Recently, as Texas Board of Chiropractic Examiners (TBCE) enforcement chair, I had the opportunity to write an article for the Texas Journal of Chiropractic as part of an effort to help Texas DCs avoid board sanctions.1 In addition to scope-of-practice issues, some boards have rules on the proper use of advertising and credentialing, and violations abound.
A quick survey of chiropractic websites, print ads and Yellow Pages ads demonstrates a chronic misunderstanding of the proper role of the National Board of Examiners (NBCE), state boards, specialty boards and credentialing groups. The problem is national in scope.
Credentialing and Certification
Using credentials incorrectly is a form of misleading advertising and could lead to disciplinary action by state boards and even legal action by the NBCE when its name is involved. Many times, credentials are considered proprietary and have rules attached for their use. For example, some specialty boards do not allow the use of the term board eligible. They take the position that you are either board certified or not. And yet, there are quite a few board-eligible DCs (e.g., orthopedics).
Many DCs also claim board certification where none exists. This is misleading to the public, giving the impression you have advanced credentials.
Why the Misunderstanding?
Many such problems seem to emanate from a misunderstanding of the role of various professional boards, agencies, specialty boards, etc. State boards are regulatory and issue licenses to practice. State legislatures define the scope of chiropractic allowed for the state. Together, they define the rules, boundaries and limitations for the practice of chiropractic in the state.
National organizations, on the other hand, serve two credentialing roles: licensing or specialty board testing. The NBCE is a testing agency validating the knowledge competency to practice chiropractic through various examinations. It does not award specialty board certifications.
Specialty boards are academic boards certifying competency in specialty areas after a 3-5-year program and the passing of written, practical and oral exams. They award diplomate and fellow designations. The two main organizations with specialty councils are the ACA and ICA. There are also private organizations awarding diplomates.
Training vs. Licensure
DCs, especially new ones, often assume scope and education are synonymous. There appears to be a disconnect in understanding – what you are trained to do is not what you are licensed to do. Even specialty board training and certificate completion will not allow you to expand your scope of practice unless your legislature has tiered your license.
This can be frustrating; however, it must be understood that state boards are responsible for enforcing what you are licensed to do to protect the public.
Credential Use and Misuse
The NBCE designation "Diplomate of the National Board" is commonly misused, especially by those graduating after 1982. The NBCE does not designate specialty board status and has a clear position statement on its website regarding how to use the designation properly if you graduated before 1983.2
Basically, this designation only certifies successfully passing parts I and II of the National Board Exam. Here is the link for the NBCE position statement on how to properly use the diplomate certificate: http://mynbce.org/score/licensing-certification/. If you were licensed before 1983, the NBCE recommends using the following: "Holds NBCE Diplomate Certificate 19XX."
By the way, it is also incorrect to state you are board certified in acupuncture when you only have a certificate of attainment from the NBCE.
Many chiropractic practice websites claim the doctor is "board certified by the state board of chiropractic examiners. This is commonly misused and misleading advertising. State boards license DCs to practice within their legislated scope of practice. They are not board-certifying agencies.
Others indicate certifications in certain techniques where the organization does not issue certifications, or does not even exist. Claiming certification in a general technique such as diversified technique, for example, is misleading unless there is a certifying agency.
Diplomate status is awarded based on completing a specialty board program and passing written and oral examinations. Upon completion of the requirements, you may use the appropriate credentials. It is important to check with your specialty agency to determine their guidelines for the proper use of credentials.
Some states require you to identify your credentialing board when using advanced credentials. Certificates are generally awarded by colleges or other organizations, and should be clearly identified. However, keep in mind they are not board certifications and should not be stated as such. Certification programs do not meet the criteria of specialty boards.
A Word About Degrees
Grammatically, it is a good idea to list degrees in the order awarded. Double "doc-ing" is not grammatically correct and actually gives the impression of a poor education. This is a conundrum for the DC due to states requiring identification as a chiropractor. However, it is more appropriate to state "John Deerefield, DC," or "Dr. John Deerefield, chiropractor" than "Dr. John Deerefield, DC" – i.e., double doc-ing.
Professional Takeaway
It is often a challenge when marketing to make your image as positive and strong as possible. The use of credentials is one way of making the public aware of your qualifications. However, misuse of credentials can lead to disciplinary action by state boards for misleading advertising and even legal sanctions when using proprietary names.
Professionalism dictates the proper use of credentials to present an accurate portrayal of one's qualifications. Failure to do so reflects poorly on you and the profession.
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?
