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.”

30 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

      1. Very interesting document from 38 years ago. Very dated and obsolescent – like comparing the dawn of the motor vehicle age in 1909 with the already developed Jet age in 1947 – 38yrs later.
        In the 1970″s there was a strong PC type movement to look at “CAM” – “Complimentary and Alternative Medicine” in a favourable light rather than just calling neutered male bovine faeces by its less politically correct but equally factually correct common name.
        Chiropracty cannot cure anything. It may alleviate some musculoskeletal back pain and, in the hands of an apparently or genuinely sincere and caring practitioner, may be an effective placebo.
        Some might be misled by pseudoscience and snake oil and waste good money on it but being able to market something doesn’t make it a benefit to mankind.
        If it looks and waddles like a duck it probably goes………

  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.

    1. This is a completely unscientific study.
      Firstly the “examiners” would have been biased as they were likely Chiropractors and would have known that the persons sitting the exams were chiropracty students.
      secondly no mention of blinding.
      Thirdly to to say they followed the marking guide is disingenuous. How can you compare the results of a test taken by one set of people in a specific situation then compare the results of the same test marked by different markers with completely different training and experience.

      I would suggest a better way would be to have an in depth MCQ ( Multiple Choice Questionnaire) on the topics concerned made up by an unrelated group of Orthopaedic experts,with both groups of people sitting the exam at the same time via an online link up to prevent leakage of questions prior to the event.
      The marking would be done by computer based on the agreed correct answers inputted by the experts setting the question.
      I am sure the Popes team did better in the astronomy exam when tested by the Vatican than Galileos team!
      Lies, damn lies and statistics. Evidence biased evidence and total…..

  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 failure without access to a report. Also during GP training there is more. So yes. We can absolutely read an xr image.

      2. GP’s do not take Xrays – they order them. These Xrays are taken by radiographers who probably have more in depth training in anatomy, nuclear medicine, radiation and physiology than any chiropractor, and focus their skills purely on taking high quality medical images including Xrays CT and MRI and sonographic scans – in fact many sub-specialise in a specific type of image by further post graduate study. They must surely be far superior at taking such images than a part timer.
        These images then go to a radiologist who views and reports on his or her findings. This radiologist has trained for 6 or more years as an undergraduate in a highly competitive environment, worked at least 2 years in a hospital as a junior doctor, then trained for several years in Radiology/ Medical imaging, having to pass many very difficult examinations before they can practice independently.
        So you can choose to see the GP who has a very good general knowledge in the Medical field, who then sends you to an expert in the taking of Xrays, who in turn takes the image and sends it to another doctor who is an expert in interpretation. This person then views the images and reports on them to the referring General Practitioner. The GP, using his broad knowledge of medicine, then makes a management decision based on all the evidence in front of him, including therapeutic measures or referral to another specialised expert if needed.

        Or I can see the person (? training based on dubious science) who tries to master all these tasks except he can only offer to fix you by straightening out so-called misalignments. Not much good if you have pneumonia or cancer.
        Who would a thinking person choose?

  11. In Australia , both GPs and Chiropractors are referred to as Drs, but are not classified (article) as such under the Australian Qualifications Framework. Of GPS believe Fowler said, “referred but not conferred”.

    Good article. Interesting comment.

  12. This is an interesting topic. My son is currently completing his chiro degree at Macquarie and my daughter is completing post graduate medicine at the University of Melbourne after having first completing medical science at Sydney Uni. My daughter had a UAI of 99.4 and unfortunately missed out on undegaaduate medicine. My son is 3 years younger and had a UAI of 67 – fortunately he was still able to enter Macquarie Uni for the course. They joke that he will graduate before her and that he will technically be the first doctor in our family however our daughter is the brainiac in the family and to be honest the only one who knows anything about health care. My son has a very good knowledge of the back but his course does not appear even remotely close to being as demanding as that of his sister. At the end of the day I am very proud of both my kids but the reality is you need a medical degree to be a doctor and the entrance requirements for both courses are incredibly disparate. A chiropractor is good for back problems up to a limit I would think however they are not doctors and do not have the level of knowledge of doctors from what we can see. It is a shame that such silly debates must happen but that is a byproduct of the hubris of the chiro profession. They are both good professions but a doctor is in another league to a chiropractor.

    1. @Parent of both!

      I enjoyed reading your comment. You also understand the fundamental point. Which is that doctors are smart, Chiros are not (I’m talking averages here).

      That being said, Chiros do do (and can do) good work. But when they compare themselves to medical doctors, they exhibit a gross lack of self-awareness.

  13. It’s no coincidence that actor Charlie Sheen’s character’s dead beat brother in “Two And A Half Men” was a chiro…

  14. Mr John Cunningham is an Australian-trained orthopaedic surgeon who specialises in the treatment of spinal disorders… 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.

    I wonder how (Dr?) John Cunningham would feel about the OAM awarded to a chiropractor in 2018, for services to chiropracty?

  15. And what was the name of that chiropractor so we can check. ? Orthopaedic surgeons are referred to as Mr by convention (too long a history to go into look up the napoloenic wars). We must have evidence for this especially as chiro has no valid scientific evidence to support their claims. Even if true it’s a bit like saying Mr chicken farmer was awarded an OAM for services to chicken farming, i.e. if true the quack chiro was not awarded an OAM for services to medicine, surgery or any scientific discipline.

