ICA Board Calls for "Immediate, Profound Reforms" of the NBCE

Editor's note: During our investigation of the National Board of Chiropractic Examiners (NBCE) and the development of our article on that subject (please see "NBCE: Violating a Professional Trust or Doing Business as Usual?" at http://www.ChiroWeb.com/18/03/13.html), Dynamic Chiropractic was unaware that both the International Chiropractors Association (ICA) and the American Chiropractic Association (ACA) were also looking into the situation.

In this issue, we are presenting the ICA's comments on the NBCE. Except for this editor's note, all the text you will read is from the ICA. It begins with some background information, followed by an "open letter" to the NBCE, and concludes with some commentary. The ACA's position on the NBCE is being formulated by their board and is expected to be ready for publication in our next issue.

 

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ICA's Board of Directors, after a six-month period of fact-finding, discussion and analysis, has issued an "Open Letter to the National Board of Chiropractic Examiners" calling for a series of immediate and far-reaching changes in the structure and policies of that organization.

ICA's Board convened during their mid-year meeting in Orlando, Florida in November 1999 and decided upon a series of steps that could be vital in correcting the damaging and abusive procedures and excessive costs presently in place in the National Board's testing system."The reasons behind this unprecedented step are obvious," said ICA President Dr. Robert Hoffman, "Every student, every new graduate and most of the educators I have spoken to since I became ICA president in May have literally begged for help from ICA to do something to bring reason and responsibility to the National Board testing process."

ICA began its fact-finding by obtaining the federal tax records of the National Board, which are a matter of public record. Those documents revealed the massive economic empire that the organization has built over the years, amassing millions in assets and registering an annual profit of well over $1 million. "ICA estimates that the National Board has added over $50 million to the student debt burden over the past 12 to 14 years," Dr. Hoffman continued. "In light of what we know about the financial strength of the National Board, the fees they charge and the delays they cause in obtaining licensure are indefensible and must be reformed."

ICA's executive committee met on December 15, 1999. Upon reviewing all of the data collected by ICA and other organizations, it approved the publication of a call for reform in an "Open Letter to the National Board," which reads as follows:

Open Letter to the NBCE

From the ICA Board of Directors to the Directors of the National Boardof Chiropractic Examiners:

The International Chiropractors Association, in response to genuine expressionsof concern by hundreds of students, new graduates, educators and doctorsin active practice, has undertaken an objective examination of the economics,politics and procedures presently in place in the testing process conductedby your organization. Our findings obligate this organization, as a responsiblebody concerned with the health and future of the chiropractic profession,to challenge the National Board of Chiropractic Examiners to recognizeserious problems and abuses within your system, and immediately undertakereforms to resolve a series of alarming and indefensible abuses.

Chief among the concerns that need to be addressed are the costs of NationalBoard testing. These costs are a major burden to any candidate for newlicensure and are not limited to the prices you charge for taking theexaminations. The thousands of dollars new graduates pay for your feesare most often borrowed and remain an ongoing burden to an already hard-pressed,loan burdened community. Arguments about the cost of testing cannot deflectthe legitimate concerns of those being forced to take your examinations.Steps to provide for computer-based objective testing such as are employedin most other postgraduate qualification examination processes need tobe explored as do other means of reducing costs. Reducing profit margins,however, is a moral imperative in light of the economic facts, both yoursand those of the student community.

Steps must be taken to reduce the long delays in candidates' abilitiesto take the National Board examinations and to obtain results. The almostunbelievable lag time of many months in the tabulation of scores and theissuing of results is perhaps the single most alarming element in theoperational methodology of the National Board. ICA cannot believe thatthe National Board is unaware of the costly and disheartening impact thesedelays have on candidates for licensure.

ICA urges an immediate re-channeling of resources to additional staffor technology that will change this shameful situation. The financialprofile of the NBCE certainly indicates that the resources are availableto make this possible. Once again, an exploration of online proceduresand technologies is indicated. The ability to obtain test results and,consequently, qualify for licensure, is the only means new graduates haveof beginning to earn a professional living. Delays must be reduced withan immediate goal of cutting the turn-around time in half.

ICA has significant concerns about the substance on which new graduatesare being tested. The ICA has, as every professional society is entitledto construct, its own vision and values for the chiropractic profession.Our concerns about the substance of National Board testing do not, however,stem from philosophical differences between ICA's values and yours. Rather,they stem from an objective reading of state laws and chiropractic collegecurriculum in comparison to the test contents, especially Part IV. Wesee a major divergence between what chiropractic is defined as being bylaw, how it is taught in the colleges, and the direction of your testquestions. To test candidates for licensure on topics outside the professionalscope of chiropractic as established by law, in a context far differentfrom which they were taught in chiropractic college, is simply inappropriateand unreasonable.

ICA challenges the National Board to convene a national conference ontesting substance that will correct this drift away from the fundamentalsof chiropractic and into the realm of other professions. This nationalconference should contain panels of democratically selected representativesfrom the educational process, state boards, professional organizationsand the National Association of Chiropractic Attorneys. This step canbe immediately undertaken and would have ICA's emphatic support. ICA believesthat accountability, responsibility and disclosure are vital to the properfunctioning of any organization that puts itself forward as a quasi-publicauthority-seeking jurisdiction over a profession, as the National Boardof Chiropractic Examiners certainly does.

Therefore, ICA believes that the governing structure of the NationalBoard must be changed to provide for the public and democratic selectionof a majority of the National Board's governing body. Such democraticand open governance is essential to restoring public and professionalconfidence in the functions of the National Board. Elements of this processshould include term limits, public reporting of activities and decisions,including financial records, leadership expenses and compensation, andresponsible democratic participation on the part of broad based professionalbodies such as the Congress of Chiropractic State Associations, the NationalAssociation of Chiropractic Attorneys, specialty groups and establishednational membership organizations.

