Motivations, Training Outcomes, and Clinical Practice Characteristics of North American Chiropractors: A Cross-Sectional Survey

Introduction

Understanding why clinicians choose specific training pathways is an important aspect for training future clinicians. Motivation shapes learners’ engagement, learning strategies, persistence, and well-being, which in turn influence training outcomes and downstream practice behaviors in health professions education.^1,2 Within self-determination theory, higher autonomous (i.e., intrinsic) motivation is consistently associated with deeper learning, higher academic performance, greater persistence, and better well-being. These are outcomes that are directly relevant to preparing clinicians for evidence-based, patient-centered care.³ Across mainstream medicine more broadly, systematic reviews show that students’ career-choice motivations commonly include altruism, interest in health care, prestige, job security, and personal or family influences, with variation by context, country, and income level.⁴ These patterns underscore why clarifying profession-specific motivation profiles is important for tailoring recruitment and curricular design to optimize learning and professional development.^1,3

Motivation profiles may differ in complementary and integrative health professions, where training often emphasizes holism and self-management. Past motivation-associated work in these health professions shows a stark contrast when compared to mainstream medicine with desires for self-healing, improved knowledge, and self-empowerment being identified as significant motivators.^5,6These include alignment with holistic philosophies, desire to expand skills, improve outcomes, and reduce practitioner fatigue. This suggests that motivations shape both training experiences and practice patterns in hands-on, non-pharmacologic disciplines.^7,8 Notably, within the chiropractic literature to date, explicit assessment of self-oriented motives such as “self-healing” appears uncommon, representing a gap given emerging interest in how clinician well-being and personal health practices interact with training and patient care .⁹

Chiropractic occupies an important role in conservative, nonpharmacological management of neuromusculoskeletal complaints. (10.11) However, the empirical literature on motivations remains limited and is often focused on students or produces practitioner profiles that are incomplete and difficult to draw conclusions from. Several cross-sectional studies of chiropractic students reported that the desire to help others, prior personal experience with chiropractic, and attraction to a holistic, non-pharmacologic approach were prominent drivers of degree choice.^9,10 International surveys also suggest that chiropractic students hold generally positive attitudes toward evidence-based practice (EBP), positioning motivation as a plausible lever for strengthening EBP uptake during training and putting it into practice.¹¹ Correspondingly, chiropractic curricula that explicitly embed EBP training have demonstrated improvements in knowledge, skills, and attitudes, highlighting a link between educational design, learner engagement, and measurable training outcomes.¹² Among practicing chiropractors, surveys from Sweden and South Africa point to favorable EBP attitudes but variable implementation, emphasizing the need to understand how earlier motivational profiles might relate to subsequent professional behaviors and continuing education engagement.^13,14 Probability-sampled surveys have established that North American chiropractors sort into distinct orientation subgroups ranging from biomedically integrated to traditionally aligned and that these subgroups differ in clinical ideology, beliefs, and practice patterns.^15–17 Prior work has also linked teaching institution background to downstream practice characteristics among Canadian chiropractors, suggesting that training context shapes the orientation a practitioner ultimately adopts.¹⁸ Yet whether these orientation differences trace back to earlier training motivations and perceived outcomes remains unexplored.

Taken together, these data indicate that characterizing chiropractors’ training motivations and examining their relationships with salient training outcomes and practice characteristics is needed. Less is known about whether motivations persist or evolve once in practice and how chiropractors rate their training outcomes and describe their practice characteristics. This is both timely and actionable for educational design and workforce development.^1,14

This paper focuses specifically on chiropractors, aiming to delineate motivation profiles, including underexplored self-oriented motives, and to relate these profiles to training experiences and outcomes relevant to evidence-based, person-centered neuromusculoskeletal care. Few studies have examined training motivations, outcomes, and practice characteristics of chiropractors within the same framework.

