The NBCE’s Practice Analysis Survey: A Sham of Stakeholder Engagement

The National Board of Chiropractic Examiners (NBCE) has recently circulated a Practice Analysis Survey, urging chiropractors to participate and share their insights, claiming that the input gathered will "shape the future of chiropractic practice." However, this call for engagement rings hollow in the wake of NBCE's recent actions that suggest they have little genuine interest in the opinions of stakeholders.

A Pattern of Ignoring Stakeholders

In January 2024, the NBCE conducted a feedback process concerning their controversial decision to centralize the Part IV exam at their headquarters in Greeley, Colorado and effectively centralize control of the profession by NBCE. This move, which consolidates their power over chiropractic licensure, was met with significant resistance. Despite the far-reaching implications of this decision, the NBCE's outreach was notably limited. They only sought feedback from 11 chiropractic schools worldwide, resulting in just 22 responses—a tiny fraction of the institutions and individuals who would be affected by this change.

Even within this small sample, the feedback was mixed at best. According to the NBCE's own report, seven respondents supported or understood the need for centralization, another seven expressed serious reservations about relocating the exam, five opposed the move entirely, and three felt they lacked enough information to form an opinion. This response highlights the deep concerns within the profession about the NBCE's power grab, concerns that the NBCE has ignored and brushed aside.

The Nerve of NBCE’s Claims

The NBCE’s email encouraging participation in their Practice Analysis Survey is particularly galling. They claim that by contributing to the survey, chiropractors will have a direct impact on shaping the future of the profession. However, recent and past history shows that the NBCE has little regard for the input of the chiropractic community when it conflicts with their own agenda.

Despite significant pushback from schools and concerns from states like South Carolina about how these changes will negatively affect students, the NBCE has pressed forward with their plans. They’ve refused to provide crucial outcomes data that could validate the necessity of their exams, further fueling the belief that these exams are more about maintaining control and generating revenue than about ensuring competency in the profession.

Its Good to Have a Monopoly

The NBCE’s dominance over chiropractic licensure exams has long been a point of contention. Their exams, particularly the Part IV clinical competency test, have been criticized for undermining the authority of accredited chiropractic schools. These institutions are tasked with educating and certifying the competency of their graduates—graduates who must then undergo additional, costly testing to satisfy the NBCE's requirements. This redundancy not only strains students financially but also suggests that the NBCE does not trust the rigorous assessments already conducted by these schools.

In reality, the NBCE's exams serve to restrain trade by creating unnecessary barriers to entering the chiropractic profession. They position themselves as the ultimate gatekeepers, a role that should rest with the educational institutions that have already vetted and certified their graduates.

This is the dirty little secret no one is talking about - or wants to talk about. If the claims that NBCE Part IV exams are necessary then the only conclusion is that the schools are handing out diplomas to people that are incompetent. That should be a scandal that the profession investigates immediately and with no stone unturned. But of course no such investigation is underway because the NBCE, CCE and FCLB enjoy monopolies.

Meanwhile, other healthcare professions have moved away from similar high-stakes exams. Both the medical and osteopathic professions have eliminated their versions of the Part IV clinical competency tests, recognizing that comprehensive evaluations conducted by accredited schools are sufficient for certifying the readiness of their graduates. The fact that the chiropractic profession continues to be saddled with these redundant exams speaks to the NBCE’s desire to maintain its monopoly, not to any genuine need for additional assessment. And the fact that the NBCE cannot provide outcomes data related to their public claims is further evidence that it is simply a conduit for student loan money. 

A Call to Reject NBCE's Legitimacy

Chiropractic school's call for alumni to participate in the NBCE survey is a slap in the face to alumni that paid for their education, were certified competent by the faculty, and given a diploma. The completion of the survey is nothing more than an attempt to lend legitimacy to their ongoing power consolidation. Alumni should be outraged—not supportive. By participating in this survey, they are unwittingly endorsing a system that undermines their profession and perpetuates a monopoly that serves the NBCE's interests, not those of the chiropractic community.

It is time for chiropractors to recognize the NBCE’s tactics for what they are: a moral crime against the profession. The real way to advance chiropractic care is to empower the educational institutions that have always been at the forefront of training competent practitioners—not to hand over more control to a single organization that has shown time and again that it does not truly value the input of its stakeholders.

Conclusion

The NBCE’s Practice Analysis Survey is a hollow gesture from an organization that has consistently ignored the concerns of the very community it claims to serve. It’s time for chiropractors to push back against the NBCE’s monopoly, reject unnecessary exams like Part IV, and demand a system that respects the authority of chiropractic schools and the professionals they educate. Lets ensure that the future of chiropractic practice is shaped by those who truly have the profession’s best interests at heart—not by a single, self-serving entity.