The Clinical Internship

Medical Internship verses Chiropractic School Clinic

After 4 years of college, the typical med student will complete 9 years of medical school three of which will be as an intern in a real working hospital. During this internship they will have the opportunity to examine, diagnose and even treat thousands of patients with every possible injury or disease you can imagine.

On the other hand, chiropractic students are typically only required to perform 200 spinal adjustments, 20 physical exams and 25 blood and urine analyses… not on sick people… because they seldom see any of them… but rather on themselves, their family and friends and anyone else they can convince to come into the school clinic.

Think I'm pulling your leg? Well, let's once again ask some chiropractors to give us the lowdown:

Not Much Experience

A family practice doctor asked the chiropractors on the Chirotalk discussion board just how many complete histories and physicals the typical chiropractic student would perform prior to graduation.

The answer he received from Dr. Allen Botnick, DC was 12. [8]

The same family doctor asked, "What range of pathology does the average student see?"

Dr. Botnick gave the following reply:

Malingering, hypochondriacs, sore backs and necks-maybe a headache if you're lucky. I once had a patient with a suspected prolapsed disk and I wasn't allowed to neither order a diagnostic test nor treat. The patient was discharged to an outside physician. [8]

The family practice doctor again:

So, do the legislators who are deciding who is qualified to do this type of exam have the slightest clue that chiropractors have essentially no training?

In medical school it would be common to do 2 or 3 H & P's in one day on a hospital rotation … In family practice residency, the numbers could easily hit 6-8 or more in one day on an inpatient internal medicine rotation.

These are patients that are being admitted to the hospital either for treatment of known serious disease or with pathology that requires further diagnostic workup to arrive at a diagnosis.

I wouldn't consider 12 H & P's enough to pass a 6-week med school clerkship, much less qualify to do this work unsupervised. [8]

If my math is correct, that would mean that the average med student will perform somewhere between 1000 to 5000 complete histories and physical exams (H & P's) on real honest-to-goodness sick people … while the average chiropractic student will do 12 exams on what is for the most part make-believe patients.

Chiropractic Students Almost Never See Real Patients

The clinic duty during the eighth semester was part-time and turned out to be little more than a chance to wear a white lab coat and carry a stethoscope. The clinic served chiropractic students and their families and provided little opportunity to see "real" patients. Yet we were told that upon graduation we would be qualified to practice as primary-care providers, responsible for diagnosing whatever ailment a patient might present. [5]
Chiropractic outpatient clinics, where the so-called 'clinical' training takes place are not affiliated with any hospital. Students do NOT see the patients they've only read about, so that their clinical judgement and opinion about a rash, a bump, or even a pain is almost worthless. If a student spends their entire clinic life "mastering" such an irrelevant medicine, how does this speak to the issue of training for primary care, or even a back specialist? [7]
The only physical examinations we performed were on our fellow students. [5]
Don't even get me started about chiros thinking they can treat infants and children, or organic disease which most have no practical experience with at chiro college before hitting the "real world." I know at my school we never even examined a baby. [6]
During our final (9th and 10th) semesters, we worked full-time at the clinic. The school portrayed this experience as an opportunity to practice what we had learned and to hone our diagnostic and manipulative skills. Nothing could have been further from the truth. [5]
For one thing, since they're not trained in hospitals, chiropractic students are exposed to a limited range of pathology. [3]
… the vast majority of "patients" were really not patients at all. We were urged by the clinic director to recruit any and everyone we knew into the clinic to practice chiropractic upon them, whether they needed it or not. [22]
As "interns," we were required to perform 200 adjustments, 20 physical exams, and 25 blood and urine analyses. Many of the lab write-ups were completed using old reports that were made available to us. We were told that the accrediting organization had no problem with this practice. [5]
Being at clinic can be like having a free ticket to "Ripley's, Believe It or Not." The atrocities that go on daily in the name of 'The Chiropractic' are too many to enumerate:
… using non-medically diagnostic x-rays … "Adjusting" the first cervical vertebra on a patient who has fainted (as an emergency measure) … faculty DCs, who when asked to confirm an arrhythmia on a patient, telling a student not to worry about it (since the instructor has no idea what to listen for) … [7]

Cheating to Fulfill Clinic Requirements

From my own personal experience as a student at Life University, I noticed that academic cheating and dishonesty was widespread. No place was this more evident than in clinic. [9]
The drive to meet clinical requirements motivated many students to use all kinds of "shortcuts" in order to meet their bottom line: patient visit numbers. In fact many were probably not even aware that what they were doing was in fact cheating. [9]
Because the majority of the students that you knew probably used one scheme or another, you may not have thought of it as cheating. If it was a behavior you knew you had to hide so that you wouldn't get caught, chances are quite good that you were cheating.

So I will spell out some scenarios to give you some examples of typical kinds of hidden/ dishonest methods I found commonly occurred.