  16. IMHO, chiropractors aren’t remotely close to GP’s. A few reasons for this:

    – Length of study: Your average chiro spends 5 years in uni (3 years undergrad, 2 years Masters), whilst these days your average doctor is spending 6-7 years in uni (usually 3 years undergrad and 4 years postgrad), FOLLOWED BY additional on-job training not to mention physician training/examinations later down the road (minimum 2 years study? So now coming up to ~9 years study minimum…)

    – Breadth of study: Whilst I’m willing to believe that some chiros – in addition to physiotherapists and osteopaths – may be more clued-up on their orthopaedic knowledge at times, the reality is that your average GP knows MUCH more than orthopaedics. They’re generalists – generalists meaning respiratory medicine, basic surgery, basic ob/gyn, neurology (do chiros even study basic stroke/MS etc neuropathophysiology in their courses?!) etc. As a physiotherapist, I’m often telling my patients that my job is to know musculoskeletal issues REALLY well and to work WITH the patient’s GP for this, but if it’s anything outside of this (eg cancer, MS, suspected cardiac issue, bells palsy) then they really need to get primary care from a doctor. We all have to appreciate the limitations of our professions and I have serious ethical concerns about any clinician who thinks they can override this guideline and not put their patient’s health at stake…! (seriously, what is a chiropractor going to do about cancer, schizophrenia, or even diabetes?)

    Regarding the study above where they did an orthopaedic quiz on chiros vs doctors – is there more info regarding the methodology about this? But generally speaking – even as a physio I’m not too concerned. I’m very happy for GP’s to look things up as needed – what’s more important to me is that they won’t do any harm AND can ensure the patient gets the treatment they need.

    I also note that at present, chiropractors and osteopaths are not permitted to work within Australian hospitals.

  17. I have had many chiropractic ‘corrections’ after having suffered muscular spasms in my back and neck from various physical excesses (I like strenuous sports). I have also seen a GP for any number of physical ailments. They each have their purpose.
    I do not care what a chiropractor learns as part of their training. Neither do I care what credentials a GP carries. I simply care that they both studied their respective areas properly and learned it well enough to treat me for what I chose to consult them about. NOTE: There are bad chiropractors and there are bad GPs as in any field.
    Chiropractors do things that GPs cannot and vice versa. I don’t understand why people try to compare them. To those chiros who try to be GPs, I say ‘why bother’. Just do your thing. It’s a wonderful thing you do. i.e. ease/remove peoples’ discomfort and pain caused by spinal-orientated trauma. I don’t care how, but it works. More than 20 years of chiro treatment demonstrates this to me beyond doubt.
    If I disrupt something in my back or neck while at the gym because I went too far on a movement, or lifted something too heavy, there is absolutely no way I’d see a GP. Someone tell what they would do other than prescribe rest and/or medication? And if they were smart enough to refer me to a physiotherapist, I’ve wasted my money by getting a referral I didn’t need. Instead, I’d see one of a number of physical practitioners (physiotherapist or chiropractor), or simply go to a remedial massage therapist.

  18. Currently studying Chiropractic; I have spent the last four years vigorously studying evidence-based chiropractic, science and anatomy subjects and am constantly informed about the importance of co-care with other medical professionals. That is in the form of referrals, second opinions, record gathering. I also only know of some Chiropractors who would only use the word Doctor if it was followed by ‘of Chiropractic’, which is them displaying their area of expertise. I do not believe the conflict and degradation of either profession is necessary or constructive.

    1. Every chiropractor I have met introduce themselves as “Doctor” followed by their name or last name. They write articles in the local news papers as Dr Smith, for instance, talking about the ills of vaccines or other medical treatments. We only find out they are chiropractors after real medical doctors write counter articles. I don’t know why chiropractors feel they need to be so disingenuous.
      There is one chiropractor currently going viral online, US Scott Perlman, which is more of the same. He presents himself as a doctor and does not mention he is a chiropractor. We only find out he is a chiropractor once we look into him further.

    1. I assume you are referring to the sections of the AMA statement:
      “There is limited efficacy evidence regarding most complementary medicine and some have the potential to cause adverse reactions or interact with conventional medicine. Unproven complementary medicines and therapies can also pose a risk to patient health either directly through misuse or indirectly if a patient defers seeking medical advice.
      “Consumer investment in unproven medicines and therapies also risks patients being unable to afford necessary, evidence-based treatment when there are out-of-pocket costs.
      “There is a substantial gap between the use of complementary medicine and the evidence to support that use.
      “The majority of complementary medicines do not meet the same standards of safety, quality and efficacy as mainstream medicines as they are not as rigorously tested. Information about the level of testing and evidence should be easily accessible by medical practitioners, consumers and complementary medicine practitioners.” and
      “In the absence of sufficient efficacy data, it is essential there be clear and true statements regarding the efficacy and standards of evidence relied on, including accurate labelling.”
      – Tim Mendham, executive officer, Australian Skeptics Inc

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