Core and Complementary Chiropractic:
Lowering Barriers to Patient Utilization of Services

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SOURCE:   J Chiropractic Humanities 2016 (Sep 15);   23 (1):   1-13

John J. Triano, DC, PhD and Marion McGregor, DC, PhD

Graduate Education and Research Program,
Canadian Memorial Chiropractic College,
Toronto, ON, Canada

OBJECTIVE:   The use of chiropractic services has stalled while interest in accessing manipulation services is rising. The purpose of this paper is to consider this dilemma in the context of the dynamics of professional socialization, surveys of public attitudes, and a potential strategic action.

DISCUSSION:   This is a reflection work grounded in the literature on professional socialization and the attitudes held regarding chiropractic in modern society, to include its members, and in original data on training programs. Data were interpreted on the background of the authors’ cross-cultural experiences spanning patient care, research, education, and interprofessional collaboration. Recommendation on a strategic action to counter barriers in patient referrals was synthesized. Professional socialization is the process by which society enables professional privilege. Illustration of typical and divergent professional socialization models emerged that explain cognitive dissonance toward the profession. Questions of trust are commensurate with the experiences during patient encounters rather than with a common identity for the profession. Diversity among encounters perpetuates the uncertainty that affects referral sources. Commonality as an anchor for consistent professional identity and socialization through the content of core chiropractic, defined by training and practice, offers a means to offset uncertainty. Complementary chiropractic, analogous to complementary medicine, provides an outlet under professional socialization for the interests to explore additional methods of care.

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CONCLUSION:   The practice workplace is an effective lever for altering barriers to the use of services. Clarifying rhetoric through conceptualization of core and complementary practices simplifies the socialization dynamic. Further, it takes advantage of accepted cultural semantics in meaningful analogy while continuing to empower practical diversity in care delivery in response to evolving scientific evidence.

KEYWORDS:   Chiropractic; Delivery of Health Care; Professionalism; Referral and Consultation; Social Identification; Socialization

From the Full-Text Article:


A collective professional identity is a dynamic and strategic device through which the service of a profession is framed. Identity defines what a profession does. Its development should be an active strategy of professionalism [1, 2] that is, at its base, a rhetorical argumentation operationalized through daily practice. Ryynanen [3] contends that the most important difference between individual and collective identities is that the former emphasizes difference and the latter frames commonality. “Social identity refers to the ways in which individuals and collectives are distinguished in their social relations with others. In order to identify things, one has to have something in common, but also something that is distinct from the others.”(p30)

Few would disagree with the notion that history of the profession over the past century has been more invested in drawing distinctions than in the celebration of commonality. [4–6] From the public’s perspective, these intraprofessional distinctions are unnecessarily complex. They are equivalent to cognitive dissonance that creates a pragmatic confusion precisely at the level most highly valued by individual members of the profession — that of care utilization. We take a critical look at the emerging role of professional identity argumentation within chiropractic and offer observations on how a focus on core commonality with recognition of complementary chiropractic approaches respects both collective and individual identities and can clarify public perceptions, lowering barriers to chiropractic utilization.

To begin, a caveat is necessary. Although what follows is evidence informed and calls on the existing understandings of professions, professionalism, professional identity, professional socialization, and legitimacy, we do not contend that these observations are a priori evidence based. These are reflections from our readings, data, and cross-cultural experiences as members of several interprofessional communities in health care, including solo clinical practice, chiropractic colleges, professional associations, university faculty, integrated interprofessional spine care practice, and research settings, and professional socialization through memberships in the North American Spine Society and the Canadian Spine Society.

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