Chiro v GP – who’s more qualified?

Is it true that GPs and chiropractors do much the same level of training and are thus equally qualified to practice primary healthcare?

Should chiropractors play the role that GPs currently do as the first stop for medical consultation?

The argument used by chiropractors to practice as primary healthcare is that they must go through the same level of medical training as GPs, including the same courses, and are thus as qualified to offer primary healthcare as GPs.

The question is whether this is true.

The vision statement of the chiropractic profession’s peak body, the Chiropractors’ Association of Australia (CAA), positions chiropractic as an alternative health system distinct from the mainstream and aims to “achieve a fundamental paradigm shift in healthcare direction, where chiropractic is recognised as the most cost efficient and effective health regime of first choice, that is readily accessible to all people”.

In an article on the Choice website, Karina Bray, senior content producer – health for Choice, laid out some of the issues associated with chiropractic and differences between it and the GP profession. Apart from the level of qualifications, these issues included the anti-vaccination stance of many chiropractors, the potential for misdiagnosis, and preventative manipulations which may cause problems where none previously existed.

The claim for chiropractic training

‘OzSydGuy35’ responded to Bray’s article on the Choice site with a comment that the article was biased, with Bray apparently showing a lack of understanding of what training chiropractors go through, “which is a full three-year Bachelor’s degree in science followed by a two-year Master’s degree”.

“If anyone does some research instead of taking extreme biased views they can clearly see chiropractors do take extensive training and just as much as GPs in the science side of things. The courses are very similar, GPs require [sic] and the same as chiropractors’ courses in anatomy, physiology, physics, chemistry and biochemistry, neuroanatomy, etc. These courses do not differ. They are not taught by anyone different either. The person in question teaching the specific course has to have a degree in that specific course, ie a biochemistry teacher has to have a Bachelors of Biochemistry with honours etc, depending on the university of the min requirements, hence some are better than others just like medicine, both require a minimum though rest assured, as per law.

“Chiropractors also learn ECG monitoring, blood pressure etc (that’s why they can do this stuff also) as you get taught this in anatomy and physiology second level. The only parts where they differ is GPs branch off into getting training for drugs where chiropractors actually keep going with even more in-depth anatomy and physiology specific to what they deal with each day.

“Even the years are the same, check out the Australian AMA page, takes 4-6 years. Chiropractic takes minimum five Then medical does a further one year normally hospital residency. A chiropractic does this in addition to its normal studies for two years in their Master’s degree.

“Both are classified as Doctors. One is of medicine to prescribe drugs. The other is a non-drug prescribing profession. Both have their needs in society. Most nurses or MDs agree with this.”

OzSydGuy admits that “more research is needed” but adds “If people are getting relief from this and there is lack of scientific evidence around, that does not mean it does not work. Just means we need more studies to show why it works in the people that it does and how.”

There are many chiropractors who would share OzSydGuy’s views.

Unfortunately, it’s not true.

The reality of medical training

Mr John Cunningham is an Australian-trained orthopaedic surgeon who specialises in the treatment of spinal disorders. He is a Fellow of the Royal Australasian College of Surgeons and of the Australian Orthopaedic Association. In the 2016 Australia Day honours, he was awarded a Medal of the Order of Australia (OAM) for services to medicine and the promotion of immunisation.

He suggests that OzSydGuy’s “understanding of chiropractic training, and the training of GPs, is considerably lacking”.

For a start, Mr Cunningham says, a GP must complete a medical degree, which these days is often a 6-7 year program of the medical sciences as well as clinical medicine. It is taught by scientists specialised in the field, as well as clinicians.

“Medical practitioners are taught evidence-based medicine, meanwhile chiropractors are taught make-believe like Gonstead, pregnancy and paediatric chiropractic – completely without evidence. Medical students are not taught by chiropractors, nor are chiropractors taught by medical practitioners. The courses differ and they differ enormously. How do I know? Because I did a science degree with chiropractors at UNSW before completing a medical degree.

“While their science degree was similar, they only did one major in anatomy, and so missed out on physiology and biochemistry. Just anatomy. They were not exposed to nearly as much detail of the other subjects as medical students, nor did they learn anything about human behaviour, microbiology or pharmacology. Just anatomy.

“To even suggest that chiropractors learn ECGs in the same detail as a medical practitioner is laughable.

“Making a claim that the two streams simply branch off is ridiculous. They share no common ground to begin with, so cannot ‘branch off’, as OzSydGuy puts it.

