How Chiropractic Schools Build Board Ready Graduates with Dr. Deb Bushway

What should a chiropractic education guarantee when a student finally walks across the stage: seat time, or real competence? We sit down with Dr. Deb Bushway, president of Northwestern Health Sciences University, to get specific about what “practice-ready” actually means and why outcomes like graduation rates and chiropractic board pass rates are still the clearest promise a program can make to students and the public. Along the way, we talk candidly about how easily education can drift into tradition instead of measurable skill. 

We also go straight at a pain point every new chiropractor recognizes: business readiness. Great clinicians can still struggle with pricing, cash flow, staffing, and the day-to-day reality of private practice. Dr. Bushway explains an approach built for how people learn and when they need the information: online practice management modules reinforced throughout school, plus free access after graduation when the lessons finally feel urgent and practical. 

Then we zoom out to the bigger system shaping chiropractic training: the relationship between academic programs, accreditation, licensing boards, and the NBCE. We discuss why standardization matters, why hours are a shaky proxy for learning, and how competency-based education could raise clarity and quality across the profession. We also share a powerful VA story that shows how integrative care can shift minds fast when results are undeniable. If you found this useful, subscribe, share the episode with a colleague, and leave a quick review with your biggest takeaway.

Transcript

Welcome And Guest Introduction

SPEAKER_02 0:06

Hello, I'm Dr. Ellen Ford, the chairman and founder of Activator Methods International. And I'm very happy this morning to have our guest, Dr. Deb Bushway, who is the president of Northwestern Health Science University. Welcome, Dr. Bush.

SPEAKER_00 0:20

Thank you so much. I'm excited to be here.

SPEAKER_02 0:23

You know, um, it's not prisons are busy, so it's hard to get them to sit down long enough to do an interview. And so I'm very happy to have you here. She's here for the Arizona Association of Chiropractic's big seminar

What Education Owes The Profession

SPEAKER_02 0:35

this this weekend in Arizona. And uh I want to ask a few questions, Dr. Bushway. What about what's the role of education in the chiropractic profession today?

SPEAKER_00 0:46

Yeah, that's such an important question, of course, near and dear to my heart, right? Um and uh, you know, one of the things I have uh a fair amount of experience in higher education. One of the things I've learned over the years is that because everybody went to school, they believe they're an expert in education, right? And there's truth in that. Um, but the reality is that people have lots of different expectations about what education and chiropractic ought to be doing. And in my opinion, the role is for us to graduate practice-ready chiropractors according to the standards defined by the profession and the accreditors. So the licensing boards and accreditors and us, we come up with standards and we are holding the bar about what the outcomes are when those people graduate. Now, they're not going to be experts yet, right? They're beginning practitioners, but they're going to be solid, effective practitioners when they graduate.

SPEAKER_02 1:45

Now, if I remember correctly, Northwestern Health Science University is in the top one or two people when it comes to scores in education and graduation and so forth. Tell me a little bit about that.

SPEAKER_00 1:57

Yeah, thank you for asking that. We are always really pleased with that. We believe strongly that higher education has to

Outcomes That Matter Most

SPEAKER_00 2:05

focus on outcomes for students rather than just inputs. And some of those key outcomes for a student is can they pass the boards? Can they graduate? And so we believe that once a student joins us, they're one of us, and it's our job to get them to graduation and to pass the boards if they're at all capable. And those are outcomes that we value highly. So, yes, we're always number one or number two in both graduation rates and board pass rates for the chiropractic programs across the country. Trevor Burrus, Jr.

SPEAKER_02 2:34

And that's what a student wants to know. Am I going to pass the boards? I mean, that's the foremost thing in their head. Right. The other thing I hear is when they get out, they don't have enough business savvy. And so how is Northwestern meeting that challenge?

