While public demand for chiropractic care is at an all-time high, the profession faces a "perfect storm" of internal and external pressures. A major concern is declining school enrollment, which has dropped from 15,000 to 10,000 students over the last two decades. This contraction is exacerbated by the unsustainable cost of education; the average graduate carries over $300,000 in debt while earning an average annual salary of only $70,000. The impending elimination of Grad PLUS loans in 2026 poses a further financial threat to chiropractic institutions.

In addition to financial hurdles, insurance reimbursement rates have remained stagnant for over 20 years, making it difficult for established doctors to pay associates competitive wages. This financial strain often leads to a cycle where "chiropractors eat their young," overworking new graduates who are already burdened by massive debt. While some advocate for a purely cash-based system, the author notes this may restrict care to the wealthy, which contradicts the profession's original mission. Addressing these systemic issues—from tuition inflation to reimbursement reform—is essential for ensuring that the profession moves toward a future of growth rather than decline.