Do Chiropractors Work in Hospitals? Understanding Where Chiropractors Practice

Chiropractors are at the forefront of an evolving aspect of integrative healthcare that challenges traditional assumptions about hospital practice settings. The short answer: yes, chiropractors do work in hospitals, though the extent and nature of this integration varies significantly across healthcare systems.

Understanding where chiropractors practice matters for students considering the profession, patients seeking care, and healthcare administrators exploring interprofessional collaboration models. This analysis of different journal reviews examines hospital-based chiropractic care, compares it with private clinic settings, and explores what these practice environments mean for the future of chiropractic medicine.

Considering a career in chiropractic? Explore how SCU’s Doctor of Chiropractic program prepares graduates for diverse clinical settings, including emerging hospital-based roles.

The Current State of Hospital-Based Chiropractic Care

Growing Integration into Hospital Systems

Hospital-based chiropractic care represents a significant shift in how the healthcare establishment views spinal manipulation and conservative musculoskeletal care. A 2018 study published in the Journal of Manipulative and Physiological Therapeutics surveyed doctors of chiropractic working in integrated healthcare facilities and found that 40% reported working in hospital settings, with others practicing in multispecialty offices, ambulatory clinics, and various healthcare environments. This research surveyed 38 chiropractors working in private sector medical facilities and revealed that most were employees receiving salary compensation while collaborating closely with medical professionals.

Several major hospital systems have established formal chiropractic integration:

Veterans Affairs (VA) Healthcare System: The VA represents the largest employer of chiropractors within hospital settings in the United States. Following a 2004 mandate, the VA began systematically integrating chiropractic services across its medical centers. Research published in the Journal of Manipulative and Physiological Therapeutics in 2016 documented trends in chiropractic utilization within the VA system, showing substantial growth in both services and patient access since implementation. A 2021 cross-sectional survey published in JMPT further characterized VA chiropractors, finding that most work full-time in physical medicine departments and provide comprehensive diagnostic and treatment services.

Military Treatment Facilities: All branches of the U.S. military now include chiropractic care within their healthcare delivery. A 2019 scoping review published in Chiropractic & Manual Therapies found that chiropractic services have been integrated into more than half of military treatment facilities across the United States. A 2018 randomized trial published in JAMA Network Open examined active-duty U.S. service members and found that those receiving usual medical care plus chiropractic care experienced significantly greater pain relief and satisfaction compared to those receiving usual medical care alone.

Academic Medical Centers: Institutions like the University of Pittsburgh Medical Center, Boston Medical Center, and others have integrated chiropractic services into their pain management and spine care departments. A 2018 multisite qualitative case study published in the Journal of Alternative and Complementary Medicine examined nine U.S. private sector medical facilities (including five hospitals) that had integrated chiropractic care, finding high satisfaction among patients, medical providers, and administrators.

Why Hospitals Are Adding Chiropractic Services

The integration of chiropractors into hospital settings stems from several converging factors:

Opioid Crisis Response: Hospitals face increasing pressure to offer non-pharmacological pain management alternatives. Chiropractic care provides evidence-based treatment for certain musculoskeletal conditions without medication risks. A 2020 study in Pain Medicine found that patients with spinal pain who saw a chiropractor had approximately half the risk of filling an opioid prescription compared to those who did not. Among patients who saw a chiropractor within 30 days of diagnosis, the reduction in opioid use was even greater.

Value-Based Care Models: Healthcare reimbursement increasingly rewards outcomes rather than procedures. Conservative treatments like spinal manipulation often cost less than surgical interventions while providing comparable outcomes for specific conditions. A 2019 study in BMJ Open examining over 216,000 patients found that those who received initial treatment from chiropractors or physical therapists had 90% decreased odds of short-term opioid use and substantially decreased odds of long-term opioid use compared to those initially seeing primary care physicians.

