Working at Tribal Clinics: The Chiropractic Opportunity

This article explores the significant opportunity for chiropractic physicians to serve Native American tribal communities, highlighting a critical need and emerging pathways. With 574 federally recognized tribes and millions of members, Native Americans face disproportionately high rates of chronic pain and substance use disorders, exacerbated by historical underfunding and limited services at traditional Indian Health Service (IHS) clinics. Notably, IHS clinics were historically high opioid prescribers.However, the Indian Self-Determination and Education Assistance Act of 1975 empowers self-determining or "638" tribes to take control of their health clinics and add services beyond the basic IHS offerings. In response to the opioid crisis and the need for non-pharmacological pain management, some "638" tribes are successfully petitioning and integrating chiropractic services into their medically integrated clinics. While challenges exist, such as navigating medical EHRs, adapting care plans, and requiring cultural humility due to generational trauma and historical distrust, working in tribal clinics offers a rewarding chance to provide essential care to a population often denied guideline-adherent treatment, aligning well with their focus on addressing pain and function. This represents a crucial step towards integrative care and addressing health disparities.