“And a medical degree is only the start. GPs must also complete a three-year Vocational Training Pathway covering many aspects of medicine not covered in detail in the undergraduate section of training, as well as passing more exams, and then a fellowship exam. So we’re up to ten years just now.

“And OzSydGuy thinks that’s only about drugs? What do GP’s see? Only the broadest range of conditions that can be treated with evidence-based medicine. Yes drugs are used, but what about, say, an asthma plan? Diabetes counselling? Family planning? Psychiatric care? End of life care? Paediatrics? Learning difficulties? Musculoskeletal complaints? Dermatology? I could go on, but to simplify things to the idea that ‘all GPs do is prescribe drugs’ is ludicrous.

A chiropractor is trained now in universities, Mr Cunningham says, but “many aspects of their curriculum are not evidence-based. Simple as that.”

“And saying ‘more research is needed’ is not the same as saying ‘it works’. Much research has already been done, and the only thing that chiropractic can treat better than GPs is acute back pain, and only then in a small subset of patients. Researching it more may provide more evidence for other conditions, but it also may not. One’s chickens should not be counted before they’re hatched.

“Suggesting that chiropractors can replace GPs because some of their subjects have the same broad title as each other is blatantly false. You might make the same claim about physiotherapists, osteopaths, nurses, pharmacists, and I could go on. GPs have their place, and that is as the primary family physician. Chiropractors should learn their place too, and it’s not where they think it is.”

14 thoughts on “Chiro v GP – who’s more qualified?”

  1. In the USA, I have seen this chart (and various versions of it) referred to many times by those claiming chiropractic education is the same as MD education:

    It may or may not be true, but what those on the chiropractic side neglect to mention is that the MD training is only entry level. After those hours the MD then goes on to a multi-yr residency and then subsequent specialist training. The chiropractic hrs do not come remotely close.

  2. It’s ridiculous how this is even an issue! Medical education is vastly more superior and complex than any chiro course could ever be.
    This assertion that chiros study 4-5 years does NOT legitimise their position in the health care system. Five years of studying nonsense alongside a bit of anatomy, does not change the fact that it is still nonsense! Chiros need to understand that their disjointed superficial book knowledge of the biomedical sciences is insufficient and incompatible with competent clinical practice. Their training does not give them the experience and perspective to make clinical decisions regarding presentations that are completely outside their scope of practice!
    Furthermore their use of the honorific title of ‘doctor’ is particularly deceptive and undeserved.
    The world would we a better place if chiropractors stopped being delusional about their identity. They are at best glorified massage therapists, at worst a dangerous cult.

  3. Chiro 101#
    How to fix dermatitis=crack Apophyseal joints in spine.
    How to treat deafness =As above plus take several xrays ( only use safe and natural type of radiation)
    How to fix obesity =crack spine + sell expensive dodgy vitamins +sign up for treatment plan
    How to fix autism =crack spine ,blame vaccination + sell cure of dodgy expensive vitamins
    How to cure Crohns Disease (see #1, 2 or 3 ..)
    How to treat migraine =crack neck (mind those vertebral arteries) some safe xrays, sell more vitamins

  4. It doesn’t really matter how long the courses are. It’s about what is taught. The good surgeon nails it when he says “medical practitioners are taught evidence-based medicine, meanwhile chiropractors are taught make-believe”

    End of story.

  5. Someone collapses on an aircraft. “Is there a doctor on board?” asks the Chief Steward.

    Who would you prefer? A chiro? Or an experienced GP?

  6. Chiros need to learn their place.
    Their place is in the history books, alongside alchemy and humor medicine.

    But that won’t happen until their bs is exposed. Education in elementary and highschool must change to include pseudoscience, and explain why it doesn’t work. Imagine how much wasted money could go towards research and development of medicine if people stopped using chiropractic “medicine” and homeopathy and used that money to buy actual medicine.

    1. Dear Dieago,
      The ‘bs’ of chiros was revealed by the NZ Royal Commission into chiropractic, the medical fraternity descended upon NZ from around the world to finally put an end to chiropractic.
      Unfortunately the truth was revealed and medicine was very disappointed.
      If you are really interested in the truth have a read, but I think a bunch of morons known as ‘australian skeptics’ would prefer to vent their ignorant vitriole, without ever experiencing a visit to a chiro or understanding what chiropractic is actually all about.$file/Chiropractic%20in%20NZ%20-%20report.pdf

  7. Just a quick note to the author “Tim” (no last name in your byline? weird) – if you’re going to directly quote a person’s bad grammar and then put a “[sic]” in the quote to highlight it, you should really be consistent and do the same for the quote from Cunningham, “many aspects of their curriculum is [sic] not evidence-based.” To not do so just looks petty.