Patient Demand: Consumer interest in integrative and complementary medicine continues growing. Hospitals responding to patient preferences by offering chiropractic services can improve patient satisfaction scores and competitive positioning in their markets.

Joint Commission Standards: The Joint Commission, which accredits hospitals, now includes non-pharmacological pain management strategies in its pain management standards, creating institutional incentives for hospitals to expand their conservative care options.

Hospital-Based Practice vs. Private Clinics: A Comparative Analysis

1. Patient Population and Case Complexity

Hospital Settings: Chiropractors in hospitals typically encounter more complex cases involving multiple comorbidities, post-surgical patients, and individuals requiring coordinated care from multiple specialties. Hospital-based chiropractors often work with trauma patients, individuals recovering from strokes affecting mobility, or patients with chronic pain conditions complicated by other health issues.

Private Clinics: Clinic-based chiropractors generally see a broader range of patients, from wellness-focused individuals seeking maintenance care to acute injury cases. The patient population tends to be more ambulatory and less medically complex, though this varies considerably by practice location and marketing approach.

2. Scope of Practice and Autonomy

Hospital Settings: Hospital chiropractors typically function within interdisciplinary teams with formalized referral protocols and communication structures. Their treatment plans often require coordination with attending physicians, physical therapists, and nursing staff. Documentation requirements mirror medical record standards, and chiropractors may participate in hospital committee work, quality improvement initiatives, and interdisciplinary rounds.

Private Clinics: Clinic owners or solo practitioners exercise greater autonomy in clinical decision-making, business operations, and practice style. They control their scheduling, service offerings, and can more easily implement specialized techniques or niche focus areas. However, they also bear full responsibility for business management, marketing, and administrative operations.

3. Compensation and Benefits Structure

Hospital Settings: Hospital-employed chiropractors receive salaries with benefits packages including health insurance, retirement contributions, paid time off, and malpractice coverage. Salary ranges typically fall between $75,000-$110,000 annually depending on geographic location, experience, and facility size. The trade-off for salary stability is less income potential than successful private practice ownership.

Private Clinics: Income potential in private practice varies dramatically based on location, business acumen, and practice volume. Solo practitioners or practice owners can potentially earn significantly more than hospital-employed counterparts, with established practices sometimes generating $150,000-$300,000+ annually. However, this comes with business risks, overhead costs, and income variability.

4. Professional Development and Research Opportunities

Hospital Settings: Academic medical centers and large hospital systems often provide continuing education funding, opportunities to precept students, and access to research infrastructure. Hospital-based chiropractors may co-author research papers, present at medical conferences, and participate in clinical trials examining integrative care models.

Private Clinics: Professional development in private practice depends on the practitioner’s initiative and investment. While clinic-based chiropractors can pursue research and teaching independently, they typically have fewer institutional resources supporting these activities unless they establish academic affiliations.

5 Key Practice Settings Where Chiropractors Work

Beyond the hospital-versus-clinic dichotomy, chiropractors practice in diverse environments, each offering distinct professional experiences:

1. Multidisciplinary Integrative Health Centers

These facilities house chiropractors alongside acupuncturists, physical therapists, massage therapists, and sometimes medical doctors. Examples include centers like the Osher Center for Integrative Medicine at UCSF or the Mayo Clinic’s Integrative Medicine program. This model emphasizes whole-person care with formalized communication between providers. Chiropractors in these settings often treat patients referred by other practitioners within the center and may collaborate on treatment plans.

2. Sports Medicine and Performance Facilities

Professional sports teams, Olympic training centers, and collegiate athletic departments increasingly employ chiropractors as part of their sports medicine staff. These roles involve treating acute injuries, providing performance optimization care, traveling with teams, and working closely with athletic trainers and team physicians. Organizations like the American Chiropractic Board of Sports Physicians certify specialists for these positions.

3. Corporate Wellness Programs

Some large corporations bring chiropractors on-site to provide ergonomic assessments and treatment for employees. Companies recognize that addressing musculoskeletal complaints proactively can reduce healthcare costs and absenteeism. This emerging practice setting typically involves contract relationships rather than traditional employment.

