Survey of NYS Chiropractors

Survey of New York State Chiropractors: Membership in Professional Associations and

Barriers to Membership

Shannon L. Passalacqua

A project proposalsubmitted to the Faculty of D’Youville College

Division of Academic Affairs

in partial fulfillment of the requirements

for the degree of

Doctor of Chiropractic

in

Doctor of Chiropractic

Buffalo, NY

May 5th 2012

Survey of NYS Chiropractors

Copyright © 2012 by Shannon L. Passalacqua. All rights reserved. No part of this thesis may be copied or reproduced in any form or by any means without written permission of Shannon L. Passalacqua


PROJECT APPROVAL

Project Committee Chairperson

Name: _______________________________________________________

Discipline: ___________________________________________________

Committee Member

Name: _______________________________________________________

Discipline: ___________________________________________________

Project defendedon

May 4th 2012


Abstract

Professional associations serve as a support system for the professions that they

represent. The chiropractic profession has several associations on both a national and state level

for which chiropractors can be members. Chiropractors’ membership in the professional

associations is reportedly low. As of July 2011, NYS has 4,584 licensed chiropractors of which

only 580 are members of the American Chiropractic Association (ACA). This demonstrates a

lack of commitment that chiropractors in NYS have for the associations that support their

profession. Professional associations serve a multitude of roles some of which include providing

legislative advocacy, protecting the rights of DCs, providing advertising and marketing; and

fostering inter-professional relations. The purposes’ of this study are a) determine what

proportion of chiropractors in NYS are members of professional associations; b) to which

associations’ they belong; and c) to determine what barriers exist that make chiropractors in NYS

reluctant to become active members of a professional association.


Table of ContentsINTRODUCTION..............................................................................................................................7

Statement of the Problem........................................................................................................................8

Purpose....................................................................................................................................................8

Significance of the study.........................................................................................................................9

Research Objectives..............................................................................................................................10

LITERATURE REVIEW..........................................................................................................................11

Definition of terms................................................................................................................................18

METHODOLOGY....................................................................................................................................19

Administration of Survey......................................................................................................................19

Procedure and Time Frame....................................................................................................................19

Analysis.................................................................................................................................................20

Validity..................................................................................................................................................20

Reliability..............................................................................................................................................21

Assumptions..........................................................................................................................................21

Scope and Limitations...........................................................................................................................21

RESULTS.................................................................................................................................................23

Demographics........................................................................................................................................23

Importance and role of professional associations...................................................................................23

Membership in national chiropractic associations.................................................................................23

Membership in New York State chiropractic associations.....................................................................24

Barriers to membership.........................................................................................................................24

Increasing membership..........................................................................................................................25

ACA/ICA Merger and perceived benefits..............................................................................................25

DISCUSSION...........................................................................................................................................26

CONCLUSIONS.......................................................................................................................................30

Works Cited...............................................................................................................................................31

Tables........................................................................................................................................................33

Appendices................................................................................................................................................40

Informed Consent..................................................................................................................................40


List of Tables

Table

1. Chiropractic colleges attended

2. Number years in practice

3. Types of practice settings

4. Purposes of professional associations

5. Membership in national chiropractic associations

6. Membership in state chiropractic associations

7. Barriers to membership

8. Increase overall membership

9. Attitudes toward ACA/ICA merger

10. Attitudes of current members toward an ACA/ICA merger

11. Perceived benefits of ACA/ICA merger

12. Membership fee schedules


INTRODUCTIONHealthcare professions have a number of professional associations that provide a strong

support system and a sense of unity for their members. Professional associations serve many

purposes, such as providing legislative advocacy to the profession, protecting patients and

doctors' rights, providing advertising and marketing, informing the public, and fostering inter-

professional relations. Professional associations are essential spokespersons for the profession

with which they are affiliated. The chiropractic profession has several professional organizations

at both the State and National level of which Doctors of Chiropractic (DCs) can become

members. Many of the various State and National chiropractic associations were formed by

necessity as a result of the challenges confronting the profession. Historically, DCs have faced

opposition from the allopathic and osteopathic communities. In response to that hostility, DCs

sought their own legislation from various states and were challenged to demonstrate that their

education qualified them for independent licensed practice. Records indicate that there are

professional associations supporting the chiropractic profession as far back as 1906 when D.D.

Palmer founded the Universal Chiropractic Association (UCA). D.D. Palmer’s son B.J. Palmer

always maintained that the UCA had been founded for the purpose of providing legal protection

to chiropractors (Keating, & Rehm, 1993). Today, there are several professional associations

supporting the chiropractic profession, the American Chiropractic Association (ACA) and the

International Chiropractic Association (ICA) on a National level as well as at least two New

York State Associations. The two major State associations are the New York State Chiropractic

Association and the New York State Chiropractic Council. These State associations function to

ensure that the chiropractic profession gets necessary assistance by providing legal and

legislative support, and by supporting DCs rights and privileges as health care providers


Currently, DC membership in the professional associations that support the chiropractic

profession is under subscribed.

