From Complaining to Action: Refuse to Sit on the Sidelines
By Guy Riekeman, DC, President, Life University
It's easy to sit on the sidelines and point to things that aren't working; actually knowing what needs to be done and how to do it is an entire different story. Too often, we see well-meaning chiropractors dissatisfied with developments within the profession launch wholly ineffective counterattacks.They rail in the chiropractic media but don't put their anger into action, or attack a chiropractic entity that has no authority on the issue at hand. Both approaches lead to a lot of noise and frustration, but no tangible results.
Chiropractic's political and regulatory landscape is complicated and, sometimes, dysfunctional. But knowing who does what and where the greatest potential is for grassroots impact can empower practicing DCs with a voice that will be heard in the right places by the right people and, just possibly, drive change. It's a bit of an alphabet soup, but here's a primer on which chiropractic organizations do what and how field chiropractors can most effectively gain entry and influence.
ACA / ICA and Other National Trade Organizations
Grassroots activism starts here with the American Chiropractic Association and the International Chiropractors Association. They act as national trade associations to represent the profession, lobbying the government regarding legislation, performing public relations and community education and outreach, and assisting members in their professional development. There are also smaller organizations at the furthest ends of each scope-of-practice spectrum, such as the International Federation of Chiropractors and Organizations (IFCO) and American Academy of Chiropractic Physicians (AACP). Which organization you join depends primarily on your practice philosophy.
How to get involved: Anyone can join and participate as a dues-paying member. Each group also has a governing board whose leaders are voted into position from the general membership. Being active in a professional organization is a good way to hone skills, get familiar with the issues, boost visibility, and position yourself for selection to a state board.
State Licensing Boards
Every state has its own licensing board that defines the scope of practice, administers licensing exams, and grants and revokes licenses. An appointment to a state board is often an entry point into a strong political role within the profession. If you're interested in scope-of-practice issues, such prescription / prescribing privileges (pro or con), this is the right place to get engaged. Lobbying the ICA, ACA, the colleges or even the Council on Chiropractic Education (CCE) will not directly impact scope-of-practice concerns.
How to get involved: Appointments are made by the governor and typically involve a three- to five-year term. Appointees are typically those who have been very active in their state associations, although the appointments may have political overtones.
Federation of Chiropractic Licensing Boards (FCLB)
This organization represents an alliance of all of the state boards, although it has no formal authority over the states. The FCLB operates as a clearinghouse and forum for the discussion of regulatory issues and strives to promote uniform practices, although it cannot impose them.
The FCLB provides a public record of state board actions related to specific practitioners through the Chiropractic Information Network / Board Action Databank (CIN-BAD) Official Actions Database (OAD). The OAD contains information on chiropractors with public board actions taken by chiropractic regulatory licensing boards and/or exclusions from Medicare/Medicaid reimbursement by the U.S. Department of Health & Human Services.
The FCLB also operates PACE (Providers of Approved Continuing Education), a centralized CE approval clearinghouse intended to provide greater standardization and quality oversight for continuing education. It also elects regional directors to the National Board of Chiropractic Examiners (NBCE).
How to get involved: Chiropractors currently serving a state board appointment are eligible for election to the FCLB. The federation can be seen as a maximum point of interconnectedness among the profession's various organizations, as individuals often move from service on a state board to election to the FCLB and then potential election to the NBCE.
National Board of Chiropractic Examiners (NBCE)
The NBCE creates and administers the examinations that all states require students to pass before sitting for a state license to practice chiropractic. Chiropractic college faculty play active roles with the NBCE as developers of test questions and administrators of testing procedures.
How to get involved: States that use NBCE exams may name delegates to attend the NBCE annual meeting. At the meeting, district delegates nominate a person to serve as district director. An assembly of all state delegates votes to accept or reject each district nominee. Two seats are filled by appointment by the FCLB. The board then elects at-large directors for terms ranging from one to three years. The four officers (president, vice president, treasurer and secretary) comprise the NBCE Executive Committee.
Council on Chiropractic Education (CCE)
The CCE is recognized by the U.S. Secretary of Education for accreditation of programs and institutions offering the doctor of chiropractic degree. CCE develops accreditation criteria to assess how effectively programs or institutions plan, implement and evaluate their mission and goals and outcomes of their chiropractic programs.
In 2012, the CCE adopted its new Standards, which move away from dictating specific curricula to the creation of broad meta-competencies against which organizations must prove measurable improvement and progress in relation to their own mission and purpose. The new Standards provide DC programs with greater flexibility in designing curricula and clinical experiences.
Contrary to popular belief, the CCE plays no role in defining scope of practice, although it would be naïve to assume that the interaction of the CCE, FCLB, NBCE and the colleges does not "encourage" professional changes that influence the direction of the profession.
How to get involved: The CCE Council is comprised of 24 members who manage the business of the organization, carry out all accreditation functions and decisions, and revise CCE bylaws, policies and standards. Of the 24 members, 12 are mandated to be chiropractic program representatives, four are members of the public and eight are practicing DCs. There is an annual call for nominations and anyone can nominate an individual for election to the council.
World Federation of Chiropractic (WFC)
The voting members of the WFC are national associations of chiropractors in 88 countries. The organization promotes uniform standards of chiropractic education, research and practice; informs the public about chiropractic; strives to unite members of the profession; and acts with national and international organizations to provide information and assistance related to chiropractic and world health. Every two years, the WFC holds a combined business meeting and conference that features invited papers and research abstracts.
How to get involved: Full and voting members of the WFC are national associations of chiropractors, although associate membership is available to anyone who supports the goals of the organization. Applications for membership are available on the WFC Web site.
Association of Chiropractic Colleges (ACC)
The ACC is the collective voice of the 19 chiropractic colleges and universities in the United States and Canada. Its focus is on safeguarding education quality and serving as a voice for chiropractic education to government bodies and the public. The organization is not directly connected to any other chiropractic organizations and thus maintains a more independent stance.
How to get involved: Membership in the ACC is intended for the college presidents or their designees and is not open to general members of the profession. Each college has a representative to the ACC; from these individuals, an executive committee is elected.
Congress of Chiropractic State Associations (COCSA)
This organization is somewhat unique in that its focus is completely on supporting the functioning of the state associations, regardless of philosophy or practice approach. The group provides a forum for state associations to learn from one another and share best practices in how similar challenges may have been met in another region.
COCSA holds an annual convention focused on training for elected leaders and paid staff on how to more effectively manage the association. The congress also sponsors the annual National Chiropractic Leadership Forum, which brings chiropractic's national organizations to the table in an effort to foster unified leadership for the profession.
How to get involved: Membership in COCSA is extended to state associations as a group and is awarded through the Chiropractic Organization Application, available online.
When It Actually Works
Although like any profession, it can take some know-how to navigate chiropractic's complex professional and regulatory bodies, each of these organizations exists to serve chiropractors and the profession. If you have the passion to make a difference and willingness to invest your time and talents in "learning the ropes," there's no question you can impact the course of the profession.
Dr. Guy F. Riekeman, president of Life University in Marietta, Ga., has held leadership positions in chiropractic education essentially since his graduation from Palmer College of Chiropractic in 1972. He was appointed vice president of Sherman College in 1975 and has served as president of all three Palmer campuses and as chancellor of the Palmer Chiropractic University System. In 2006, he was elected to the board of directors of the Council on Chiropractic Education.