NBCE Pushes Flawed Justification for Part IV Centralization
The American Chiropractor magazine recently published a press release from the The National Board of Chiropractic Examiners (NBCE) in which the NBCE attempts to justify their decision to centralize the Part IV exam in Greeley, Colorado, and to retain exclusive control over chiropractic licensure. The Press Release follows profession wide outrage at the land grab for control of the chiropractic profession being orchestrated by the NBCE and its patrons. They portray this move as a strategic step forward, but in reality, it is another attempt to solidify their monopoly over the chiropractic profession.
CLICK HERE for a copy of the Press Release
Interestingly, while the American Chiropractor magazine published the NBCE's Press Release along with previous glowing stories about the NBCE, they have not published a single news item about the resistance and opposition to this move despite the fact that more organizations and individuals have spoken out against it then support it. This speaks volumes about the bias of the magazine and its Editors. Below, we dissect each of the NBCE's points and expose the logical fallacies, misinformation, and disregard for stakeholders inherent in their plan.
FALSE Claim: Third-Party Testing is Necessary for Consistency
The NBCE claims that independent, third-party testing is needed to ensure uniform standards across all chiropractors, citing concerns over inconsistencies in college assessments. This argument is flawed for several reasons. First, chiropractic colleges are already accredited by both specialized and regional accrediting bodies, which certify their ability to properly assess student competency. These colleges conduct rigorous internal evaluations, including Objective Structured Clinical Examinations (OSCEs) and direct faculty assessments, to ensure that graduates are prepared for professional practice. The claim that in-school assessments are inadequate ignores the extensive, established accreditation processes and undermines the authority of these institutions.
Moreover, the medical and osteopathic professions have abandoned their equivalent high-stakes clinical skills exams. The USMLE Step 2 CS for MDs and the COMLEX Level 2-PE for DOs have both been suspended or eliminated due to the realization that in-school assessments are more than sufficient for evaluating competency. If these professions can trust their educational institutions, why can't chiropractic? The NBCE's insistence on maintaining their exam is more about preserving control than ensuring competency.
FALSE Claim: Standardization and Consistency
The NBCE argues that centralizing exams will guarantee uniform evaluation, thus eliminating regional discrepancies. However, they fail to provide any evidence that existing regional testing has led to inconsistent outcomes or compromised public safety. The NBCE already conducts Part IV in a quasi-regional fashion, holding the exam at various chiropractic schools around the country. If regional testing truly led to discrepancies, then the NBCE has been administering an invalid and unreliable exam for decades, and they should provide evidence to support these claims. Given that a coalition of organizations has asked the NBCE for outcomes data and they have not provided it, one can only assume that they are either withholding those data or that it does not exist. Despite repeated requests, the NBCE has not provided any empirical evidence demonstrating that any of their testing, let alone centralized testing, results in better practitioners or improved public safety.
Furthermore, regional and state differences in culture, diversity, and scopes of practice are strengths of the chiropractic profession, not weaknesses. These differences reflect the unique needs and expectations of diverse communities across the country. By attempting to impose a one-size-fits-all approach through centralized testing, the NBCE ignores these valuable variations, which actually argue against centralization. The suggestion that eliminating regional differences ensures fairness is a logical fallacy; true fairness involves acknowledging and accommodating regional diversity, not eliminating it.
FALSE Claim: The Schools are On Board - 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.
Additionally, the idea that centralizing the exam in Colorado ensures fairness ignores the financial burden and logistical challenges placed on students. These challenges disproportionately affect those who are already struggling financially, adding yet another barrier to entering the profession. This is especially egregious given that chiropractic students already graduate with substantial debt—forcing them to spend more on travel and lodging is neither fair nor supportive of the future of the profession. Beyond that, all students are already assessed for clinical competency prior to graduation by the chiropractic program. Centralizing Part IV positions the NBCE as the final arbiter regarding whether or not a graduate can get a license to practice, centralizing power over chiropractic licensure to one private corporation.
FALSE Claim: Enhanced Training and Evaluation through Video Recording
The NBCE touts the use of video recording to ensure objective evaluations and enhance training. While this may sound promising, it is hardly an innovation that requires centralization. Video recording could easily be implemented at multiple regional sites or within the chiropractic colleges themselves. The claim that this technology necessitates a centralized location is a false equivalence—video recording is not inherently tied to a single testing center. The NBCE is using technological improvements as a smokescreen to justify their power grab, ignoring feasible alternatives that would be less burdensome to students.
