NBCE: 60 Years of Excellence Rooted in a Higher Purpose
Karlos Boghosian
DC
1. Steven C. Roberts, J.D., LL. M.
At-Large Director
2. Donna Mannello, D.C.
At-Large Director
3. Danita Thomas Heagy, D.C.
District V Director
4. Norman Ouzts, D.C.
Chief Executive Officer
5. Margaret Freihaut, D.C.
Treasurer and At-Large Director
6. LeRoy F. Otto, D.C.
Vice President and District II Director
7. Karlos Boghosian, D.C.
President and At-Large Director
8. Jason Jaeger, D.C.
Secretary and District IV Direct
9. James Buchanan, D.C.
District I Director
10. Carol Winkler, D.C.
FCLB Appointment
11. Gary DiBenedetto, D.C.
District III DirectorDirector
12. Robert Daschner, D.C.
FCLB Appointment
Every organization has a higher purpose for its existence. Purpose is the conscious link that binds a group together and serves a function as important as the cerebrospinal fluid that nourishes and protects the nervous system within an organization. A compelling purpose is like a magnet that attracts various stakeholders and constituents together and aligns them towards a common direction. Throughout challenges and successes purpose is there providing clarity on what must be done. The National Board of Chiropractic Examiners’ purpose is as clear and relevant today as it was when the organization was founded in 1963. This year, as we proudly celebrate the 60th anniversary of the NBCE, we do so with full acknowledgement of both our past and our potential. This milestone is an opportune time to honor the rich history of our great profession, recall the strength and resolve of early chiropractic pioneers, reflect on important achievements and envision future possibilities rooted in our purpose. As we look to the future, we have a continuing obligation to safeguard public trust and preserve our profession’s accomplishments.
NBCE’s mission is to ensure professional competency through excellence in testing. Our founders understood deeply the positive impact industry standardization and professional assessment could have on public safety and public trust. They were committed and determined to advance every facet of our beloved profession. Their determination contributed to the survival and growth of chiropractic through regulation, accreditation, examination and education. Chiropractic is secure as a regulated profession and vital health care option and doctors of chiropractic are trusted as health care providers through the heroic efforts of our predecessors. To honor the sacrifices of the early pioneers of chiropractic and inform the work ahead it is important to reflect on the obstacles that the profession faced and how the NBCE’s enduring purpose was bom in response to challenges to the profession.
The NBCE creates the bedrock of our entire profession. Someone has to set the baseline and if there’s no baseline, there is no solid ground upon which to stand. NBCE attracts high-quality leaders who are not motivated by any reason other than doing the right thing, and sometimes they deal with exceedingly difficult subjects. The fact that they’ve been doing it for 60 years now is remarkable. Having a national organization that provides uniformity to the regulatory process is helpful because it goes way beyond any single state. It’s like the saying, the sum is greater than the parts. It’s critical that through administration of the exam, there is a benchmark set for those who enter the profession with the competence to ensure patient safety.”
—Wayne Bennett, DC, DABCO, Arizona District IV Delegate
Defining Moments:
Celebrating Our Legacy
The birth of chiropractic. The chiropractic profession was born in 1895 when Daniel David Palmer gave the first chiropractic adjustment. Just a few short years later, however, the fledgling profession was preyed upon.
Targeted campaigns. Throughout the early 1900s, chiropractors were under attack. Many were accused of practicing medicine without a license and thousands of chiropractors were arrested and jailed during targeted campaigns. Despite growing interest and demand from the public, organized and persistent attempts to discredit and disband the chiropractic profession jeopardized the very existence of chiropractic care.
The decades-long battle for lawful recognition. Beginning in 1913 with Kansas and concluding in 1974 with Louisiana - the first and last states to implement state chiropractic practice acts - the path to regulation was extremely arduous. The passage of regulatory and licensure acts that resulted in lawful recognition of the chiropractic profession were only achieved after battles fought over decades by passionate leaders and servants who always placed the best interests of patients first. Those early chiropractic pioneers had the vision and actions needed to establish a formal licensure process to protect patients and shelter practitioners from unjust persecution.
And the challenges kept coming. The profession was confronted with numerous challenges and opportunities related to the enactment of nationwide licensure laws. Diversity in practice acts, varying and inconsistent state requirements for licensure, and attempts to employ the basic science boards as a clearinghouse by the national medical board were further obstacles posing serious threats to the profession.
At times, basic science examinations were administered to seemingly discourage licensure and to make it difficult —if not impossible— for chiropractors to pass. Examples of such intentional testing complications were widespread including one jurisdiction which reported no chiropractor passing an examination from 1929 to 1950. Despite the challenges, the profession moved forward with a growing recognition that an organized approach to standardization was necessary.
By the early 1960s, many health care professions were forming national examining boards with nationwide jurisdiction. Chiropractic leaders recognized it was time to enact a national testing agency of their own or risk being one of the only professions without one.
