Issue 10 - July2004

FCLB: A regulatory system for the good of chiropractic

The beginning of chiropractic regulation in the United States has deep roots, with Illinois holding early honors. Minora Paxson, graduate of “Chiropractic Sch. Davenport,” secured certificate #438 on May 24, 1904. She was licensed as an “OP” — Other Practitioner — under the Illinois 1899 Medical Practice Act, which contained the first regulatory language permitting the legal practice of chiropractic.

The first specific chiropractic licensing law in the world was passed by the Kansas Legislature in 1913. Because of a delay in appointing the Kansas board, North Dakota actually granted the first chiropractic license to Guy Woods, DC, in April of 1915. The first chiropractic license under the Kansas law was issued to Anna Foy, DC, a month later on May 12, 1915.

A federation was born
The first meeting of the chiropractic regulatory agencies occurred in 1919, as part of a joint session with B.J. Palmer and the Universal Chiropractic Association. Five boards were represented by 14 doctors. Connecticut, Kansas, Nebraska, North Carolina and North Dakota laid the groundwork at that meeting for the future of the federation as we know it today.

In 1926, the International Congress of Chiropractic Examining Boards was formed. It was reorganized in 1934 as the Council of State Chiropractic Examining Boards (COSCEB).

The organization was renamed the Federation of Chiropractic Licensing Boards in 1968, which is when it was granted recognition as a nonprofit organization by the Internal Revenue Service. Formal adoption of the new name occurred in 1972.

Building today’s regulatory system
Over the years, the members of this energetic group have envisioned the present day regulatory system for chiropractic. This has included formation of the National Board of Chiropractic Examiners in 1963 and recognition in 1974 of chiropractic college accreditation by the U.S.Department of Education (formerly Health, Education and Welfare).

Through the efforts of the Federation’s individual boards, practice requirements are more common than ever before and the forum for discussion of the global regulatory future has emerged.

A Code of Conduct for regulatory board members was developed by the FCLB, and subsequently adopted by the Federation of Associations of Regulatory Boards (FARB). It has now been adopted by numerous licensed professions.

More uniform credentials for initial licensure are evolving, as are the testing standards and processes that undergird them.

Model reference components of a disciplinary code are in place, as is the computerized online databank to support them. The database, called CIN-BAD, has been expanded to include current licensure information as well as public board actions and federal exclusions. The Internet-based program now includes records for over 60,000 practitioners and is the cornerstone of the Federation’s next expansion phases.

Next on the agenda
Following five years of develop-ment, the PACE (Providers of Approved Continuing Education) program has been officially unveiled. This centralized approval service for continuing education is designed to streamline multi-jurisdictional applications by providers and also reduce the workload for boards. Resources are scarce; working together to take advantage of economies of scale frees boards to concentrate on other public protection matters.

International outreach is the other major new initiative.

This is characterized by doctors relocating much more freely, and treating patients in a variety of unconventional settings. As a necessary partner, chiropractic regulation is on the verge of its next big leap — into a flexible and responsive network of professional authorities dedicated to public protection, accountability, and mobility.

Future of licensing and regulation
The number of licensed doctors of chiropractic continues to increase modestly but steadily each year. Current U.S. estimates are around 62,000 who hold about 84,000 licenses among them. (Some doctors hold licenses in more than one jurisdiction). This represents an 18 percent increase in the total number of active licenses since 1996.

California leads the United States with 13,400 licenses. New York is second with 6,200 licenses. The next tier of high numbers includes Florida, Texas, and Pennsylvania, each posting approximately 4,000 to 4,500 licenses.

(Note: Exact numbers are available on the Federation’s website at www.fclb.org.)

U.S. chiropractic boards have increasingly accepted standardized licensure examinations offered by the National Board of Chiropractic Examiners, resulting in improved practitioner mobility. Doctors can demonstrate uniform mastery of identical academic and clinical requirements, easing their compliance with state-based licensure requirements.

The Federation’s CIN-BAD system of databases has also assured boards that practitioners wishing to relocate or help with transitional sporting events are duly qualified. In short, mobility is better today than ever before for doctors of chiropractic.

Professional regulation in the United States has been uniquely state-based and the FCLB does not see this changing for chiropractic or any other mainstream professions. While there are logical opportunities for shared resource management and certain federal requirements for accountability, the FCLB does not foresee centralized licensure for the chiropractic profession.

We do, however, foresee increasing requirements for all healthcare professions to demonstrate their accountability to the public. The chiropractic profession is not exempt from higher levels of scrutiny and ethical expectations by the public and the media. Our society expects its doctors to be trustworthy, compassionate and bright, as well as to be life-long learners who keep abreast of a wide array of best practices in healthcare.

FCLB Values
Regulation is the art of codifying gray circumstances into black and white. Reflecting the evolving world focus on ethics, regulators balance freedom and the nuances of professional expression against the public’s need for definition and protection. This is an exciting time in chiropractic regulatory law.

At the center of our Federation, without exception, is the chiropractic regulatory community’s deep and abiding concern for the protection and welfare of its patients. The story of chiropractic’s healing touch as it has been written, and the chapters yet to come, are based on this fundamental foundation.

This article was contributed by Donna M. Liewer, executive director of the Federation of Chiropractic Licensing Boards, www.fclb.org.