SPEAKER_00 2:50

It's a big challenge, right? And we've tried a lot of different ways. And um, still students will say

Teaching Business When It Clicks

SPEAKER_00 2:55

they didn't tell us anything in school. Well, we know we did, but that's not an answer. If the student's experience is they didn't tell us about uh business in school, it it doesn't matter if we believe we told them because we're not telling them in a way that meets their needs. So what we decided to do is we made, with the support actually of NCMIC, we made a set of online modules. We use them throughout their time with us. Every try of those 10 tries, they get different exposure to some part of the business. But then after they graduate for the first year post-graduation, they have access to all that content for free. And it's online, it's searchable, it's easily accessible. Because then is when they want it, right? It's a little bit, sometimes I say it's like, I don't know if you ever saw the Charlie Brown movies and the teacher would talk. And when Charlie Brown wasn't interested, it would go, wah, wah, wah, wah. And I think we're a little bit like that. Well, we're talking about business when they want to learn how to adjust, right?

SPEAKER_02 3:54

That's their primary thing. But then as soon as they get out, unless they go into one of the big things like Chiro Wan or joint or something like this, where the business is run by professionals, uh, they have to do it. My my wife asked me one day, why do people like medicine? And I said, because they don't have to do anything go but to go treat patients. Yeah. And they don't have to worry about cash flow, they don't have to worry about their bottom line. All they do is, you know, treat patients. And I think that's probably what you're trying to solve there with the online.

SPEAKER_00 4:26

It is, but it is definitely what we're trying to solve. And um the data I saw recently is about 85% of recent grads still go into private practice of some kind. So we still need to help support

Succession Plans And Practice Value

SPEAKER_00 4:40

them.

SPEAKER_02 4:40

Well, and the other thing is um there's a lot of practitioners out there that would like to sell their practices. Yes. And there's uh there I finally found a group that's doing it now.

SPEAKER_00 4:51

Oh, good.

SPEAKER_02 4:52

And that's a very important thing. It's called Sidecar. Okay. And uh they're from South Dakota. Oh. And they're right in your neighborhood. Oh, yeah. And uh it's Nathan Unruh and Doug C, and they they have a plan. It's called a succession plan.

SPEAKER_00 5:06

And that's so great to hear.

SPEAKER_02 5:09

And so that's something for you to just uh track it because uh the kids come out, they work like for a year with a really established practitioner, and in the process, they get bank financing and everything so they can buy the practice. And I'm looking at I I had a couple of people in a seminar come up to me here just in this last year and say, What's my practice worth? And I said, Nothing. Unless you have a successor. Yeah. And uh I have one friend of mine in Boston, uh, Tom David who worked with me for 40 years. And uh he was gonna give his practice to his son, and I said, Hold it. You worked hard for this, Tom. So he built the succession program, and he's making the same money for 10 years after he after he retired.

SPEAKER_00 5:57

So it's a big problem, and I love hearing that because we've been struggling with how can we support our alumni and our students to make those matches, right? And so I love hearing that resource that's doing that because that's exactly what it takes.

SPEAKER_02 6:11

Yes, and it's and it's be it the both of these guys are field practitioners that have had a lot of experience and so and both of them have gone through this accession plan themselves. Yes. And so they know how it works and what to do and so forth. So how to make it work. Now, how how should the role of the academic programs, the CCE and the NBCE and FCLB interact? That's kind of a politically

Boards Accreditation And Standardization

SPEAKER_02 6:35

loaded question.

SPEAKER_00 6:37

I'm gonna I'm gonna try to stay above the political um intrigue about it, but it is an important question. In my mind, um we need those groups to maintain some autonomy because they each have a different role to play in maintaining quality for the profession, right? Um and by that what I mean is we educate people, okay, but if we don't have a board exam to validate from an external perspective what students are learning, then we can say they're great, but my standard of great might be really different than another school's standard of great. So we need these this external exam. In my mind, it could be more competency-based, and everybody knows that, so that's no secret. But that is part of it. We also need the boards to play a role in understanding what does a good chiropractor look like? What are the key competencies that they need? What are the risks they're seeing when people out there practicing so we can educate and try to sort of inoculate against those risks?

SPEAKER_02 7:43

Aaron Powell You know, I have to say that I was not uh in favor of everybody flying to Greeley, Colorado to take aboard. I'm still not sold. But I think I know why. I mean, they they got such different groups and different colleges that they had no standardization. Is that am I thinking right?

