During my 35 years in the chiropractic profession, I have been forced to attend available continuing-education programs that were occasionally incredibly beneficial, but frequently not worth my time. I have sat through philosophy sessions that spent most of the time bashing medicine, and others that taught I needed a syringe in my office or I was going to fail. At both ends of the spectrum, I got my CE credits, although my time could have been better spent by acquiring a higher level of clinical excellence through better course options.
Currently, the system fosters and perpetuates an extremely limited and antiquated paradigm in learning, but fortunately, there are simple, cost-free solutions. I recently petitioned the New York State Education Department, Chiropractic Unit (my licensure board) to make changes in our system, and these are the same changes that should be reflected nationally. I urge every doctor of chiropractic to petition your state board demanding the same changes if applicable.
I am petitioning the chiropractic board here in New York to create changes at the regulatory level regarding how graduate chiropractic education (postdoctoral education) is structured. Currently, the system is functioning under restrictive constructs that have created a potential public health risk. These risks are compounded every day as new scientific findings are released across professions.
Chiropractors are primary health care providers and portals of entry into the health care system in New York, yet the sponsoring entities currently in place cannot keep up with the graduate-level academic demands to keep primary spine care providers, let alone primary care providers in general, current on these issues.
Three Changes to Improve Our Continuing Education
There are three levels of regulatory changes needed in continuing education for chiropractors in every state:
1. Give course instructors an incentive to create new content. For example, the legal profession in New York offers three credits for every hour of instruction to incentivize both future and quality content.
Every creator or presenter of a continuing-education course should be given at least one credit for courses taught, if not three as prescribed by the legal profession in New York according to the New York State Unified Court System (2014).1 Beyond the incentive, as an example, it takes creators of courses often countless hours to create courses, yet they get no CE credits and are mandated to take other courses, limiting their time from finding cutting-edge research to learn and then teach to the chiropractic profession.
2. Accept the national umbrella of the Federation of Chiropractic Licensing Boards' PACE courses to be considered toward licensure credits in all 50 states. In medicine, the ACCME (Accreditation Council for Continuing Medical Education) is a national medical umbrella recognized by all 50 states and U.S. territories for AMA graduate medicine credits. This allows a medical doctor in any state to benefit from courses created without state restrictions and learn all that is available in our nation.
As a provider of continuing education, it is a daunting and expensive task to apply for continuing-education approval in all 50 states and territories individually for each course created. As a result, those providers limit the states applied to due to a lack of resources.
This is not a function of an application fee; it is a function of mandating multiple full-time staff members to manage the application process and then interface with the sponsors and state regulatory agencies. This is a verified common theme among many continuing-education providers nationally. Therefore, most providers limit the states they apply to, and every state not approving credits issued by the PACE program prevents the many quality courses from being offered to doctors of chiropractic in other states. The lack of available courses in other states is a direct risk to providers in those states.
I am not suggesting the removal of any current regulatory ability of political or educational institutions to sponsor continuing education, although politics should have no place in academia. I am, however, strongly suggesting the addition of courses approved by the FCLB's PACE program, as the only national umbrella available, to the pool of graduate-level chiropractic education available to doctors of chiropractic for their continuing-education credit requirements.
This would instantly, at no cost to the state, increase the availability of knowledge available to chiropractors – to the immediate and perpetual benefit of its citizens, to whom the chiropractic boards are ultimately held responsible.
I also realize the political and financial issues this would create for the organizations that historically have monopolized continuing education. However, the safety of the people of our country has to take precedence over fiscal or political issues. This will again cost the people of our country nothing. Currently, 28 states and territories accept PACE credits.2
3. Accept AMA credits approved by the ACCME toward chiropractic continuing-education requirements when the topics fall within the scope of practice for doctors of chiropractic. Medicine has infinitely more resources in research and teaching than chiropractic has or will have in the near future, based upon medicine's infrastructure and funding at the private and governmental levels. Therefore, the chiropractic profession is severely limited in terms of learning new technology and chiropractic boards are not "nudging" doctors of chiropractic to be current in health care by not allowing medical continuing-education credits to be considered toward re-licensure.
As an example, concussion is an increasingly common clinical presentation in a chiropractor's office. However, as a finding it has been limited by a diagnosis of exclusion: ruling out bleeding in the brain and a history of cognitive and or motor functional losses. Recently, there has been a diagnostic breakthrough in early detection, rendering a conclusive diagnosis for concussion with a blood test.3
Although this is applicable in our offices, we have no formal access to learn this and other cutting-edge technology until someone like me, who is comparatively poorly qualified in comparison to the originator of the research or a specialist in their respective field, spends the time to teach what I have learned out of my specialty to our profession (at no continuing-education benefit to myself).
Medicine offers a rich source of graduate medical programs that are directly applicable to the practice of chiropractic. Although we are not seeking medicine to justify chiropractic, it would be Pollyannaish to think we cannot learn MRI interpretation, differential diagnosis, tumor detection, stroke screening, etc., from medical academia.
States such as Virginia and Maryland already accept ACCME credits for chiropractic continuing education – to the perpetual benefit of the people living in those states. I recommend all states remove their restrictive regulations, understanding that we would not be breaking any new ground – only helping to protect our citizens by giving doctors of chiropractic an opportunity to practice at a higher level of clinical excellence.
Chiropractors Need More Access, Better Choices
I conducted a survey on June 27, 2016 for all 50 states and asked a single question: "Do you wish the chiropractic profession had more access to better continuing-education courses?" Just over 96 percent of the 696 respondents (all doctors of chiropractic) reported they want more access to better-quality continuing education.
This result validates my observations and market research over the past decade on this topic. These are common-sense suggestions that reasonable people should consider when charged with protecting the citizens in their respective state.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
