Table 2

Possible reasons for the continued marriage between evidence-friendly and traditionalist chiropractors

Solidarity• In front of authorities, the two factions often have to work together in order to appear to be a large and united profession, for which reason they attempt to reach a common ground, for example, when ‘officially’ defining chiropractic. Thus broad nebulous terms such as ‘prevention’, ‘spinal health’, ‘patient centered’ are used to prevent complete insight into what is really going on.

• The past history (i.e. the concept that they have had a hard time, that they have fought together, and the feeling that they are ‘special’) seems to hold the two factions together against common ‘enemies’.

• Personal friendships, often dating from formative years, also make it difficult to confront colleagues who we consider practising too much on the fringes of credibility.

Economy• The evidence-friendly group has a financial interest in not being associated with the traditional chiropractors. However the latter group is riding on the credibility provided by the evidence-friendly group, which allows participation in legislation and reimbursement schemes and educational acceptance for their schools.

• Being a large group rather than two smaller groups makes it easier to negotiate and deal with insurance agencies, government regulators, and health authorities.

Happy family• Chiropractors have, traditionally, been socially isolated in the health care community but over the past decades the evidence-friendly chiropractors have been made welcome to join forces with traditional health care practitioners such as medicine and physiotherapy. However, when this occurs, the traditionalists are discretely kept in the background, not to scare policy makers and other stake holders off, which could stop this development.

Fear of unknown, weaker partner• To separate the chiropractors into two professions would entail many changes, new political fights and an important task in relation to information and branding that doubtlessly requires careful consideration and a lot of work.

• Clearly, the traditionalist group is most vulnerable because they would have to assume their true nature. Their approach is unlikely to appeal to authorities, third party payers and a large portion of the general public.

Hope of future improvements• Many chiropractors do not see the problem as permanent, but view it as more of a short-lasting challenge, thinking that it is better to stay together, in order to be a large group and to have an influence on ‘the fringes’.

• Many believe that extremists on both sides in the end will get to see the light and come and join ‘the middle ground’.

Family name• Finally and very importantly, the family name (“chiropractor”) is central. To find another name would mean re-establishing connections with the public, insurance agencies, and government regulators and health authorities, which would not be easy. Therefore, both groups may well be hanging in there, mainly, in order to keep the name.