FALSE Claim: Resource Optimization and Cost Efficiency
The NBCE claims that centralizing testing will optimize resources and reduce costs, which will supposedly benefit examinees by stabilizing exam fees. However, this argument falls apart when considering the additional travel expenses students will incur, repeated trips to the NBCE Mecca due to weather, missed flights, illness and failed exams among a host of other obstacles. While the NBCE promises discounts on hotels and airfare, this is a superficial solution that does not address the root problem: the unnecessary requirement to travel at all. The financial burden of travel, lodging, and time away from other responsibilities far outweighs any marginal savings the NBCE claims to offer. Moreover, the NBCE has not provided any clear breakdown of how these cost savings will be passed on to students, nor have they justified why centralized testing is the most cost-effective solution compared to regional options.
The NBCE’s financial history also raises concerns about their motivations. Internal reports reveal that the NBCE holds $41 million in assets, and over $2 million was paid to directors and administrators in 2022 alone. Additionally, over $3.5 million in student loan funds were funneled to the Federation of Chiropractic Licensing Boards (FCLB) over the past five years – never mind all the years prior. These funds, derived largely from student debt, have been used for questionable purposes that do not directly benefit students or enhance educational quality. The concentration of financial resources within a select group of individuals and the close financial ties between the NBCE and other private chiropractic corporations further suggest that their decision-making process is driven by self-interest rather than genuine concern for the chiropractic community.
A review of minutes from recent state board meetings where this centralization has been discussed reveals confusion and concern on the part of state board members about this implementation and what it means for students and the state boards. Issues such as whether or not the exam is necessary, weather events, missed flights, repeated travel back and forth to the NBCE Mecca for those who fail the exam and a number of logistical issues have not been thoroughly evaluated.
FALSE Claim: Accessibility and Flexibility of Centralized Testing
The NBCE asserts that the new testing facility will offer greater scheduling flexibility, with exams available 48 weeks out of the year. While this may sound beneficial on the surface, it ignores the core issues: The exam is wholly unnecessary since schools already assess and certify clinical competency. Beyond that, the location itself is inaccessible for many students. Forcing all examinees to travel to Colorado disregards the diverse geographic distribution of chiropractic students across the country and internationally. The supposed flexibility in scheduling does not negate the fact that students will still need to incur significant travel costs, which were previously avoidable when exams were offered regionally or at the schools. The NBCE's framing of this as a benefit is disingenuous at best.
FALSE Claim: Enhanced Public Trust Through Standardized Testing
The NBCE claims that centralized, standardized testing will enhance public trust by ensuring all chiropractors meet the same rigorous requirements. However, they fail to acknowledge that the medical and osteopathic professions have found other, more effective ways to build public trust without relying on high-stakes, centralized exams. By empowering educational institutions and focusing on continuous, formative assessments, these professions have managed to uphold public trust while reducing unnecessary burdens on students. Chiropractic colleges are fully capable of assessing competency in a way that maintains public trust, and there is no evidence to suggest that an additional layer of NBCE testing is needed to achieve this goal.
FALSE Claim: Community and Collaboration
The NBCE's claim that centralizing testing fosters a sense of community among examinees is laughable. Students are being forced to spend significant money and time to travel to a single location, only to be subjected to a stressful, high-stakes exam that is completely unnecessary. Moreover, the NBCE is directly signaling to the public that they do not trust the profession’s educational institutions, regional and specialized accreditors (CCE) and that only the NBCE is capable or qualified to assess the competency of chiropractic graduates. It is an indictment against the entire educational process within chiropractic. This does not foster community—it fosters resentment. True collaboration and community-building occur in educational environments where students can learn from one another in meaningful ways, not during a one-off unnecessary examination at an unfamiliar location by a private corporation that enjoys a monopoly.
Conclusion: A Call for Action
The NBCE's decision to centralize the Part IV exam and their justifications for doing so are riddled with logical fallacies, misleading claims, and a blatant disregard for the real needs of chiropractic students and educational institutions. The lack of transparency, absence of outcomes data, and the failure to genuinely engage stakeholders in the decision-making process make it clear that this move is about consolidating power, not about improving the profession or protecting the public.
We call on state regulatory boards across the country, to remove the mandate requiring the NBCE’s Part IV exam for licensure. It is time to trust the accredited educational institutions that train and assess our future chiropractors and to end the restraint of trade and unnecessary monopoly that the NBCE has built over the years. The chiropractic profession deserves better, and it is up to us to demand the changes that will truly advance the field.
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