Chiropractic CE: At a Crossroads & a Crisis

The chiropractic profession is being accepted at unprecedented levels nationally. We have emergency rooms, hospitals, surgical and medical groups, large corporations and a myriad of other entities seeking out the "best of the best" in our profession to refer to and work with collaboratively. This is called "primary spine care," where we are the first referral option for mechanical spine issues.

Some will argue that we are not purely "pain doctors"; however, if the patient is not in your office, you are nothing and being accepted in mainstream health care is the only sustainable solution to increased utilization.

Knowledge (and Credentials) = Power

Over the past 20 years, significant market research has proven that the only avenue to ensure these types of relations and acceptance is through formal credentials and the knowledge associated with those credentials. Our professional schools are responsible to teach us enough to graduate and pass our boards; the rest is on each of us individually, and that comes in the form of continuing education. In medicine, it is called graduate medical education and in chiropractic, it is called postdoctoral education. Medicine does it right, whereas our profession has placed too many regulatory and systematic roadblocks that prevent our doctors from many quality graduate-level educational opportunities.

Roadblocks to Continuing Education

The problem comes from having too many states that are autonomous in delivering continuing-education credits and not having a centralized system in place, as medicine does. Medicine has the Accreditation Council for Continuing Graduate Medical Education (ACCGME); one body that is accepted in all 50 states for continuing-education credits. Our profession doesn't. The closest we have is the Federation of Chiropractic Licensing Boards that only covers 28 states, not representing the most populated states for chiropractors in our country.

Many of the other 22 states are broken, and it is not the fault of those working in those states; it's the system that is not working. A few examples of the broken system highlight the crux of the problem:

• In New Mexico, the state board did not have anyone approving courses for two years and applications were not processed, so courses were prevented from being approved.
• In California, courses previously approved are no longer being accepted and multiple additional applications for those same courses are being requested, with fees for each application. In many cases, only partial credits are approved arbitrarily, delaying or preventing quality education.
• Florida utilizes an intermediary, whose system is often broken and applications sit, often passing course application deadlines and blocking approvals permanently. (Florida also does not accept any live webinars.)
• Oklahoma charges $300 per course, precluding shorter courses from being viable financially to the provider.
• Arizona held up the approvals of all new courses pending unreasonable license verification of course instructors.
• Many states such as Kentucky, Louisiana and Wisconsin do not accept any online courses, and others, like New Hampshire, only accept a very limited number of credits online.

Limiting Our Options

Most states limit online education, forcing you to attend live events and even precluding live webinars. Why? This is often at the urging of state organizations that want you to attend their events as a profit center, and then lobby to mandate that legislatively.

Does it bring a higher quality of education? No. A live webinar brings you the exact same information in a timely manner, allowing a more diverse amount of higher-quality instruction, as technology has opened that door. To the state organizations that need the revenue, my answer is simple: provide higher quality education and compete at a higher level, rather than mandating doctors to attend your live event for the wrong reasons.

The other argument is to prevent "scammers" of the CE system. It is pollyannish to think that an unethical doctor won't find a way to "scam" the live event as well. I have done both, and providing handcuffs at the live events is the only real solution. One real solution to prevent scammers is to mandate testing for all CE and have the instructor offer a non-related challenge question and answer, and explain that toward the end of the program. Unless the doctor is attending, they will not pass the test and be forced to retake the course, with no opportunity to retake the test.

All of the above and more prevent qualified graduate chiropractic education, with a broken system preventing timely approvals, and "world-renowned educators" prevented from teaching due to scheduling and travel restrictions. Distance learning with today's technology is commonplace in almost every undergraduate arena nationally, and in medical academia under the umbrella of the ACCGME. Why not in chiropractic?

What We Must Do to Fix It

As a profession, every academic institution and its professors, every state and national political organization, every state board and its members, every publication, every consulting firm, and every individual doctor must take action and petition and pressure the states to put our postdoctoral education under one umbrella. The time is now because the opportunities are here, and if we do not respond from a posture of clinical excellence, those opportunities might pass us by.

We do not need to "reinvent the wheel," as we already have a system in place called the Federation of Chiropractic Licensing Boards that is a viable national umbrella. Like everything in society, it is an imperfect process, but it is the best we have and is a "work in progress," continually getting better and correctly serving the profession.

We must be able to first serve our patients at a higher level, and then compete in the marketplace through a higher level of clinical excellence. It is the single best solution.

Author's Note: Please note that because I am a CE provider, I am potentially subjecting myself to negative consequences by the boards named in this article. However, this subject is critical to our profession and a risk worth taking to help chiropractic spiral upward.