Obtaining a Doctor of Chiropractic degree requires enrollment in a CCE accredited institution’s 3.5-year program.  From the time you begin your chiropractic training, it is important to start to think about what type of “track” you would like to be on.  A “track” is a particular pathway that leads to the type of practice you feel is right for you.  In chiropractic, there are multiple pathways, however the easiest way to organize your thoughts on this subject is to decide whether you would like to be a generalist or specialize in a particular area of care.  Chiropractors that practice as generalists typically have a practice that focuses on family care with a wellness component.  Chiropractic generalists see a wide variety of clinical issues and look to treat the whole patient from a conservative perspective counseling them on exercise, nutrition, and other health related areas.

In contrast to that, a Doctor of Chiropractic can decide to become a specialist and concentrate their clinical work in a specific area such as sports, pediatrics, functional medicine, or injury/trauma.  Making the decision to specialize is the first step, the second step is understanding how the training process will work, giving you the knowledge to function as a specialist.  Advanced training to become a specialist in medicine, is termed a Fellowship.  Wikipedia defines Fellowship in the following manner.   “Fellowship training is part of the process of becoming a specialist.  Fellowship training is defined as the period of medical training, in the United States and Canada, that a physician, dentist, or veterinarian may undertake after completing a specialty training program (residency). During this time (usually more than one year), the physician is known as a fellow. Fellows are capable of acting as an attending physician or a consultant physician in the specialist field in which they were trained, such as Internal Medicine or Pediatrics. After completing a Fellowship in the relevant sub-specialty, the physician is permitted to practice without direct supervision by other physicians in that sub-specialty, such as Cardiology or Oncology.”

The KEY to the Fellowship process lies in the actual clinical exposure, which is guided by a mentor in that specialty and whose foundation is research/evidence based.  The clinical and case specific side is where the real learning occurs, and the Fellow is applying their base knowledge to clinical case situations.  The focus of the Fellowship is not merely on treatment, but also on diagnosis and management of various conditions.  The Chiropractic profession has a very well-established foundation for our chiropractic school curriculum and that level of education is equivalent to programs in medicine and osteopathy, however that is where we cease to keep up.  In medicine and osteopathy after a student graduates, they are a physician, but they are not yet board certified.  They will enter a medical residency program to receive further training in that area of specialty leading to Board Certification.  For example, residencies in Family Medicine are 3 years in length and seven years for neurosurgery.  Residency provides the clinical experience consistent with the medical specialty.   Once the residency program is completed, the physician can continue onto additional training within a Fellowship Program.   Examples of Fellowship Programs would be Cardiology, Vascular Surgery, Sleep Medicine, Reproductive Endocrinology, and Interventional Radiology.

A Spine Management Physician is a specialty within the chiropractic profession that focuses clinical education on the diagnosis and management of pain of spinal origin, while serving as the formal administrator of that patient’s course of care.  This not only includes understanding the cause of the patient’s pain but also having a working knowledge of all the possible interventions from the other providers in the community.  The National Spine Management’s 2-year Fellowship in Spinal Biomechanics and Trauma provides in-depth training in Advanced Spinal Imaging, Spinal Biomechanics, Documentation Management and Patient Triage within the context of interprofessional case management.  Over this two-year training program, each candidate will complete didactic course work, research and case reviews, clinical presentations all while completing clinical rotations in Interventional Pain Management, MRI Physics, Neuroradiology, Orthopedic Surgery, Neurosurgery, Emergency Medicine, and Internal Medicine.  Prior to each of the rotations, the fellowship candidate is required to complete a pre-test, summarize evidence based, peer reviewed research papers and then complete the rotation.  At the end of the rotation, the candidate will take a post-test to “test out of” the rotation.

Presently, there are two pathways available for the Doctor of Chiropractic to choose when considering the Fellowship in Spinal Biomechanics and Trauma.  The first pathway is for Doctor of Chiropractic who are currently in practice and want to enhance their specialty training and become a Spine Management Physician.  The Fellowship and its rotations are completed in the doctor’s own community with no travel required.  The purpose is to ensure you are making interprofessional connections while completing your rotations and learning.  The second pathway is for the recent graduate who has not yet established a practice and is looking for employment opportunities which include advanced training.  In this case, the graduate would enter the Fellowship in Spinal Biomechanics and Trauma for a 2-year employment period with a Doctor of Chiropractic who has completed the same Fellowship Program.   The new graduate upon entering the program would be mentored by the Senior Fellow at a location that is desirable for the graduate.  The clinical work would occur in the Senior Fellow’s clinic and the rotations would be completed within the clinic’s community.  Clinical Fellowship sites can include private clinics, outpatient medical centers or hospital-based systems.

Fellowship training cannot occur successfully without the clinical component.  A Fellowship is clinically based and not simply didactic.  For candidates to be successfully trained they must be immersed in the clinical world seeing patients daily.  Currently the National Spine Management has Fellow graduates that sit on hospital boards, work in hospital settings, triage cases for neurosurgical groups all working at the highest levels in spine care.