The American Chiropractic Association (ACA) announced this week that ACA Executive Vice President Karen Silberman, CAE, renewed her contract and would continue in her position with the new title of chief executive officer. Silberman has been ACA’s top executive for the past eight years, a time of tremendous transformation within the association – and outside it.
Under her tenure, ACA streamlined its governance structure, shifting to a competency-based board model, and launched a rebranding initiative that positioned ethical practice at the heart of members’ identity as ACA chiropractors.
Silberman also shepherded ACA through the COVID-19 pandemic. Under her direction, ACA was able to support its members during a difficult time, ensuring they had the information and resources needed to effectively practice as part of the essential workforce.
In the years since, Silberman has strengthened ACA’s financial sustainability by not only delivering balanced budgets but also by finding ways to expand the association’s non-dues revenue.
In a press release, ACA president Marc Nynas, DC, expressed gratitude to Silberman for her steady leadership through it all. “ACA has been fortunate to have Karen at the helm through some very challenging and uncertain times. We are grateful and look forward to continuing to work with her,” noted Dr. Nynas. “Her expert guidance and deep well of knowledge in governance, administration, budgeting, and strategic planning have kept us on course toward our goals.”
The ACA Blog checked in with Silberman recently to learn more about the progress that ACA has made under her executive guidance, and to find out what may be ahead.
Q: The governance and rebrand initiatives were pivotal events for ACA. From an operational standpoint, what stood out to you?
Silberman: When I joined the ACA eight years ago, the organization was at a critical inflection point—facing challenges related to governance, declining membership, financial instability, and questions about its long-term relevance. Recognizing the need for bold, coordinated action, I worked with a group of dedicated leaders — Drs. Ray Tuck, David Herd, Tony Hamm, Eric Benson, and Leo Bronston — to address those challenges. Together, we crafted a planning process that not only redefined our direction but also restored stability and set the stage for growth. The outcomes were transformative. We successfully transitioned to a competency-based board model, launched a comprehensive rebranding initiative, and redefined ACA’s identity to better reflect our mission and value to members. These changes contributed to renewed relevance, financial stability, and operational agility.
What stood out to me, and continues to be an important tool for ACA, is the organizational dashboard (a type of progress report). It helps ensure follow-through and alignment across the organization, to track progress against strategic goals and reinforce accountability at every level. The annual dashboard has become a unifying tool, keeping everyone focused and driving collaboration toward shared outcomes.
Q: One of the reasons behind ACA’s governance change was to spark more engagement from early-career doctors in leadership and volunteer committees. How is that going and what does it mean for the association and its future?
Silberman: Historically, ACA’s membership was relatively homogenous; however, as the profession evolved, a younger and more diverse cohort began entering the field. We saw this as an opportunity to both engage emerging professionals and advance our equity goals. We implemented a policy requiring at least one early-career practitioner to serve on each of ACA’s 25 committees. This not only created meaningful leadership pathways for younger members but also brought fresh, diverse perspectives to every facet of our work.
This has resulted in more NextGen leaders taking an active role in committees, within the House of Delegates and our first NextGen board member, Dr. Maithy Ta. We also launched a Health Care Fellowship program that gives younger members a chance to learn from our seasoned coding and documentation experts. The changes have led to several younger doctors being appointed to advisory positions with important external groups such as PCORI, the National Quality Forum and AMA’s CPT Health Care Professionals Advisory Committee. We can rest assured there will be a bright future with this new generation of leaders, who are gaining invaluable experiences at this stage of their careers.
Q: Work life changed almost overnight during the pandemic. Operationally, how was ACA able to adapt so quickly? What do you remember most from that time?
Silberman: The pandemic was a challenging time for everyone. Like many organizations, ACA transitioned to a fully virtual operation in March 2020. Fortunately, this shift had no negative impact on our productivity or service to members. In fact, it revealed that the necessary technology—Microsoft Teams, Zoom, and others—had always been available; we simply had not needed to rely on it until then.
Our team adapted seamlessly because we were already strong and well connected. Prior to the pandemic, we maintained consistent communication, which continued virtually without missing a beat. We held regular meetings—both large and small—to stay aligned, share progress, celebrate wins, and solved problems together. Despite the uncertainty, I developed a deeper appreciation for our team’s commitment to our members and the profession.
One significant achievement during that time was ACA’s successful advocacy with the Department of Defense to recognize chiropractors as essential workers. This ensured our members could continue serving their patients and contribute to the broader healthcare response.
We also faced uncertainty around membership, which made up 85% of our operating budget. Even a minor decline posed serious risk. I led the team in scenario planning for potential 5%, 10%, and 20% membership losses. These were difficult discussions, but by prioritizing our commitments, developing contingency plans, and transparently communicating with staff and the board, we reduced anxiety and strengthened our unity. Knowing we had a plan in place gave us the confidence to face whatever came next.
Q: ACA, under your leadership, has been successful in finding novel ways to enhance its non-dues revenue. Tell us more about that.
Silberman: Ensuring ACA’s financial sustainability has required a dual focus: strengthening internal operations and expanding external revenue opportunities. Through disciplined financial management and strategic revenue growth, we’ve not only stabilized the organization but positioned it for long-term success.
Internally, we implemented a structured annual financial cycle to maintain real-time visibility into revenue, expenses, and investments. This process has enabled us to identify trends early, anticipate financial challenges, and make timely course corrections.
Externally, we have strategically grown non-dues revenue, which has become an increasingly significant portion of our overall budget. Key initiatives have included:
- Revamping our corporate partner program, tailoring engagement opportunities, and ensuring our partners receive high-value exposure and access to our members.
- Expanding advertising platforms, including targeted options on our website, social media, member forum, and weekly newsletters.
- Growing our endorsement program to attract partners by leveraging ACA’s brand and member trust.
- Establishing an association management services department, through which we provide operational oversight and day-to-day management for independent state associations.
These diversified revenue streams have not only increased our financial strength but also expanded ACA’s reach, visibility, and influence. As a result, the organization is not only more financially sustainable but also more agile, mission-focused, and positioned for continued growth.
Q: As you embark on this next chapter with ACA, what are you looking forward to?
Silberman: I am very excited about this next chapter for ACA. We will continue to grow and strengthen as an organization, amplifying our impact on health policy, advocacy, and education. Our members can look forward to ACA’s unwavering focus on advancing the profession, most notably through our efforts to pass the Medicare modernization bill. I’m truly looking forward to the day that bill is signed into law and the positive, long-term effect it will have on the entire chiropractic profession.
Supporting this work are our expert volunteer leaders, who inspire me every day. Their commitment—their willingness to consistently give their time and expertise—makes the profession stronger and better. Working alongside such dedicated and caring chiropractors has truly been one of the highlights of my professional life.
In addition to our advocacy, ACA continues to lead in critical areas such as evidence-based healthcare, coding and documentation, and participation in CPT and RUC processes. These efforts reinforce the value of chiropractic services and ensure we are well positioned in today’s evolving healthcare landscape.
I’m energized by the future and proud to be part of a community that shows up, works together, and is deeply committed to the health and well-being of patients and the profession.