4. Federal Healthcare Systems

Beyond the VA system mentioned earlier, chiropractors work in Indian Health Service facilities, Federal Bureau of Prisons healthcare units, and other federal medical settings. These positions offer government employment benefits with the mission-driven satisfaction of serving specific populations.

5. Academic and Research Institutions

Chiropractic colleges and research institutions employ clinicians who divide time between patient care, teaching, and research activities. These roles suit practitioners passionate about education and advancing the evidence base for chiropractic interventions. Institutions like Southern California University of Health Sciences employ faculty clinicians who model interprofessional practice for students.

What This Means for Aspiring Chiropractors

Clinical Competency Expectations: Hospital credentialing requires documentation of education, clinical competency, and often board certification. Programs like SCU’s Doctor of Chiropractic degree emphasize evidence-informed practice and interprofessional collaboration skills essential for hospital integration.

Communication and Documentation Skills: Hospital-based practice demands proficiency in medical terminology, electronic health records, and interdisciplinary communication. Chiropractic students benefit from programs that expose them to integrated clinical experiences during their education.

Diverse Career Pathways: The profession’s evolution means graduates aren’t limited to traditional private practice models. Understanding various practice settings helps students make informed career decisions aligned with their professional goals and lifestyle preferences.

Specialization Opportunities: Hospital-based roles often favor practitioners with specialized training or board certification in areas like sports medicine, neurology, or rehabilitation. Students interested in hospital careers should consider post-graduate residencies or certification programs.

The Evidence Base for Hospital Integration

Research examining chiropractic care within hospital systems provides insights into outcomes and utilization patterns:

The 2018 JAMA Network Open trial examining chiropractic care at military treatment facilities found that active-duty service members receiving usual medical care plus chiropractic care had significantly better outcomes at 6 weeks compared to those receiving usual medical care alone. The study reported high patient satisfaction with chiropractic services and no serious adverse events.

A 2016 systematic review published in the Journal of Evidence Based Complementary and Alternative Medicine examined chiropractic integration in military and veteran health care facilities, finding that chiropractors collaboratively manage patients with other providers and focus on reducing morbidity for veterans while rehabilitating military service members to full duty status. Patient satisfaction with chiropractic services was consistently high across reviewed studies.

The 2018 qualitative case study examining nine medical facilities with integrated chiropractic care found that delivery of chiropractic services was perceived to have high value among patients, medical providers, and administration. Patient clinical outcomes, patient satisfaction, provider productivity, and cost offset were identified as markers of clinic success.

Challenges and Considerations in Hospital-Based Practice

Integration isn’t without obstacles:

Credentialing and Privileges: Hospital credentialing processes designed for physicians don’t always align smoothly with chiropractic education and licensing structures. Each facility must establish appropriate privilege delineation for chiropractors, specifying which patients they can treat and under what circumstances.

Interprofessional Relationships: While many healthcare professionals welcome collaboration, some physicians remain skeptical of chiropractic care. Hospital-based chiropractors must demonstrate clinical competency and evidence-based practice to build collegial relationships.

Reimbursement Structures: Hospital billing systems aren’t always optimized for chiropractic services, creating administrative complexity. Facilities must establish clear protocols for documentation and coding.

Role Clarity: Overlapping scopes between chiropractors, physical therapists, and physicians can create role confusion. Successful integration requires clear delineation of each profession’s contributions.

Future Trends in Chiropractic Practice Settings

Several trends suggest continued evolution in where chiropractors practice:

Accountable Care Organizations (ACOs): As healthcare moves toward coordinated care models, chiropractors increasingly participate in ACOs that manage population health. These structures create opportunities for chiropractors to serve as musculoskeletal specialists within broader care teams.

