Diversity and Chiropractic: A Conversation

ACA’s first diversity forum touches on potential strategies to increase cultural competency among chiropractors.

By Annette Bernat

Enhancing diversity in the chiropractic profession will be a vital and ongoing process to meet the needs of the nation’s ever-changing population, according to chiropractors gathered at a leadership roundtable in December to explore issues related to equity, diversity and inclusion (EDI).

The EDI Forum’s Leadership Roundtable, which took place via Zoom, is the first of its kind organized by the American Chiropractic Association (ACA) Committee on Equity, Diversity and Inclusion. It aimed to continue conversations ACA began three years ago that resulted in a 2018 diversity statement acknowledging cultural agility as “a foundation for competent healthcare delivery to improve patient outcomes and engage in public health initiatives.”

A free recording of the EDI Forum has been made available to ACA members and can be accessed on the Learn ACA platform.

“We have the capacity to contribute to a more equitable world through the lens of public health,” noted William Foshee, DC, chair of the EDI committee in his opening remarks.

Dr. Foshee explained that there is growing recognition that issues surrounding diversity and inclusion play a significant role in healthcare outcomes, and that health care organizations across the country and national groups such as the American Public Health Association (APHA) have identified racism as a threat to public health. (“Racism is a longstanding systemic structure in this country that must be dismantled, through brutally honest conversations, policy changes and practices,” APHA declared in a May 2020 statement.)

Keynote speaker Dionne McClain, DC, who is the first African American woman to serve on the California Board of Chiropractic Examiners and who serves as its current vice chair, encouraged attendees to step out of their comfort zones to learn more about the history of explicit and implicit bias against minorities and how cultural competency can positively impact healthcare access and outcomes.

Dr. McClain, who also serves on the Federation of Chiropractic Licensing Boards’ diversity committee, underscored the urgent need for the chiropractic profession to learn about and adapt to the needs of the American population, which data shows is becoming increasingly diverse. She shared statistics from a 2012 paper showing that by the year 2050, more than 50% of the U.S. population would be comprised of non-white minorities, compared with only about 30% now.

Additional EDI Forum panelists included Michaela Edwards, DC, president of the American Black Chiropractic Association; Angel Ochoa-Rea, DC, president of the National Gay and Lesbian Chiropractic Association; and ACA Committee on Equity, Diversity and Inclusion members Joshua Lederman, DC, and Nakiesha Pearson, DC, who also served as moderator.

Enhancing Cultural Competency

The panelists agreed the chiropractic profession could serve minority communities better by enhancing the cultural competency of its providers. Among suggestions offered to achieve this goal were:

  • Updating requirements in state continuing education programs to include more cultural and diversity training.
  • Creating environments within the profession that reflect diversity. Dr. McClain believes this could also play a role in attracting more minorities to chiropractic colleges. She recommends things such as artwork in the schools and marketing materials be reevaluated and redesigned so they are more inviting to a diverse population.
  • Committing to learning about diversity on an ongoing basis. Cultural competency takes work and time, noted Dr. Ochoa-Rea. “Being culturally competent today may be different in 10 years. It’s an ever-changing thing.”
  • Getting chiropractic care included in state Medicaid programs and establishing more residency programs, both of which would put chiropractors in positions to learn about and serve a more diverse patient population.

It Starts with Leadership

There was strong consensus among the panelists that increasing representation of minorities in leadership positions is key to improving diversity across the chiropractic profession, though it’s not just about “checking a box.” As Dr. McClain noted, “The change starts with putting people in place who have an understanding of diversity and who will reach back and open doors and start that interaction.”

Dr. Ochoa-Rea recalled how he personally experienced challenges as a gay man when he was a student at Life Chiropractic College West. He has since had the opportunity to increase awareness and sensitivity to diversity issues at the school by becoming Life West’s chair of diversity, a board-level position. He says having a diversity officer in higher education institutions is a good way to encourage difficult conversations about diversity, bias and privilege, and then create accountability through action. “It’s one thing to say you are diverse, and another to actually bring people in and make yourself accountable,” he said.

While having more minorities in leadership and teaching positions is a goal, significant obstacles remain. Dr. Edwards noted that less than 1% of chiropractors in the U.S. are African American. “We just don’t have enough,” she said.

Dr. Ochoa-Rea said he will occasionally discuss the possibility of a chiropractic career with some of his young minority patients who he believes might be well suited for the profession.  “If you see patients who would make great chiropractors, talk to them about it,” he urged.

More Than a Spine

Even as the movement to bring more diversity to the chiropractic profession gains steam, there are some who are hesitant to address diversity among patients and prefer instead to view them equally on a biological level. “They are people who only see a spine,” noted Dr. Edwards. But she says that perspective does not change the fact that there are many differences we should consider when interacting with a diverse population.

“There are things we can see, and we should acknowledge them and treat the patient like they want to be treated. Rather than acting like everyone is the same,” agreed Dr. Lederman.

“It sounds good, but it is unrealistic and not the way we live,” observed Dr. McClain. “You do need to see beyond a spine because there are so many cultural differences. I think your patients want you to value and see who they are. You have to be sensitive to the needs of the individual.”

Access the full Zoom recording of the EDI Forum on the Learn ACA platform and look for future events in the EDI Forum, organized by the ACA Committee on Equity, Diversity and Inclusion.