SPEAKER_00 7:59

Aaron Powell That's what they will say is that they had that this was the problem they were solving was standardization. No surprise. I think they could have solved it other ways as well. But I think that the problem of standardization is worthwhile to solve. Yeah.

SPEAKER_02 8:14

Yeah, I agree. Um You know, I heard somebody the other day say at the top we were at about 11,500 uh students

Enrollment Declines And Public Awareness

SPEAKER_02 8:25

in school, and then it may go down to 9,500 in the next five years. Is that what you're hearing or what's your take on this?

SPEAKER_00 8:34

We're definitely hearing something like that. Um and there has been a decline over the last few years in sort of national enrollment numbers, and it's very hard to know how to predict where that will land, right? And I think there are lots of factors going into that. And one of them is all of our shared role in helping the the population, the public, understand how important chiropractic is to our healthcare systems in the country. And I do think we all play a role in that, in making sure that the public and prospective students understand how important this profession is to help maintain the well-being and health of the population.

SPEAKER_02 9:17

Well, I think this is where like the VA has helped out a great deal. And uh I remember, you know, oh, this is some years ago, but I was involved in this because I was here in Arizona and we needed one co-sponsor to have it into the VA. Oh and they said, Can you fly to Washington, D.C. tomorrow? And I said, Sure. So I walked into Senator

The VA Story And Integrative Care

SPEAKER_02 9:40

McCain's office, okay, met by one of his staff, which is normal for a senator's office. And uh he said, Oh no, the bill is too highly controversial, he's not gonna co-sponsor that. And just then McCain walked in and I said, Hi, uh Senator, I said, I'm Dr. Ford and I'm one of your constituents. And he and I said, Would you like to hear a sea story? Now there's not a sailor alive that will not stop and listen to a sea story. He said, Well, yeah, tell me. Of course, yeah. I said, I was on board the USS Alacrity, mine division 45, and that's you know, during when the time was Cuba, we're having a little problem, and now he's listening.

SPEAKER_00 10:17

Yeah.

SPEAKER_02 10:17

And I said, uh we went on Liberty one night and came back, our ships were gone. And we wondered what happened to our house, you know. And so they said, well, they had to take them out because of a missile attack problem. And so they said uh they're gonna pick you up in the morning and put you on board. So we were on board that night going down to Cuba. We hit rough weather, and the captain was in the captain's chair, and I saw him just get up to get a cup of coffee, and he slipped and hurt his back. McCain's now really interested. And I said, he said, Well, what happened? And I said, Well, we went down to his state room and then he looked at me, he said, Four, aren't you a chiropractor? And I said, Yes, sir. He said, Then do what chiropractors do. And I gave him an adjustment and he was on the bridge the next morning. He said, And what was the next morning? I said, We're going into Guantanamo Bay to take the mines out to get the USS Ranger out. He said, So if you hadn't been there to adjust him, he may not have been there for that wonderful mission. I said, That's right, sir. And he said, co-sponsor the bill.

SPEAKER_00 11:18

Oh, that's a great story.

SPEAKER_02 11:20

And it was all over. You know, he's just that was that was the last one we needed to get it into the VA.

SPEAKER_00 11:26

So that's an awesome story. I didn't know that. I love hearing that story. But the VA has been a leader.

SPEAKER_02 11:32

Well, and I think, you know, that was uh and I started then the VA here in uh Carl T. Hayden Medical Center, and that's the first time I was in integrated practice.

SPEAKER_00 11:43

Okay.

