Teaching, leadership, scholarly productivity, and level of activity in the chiropractic profession: a study of graduates of the Los Angeles College of Chiropractic radiology residency program.

OBJECTIVE: The purpose of this study was to track the graduates of the Los Angeles College of Chiropractic (LACC) radiology residency program, review their scholarly productivity, and report those involved in teaching and leadership positions.
METHODS: Former LACC residents' career information was identified through publicly available electronic documents including Web sites and social media. PubMed and the Index to Chiropractic Literature databases were searched for chiropractic graduate job surveys, and proportional comparisons were made between the career paths of LACC radiology residency graduates and those of non-residency-trained chiropractors.
RESULTS: Of 47 former LACC residents, 28 (60%) have or previously had careers in tertiary (chiropractic) education; and 12 (26%) have attained a department chair position or higher at tertiary teaching institutions. Twenty-two (47%) have or previously had private radiology practices, whereas 11 (23%) have or previously had clinical chiropractic practices. Often, residency graduates hold or have held 2 of these positions at once; and one, all 3. Chapters or books were authored by 13 (28%).
CONCLUSION: Radiology residency LACC graduates are professionally active, particularly in education, and demonstrate scholarly productivity.

Introduction

In 1999, the authors published an article chronicling the status of graduates of the radiology residency of the Los Angeles College of Chiropractic (LACC) under the tutelage of Joseph W Howe, DC, DACBR. At that time, the program had produced 34 graduates. Since then, the school has grown and added several programs, changing its primary name to Southern California University of Health Sciences, within which is still housed the LACC; and the total number of radiology residency graduates as of 2009 was 47. Our impression from the earlier study was that a relatively large number of residency graduates seemed to have gone into tertiary teaching, gained leadership positions, and contributed to scholarly literature, although no formal analysis of the data was done.

In 2010, it was decided that a new accounting, with inclusion of the recent graduates, and some career analysis might further clarify the career path of these graduates. We thought it likely that more LACC-trained chiropractic radiologists are in the profession now than 10 years ago because the residency has produced 1 or 2 graduates each year and few have reached retirement age. We also hypothesized that more graduates would have been advancing in their careers for a longer time. Based on this and our impression from the first article, we hypothesized that a higher proportion of chiropractors with the additional training of a radiology residency might attain positions in teaching, academic administration, and international relocation in comparison to non–residency-trained chiropractors. The purpose of this study was to track the radiology graduates of the LACC radiology residency program, review their scholarly productivity, and report those involved in teaching and leadership positions.

Methods

The names of graduates of the LACC radiology residency from 1978 through 2009 were obtained from the school's radiology department. These names were searched for through the publically available Web sites of teaching institutions and private practices. For those whose employment was not known, a search was made using the search engine Google and the social networks Facebook and Linkedin. If the name alone was not specific enough to generate a result, the name plus chiro or radiology was searched for. These searches were performed from 20 August 2011 through 23 May 2012.

Career activities were divided into clinical practice, radiology practice, teaching (including educational administration), and nonchiropractic. Clinical practice was defined as primary contact with patients, involving diagnosis and treatment. The type of practice (eg, associate, solo, part of multidisciplinary clinic) was not considered. If the clinical practice predated entrance to the residency, it was not counted in this study. Radiology practice was defined as reporting on plain film or advanced imaging as a referral activity. Again, type of practice was not considered. That is, a radiology practice could involve owning an x-ray machine and obtaining and reporting on plain films for referring practitioners, whether chiropractic or medical; it could involve reporting images at an imaging center; or it could mean reporting on images obtained at other facilities. Teaching (and administration) was defined as occurring in a chiropractic teaching institution, whether a private school or as part of a university. Nonchiropractic was defined as any professional activity not involving the practice of chiropractic or radiology, retirement, or unemployment.

Books and chapters published were discovered or confirmed either on the graduates’ professional Web sites or via the online bookshop Amazon by searching for the author's name.

Results were categorized by type of activity, and results were compared with data in the literature regarding employment and professional performance. We searched PubMed and the Index to Chiropractic Literature for the terms chiropractic and job analysis or jobs or career.

Graduates were counted in all categories in which they have worked. For instance, if a graduate ran a part-time radiology practice while working full-time as a teacher, (s)he was counted in both categories. If a graduate taught for a time then left teaching to pursue clinical practice, (s)he was also counted in both categories.

Results

The LACC radiology residency reported that it produced 47 graduates from 1978 to 2009. Please see Table 1 for a list. Four (9%) have relocated to other countries to teach. These are listed in alphabetical order by last name (Appendix A).

