Findings / Recurring Themes.
Five themes were identified from the data. They were: “Not worth the money”, “Tarnished image of the profession”, “Going it alone / what’s in it for me”, “Lack of visibility”, and “Two warring factions”.
In support of these themes, ‘word trees’ were developed from the verbatim quotes of the participants and are included to support the five themes. These are found in Appendix 1.
Theme 1: “Not worth the money / What’s in it for me”.
The respondents viewed chiropractic PAs as lacking in value for money and not worth the cost of annual membership. Some mentioned that PAs offered access to reduced professional indemnity and malpractice insurance rates as a temptation to join but as not being sufficient. Others spoke about financial hardship and choosing not to join as a way of making savings (Fig. 1 word tree).
R7: “My thoughts & the ones from the people that I've spoken to from what I've understood, number one is cost, they really don't see any value in it”.
Theme 2: “Tarnished image of the profession”
The most frequently recurring theme was a perception that the profession of chiropractic has a poor standing in the eyes of the public and other health professionals.
R1 “we worked so hard to be Chiropractors. And we study so much and know so much about the human body in this area or domain. And we are looked upon as worthless by the greater community. I don't like that. And it's not fair.. . it's the only profession that has this sort of thing happening to it that's going through a university-based model”.
Respondents thought the profession lacked homogeneity, unity, it was without recommended guidelines of care, and uniform treatments.
R8 “I'm not real comfortable with some of those other (chiropractic) techniques. And if they're big parts of gatherings I don't know whether I want to be part of that”.
Theme 3: “Going it alone”
The chiropractic professions were not thought of as providing anything deemed to be essential for practice or of direct benefit to themselves. It was mentioned by three respondents that the decision not to re-join the PA was made after forgetting or overlooking the renewal date as becoming aware that there was no discernible difference whether they belonged or not. There appeared to be a high valuing of the individual and a low valuing of supporting the profession as a whole. Figure 2 is a ‘word tree’ developed from the verbatim quotes in support of this theme.
R1 “I kind of plod along without it being any direct impact on me …. I can kind of get by with not having to be a part of them”.
Some spoke about being confident in their abilities and not needing the support offered by a PA, while others expressed discomfort with professional gatherings and assigned minimal value to group membership.
R4 “I haven't been part of that sort of group that get all funny about being professional and they go to all the seminars and all this sort of hype around the profession. I'm just not into it at all. Number one I don't have time to do it. And number two I just don't identify with that sort of professional thing”.
Theme 4: “Two warring factions”
Within Australia there are two PA’s. One is thought of as providing open membership that embraces all chiropractors’ beliefs (from vitalism through to evidence-based practice) with the other describing itself as “evidence-based”. The interviewees expressed views that recognised this spectrum within Australia PAs but also more broadly within the profession and they did not want to be seen as part of this disunity (Fig. 3 word tree).
R9 “The disagreement we have is obvious. . .some of us are on the philosophy or you know a lot of Chiropractors do things that are unfounded, let's say, or unproven, or unresearched or whatever term they use, but there are some of us who are evidence based. So, there's always this form of dissociation from part of the profession and in itself shows that the whole profession is weak”.
Theme 5: “Lack of visibility “
Respondents expressed views indicating they perceived PAs as lacking a visible presence and this was perceived by some as being poor communication. Consequently, chiropractors were thought to not understand the full range of benefits that PAs provided. Respondents wanted this information to be easily accessible and were dissuaded from searching at the prospect of the level of difficulty involved (Fig. 4 word tree).
R4 “So maybe there needs to be a bit more awareness about what they're actually offering and why they're even there in the first place.. .. it feels like sometimes there's all this information out there that you have to sift through and find it in some random website somewhere”.
This PAs were expected to be consistently working at being a high-profile presence in the day-to-day workplace with a range of relevant resources.
R6 “In general I guess making it more obvious, the benefits of joining. I mean I know that and you know that on their websites and they do have it …. to be honest you know, I kind of forget that they're there and unless I went and sought out that information”
How to improve PAs.
Finally, suggestions were sought from the nine respondents for actions PAs could undertake to increase the likelihood of non-members join. These are summarised and ranked from most frequently to least frequently occurring in Table 1.
Table 1
Respondents suggestions for chiropractic PAs to increase the likelihood of non-members joining
Description of theme from most to least frequently suggested | Times mentioned |
Provide continuing education / lectures | 6 |
Frequent email updates, especially practice / business / specific material E.g., such any regulatory changes or what is happening in the profession | 5 |
Improve the image of profession through the media | 3 |
Be seen to be regulating its membership | 3 |
Increase patient numbers through effective use of the media | 2 |
Create interest groups such as Sports Chiropractic / Paediatrics | 2 |
Assist breaking down the barriers between professions | 2 |
Assist with employment of new graduates | 1 |
Cheaper membership | 1 |
Guidelines for practice | 1 |
Greater student support | 1 |