Statement of the ProblemThe ACA and ICA have significantly less support from licensed chiropractors than the

American Medical Association (AMA) has from medical doctors. It has been demonstrated that

the majority of actively practicing physicians are members of the AMA while a mere estimated

10 % of actively practicing chiropractors are members of the ACA (McClelland, 2002). This is

of great concern and needs to be addressed if the chiropractic profession wants to have a voice in

the healthcare debate as well as acceptance among other healthcare professions. The chiropractic

profession could gain legislative and cultural authority if the profession as a whole came together

and was more supportive of the profession on both a National and State level. Chiropractors

should take pride in their profession and demonstrate their pride by supporting the professional

associations that work hard to defend the chiropractic profession. Recently DCs in NYS were

under pressure when they nearly lost an ACA delegate due to a decline in membership. Why are

NYS chiropractors not members in the associations available to them such as the ACA, ICA, and

the New York State Chiropractic Association? What barriers exist that keep Doctors of

Chiropractic in NYS from participating in important professional associations? Unity within the

chiropractic profession has also been a topic of much interest. For over 100 years, the profession

has been seeking unity mainly between the two major associations, the ACA and the ICA, but

also unity among chiropractors.

Purpose The proposed study will investigate what barriers may result in the reluctance of

chiropractors in NYS to become active members of a professional association. Additionally, the


proposed study will attempt to determine what percentage of chiropractors in NYS are members

of a professional association and to which associations they belong. For those chiropractors who

are members of an association, the study aims to determine what attracts them to a particular

association over another? It is important to determine what can be done to increase overall

membership into chiropractic professional associations in order to gain support and political

authority for the chiropractic profession. This study will also attempt to identify the issues of

unity within the chiropractic profession by seeking information from those that participate in the

survey regarding their attitudes towards unity between the ACA, and the ICA.

Significance of the studyThis study is important because it will allow for the investigation as to why NYS

chiropractors are not actively participating as members in the professional associations that are

available to them. Perhaps it will encourage DCs to become more involved in their profession

outside the realm of their private practices and to demonstrate support for their profession. This

study hopes to point out to its participants the important role that the professional association

plays as well as the importance of their membership. The chiropractic profession has long been

fighting for its recognition as a form of primary healthcare. The profession as a whole is

constantly facing scrutiny from other healthcare professions, particularly the medical profession;

therefore, it is that important that chiropractors’ take pride in their profession and actively

support these professional associations in hopes that chiropractors may be accepted within the

medical community as primary care physicians. This study is also of great importance in

determining the perception of chiropractors regarding unity within the profession. Perhaps by

pointing out lack of uniformity that exists within the profession as well as the need for


chiropractors’ to be more willing to participate in professional associations and take an active

role in promoting unity to strengthen the profession as a whole.

Research ObjectivesThe objective of this project will be to determine:

1) To which professional National and State chiropractic associations do NYS chiropractors

belong?

2) What barriers to membership exist for NYS chiropractors?

3) To determine what can be done to increase overall membership into chiropractic

professional associations

4) The attitudes of NYS chiropractors toward professional associations such as the AMA,

ICA, NYSCA, and the New York State Chiropractic Council

5) To determine the attitudes of NYS chiropractors about the possibility of a merger

between the ACA and ICA


LITERATURE REVIEWUnification of chiropractic associations in the United States has been a goal that many

have tried to achieve since the first American Chiropractic Association was formed in 1905.

Unification between the American Chiropractic Association (ACA) and the International

Chiropractic Association (ICA) in the Unites States has been attempted several times in order to

form one strong professional organization within the chiropractic profession (Griffin, 1988). The

many early professional organizations were associations formed by necessity as the development

of various State and National chiropractic organizations were mandated by the challenges

confronting the profession. As chiropractors became more numerous, they faced increasing

hostility from the allopathic and osteopathic communities (Keating, & Rehm, 1993).