The aim of this study was to gain a greater understanding of the motivations, practice characteristics, and training outcomes of chiropractors. Secondarily, we hypothesized that practice orientation would form distinguishable categories along a biomedical-to-traditional continuum and would be associated with selected practice behaviors.

Methods

Survey Data Collection

We conducted a cross-sectional, web-based survey of healthcare professionals representing many professions across biomedical and complementary and integrative practices to characterize¹ motivations for entering the profession,² perceived training outcomes, and³ current practice characteristics from September 2024 – May 2025. This report only presents data from the chiropractic respondents. The study protocol and instrument were reviewed by the University of North Carolina Institutional Review Board (#24-1367), and participation was anonymous with consent implied by survey completion; the questionnaire header stated the study purpose, confidentiality, and an estimated completion time. We report this survey in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).¹⁹

The target population was licensed and retired chiropractors in the United States and Canada. We recruited via 5 professional gatekeepers consisting of state chiropractic associations³ and chiropractic education program alumni groups² who distributed a standardized email invitation containing the survey link to their membership lists. The research team did not directly contact individual members and did not receive membership rosters. No monetary incentives were offered.

The survey data was collected via the online Qualtrics (Qualtrics International Inc., USA) platform using the English language. The Qualtrics platform allows for adaptive display and skip logic to tailor survey items (e.g., those not in active practice received items to identify the reasons). While the core architecture followed a standardized format for all professions, separate forms were deployed for each that included profession-specific questions.

The instrument relied on 7-point end-anchored unipolar scales mapped to 3 primary constructs: motivations for becoming a chiropractic physician, training outcomes, and current practice characteristics. Additional items addressed self-rated health, stress, modalities offered, referral patterns, new-patient volume, visit time, telehealth, ownership, and basic demographics (age, sex, location, rurality). Chiropractic-specific items addressed practice orientation along a spectrum from biomedically integrated to “vitalistic” chiropractic, enabling a planned profession-specific subgroup analyses.^15,17 The motivation, practice characteristics, and training outcome items were adapted from prior published work where scales demonstrated adequate reliability.^20–24 Chiropractic-specific items addressing subluxation orientation, manipulation frequency, and imaging practices were newly developed for this study based on constructs identified in prior literature.^15–18 Prior to initiating data collection, three independent active practitioners and a non-participating state association board were consulted on the content of the survey for relevance to the profession and clarity of constructs with feedback being used to refine these new chiropractic-specific items. However, formal content validity testing was not conducted.

For interpretation, motivation items ranged from 1 (“Not Important”) to 7 (“Most Important”), training outcome items from 1 (“Not My Experience”) to 7 (“Exactly My Experience”), and practice characteristic items from 1 (“Not At All Like Me”) to 7 (“Exactly Like Me”). Scores of 6–7 were considered high endorsement, 3–5 mid-range, and 1–2 low endorsement. For descriptive presentation of results, items were grouped into thematic domains by the authors based on item content. These groupings were not derived from a prior taxonomy or factor structure. To characterize the internal consistency of the domain groupings, Cronbach’s α was computed for each full outcome block and for each thematic sub-domain grouping using complete-case analysis. A preliminary exploratory factor analysis (principal components extraction with varimax rotation, eigenvalue > 1 retention criterion) was conducted on each block to evaluate the empirical structure underlying the thematic groupings. The full wording of the survey and response options are provided in Supplement 1.

To eliminate breakoffs and protect against low-quality responses, responses were accepted for analysis only if a primary outcome block was answered without straight-lining (i.e., selecting the same response value for all items within a block). We also utilized the Qualtrics’ anti-ballot-box-stuffing measures to flag duplicate entries from the same device. The survey captured no direct identifiers such as IP address or geolocation. Responses were anonymized by the platform.

