A Chiropractic program consists of five academic years of professional education at an accredited college averaging a total of 4,822 hours of coursework, which is about the same as for Medical Doctors. However, instead of courses in medications and surgery, Chiropractic programs include courses in Manipulation, Physiotherapy, Nutrition and Advanced X-Ray. Doctors of Chiropractic are licensed as primary care physicians in all 50 states, and State licensing boards regulate the Chiropractic profession just as in the Medical profession. There are 18 Chiropractic colleges in the United States and 44 Chiropractic colleges worldwide.