Telehealth Expansion: While manual therapy can’t be delivered remotely, chiropractors are incorporating telehealth for consultations, follow-up appointments, and exercise prescription. This hybrid model may become standard across all practice settings.

Direct Primary Care Models: Some chiropractors are establishing direct primary care practices where patients pay monthly fees for unlimited access to care, bypassing traditional insurance models. These practices sometimes incorporate basic primary care services within chiropractic scope of practice.

Hospital Employment Consolidation: The broader healthcare trend toward hospital employment of formerly independent practitioners may accelerate for chiropractors, particularly in markets with large health systems.

Making an Informed Career Decision

For students exploring chiropractic education, understanding practice setting options helps shape educational priorities:

If hospital-based practice appeals, seek programs emphasizing:

• Evidence-based practice methodology
• Interprofessional education experiences
• Research literacy and critical appraisal skills
• Medical terminology and documentation
• Diagnostic imaging interpretation

Southern California University of Health Sciences structures its Doctor of Chiropractic program around these competencies, preparing graduates for both traditional and emerging practice environments. The university’s emphasis on whole-person health and interprofessional collaboration aligns well with integrated healthcare delivery models.

Ready to explore your chiropractic career options? Request more information about how SCU prepares graduates for diverse practice settings or schedule a campus tour to experience the interprofessional education environment firsthand.

Frequently Asked Questions

Do chiropractors have to go to medical school to work in hospitals?

No, chiropractors attend specialized chiropractic colleges for their Doctor of Chiropractic (DC) degree, which typically requires 4 years of graduate education following an undergraduate degree. While chiropractic education includes many sciences also taught in medical school (anatomy, physiology, pathology, radiology), it’s a distinct educational pathway. Hospital employment requires the DC degree, state licensure, and typically board certification, but not medical school attendance.

Can chiropractors admit patients to hospitals?

Generally, chiropractors cannot independently admit patients to hospitals, as admission privileges typically require being a physician. However, hospital-employed chiropractors treat patients admitted under other physicians’ care, providing consultation and co-management services within their scope of practice.

Do all hospitals have chiropractors on staff?

No, hospital-based chiropractic care remains relatively uncommon compared to private practice settings. Estimates suggest 3-5% of U.S. hospitals employ chiropractors or grant them privileges. The VA system, military hospitals, and some progressive academic medical centers lead this integration, but many community hospitals don’t yet include chiropractic services.

How much do hospital-based chiropractors earn compared to private practice?

Hospital-employed chiropractors typically earn salaries ranging from $75,000-$110,000 annually with benefits, while private practice income varies widely from $60,000 to over $300,000 depending on practice success, location, and business model. Hospital employment offers stability and benefits but generally lower income potential than successful private practice ownership.

What conditions do chiropractors treat in hospital settings?

Hospital-based chiropractors primarily treat musculoskeletal conditions including low back pain, neck pain, headaches, and extremity joint complaints. They may also provide care for post-surgical patients, trauma patients with spinal concerns, and individuals with complex chronic pain conditions as part of interdisciplinary teams.

Is chiropractic care covered by insurance in hospitals?

Yes, when chiropractors provide care within hospital settings, services are typically billed through the hospital and covered by insurance like other hospital-provided care. Medicare, Medicaid (in most states), and private insurance generally cover chiropractic services for appropriate conditions, though coverage specifics vary by plan.

Do I need special certification to work in a hospital as a chiropractor?

While basic licensure requirements are the same regardless of practice setting, many hospitals prefer or require board certification in chiropractic specialties. Post-graduate residencies in areas like sports medicine, rehabilitation, or radiology can strengthen credentials for hospital positions. Each hospital establishes its own credentialing criteria.

Are there chiropractic residency programs for hospital-based training?

Yes, several institutions offer post-graduate residency training programs in chiropractic specialties. These typically last 2-3 years and provide advanced training in areas like sports medicine, radiology, or neurology. Residencies often include rotations in hospital settings and prepare graduates for board certification and specialized practice environments.