  1. Paying for patient fees, or for a patient's time in order to fulfill requirements.
  2. Subjecting family and friends to unnecessary radiation in order to meet your X-ray requirements without following through with any real treatment for those patients once the needed credit was obtained in order to pass.
  3. Falsifying clinical documents and/or inventing clinical findings to ease your way towards obtaining Clinic credit.
  4. Attempting to load your care plans in order to increase the number of patient visits based on your own needs for credit rather than the needs of the patient for treatment.
  5. Cheating on exams by studying stolen tests.
  6. Sneaking a peak at a friend's answers during an exam.
  7. Clocking your friend into the clinic time clock so that they could obtain credit for time they did not spend working in the clinic. Or signing friends into class so that they would be counted as being present for a class while they were actually absent.
  8. Writing an exam for someone else.
  9. [9]
I paid for a large portion of my patient visits too. On the clinic documents, I just "told them what they wanted to hear" like everyone told me to do for my board exams. [9]
Paying for tests, xrays, etc. for your clinic requirements was very common at Palmer when I went there in the early '80's. On the one hand: paying for something you needed and there is no medical justification is not unethical. You needed it, the patient didn't. [9]
On the other hand: It did prepare you for the real world of chiropractic. Your real patients probably didn't need your services so you fabricated the need to the patient and or their insurance company. [9]
Could you imagine this being done at medical school? "Mr. _, I need just one more appendectomy to graduate, I know you don't need it, but I will pay your bill for you if you will let me do it. [9]
At the suggestion of my supervising clinicians, most of my "patients" were, in reality, friends and family who I wanted to assist me in obtaining the necessary requirements for the clinic so I could graduate. [22]
Did I make it through clinic on recycled old patients...yep...did I have our best friends and her three kids come in many times....yep. I knew then this was a bunch of hoo haa but damn...I was less than a year from getting out so I went through the garbage to get the degree. [9]

Chiropractic Students Have to Drum Up Fake Patients

… I was advised by the [Cleveland Chiropractic College] admissions representative that my clinical experience would involve treating sick and injured public patients who sought out chiropractic treatment at the clinic. The admissions representative seriously misrepresented the nature of the clinical experience.

Contrary to her assurances that I would fulfill my clinical requirements with patients provided to me by the clinic I learned at the beginning of the seventh trimester that in fact I would have to round up friends and acquaintances so I could experiment on them and practice chiropractic manipulation. [22]
Students who were not recruiting enough patients to pass the course became desperate. A large wooden sign hung in the hallway with carved letters that read "Whatever It Takes." [4]
Now about clinic....since drumming up numbers of patients doesn't have a damn thing to do with learning to be a doctor I felt the school cheated me. Nobody wanted the service...and it sounds like every school had the same problem. [9]
Even back in the early 80's we were paying for people to come in to the clinic at Life. At the time, the fee for a patient was five dollars per visit, which was eventually raised to eight dollars. I remember very distinctly going from door to door at the nearby apartment complexes asking people if they had any back or neck pains, and that, out of our "generosity", as a way of "giving back", we would make it possible for them to get treatment for free. We were desperate back then too. [9]
Successful students targeted faculty and families with young children who could receive care at discounted rates. Many students paid their patients' clinic fees out of desperation. [4]
Even worse, we were forced to recruit most of the required patients. An easy method was to bring family and friends to the clinic during "free exam" times. At other times, patients needed to pay to see the students. [5]
Another strategy was to pay strangers to pose as patients. It was then simple to manufacture a problem, exam findings, and a treatment plan. It was possible to convince some of these people to have x-rays taken, thus helping to fulfill the requirement in this area. [5]
The most efficient way to reach the goal of 200 outpatient adjustments was to have everyone you saw come in as often as possible. Clinical necessity was irrelevant. [5]
It was never explained to me by the admissions personnel that the clinic was a money making venture for Cleveland Chiropractic College and that the student was required to lure or entice friends and family into the clinic, and then charge them for chiropractic treatment which they did not need. [22]
Instructors advised us to use direct solicitation. They encouraged us to visit drugstores and to target people in pain. This approach was often difficult, because many local residents had been solicited so often that Life students were regarded as desperate and fanatical. [4]
Compared to the experiences of my friends in medical and dental school, my "internship" was an embarrassment. [5]

Are you starting to get the impression that something's wrong at chiropractic school?

So far, we've seen that chiropractic schools attract below average students … that classroom instruction is just a "theatrical prop" … cheating on exams is rampant and even encouraged … and now we've seen that the "clinical experience" where chiropractors are supposed to learn how to treat patients is little more than a ridiculous charade.

In fact, chiropractic school appears to be nothing but a ridiculous charade from beginning to end. How can this be? How did this come about and who is to blame?

What must the faculty and administration be like?

Well, you're about to find out.

Next: The Faculty and Administration


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About the Author

Dean Moyer is the author of the books, Rebuild Your Back, Rebuild Your Neck and The Pain Relief Manual. Copies of his books are available exclusively through this website. Read more...

Rebuild Your Back
Rebuild Your Back
Second Edition
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Rebuild Your Neck
The Pain Relief Manual
The Pain Relief Manual

Last updated: Sept 13, 2006