The study used a convenience sample of organization-recruited volunteers. Design weights require a known sampling frame and population-level demographic benchmarks against which to adjust; neither a comprehensive chiropractic licensure registry nor a validated demographic reference distribution for the North American chiropractic workforce is available at this time, precluding their application. Invitations were distributed by participating organizations via an anonymous survey link, and recipient counts were not available to the research team; therefore, a response rate could not be calculated. Analyses are therefore presented as descriptive estimates of the responding sample.

Statistical Analysis

The primary outcomes are reported with mean and total respondents at each level of the scales, sorted by mean from high-to-low. Analyses used a complete-case approach at the outcome-block level. Respondents were included in the analytic dataset if they completed at least one of the 3 main outcome blocks (motivations for training, perceived training outcomes, or current practice characteristics). Respondents who did not complete any of these blocks were excluded. For block-specific analyses, we included only respondents who completed that block; respondents who partially completed a block were excluded from analyses of that block. Missing data occurred primarily as survey non-completion at the block level rather than selective item non-response within blocks. Each outcome table reports the number of respondents who completed that block. We did not observe obvious differences in block completion by respondent characteristics. Proportion-based items (e.g., new-patient x-ray rate) were recoded to midpoint values for continuous analysis using the scheme shown in Table 1.

Chiropractic Subgroup Comparisons

Practice orientation subgroups were defined a priori using a single item assessing subluxation use: “Which statement best describes how you define chiropractic subluxation?” Response options defined 3 subgroups along a biomedical-to-vitalistic continuum: (1) Do not use — “I don’t use the term ‘subluxation’”; (2) Biomechanical/Modern — “A functional spinal joint dysfunction that may contribute to pain or impaired movement”; and (3) Vitalistic — “A misalignment of the vertebrae, which interferes with nerve function and innate healing, leading to dis-ease.” This operated as a pragmatic, self-identified proxy for practice orientation based on a single item, rather than as latent or exhaustive ‘types’ of chiropractors. This 3-category operationalization aligns with prior surveys characterizing ideological subgroups among North American chiropractors.^15–17 We used Kruskal–Wallis tests with epsilon-squared (ε²) effect sizes. Dwass–Steel–Critchlow–Fligner (DSCF) pairwise tests provided multiplicity-controlled post-hoc comparisons. Monotonic associations with ordered variables (e.g., orientation or percent-category codes) used Spearman’s ρ due to non-normality.

Within-Person Analyses

For paired items, such as current health vs. health before studying the profession, we tested within-person differences using Wilcoxon signed-rank tests with rank-biserial r. To assess whether change differed by subluxation orientation, the individual difference score was analyzed across the 3 subgroups via 1-way ANOVA with Tukey–Kramer post-hoc tests.

Assumptions and Effect Sizes

For ANOVA models, we examined residual plots for approximate normality and homoscedasticity. When assumptions were materially violated, results were checked with Kruskal–Wallis tests as sensitivity analyses. Because outcomes were ordinal and distributions were non-normal, we used nonparametric tests for primary analyses.

We summarize degrees of freedom (χ²) and p-values for Kruskal–Wallis, ρ and p for Spearman testing, W and p (with rank-biserial r) for Wilcoxon, and ε² as the effect size, interpreted as the proportion of variance explained by rank. ε² effect sizes were defined a priori with Cohen-style benchmarks: <0.06 being small, <0.14 being medium, and >0.14 being large. All tests were 2-sided with α=0.05. No adjustment for multiple comparisons was applied and all findings should be interpreted as exploratory and hypothesis-generating rather than confirmatory. Analyses were conducted in JMP Pro 17.2 (SAS Institute, USA) and corroborated as needed in R (v4.4.2).

Results

A total of 330 responses were started. After applying exclusion criteria, 303 respondents were eligible for analysis. No respondents were excluded for straight-lining or ballot-box-stuffing; 27 were excluded for not completing any main outcome block. Most respondents were male (70%), in active practice (95%), practiced in the United States (96%), were practice owners (72%), and practiced in non-rural settings (79%). New patient visit time averaged 41 minutes, with 30 patient-contact hours per week and monthly visit volumes around 272 visits. Average completion time of the survey was 28.2 minutes. Sample characteristic information is presented in Table 1.