    Also, they’re =/= their =/= there. “One’s chickens should not be counted before their hatched” makes no sense at all.

    1. Thanks for the proofing Rose. I have corrected those errors. You might note that as an editor, I often correct the sorts of slips that anyone can make, not so much to cover them up but rather to make reading easier, especially for people with a keen eye for errors. The [sic] in OzSydGuy’s text is because there is no clear correction that can be made – his sense is uncertain. As I recall, there were other things in his text that were corrected, but I may be mistaken. Regards, Tim Mendham, editor. BTW – does “Rose” have a surname?

  8. Cheers for the response Tim. That’s fair enough – of course it would be super frustrating for a reader to constantly bump up against speech-like grammar put down directly into text, peppered with [sic]s everywhere. I brought it up just because the choice to *not* change bad grammar and instead insert a [sic] I think is often done to be a bit smug (not always a terrible thing). But when it’s selectively done only to the target of a critique and not with the person supporting the writer’s argument, it comes off as either unconsciously blind, or just a bit mean. Hope this is relateable/understandable to you, and glad you’ve corrected it.

    PS – Rose does indeed have a surname, but I’m a commenter on an article, not the author of an article in a community that values transparency and traceability of sources. ;)

  9. Interestingly Bonello and Tuchin, the scientific chiropractors from the other chiropractic association that the Friends of Science in Medicine suggest you see, did a study in 2002. A questionnaire was written by a senior orthopeadic surgeon and given to Australian Orthopaedic residents and final year chiropractic students. 80% of the orthopaedic students failed the test and 70% of chiropractic students passed.

  10. I am a GP. When I read the title of the article I was pretty shocked and disappointed that this comparison could even be raised. After studying for so long and so hard I couldn’t believe that this question was something people were asking. But then reading the article and the comments at the bottom really restored my faith that people are starting to understand the difference in training requirements.

    I think it’s also important to point out that aside from the differences in training of what we study, the pre-selection of medical students is much more intense. To actually get in to medical school in the first place many people have already done a degree and then they do the GAMSAT test, which is a 6 hour test of sciences (physics, biol, chemistry) and humanities purely for the purpose of selecting only the top people for medical schools. And from that test only a certain percentage of the top marks get offered a place. So before you even begin medical school you’ve already had to study intensely to be in the top percentage. Then once you finish medical school, before any GP can even start officially training to become a GP with the Royal Australian College of General Practice you are required to have worked 2 general years as a doctor gaining experience in a hospital, that’s after a 3 year science degree and a 4 year post graduate degree of medicine. And nowadays there are entry exams to be accepted to START training as a GP (let alone exams to finish/become qualified). People who want to become GPs in Australia have to apply after they’ve done med school and their 2 general hospital years to start training as a GP, you have to sit an examination, and then do a stationed interview. Then, just like GAMSAT, they only take a certain percentage of the top marks to BEGIN training as a GP. Then after your 2-3 years training and studying as a GP you do three more exams to finish.

    So just to summarise: GPs usually do 3 year science degree, then 6hour GAMSAT where only the top are selected for medical school, then two years hospital, then pre-GP training selection exams by the college of GPs (again only top selected), then 2-3 years GP training, then three final “fellowship” exams (side note those exams cost us $8000).

    By that stage our university debt is massive, we have sacrificed thousands (literally) of hours of personal time with loved ones and doing fun things to have the knowledge to treat a hugely broad range of complex medical conditions, ask specific and appropriate questions about symptoms and a huge range of diseases, having skills to examine any part of the body required, arrange relevant tests, interpret those tests and initiate treatment safely, with appropriate education and counselling.

    1. I understand your commitment to your profession and the number of hours you study. And the cost. It is not easy being a GP. But the question is can you actually read X rays or do you just rely on a radiologist to tell you what is wrong. You study many diseases and rotate through many departments, but how long do you actually spend studying the spine and spinal problems. In fact only about 20 % of med students rotate for 2 weeks through an orthopaedic department.

      1. GPs can absolutely read XRays. We study them all the way through medical school. They are integrated into the course so it’s not just within an orthopaedics rotation that x-ray teaching occurs. We were examined on them constantly. We would see XRays multiple times a day as interns and residents making calls on night shifts about pneumonia or heart f
        ailure without access to a report. Also during GP training there is more. So yes. We can absolutely read an xr image.

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