The National Board of Chiropractic Examiners (NBCE) has set forth a plan to centralize Part IV exams in Greeley, Colorado, a decision that has stirred a variety of responses from a small segment of chiropractic schools. Despite the broad impact this decision could have across the globe, the NBCE’s stakeholder engagement appears to have reached only a fraction of the institutions affected. With feedback gathered from just 11 schools out of the many around the world, the depth and representativeness of this consultation come into question. 

According to the document, in January 2024 the National Board of Chiropractic Examiners (NBCE) gathered feedback on the proposed centralization of the Part IV exam. The NBCE conducted calls with the test site staff leadership at every Part IV site to present the changes and solicit feedback. Following these discussions, and after providing additional information to address concerns from various Doctor of Chiropractic Programs, the NBCE distributed a final survey to assess the schools' support for the proposed changes. This survey garnered 22 responses from only 11 different chiropractic programs. 

The results indicated general support for some of the proposed changes; however, the idea of moving to a centralized testing location received “mixed reactions” according to the NBCE. Specifically, NBCE claims that seven respondents “supported” or at least “understood” the necessity of moving to a centralized location, another seven acknowledged the need for change but expressed reservations about relocating the exam to Greeley, Colorado. Five respondents did not support the move, and the remaining three felt they lacked sufficient information to form an opinion on the matter. 

Scope of Feedback

The chiropractic community is extensive, with 19 schools in the Association of Chiropractic Colleges (ACC), which includes two in Canada and one in France. There are also non-ACC member schools like Sherman and Campbellsville, and 19 schools accredited by the Council on Chiropractic Education (CCE) in the United States alone. Internationally, there are at least 25 additional schools, including six accredited by the Council on Chiropractic Education Australasia (CCEA) and twelve by the European Council on Chiropractic Education (ECCE). Given this wide array of institutions, the feedback from respondents at only 11 schools highlights a significant gap in the NBCE’s engagement efforts.

Analysis of Feedback 

Of the 11 chiropractic schools that participated in the NBCE’s feedback process, the reactions were generally skewed towards concern or opposition. Seven respondents either supported the change or at least understood the need for centralized testing. This support is contingent upon perceived benefits such as increased testing efficiency and better standardization. Seven understood the need for the change but expressed concern over the choice of moving the exam to Greeley. Five did not support the move to a centralized location and the remaining three said they did not have enough information to determine their level of support. This indicates that the majority of respondents from chiropractic colleges did not support the move or did not have enough information to decide. 

Concerns and Criticisms 

The limited feedback, combined with substantial concerns from a majority of the engaged schools, paints a picture of a decision that may not have been fully thought through in terms of its broader impact. Respondents that were not supportive or had reservations highlighted the need for better communication and more detailed justifications for why the centralization at Greeley is necessary and how it would benefit the broader educational community beyond the NBCE’s operational efficiencies. 

NBCE Ignores Stakeholders it Doesn’t Want to Hear From 

A coalition of chiropractic organizations has come together to express significant concerns regarding recent changes announced by the National Board of Chiropractic Examiners (NBCE). They claim the changes, which include centralizing Part IV exam testing in Greeley, Colorado, have been criticized for consolidating control, increasing the financial burden on students, and ignoring vital stakeholder feedback.

The group's response stems from the NBCE's claim that the recent alterations to its exam and policy framework "directly address the key pieces of feedback we heard across all our stakeholder groups." Contrary to these claims, the coalition asserts that the NBCE has selectively ignored input from thousands of stakeholders opposed to the monopolistic structure benefiting financially from unnecessary examinations. 

On October 24, 2023, several member organizations sought essential data from the NBCE to evaluate the impact of its exams on chiropractic education and practice. The response from the NBCE was significantly delayed and ultimately unhelpful, providing no meaningful data and failing to address requests for information on licensing exam success rates, performance trends, and other critical metrics. This lack of transparency has raised concerns about the NBCE's accountability and its sweeping claims regarding competency, public safety, and excellence in testing. 

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General Feedback Trends 

The overarching feedback trend calls for more transparency and inclusivity in how the NBCE communicates and makes decisions affecting a global community of chiropractic practitioners and students. There is a clear demand for a comprehensive explanation and a more detailed discussion on the impact of such significant changes. Given the fact that the NBCE enjoys a statutorily mandated monopoly and effectively acts as the sole gatekeeper to licensure it’s not likely they will ever listen to those stakeholders they do not agree with and the internal document from the NBCE is clear evidence they are not listening to stakeholders. 

Part of a Larger Problem

In an unprecedented show of unity and resolve, several dozen chiropractic organizations, non-profit foundations, schools, and businesses have come together to endorse a series of significant Resolutions advocating for a free and competitive marketplace in chiropractic education, licensing, and practice, challenging these longstanding issues within the profession.

The united statement and the Resolutions reflect a deep-seated need for change in the chiropractic profession. Historically, the field has been dominated by what Dr. Lawrence J. DeNardis of the National Advisory Committee on Institutional Quality and Integrity (NACIQI) of the U.S. Department of Education termed a "virtual cartel". This monopoly has marginalized various factions within the profession, particularly those practicing conservative chiropractic methods.

As this situation continues to unfold, it is imperative for all stakeholders, including chiropractic colleges, practitioners, regulatory boards, accreditors, and the public, to critically evaluate the role and claims of the NBCE. The future of chiropractic care hinges on a balanced, fair, and transparent regulatory environment, one that truly reflects the collective will and needs of the chiropractic community.

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Conclusion 

The decision by the NBCE to centralize Part IV exams in Greeley, Colorado, has clearly revealed divisions within the chiropractic educational community and was clearly made based on what is in the best interests of the NBCE and not the larger chiropractic community. The feedback from respondents at only 11 schools—out of dozens globally—raises significant concerns about the inclusiveness and effectiveness of the NBCE’s stakeholder engagement process. The predominance of concerns and criticisms among these responses underscores the need for the NBCE to revisit its approach and decisions. It also calls the larger chiropractic community to demand an end to the monopoly controlling chiropractic education, licensing, testing and practice.