SPEAKER_02 11:43

Which gave me a whole new look. And uh one day the chief exercise medical officer came in and said, We've got a bit of a problem, Marlon. And I said, What's that? He said, uh, the PTs are on the rage. They don't want you in the building. And he said, Could you come down and give them a little uh idea what you do? So I grabbed a portable table and went down. There were about 20 of them. And I told them who I was, and I said, you know, and I use activator. Anybody ever have an activator adjustment? This guy says in the back and says, I do. I'd like, would you adjust me? That's awesome. Long story short, I said, you know, we're not doing rehab, we're not doing the we're doing spine, we're not even competing with you guys. And I ended up adjusting 20 of them. That's awesome. And the problem was over. We never had another competitive problem in it. And the medical director said, How did you do that? I said, a little bit of demonstration. Yeah. Yeah. Yeah. But long story is when you get

Competency Over Clock Hours

SPEAKER_02 12:35

an integrated practice, you really see how valuable chiropractic is.

SPEAKER_00 12:38

So we believe that's firmly. And Northwestern were really big advocates of whole person care or integrative care. Trevor Burrus, Jr. Yes.

SPEAKER_02 12:47

Pardon me. It sounds like chiropractic education is similar to how how all higher education needs to make some significant changes. How can that be done?

SPEAKER_00 12:56

Yeah, there are um a lot of changes that need to get done in higher ed and and in Cairo in particular. I mean, if you think about it, over time things have to change and adjust. We were just talking about how work is more often remote now than it used to be before. And those same changes happen in higher education. And one of the things for chiropractic education is it's really rooted still. And I'm gonna say 80 years ago or a hundred years ago when it was sort of created and founded as unique institutions that taught chiropractic only. Um and people many people went to school in that way, and that worked, and it was a great model for the time. The problem is the pressures on small institutions right now are it's very real. It's very expensive to be a h institution of higher education. And there are two primary ways that those programs need to keep innovating. One is the academic model, and the other is frankly the business model. And so the academic model, as I've already said to you, has to do with counting hours. So to get licensed in many, many states still, you have to have 42 or 4,400 hours. Hours are a proxy for learning. Hours assume that if you sit by me and my wisdom for long enough, you'll become wise as well. And honestly, people learn in different ways. It might take me 10 hours to learn what you can get in two hours. And we ought not make you sit for the other eight hours and be bored and tedious. We ought to assess that you've got the competency and move on to the next one. So that's what I mean by focus on outcomes versus inputs. That's a huge shift when you've got everything from an accrediting board to a licensing board to, you know, even the testing board looking at hours people spend rather than what they've learned. So that shift we're working on really hard. The business model shift is a little more disruptive. Well, maybe the other both maybe they're both so disruptive. I don't know. But we came from a model where the chiropractic programs funded the institutions and it was okay to keep raising the tuition

The New Economics Of Chiropractic Schools

SPEAKER_00 15:10

for a period of time. Inflation that the schools have to deal with is way bigger. And you can't scale the cost with a small program in the same way you can with a large institution. You know what it means to scale a business. It's hard to do with a very small program. So you see some growth in some of the programs, but as I said earlier, growth has to be done the right way that people can still succeed in it. So there's gonna be things like affiliations and partnerships and maybe joining systems, other models to deliver these chiropractic programs that we're gonna see happening. Many people right now think in higher ed like mergers are the academic are the business model innovation for right now. How do we get that done while we maintain the spirit, if that's the right thing? The spirit and the essence of a good chiropractic program.

SPEAKER_02 16:08

So I talk to a lot of college presidents. Yes. And I'm thinking of John Scrinth right now, who's probably one of the leaders in bringing other things into the campus. But you have to he told me, he said you have to be very careful. You do. Because, you know, if you're coming in like a PA program, you probably should have five million dollars in the bank in about five years to be able to handle this. And they didn't do it correctly at Logan. I mean, uh I've been close to that.

SPEAKER_01 16:36

Yeah.

SPEAKER_02 16:37

And it was a problem because they put too much money in too many people, and uh they're gonna be lucky to even keep that program going. And so it's expensive.

SPEAKER_00 16:46

It's expensive. I'm gonna tell you, we just announced this. So I'm a little nervous to tell you, but I'm gonna tell you, we have um just announced a new affiliation with um a program in Minneapolis called the Minneapolis School of Nurse and Anesthesiology. And so they need an affiliation to do their degree granting. And they are already, they've been in existence 80 years. They are also top 100% of their students in the last three years have passed their boards. So top outcomes. And so we are affiliating with them to do their degree granting, and we will get revenue from that, and they will continue to benefit from it. And they're coming to us because they love the idea of integrative care, because they love being on a health sciences campus, and they've been at one of the state universities, and they're very excited about joining us.