Internal consistency of the 3 primary outcome blocks was acceptable to excellent. The motivation block demonstrated excellent overall consistency (α = 0.904; n = 286; k = 34 items); thematic sub-domain α values ranged from 0.601 (Extrinsic/Status) to 0.878 (Self-Oriented/Wellness). The training outcomes block demonstrated good overall consistency (α = 0.865; n = 209; k = 11 items), with sub-domain α values ranging from 0.646 (Spiritual/Emotional Support) to 0.761 (Clinical/Professional Competency). The practice characteristics block demonstrated acceptable overall consistency (α = 0.756; n = 280; k = 20 items); sub-domain α values were lower (range 0.163–0.514), consistent with the block’s intentionally heterogeneous coverage of distinct practice dimensions rather than a single latent construct. A preliminary exploratory factor analysis broadly supported the thematic groupings: the 34-item motivation block yielded 8 factors explaining 61.8% of variance, with dominant loadings corresponding to the proposed thematic domains; the 11-item training outcomes block yielded 2 factors (55.1% of variance) distinguishing clinical/professional from holistic/wellness competency clusters; and the 20-item practice characteristics block yielded 7 factors (63.3% of variance), further confirming the empirical heterogeneity of that domain.

Across 33 motivation items (median item mean 4.77), the highest-rated domains were prosocial and meaning-oriented (Table 2). The top items by mean were “Meaningful work,” “Help others,” “Potential to make a difference in the world,” “Make a positive impact on my community,” and “Gain a deep understanding of health.” Intellectual/biomedical interests also rated highly (e.g., “Interest in complementary or integrative medicine,” “Intellectual stimulation”). Extrinsic/status-oriented items were lowest (e.g., “Unable to get into medical school,” “Social status,” and “Prestige”). Security-oriented items were moderate-low. The summary of all motivation items appears in Table 2.

The average item mean for training outcomes was 4.36 (Table 3). Highest-rated outcomes reflected core clinical and communication competencies: “It helped me identify the root cause of patients’ problems,” “It gave me confidence in advising patients about diet, nutrition & lifestyle,” “It prepared me for clinical practice,” and “It increased my confidence in caring for myself.” Lower-rated outcomes clustered in a spiritual/emotional support domain: “It gave me confidence in addressing patients’ spiritual concerns,” “It contributed to my spiritual growth,” and “It gave me comfort in dealing with patients’ emotional issues.” Items related to personal health and compassion were mid-range (“helped me improve my health” and “helped me sustain my health”).

Practice characteristic items are present in table 4. Across retained items, the average item mean was 4.8. Highest-endorsed items centered on clinical judgment and autonomy. Items reflecting time/meaning were mid-to-high: “Helping patients tell their stories has therapeutic benefit” and “I frequently use physical modalities to provide symptom relief.” Work-life items were moderate: “I enjoy good work-life balance” and “I’m comfortable with my financial situation.” Lower means concentrated on burden and biomedical testing or other adjuncts: “I often feel exhausted from this work,” “I typically rely on laboratory tests and/or imaging studies to make a diagnosis,” and “I frequently rely on nutritional supplements in patient care.”

Among our Doctors of Chiropractic (DCs) sample, subluxation orientation (Do not use vs Biomechanical vs Vitalistic) was associated with multiple outcomes. Subluxation definition response values are presented in table 5. For manipulation/adjustment frequency, a substantial positive association with orientation was identified with post-hoc testing indicating greater use of manipulation in treatment plans for DCs with a “Vitalistic” orientation compared to others with a moderate effect size.

Subluxation orientation was also inversely related to the proportion of new patients receiving x-rays indicating lower use of x-rays for new patients when DCs have greater biomedical alignment with a moderate effect size. Subluxation orientation was inversely associated with DC education satisfaction with post-hoc tests highlighting greater dissatisfaction with their education from respondents that are more biomedically aligned (moderate effect size). Analyses of orientation are presented in table 6.

