Hawaii is like many areas of the U.S. facing a shortage of healthcare workers; however, its status as an island 2,400 miles off the coast of the mainland does pose unique challenges. To attract more chiropractors, Gov. Josh Green recently signed into law S.B. 2050, making Hawaii one of the first states in the nation to establish a statutory pathway for chiropractic students in the clinical phase of their education to participate in supervised preceptorships with licensed chiropractors.
The ACA blog caught up with Dean Shivvers, DC, president of the Hawaii Chiropractic Association, to learn more about the state’s plan to keep more chiropractors training and establishing practices in the Aloha State.
What are the current challenges in Hawaii that led up to creating the new preceptorship program?
Dr. Shivvers: Hawaii is home to approximately 350 licensed chiropractors, however the number actually serving communities across all the islands is closer to 100. Chiropractors play an important role in helping patients manage musculoskeletal conditions, reduce pain, improve function, and avoid unnecessary medications, imaging, injections or surgery.
Despite the tremendous need for chiropractic care, Hawaii faces a significant workforce challenge. Unlike many other healthcare professions, Hawaii does not have a chiropractic college. Every chiropractor practicing in our state must relocate thousands of miles away to attend school, and once they establish roots on the mainland, many never return.
At the same time, Hawaii’s population continues to grow and age, increasing the demand for conservative, nondrug treatment options. Many clinics have struggled to recruit associate doctors, particularly on the neighboring islands, where shortages can be even more pronounced.
The Hawaii State Chiropractic Association recognized that if we wanted to improve access to care for patients in the long term, we needed to create a pathway that would encourage chiropractic students to experience practicing in Hawaii before graduation. Research consistently shows that healthcare professionals often establish careers where they complete their clinical training. Creating a structured preceptorship program gives students the opportunity to experience both the professional and personal benefits of practicing in Hawaii, making it much more likely they will return after graduation.
What exactly is a chiropractic preceptorship?
Dr. Shivvers: A chiropractic preceptorship is an advanced clinical training experience that takes place during a student’s final phase of education. Rather than treating patients exclusively within a chiropractic college clinic, students work under the direct supervision of an experienced licensed chiropractor in a private practice setting.
This differs from a traditional internship because students are exposed to the day-to-day realities of practicing in the community. They experience patient flow, interdisciplinary communication, documentation, business operations, and long-term patient management in a real-world healthcare environment.
It is also different from being an associate doctor. Preceptees have not yet graduated or obtained a chiropractic license. They remain students throughout the program and work only under the direct supervision of a licensed chiropractor, who maintains responsibility for patient care.
What will preceptees do in Hawaii? And is there anything they will be restricted from doing?
Dr. Shivvers: Preceptees will participate in many aspects of patient care under direct supervision. They will perform patient histories, examinations, clinical assessments, treatment planning discussions, rehabilitation instruction, patient education, documentation, and chiropractic adjustments as permitted by the supervising chiropractor and applicable regulations.
Every patient must provide informed consent before receiving care involving a preceptee, and the supervising chiropractor remains fully responsible for all clinical decisions and patient care.
Preceptees are not licensed chiropractors. They cannot independently diagnose or treat patients, cannot practice without supervision, and cannot establish their own practice. Their role is educational, allowing them to gain real-world experience while maintaining the highest standards of patient safety.
What will participating DCs who host the preceptees gain from the experience?
Dr. Shivvers: Hosting a preceptee benefits both the profession and the individual chiropractor.
Participating doctors have the opportunity to mentor the next generation of chiropractors while introducing students to the unique opportunities available in Hawaii. Many preceptors may ultimately recruit their preceptees as future associates, reducing one of the greatest challenges facing practices today—finding qualified chiropractors who want to live and work in Hawaii.
Beyond recruitment, mentoring often helps experienced doctors refine their own clinical skills and stay engaged with the latest educational standards. It creates stronger relationships between practicing chiropractors and chiropractic colleges while strengthening the profession as a whole.
Most importantly, expanding the chiropractic workforce means more patients throughout Hawaii will have access to timely, high-quality conservative health care.
What other states offer chiropractic preceptorships, and, to your knowledge, what benefits have they experienced?
Dr. Shivvers: Several states have established chiropractic preceptorship programs or similar community-based clinical education models in collaboration with chiropractic colleges. States including Iowa, Illinois, Missouri, Texas, and others have successfully utilized these partnerships to expand clinical training opportunities.
One consistent benefit has been improved recruitment. Students who complete clinical experiences in a community frequently choose to begin their careers there after graduation. These programs also expose students to a broader variety of patient conditions and practice settings than they may encounter in an academic clinic alone.
Hawaii’s program is especially significant because of our geographic isolation. Since we do not have a chiropractic college, providing students with an opportunity to train here creates a direct pipeline that has never existed before.
When will the first Hawaii preceptees be selected? Who is eligible and what will the process of applying be like?
Dr. Shivvers: Now that the legislation has been enacted, the Hawaii Board of Chiropractic will develop the administrative rules needed to implement the program. We anticipate working closely with the Board, chiropractic colleges, and practicing chiropractors to establish eligibility requirements and application procedures.
Eligible participants will generally be chiropractic students who have completed their required classroom education and entered the clinical phase of their doctoral program.
The exact timeline for accepting the first preceptees will depend on completion of the administrative rulemaking process. Under the law, the program becomes effective on July 1, 2028.
Will those who participate be paid?
Dr. Shivvers: Whether preceptees receive compensation will ultimately depend on the individual preceptor and chiropractic college agreements. Some programs across the country are unpaid educational experiences, while others provide stipends, housing assistance, or compensation. We hope Hawaii practices will develop creative opportunities that make participating attractive for students considering relocating to our state.
What is your advice for other states that might be interested in establishing a preceptorship program?
Dr. Shivvers: I would encourage every state association to explore it.
Healthcare workforce shortages are affecting many professions, and chiropractic is no exception. Preceptorships provide an opportunity to connect students with practicing doctors, strengthen clinical education, and improve long-term recruitment.
Building a successful program requires collaboration between state associations, licensing boards, legislators, chiropractic colleges, and practicing doctors. Patient safety must remain the highest priority, with clear standards for supervision, education and accountability.
For Hawaii, this legislation represents much more than a new educational program. It is an investment in the future of our profession and, more importantly, in the health of our communities. By helping more talented young chiropractors establish careers here, we can expand access to conservative, evidence-informed chiropractic care for patients across every island for decades to come.
