NBCE's Exam Changes: Consolidating Power and Burdening Students

Following profession wide outrage about the behavior of its leadership, management of finances, mass resignations and monopolistic control over the profession, the National Board of Chiropractic Examiners (NBCE) recently announced what it describes as "critical advancements" to its exams as part of its so-called "Advancement and Development Project." 

Among these changes, scheduled for implementation in 2026, are a redesigned exam format and the controversial decision to administer all Part IV exams exclusively in Greeley, Colorado. The move forces every single graduate to make a pilgrimage to NBCE headquarters in order to be deemed competent enough to get a license. This is despite the school that issued the diploma already certifying students’ competency during over 4000 hours of education and competency evaluations. Never mind that the schools are all accredited by the Council on Chiropractic Education and regional accreditors. 

“Not enough” say the leaders and supporters of the NBCE which enjoys a monopoly on testing throughout the United States meaning no one is competent until they say you are.

While the NBCE claims these changes reinforce its commitment to high-quality assessments, a closer look reveals a troubling consolidation of power that places undue financial burdens on students and undermines chiropractic educational institutions and their autonomy.

Centralized Testing Location: A Financial Burden Disguised as Opportunity

The decision to centralize all Part IV exams in a single location in Greeley, Colorado, forces every chiropractic student to travel, regardless of their proximity to the testing site. The NBCE insists this change will "increase testing opportunities" by keeping the location open 48 weeks per year. However, this decision effectively imposes significant additional travel and lodging expenses on students, many of whom are already struggling with substantial educational debt.

The NBCE attempts to placate students by mentioning discounted airfare partnerships, negotiated hotel rates, and an airport shuttle service. These superficial gestures, however, come across as tone-deaf and dismissive given the high exam fees and financial struggles already faced by students. While students pay exorbitant amounts just to take these tests, NBCE directors are reportedly paying themselves substantial compensation, highlighting the disconnect between the organization's priorities and the needs of its stakeholders.

Consolidating Power and Further Undermining Chiropractic Schools

Centralizing the Part IV exam in Greeley not only burdens students financially but also consolidates the NBCE's control over the chiropractic profession. This move forever positions the NBCE as the final arbiter of chiropractic education quality, despite chiropractic colleges already certifying student competency through graduation. By inserting itself into this role, the NBCE undermines the authority of accredited educational institutions, dismissing their capacity to validate student competency.

Additionally, stakeholders have long criticized the NBCE for its monopolistic practices and excessive fees, particularly through its 25-year agreement with the Federation of Chiropractic Licensing Boards (FCLB). This agreement ensures exclusive FCLB support of NBCE exams, further limiting competition and empowering the NBCE to set exam fees at will. Its also no coincidence that the FCLB Headquarters is at the NBCE where they are provided free rent courtesy of student loan money. The centralization of the Part IV exam reinforces this monopoly and dismisses the role of the schools and external educational bodies.

Exam Fee Stability: A Hollow Promise

The NBCE claims that the centralized testing location will help stabilize exam fees by managing administrative costs more effectively. However, the organization's historical pattern of fee increases contradicts this promise. In 2021 alone, the NBCE reported $5.1 million in excess income, a sum higher than all student payments for Parts I and II exams combined. Despite this, the NBCE raised exam fees for 2021, further straining students' finances.

By imposing additional travel and lodging costs on students, the NBCE undermines its purported goal of fee stabilization. Instead of genuinely reducing exam fees, the organization is simply shifting the financial burden from one area to another.

Advancement and Development Project: Lack of Transparency 

The NBCE touts its so called "Advancement and Development Project" as a rigorous process that incorporates stakeholder feedback. However, the NBCE conspicuously omitted stakeholder dissatisfaction data from a survey showing that 1,343 chiropractic professionals and students overwhelmingly expressed their dissatisfaction with the NBCE's financial management and monopolistic control.

