Chiropractic is a regulated health care profession in the United States–and has been for more than 100 years. Before being granted a license to practice, doctors of chiropractic (DCs) must meet stringent educational and competency standards.1
Along with completing pre-professional college education and graduating from an accredited chiropractic college, DCs who wish to attain a license to practice in the U.S. must first pass rigorous national board exams to verify that they have the knowledge and skills necessary to effectively and safely treat patients.1 Individual state chiropractic boards, which approve and manage licensure, have additional requisites that must be met.
The national board exam system for the chiropractic profession is managed by the National Board of Chiropractic Examiners (NBCE). NBCE develops, administers and scores standardized exams that assess chiropractic college graduates’ knowledge, higher-level cognitive abilities and problem-solving in various basic science and clinical science subjects. NBCE’s exam is divided into four parts: basic sciences (Part I), clinical sciences (Part II), clinical competency (Part III), and practical skills (Part IV).
Each state has its own requirements for chiropractic licenses, based in part on the scope of practice determined by the state for DCs within its borders. In some states, chiropractors may provide a wide variety of treatments; in others, their services are more focused. In addition to meeting established educational requirements and passing national board exams, licensure in a state might include testing to verify a doctor’s knowledge of the state scope of practice, a background check, providing personal references, and proof of malpractice insurance.
Most states have their own chiropractic regulatory board that not only administers licensing for chiropractors but also takes action in cases where consumer complaints are reported. In some states where there is no chiropractic-specific board, this role is administered through a state medical board or a board that represents multiple healthcare professions.
Like their medical colleagues, chiropractors must renew their licenses on a regular basis. As a requirement for renewal, most states mandate that chiropractors take continuing education (CE) courses and earn a specific number of CE credits each year.
The Federation of Chiropractic Licensing Boards (FCLB) provides a forum in which state chiropractic licensing board members meet to address common areas of interest and concern with respect to chiropractic regulatory law. Among its activities, FCLB compiles and publishes regulatory board contact information (see list here) and summaries of the requirements to obtain and maintain licensed status in the United States and its territories, Canada, and Australia. FCLB also maintains a database of public actions taken with regard to individual chiropractic licenses, provides certification of chiropractic continuing education courses through its PACE program and provides a certification course for chiropractic assistants.
DCs are educated in nationally accredited, four-year doctoral graduate school programs through a curriculum that includes a minimum of 4,200 hours of classroom, laboratory and clinical internship, with the average DC program equivalent in classroom hours to allopathic (MD) and osteopathic (DO) medical schools.
Chiropractors are designated as physician-level providers in the vast majority of states and the federal Medicare program. The essential services provided by DCs are also available in federal health delivery systems, including those administered by Medicaid, the U.S. Department of Veterans Affairs, the U.S. Department of Defense, the Federal Employees Health Benefits Program, Federal Workers’ Compensation, and all state workers’ compensation programs.
The typical applicant at a chiropractic college has already acquired nearly a pre-medical undergraduate college education, including courses in biology, inorganic and organic chemistry, physics, psychology and related lab work. Once accepted into an accredited chiropractic college, the requirements become even more demanding — four to five academic years of professional study are the standard. Because of the hands-on nature of chiropractic, and the intricate adjusting techniques, a significant portion of time is spent in clinical training.
In some areas, such as anatomy, physiology, rehabilitation, nutrition and public health, they receive more intensive education than their MD counterparts. Like other primary health care doctors, chiropractic students spend a significant portion of their curriculum studying clinical subjects related to evaluating and caring for patients. Typically, as part of their professional training, they must complete a minimum of a one-year clinical-based program dealing with actual patient care.
This extensive education prepares doctors of chiropractic to diagnose health care conditions, treat those that are within their scope of practice and refer patients to other healthcare practitioners when appropriate.
This course of study is approved by an accrediting agency, the Council on Chiropractic Education, that is recognized by the U.S. Department of Education.
- Practice Analysis of Chiropractic 2015, National Board of Chiropractic Examiners, www.nbce.org. Accessed 2019.