The National Board of Chiropractic Examiners (NBCE) has announced that beginning in 2026, the Part IV exam will be conducted at NBCE headquarters in Greeley, Colo. The change is an element of the organization’s Advancement and Development Project, which also includes tripling the number of Part I and Part II testing opportunities and providing a single score for both exams, which is expected to significantly increase the passing rate.1
According to the NBCE in a press release announcing the Part IV changes, “The Advancement and Development Project was initiated in response to stakeholder feedback around increasing testing opportunities, advancing technology in pre-licensure exams, and managing costs to avoid exam fee increases. To thoroughly address these concerns, NBCE conducted extensive research,” including studying best practices in other regulated health fields, exploring practical exam technology, and examining clinical assessment methodology.
“The intent is to produce more efficient exams while maintaining the fairness, reliability, and validity of the exams and providing more testing opportunities.”
In the current model, approximately 1,280 staff members are hired across the nation for each administration of the Part IV exam. However, the infrequency of exams, conducted only twice a year over two days, poses difficulties in finding and retaining reliable, high-quality staff. This results in premium wages and potential inconsistencies in the examination experience across different locations.
The decision to move to a centralized assessment center addresses several challenges inherent in the current examination model that render it unsustainable over time. These challenges include staffing concerns, standardization across multiple locations, limited capacity for innovation, and escalating operational costs.
Centralizing the Part IV exam allows NBCE to redesign the testing experience to more accurately reflect real-world patient encounters and implement the latest technology to support exam delivery. In addition to directly addressing the needs of examinees, chiropractic colleges and state licensing boards, the solution also provides more flexibility to pilot and implement future innovations. Rolling out new technology or processes at 14 test sites is both challenging and cost-prohibitive compared to a centralized approach.
By consolidating the Part IV exam administration to a single location on NBCE’s campus, these challenges are addressed while delivering several key benefits to examinees and stakeholders, as stated by the board in its release:
"1. Enhanced Efficiency: With a dedicated testing facility, the exam will be administered 48 weeks out of the year, significantly reducing waiting times and allowing examinees to take exams when they feel most confident in their abilities. This could also expedite the licensure process by up to three months, enabling future chiropractors to start their careers and earning potential sooner.
2. Improved Standardization: Centralizing the exam ensures a consistent experience for every examinee.
3. Cost Savings: The transition to a centralized assessment center will enable the implementation of enhancements such as increased testing opportunities and advanced technology like video recording while, at the same time, lowering monthly expenses by 6%. In contrast, realizing these same benefits at on-campus locations would result in a minimum increase of 64% in NBCE’s Part IV expenses.
4. Real-World Relevance: The redesigned exam format better reflects real-world patient encounters and clinical examinations offered at Doctor of Chiropractic Programs. This adjustment aims to improve the exam’s efficacy in assessing candidates’ clinical skills. Establishing the Part IV testing facility at the NBCE headquarters in Greeley will require an investment of between $8-$11 million for construction and technology. The NBCE has expressed that it does not intend to increase Part IV exam fees to meet these expenses. As part of the process, the NBCE is looking to establish an airport shuttle service and negotiate reduced hotel rates for examinees."
The goal of the changes to the computer-based exams and the centralized Part IV exam is to get students licensed and practicing sooner, which should more than offset the additional travel costs, according to the board.
“An important part of the Advancement and Development project has been collaborative evaluation and we are grateful for the time our many stakeholders have invested to share their feedback and insights with us to inform this next step in the future of chiropractic licensure,” said Dr. Karlos Boghosian, NBCE president, in the release. “NBCE is committed to making investments that will empower us to scale more efficiently, innovate faster and ensure professional competency and public safety through excellence in testing.”
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When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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