The ACA today has evolved through a series of several unions. The first known

association was the ACA formed in 1905. However, it was more of an alumni group and less of

a professional organization. In 1922, a second ACA was formed but was as an ascendant of the

first one, nor is there any relation to the current ACA, but consequent mergers would bring it to a

precursor stage (Plamondon, 1993). In 1906, B.J. Palmer founded the Universal Chiropractic

Association (UCA) primarily to defend chiropractors against charges of practicing without a

license while State associations were organized to obtain State practice acts to legalize

chiropractic (Griffin, 1988). The UCA certainly served B.J. Palmer’s intent to provide legal

defense during its 24 years of existence, winning 85 – 90% of all cases handled (Keating, &

Rehm, 1993). The ACA of the 1920’s is an ancestor of today’s ACA and was established as an

alternative to B.J. Palmer’s UCA (Keating, 2000). In 1925, the UCA split, setting the stage for

the formation of the ICA’s predecessor organization known as the Chiropractic Health Bureau


(CHB) in 1926 with B.J. Palmer as its founder and president. The CHB was a defense

organization with no time or funds for legislative action, public relations or any other activities

except legal defense or members who were prosecuted for practicing medicine without a license

(Griffin, 1988). It was during this time that other groups started to form, such as examining

boards, State chiropractic associations, and educational institutions. In 1926, various State

boards of examiners created an International Congress of Examining board, which was followed

in 1928 by the creation of both the International Congress of Officers of State Chiropractic

Associations and the International Congress of Chiropractic Educational Institutions. Each of

these three associations acted as separate and distinct congresses making it difficult to have any

sort of unity in support of the chiropractic profession. In September of 1928, the three

congresses federated themselves into the International Chiropractic Congress (ICC) (Plamondon,

1993).

The ICC was not satisfied with just the merging of the congresses so the leaders of the

ICC brought together the ACA and the UCA to form the National Chiropractic Association

(NCA) which was founded in 1930 (Plamondon, 1993). The NCA has organized the chiropractic

profession along lines similar to those of the American Medical Association. The affiliation of

the ICC with the newly formed NCA may have been significant not only as a unifying step in the

chiropractic organization, but also in terms of the structure of the NCA. The divisions of the

ICC became the core of the councils of the NCA; this organizational framework persists within

today’s ACA. The union of the ACA and UCA was the most progressive step that the

chiropractic profession had seen at that point to unify their professional associations and marked

a major step in the maturation of the chiropractic profession (Keating, & Rehm, 1993). While the

idea behind the formation of the ICC was commendable, it did not work out very well and in


1934 with the NCA’s councils and committees of State examining boards, State chiropractic

associations, and educational institutions as well as the calls for unity coming on the heels of the

Depression, the function of the ICC was absorbed by the NCA (Plamondon, 1993).

In 1941, the Chiropractic Health Bureau changed its name to the International

Chiropractors Association (ICA). B.J. Palmer remained as president and held this position until

his death in 1961. Unity was still a priority for the majority of the profession and after several

failed attempts to unite the NCA and ICA, six ICA leaders resigned from their positions and

joined six NCA leaders to produce a document entitled a “Master Plan for Chiropractic Survival

and Advancement.” The acceptance of this document set into action a plan for the development

of a new, strong chiropractic organization known as The American Chiropractic Association

(ACA). Applications were made available to join the ACA. If 1,500 or more ACA applications

were received from ICA members and non-NCA members before August 1, 1963, then the NCA

would join the ACA as a body of one. The combination of 1,500 ACA applications along with

the 5,600 NCA members would make an organization of well over 7,000 members, which at that

time was the majority of active practicing chiropractors in the US (Plamondon, 1993).

In June of 1963, the House of Delegates unanimously endorsed the Master Plan. By the

end of September 1963, 1,576 membership applications had been received, and the ACA action

committee and the NCA Executive Board of Directors met to draft the official ACA bylaws and

Code of Ethics. The decision to join the NCA and the ACA together was finalized on October 7,

1963. The NCA agreed to transfer all assets, facilities, resources, personnel, and membership to

the new ACA by January of 1964 (Plamondon, 1993). This newly founded ACA did not bring

about the intra-professional unity that was hoped for. However, it did produce a consolidation


that aided some of the major professional accomplishments of the 1970s. Some of these

accomplishments included the recognition of the Council on Chiropractic Education (CCE) by

the United States Office of Education, and the inclusion of chiropractic care in the federal

Medicare program (Keating, & Rehm, 1993).

Throughout the years, the ACA had tried many times to unite the chiropractic profession.

In 1982, the ACA once again attempted to merge with the ICA. The House of Delegates

authorized and encouraged the ACA representatives to continue to push for a union between the

ACA and the ICA. A motion was adopted to hold a joint legislative conference with the ICA.

