The Currency of Service

Chiropractic talks about service constantly. You hear it in recruitment ads, speaker bios, award nominations, retirement tributes. Everyone is serving the profession, serving the community, serving more people. It’s not the kind of thing that registers as unusual until you realize how much it occupies the space where other professions use different language entirely. Medicine emphasizes evidence and outcomes. Law emphasizes advocacy. Finance emphasizes returns and strategy. But this comparison only works if you assume all professions are actually trying to say the same thing about themselves and just chose different words.

The easiest explanation is that chiropractic has always attracted people who view their work as a calling. That’s not accidental. The founding narrative of the profession emphasizes purpose beyond commerce, helping people, restoring health, serving something larger than yourself. That appeals to a particular kind of person, and if you draw practitioners who genuinely experience their work as a vocation, then using the language of service makes sense. But this is true of medicine and nursing and physical therapy as well. They have plenty of practitioners who entered because they wanted to help. Their professional conversations don’t circle back to service with anything like the same frequency.

Why that difference matters isn’t immediately clear. The vocational explanation captures something real, but it’s incomplete. Chiropractic spent most of its first century fighting for legitimacy; the profession wasn’t universally recognized, licensing was inconsistent across states, and insurance coverage remained uncertain. If you’re constantly being questioned about your right to exist, you learn to lead with your intentions. You emphasize that you’re not in it for money or status, and you’re here to help. Over time, when your credentials are under fire, demonstrating your motives becomes part of professional identity, and that service language becomes defensive.

Yet this historical explanation doesn’t hold up either, because the language has become more prominent, not less, as chiropractic’s legitimacy battles have largely ended. Licensing is now established, and insurance coverage is more stable. The profession isn’t fighting for its right to exist the way it was fifty years ago. A profession that has felt misunderstood develops reflexes that persist long after they’re necessary. You keep emphasizing benevolence even after skepticism fades, because the habit is deep. You’re establishing good faith by default, not just to patients or insurance companies, but to yourself. It’s a way of managing old wounds that nobody talks about directly.

Markets communicate value in ways that matter psychologically, regardless of why you entered the profession. When something is paid well for, the market is saying it’s valued. You need to know that what you do is recognized as worth paying for. Over decades, if a profession feels economically undervalued relative to the complexity of the training and the work involved, that absence of recognition changes something fundamental about how the profession sees itself. The economic signals stop working. The market isn’t telling you what you need to hear, and eventually you stop looking to the market to tell you anything at all.

What happened next in chiropractic culture is subtle enough that most practitioners never noticed it happening. The profession didn’t consciously decide to replace one status system with another and didn’t announce the transition. It simply began to allocate respect along different lines. In the 1960s and 1970s, when insurance reimbursement was unpredictable and practices were often marginal, the chiropractors who gained influence weren’t necessarily the most financially successful ones. They were the ones who showed up, who attended state association meetings, who sat on committees, who wrote articles in professional publications, who took on leadership roles that paid nothing and demanded enormous time, who visibly sacrificed. A practitioner who built a thriving practice but didn’t participate in association work began to look slightly suspicious, not overtly, but in the texture of how the profession talked about practitioners. That person was said to be “successful,” which carried a subtle undertone. Successful at what, exactly? Making money? As if that were somehow beside the point of actually being a chiropractor.

Over forty years, this distinction hardened into something like an actual value hierarchy. The chiropractors the profession recognized and elevated were disproportionately the ones who had chosen association leadership over financial maximization, the ones who had sacrificed, who had gone on speaking circuits without compensation, who had taken on board positions that cut into their practice time, who had mentored younger chiropractors without billing them. The profession learned to admire this choice and to see it as the truest expression of what a chiropractor could be. Meanwhile, the chiropractor who built an extraordinary practice, who dominated market share in their community, who generated excellent outcomes and made significant income, that person began to register as slightly outside the profession’s central identity. Not bad, necessarily, but not the example or the model or the one the profession held up when it wanted to show what a chiropractor should aspire to be.

This shift didn’t happen because anyone sat down and planned it. It happened because the profession needed status markers that weren’t tied to insurance reimbursement rates or market forces; it couldn’t control those external systems, but it could control what it admired internally. It could build a reward system around visible commitment, teach practitioners to see sacrifice as virtuous and financial success as slightly suspect, and create an internal hierarchy where leadership in the profession, speaking engagements, association work, and mentorship became the real currency, the things that actually made you someone the profession wanted to become.

The word serve didn’t cause this shift but emerged from it. The language was the way the profession articulated what it had learned to value. When chiropractors talked about serving, they were describing the behavior the profession had identified as worth admiring: taking on roles that didn’t maximize income, giving time and expertise to the collective benefit, putting the profession’s advancement ahead of individual financial gain. That’s what serve meant, not benevolence in the abstract, but the specific choice to organize your career around the profession rather than organizing the profession around your career.

Most practitioners have never consciously examined this system and have inherited it and use the language because it feels true. The word serve has become so embedded in how practitioners talk about themselves that the alternative - measuring worth primarily through economic success and practice outcomes begins to feel impossible, maybe even corrupting. But the language itself might be quietly revealing something about what a profession does when external markets don’t consistently recognize its value. It shows how professions build internal systems that reward different things. How they create meaning through moral status instead of economic status. How a professional community can quietly reorganize its entire value hierarchy around what it can control when it can’t control what the market does to it.

That raises harder questions about the cost of organizing a professional community around sacrifice rather than expertise, around calling rather than compensation, whether a culture built so heavily on moral incentives can actually sustain itself, whether the chiropractors who chose association leadership over financial maximization built something real for the profession or whether the profession simply learned to admire the choice because it had no other way to recognize value, whether there’s a difference.

Dr. Glenn Jaffe is a practicing chiropractor with more than twenty years in the profession. He served as president of the North Carolina Chiropractic Association and has worked at the national and legislative level on the profession's governance priorities. He is the founder of BoldAzure, a leadership platform for chiropractors. He writes about where the profession is, how it got there, and what maturation actually requires.

Learn more at boldazure.com