The Institute for Alternative Futures (IAF) is a leader in the creation of preferred futures. Since its founding in 1977 by Clement Bezold, Alvin Toffler and James Dator, IAF has helped organizations monitor trends, explore future possibilities and create the futures they prefer. IAF draws on a robust selection of futures methodologies, such as environmental scans, forecasts, scenarios, visioning and its own “aspirational futures” technique.
Recently the institute released Chiropractic 2025: Divergent Futures (pdf) which was made possible by funding from the NCMIC Foundation.
Therein, 4 scenarios are presented:
Scenario 1: Marginal Gains, Marginalized Field
As health care reorganizes, the historical isolation of chiropractors hinders most DCs in joining integrated care provider organizations. The majority remains in solo and small group practices and face major challenges in building or maintaining an adequate patient base. Research to develop and demonstrate evidence-informed practice grows. This gets DCs more favorable attention, yet networks often use the data to limit fees and the number of visits. Five states assign broader practice rights to DCs. Focused-scope oriented colleges join leading academic medical centers in exploring quantum biology to explain healing and subluxation. However, four chiropractic colleges close. Low starting income for chiropractors in many settings, and limited career prospects for most DCs coupled with high student debt, hamper the growth of the profession over the decade leading to 2025.
Scenario 2: Hard Times & Civil War
Another recession hits in 2015. The economy improves in subsequent years, but the market for chiropractors does not rebound. Millions of patients enroll in high-deductible catastrophic care plans, and stressed families struggle to support their health. Only clear and compelling value can sustain chiropractic practices. Yet the scarce base of comparative effectiveness research for chiropractic hurts DCs. The variability in quality and outcomes among solo and small practice practitioners also causes DCs to be overlooked by ACOs and PCMHs. Instead, chiropractors are on a “hamster wheel” of many, ever-shorter visits and lowering their expenses enough to make a living. Most visible to the public is the noisy civil war between the broad-scope chiropractors seeking expanded practice rights and the vehement opposition of focused-scope chiropractors in every state where expanded rights are sought. Ten chiropractic colleges close and many chiropractors are driven from the field.
Scenario 3: Integration & Spine Health Leadership
The U.S. achieves near universal health care coverage. Patients play an assertive role in getting the care they want, stimulating and using digital health coaches and alternative or conventional approaches according to their individual needs and wants. Providers use predictive models and simulations to help their patients achieve the best health possible. Chiropractic enters mainstream medicine as the spinal health expert in the health care system. Many join PCMH and other integrated care teams and become critical partners in addressing back pain and spinal health. “Big data” on patient care provides additional compelling evidence from chiropractic outcomes. Other chiropractors find that growing public acceptance means that they can sustain their independent or group practice and in many cases thrive. Ten states pass legislation broadening practice rights for chiropractors.
Scenario 4: Vitalism & Value
Research supporting chiropractic and integrative health care grows, including the exploration and development of contemporary vitalism. Popular awareness of self-healing and interest in modalities that support it grow as well. Many chiropractors succeed as the leading providers for spine health in integrated systems. Many other chiropractors do well among patients enrolled in high-deductible catastrophic care health plans, who rely primarily on out-of-pocket expenses and self-care approaches with the help of sophisticated digital health coaches and local market transparency. Chiropractors also join efforts to shape community conditions that promote health and wellbeing. However, outcomes research, the movement to capitated care, and transparency in prices that chiropractors and others charge, keep the chiropractic profession from growing faster.