Chiropractors’ perception of occupational stress and its influencing factors: a qualitative study using responses to open-ended questions

The primary aim of the current study was to examine the perceptions of occupational stress among a representative sample of chiropractors in the US. This mixed methods approach, with emphasis on the qualitative analysis, generated three main categories and 14 subcategories representing the perceived occupational stressors among DCs. Overall, the results showed that the most of the participants believed that MCO regulation, MCO reimbursement, and Scope of practice issues were the most common stressors that negatively influenced their professional and personal lives. Interestingly, scope of practice amongst DCs is highly variable [32–34] in the US, and when coupled with cost of living differences, a strong connection between these factors became apparent. The participants responses indicated their perception of a cause effect relationship between occupational stress, emotional exhaustion and “cultural authority, government / Obama, education, long hours, time, tools, medical, competition for other professions, documentation, scope, expectations; overhead; risk; scope of practice; paperwork; State associations; college / school; unethical; pay; EHR/EMR; communicating; balance; respect; unity; reward; AMA; boredom”. High student loans, the non-recognition by the medical community, and the administrative aspects of operating a business, also have a significant negative implication(s) on DCs’ practice life; by means of reducing resources and increase demands, as outlined in the control-stress model [5] and job-demands control model [10, 11]. However, collectively it appeared that most significant stressor within the chiropractic profession is “the frustration with the insurance companies”. Complaints of constantly getting denied, the extremely low reimbursement (gets lower every year), the raising of co-pays to make patients not want to come in appear to be overwhelming the modern day DC. These findings are consistent with much of the current occupational stress research [10, 20–22, 27]; which lends the notion that major changes in the health care system have been driven by increase-regulation via third-party payer systems.

Similar precursors/processes to occupation stress and EE have been observed in a comprehensive group of health professionals [2, 4, 17, 35–37] – and while some stressors were consistent across occupations, others were more rare or occupation specific. Across health professions, it appears that healthcare workers suffer from occupational stress because of higher expectations, not enough time, lack of skills and social support at work [21, 35–37]. Notably, interpersonal conflict appears to be the most prevalent stressor across all occupations [20, 22] – organizational constraints and workload are just as commonly reported in the literature. Interpersonal conflict occurs when a person or group of people frustrates or interferes with another person’s efforts at achieving a goal [38] – and may be reflective of the unique cultural-specific perceptions of stress that occur in the chiropractic profession.

As the content analysis progressed, a conceptual pattern amongst the participants began to unfold. It appears that many of the participants agreed – Chiropractic’s lack of internal consensus and legitimacy (cultural authority) inhibits chiropractic’s ability to keep up with rapidly changing events. Further, participants repeatedly noted/suggested that in order for the chiropractic profession to progress, that is keep up with external health care events, e.g., the Affordable Care Act, Health Care Education Reform Act, etc., the profession would needs to come to some modicum of internal consensus. Internal consensus will be needed if the profession is going to achieve cultural authority [39]. Keeping the profession rooted in metaphors — i.e., Universal Intelligence, Innate Intelligence, Subluxation, dis-ease, etc. — which for some have become unquestionable myths and dogma inhibits chiropractic’s achievement of legitimacy, the other necessary ingredient of cultural authority [40].