Table 1

List of LACC radiology residency graduates: 1978-2009

Name	Year
1. Sharon A. Jaeger	1980
2. Dennis Spurgin	1981
3. George King	1981
4. Victor Y.W. Tong	1983
5. Cynthia A. Baum	1984
6. Gary Lindquist	1984
7. Margaret A. Seron	1984
8. Anita L. Manne	1985
9. Michael A. Sladich	1987
10. Phil Shanks	1986
11. Marshall Deltoff	1986
12. William Whittley	1987
13. Larry Wyatt	1987
14. Gary Bustin	1987
15. Tracy Matsumoto	1988
16. Gary Schultz	1988
17. Glynna Rangel	1989
18. Tim Mick	1989
19. Debbie Cherachanko	1990
20. Jeff Cooley	1990
21. John Taylor	1992
22. Tim Hall	1991
23. Tracy Hoyt	1992
24. David Gendreau	1993
25. Todd Knudsen	1993
26. Robyn Mitchell	1994
27. Kathleen Thorn	1995
28. Steven Weiner	1995
29. Curtis Yomtob	1996
30. Sheryl Pressman	1997
31. Michael Mestan	1997
32. John Bassano	1998
33. Jose Serrano	1999
34. James Ma	1999
35. Kenneth Young	2000
36. Jason Vanderford	2000
37. Susan Moreau	2001
38. Laura Gardiner	2002
39. Steve Kulbaba	2002
40. Jamie Kowal-Baietto	2003
41. Cliff Tao	2003
42. Mathew Eurich	2004
43. Chris Watkins	2006
44. Sara Donahue-Mathov	2007
45. Dave Dengler	2008
46. Amanda Satterlee	2009
47. Darlene Vanderford (nee Valdez)	2009

Twenty-four (51%) of the residency graduates have or have had jobs in teaching and academic administration and have stayed in the United States, and several have risen to prominent positions; 12 (26%) have been appointed to Chair of department positions or higher (Appendix B).

A total of 29 graduates have worked in private clinical or radiology practices: 21 (45%) in private radiology practices and 11 (23%) in clinical practices. Whereas some of these chose these career routes solely, some have both types of practice at once; many of those in education also practiced privately, and one engaged in all 3 activities simultaneously (Appendix C).

LACC's residency graduates participate in the larger organizational aspects of their profession. Nearly all are members of the American Chiropractic College of Radiology (ACCR), and many are also in the American Chiropractic Association's Council on Diagnostic Imaging (CDI) as well as their local state or national chiropractic organizations. In addition to simple membership in various associations, many have held or currently hold executive positions on state or national boards and/or trade organizations. Membership in multiple organizations and officer or board status were considered evidence of higher performance levels, but only in an impressionistic way; quantification was not attempted, nor was comparison with non–radiology-residency-trained chiropractors (Appendix D).

The residency graduates have published articles in peer-reviewed journals, trade newspapers, magazines, newsletters, and blogs. Graduates have also given platform presentations and exhibited posters at conferences, too many to list here. In addition, 13 LACC graduates have either authored or contributed chapters to books (Appendix E).

Six of the LACC residency graduates have augmented their education with either further professional certifications or academic degrees (Appendix F).

No information was found for 1 graduate: James Ma. Another, Darlene Vanderford, did not fit into any of our categories, but is considered here as still in the profession of chiropractic, working in clinical utilization review. As of this writing, 2 graduates, Kathy Thorn and Sheryl Pressman, have left chiropractic practice and academe; but both worked in them after leaving the residency. We found none that did not work in chiropractic at least for a time.

Table 2 shows a summary of what we considered the most significant professional activities.

Table 2

Summary of significant professional activities

	Teaching	Clinical practice	Radiology practice	Books and chapters
1	John Bassanoa	David Dengler	Gary Bustin	John Bassano
2	Gary Bustin	Laura Gardiner	Jeffrey Cooley	Cindy Baum
3	Jeffrey Cooleya	Tracy Hoyt	David Dengler	Jeffrey Cooley
4	Marshall Deltoffa	Sharon Jaeger	Mathew Eurich	Marshall Deltoffb
5	Mathew Eurich	Jamie Kowal-Baietto	Laura Gardiner	Sharon Jaegerb
6	David Gendreau	Tracy Matsumoto	Tracy Hoyt	Gary Lindquist
7	Todd Knudsen	Michael Mestan	Sharon Jaeger	Anita Manne
8	Jamie Kowal-Baietto	Susan Moreau	Todd Knudsen	Tim Mick
9	Stephen Kulbaba	Dennis Spurgin	Jamie Kowal-Baietto	Margaret Seron
10	Anita Manne	Chris Watkins	Stephen Kulbaba	Gary Schultz
11	Sara Mathov	Kenneth Young	Michael Mestan	John Taylorb
12	Michael Mestan		Tim Mick	Larry Wyattb
13	Tim Mick		Robyn Mitchell	Kenneth Young
14	Susan Moreau		Gary Schultz
15	Sheryl Pressman		Cliff Tao
16	Glynna Rangel		John Taylor
17	Gary Schultz		Kathleen Thorn
18	Jose Serrano		Victor Tong
19	Dennis Spurgin		Jason Vanderford
20	Cliff Tao		Chris Watkins
21	John Taylor		Steven Weiner
22	Victor Tong		Kenneth Young
23	Jason Vanderford
24	Chris Watkins
25	Steven Weiner
26	Larry Wyatt
27	Curtis Yomtob
28	Kenneth Younga

Moved internationally.