For the first time, the ICA and ACA were to co-sponsor a joint legislative conference and

congressional reception to be held in September of 1983. In 1984, ACA-ICA Joint Committee

was appointed by then ACA President Kenneth Padgett. The committee held several meetings to

discuss the possible merger of the two associations. As a result of these meetings, a convention

was scheduled to be held in 1987 to discuss unifying the profession (Plamondon, 1993). This

joint convention between the two associations was a unique and historic opportunity for leaders

of the chiropractic profession to come together and address common problems and form strategic

plans and solutions. The convention took place in Las Vegas, Nevada in July of 1987; a set of

proposed bylaws for a new, merged ACA-ICA had been drafted prior to the convention in the

hope that the merger would occur and the two governing bodies would become one. However, a

decision regarding the merger was not made during the convention. It wasn’t until January of

1988 when the ICA Board of Directors voted 13 to 4 to have the members decide whether the

ICA should merge with the ACA. Ballots were tabulated on July 16, 1988 and 55% percent of

the ICA members voted for the merger while 44% voted against the merger. According to the

laws of the District of Columbia where the ICA is incorporated, a two-thirds majority vote of an


association’s membership is necessary for a consolidation to occur. In order for the merger to

occur, 66% of the members would need to vote in favor of a merge. A special membership

meeting was held by the ICA in February of 1989 in which another vote regarding a merger

between the two associations took place. There were 3,115 ICA members who cast ballots and,

50.3% voted in favor of the merger while 49.7% voted against the merger. Although a majority

of the ICA members elected to merge with the ACA, the attempt failed (Plamondon, 1993).

Today, after more than 100 years of fighting for unity between these two very important

and influential associations in the chiropractic profession unity has yet to be accomplished.

Perhaps someday the chiropractic profession will see a merger between the ACA and the ICA as

an effort to provide the unity the profession so desperately needs. A unified governing body

would provide a way for the profession to come together and break into mainstream healthcare.

It is possible that with merging the ICA and ACA the chiropractic profession would gain more

acceptances, and chiropractors could be thought of as primary care providers.

While the ICA and ACA are the two major chiropractic associations on a National level,

there are also several State associations that provide support for the chiropractic profession. In

NYS there is the New York State Chiropractic Association (NYSCA) whose mission is to

enhance the public health by assuring universal access to safe and effective health care, and to

lead chiropractic toward full integration in the evolving health care delivery system as the

treatment of choice for the conservative management of neuromusculoskeletal dysfunction.

NYSCA also strives to advance research, raise educational standards of the profession, and

embrace the highest professional ethics and standards. NYSCA was founded in 1970 in New

York City but has since moved its headquarters to the Albany NY (NYSCA, 2004). NYS has


notoriously been one of the more difficult states to practice in terms of reimbursement and scope

of practice. Thus, it is important to have State associations such as NYSCA to provide support

for the profession and advocate for doctors of chiropractic who practice in New York. There is a

second organization in NYS known as the New York Chiropractic Council. The New York

Chiropractic Council’s mission is to direct people to the realization that healing comes from

within; and that ultimately the promotion of health and wellness is superior to the treatment of

disease. The purpose of the New York Chiropractic Council is to promote the basic philosophy,

science, and art of chiropractic. The New York Chiropractic Council also has its members’ best

interest at hand and focuses to protect the welfare of its members to practice chiropractic without

compromise, with parity and respect as well as to protect the public’s ability to receive

chiropractic care without prejudice, ridicule, or financial penalty from any individual, group, or

profession. Keeping chiropractic separate and distinct from all other professions is another goal

that the New York Chiropractic Council aims to achieve (New York Chiropractic Council,

2011). This is an important goal so that the chiropractic profession is recognized as a distinct

profession that deserves a level of integrity and respect from not only members of the profession,

but also members of other healthcare professions. Membership is just as important on a State

level as it is on a National level. According to the New York State Chiropractic Council,

In today’s changing political and economic climate it has become increasingly evident

that membership to a statewide organization is crucial for success. The New York

Chiropractic Council has emerged as the preeminent chiropractic organization in New

York State. And as the Council’s membership continues to grow so does its voice in

legislative issues, which affect the rights and privileges of all chiropractors and patients

in New York (New York Chiropractic Council, 2012).


Professional associations are commonly understood as agents of reproduction rather than

change. They are in place to monitor the routines of licensing, training, and professional

development. Professional associations are also there to monitor behavior within a profession

and take disciplinary action when necessary (Greenwood, Suddaby, & Hinings, 2002).

Professional associations play an important role by providing support to a profession and by

influencing public policy to better the profession. Successfully influencing public policy

depends not only on the resources and organizational strength of the State and National

associations, but upon the degree of opposition from, and alliances with, other groups within the

profession as well as within other healthcare professions (Akers, 1968). For instance, the

chiropractic profession has experienced persistent opposition within itself as well as from other

health care professions such as allopathic medicine, dentistry. DCs have demonstrated a lack of

membership in the professional associations available to them. In order to bring a sense of unity

and agreement to the profession, the profession as a whole must come together and support what

chiropractors do. By supporting and being a member of a professional association, one is

demonstrating one’s pride and respect for the chiropractic profession. It is not what a

membership offers that is important; sure there are many benefits that come with being a

member of a professional organization but it is what your membership offers the association.

