The New Chiropractic Pioneers - Part 1

By Michel Tetrault, DC - Chiropractic Diplomatic Corps  

*** A series of articles designed for chiropractic students and others interested in foreign practice.***

 As we observed the turn of this century, we find around 15,000 students enrolled in chiropractic schools and 69,000 Chiropractors in practice worldwide. The USA has 13,000 of the students while there are only 400 students enrolled in the 6 recognized schools located in non-English speaking countries. 85% of the DCs are in the USA and only 5,000 DCs are located outside of the United States and Canada. There are more DCs in practice in the state of Indiana than in all of Asia, Africa and Latin America combined. 

This is the first of a multi-part article on “Practicing Abroad.” It is our desire to inform you, as students, of the opportunities and responsibilities of a foreign practice. Undoubtedly, it is hoped that these brief articles will either stimulate in you an interest in practicing outside of the USA and Canada, or strengthen your resolve, if you already plan on practicing abroad. There are many opportunities in chiropractic during the next century to be found outside the USA. Under the current global economic standards, the world can support upwards of 350,000 chiropractors and we have met only 20% of that total. 

The Chiropractic Diplomatic Corps, a humanitarian, non-government, international organization, has set up an Internet based “Foreign Service Registry.” Some 500 DCs and students (10%) have registered their desire to practice abroad in 65 different countries. The majority expressing interest in Europe (43%) with the balance requesting Asia (27%), Latin America (28%) and the last 2% looking at Africa and the Middle East. Fifty percent of the registrants have been in practice less than three years or are still in school. Thirty percent have been in practice 4 to 10 years and the remaining twenty- percent in practice over 10 years. 

Imagine being a DC in the early 1900's? That same opportunity to pioneer chiropractic is just a plane ride away, offering you the chance to be a leader and to nurture the growth and development of chiropractic. See yourself respected as a drugless healer and treated according to the degree of education and social position you could earn as a valuable player in the future of chiropractic. If you don’t think these are tangible goals in your hometown, think again, think differently or think abroad. 

Your thinking decides your success in life. If you go back to hometown USA and accept the status quo or practice where everybody else wants to be, you will create one type of reality for yourself. On the other hand, when you step “out side this box”, when you go where very few have gone and little is familiar to you, this foreign environment breeds creative and adaptive traits, evoking your noblest efforts. You are literally forced to think differently and, in so doing, create a different future for yourself. Up to the challenge? Three challenging areas come immediately to mind: language, time and finances. 

The first major subject to consider is language. Chiropractic needs to be communicated to people in their own language so you should determine if you have the aptitude to learn another language; and one language in particular. Some of you already speak this “particular” language because of family heritage, previous travels or personal interest. The next two major challenges are time and money. That is: “When will be the best time for you to move abroad (or back home) and when will your finances support the move and the new practice?” Speaking to the “back home” crowd, statistics sadly report that only 30% of the foreign students who were provided full chiropractic scholarships returned home to set up practice after graduation. Until there are schools that teach chiropractic in every major language and in every region on earth, American Schools will need to see a greater percentage of their graduates establishing a foreign practice. If you are a foreign student or here on an international scholarship, please recommit yourself to your people and bring them chiropractic the way only you can. Are you willing to let foreigners decide how chiropractic is to be developed in your country (in your absence)? Besides, America is not the land of golden opportunities it once was. The opportunities for chiropractic are beginning to see a rising potential in less serviced countries. 

The next upcoming sections will discuss the needs for humanitarian services and thoughts on future planning which include you and your family semi-retiring in your favorite country, for those who wish to wait before practicing abroad. Later, detailed steps involved in setting up a foreign practice will be outlined. If you wish more information, you are invited to further check this Chiropractic Diplomatic Corps’ web site. The current global statistics on the state of chiropractic are available there, along with links, articles and much, much more.

The New Chiropractic Pioneers - Part 2

This article focuses on available humanitarian programs and other things you can do in the future about bringing chiropractic to under served countries. It is completely understandable that you wish to practice in your home state or other location in the USA or Canada. Many doctors have a successful experience in practice for 15 to 25 years, then find inside themselves the desire to “reach-out to do more” for their personal fulfillment and are now looking to start over in a foreign country. Many of you reading this article right now will be in exactly such a position, years down the road. Here are a few suggestions to keep that spirit of “service” alive in you over the years: 

Mission programs.