Finally, ICA calls for the complete severance of financial relationsbetween the National Board of Chiropractic Examiners and the Federationof Chiropractic Licensing Boards. The blatant conflict of interest inherentin this relationship has troubled a broad segment of the chiropracticprofession, including the ICA, for many years. For a vendor marketingtesting services to dominate and fund an organization comprised of theconsumers of those testing services is, on its face, inappropriate. Thatthe FCLB has worked so aggressively to promote the power, reach and revenueof the National Board is clear evidence of the need to separate thoseorganizations for the greater good of the chiropractic profession.

ICA is aware that sound, credible alternatives to the testing servicespresently provided by the National Board of Chiropractic Examiners doexist. ICA hopes that major reform can be accomplished within the existingstructure of the National Board. We believe that a concerned professionwill demand it. If such reform does not take place in a timely manner,ICA has no doubt but that competing agencies will develop very rapidly.Such an effort will, under the right circumstances, have the reluctantbut emphatic support of the International Chiropractors Association anddozens of other chiropractic professional organizations.

The National Board of Chiropractic Examiners has an opportunity to self-correctthe long list of problems that ICA and other organizations have outlined.It is ICA's sincere hope that you will have the vision, courage and senseof responsibility for the greater good of the chiropractic professionto act on your own. This is ICA's challenge to you.

Thank you for your attention to these very important matters. ICA looksforward to your response.

Sincerely yours,

Robert J. Hoffman, DC, FICA President

Commentary from the ICA

The National Board of Chiropractic Examiners has been very aggressive in promoting the expanded legislative and regulatory mandate of their products. In state after state, the sales force of the National Board has sought to add more and more components to the required testing for licensure. Presently, this sales effort is working to expand the number of states that "require" Part IV of the National Board's testing series. ICA has been concerned by some of the arguments that have been put forward on behalf of this new testing level. In particular, ICA takes issue with the assertion put forward by persons representing themselves as acting for the National Board that the public needs and is demanding a greater level of professional testing for candidates for chiropractic licensure.

ICA has examined the public record regarding chiropractic safety, quality and consumer demands and complaints regarding chiropractic licensure and has found virtually no evidence that on any level, arguments of public concern can be substantiated. Quite the contrary, in fact. Public measures of satisfaction with chiropractic services and practitioners are at an all-time high, topping the charts compared with public attitudes toward medical professionals and institutions. ICA has recently spoken out on such marketing tactics through formal letters, written at the request of our members, to state licensing boards in Illinois, Michigan, New Jersey and Arkansas, challenging the assertions put forward by National Board salespeople that the public is "demanding" more and more professional testing of candidates for professional licensure.

ICA has also worked to ensure that state boards and the public are fully aware of the economic incentives behind the expansion efforts of the National Board, by making their federal tax records available to state decision-makers.

The aggressive efforts on the part of the National Board to expand their authority and economic reach have prompted some interesting and innovative responses by organizations besides ICA. Recently, the New Jersey State Board of Chiropractic Examiners issued a public letter to all chiropractic licensing boards attempting to develop support for their effort to require the National Board to change the manner in which they develop Part III of their current examination series.

This letter, having been released profession-wide, is now a public document. ICA was provided copies of this letter by many concerned members of state licensing boards who asked for input and support from ICA. The full text of this letter is available on ICA's website, along with other related documents, at www.chiropractic.org .

In a letter dated December 10, 1999, Anthony DeMarco, DC, president of the New Jersey State Board, stated:

"... There is great reluctance on the part of many board members to approve Part IV, due partially to the manner in which the NBCE develops the Part III Examination. The secretive and incomprehensible development process of the Part III Examination is very troubling. There is concern that unless corrected, these same procedures may one day be put into place for the Part IV Examination. The New Jersey Board is therefore seeking input and support from all licensing boards nationwide in requesting that the NBCE modify their Part III development procedures...."

"... the board believes that the inequitable and secretive nature of the Part III development process has gone unquestioned for far too long. The Board is concerned that these same secretive procedures will slowly make their way in the Part IV examination. It is for this reason that the Board would like to have these issues addressed prior to requiring part IV. The individual licensing boards may wish to reconsider their continued support of any mandatory licensure examination that fosters limited input and participation, and does not allow the opportunity for review..."

"...It is respectfully requested that your board expeditiously complete the attached survey and fax it back to this board with a copy to the NBCE..."

The process of qualifying for licensure should be objective, fair and strictly related to the realities of practice in a jurisdiction, as established by law. ICA strongly encourages all state chiropractic licensing and regulatory boards to carefully consider and respond to the New Jersey initiative. Likewise, ICA encourages all doctors of chiropractic who are concerned about the future of the chiropractic profession to let their respective state regulatory and licensing boards know how you feel about the New Jersey approach to securing a more equitable and relevant chiropractic examination process from the National Board.

"Each individual doctor of chiropractic has the opportunity to help shape a brighter and more reasonable and responsible licensure process by making themselves heard through their own state board." said Dr. Robert Hoffman. "We each have a personal stake in this matter because at present, the National Board, which was elected by no one, neither chartered nor accredited by any national government agency or recognized body, and, it appears, responsible to no one, is just not doing the job the profession needs or wants at this time."

ICA invites your comments and encourages a serious profession-wide discussion on these critically important matters. "ICA will lead the way in demanding fairness and responsibility from the National Board, or, lead the way to the establishment of an alternative," said Dr. Hoffman. "The choice, for the moment, is in the hands of those who govern the National Board. We hope it is a wise one."