Being a member of a professional association allows one the opportunity to be involved, to

support the profession and to be a part of any changes made in that profession. If the

chiropractic profession is ever going to attain the same stature of the AMA, unity needs to take

place among chiropractors’. The first step in encouraging chiropractors to become members of

professional associations is to educate them on the importance of such associations.


Definition of terms

ACA – American Chiropractic Association

CCE- Council on Chiropractic Education

CHB – Chiropractic Health Bureau

ICA – International Chiropractic Association

ICC – International Chiropractic Congress

NCA – National Chiropractic Association

NYSCA – New York State Chiropractic Association

UCA- Universal Chiropractic Association


METHODOLOGY

Administration of Survey

The method of administration will be a web-based survey distributed to licensed

chiropractors in NYS using Survey Monkey ®. The survey will consist of questions regarding

the participants’ membership status and membership barriers of both National chiropractic

associations as well as NYS associations. The survey will attempt to demonstrate not only

membership statistics in these associations in NYS as well as barriers to membership. The

survey will also ask questions regarding cultural authority within the chiropractic profession in

order to determine where chiropractors in NYS stand on this topic. The survey will also attempt

to determine whether chiropractors in New York feel that there is a need for a unified

professional association within the chiropractic profession. A copy of the survey is attached in

the appendix.

Procedure and Time Frame

The survey used in this study will first undergo a pre-test phase in which the survey will

be given to 5 to 10 chiropractors in order to determine clarity of questions and to detect any

inconsistencies in the survey questions before the final survey is administered to the main survey

population. Once the pre-test phase is completed, a web based survey will be distributed to

licensed chiropractors in NYS for using the online survey service Survey Monkey ®. The survey

will be accessible for 3 weeks. Prior to participation in the survey, participants will be required to

acknowledge that they have read and understood the informed consent form which is found in

the appendix.


Analysis

Demographic information, such as how many years participants have been in practice,

what chiropractic school they graduated from, and what type of setting they currently practice in,

were analyzed. Descriptive analysis was based on the responses to determine what percentages

of participants completing the survey belong to the following associations: American

Chiropractic Associations, International Chiropractic Association, World Federation of

Chiropractic, New York State Chiropractic Association, and the New York State Chiropractic

Council. Analysis was performed to determine what percentage of survey participants are

former members or have considered becoming members of the above named associations.

Analysis will also be performed to determine the top five barriers to membership of these

associations. Questions will be asked and analysis will be performed to determine what can be

done to increase overall membership in the professional associations offered to the chiropractic

profession. Analysis will also attempt to identify issues of unity within the chiropractic

profession to determine the attitudes of NYS chiropractors regarding unity between the ACA and

ICA.

Validity

The survey used in this study is similar in nature to those used in studies conducted in

other health care professions such as the American Medical Association and the American

Dental Association regarding membership in their respective associations. Face validity was

addressed by pre-testing the survey before it was widely distributed. A group of ten DCs took

the survey to determine sensibility and clarity of questions, and to seek comments on the

questions prior to final editing. Content validity was addressed by comparing the survey used in


this study to those previously used in similar studies to determine if the questions asked were

appropriate to answer our research questions.

Reliability

The reliability of the survey will depend on both the integrity of the questions asked in

the survey as well as the truthfulness of the respondents. The study should prove to be reliable as

it is repeatable and should yield consistent results. The survey used in this particular study could

potentially be used in any State within the US in order to determine membership as well as

barriers to membership of chiropractors in any particular State within the US.

Assumptions

One of the major assumptions of this survey is that the participants are responding to the

survey questions truthfully to the best of their ability and that the outcomes of the survey reflect

their opinions. A second assumption is that the survey is both valid and reliable and does not

contain any questions that may be considered biased. A third assumption is that the participants

of the survey fully understood each question asked.

Scope and Limitations

Several limitations of this study have been identified. First, a small and limited sample

population was recruited, given that the survey is limited to chiropractors licensed in NYS. A

second limitation is the limited number of responses received at the completion of the study such

that the results may not demonstrate a true reflection of the entire population of DCs in NYS. A

third limitation of this study is the 3-week time limit that the survey was accessible. Fourth, the

study is also by the fact that a limited sample of DCs were provided an opportunity to access the

survey link via email because of the researched did not have access to email addresses of all


DCs. For example, we only had access to an email address list from the ACA (upstate and

downstate) and to distribution of the survey link in the statewide NYSCA newsletter. One final

limitation to consider is that it is unknown how many chiropractors the survey actually reached

in comparison to how many responded.


RESULTS

Demographics

A total of 165 chiropractors licensed in NYS completed the survey using Survey

Monkey®. Fifty-five percent of respondents graduated from New York Chiropractic College

and the remainder graduated from 15 other colleges (Table 1). Over half of the respondents

indicated that they have been in practice for more than 20 years (Table 2). The vast majority

(67.8%) of respondents currently practice in a sole proprietorship while the remainder practices

as either an associate, in an interdisciplinary setting, a partnership, a corporation, or as faculty in

a chiropractic program (Table 3).

