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

BACKGROUND: Physician referral rates to chiropractors remain low in Quebec, and few multidisciplinary clinics include both professions. Yet these settings represent a unique opportunity to study interprofessional collaboration in musculoskeletal care. This study aimed to identify facilitators and barriers to physician-chiropractor collaboration in multidisciplinary clinic settings, and to evaluate perceptions regarding the effectiveness of collaborative efforts on patient care. METHODS: An explanatory sequential mixed-methods design was employed. Between February and November 2024, quantitative data were collected via surveys of 23 chiropractors and 19 physicians practising in multidisciplinary clinics including both professions. Qualitative data were collected through a semi-structured focus group with seven chiropractors and individual semi-structured interviews with five physicians. Survey data were reported with descriptive statistics, and qualitative data were analyzed using thematic analysis. RESULTS: Survey results indicated that nearly 70% of physicians referred patients to chiropractors at least monthly, driven primarily by established relationships or patient requests. Despite broadly positive mutual attitudes, physicians expressed concerns about the safety of cervical manipulation and professional liability. Chiropractors identified personal knowledge of other providers and physical proximity as the strongest enablers of collaboration with physicians, while clinical workload and patients' financial constraints were the primary barriers. Both professional groups attributed high value to interprofessional collaboration; most chiropractors and physicians reported that collaboration improved patient satisfaction, clinical outcomes, and overall quality of care. Qualitative analysis revealed three themes: perception, organization of care and services, and communication. Perceptual barriers included educational silos, historical professional tensions, and variability in chiropractic practices. Structural obstacles included out-of-pocket costs, exclusion from public care settings, and administrative burdens. Facilitators included personal experience with chiropractic care, co-location, clear referral pathways, and direct communication modalities. CONCLUSIONS: In multidisciplinary clinic settings, interprofessional collaboration between physicians and chiropractors is valued and perceived as beneficial by both professional groups. Despite a favourable relational environment, collaborative practice remains heavily reliant on informal, relationship-driven interactions rather than embedded organizational structures. Our findings underscore the need for education, organizational integration, and communication infrastructure to improve interprofessional musculoskeletal care.