Before you read my thoughts, understand that this is more than an issue of fiscal responsibility. The NBCE makes almost all of its $7 million+ income as the only testing organization from which graduating chiropractic students can take their national exams. The students are the segment of the profession that can least afford to spend money unnecessarily. They also have no other testing options. The chiropractic students are at the mercy of whatever fees the NBCE wants to charge for the exams (Parts I, II, III and IV).
After eight months of investigation, it is clear that some major changes need to be made at the NBCE. Here are my recommendations:
Institute Term Limits
I believe that the reason for the situation at the NBCE is that the same people have had control for more than 15 years. Are they really the only ones qualified to be on the board? Term limits bring in new blood and new ideas. They also prevent empire builders from spending too long in control. No one should serve more than six years on the NBCE Board of Directors.
Reduce the Board
With four at-large board members elected by the other board members, it is easy to see how once a group gets in power, it takes decades to get them out. Reduce the at-large board members to at most two (or eliminate them altogether) and let them be elected by the delegates. This board doesn't need 11 members: nine or seven will do nicely.
I'm sorry, but I just don't buy this "appearance of a conflict" excuse for why the NBCE directors aren't working with the rest of the profession. In their position, they should have formal liaisons with the ICA, ACA and the chiropractic colleges through the ACC. This is not a criticism of the current tests, but having liaisons with the rest of the profession would allow more input from the field, which can only result in tests that better reflect the current practice of chiropractic from all perspectives and philosophies.
Cut Back on Travel Expenses
Students taking all four exams pay $1,450 at a time when they really need to save every dollar. The cost of Part IV has increased from $550 to $850 since its development in 1996. Believe it or not, the NBCE directors recently considered increasing Parts I, II and III by as much as $50 each. This would net the NBCE an additional $354,750 per year. Their income already exceeds their expenses for the first nine months of 1999 by $1,444,655. Why they want even more excess revenue is a mystery.
At the same time they are discussing increasing the price tag on the tests, each director is spending an average of $55,000 in travel per year. Perhaps a few changes could save a few dollars:
- Send staff members (rather than board members) to observe test sites on an auditing basis and to other meetings as appropriate.
- Cut the board meetings from seven days down to four days (as suggested by one member of the board) and cut out all of the resort meeting locales. Meet at the corporate office in Greeley where the staff and records are located.
- The NBCE Executive Committee, which is comprised of six members of the 11-member NBCE Board of Directors, should be reduced to three or four board members.
- Reduce trips to foreign countries from 10 days to five days (something closer to the length of the meeting).
- Quit trying to micro-manage and reduce all other meeting days to what is absolutely needed, using more staff and fewer board members.
- Adopt the ACA's reimbursement policy of $200 per diem to cover all expenses, instead of $500 plus all expenses paid. This will definitely reduce the travel time.
According to my calculations, these changes, combined with the reduction of at least two at-large board seats, would reduce the number of board travel days from 433 to 193. It would reduce the cost of airfare from $36,000 to $24,750 and would result in a total reduction in travel expenses of at least $400,000 (667 student test equivalents).
Eliminate Three Country-Club Memberships
This is perhaps the most flagrant and insulting item on the budget. It merely echoes the country-club attitude that many people feel has permeated the NBCE Board of Directors.
Put a Limit on Restricted Assets
The restricted account is over $5 million now, growing by approximately 6% per year. That's more than enough. The restricted interest income should be shown on the revenue statement.
Eliminate the 8% Revenue Restriction
In my opinion, the 8% revenue restriction is being used to hide the fact that the NBCE excess revenues are almost $1.5 million per year. There is no need to add another $500,000+ into the restricted asset account. With $20,000 per month in investment interest from $4,586,650 in unrestricted investments, the budgeted total excess revenues over expenses can be reduced to a much more reasonable $400,000 (5%+?).
Reduce the Costs of the Tests
Based on the suggestions above, the savings combined with the reduced need for excess revenue would be enough to reduce the costs of Parts I, II and III by $50 each down to $450 for all three (rather than the current $600). It would also be enough to reduce Part IV by $200 down from $850 to $650.
Convert Parts I, II and III to Electronic Tests
Twenty years ago, I took a securities test to qualify to manage my own stockbrokerage office. The securities test is as critical for aspiring stockbrokers as the chiropractic national boards are for interns. Although I only dealt with people's life savings, it was every bit as critical as the chiropractic boards. I took the test at a testing center that gave all manner of exams for various professions. All I had to do was schedule a test time (I could take it at any time) and show up. The test was given on a touch-screen computer while a proctor/administrator watched from a control console above me. The test results came back quickly.
In that 20-year interval, the NBCE has been "exploring the feasibility of computerized testing." Computerized testing should be a top priority if for no other reason than the time benefit to the chiropractic students. It would result in a significant reduction in testing costs. It could reduce the total cost of the four tests down to under $1,000. The fact that this has not happened during the last 20 years speaks loudly of the need for new board members.
Clean the Slate
Looking at the current situation, it is clear that none of these changes will occur under the current board of directors. They were almost stoned by the delegates at their last meeting when they insisted that a vote for term limits was "out of order." They promised the delegates that the district directors would have a proposed by law regarding term limits ready for their review by January 1, 2000.1 It never happened.
My suggestion is simple. Before the next annual meeting in May, each director should resign. At the annual meeting, the delegates should pass by laws to institute term limits and eliminate the at-large positions. They should then elect a new board from among those they have faith in.
This is not to say that every member of the board has violated the professional trust. This is not true. But the situation has gotten to a point where the new board must begin without all of the unnecessary expenditures and money hoarding that has become part of the NBCE's corporate culture. I have great faith that the NBCE delegates recognize those current board members whom they can trust and will elect them back on the board as they see fit. The first job of the new board should be a review of all expenses.
Some people might look at this article and interview with the NBCE and remark that they are just functioning like any good business. If this is true, then they need something that every good business has:
Competition is what causes good businesses to stop thinking about themselves and start thinking about their customers (the chiropractic students).
I predict that if the National Board of Chiropractic Examiners does not make the above changes, within three years at least one other testing organization will emerge, offering lower priced tests and better service to the graduating DCs. Once they see the profit margins of the NBCE, they would be crazy not to.
These are my thoughts: what do you think? Please submit your comments by mail, fax, e-mail ( ) or post them online at: http://www.ChiroWeb.com/cgi-bin/ubb/open/Ultimate.cgi.
1. Nat'l Board Delegates Seek Greater Authority. Dynamic Chiropractic May 31, 1999; http://www.ChiroWeb.com/archives/17/12/20.html.
Click here for more information about Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher.