NBCE Under Fire: Chiropractors Outraged Over Centralized Testing Monopoly
Students and Schools Push Back as NBCE Ignores Feedback and Expands Control Over Chiropractic Licensure
The National Board of Chiropractic Examiners’ (NBCE) is facing an unprecedented wave of backlash following their decision to move forward with centralizing Part IV exams at a new 15,000-square-foot assessment center in Greeley, Colorado. Despite widespread opposition from students, chiropractic schools, and rank-and-file practitioners, the NBCE is proceeding with a plan that critics say will further solidify its monopoly over chiropractic licensure — and saddle students with more debt and logistical challenges.
The controversy over the NBCE’s centralization effort is the latest flashpoint in a long-simmering battle over the control of chiropractic education and licensing. The NBCE’s decision to break ground on the new facility comes even as internal documents reveal that most chiropractic schools opposed the move, and the NBCE has failed to provide data to justify its claims about improving testing standards and public safety.
A Broken Process and Ignored Feedback
Internal documents from the NBCE paint a clear picture of a decision-making process that lacked transparency and genuine stakeholder engagement. According to an internal report obtained by McCoy Press, the NBCE conducted a survey about the centralized testing plan in January 2024 — but only 11 schools out of the dozens impacted by the change even responded. Of those, just seven supported the idea or said they understood the need for it, while seven others expressed reservations about the location in Greeley, and five flatly opposed the plan. Three respondents said they lacked enough information to form an opinion.
Despite this tepid response, the NBCE presented the feedback as broad support for the project and announced its decision to move forward. The internal report highlights growing frustration among chiropractic schools over the NBCE’s refusal to listen to stakeholder concerns. One school representative wrote, "This move will only increase costs for students and create logistical challenges — all for the benefit of the NBCE, not the profession."
Outrage from Students and Practitioners
The chiropractic community's frustration has boiled over onto social media, where students and practitioners have accused the NBCE of exploiting students and acting out of financial self-interest. In a widely circulated Facebook post, Dr. Matthew McCoy called the NBCE’s move "disgusting," highlighting that medical and osteopathic professions eliminated their equivalent Part IV exams years ago, yet chiropractic students are still required to take the costly and burdensome test.
"All of that money on the backs of students and their debt for an exam that’s completely unnecessary," McCoy wrote. "The schools already certify clinical competency. This is all about money and power. Shame on all of us elders in the profession for allowing this to go on."
Other students echoed McCoy’s outrage. One student commented:
"We already pay so much in tuition. We shouldn’t have to pay an extra $4,295 for five board exams. My state requires PT. It’s absolutely disgusting."
Another student pointed out that NBCE does not cover travel, lodging, or meal costs for students who must fly to Colorado to take the exam — costs that can exceed $1,000 on top of the exam fees. "They are treating students like cash cows," one commenter wrote.
No Data, No Transparency
One of the most damning aspects of the NBCE’s push for centralized testing is its failure to provide any empirical data to justify the change. The Foundation for Vertebral Subluxation (FVS) and a coalition of chiropractic organizations sent a detailed request for outcomes data to the NBCE in October 2023, seeking information on exam pass rates, clinical competency trends, and other performance metrics.
After nearly three months, the NBCE responded — but without providing any of the requested data. Instead, the NBCE redirected stakeholders to other sources or claimed that the data "did not exist." The FVS and its partners described the response as "an attempt to obfuscate the issue."
"The NBCE makes sweeping claims about ensuring competency and public safety through its exams — but when asked to back those claims with data, it couldn’t deliver," said one coalition member. "That’s not just troubling — it’s proof that the NBCE’s real interest isn’t protecting the public. It’s protecting its monopoly."
The CHEA and CCE Connection: A Protected Monopoly
The NBCE’s centralization effort is part of a larger problem within the chiropractic profession: the deeply intertwined relationship between the NBCE and the Council on Chiropractic Education (CCE), which accredits chiropractic schools.
A recent hearing before the Council for Higher Education Accreditation (CHEA) exposed how the CCE’s reliance on NBCE exam scores creates a self-perpetuating monopoly. The CCE mandates that schools use NBCE exam scores to demonstrate clinical competency — even though schools already assess clinical skills through their own internal exams.
"If CCE were serious about providing alternatives to NBCE scores, they would work with schools to create a national licensure tracking system," said Dr. Mike Guinosso, who testified at the CHEA hearing on behalf of the Coalition for Freedom in Chiropractic. "Instead, CCE’s reliance on NBCE data ensures that the monopoly remains intact."
What the United States Department of Education’s NACIQI’s labeled a “virtual cartel” — including the NBCE, CCE, the Federation of Chiropractic Licensing Boards (FCLB) and their patrons — operates with little oversight and virtually no accountability. The CHEA testimony further revealed that the CCE participates in closed-door meetings with NBCE and FCLB at the Chiropractic Summit Group, which excludes many organizations and schools and refusing to provide updates to the broader profession.
Exploitation of Students and the Growing Debt Crisis
The financial impact on students has become a flashpoint in the controversy. Between exam fees, travel costs, and lodging expenses, students face a cost of thousands of dollars just to take Part IV — on top of the hundreds of thousands of dollars in student loan debt they already carry.
"It’s part of the whole Department of Education/student loan mess," one student wrote on Facebook. "Exam fees can be covered by additional loans — if you can get approved for them. But do we actually have a choice at this point?"
The growing debt burden is compounded by the fact that the NBCE's own claims about ensuring competency and public safety remain unverified. Without outcomes data, critics argue that the NBCE is profiting off students under the guise of professional standards.
Where Is the Oversight?
The NBCE’s Part IV centralization plan has exposed glaring weaknesses in the oversight and accountability structure of chiropractic licensure and education. The NBCE effectively serves as the gatekeeper to chiropractic licensure in all 50 states, yet it operates as a private corporation with no meaningful oversight from regulators or government agencies.
With growing anger from students, schools, and practitioners, the chiropractic profession appears to be at a breaking point. Calls for reform — including an end to the Part IV requirement and a restructuring of the NBCE and CCE’s relationship — are gaining momentum.
"This is not about protecting the public," said one chiropractor. "This is about protecting a monopoly. And the ones paying the price are the students."
Conclusion: A Profession at a Crossroads
The NBCE’s decision to centralize Part IV testing in Greeley has laid bare the structural problems within chiropractic education and licensure. With no meaningful data to justify the change, growing debt for students, and clear evidence of a protected monopoly between the NBCE and CCE, the future of chiropractic is at a crossroads.
The next steps will depend on whether students, schools, and rank-and-file chiropractors are willing to demand real change — or whether the NBCE and CCE will continue to operate unchecked.
