Beyond the Numbers: Why the 2025 NBCE Survey Fails to Reflect the Chiropractic Workforce
Despite its pretty packaging the survey is just another marketing ploy by the NBCE monopoly
“They tell us they’re safeguarding the public—yet the data they wave around doesn’t even capture the profession they claim to police.”
Breaking: The Numbers Don’t Add Up
The National Board of Chiropractic Examiners (NBCE) has just released its Practice Analysis of Chiropractic 2025, trumpeting it as “a comprehensive profile of the chiropractic profession and practicing chiropractors across the U.S. and its territories.” On paper the sample looks impressive—3,876 respondents—but that is barely five percent of the estimated 77,000-strong workforce. Scratch the surface and the survey’s grand narrative begins to crumble.
Who Could Even Be Invited?
NBCE’s sampling frame was every license on record, not every individual chiropractor. Because many DCs hold multiple state licenses, the total population was artificially inflated and state quotas distorted. NBCE required ten percent of each state’s licence count; in tiny jurisdictions such as Delaware and Mississippi that translated into only three responses, delivering sampling errors north of fifty percent. Invitations moved exclusively through association e-blasts and social-media posts, leaving out non-members, part-timers, and dissident voices. No random draw, no follow-up—just whoever clicked the link.
“A survey no one saw is now being sold as gospel.”
Who Actually Answered?
Coverage: 3,876 respondents ≈ 5 % of the profession.
Age: 58 % aged 50 +, only 5 % under 30, despite Gen Z dominating college rolls.
Sex: 30 % female, yet women are nearly half of recent graduates.
Race/Ethnicity: 69 % White, 19 % non-White; the U.S. workforce is ~40 % non-White.
Work Pattern: Anyone practicing < 20 h/week was excluded from most analyses—good-bye to locum, academic, and semi-retired DCs.
Weighting the data cannot fix a self-selected sample whose missing voices remain unknown.
NBCE’s assurances of national representativeness rest on a self-selected convenience sample, license-count weighting that cannot correct for hidden biases, and state subsamples so small their error margins can exceed fifty percent. When coupled with the deliberate omission of part-time and newly graduated cohorts, the 2025 survey is best viewed as a detailed snapshot of older, white, full-time, association-connected male chiropractors—not the entire profession.
Internal Admissions of Limitation
NBCE concedes its study is “non-experimental” with “potential selection and response bias” and warns readers that interpretation is “their responsibility.”
Translation: buyer beware.
The Real Bottom Line
The report is the NBCE’s biggest dataset to date, yet its methodology is self-selected, association-mediated, and quota-capped. The results generalise best to older, White, full-time, association-connected male chiropractors—not to the diverse, rapidly changing profession the public sees.
State figures built on < 30 respondents carry error bars wider than the Grand Canyon; emerging cohorts (women, Gen Z, minority DCs) remain invisible; and every practice-pattern statistic is self-reported.
NBCE’s Shaky Claims of “Representativeness”
“National-level representation.” Some states mustered only three to twelve respondents—statistically useless yet rolled into the national average.
“Weights account for non-response bias.” License counts are not people, and NBCE had zero data on the age, philosophy, or gender of non-responders.
“Sample size ensures adequacy.” A big convenience sample is still a convenience sample. Size alone cannot cancel bias.
“Comprehensive profile.” Part-time and retired DCs were tossed out; the remaining pool is older, Whiter, and more male than today’s graduates.
“When the NBCE claims it ‘ensures competency and safety,’ remember: it can’t even ensure a representative survey.”
A Profession Fed Up: Centralized Testing, Board Paydays & the Student-Loan Pipeline
The survey fiasco lands at a moment when chiropractors are already furious with the NBCE.
Centralizing Part IV in Greeley, CO
Last year the NBCE announced it would force every candidate in the world that wants to get a license in the US to travel to a single testing centre in Greeley, Colorado for the high-stakes Part IV exam. Students blasted the move as a logistical and financial nightmare that heaps extra debt on the very generation the survey under-samples. Never mind that chiropractic schools already assess and certify the competency of its graduates prior to graduation and that MD’s and DO’s did away with their version of Part IV exams. Critics also question why a national exam must be tethered to NBCE’s backyard.
“Centralizing the exam isn’t about quality—it’s about keeping the money machine inside NBCE’s fence.”
Board Compensation & “Friends-and-Family” Funding
Public filings and investigative reports show board members and senior staff pocket six-figure sums while exam fees climb. One analysis revealed that travel and meeting budgets alone once topped $600,000 a year.
Student-Loan Money in a Closed Loop
Because licensure exams are mandatory for graduation and state licensure, federally backed student-loan dollars flow straight to NBCE—which then funnels grants and payments to partner organizations and private corporations in its network. Exposés have documented millions shifted to associations that lobby against loan-cap reforms, ensuring tuition (and exam) revenue stays sky-high.
Awakening to a Monopoly
From petition drives to mass-e-mails, the profession is openly calling NBCE a self-serving monopoly operating at the heart of a licensing cartel. The bitterest irony: the very graduates most burdened by mandatory exams and mounting debt—Gen Z chiropractors—were largely excluded from the “representative” survey NBCE now touts as evidence of its relevance.
“If you paid thousands of dollars to take an unnecessary exam in Colorado, at least expect the Board to count your generation in its data.”
Why It Matters
State boards, insurers, and legislators lean on NBCE numbers to justify scope-of-practice rules and continuing-education mandates. When the underlying survey is this skewed—and the organization’s financial motives so questionable—policy built on NBCE data is at best shaky, at worst harmful to new practitioners and underserved communities.
Call to Action
Demand transparency: NBCE should release the data to back its claims.
End monopoly testing: Halt the Greeley centralization; explore program-based or state-based competency options.
Audit the money trail: Trace how student-loan dollars move through NBCE and its partner entities.
Insist on modern sampling: Next practice analysis must use probability methods or mandatory reporting—not open-link convenience samples.
“If the NBCE wants to call itself the profession’s watchdog, it’s time it learned how to measure—and answer to—the whole pack.”
Conclusion
NBCE’s assurances of national representativeness rest on a self-selected convenience sample, license-count weighting that cannot correct for hidden biases, and state subsamples so small their error margins can exceed fifty percent. When coupled with the deliberate omission of part-time and newly graduated cohorts, the 2025 survey is best viewed as a detailed snapshot of older, white, full-time, association-connected male chiropractors—not the entire profession.
Beyond the Numbers, the story is simple: the NBCE’s 2025 Practice Analysis is a narrow snapshot masquerading as a panoramic view—another example of the Board’s pattern of overstated claims and under-delivered evidence. Until real transparency replaces glossy rhetoric, the profession—and the public—deserve better.
Thank you for exposing what is seen by any researcher as fraud. I can’t believe the NBCE could do so poorly and publish figures which they tell us to believe at our own peril. I’ve made a note to never cite this report in my teaching and research. One would like to think that an organisation which tests students for a reason I don’t comprehend, would be able to conduct a straightforward survey in an ethical and sound manner. If they cannot do this, what other weaknesses are there in the testing materials they generate?
So how would you build a survey to cull accurate data to be reflective of chiropractic in 2025?