In paired comparison, current health did not differ from health before studying. In contrast, current health was related to current stress (Table 7). Subluxation orientation did not relate to self-rated health.

Discussion

Overall, respondents reported a motivation profile anchored in prosocial and meaning-oriented drivers with comparatively low endorsement of extrinsic and status motives. In our exploratory analysis, practice orientation, operationalized via subluxation definition, was associated with manipulation frequency, new-patient spinal x-ray use, and education satisfaction. Our findings are also consistent with past work that chiropractors can be placed along a biomedical-to-traditional philosophy continuum with distinct patterns of practice across the continuum.^15–17

Our DC motivation profile extends, and largely agrees with, earlier student-focused work showing altruism, meaning, and holistic interests as leading reasons for entering chiropractic training.⁹ By documenting the item-level distributions in practicing chiropractors, our results move beyond student samples and clarify which motives remain salient into practice. In addition, high endorsement of intellectual and biomedical interests is consistent with reports that chiropractic learners and clinicians express positive attitudes toward EBP and can benefit from explicit EBP instruction during training.^11–14 However, we find that items like “self-healing” do not score highly in chiropractors, in contrast to other complementary health professions.^5,6,25 Respondents in our sample reported high satisfaction, strong autonomy, and sufficient time with patients, alongside heavy reliance on history and physical examination and comparatively low reliance on routine labs, imaging and supplements. This pattern is consistent with prior reports of high job satisfaction among chiropractors²⁶ and with qualitative descriptions that the “best aspects” of chiropractic include helping patients and transforming quality of life.²⁷

Bearing in mind that practice orientation was captured by a single subluxation-definition item serving as a pragmatic proxy, the within-profession orientation signals we observed in our sample, such as greater manipulation frequency and higher x-ray proportions among respondents identifying with a “vitalistic” philosophical orientation, and lower values among “Do not use” and biomechanical/modern respondents, maps conceptually onto ongoing discussions in the chiropractic literature, and within the profession as a whole, about appropriate imaging and evidence-aligned care.^15–17 Contemporary clinical guidance consistently recommends against routine spinal imaging in the absence of red flags, a principle endorsed by the Canadian Chiropractic Guideline Initiative,²⁸ Choosing Wisely recommendations,^29,30 and mirrored in the American College of Radiology Appropriateness Criteria for low back pain.³¹ Our subgroup differences in x-ray use are therefore directionally consistent with broader guideline emphasis on selective imaging and may reflect how practice orientation shapes clinical thresholds for ordering tests. It should be noted, however, that imaging decisions in real-world practice are also shaped by structural and system-level factors beyond professional ideology that were not captured in this survey and that likely contribute to variability in imaging rates independent of practice orientation. Future work should examine whether education or quality-improvement interventions that emphasize guideline-concordant imaging can narrow these differences.

