The NBCE’s Part IV Pilot Exam: A Failed Attempt to Maintain Control

The National Board of Chiropractic Examiners (NBCE) recently celebrated the what they refer to as the "successful" pilot of its redesigned Part IV exam, held in July 2024, but behind the flashy announcement lies a series of troubling issues they hope to ignore. The redesigned exam, featuring advanced technology like dual-camera video recordings, is being touted as a breakthrough in evaluating chiropractic competence. However, the NBCE’s lack of transparency, unwillingness to provide crucial outcomes data, and its monopolistic control over chiropractic testing raise serious concerns about its motives and the actual value of this exam.

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The MD's and DO's have Done Away with their Part IV Exams

The Chiropractic cartel often refers to standards within the medical and osteopathic professions to justify over regulating chiropractic or expanding its scope. Its interesting that they somehow have ignored how medical doctors (MDs) and Doctors of Osteopathy (DOs) have significantly reformed their licensure exams in recent years, doing away with their outdated, redundant tests in favor of more streamlined, evidence-based assessments that reflect the realities of modern practice. The MD's and DO's turned clinical competency evaluation over to the schools during COVID and haven't looked back. Many states no longer require a clinical skills exam for DOs and MDs, acknowledging that these exams were costly, time-consuming, and failed to demonstrate improved patient outcomes. This shift in medical and osteopathic licensure reflects a growing recognition that rigid testing structures don’t necessarily correlate with practitioner competence or public safety.

In stark contrast, the NBCE seems determined to push forward with its costly and redundant Part IV exam under the guise of "innovation." By emphasizing superficial technological updates like video recordings, they are attempting to maintain a stranglehold on chiropractic licensure. The NBCE is ignoring these developments in the MD and DO professions, which have recognized the futility of these types of exams. Instead of following this more progressive approach, the NBCE is rushing to implement their changes, hoping to solidify their monopoly before the broader chiropractic community can question their motives.

This strategy of moving quickly under the radar is a clear attempt to avoid scrutiny and maintain the status quo, even as other health professions are abandoning these outdated models. It’s time for the chiropractic profession to follow the lead of MDs and DOs by questioning the necessity and value of exams like Part IV, rather than accepting them as a fixed part of the licensure process.

NBCE Neglects to Provide Requested Outcomes Data

On October 24, 2023, a consortium of chiropractic organizations, sent a formal request to the NBCE seeking essential data to evaluate the impact of their exams on chiropractic education and practice. This request was made in response to the NBCE’s "Advancement and Development Project" and was aimed at addressing broad, sweeping claims the NBCE has made about the role their exams play in ensuring competency and public safety.

The NBCE took nearly three months to respond, and when they did, they failed to provide the requested data. Instead, the NBCE sent stakeholders on a wild goose chase, effectively acknowledging that the data to support their claims of competency and safety either did not exist or was inaccessible. This lack of transparency casts a shadow over the NBCE’s operations and raises serious questions about the validity of their exams and the motives behind their monopolistic grip on chiropractic licensure.

Stakeholder Requests for Outcomes Data Ignored

The consortium specifically sought data on crucial areas such as licensing exam success rates, performance trends over time, chiropractic college performance, practice success metrics, and safety records. The NBCE’s failure to provide comprehensive responses to these requests speaks volumes about their reluctance to be held accountable. In particular, the NBCE did not produce empirical evidence to back their claims that their exams ensure public safety and competence in the chiropractic profession.

The NBCE's ongoing refusal to engage in open and transparent discussions about the impact and relevance of their exams undermines their credibility. The chiropractic profession deserves more from an organization that holds such immense power over licensure, education, and regulation.

Internal Documents Reveal Disregard for Feedback

In January 2024, the NBCE gathered feedback from only 11 chiropractic schools about the proposed centralization of Part IV exams to Greeley, Colorado. The results revealed a divided response, with seven respondents acknowledging the necessity of change but expressing reservations about the centralization, five opposing the move, and three feeling they lacked sufficient information to form an opinion.

Considering the global impact this decision would have on chiropractic education, it is shocking that the NBCE consulted only a fraction of affected schools. The broader chiropractic community, including dozens of institutions worldwide, was largely ignored in this so-called stakeholder engagement process.

NBCE's Monopoly on Chiropractic Testing

For decades, the NBCE has maintained a monopoly on chiropractic testing and licensure, reaping financial rewards while ignoring the needs of the profession. The organization’s influence stretches into every corner of chiropractic education, licensure, and regulation, creating a virtual cartel that effectively blocks any meaningful competition or reform. This monopolistic control has been sustained by lobbying efforts and strategic relationships with state regulatory boards, all under the guise of ensuring public safety and competency.

However, as more chiropractic organizations and educational institutions express dissatisfaction with the NBCE's actions, it is becoming clear that the board's real agenda is preserving its financial interests. The NBCE’s refusal to provide outcomes data or adequately address concerns about their exams only reinforces the perception that they are more interested in maintaining control than genuinely advancing the profession.

Participants in the Pilot Exam

Who took part in the test?

Dr. Norman Ouzts (NBCE CEO), Christian Corona, Norelvis Fulton, Nicole Vuong, Alexander Schernecke, Candice Kingsman, Taras Woodson, Ariana Sirgew, Arden Leblanc, Dr. Karlos Boghosian (NBCE President), Dr. Marty Freihaut (NBCE Treasurer). Not pictured- Dr. LeRoy Otto (NBCE District II Director). Lauren Kettenhofen, Miranda Schultz, Ryan Evans, Rick Murphy, Hong Fei Wei, Elizabeth Ellis, Rafael Torres.

These individuals participated in the pilot and are ultimately part of a system designed to maintain the NBCE’s monopoly rather than address the core issues within chiropractic education.

A Call for Change

The chiropractic profession is at a crossroads. The NBCE’s refusal to provide outcomes data, their mishandling of stakeholder feedback, and their continued monopolistic control over licensure are unacceptable. It’s time for the profession to demand an end to the NBCE’s control and work towards a more transparent, accountable, and equitable system for chiropractic testing and regulation.

A growing coalition of chiropractic organizations, schools, and practitioners has already begun calling for significant reforms. The chiropractic community must stand united in demanding the NBCE either provide the data to back up their claims or step aside to allow for meaningful change.

The future of chiropractic care depends on a balanced, fair, and transparent regulatory environment—one that genuinely reflects the collective will of the chiropractic community and prioritizes public safety, competence, and professional growth. The NBCE’s Part IV exam redesign is not the solution. It’s a distraction from the real problems, and the time for change is now.

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