as evaluating whether or not a patient is healthy enough to return to work or active military duty, while others require working within the legal system to provide medical knowledge and expert information.
Those interested in certification may go through the American Board of Forensic Professionals (DABFP), which requires 300 hours of clinical experience in forensic areas and passage of a written and oral exam.
Internal Medicine & Family Chiropractic
The American Chiropractic Association – Council on Diagnosis and Internal Medicine (ACA-CDID) oversees the certification and continuing education for chiropractors interested in internal medicine that relies on natural treatment and care. Chiropractors with diplomate status in diagnosis and internal disorders (DABCI) can work with patients from all types of backgrounds and may use some of the following techniques:
- Clinical nutrition
- Vitamin and mineral supplementation
- Homeopathic medicine
- Botanical medicine
- Natural hormone replacement
- Pharmacologic consulting
Internal medicine is the only chiropractic specialty recognized in each state. Those interested in a DABCI must demonstrate 300 hours of clinical experience in internal medicine, pass a written and oral exam, and complete at least 12 hours of continuing education every year.
Chiropractic neurologists examine how the body’s sensory and musculoskeletal systems interact with the neurological system, relying on the body and patient’s environment to diagnose changes within the nervous system and understand how to improve their quality of life. This could include patients suffering from issues such as vertigo, traumatic brain injuries, or even recovering from a concussion.
The American Chiropractic Neurology Board (ACNB) offers a diplomate status in chiropractic neurology, which requires 300 hours of clinical experience in functional neurology, as well as the passage of written and performance exams. There are also sub-certifications offered by the following boards and councils:
- American Board of Electrodiagnostic Specialties Fellow (FABES)
- American College of Functional Neurology Fellow (FAFCN)
- American Board of Vestibular Rehabilitation Fellow (FABVR)
- American Board of Childhood Developmental Disorders Fellow (FABCDD)
- American Board of Brain Injury & Rehabilitation Fellow (FABBIR)
- American Board of Neurochemistry & Nutrition Fellow (FABNN)
These subspecialties often focus on patients whose health needs are unmet by traditional care techniques. Each sub-specialty requires passage of additional exams, as well as a demonstration of relevant clinical experience.
Neuromusculoskeletal Medicine Chiropractors
Chiropractors specializing in neuromusculoskeletal medicine, formerly known as chiropractic orthopedists, evaluate and treat injuries and conditions of the neuromusculoskeletal system. They particularly focus on the spine, hands, and feet of each patient and see those who suffer from acute or chronic pain.
Neuromusculoskeletal specialists are certified through the International Academy of Neuromusculoskeletal Medicine (DIANM) and must complete 300 hours of clinical experience, as well as a two-part online exam. Requirements differ from state to state, so those interested in this certification should double-check with their state licensing board prior to pursuing certification.
Almost half of the cases treated by chiropractors were diagnosed as a nutritional disorder. This may include issues such as iron deficiency, obesity, malnutrition, and more. Chiropractors specializing in nutrition may provide patients with recommendations for changes in diet, wellness and lifestyle counseling, exercise, or risk-avoidance (such as alcohol) to manage or improve health. There are two options for chiropractors looking to gain additional knowledge and expertise in nutrition:
- Chiropractic Board of Clinical Nutrition (CBCN)
- American Clinical Board of Nutrition (ABCN)
Both boards offer a diplomate that requires 300 hours of online coursework and passage of an examination. Notably, the ABCN is the first diplomate open to medical professionals in other fields who hold a doctorate or higher.
Occupational Health Chiropractic
The United States Occupational Health and Safety Administration estimates that as many as 1.8 million workers suffer work-related musculoskeletal disorders and injuries. This may include employee injury and discomfort related to excessive repetition of movements, awkward or static postures, or not having enough time to recover after a task. Chiropractors working in occupational health help employees prevent and recover from musculoskeletal injuries and disorders, ensuring they can work safely and effectively.
The American Chiropractic Board of Occupational Health (DACBOH) offers a diplomate for those interested in pursuing a specialty in occupational health. The diplomate requires 300 hours of education, including a field study project, and passage of a written examination.
Chiropractors who like to work with children and teenagers should consider a certification in pediatrics. This field of chiropractic care differs from working with adult patients because children’s bodies are different. Their bones have more cartilage and their ligaments and joints are both extremely flexible. They also describe symptoms in unique ways and may require alternative approaches to diagnosis and intervention.
Those interested in getting certified as a pediatric chiropractor should contact the American Board of Chiropractic Specialties for further information on the American Board of Chiropractic Pediatrics diplomate.
Radiologists use medical imaging, such as x-rays and ultrasounds, to understand and diagnose injuries or diseases. They also advise medical teams on which types of imaging exams to use. Chiropractic radiologists focus on the neuromusculoskeletal system and medical imaging to help medical doctors, chiropractors, or other members of a medical team understand and interpret patient needs.
Chiropractic radiology is still a relatively new field; there are currently less than 200 licensed practitioners in the United States. Certification is overseen by the American Chiropractic Board of Radiology (ACBR), which requires completion of a three or four-year post-graduate residency program in radiology. Passage of a two-part written exam is also required.
Chiropractic rehabilitation is the practice of using chiropractic care to improve health and mobility, restoring the body’s original ability to do its job. Each injury is unique and may require different techniques and treatment to help patients recover from an injury. Patients that may see a chiropractic rehabilitation specialist include those suffering from injuries related to a car accident, athletic injury, falling, and more.
Those interested in pursuing a certification in rehabilitation must take the diplomate offered by the American Chiropractic Rehabilitation Board. This diplomate requires 150 hours of seminar courses, completion of a two-part written exam and one oral exam, and submission of a written case study.
Perhaps one of the best-known specialties of chiropractic, those certified in sports chiropractic help athletes recover from (and prevent) injuries incurred while playing a sport. Care may include exercises to strengthen the body and improve range of motion, as well as manipulations and adjustments to treat injuries such as tears and sprains.
The American Chiropractic Board of Sports Physicians (ACBSP) is the governing body for diplomate programs that certify chiropractors in sports medicine. The first step in getting certified is successfully completing the Certified Chiropractic Sports Physician (CCSP) program, which requires passage of a two-part written exam and satisfaction of at least one of the following requirements:
- Completion of at least 100 hours of postgraduate education in the Certified Chiropractic Sports Physicians program at an accredited chiropractic college.
- Hold a current Athletic Trainer Certification (ATC)
- Completed a master’s of science (MS) degree at an accredited college in an equivalent program in sports medicine
- Completed the first year of a sports medicine residency program with an accredited college
Chiropractors who wish to gain the highest certification in sports chiropractic can apply for the diplomate offered by the American Chiropractic Board of Sports Physicians (DACBSP). Licensed chiropractors seeking this certification must demonstrate that they have completed at least one of the following educational requirements:
- Hold an active CCSP certification and have completed at least 200 hours of postgraduate education in a diplomate program at an accredited chiropractic college.
- Hold an active CCSP certification with completion of a master’s of science (MS) at an accredited college in an equivalent program in sports medicine.
- Completion of a sports medicine residency program in its entirety.
They must also take a written exam, six-part practical skills exam, submit a written project, and demonstrate a minimum of 100 hours of clinical experience in the field.
Bree is an urban planner and freelance writer based in Seattle, WA. She has worked on land use and housing policy issues throughout the Pacific Northwest. She previously led Run Oregon Run, a nonprofit dedicated to helping Oregonians run for office and apply to boards and commissions. When not writing, she is lovingly tending to her cast iron pans.