We have surveyed the chiropractic workforce in all UN member countries using an electronic survey of contact persons of constituent member associations of the WFC, WFC files, personal correspondence, government websites, and Google searches. Chiropractors are available in 90 countries, but 50% percent of these have 10 or fewer chiropractors. The lowest provision of chiropractic services, both absolutely and per capita, is found in low- and middle-income countries. This is reflective of the location of chiropractic educational institutions in few, predominantly high-income countries. These institutions are accredited by government/federal institutions or international chiropractic accreditation counsels, which warrant a standard level of quality. But, many receive little or no public financial support, so access to education is for the few who can afford tuition fees. Direct access to chiropractic services is ensured in most countries, but public reimbursement schemes are few, which again limits the access to those who can afford either the service fee or private health insurance payment. Finally, we have observed variation in scope of practice. Importantly, the care of children is under regulation or restrictions in most countries, and chiropractors are only legally recognized in 68 of the 90 countries, and explicitly illegal in 12 countries.
In comparison to similar rehabilitaton professions such as physiotherapy, the chiropractic workforce is relatively small. This may partly be due to the education of physiotherapists, which is often incorportated in the faculty of medicine or rehabilitiation sciences of major univerities as opposed to the chiropractic education, which is predominantly offered at independent schools or colleges, at least in North America. Regardless, the variations in the density of the chiropractic workforce both within and across high-, middle-, and low-income countries are mirrored by other professions. The World Confederation of Physical Therapy reports an estimated number of 450,000 physical therapists worldwide with the number of physio therapists per capita per 100,000 ranging from 0.19 in Malawi to 282 in Finland . When comparing to other rehabilitation providers, in the United States there are 13.8–25.4 occupational therapists for every 100,000 people and 27.3–37.2 speech language pathologists for every 100,000 people .
We used multiple resources to get the best possible overview of the chiropractic workforce. The number of chiropractors is a crude estimate based on membership of national or regional associations, but not all chiropractors are members of an association, and some may be members of more than one. Globally, central national registers of the human health workforce are the exception rather than the rule, and the information of rehabilitation staff is fragmented and insufficient . This has been attributed to the lack of common definitions, inadequate resources needed to monitor the workforce, and little or no political determination .
The main data collection method was the electronic survey, but we also gathered data from web searches, WFC records and personal communication to supplement, validate and increase the granularity of the data. Despite this, we have a large proportion of missing data, and we do not know the validity or accuracy of the data collected in the survey. Responders to the survey were predominantly from countries with well-established, larger cohorts of chiropractors organized in national or regional associations, well-defined legislation, and the presence of a chiropractic educational institution. This limits the findings of this report, but is, however, reflective of the challenges associated with the of lack of chiropractic resources in many countries. From the personal communication with WFC contacts, lack of or poor internet connections, unfamiliarity with surveys, and legislative struggles in some countries, or the lack of applicability of questions in countries with unclear legislation or regulation were reported as barriers for responding. Similarly, missing data limit the generalizability of results. Finally, the survey was issued in English only, which may have led to misinterpretations of questions, or deterred some from responding to parts of or the whole survey.
In this report, we described the characteristics of the chiropractic workforce worldwide to improve our global understanding of rehabilitation resources. This report highlights the availability of chiropractic educational institutions, post-graduate training, accreditation, the active health workforce stock, governance, and health workforce policies. To fully map the chiropractic workforce in accordance to the NHWA, more information is still needed on education finances, health labour market flow, employment characteristics and working conditions, health workforce spending and remunerations, skill-mix composition for models of care, and health workforce information systems. Further, issues such as gender and ethnic inequality and underserved communities need to be investigated. Due to the large variation in numbers, legislation and scope of practice, this may be best done at national levels and perhaps undertaken alongside investigations of other rehabilitation professions, such as physiotherapy and other types of manual and exercise therapists.