Importance and role of professional associations

Of the 165 respondents, an overwhelming majority (97.6%) indicated that professional

associations are important, and only 2.4% indicated that professional associations are not

important. With regard to the roles that professional associations serve within the chiropractic

profession, 97.5% of respondents indicated that professional associations provide legislative

advocacy. Other roles of professional associations, such as to provide legislative advocacy, to

protect DC rights, to act as spokesperson for the profession, and to inform the public about

chiropractic and its benefits, are listed in (Table 4).

Membership in national chiropractic associations

Regarding current and former membership in various state and national associations, a

wide variety of memberships were reported. For example, 61.9% (of 165 respondents) are

current members of the ACA and 31.3% are former members of the ACA. Five percent of

respondents indicated that they have never been a member of the ACA, and 5% indicated that


they are currently considering membership. In regards to membership in the ICA, 58.2%

indicated that they have never been a member while 30.9% indicated they are a former member.

The details of membership are listed in Table 5.

Membership in New York State chiropractic associations

Respondents were asked about membership in the two major New York State

chiropractic associations. A variety of memberships were reported in both NYSCA and the New

York State Chiropractic Council. Of 165 respondents, 72.3% are current members and 16.4%

were former members of NYSCA while the remainder have either never been a member or are

considering membership. With regard to the New York State Chiropractic Council, 61.1% have

never been a member, 22.2% are former members, but only 13% are active members (Table 6).

Barriers to membership

Respondents were asked to indicate what barriers to membership exist. More than half of

respondents (53.3%) indicated that membership fees were too expensive while 48.0% indicated

that they had too many other expenses. Surprisingly 36.7% of respondents answered “no

interest” as a barrier to membership and 32% felt that the associations provided little support to

the profession (Table 7). Several respondents provided written responses indicating that they felt

the lack of unity within the profession was a barrier to membership and expressed the need for

one authoritative voice within the profession on both a national and state level.

Increasing membership

Respondents were asked what actions could be taken on behalf of the professional

associations to increase overall membership. Over half of respondents (67.8%) indicated that

professional associations should provide more support to the profession in order to increase


membership. Decreasing membership costs was also a common response with 53.4% indicating

that they felt this would increase membership (Table 8). Many respondents provided written

response to this question and again indicated that unity within the associations would increase

membership. Respondents also indicated that professional associations should provide more

awareness to DCs about the benefits and importance of professional associations.

ACA/ICA Merger and perceived benefits

With regards to a potential merger between the ACA and ICA, 53.2% indicated that they

would like to see a merger and think it is possible and 40.3% indicated that they would like to

see a merger but do not think it is possible. Regardless of whether respondents felt a merger was

possible or not an overwhelming combined 93.5% of respondents indicated that they would like

to see a merger while only 6.5% indicated that they would not like to see a merger (Table 9).

Opinions regarding an ACA-ICA merger varied widely among current members of the national

and state associations (Table 10).

With regards to the perceived benefits of a potential merger between the ACA and ICA,

97.9% of respondents indicated that increased legislative authority would be of benefit. Other

perceived benefits include increased cultural authority among other health professionals (63%)

and increased cultural authority within the community and potential patients (54.8%). Finally,

41.8% of respondents felt that standardization of evaluation and treatment approaches would be

of benefit (Table 11).


DISCUSSION

Membership in chiropractic professional associations is undersubscribed and as a result

the profession as a whole lacks legislative and cultural authority. Professional associations are of

utmost importance and serve a multitude of purposes. In order to gain legislative and cultural

authority; membership in professional associations must increase on both a national and state

level. In an effort to determine membership in professional associations as well as barriers to

membership that exist among licensed chiropractors in NYS a survey was conducted using the

web-based survey service Survey Monkey ®.

Survey respondents were asked questions regarding their attitudes toward the importance

of professional associations, purposes of professional associations, membership status in both

national and state chiropractic associations, barriers to membership, and their attitudes regarding

a merger between the ACA/ICA. Almost all survey respondents indicated that they felt

professional associations were important. The majority of respondents were currently members

of the ACA, NYSCA, or both. In regards to the purposes professional associations serve, it was

determined that respondents felt professional associations serve the following purposes

1. To provide legislative advocacy

2. To protect DCs rights

3. Act as a spokesperson for the chiropractic profession

4. To inform the public about chiropractic and its benefits


5. To foster inter-professional relations

These are all important purposes for an association to serve in order to strengthen the

chiropractic profession as a whole. Professional associations should be heavily involved in

legislature that affects the profession, they should advocate for the rights of the DCs, and act as

the voice for the chiropractic profession.

