End of an Era: FCER Decides on Self-Liquidation

The Foundation for Chiropractic Education and Research (FCER) has announced it will self-liquidate, meaning the organization will cease operations after serving the chiropractic profession for more than 60 years. The FCER Board of Trustees made the difficult decision after numerous efforts to find another organization that could take over the foundation's efforts on behalf of the profession. In this exclusive interview with Dynamic Chiropractic, FCER President Dr. Charles Herring discusses the FCER's history, accomplishments and final years, and emphasizes the need for continuing scientific support of chiropractic care as a means to advance the profession and maximize patient care.

Talk about the history of FCER and its many accomplishments.

In 1943, a group of chiropractors recognized that the future of the profession relied on an organization of chiropractic education and research that supported chiropractic theories and practices. Early on, FCER played an instrumental role in the chiropractic colleges obtaining national accreditation. From there, FCER evolved to meet additional needs of the profession and turned its focus on research.

Over the foundation's history, volunteers contributed more than 33,000 articles and helped fund over 152 randomized, controlled trials concerning chiropractic manipulation, as well as supported over 100 research fellowships leading to MS and/or PhD degrees. FCER's Fellowship and Research Residency programs have assisted in the education of many influential researchers and educators, [including] Scott Haldeman, DC, MD, PhD; Reed Phillips, DC, PhD; John Triano, DC, PhD; Rand Swenson, DC, MD, PhD; Christine Goertz, DC, MPH, PhD; Gregory Cramer, DC, PhD; William Meeker, DC, MPH; Alan Breen, DC, PhD; and many others.

With the support of NCMIC, Standard Process, Foot Levelers, ACA, NBCE, and many others too numerous to list, FCER has funded $11 million in chiropractic research. These pilot projects were then used to obtain over $20 million in federal grants for research projects at various chiropractic colleges.

In a long-range planning conference in November of 2006, FCER's Board of Trustees made [several] very focused decisions about the needs of the profession and the role that FCER should play in meeting those needs. With the availability of federal grants to fund major research projects and the declining contributions of large sums of money from various sources, FCER began to focus on pilot studies, which had already been a trend for a number of years. The board realized that the chiropractic research community would be able to leverage those studies into major federal grants. A second area of concern was the evolution of evidence-based health care. [The FCER board] made a very conscious decision to become the evidence-based resource for the practitioner and the student. The launch of the FCER "Evidence Based Resource Center"(EBRC) in 2007 was the first step to address these evidence-based needs. A second step was the creation of an evidence-based Web page - DCConsult.com - in 2008.

Attendees of the recent World Federation of Chiropractic meeting in Montreal, Canada, witnessed the fruits of FCER's labor. Numerous attendees commented to me personally that the quality of the program made them proud of our profession and its research community. As president of FCER, I was extremely pleased to see the vision, hard work, and financial support of many individuals and groups making a significant impact for the chiropractic profession.

But over the years, large contributors have not continued supporting FCER at the level they once did. Accordingly, and in the face of severely declining revenues, FCER leadership reduced the foundation's expenditures by over $1.2 million in the past two years. In January of this year, FCER's leadership believed that the foundation [had] finally reduced expenditures to a level that would allow the organization to continue operating within its budget and the few sustaining financial resources.

However, next came the blow that FCER could not withstand. FCER has for years received about 65% of its income from individual memberships. The current economic crisis that began to emerge in late 2008 has resulted in significant decreases in individual membership renewals. This has made FCER unsustainable from a financial standpoint. FCER is no different than many other foundations over the past few years; unfortunately, it is just one of many that have been forced to close their doors in the current economic crisis.

Some people have suggested that FCER's time has passed. How would you respond?

As stated above, FCER's board of trustees has recognized over the years the need to change its focus based on the needs of the profession and the available financial resources. Originally, the foundation focused on education and accreditation. The foundation then focused on major research funding and infrastructure development of the research community. As a result of decreased contributions from large donors and the development of federal grants, the focus of research changed to funding pilot studies that could help the researchers obtain federal grants using the results of the pilot studies funded by FCER.

Additionally, FCER has continued to support fellowships and research residencies.Over the past two years, FCER has also focused on supporting the needs of the individual chiropractor and student to better understand and use the scientific evidence in the treatment of patients. With the need to continue development of the intellectual capacity and educational knowledge of our research infrastructure, FCER has always funded fellowships and residencies. This has been a primary focus [of late].

Finally, the emphasis on evidence-based needs of the profession has become our focus. Some may say that this new direction is not important, but review of the external forces that evidence-based practices are having on clinical practice is widespread. Health care insurance companies, workers compensation programs, the courts, Medicare, and even the developing national health care "insurance" debate will turn to how to reduce costs and manage the quality of care. This will require more evidence than we currently have available.

Where does the loss of FCER leave our profession? Are there other organizations and processes that are picking up the ball?

Facing the many current and future challenges of evidence-based practice, the loss of FCER will leave the profession in many ways in a position to be unable to support the need for chiropractic care for many conditions. While many in the profession believe that we do not need more evidence or that evidence is not important, the fact is that most policy-makers in the payer world sees scientific evidence as the way to cut costs and continue to provide payment for those services that have demonstrated the greatest benefit to their insureds. Scientific evidence [can support] the statistical probability that one treatment will bring about better outcomes than another. As Congress said a few years ago, "You are in a fight against other health care providers to receive a greater portion of the health benefit dollars that Medicare spends. You will need to demonstrate to Congress why your services are more effective than others if you wish to receive more."

I have spoken to Lou Sportelli, DC [president of NCMIC] regarding the future of research. I know that NCMIC has established a research foundation and is funding that foundation with money to create a [self-perpetuating]fund for chiropractic research. Other than NCMICs efforts, I do not see any other organization stepping up to fill the void that will now exist with the absence of FCER.

Anything else you'd like to add?

I would be remiss if I failed to thank the many individuals who have supported FCER with their time, talents, and money for all these many years. There are too many to list here, but their efforts have been appreciated by FCER and often have gone unnoticed by the profession at large. These individuals are the ones who have understood the necessity of supporting this profession through the efforts of FCER. I have often said that every current effort and every future need and battle will need the underpinning of research evidence to make our arguments strong and our inclusion assured. Even the public understands the importance of research, and they are being encouraged to seek care that is supported by the evidence.

[Personally, I believe] the loss of FCER will have a devastating effect on the chiropractic profession. As has been the case for so long, the benefits [of this organization] do not hit you in the face ... they just build the very foundation for the argument that chiropractic care is beneficial. I hope someone or some organization will pick up the mantle.

Note: The FCER made the announcement that it would self-liquidate after we went to press with the Oct. 7 print issue, which notes that the FCER is filing for bankruptcy. The change in language does not affect the foundation's intention of ceasing operations thereafter.