SPEAKER_02 17:39

So I think there are ways to solve these things. You know, uh it's just like uh

Online Hybrid Learning Done Right

SPEAKER_02 17:45

having the first two or three years online. Yes. And if I remember correctly, you came from was it Camperville or what what do you think?

SPEAKER_00 17:53

I came from Capella.

SPEAKER_02 17:54

Capella, I'm sorry. That's what it was is Capella. And you knew online long before the people were into it in chiropractic. But uh don't you think things are online today? I mean, uh in our own business, uh the virtual training has gone online.

SPEAKER_00 18:10

Yeah, you guys have, yeah.

SPEAKER_02 18:12

And we we have a thousand doctors every year that take virtual training, and uh it's the way they do it now to get their license renewed, and they actually learn, they say better because they can sit in their office and do it a little piece at a time. And uh so we've and we're bundling it now so you can take different parts.

SPEAKER_00 18:33

Smart. I mean, my opinion is that of course you can't teach everything about activator or chiropractic in the online environment, but the didactic part you can teach better in the online, and then you can use the face-to-face time to get the top of what you need from a interpersonal.

SPEAKER_02 18:52

You know, I told you that we have 150 papers and 30 clonic compressors.

SPEAKER_00 18:56

Amazing.

SPEAKER_02 18:57

Well, one of our papers was uh testing online versus a manual in New Zealand, and they tried it with hands-on and then with online, and actually found the online was slightly superior to hands-on because people get look at it closely, go back and review it, where in a seminar they couldn't even get nearer to the table to see what the guy was doing and so forth. So I think there's some value both ways.

SPEAKER_00 19:24

Both ways. And some people don't like the online. Well, then we have to have options for them as well.

SPEAKER_02 19:30

Well, we're coming to Northwestern Health Science University in October for a live seminar, and we're really looking forward to that. And I I think some of the value of a live seminar is camaraderie. Yes. And uh, you know, they all get together, eat together, and uh drink together. And well, but they they learn from each other and they're doing the same kind of thing, and so they really build themselves up, and so that's why we have big attendance for those. So we'll look forward to that this fall.

SPEAKER_00 19:58

We're excited you're coming. And it's true, it's still hard to replicate the whole in-person experience in the online environment. That's why you know we do a lot of hybrid work. So our main lectures are actually delivered what we call flex. So you can come in person to the lecture. We record it so you can view it later, so you can learn again, like you said, or we live stream it. So if for some reason you can't be there, you're not well, whatever it is, you can still watch it.

SPEAKER_02 20:27

See, that's repetition, you know. And I had a friend of mine one time said you have to have repetition for learning. You do. It's just part of how

Closing Thanks And Sponsor Message

SPEAKER_02 20:35

the body and the mind works. So uh well, I think you sound like you're on top of it.

SPEAKER_00 20:41

Well, I don't know about that. Maybe a good day.

SPEAKER_02 20:44

I really appreciate you being uh here in the podcast today. And thank you. Uh we're gonna put this out to a lot of people. We're we're making some real progress in our podcast, and uh so everybody's having a look to see what people's opinions are on a lot of things.

SPEAKER_00 21:00

So it's an honor to be here. I appreciate you having me. So thank you, Dr.

SPEAKER_02 21:04

Bushway, the president of National Health Science University in uh Minneapolis. Well, Richfield, I guess it is, isn't it?

SPEAKER_00 21:10

Bloomington.

SPEAKER_02 21:11

Bloomington.

SPEAKER_00 21:12

Right next to Richfield, yeah.

SPEAKER_02 21:14

Being in Old Minnesota and I'm off a bit because I haven't been there for 30 years. You'll be there soon. Yeah, we'll be there soon. So thank you very much. All right, thank you. You can find more information on this table at softechtables.com.

SPEAKER_01 21:38

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