Barriers to membership were also investigated to determine what factors prevent DCs

from holding membership in the professional associations available to them. The following

barriers were determined to exist

1. Membership costs are too expensive

2. DCs have too many other expenses

3. Membership does not provide enough benefits

Over half of respondents felt that membership dues are too expensive and therefore prevent DCs

from becoming active members. According to the ACA and ICA websites, membership dues are

dependent on number of years in practice. Membership fee schedules for the ACA, ICA,

NYSCA, and New York Chiropractic Council can be found in Table 12. Slightly less than half of

survey respondents indicated that membership does not provide enough benefits; however there

are a multitude of benefits that membership provides. Each association offers several benefits,

some of the benefits of each association can be found in Table 13.

This study also aimed to determine what can be done to increase overall membership in

professional associations. Survey respondents indicated that they felt membership would be


increased if the associations provided more support to the profession, decreased membership

costs, and offered more benefits. The common theme amongst respondents involved cost and

membership benefits. Perhaps current and potential members are uninformed about the benefits

entitled to them. Professional associations must address this and inform their current and

potential members about the tangible benefits associated with membership in an effort to

increase membership.

The attitudes of respondents regarding a possible merger between the ACA and ICA was

investigated in this study and it was determined that the vast majority of respondents would like

to see a merger regardless of whether or not they felt it was possible. This demonstrates that DCs

would like to see some form of unification within the chiropractic profession. Unification of the

profession would provide several advantages to the profession including increased legislative

authority, increased cultural authority among other health professions and within the community,

as well as standardization of treatment approaches. The profession as a whole would have the

opportunity to strengthen if there was one unified voice as opposed to several conflicting voices.

Further research needs to be conducted regarding membership in chiropractic

professional associations. Research should be conducted on a national level to determine the

attitudes of chiropractors regarding professional associations, barriers to membership, and the

potential for an ACA/ICA merger across the United States. Surveying chiropractors across the

country would provide better insight into how the profession as a whole views its professional

associations. Surveying a larger population of DCs would provide a better indication as to what

barriers truly exist, and what can be done to improve membership across the country in national

associations such as the ACA and ICA. There are several limitations of this particular study


which include a small and limited sample size. For example, the survey was limited to

chiropractors licensed in NYS. Another significant limitation of this study includes the

population of DCs in NYS to which the survey was distributed to. The survey link was sent out

to email lists of the upstate and downstate NY ACA members, as well as the NYSCA email list

and as a result reached fewer DCs who are not members of those associations. In the future the

study may be repeated and sent to DCs not on the membership list of these associations.

Although there are several limitations, this study provides insight into some of the

barriers that exist to membership and what can be done to increase overall membership in

professional associations. Increasing overall membership is of significant importance because it

will increase the strength and voice of the profession particularly from a legislative standpoint.

Increasing legislative authority would provide the opportunity for the chiropractic profession to

advocate for better insurance reimbursements, wider scope of practice, etc. This study also

demonstrates that many DCs would like to see a merger between the ACA and ICA. This

demonstrates that the profession would like for there to be one unified voice.


CONCLUSIONS

Membership of NYS chiropractors in professional association appears to widely vary

among the national and state associations. More NYS DCs appear to be members of the ACA

and NYSCA and fewer are members of the ICA and the New York Chiropractic Council.

Among the most important purposes of professional associations is to provide legislative

advocacy. Barriers that exist to membership are heavily associated with cost of membership.

The majority of survey respondents indicated that they would like to see a merger between the

ACA and ICA and many indicated that having one authoritative voice is necessary and crucial in

order for the profession to gain the legislative and cultural authority it deserves.


Works Cited

"ACA - Member Benefits." American Chiropracitc Association. N.p., n.d. Web. 28 Apr. 2012.

<https://www.acatoday.org>.

"ACA - Membership Categories." American Chiropractic Association. N.p., n.d. Web. 28 Apr.

2012. <https://www.acatoday.org/level2_css.cfm?T1ID=11&T2ID=42>.

"ACA- Value of Tangible Benefits." American Chiropractic Association. N.p., n.d. Web. 28

Apr. 2012. <https://www.acatoday.org/index.cfm>.

Akers, R, and R Quinney. "Differential Organizaton of Health Professions: A Comparative

Analysis." American Sociological Review May (1962): 104-121. Print.

Akers, Robert. "The Professional Association and the Legal Regulation of Practice." Law and

Society Review 2.3 (1968): 463-482. Print.

Bucher, R, and J Stelling. "Characteristics of Professional Organizations." Journal of Health and

Social Behavior March (1969): 3-15. Print.

Gersick, C.J, J Dutton, and J Bartunek. "Learning from Academia: The Importance of

Relationships in Professional Life." The Academy of Management Journal 43.6 (2000):

1026-1044. Print.