The inverse association between biomedical alignment and education satisfaction is one of the more theoretically interesting findings of our dataset. Several explanations merit consideration. First, a curriculum-practice mismatch may be at play. Chiropractic programs, due in part to national board examination content, have historically integrated traditional philosophy alongside biomedical and evidence-based content, and practitioners who ultimately adopt a biomedical orientation may have found this emphasis misaligned with the practice model they came to favor. Prior work linking teaching institution to downstream practice characteristics among Canadian DCs supports this interpretation, suggesting that training context shapes professional orientation in meaningful ways.¹⁸ Second, generational and cohort effects may contribute as practitioners who trained in earlier eras when traditional models were more dominant may have had fewer EBP-integrated learning experiences. This could produce lower satisfaction among those who now favor a biomedical approach and retrospectively perceive their training as insufficiently evidence-aligned. Third, ongoing tension around evidence-based practice integration within chiropractic education, as documented in surveys of chiropractic students and practitioners in multiple countries, may mean that biomedically aligned practitioners perceive a persistent gap between guideline-concordant care and what they were formally trained to do.^11–14 Next, while the directionality of this association cannot be established from a cross-sectional design, it is equally plausible that lower education satisfaction preceded or contributed to a biomedical orientation, rather than following from it. Practitioners who found traditional-philosophy-heavy curricula unsatisfying may have subsequently gravitated toward a more biomedical identity as a corrective response. Finally, biomedically aligned chiropractors in our sample may evaluate their training against a different reference standard than their vitalistic counterparts.³² Greater professional contact with physicians, physical therapists, and other allied health providers could change the bar against which chiropractic education is retrospectively judged by respondents, independent of any objective difference in training quality. These interpretations are speculative and limited by the cross-sectional, self-report design of our current sample. Prospective studies tracking satisfaction across training cohorts and institutional contexts would be needed to disentangle these explanations. Nonetheless, prior work demonstrates that EBP-targeted curricular reforms can improve knowledge, attitudes, and self-assessed skills in chiropractic programs,¹² and our findings suggest that a renewed focus on evidence-aligned training may have particular salience for improving satisfaction among biomedically oriented practitioners.

The patterns we observe with high intrinsic, prosocial motives, and lower status-seeking differs from motivational profiles often reported in medical student literature, where job security, income, prestige, and family influence commonly feature alongside altruism and scientific interest.⁴ The contrast is informative because the quality of motivation (intrinsic vs. extrinsic) is associated with deeper learning, persistence of knowledge, and greater performance in health-profession education.¹ If a chiropractor’s motivation profile skews toward autonomous motives, this could be leveraged educationally by coupling meaning and purpose-centric elements with EBP pedagogy to sustain engagement and transfer into practice. Taken all together, what respondents do (history/physical first, selective testing, emphasis on time and autonomy) and what respondents feel prepared to do (clinical reasoning, lifestyle counseling, communication) are coherent and synergistic. Embedding communication training alongside EBP content can leverage the high-autonomy context to improve adherence and patient experience.

We also provide the first examination of self-oriented motives among chiropractors. Our instrument included items such as “heal myself,” “grow spiritually,” and “improve my health.” While such motives are rarely foregrounded in chiropractic papers, they plausibly intersect with clinician well-being and professional identity formation. These are areas linked to performance and persistence in broader health-profession education. Making these motives explicit can help programs scaffold healthy, ethical integration of personal wellness practices and reflective exercises alongside EBP. A detailed discussion of autonomous motivation within self-determination theory and its relevance to learning and well-being in health professions education is provided by Kusurkar et al.¹

This study adds several novel elements to the chiropractic literature. One contribution is item-level motivation distributions in a sample of practicing DCs. Prior work emphasized students while we provide a practitioner-level map showing where endorsement concentrates on 7-point scales, enabling more precise curricular and messaging decisions such as in recruitment materials and continuing professional development (CPD) design that highlight meaning, helping others, and intellectual growth. This granularity also facilitates comparisons across subgroups and over time if repeated surveys are used. Also, by tying subluxation orientation to manipulation frequency and x-ray use, we connect identity and ideology markers to tangible behaviors. Given strong, multi-organization guidance to avoid routine imaging for uncomplicated LBP, these subgroup differences are actionable targets for guideline-concordant care efforts.

Two practical implications follow. First, the high autonomy and time signal points to an environment conducive to shared decision-making and therapeutic communication, both of which are associated with better adherence and outcomes across health professions; meta-analytic evidence shows communication training improves adherence substantially.³³ Second, given the low endorsements for items tied to routine testing and adjunctive modalities, stewardship initiatives associated with reducing x-ray use may be well received where they preserve clinician autonomy while reinforcing selective imaging and evidence-aligned pathways for common spine complaints.²⁸ Audit-and-feedback and point-of-care prompts may harmonize practice patterns (e.g., x-ray ordering thresholds) without forcing a single identity narrative and preserving professional autonomy. Multi-professional collaborations may further normalize evidence-aligned pathways for common spine complaints.

