NBCE Fees Survey: The Results Are In

A total of 1,343 doctors of chiropractic and students completed Dynamic Chiropractic's online survey regarding the fees charged by the National Board of Chiropractic Examiners (NBCE) and its resultant excess profits. Here's how the profession answered when asked the following three questions, along with a sampling of comments from the 495 respondents who weighed in on a variety of potential issues:

1. In 2021, the NBCE had excess income of $5,178,512. This is more than what all students paid for Parts I and II combined. Should the nonprofit NBCE rebate the money paid by chiropractic students for Parts I and II exams ($710 per exam, per student) in 2021?

     Yes – 86%
     No – 14%

2. Also in 2021, the NBCE donated over $1 million to other chiropractic organizations. Should the NBCE cease using student exam fees to make donations to / purchase sponsorships from other chiropractic organizations and apply that money to reduce the exam fees?

     Yes – 90%
     No – 10%

3. Based on 2021 financial figures, the nonprofit NBCE could reduce the total cost of the Parts I – IV exams from $3,715 to $2,200 by applying the donation / sponsorship money to reducing those fees and reducing its excess income. Should the NBCE reduce its Parts I – IV total exam fees by at least $1,500 per student and keep its exam fees at a level at which its excess income from operations and investments is no more than 5% of its examination fee revenue?

     Yes – 94%
     No – 6%

Excessive Fees

Nearly 500 respondents included comments, many of which focused on how the NBCE exam costs have added to the financial and emotional struggles chiropractic students (and former students) face. As one student stated:

"These excessive fees [add to] the anxiety and stress over taking these exams. Chiropractic school is already extremely expensive and inflation is rising rapidly. There are students struggling to pay rent and provide food for themselves and their families because we cannot get a lucrative job while being in school and living off loans is simply not enough. These fees NEED to be reduced."

Other survey respondents were less diplomatic in their criticism:

"They are literally robbing us because they can. What are we supposed to do? Not get our licenses? It is disgusting and should be illegal."

"I feel extremely taken advantage of as a student by the NBCE."

"It's absolutely ludicrous that we have to pay that amount for boards considering the profit that is being made."

"They shouldn't be robbing from us students. We're paying for this stuff with loans and NBCE is just trying to fill their pockets."

"Ridiculous money grab. Give these poor docs a break."

"Every student I talk to feels that they are robbed by these exams."

Too Many Exams

Many suggested the number of exams should be reduced:

"No other professional students have to pay so much to prove their knowledge. We've already passed the coursework. Give us ONE reasonably priced examination."

"Part 4 is the only test that means anything to a chiropractor. The 1st 3 are straight money grabs. The 4th one is the only one worth money to me."

"Part 2 and 3 is the same material.  They make us waste time and money."

"Discontinue Part I altogether. Part IV is the clinical exam that demonstrates competency to practice."

"Why have Parts 1-2-3 if the education facilities are already teaching and testing the students? Why do we need them to be tested again? Ego? Part 4 makes sense; the other tests Part 1-2-3 do not make sense."

"My daughter recently took the FL bar, which cost around $1,000, but the leadership thinks charging 5x that amount is appropriate for young graduates entering the profession. Perhaps this is a reason why chiropractic colleges are struggling to attract new students!"

Donating Students' Money

Many respondents were also frustrated by the NBCE donating money:

"I'm scraping just to pay for these exams to find out they're utilizing our fees to donate to other chiropractic sponsorships! That should be our choice."

"Respectfully, if I want to donate to a chiropractic organization I will do it myself, with my own money, and to an organization that I choose to support."

"The NBCE is not in business to be a donation center for other non-profits, regardless of whether or not they are supporting chiropractic organizations. Most students are living on low budgets, much of it borrowed money. They should not be charged more than is necessary to administer the tests. If the NBCE finds itself with a surplus, that's a clear signal that it is charging too much and it needs to lower its testing fees, not give the money away."

"Why is the National Board using student money to give to other organizations? Both the board and other organizations should be ashamed of themselves by using its next generation of doctors' money only to increase our student loan fees and ultimately increase our debt! Shame on you."

Standing Up for the NBCE

A few of the comments tended to be more positive toward the NBCE:

"The administration of the examination takes many paid participants for standardization and security. Without this ability to find proctors, patient actors, trainers, and administration people, the exam will regress to the unfair state board testing that our profession had to deal with in the '80s. The NBCE brings in experts from all over the spectrum from our profession for input regarding item writing for all exams. This also costs money. The NBCE, like any organization, can and should reduce costs, but until you know everything that goes into it, try not to attack it. It is one of the few institutions in our profession that is actually helping us stand up to scrutiny from outsiders. The exam is helping to nationally standardize our profession."

"The NBCE helps to keep students who are not ready from becoming licensed. I am a part IV examiner and so many last-quarter students are incompetent. The exams are straightforward, they are just not prepared by their colleges. Yes, the same colleges that have a vested interest in making money just like the NBCE."

The NBCE-FCLB Monopoly

Still others questioned the contractual monopoly between the NBCE and FCLB:

"It's simple; they have a monopoly on Chiropractic licensure. They can charge whatever their little hearts desire and the fledgling chiropractic students HAVE to pay if they want to practice, what they have spent YEARS, MONEY, AND TEARS to obtain. Solution is easy; they need competition, otherwise this will continue."

"NBCE is a monopoly and they operate like one. They do not care about chiropractic nor students' success."

"The NBCE makes the exams so expensive because students HAVE to take them, so they can essentially set the price at whatever they want. It is ridiculous to have to pay over $3,000 for exams, when the majority ... are online."

"No competition = higher greedy pricing preying on students who most likely have to use student loan money to pay for boards, which will then actually cost them double-triple by the time loans are paid off, just so the NBCE can donate 'our' money so they can look good and benevolent. I know, I lived it and paid dearly."

"Students need to stand up and let their voices be heard. The profession needs competition and a new national chiropractic examination organization needs to happen fast."

"The excess money has corrupted the FCLB to the point [that] states are dropping out of its membership. There needs to be an independent audit of the NBCE and a disassociation of the FCLB from the NBCE. Finally, the leadership of both of these organizations should be replaced by a bylaw change that limits their participation to only 6 years (2 terms) to keep corruption and nepotism from their ranks."

"There should be an attorney general investigation into the NBCE donating 5% of fees to the FCLB. This is a clear conflict of interest."

"The NBCE and the FCLB should be disbanded. They are unnecessary and engage in restraint of trade. They should both be sued based on: www.supremecourt.gov/opinions/14pdf/13-534_19m2.pdf."

Other Perspectives

A few respondents suggested the NBCE was overspending and could save even more; for example, by "eliminating the excessive honoraria paid to directors, reducing travel for directors, and substantially cutting the lavish spending on their board retreats and board meetings held at luxury hotels."

Other doctors questioned the high exam fees; one asked, "What expenses could have increased in the administration of these tests to warrant such an exorbitant fee to be assessed?"

There were also several comments regarding tremendous savings afforded the NBCE by computerizing almost all of its exams.

A few respondents sought influence from outside the NBCE ; one called on "a panel of college presidents and state boards" to address the situation and another for "the ICA and ACA to stop being afraid of NBCE and think about the future landscape we are creating for newly graduated chiropractors." One doctor may have summed it up best: "The main issue is that the NBCE needs oversight."

Editor's Note: Want more? Click here to access all 495 comments made by survey respondents.