Full book (may be coauthor or coeditor).

Discussion

In 1999, many of the LACC graduates who elected to become teachers had stayed at LACC. Although this is still true, the intervening decade has seen internationalization in trade in general as well as in chiropractic. Given these societal forces, it seems inevitable that some LACC radiology residency graduates would have relocated abroad; and this was found to be true. No figures were found for comparison with non–residency-trained chiropractors, although it seems unlikely that nearly 10% of American-trained chiropractors since 1999 have moved to foreign countries.

It has been estimated that between 82% and 96% of chiropractic graduates in the United States take up clinical practice. This leaves approximately 4% to 18% to potentially go into teaching. Given that 5 times that proportion (51%) of LACC radiology residency graduates have chosen teaching, either something is different about people who choose radiology, or the radiology residency changes a significant number of its matriculates.

The LACC radiology residency graduates have also made contributions to the scholarly literature. It is not unreasonable to suggest that these research endeavors are partly as a result of Joseph Howe's academic philosophy; one of the components of the ethic imbued in the radiology training at LACC is the belief that dissemination of scholarly information is essential for the growth and survival of any profession. In addition, the CDI has had small scholarships available for residents who publish.

Six graduates (13%) have also gone on to achieve higher degrees. We did not discover any information for non–residency-trained chiropractors; thus, direct comparisons cannot be made.

What are the reasons for this apparent high level of scholarly activity? Radiology residents may be the type of people who are attracted to the activities involved in the residency itself. Those activities include writing scholarly articles, teaching, and academic logistics (organizing classes, managing student issues, creating and marking examinations). This inherent predisposition would likely result in a higher-than-usual proportion of academicians being generated from this population. It would be interesting to discover if these trends were also true for other chiropractic radiology residencies.

In addition, radiology residents must be strong academic performers. Grades in chiropractic training are considered, and there are film reading and written examination as well as an interview process to enter LACC's residency. After being accepted, residents need to attempt to memorize large quantities of diagnostic information and develop an advanced level of skill in image interpretation. Residents also must work as radiographers and junior radiologists in the school's outpatient clinics. It is a high level of activity and may attract people who are high achievers, those likely to continue to be active after the residency has been completed.

A study of vascular surgery vs general surgery residents found that vascular residents went on to have a higher percentage of advanced degrees, more publications, and more involvement in cardiovascular research than the general surgery residents. The vascular surgeons are trained in procedures that require a particularly high degree of skill and specific knowledge, and this may be somewhat analogous to comparing residency-trained chiropractors (DACBRs) to generally trained chiropractors (DCs). Although it is unknown as to whether chiropractic radiologists have a higher proportion of advanced degree holders than non–residency-trained DCs, the amount of publication revealed in this article supports the idea that chiropractic radiologists research and publish as part of their activities. This may be due to the publication encouragement both within the residency and from outside sources (eg, CDI scholarship). Chiropractors in private clinical practice likely have little incentive to publish.

For example, in Australia, chiropractic academicians have a low average output of research. It is likely that academicians publish more than clinicians because of publication requirements for tenure and promotion in some universities. Given the recent emphasis on evidence-based practice for health care, it may be useful in the future to compare radiology residency-trained chiropractic academicians’ research output with that of non–residency-trained chiropractic academicians to help understand how to increase chiropractic research.

A study of emergency medicine in 2000 found that residency-trained physicians had lower malpractice claim payouts than non–residency-trained ones. It would also be interesting to research this question for chiropractors and chiropractic radiologists in the future.

Limitations

This study was aided by new developments in technology in that information was gleaned on all former residents through Web sites and social media. However, we were limited by outdated or absent information on several of the graduates.

The study was also limited in that only information on the Web sites was included. If information was not present or low on a list of hits generated by a search engine, it was not included in this study. Thus, some of the findings may not be up to date or complete.

In the future, a stronger study could be completed if qualitative methods were used, including interviews with graduates regarding motivation for professional choices, obtaining full curricula vitae with job histories, professional service, and full publication records. Because graduates were counted in any category in which they had spent any time during their careers, there may be an overreporting of activities. If dates of employment were included, a better understanding could be obtained. Little information was found in the literature for non–residency-trained chiropractors; therefore, informative comparisons are not possible.

In addition, graduates from only one radiology residency were used as the sample; so although trends may be noted, firm conclusions cannot be drawn. Perhaps LACC is anomalous in some way; this could only be determined by a broader sampling of chiropractic radiologists. Larger studies including other radiology residency programs should be considered for the future.

Conclusion

The findings of this study show that LACC radiology residency graduates are active professionally and that many teach at the tertiary level and take positions in school administration. They participate in research; they publish, and a few move internationally. Some who choose a career in academia may simultaneously run clinical or radiology practices, and some do all three.

Funding sources and potential conflicts of interest

No funding sources or conflicts of interest were reported for this study.