The need for a body like the NBCE was established. Looking back at the state of the profession before the NBCE existed, one can only imagine what might have become of the chiropractic profession if the organization had never existed. It was clear the profession needed a national testing body that would be unbiased and provide a universally applicable exam to create a baseline for aspiring practitioners. Joined together with a common purpose, representatives from the national chiropractic associations, state board members and chiropractic college presidents came into cooperative action to establish the National Chiropractic Board of Examiners.
“Nebraska established a Basic Science Board and examination in 1927.
From 1929 until 1950, not a single chiropractic license was granted in the state due to the inability of chiropractors to pass these unfair examinations.”
—J. Nash, “The rise and fall of basic science laws, ” Chiropractic History, 2000
The struggle to form the profession’s national testing body. In 1963, the National Board of Chiropractic Examiners was formally organized and incorporated. Three unsuccessful attempts dating back to B.J. Palmer’s endeavor in the 1920s, and two efforts by the National Chiropractic Association (NCA) in the 1930s and 1940s were overcome by the dedication of individuals who banned together believing in the justness of their cause. They were determined to work together regardless of conflicting viewpoints and strong personalities, and agreed that the organization needed to be non-political, completely neutral and separate from any influencing body.
Memories of a darker time
Told by Dr. Carl Cleveland III, a fourth generation Doctor of Chiropractic and the third president of Cleveland Chiropractic College, now Cleveland University-Kansas City.
“My grandparents were both chiropractors and started a practice together in Kansas City in 1919. But the challenge was that the state would arrest chiropractors at that time for the illegal practice of medicine without a license.
My father told me stories of how my grandmother would sew quarters into the lining of his jacket as a child. She told him if he should come home from school to a locked house, it would mean she and his father were in jail but that it would be okay.
She told him he should rip open the lining of his jacket and use those quarters. Because a single quarter, she assured him, would buy him a full meal at the restaurant at the corner.”
“We will not give any examination until we can do it right.”
Dr. Edward Saunders
First NBCE President
The NBCE Board of Directors’ governing rules and regulations, grounded in the NBCE’s purpose, were adopted and the organization was tasked with designing a universal examination to assess chiropractic competency. As an indication to the foundation of high standards Dr. Edward Saunders, the first NBCE President, publicly stated in 1963 that, “We will not give any examination until we can do it right.”
The original NBCE Certificate of Incorporation, 1963
Rapid widespread adoption.
Thousands of hours of work and the contributions of so many went into preparation of the initial examinations and set another step forward toward the advancement of the profession through standardized testing. The first NBCE examination was administered in 1965 to 1,200 candidates and was split into two parts covering basic science and chiropractic subjects. Examination questions were developed by faculty from 12 chiropractic colleges and tests were administered simultaneously in five states. During its first year, 16 states recognized results from the examination and by one year later that number had quickly grown to 25 states. Just 10 years following its creation, it was proudly reported that 41 state licensing boards had recognized and adopted NBCE examinations as requirements for licensure.
Examination expansion. Continued production and administration of valid, reliable and legally defensible examinations gained the confidence of colleges and licensing boards. A commitment to excellence and steadfast belief in organizational ideals afforded the NBCE the trusted credibility for professional examination services amongst licensing boards.
By the 1980s state licensing boards were requesting a clinical competency examination to assess the clinical competence of applicants relevant to the actual practice of chiropractic and Part III was added in 1987.
In 1989, state licensing boards requested that the NBCE consider developing a national practical examination in lieu of individual state practical exams, thus providing a uniform standard from state to state - a true realization of the purpose upon which the NBCE was founded. When the first Part IV exam was administered in 1995, chiropractic became the first health occupation to require demonstration of clinical competency through a practical examination..
Today, all states recognize, and most require NBCE examination in their evaluation of licensure. The examination continues to evolve to keep pace with legislative statutes and with input from chiropractic faculty, researchers, and licensing boards.
The 60-year history of the NBCE is a testament to the chiropractic profession’s ability to debate vigorously and battle fiercely yet work together in preserving a common goal.
Meeting evolving needs. Examination expansion has meant more for the NBCE than creating the bedrock of the profession’s path to licensure. Today’s NBCE, including its International Board of Chiropractic Examiners, develops, administers and scores a variety of other examinations.
• The NBCE now administers tests internationally.
• The Special Purposes Examination for Chiropractic (SPEC) developed in 1993 has become an important tool for state and foreign licensing agencies to use in post-licensure decision-making in cases involving license suspension, revocation, lapse or malpractice.
• Due to increased demand by other healthcare professions, Ethic and Boundaries Assessment Services (EBAS) was formed in 2014, as a wholly owned for profit corporation. EBAS partners with the regulatory community, offering an exam that assesses a licensee’s understanding of ethics and boundaries in a professional setting.
• The Chiropractic College Aptitude Test (CCAT) was created to help prospective students make important academic decisions before they commit to a course of study.
These and other specialty exams developed by the NBCE are meeting the needs of licensing and regulatory bodies both in the U.S. and beyond. Consistent with its vision, the NBCE will continue to deploy resources and expertise for innovative product development to fulfill the evolving professional assessment needs of its stakeholders.
