The attrition rate of licensed chiropractors in California: an exploratory ecological investigation of time-trend data
Tóm tắt
The authors hypothesized the attrition rate of licensed chiropractors in California has gradually increased over the past several decades. "Attrition" as determined for this study is defined as a loss of legal authority to practice chiropractic for any reason during the first 10 years after the license was issued. The percentage of license attrition after 10 years was determined for each group of graduates licensed in California each year between 1970 and 1998. The cost of tuition, the increase in the supply of licensed chiropractors and the ratio of licensed chiropractors to California residents were examined as possible influences on the rate of license attrition. The attrition rate was determined by a retrospective analysis of license status data obtained from the California Department of Consumer Affairs. Other variables were determined from US Bureau of Census data, survey data from the American Chiropractic Association and catalogs from a US chiropractic college. The 10-year attrition rate rose from 10% for those graduates licensed in 1970 to a peak of 27.8% in 1991. The 10-year attrition rate has since remained between 20-25% for the doctors licensed between 1992-1998. Available evidence supports the hypothesis that the attrition rate for licensed chiropractors in the first 10 years of practice has risen in the past several decades.
Tài liệu tham khảo
California Board of Chiropractic Examiners - Rules and Regulations. Title 16, Division 4, Article 6, §355 Accessed 6/26/10, [http://www.chiro.ca.gov/business_regulations.htm]
Morgenstern H: Use of ecological analysis in epidemiologic research. AJPH. 1982, 72 (12): 336-1344. 10.2105/AJPH.72.12.1336.
California Department of Consumer Affairs: License Verification, Board of Chiropractic Examiners. Accessed 1/13/10, [http://www2.dca.ca.gov/pls/wllpub/wllqryna$lcev2.startup?p_qte_code=DC&p_qte_pgm_code=8500]
National Board of Chiropractic Examiners: Job Analysis of Chiropractic. 2005, Accessed 1/13/10, [http://www.nbce.org/publication/job-analysis.html]
Mior S, Laporte A: Economic and Resource Status of the Chiropractic Profession in Ontario, Canada: A Challenge or an Opportunity. J Manip and Physio Ther. 2008, 32 (2): 104-114. 10.1016/j.jmpt.2007.12.007.
Real Estate Center at Texas A&M University. Accessed 12/31/09, [http://recenter.tamu.edu/data/pops/pops06.htm]
Hurwitz EL, Coulter ID, Adams AH, Genovese BJ, Shekelle PG: Use of chiropractic services from 1985 through 1991 in the Unites States and Canada. Am J Public Health. 1998, 88: 771-776. 10.2105/AJPH.88.5.771.
Shekelle PG, Brook RH: A community-based study of the use of chiropractic services. Am J Public Health. 1991, 81: 439-442. 10.2105/AJPH.81.4.439.
Cote P, Cassidy JD, Carroll L: The treatment of neck and low back pain: Who seeks care? Who goes where?. Med Care. 2001, 39: 956-967. 10.1097/00005650-200109000-00006.
Sherman KJ, Cherkin DC, Connelly MT, Erro J, Savetsky JB, Davis RB, Eisenberg DM: Complementary and alternative medical therapies for chronic low back pain: what treatments are patients willing to try?. BMC Complement Altern Med. 2004, 19 (4): 9-10.1186/1472-6882-4-9.
Lawrence D, Meeker W: Chiropractic and CAM Utilization: A Descriptive Review. Chiropractic & Osteopathy. 2007, 15: 2-
Barnes P, Powell-Griner E, McFann K, Nahin R: Complementary and alternative medicine use among adults; United States, 2002. Adv Data. 2004, 27 (343): 1-19.
Ni H, Simile C, Hardy A: Utilization of complementary and alternative medicine by United States adults; results from the 1999 national health interview survey. Med Care. 2002, 40 (4): 353-358. 10.1097/00005650-200204000-00011.
Davis M, Davis A, Luan J, Weeks W: The supply and demand of chiropractors ion the United States from 1996 to 2005. Alternative Therapies. 2009, 15 (3): 36-40.
Editorial Staff: The Chiropractic Practice -- Now, and Then. ACA Survey Reveals Dramatic Changes over Last 20 Years. Dynamic Chiropractic. 1999, 17: 12-
Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, 95 Stat. 357-933. Accessed 1/2/2010, [http://thomas.loc.gov/cgi-bin/bdquery/z%3Fd097:HR03982:@@@L&summ2=m&|TOM:/bss/d097query.html]
US Department of Health and Human Services, Bureau of Health Professions. Accessed 1/1/2010, [http://www.defaulteddocs.dhhs.gov/school.asp]
Health Maintenance Organization Act of 1973. (Public Law 93-222), 42 U.S.C. § 300e, Accessed 1/14/2010, [http://www.law.cornell.edu/uscode/42/300e.html]
Editorial Staff: California Chiropractic Association Sues ASHP: Patient Access and Ability to Treat Are at Issue. Dynamic Chiropractic. 2001, 19: 16-
Editorial Staff: CCA Loses Suit to American Specialty Health, Vows to Continue Pursuing Claims. Dynamic Chiropractic. 2006, 24: 01-
Seater S: FCER Forum: Warfare requires new directions. Dynamic Chiropractic. 1995, 13 (24): 26-