Greenwood, R, R Suddaby, and C Hinings. "Theorizing change: the role of professional

associations in the transformation of institutionalized fields." The Academy of

Management Journal 45.1 (2002): 55-80. Print.

Griffin, L. "Merger Almost: ICA Unity Efforts and Formation of the American Chiropracitc

Association." Chiropractic History 8.2 (1988): 19-22. Print.

"International Chiropractors Association." International Chiropractors Association. N.p., n.d.


Web. 28 Apr. 2012. <http://www.chiropractic.org/?p=membership>.

J.C, Keating. "The origins and early history of the National Chiropractic Associations." The

Journal of the CCA 37.1 (1993): 27-51. Print.

J.C, Keating. "The Short Life & Enduring Influence of the American Chiropracitc Association."

Chiropractic History 20.1 (2000): 19-22. Print.

Johnson, C, and B Green. "100 Years After the Flexner Report Reflections on its Influence on

Chiropractic Education." The Jornal of Chiropractic Education 24.2 (2010): 144-152.

Print.

McClelland, G. "The American Chiropractic Association and Primary Care." Journal of

Chiropractic Medicine 1.4 (2002): 180-183. Print.

"NYS Medicine:License Statistics." NYS Office of the Professions - State Education Department.

N.p., n.d. Web. 28 Apr. 2012. <http://www.op.nysed.gov/prof/med/medcounts.htm>.

"NYSCA." NYSCA. N.p., n.d. Web. 22 Apr. 2012.

<http://www.nysca.com/mission_statements.asp>.

"New York Chiropractic Council." New York Chiropractic Council. N.p., n.d. Web. 22 Apr.

2012. <http://www.nycouncil.com/page/-Core-Values>.

"New York Chiropractic Council." New York Chiropractic Council. N.p., n.d. Web. 28 Apr.

2012. <http://www.nycouncil.com/index.php?

file=payments.html#_paymentForm=Dues>.

Plamondon, R.L. "Mainstreaming Chiropractic: Tracing the American Chiropractic Association."

Chiropractic History 13.2 (1993): 31-35.


Tables

Table 1: Chiropractic colleges attended

Table 2: Number of years in practice


Table 3: Types of practice settings

Table 4: Purposes of professional associations


Table 5: Membership in national chiropractic associations

Table 6: Membership in state chiropractic associations


Table 7: Barriers to membership

Table 8: ways to increase membership


Table 9: Attitudes toward a potential ACA/ICA merger

Table 10: Attitudes toward an ACA/ICA merger among current members


Table 11: Perceived benefits or an ACA/ICA merger


Table 12: Membership fee schedules


AppendicesSurvey of New York State Chiropractors: Membership in Professional Associations and Barriers

to Membership

Informed Consent

We invite you to take part in a research study about institutional policies and procedures concerning institutional review boards as they relate to educational research. This study is taking place at the Chiropractic Department of D’Youville College. The principal investigator for the study is Shannon Passalacqua

Purpose

The purpose of this project is to gather information regarding what barriers may result in the reluctance of chiropractors in NYS to become active members of a professional association. Additionally, the proposed study will attempt to determine what percentage of chiropractors in NYS are members of a professional association and to which associations they belong. For those chiropractors who are members of an association, the study aims to determine what attracts them to a particular association over another?

Procedures

The survey used in this study will first undergo a pre-test phase in which the survey will be given to 5 to 10 chiropractors in order to determine clarity of questions and to detect any inconsistencies in the survey questions before the final survey is administered to the main survey population. Once the pre-test phase is completed, a web based survey will be distributed to licensed chiropractors in NYS for one month using the online survey service Survey Monkey ®.

Risks/Discomforts

There are no risks involved with this project. All surveys will be anonymous and confidential.


Benefits

Benefits to participating in this survey include providing insight into what attracts chiropractors to one professional association over another, what can be done to increase overall membership in professional associations available to the chiropractic profession, and to provide feedback on the attitudes of NYS chiropractors regarding unity within the profession.

Voluntary Participation

Your participation in this research project is voluntary. You do not have to complete or return the survey.

Confidentiality of Records

This is an anonymous and confidential survey. There will be no record kept of participation in this project, and there is no mechanism by which your involvement will be revealed to anyone.

Questions Regarding this Research Project

I also understand I may contact Shannon Passalacqua, the principal investigator at 315-745-9210, Dr. John Taylor Chair of the Advisory Committee overseeing this research at (716) 923-4375, or Dr. Catherine Lalonde, Director of the Institutional Review Board (716) 829-8275, if I have further questions.

Statement of Consent

I have read the above information and all of my questions have been addressed. I freely and voluntarily consent to participate in this research study.

By clicking Yes below you are verifying that you are a licensed chiropractor in the state of New York and are agreeing to participate in this study


Documents

Survey of NYS Chiropractors