THE CURRENT SYSTEM of chiropractic continuing education (CE) in the United States is hindering the integration of chiropractic into mainstream health care and limits continuing education options for doctors of chiropractic (DCs). While other professions have a singular national system of credentialing CE, chiropractic continues to have a provincial system of credentialing that inhibits DCs from receiving CE at interdisciplinary conferences.
Example: If the International Association of Awesome Spine Specialists (IAASS)* was to hold a national conference and wanted to sponsor the CE for the various professions, it would apply to one national credentialing body for medical doctors, one national credentialing body for occupational therapists and one credentialing body for virtually every other healthcare profession except for chiropractic. To receive credit from the various chiropractic credentialing and licensing entities, IAASS would need to apply to virtually every state, territory, protectorate and district credentialing body. The amount of work and cost associated with this presents a barrier to include chiropractic CE. Since chiropractic lacks a national credentialing body for CE, we continue to use a convoluted and expensive system of monitoring and credentialing our CE, which results in scarce opportunities for DCs to obtain license renewal credits at multidisciplinary educational events.
The medical profession is shifting from an emphasis on traditional CE to continual professional development. Medical doctors are allowed CE credit for some rigorous career-developing activities. This includes publishing in a peer-reviewed journal, passing a specialty board, teaching, reviewing a manuscript, developing questions for the national board, managing a performance- improvement project and pursuing a relevant advanced degree (master’s or PhD level).
Who are the players?
The current system of CE involves the state licensing bodies, some state chiropractic associations and the chiropractic colleges. The individual state credentialing boards can regulate and charge for the credentialing of chiropractic CE. This applies to courses within their own borders and also to courses requiring approval outside that state, including online CE courses.
Since several states require that a Council on Chiropractic Education (CCE)-accredited college sponsor chiropractic CE, the chiropractic colleges charge the organization for sponsorship. The college may also refuse to sponsor the CE. This refusal may result from quality of content, differences in philosophy or for competitive reasons. A college that offers a master’s degree in acupuncture may refuse to credential an acupuncture credentialing program, or, a college with burgeoning online continuing education programs can withhold accreditation from privately owned online-education programs.
Some state associations earn much of their operational funds from the CE provided at regional conferences. Consequently, they would like to maintain a tight grip on the regional CE market. This may be why at least one state association is opposed to the idea of the state allowing online classes to be credentialed. There are many factors related to CE, including state laws that regulate what CE can be approved and by which organization. So the desired change would require many state associations to use political capital to make the necessary legislative changes for a national approval system.
How does the CE system affect education and integration?
Application and credentialing fees cost money, and to apply to every state, province, territory, district and protectorate is cost-prohibitive to most providers of CE. The sponsors and providers must make decisions based on economic realities. This means that big states that have a great economic appeal will have a broader selection of CE.
If we were to change our current regional system of credentialing chiropractic CE to a national accreditation council as other professions use, it would streamline the process. Moreover, it would make it easier for interdisciplinary organizations (e.g., public health, radiology and spine societies) to provide chiropractic CE at their venues.
As the chiropractic profession has evolved, it has established national accreditation organizations. A great step in the right direction for CEs is the Federation of Chiropractic Licensing Boards that has developed the PACE (Providers of Continuing Education) program, which reduces onerous paperwork via one application for many states and provides reliable reports on relicensure requirement fulfillment. [Editor’s Note: the following accept PACE: Alaska, Colorado, Connecticut, DC, Delaware, Georgia, Idaho, Illinois, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Hampshire, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, and Washington. Also accepted in: Puerto Rico and Nova Scotia.]
The Chiropractic Council on Education regulates chiropractic education. The National Board of Chiropractic Examiners has provided a sophisticated standardized national examination program. Additionally, several national specialty boards offer uniformed standards for the nation. The time has come to establish a national CE accreditation council for chiropractic. This will result in lower costs and higher quality continuing education.
*The International Association of Awesome Spine Specialists (IAASS) is a fictitious organization.