There have been many, many chiropractic mission programs where several DCs fly into a country and provide humanitarian care to the indigenous people. Some are exclusively comprised of chiropractors and others are medical missions, which have added a DC or two to their team. Life University’s “LAW: Life Around the World” and Palmer College’s “CAP: Chiropractic Abroad Program” have on-going, short-term missions that involve students AND graduate doctors. This trend will increase in the years-to-come; so, you can always plug into these schools for the experience. Coping with State Law issues, insurance issues, competition issues, IRS and other business-related issues, etc. can turn off a “turned-on” Chiropractor. The personal gratification reported by those who have participated in humanitarian missions is beyond words and will keep that giving side of you alive, as you maintain a regular Western practice. 

The Christian Chiropractic Association has been very active for many years with their ongoing missions in Poland, Ukraine, Nigeria, Mexico, Bolivia, Columbia, Costa Rica, Jamaica, Hungary, Haiti, El Slavador, Ecuador, and the Dominican Republic. Also, there are also several privately organized expeditions that go to such places as El Salvador, Panama, Peru, India, Nepal and the Philippines. So, there will always be opportunities for you to participate with a variety of organized humanitarian efforts. This is an excellent way for you to visit and experience the cultures and consider where you may wish to return and establish a permanent practice down the road. It is recommended that you keep on file the Internet resources of the Chiropractic Diplomatic Corps’ web site address so you can inquire into the listing of Chiropractic Missions.. 

Humanitarian help begins in your neighborhood.

Another way to serve the needy, without the costs associated with travel, is to look in your own community. There are several ways to provide humanitarian care in your practice by dedicating one or two slower mornings per week as “community care”, “free clinic”, “children’s clinic” days on a “sliding scale” or “low fee” basis. You can consider donating several hours weekly at a homeless shelter, battered women’s shelter or Migrant Worker Center in your community. As you get involved with local service clubs and your local Chamber of Commerce, you will develop the contacts that will expose you to the needs within your community. 

Travel and learn another language.

Not everyone is interested or motivated to have a foreign practice purely for humanitarian reasons and that’s perfectly fine. Taking a break from the practice by vacationing and traveling abroad is a fun and fulfilling experience. You will get more out of your travels by also learning the language, getting you close enough to the locals to enjoy their culture in greater depth. It comes as no great surprise that you will probably find yourself attracted to a particular country and culture. Eventually you may desire to bring chiropractic to one of the countries you visit when you find yourself ready for a foreign practice. 

Chiropractic is a wonderful profession, full of diversity and personal gratification. The bottom line: "We need more DCs in foreign practices and we will coach anyone who is willing to go forward with this endeavor." Those who feel they have the personal integrity and commitment to bring chiropractic to the under served will find inspiration in the next sections. The next article discusses criteria useful in making a proper country selection.

The New Chiropractic Pioneers - Part 3

It may come as a shock to our young or new people to the profession that chiropractic is only established in a handful of countries (USA, Canada and Australia and a few in Northern Europe). Although there are one or more DCs in some 90 countries, only 30 have laws that recognize chiropractic as a legitimate profession. Yet 65 countries have only one DC for every 100,000 to 2,000,000 people. There are 160 countries without DCs of which 120 are too poor, too small or too dangerous to try and establish practices.

Needless to say, making the right choice in selecting a country to open a practice is a serious matter. How do you select a country that is ideal for you? 

Putting things in simple terms, the greater the familiarity and the genuine affinity between the doctor and the patient, the better the choice. Blood and heritage hold the strongest bonds between people. Familiarity includes language, physical similarities and common interests. Ask yourself this question: "What group of people do I hold dear to my heart?" Unless you have actually traveled to a country or have personal experience with that culture it is difficult to know if you can genuinely care about them. 

Once you can honestly say to yourself that there is a love for the people of a particular culture or country you will have begun to narrow down your choices. The next question to ask yourself is: "Can I make a decent living in that country?" The demographics (population and economy) will indicate your potential for success if you are willing to work hard. 

How do you determine these facts? Go to a local bookstore and buy a travel book on the country(ies) of interest. There is a wealth of information there to familiarize you with many facts. Another source is the CIA World Book on line. You can access this link on our website at  under the section called TOPICs (Topics On Practicing International Chiropractic). Be sure to use Internet Explorer as your browser and scan the TIP BOX that can be accessed on the menu page of 24 topics. 

Next, take the opportunity to travel or even volunteer in a mission to your country of interest. This will either make or break your decision because it replaces fantasy with facts. It really is your "gut feeling" that will ultimately decide if all the facts are right for you. 

