Training, Professional Skills, and Experiences of Doctors of Chiropractic Working in U.S. Federally Qualified Health Centers: A Mixed Methods Study

Abstract

Objective: The purpose of this study was to examine the training, professional skills, and experiences of Doctors of Chiropractic (DCs) working in Federally Qualified Health Centers (FQHCs).

Methods: Identified FQHC-employed DCs in the United States were invited to participate in a survey about their training and practice, administered between November and December 2023. A subset of these DCs, along with FQHC administrators and colleagues, participated in qualitative interviews to explore their experiences and the skills necessary for a DC to practice effectively in FQHCs, between February and May 2024. Survey analysis utilized descriptive statistics and content analysis, while reflexive thematic analysis was applied to the interviews by identifying notable themes and creating a codebook.

Results: Of 206 DCs invited, 101 completed the survey (49.0%). Respondents averaged 18.2 years in practice (range: 1-48), and 44.8% participated in the Public Services Loan Forgiveness program. Fewer than half reported prior experience in multidisciplinary settings (47.4%), additional training through certificates (43.8%), or advanced degrees (28.1%). Many (41.8%) reported using a non-English language with patients, predominantly Spanish (80.5%). DCs frequently performed joint manipulation and soft tissue therapies, primarily for spinal and chronic pain. Interviews involved 12 DCs, 10 administrators, and 7 colleagues. Each group appreciated DCs' instructional abilities (eg, communication, patient education), patient-centered orientation, and interprofessional competencies (eg, teamwork, collaboration). DCs valued providing chiropractic access to underserved communities and focusing on patient care over business practices.

Conclusions: DCs working in FQHCs demonstrated a "team mentality" including patient-centered care, interprofessional collaboration, and communication. Their integration into FQHCs enhances team-based care and expands access to nonpharmacologic pain management.

Keywords: Centers, Community health; Chiropractic; Manipulation, Spinal; Medically underserved areas; Skills, Clinical.