Many doctors of chiropractic and chiropractic students responded with letters to our initial article on the National Board of Chiropractic Examiners (NBCE),1 and the subsequent publication of position statements from the International Chiropractors Association2 and the American Chiropractic Association.3 In reading those letters, it was clear that there was some confusion about the distinct roles of the NBCE and the Federation of Chiropractic Licensing Boards (FCLB).
To help clarify the distinction between the two organizations and gain additional understanding of the issues involved, we conducted a written interview with Vernon Temple,DC, FCLB Chairman of the Board:
DC: What is the Federation of Chiropractic Licensing Boards?
Dr. Temple: Since 1926, the Federation of Chiropractic Licensing Boards has served as the collective voice of the chiropractic licensing and regulatory boards in the United States, Canada and Australia, with an open invitation to other nations to joint our association. Each state, province or other jurisdictional licensing board elects representatives to the FCLB.
Our mission is to protect the public and to serve our member boards by promoting excellence in chiropractic regulation.
All major health care professionals have federations of their regulatory boards that serve to make the state boards more effective. They, and we, maintain databases of public board actions, conduct educational conferences for board members, and work with other professions on matters of joint interest in regulation.
In addition, all federations have a close relationship with their testing agency. In fact, many function as one organization. All federations are funded primarily by testing revenues.
DC: How does the FCLB interact with other organizations?
Dr. Temple: The FCLB has representatives who speak for chiropractic licensure and regulation within several organizations. We have two representatives on the NBCE Board of Directors (our president and vice president). We also appoint one representative to the U.S. Department of Defense Military Demonstration Project Congressional Oversight Committee, one to the Council on Chiropractic Guidelines and Practice Parameters, and one to the Federation of Associations of Regulatory Boards. We also enjoy one seat on the CCE Board of Directors and one on the CCE's Commission on Accreditation.
DC: What is the FCLB's relationship with the National Board of Chiropractic Examiners?
Dr. Temple: The responsibility of all licensing and regulatory boards is to protect the public and ensure competency of the chiropractors which their jurisdiction licenses.
In 1962, the Federation proposed the creation of an independent testing organization for the chiropractic profession. This was in response to a number of legislative efforts in some states to force chiropractors to take medical board examinations for licensure.
In other states, basic science and clinical science examinations were written by individual board members and often lacked the legal reproducibility and comprehensive nature that national testing allows us.
As a 12-year member of the Vermont Board of Chiropractic Examination and Registration, I remember well the days when we, the board members, had to prepare the tests that are now replaced by Parts III and IV. Because of limited resources, individual state licensing could never be as complete or as fair as the current NBCE exams.
In addition to ensuring quality testing, national exams also enable greater mobility for practicing doctors. Mutual recognition of exam credentials allows doctors easy access to many states without taking multiple exams or maintaining multiple licenses.
Not only was the NBCE created by the Federation's member licensing boards, but both Parts III and IV were also developed at the request of the state boards, through resolutions introduced and passed at FCLB annual meetings.
The FCLB has, and should have, a very close relationship with the NBCE. This is essential to our mission. Remember, the NBCE tests are recognized in lieu of individual state licensing exams. Therefore, it is imperative that the individual boards and the Federation remain an integral part of the test development process.
DC: How do the Federation's member boards ensure the quality of the NBCE exams?
Dr. Temple: Individual practitioners from all practice philosophies are surveyed (published as the Job Analysis of Chiropractic), which is the foundation for the NBCE exams. The individual state boards monitor the NBCE exams through their direct involvement as members of test committees by selecting the Part III and IV examinations, and are involved firsthand with Part IV as examiners.
The Federation ensures the quality of the examination processes and policies by having two members of our board serving on the NBCE Board, and by those two members observing test sites during every test administration.
Our involvement with NBCE ensures that the examinations meet the necessary criteria for licensure in all of the jurisdictions that accept it. State board confidence in the testing process is reflected in widespread number of laws and regulations requiring the NBCE exams throughout the country.
DC: Why does the NBCE fund the FCLB?
Dr. Temple: The NBCE provides about 25-30 percent of the FCLB's annual budget. Our federation, and all other health care federations, depends heavily on testing revenue for general operations.
The funding provided by the NBCE allows the FCLB to promote good regulatory service. Federations focus on teaching member boards how to better protect the public, and provide networked resources for problem solving. Fair testing, more uniform disciplinary processes, better mobility for practitioners through uniform credentials, and quality educational standards are just a few of the focus areas for federations. Consumers, examinees and licensed practitioners all benefit directly from our work.
A number of organizations, including NCMIC and ACA, have been very generous in funding special development projects. Like all other federations, dues account for only a small percentage (about seven percent) of the costs of providing FCLB services.
DC: What is the FCLB's position on the current issues relating to the NBCE?
Dr. Temple: Let's make one thing very clear. Testing is not the issue. The National Board of Chiropractic Examiners meets important criteria for licensure in those states that have accepted the exams in lieu of individual state testing. Those who have earned one or more of the NBCE credentials should be proud of that achievement. It is critical to separate the exams from the current controversy, which has to do with board structure and policies.
Legitimate issues and concerns have been raised regarding the National Board of Chiropractic Examiners, the board's structure, the bylaws and the policies. Our representatives to the NBCE have stated in a letter to all U.S. licensing board members that they welcome these issues being raised and are committed to working for needed changes.
Some issues and concerns being raised are not legitimate or well founded. Anyone who believes that testing for chiropractic licensure should be compromised or discontinued is both naÜve about state regulation and unresponsive to public safety.
For example, the ICA has voiced concerns about Part III and Part IV, stating that the contents of these tests are often outside the legal scope of chiropractic and not reflective of what a chiropractor actually does. Again, these tests are based on the profession-wide Job Analysis (which includes participation by their members) and reflect precisely the skills and knowledge necessary to safely and effectively practice chiropractic. In addition, the NBCE heavily involves state licensing boards in test development and administration.
If any state board members have questions about the development of Parts III or IV, these can be answered easily by their participation in test committees and/or administration.
DC: What can DCs do to promote change in the NBCE?
Dr. Temple: Talk to your representatives. The state licensing boards generally have a registered delegate and alternate to both the NBCE and the FCLB. These delegates will speak for the protection of the public in their state when these issues are addressed in Seattle May 3-7. Stay informed about the outcome of this important regulatory conference.
Second, be proud of your exam credentials. As members of our licensing boards, we are entrusted with the responsibility of fair and adequate testing. The FCLB believes the NBCE exams represent the gold standard in testing.
DC: Is there anything else you would like to add?
Dr. Temple: We believe that a review of the organization, although sometimes initially painful, is a critical first step in addressing concerns. Accountability of the NBCE Board of Directors to the licensing agencies, which accept their tests, is paramount.
The state licensing agencies have entrusted the NBCE with the responsibility for testing for chiropractic licensure. The state licensing boards have documented their support of national testing repeatedly by being involved in the production of Part III and Part IV and have seen the benefit of national testing to their states, to the public and to the licensed chiropractor.
I am confident that the commitment to excellence in the regulatory process, which is the foundation of the Federation of Chiropractic Licensing Boards, will help set a tone for a balanced and thoughtful review of the NBCE. This can only improve the already excellent standing as a quality testing organization while enabling change where needed.
References
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