Language is also an important factor min your decision-making. Here the question to ask yourself is: "Can I speak or learn to speak the local language?" In some countries like Norway, the Netherlands and Germany you are required to speak and write fluently in their language before being permitted to establish a permanent practice. Many countries are accustomed to having professionals who only speak English, but a doctor must rely on translators. Obviously, it is important for doctors to effectively communicate with their patients. This has always been especially true for the chiropractic practitioner. You will have to be the judge on how critical this issue plays in making your selection. 

Let us look at these questions again:

1. What group of people do you hold dear to your heart?
2. Can you make a decent living in that country?
3. Can you speak or learn to speak the local language?

Once you can fully answer these questions to your satisfaction it will become easier to narrow down your choices. After all, you can only be in one place at a time. Why not make a solid decision and plant some deep roots; your future patients deserve that. So does the profession and so do you! 

In the next article we will discuss the different opportunities available in foreign practices.  

The New Chiropractic Pioneers - Part 4

  As a chiropractic student you carry a full plate between classes, studies, clinic, work and what's left for your personal life. Thoughts about the future are overshadowed by the demands on your time in the present. Besides, it's kind of hard to envision what you have not yet experienced... being a doctor in practice.  

Whatever motivated you to enter the chiropractic profession may or may not be enough to feed your passion. As a practicing DC of over 20 years I am thankful for the ever-consuming love for my patients that continues to sustain me; even stronger today because the dream of a practice has become a reality and a lifetime purpose. As you think about graduating there is a sense of anticipation and even some trepidation. The unknown, "will I make it?" is sometimes a little scary.  

Fear if the unknown is easily conquered with knowledge and experience. If you do not have a close relationship with your field doctor, the DC back home who encouraged you, find a local DC whom is willing to be your mentor, or at least let you spend a little time in a real clinic and observe what it's all about.  See yourself in that role and visualize your ideal practice... a day in the life of Dr. (you). It's important to dream because it gives meaning to your work and raises your commitment to strive and do your best. So, do a little day dreaming. 

OK, stop right here! Before we go any further. In that daydreaming, where are you placing that clinic... in your hometown or in another location? If you see yourself in a practice outside of the United States or Canada, the rest of this article will be of particular interest to you. (If not you'll still get something out of it.) 

The Chiropractic Diplomatic Corps is an organization that encourages doctors to establish foreign practices. We want you to seriously consider pioneering chiropractic in another country or to join the growing number of DCs in the countries of your heritage or interest. Not everyone can go straight from graduation to a foreign practice; so, we would like to help those who can to find their way. 

There are two topics that we will cover here: 1. Seeking opportunities and 2. Making contacts. 

If you already have a pretty good idea of which country you're heading for, all you need is to know what opportunities are available. There are three types of opportunities:

1. Temporary or locum assignments that last 3-6 weeks or months.

2. Associate with an established practice for a few years.

3. Starting a practice from scratch (or purchasing an established one).

There are very few requests for a DC right out of school to come and take over a practice while the regular doctor takes a leave. There are a growing number of countries that require 1-2 years of internship before qualifying for licensure. We have heard of a few situations where a doctor places a new DC in an established satellite office. These are great opportunities to gain experience in exchange for a subsistence salary, but not enough money to meet student loan payments in US currency. The good locum positions generally go to a semi-retired DC and that makes a lot of sense from the resident doctor's perspective. 

An excellent choice is to seek and associateship for 2-5 years. You could be an additional DC in the clinic or the doctor in a satelite clinic. At the end of your term you may take over a clinic, buy another one or be able to start your own from scratch. As a new graduate you stand a better chance of getting hired if you are willing to stay for several years and if you apply in person. Yes, that means go to the country and meet the doctor in a personal interview. Actually, this becomes a two-sided interview and you get to see for yourself (not sight unseen) what you're getting into and with whom. 

If you have a personal relationship with a DC in practice in your country of interest you could discuss some arrangement that is mutually beneficial. If you have no contacts you need to make inquiries with the local DC representatives. Our website has this information on every country with an established National Association and can be found in the section called Global Statistics. 

yuNew graduates who can financially start on their own have either been in business before and can rely on their past experience, or have a lot of support from family and friends to guide them in those first years. Starting your own clinic doesn't mean "going it" alone. In closing, it is important to realize that the question of experience is not a casual topic since new doctors inevitably make more mistakes. When you are the only DC in the area... YOU are Chiropractic!  

Students and doctors that are listed with our Foreign Service Registry are now able to receive a monthly bulletin on International Topics.