There are two aspects to specialization within health care. The first is when a practitioner limits practice to a certain population of patients, such as pediatrics or geriatrics. The second is limiting practice to a part of the whole, as in dermatology or extremities. When family practice became a medical specialty, a third concept needed to be added, as it would seem that a family practitioner is a generalist or the opposite of a specialist. Therefore, a specialty can be defined as a group of practitioners who acquire advanced training and qualifications, have a learned society, and produce at least one peer-reviewed journal for its practitioners and others.

As in chiropractic history, the history of allopathic medicine in America began with almost all physicians working as general practitioners. Rural areas were predominant and small communities were lucky to obtain the services of even one physician.

As the country moved from a rural population to a metropolitan population, specialization became practical. Metropolitan areas, with densely packed physician and patient populations, allowed for abundant referrals for those who wanted to limit their practices to areas of interest or expertise (4). This may be the best theory on the cause of the recent advent of specialties in chiropractic. As chiropractors become more abundant and the physician populations become more densely packed, there is the opportunity for limiting practices to areas of interest. If the general population is served, then not only is there room for specialization, but it may also become necessary for survival in a very competitive market.

Another theory for specialization in allopathic medicine is the growth of science and technology (5). Although technology does not play as prominent a role in chiropractic as in medicine, expensive visualizing methods such as computerized tomography and magnetic resonance imaging have led to chiropractors specializing in radiology consulting with practicing chiropractors rather than practicing (6).

In 1970, with the inception of a specialty board, family practice was given a new status in allopathic medicine (7). A general hue and cry went up for more family physicians, and government support attempted to mandate generalists. The specialist-technologist revolution was the “medical analogy to the industrial revolution” (7).

The attention that specialists were able to lavish on their areas of specialty led to a vast increase of knowledge in pharmacologic and surgical treatment of diseases. A hundred years later, the benefits of the specialist revolution may have run their course, and the emphasis on specialization is now seen by some medical observers as the cause for the imminent collapse of the present medical care system (7). “Our leaders have noted that we now have 38,000,000 uninsured patients; explosive, uncontrollable health care
costs; a disproportionate concentration of wealth in certain specialties; ‘turf wars’; refusal to treat patients who cannot pay; overspecialization; increasing public dissatisfaction; and poor relations between physicians and other professionals and between allopathic and nonallopathic physicians” (7).

Chiropractors have begun to enter the era of specialization by focusing their practices on select groups of patients. The long-established diplomates in orthopedics and radiology are being joined by specialists in nutrition, sports chiropractic, neurology, and pediatrics. Today’s Diplomate of the American Board of Chiropractic Radiology can trace roots back to the Universal Spinographic Association founded in 1923 at the Palmer School Lyceum (8). Discussion on the future Diplomate of the American Board of Chiropractic Orthopedics began in 1964 with the introduction of graduate extension orthopedics training by the American Chiropractic Association (9). The first examinations for the Diplomate in Nutrition (DACBN) were offered in 1985. In 1987, the certificate for team physicians became a certificate for chiropractic sports physicians (10), and the Diplomate for Chiropractic Sports Physicians was approved at the 1989 ACA convention (11). The ACA Board of Governors approved the formation of the Council on Neurology in 1971. The Diplomate in Neurology has its own checkered history, culminating in the American Chiropractic Neurology Board awarding its first diplomates in 1995 (12). A Diplomate in Chiropractic Philosophy (DPhCS) was established in 2002 (13), with the first graduates completing in 2005 (14). Unlike the other diplomate programs, it does not lead the practitioner to any specialization of practice.

The chiropractic care of infants and children is that which would happen in any chiropractic practice and has been happening since the beginnings of chiropractic. After over a century of chiropractic care of infants and children, chiropractic pediatrics has emerged as a type of specialty.

Daniel David Palmer validated the adjusting of children in his 1910 Chiropractor’s Adjustor [p. 579] when he responded to M. Kueck of South Bend, Indiana. In a 1908 letter, Kueck wrote, “I think I have all Chiros beat on the youngest patient. Our daughter was adjusted when she was one day and two hours of age. That one adjustment corrected her of diarrhea.”

The Founder replied, “B.J.’s child was adjusted by his grandfather when he was four days old—you get the persimmon.” B.J. Palmer’s child, Daniel David Palmer II (Dave), was born in 1906, so his adjustment by the founder of chiropractic predated that of the Kueck child. We have no reason to believe that these were the first adjustments of children, just that they were the first recorded.

Pediatrics was offered in the curriculum at the West Coast Chiropractic College in Oakland, California, as early as 1915 (15

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