Physicians and Chiropractors Value Teamwork, Yet Québec Clinics Still Rely on Informal Ties

Physicians and chiropractors who already work under the same roof in Québec multidisciplinary clinics broadly value their collaboration and believe it improves patient care, but a new mixed-methods study finds that this cooperation rests almost entirely on personal relationships and hallway conversations rather than formal organizational structures. The research, published in Chiropractic & Manual Therapies, surveyed 23 chiropractors and 19 physicians practising in clinics where both professions are present, and followed up with a focus group and individual interviews to explain what the numbers showed.

Of 33 chiropractors and 137 physicians invited, 69.7 percent and 13.9 percent respectively completed the surveys.

The survey numbers painted a picture of goodwill paired with thin formalization. Among physicians, 68 percent referred patients to chiropractors at least monthly, driven primarily by established relationships with specific chiropractors (53 percent), patient requests (47 percent), and clinical evidence supporting chiropractic care for certain conditions (37 percent). Yet chiropractors reported that a median of only 7.5 percent of their patient referrals originated from physicians, despite family physicians being the most frequent healthcare providers present in their clinics. Formal collaborative activities were rare: 48 percent of chiropractors never scheduled collaborative meetings, 57 percent never conducted joint evaluations, and 70 percent reported no scheduled clinical case discussions with other providers. Informal contact dominated, with 44 percent reporting at least one unplanned in-person discussion with another provider each week.

Attitudes were largely positive on both sides. Most physicians surveyed had an overall positive impression of chiropractic care, with 90 percent agreeing that chiropractors provide effective therapy for musculoskeletal conditions, employ patient-centred approaches, and can reduce physician workload for musculoskeletal complaints. But opinions split sharply on one point: only 37 percent agreed that neck manipulations are safe, while 32 percent were undecided and 32 percent disagreed. Concerns about professional liability from referrals were also mixed, with 32 percent agreeing there is increased risk and 58 percent disagreeing. On the chiropractor side, 65 percent were satisfied with interactions with family physicians, though only 26 percent were satisfied with interactions involving specialist physicians, more than 40 percent of whom they never contacted.

Both groups attributed high value to working together. Among physicians, 84 percent agreed that collaboration enhanced patient satisfaction, improved service quality, and positively impacted patients’ health conditions, and 74 percent reported being satisfied with their collaboration with chiropractors. Chiropractors reported similar benefits, including increased patient satisfaction (87 percent), greater promotion of chiropractic care to other providers (83 percent), improved clinical outcomes (83 percent), and better handling of patients’ biopsychosocial needs (78 percent). The strongest facilitators identified by chiropractors were personally knowing other providers (83 percent) and provider proximity (74 percent), while the primary barriers were their own workload (48 percent), other providers’ workload (39 percent), and patients’ financial situations (43 percent).

The qualitative analysis revealed three overarching themes: perception, organization of care and services, and communication. Perceptual barriers included educational silos, with physicians reporting that their formal training actively de-emphasized chiropractic care and that chiropractic was absent from hospital-based rotations; historical professional tensions; and variability in chiropractic practice approaches, which physicians found confusing and which could breed referral hesitancy. One physician interviewed admitted uncertainty about when to refer: the contribution and the indications were unclear. Conversely, physicians who had personal experience as chiropractic patients, or who worked directly alongside chiropractors, tended to hold more favourable attitudes, and direct professional contact was described as progressively resolving initial concerns about safety and professional boundaries.

Structural obstacles clustered around money and system design. Out-of-pocket costs for chiropractic care, which in Canada is predominantly delivered in private, fee-for-service practices, were repeatedly cited as a major impediment, particularly for vulnerable populations. The exclusion of chiropractors from public healthcare settings limited opportunities for direct interaction, and administrative constraints and unclear documentation protocols were described as time-consuming. Facilitators of care organization included physical proximity, which enabled spontaneous case discussions; formal interprofessional meeting structures where they existed; and established, well-defined referral pathways. On communication, direct verbal exchange, whether face-to-face or by telephone, was rated the most effective modality, while shared electronic records were seen as a significant advance where available.

One of the study’s most striking integrated findings was an asymmetry in communication initiation. Chiropractors described themselves as the ones who most often initiated contact, sent emails, and followed up with physicians, placing a disproportionate burden on them to maintain interprofessional dialogue. This discordance surfaced clearly when the two datasets were read together: physicians rated their practice as patient-centred (90 percent) and as reducing their overload (95 percent), yet coordination often depended on patients themselves relaying handwritten notes between providers. Chiropractors’ lowest collaborative-behaviour ratings concerned development of common intervention plans and pre-established responsibility sharing, both averaging around five out of ten.

The integration of quantitative and qualitative strands also reframed the safety ambivalence. The authors argue that physicians’ split on cervical-manipulation safety reflects concerns inherited from training and professional history rather than doubts about the evidence, and that these concerns eased after direct, co-located evidence-sharing, making the ambivalence a remediable information deficit rather than a fixed objection. The study’s central integrated finding, however, is a value-structure gap: high perceived value coexisting with limited collaboration protocols, indicating collaboration sustained by informal, proximity-based exchange that is effective but fragile.

The authors are careful about the limits of their work. Both samples were small and highly self-selected: every participant already worked in a setting where both professions were present, and not a single physician endorsed negative views of chiropractic, a pattern reflecting a collaboration-oriented subset rather than broader professional sentiment. Two of the five physician interview participants were in a personal relationship with a chiropractor, which likely amplified favourable attitudes. Thematic saturation was not reached in the qualitative component, making it exploratory rather than comprehensive, and Québec’s distinct regulatory and funding frameworks may limit transferability. The authors frame their policy suggestions, including partial public funding and integrating chiropractors into family medicine groups, as hypotheses requiring feasibility and outcome studies before broader implementation. Within those constraints, the message is clear: where physicians and chiropractors share a clinic, goodwill is abundant, but the structures to sustain it are not yet built.

Subject of Research: Physician-chiropractor interprofessional collaboration in Québec multidisciplinary clinics

Article Title: Characteristics of interprofessional collaboration between physicians and chiropractors within Québec multidisciplinary clinics: a mixed-methods study

Article References: Blanchette, M.-A., Nguyen, L., Hudon-Dionne, J.-P., Lavigne, G., Mercier, M.-A., & Busse, J. W. (2026). Characteristics of interprofessional collaboration between physicians and chiropractors within Québec multidisciplinary clinics: a mixed-methods study. Chiropractic & Manual Therapies, 34(1), Article 48. https://doi.org/10.1186/s12998-026-00673-9

Image Credits: AI Generated

DOI: 10.1186/s12998-026-00673-9

Keywords: interprofessional collaboration, chiropractic, physicians, multidisciplinary clinics, Québec, mixed methods, musculoskeletal care, primary care, referral patterns, communication barriers, healthcare integration, Characteristics