Creating our Future:
The Next 60 Years and Beyond
Today’s NBCE continues on with the same tenacity and focus by our leadership and delegates from across the country. Instilled with the same resounding dedication to advancement as our founding leaders, the NBCE’s mission of “excellence in testing” serves as an effective foundation for encouraging thoughtful decisions and actions. Driven by a commitment to quality examination products, superior examination administration and service to stakeholders, the NBCE is positioned well for continued advancement.
Ongoing innovation. The landscapes of the chiropractic profession and high-stakes testing are constantly being developed as new innovations and products are introduced.
Today’s four-part exam covers basic sciences (Part I), clinical sciences (Part II), written clinical competency (Part III) and practical skills (Part IV). Innovation and administration of examinations has adapted over time to incorporate advancements in technology and make testing more convenient and accessible for students.
Parts I, II and III are computer-based tests that students take conveniently at a partnering -chiropractic college or a professional testing center as they advance through the college curricula. Part III incorporates diagnostic imaging interpretation with 30 imaging sets. Part IV’s practical evaluation of chiropractic technique and case management demonstrates hands-on clinical skills.
As NBCE marks it’s milestone 60th anniversary, a Part IV advancement and development project is underway to evaluate Part IV with the goal of developing a new exam format based on best practices and stakeholder feedback.
The organization itself has entered a period of self-assessment to ensure continued relevance. Every part of our organization has been analyzed for clarity and alignment including fiscal transparency and a significant governance overhaul.
Excellence: A Constantly Advancing Target. In concert with examination products that have undergone years of dynamic enhancements, the organization itself has entered a period of self-assessment to ensure continued relevance. “Defining excellence” is the current focus for the organization and that reflects the NBCE’s commitment to redefine what excellence means to the people impacted by products and services. Every part of our organization has been analyzed for clarity and alignment including fiscal transparency and a significant governance overhaul.
By optimizing our financial resources and implementing modern governance frameworks and best practices, the NBCE is fully transparent and better supported in the work it conducts.
Valuing stakeholders. To further ensure excellence in its testing, the NBCE has increased stakeholder engagement including involvement of state boards and chiropractic college faculty in the test development and standard setting committees. Continued conversations with the colleges offering Doctor of Chiropractic programs have been expanded regarding the NBCE’s examination development and standard setting processes. Chiropractic is once again at a critical juncture with many opportunities to broaden its application to meet new patient-centered objectives. In response, we have already adapted our use of technology to make the examination process easier and more efficient for students, but there’s more work to be done. Chiropractic students today need support to achieve licensure efficiently to begin practicing. By making examinations more accessible we can aid in this process and help states gather the necessary testing components to make their licensure determinations.
Working together for a better NBCE. An output of our strategic review will be the production of a strategic plan developed to meet the needs of our organization. To meet the current and future needs of the profession, we will need to embody the same spirit of teamwork exhibited by our predecessors, who demonstrated the power we can have when we work together. We must preserve our commitment to high quality care across the profession and strive to improve awareness of the sound principles and research upon which the care we provide is based. We can only do this with input from all of NBCE’s constituents - delegates, students, colleges, researchers, practitioners and of course, patients.
By engaging a wide range of stakeholders to help refine our strategy and articulate our vision together we are building upon our solid professional foundation.
As chiropractic advances, so will the NBCE. For many years, chiropractic has been a profession growing faster than the average for all other professions according to the U.S. Bureau of Labor Statistics. Chiropractors are also employed in more settings today than in the past.
Tomorrow’s chiropractors may work in solo or group practice, as on-site chiropractors for sports teams or companies, as a chiropractor with the U.S. Veterans Administration or Community Health Centers, hospitals or franchise systems.
Using our resources and expertise to expand our organization and fulfill the testing needs of the communities we serve will benefit our profession and our patients for many more years to come. No matter what developments are made or how chiropractic evolves in the next 60 years, the NBCE will continue to meet its mission of ensuring professional competency through excellence in testing.
Karlos Boghosian, D.C., is a licensed chiropractor and serves as president and at-large director for the National Board of Chiropractic Examiners. He is the immediate past president of the Federation of Chiropractic Licensing Boards and the Acting Chair of the Connecticut Chiropractic Board of Examiners.
He is founder and CEO of SoVita Chiropractic Centers in Hartford, Connecticut. Contact him at [email protected].
References
1. Cleveland III, C.S. NBCE ,’s 60th Anniversary. Private Interview. 2023, March 13. Unpublished.
2. Keating JC, Li ewer DM. Protection, Regulation & Legitimacy: PCLB & the Story of Licensing in Chiropractic. Federation of Chiropractic Licensing Boards; 2007.
3. Montgomery, P. National Board of Chiropractic Examiners: A Dream Fulfilled. Presented at the NBCE Annual Meeting; 2013; San Francisco, CA.
4. Phillips RB. Joseph Janse: The Apostle of Chiropractic Education. R. Phillips; 2006.
5. Sportelli, L. NBCE’s 60th Anniversary. Private Interview. 2023, March 10. Unpublished
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