Prior North American studies using probability sampling have described chiropractic subgroups and associations at the population^10,16–18 In contrast, the present study uses a nonprobability, organization-recruited sample to provide fine-grained, item-level distributions across motivations, perceived training outcomes, and practice characteristics within a single framework. These approaches are complementary as probability sampled surveys are best suited for estimating subgroup prevalence, whereas item-level distributions can be particularly useful for designing and targeting education, professional development, and implementation strategies.³⁴ Given the nonprobability design, these results are best interpreted as formative, item-level signals to inform priorities rather than population prevalence estimates.

Training outcomes were strongest in clinical reasoning, lifestyle counseling, preparation for practice, and communication/interpersonal skills, and weaker in spiritual/emotional support competencies. This mirrors chiropractic education studies in which EBP-infused curricula improved knowledge, attitudes, and self-assessed skills¹² and practice surveys showing favorable EBP attitudes but modest skill uptake and use, suggesting room for targeted reinforcement in CPD and at the point of care. Our lifestyle-counseling confidence finding also resonates with broader conservative-care guidance for spine conditions, where education and self-management are central for patient outcomes. Our results reinforce that respondent chiropractors are well positioned to support these elements. In contrast, our observed lower ratings for spiritual and emotional support are not unique to chiropractic. Across health-professions education, multiple reviews and consensus statements note limited routine preparation for spiritual care and variable implementation despite its relevance to whole-person care.^35,36

Limitations

This study has several limitations. First, the sample was a convenience sample recruited through professional organizations, so the results may not represent all chiropractors. Because the survey link was shared through third parties and we did not have recipient counts, we could not calculate a response rate or assess nonresponse bias. Second, the survey was in English only, which may have reduced participation from French-speaking chiropractors in Canada or Spanish-speaking chiropractors in Puerto Rico. Although this was a North American survey, most respondents were from the United States; we retained the smaller Canadian subset to keep the study aligned with its stated scope, but the findings should be interpreted as primarily reflecting U.S. respondents. Third, all practice behaviors were self-reported and could not be verified, and responses may be influenced by recall error or social desirability. Additionally, practice orientation was operationalized using a single subluxation-definition item as a pragmatic proxy; this is not a validated ideological scale, and professional identity is multi-dimensional and not fully captured by this single item. Readers should interpret orientation-based subgroup differences with this constraint in mind. Finally, the study was cross-sectional without adjustment for multiple comparisons, so results are descriptive and cannot support causal conclusions; differences may also reflect unmeasured factors (e.g., payer constraints, access to imaging).

Conclusion

In this cross-sectional sample, chiropractor respondents reported predominantly prosocial, meaning-oriented motivations, strong training outcomes in clinical reasoning, communication, and lifestyle counseling, and practice patterns marked by autonomy, adequate visit time, and reliance on history and physical examination over routine tests. Orientation along a biomedical-to-traditional continuum tracked behavior: “Vitalistic” respondents reported greater manipulation and higher new-patient x-ray use, whereas biomedical aligned “do not use” respondents reported lower x-ray use and lower satisfaction with their education. Within our sample, these signals point to pairing purpose-driven recruitment and curricula with rigorous EBP and communication training, and to imaging stewardship to reduce unwarranted variation. Findings are limited by nonprobability sampling, self-report, and cross-sectional design. Future probability and longitudinal studies should test whether tailored EBP/stewardship interventions improve patient-centered outcomes.

Funding Statement

Gannon Brochin is supported by the NIH National Center for Complementary and Integrative Health under award number 5T32AT003378. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funder had no role in the study design; collection, analysis, or interpretation of data; writing of the manuscript; or the decision to submit for publication.

Conflicts of Interests

The authors declare no conflicts of interest.