Key findings included that the majority of respondents voiced strong opinions regarding the financial practices of the National Board of Chiropractic Examiners (NBCE). An overwhelming 86% supported the idea of rebating the excess income of $5,178,512 from 2021, which notably exceeded the total amount paid by students for Parts I and II exams. Additionally, 90% of participants called for the NBCE to cease the use of student exam fees for donations to other organizations, suggesting instead that these funds should be used to reduce exam fees. Furthermore, a significant 94% of respondents advocated for a reduction in the total exam fees, proposing a cut of at least $1,500 per student, demonstrating a clear consensus for substantial financial adjustments in the NBCE’s operations.

On October 24, 2023 a consortium of several other organizations representing thousands of chiropractors sent a request to the National Board of Chiropractic Examiners (NBCE) seeking essential data to evaluate the role and impact of NBCE exams in chiropractic education and practice. These other organizations were responding to a request for stakeholder participation in the NBCE's "Advancement and Development Project" and assumed the NBCE was serious about wanting stakeholder participation. 

That assumption turned out to be wrong. 

The Consortium known for its advocacy in promoting freedom in chiropractic education, testing, licensure and practice, sought essential data to evaluate the role and impact of NBCE exams in chiropractic education and practice. In its marketing materials and representations to the public, state regulatory boards, accrediting agencies, federal government, schools, and students the NBCE makes broad, sweeping claims about their exams and the role they play in alledgedly ensuring competency and public safety. 

The Consortium asserted that access to pertinent data is paramount in pursuit of improved chiropractic education and examination processes. The comprehensive list of data requested from the NBCE encompassed critical aspects of chiropractic education and practice and would reveal if there is evidence to back up NBCE's claims regarding competency and public safety. 

Unfortunately the NBCE took nearly three months to respond to the stakeholders who took the time to engage in the process and once the NBCE decided to respond they did not provide the requested data and instead sent the organizations down several rabbit holes, ostensibly to find the requested data only to determine that it did not exist. 

The chief concern here is the NBCE's apparent evasion in providing comprehensive data in response to various requests made by the chiropractic community. These requests encompassed crucial areas like licensing exam success rates, performance trends over time, chiropractic college performance, practice success metrics, safety records, comparison with other health professions, and more. 

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In each case, the NBCE either provided insufficient information, redirected the request to other sources that did not address the request, or completely ignored the inquiries. Such responses, or lack thereof, cast a shadow over the transparency and accountability of the NBCE. For instance, in the case of safety records and malpractice claims involving chiropractors who have passed NBCE exams compared to those who haven't, the NBCE's response was not only inadequate but also evasive, failing to provide empirical evidence to support their claims of ensuring public safety. 

These actions by the leadership of the NBCE also demonstrates the disparity between the NBCE's public portrayal of its role and the reality of its influence and operations. The NBCE's public statements and marketing materials often present it as a crucial entity in maintaining professional competence and public safety in chiropractic care. However, the lack of empirical evidence and the evasion in addressing direct queries about its effectiveness and impact call these claims into question. 

Director Compensation and Exam Necessity 

NBCE directors receive substantial compensation while overseeing what many stakeholders believe to be unnecessary exams. Survey data reveals strong opinions that some NBCE exams, particularly Parts I, II, and III, are redundant and burdensome. By centralizing the Part IV exam location, the NBCE reinforces its unnecessary gatekeeping power and increases costs, which many view as yet another way for the organization to profit at students' expense while further consolidating their control over the profession. 

Conclusion 

The NBCE presents these changes to the Part IV exam as beneficial advancements aimed at improving assessment quality and testing opportunities. However, a closer analysis reveals that the changes reinforce the organization's monopolistic control over the chiropractic profession. Centralizing the Part IV exam location not only imposes significant financial burdens on students but also undermines the authority of accredited educational institutions. Moreover, the NBCE's response to concerns over added travel expenses with superficial discounts is dismissive of the genuine struggles students face. 

To realign the NBCE's practices with the needs of chiropractic students and the profession at large, the profession must prioritize transparency, affordability, and a re-evaluation of the necessity of their exams. Without these reforms, the profession risks destroying any autonomy the schools and graduates have left.