Organizations resist plan to change standards, call D.C.s 'physicians'

Several recently proposed revisions to the Council on Chiropractic Education (CCE) "Standards for Chiropractic Programs and Institutions," were immediately denounced by the World Chiropractic Alliance, the International Chiropractors Association (ICA), the Federation of Straight Chiropractors and Organizations (FSCO), and doctors across the United States .

A massive grassroots letter-writing campaign was launched in a bid to prevent the CCE from approving the changes. Letters were sent to CCE Executive Vice President Paul D. Walker, Ph.D., as well as Rod Paige, Secretary of the U.S. Department of Education.

Three of the proposals stirred the most controversy:

1. The newly announced "PACE" program (see accompanying article).

2. A requirement that ALL chiropractic colleges include physiotherapy in the D.C. degree requirement and in clinical competencies.

3. A "request" that schools verify that their missions incorporate the concept of training chiropractors to function as "physicians."

"These provisions could have extremely serious ramifications for the entire profession, and allow the CCE to interfere in state regulatory functions," stated Terry A. Rondberg, D.C., president of the WCA. "They could change the way chiropractic is taught, and how the public perceives it. Most critical, however, is that they clearly overreach their authority when they try to dictate the content of chiropractic education and show a decided bias toward medicalized chiropractic.

In an open letter to the profession, Dick Plummer, D.C., FSCO chairman warned the changes "will end a chiropractic college's ability (to) train practitioners who will contribute to an individual's overall well being through the correction of vertebral subluxation. The first proposed change mandates the inclusion of physiotherapy in the curriculum of all colleges. This means that the chiropractic colleges and chiropractic would become condition rather than subluxation centered."

The organizations agree that there are numerous problems with the CCE's proposals. Of primary concern is that agency's continuing effort to usurp the authority of the individual colleges, dictating not only educational standards, but educational content.  Making the situation more critical is the fact that many state boards do not realize that there is no federal requirement that students graduate from CCE-accredited schools. Schools may be accredited by regional accrediting agencies or even non-accredited by assessed by a board-appointed site team.

As Dr. Rondberg pointed out, "Use of physiotherapy is prohibited in some jurisdictions and, where it is permitted, its use is discretionary, not mandatory. CCE should incorporate into its standards that same freedom for college to include physiotherapy as an option, not a requirement."

The mandatory inclusion of physiotherapy could alter the basic character of a college's educational direction, shifting the emphasis from subluxation correction to treatment therapy.

Although shrugged off by some as "semantics," the change of the designation from doctor of chiropractic to physician has far more devastating consequences than are obvious at first glance. Repeated use of the term, coupled with its inclusion in the CCE "Standards" would be interpreted as the "official" chiropractic designation and a mandate to chiropractic colleges.

This is an extremely ill-advised proposal, since several state statutes prohibit the use of the word "physician" by chiropractors. Additionally, the terminology has no relevance to educational standards and is not therefore an issue to be decided by the CCE. Finally, use of the term would confuse the public and further blur the distinction between medical physicians and chiropractic doctors.

"The premise that CCE-style chiropractic education prepares full body, primary care diagnosticians is a dangerous farce. What we can rationally argue is that chiropractic education can prepare doctors of chiropractic to determine the safety and appropriateness of chiropractic care," Rondberg noted.

The timing of the new proposals also rankled many doctors.

The announcement was made shortly just weeks before the beginning of the holiday season and was not distributed to all chiropractic publications. Yet, the CCE gave doctors only until Jan. 5, 2003 to provide written comments to be considered during its Jan. 12 meeting.

"I do not feel that adequate time or notification has been given for all interested parties to provide input into this process," Dr. Plummer maintained.

Opposing organizations requested an opportunity to provide input during the meeting but were informed that no one would be allowed to speak at the gathering.

That decision, and the general high-handedness of the CCE, has created a wave of dissension throughout the profession. According to its site, hundreds of doctors have already joined the grassroots group, Doctors for Excellence in Chiropractic Education (DECE), which maintains a website (www.dece.org) with information about the CCE, the Life University accreditation situation, and related issues.

"Over the last several months, donations from supporters have been used to investigate every aspect of the CCE," the group announced. "Lawyers were dispatched to Wisconsin , Arizona , and Washington , D.C. to review every corporate filing ever made by the CCE. Minutes from every CCE meeting were obtained and painstakingly reviewed. Individuals with knowledge of CCE's inner workings were interviewed and their statements woven together with the facts. The picture that emerges is one of apparent gross misconduct, corporate actions of questionable legality, and apparent political abuse."

The web report continued: "The evidence uncovered suggests that the CCE has steadily worked to increase their power since winning approval from the U.S. Department of Education as the sole accrediting body of chiropractic schools. The tiny group of chiropractors that control this organization have systematically used their power to insulate themselves from any accountability to the chiropractic profession. Over the years they succeeded in convincing approximately 35 states to enact laws that only allow graduates of CCE accredited schools to be licensed in their states. With the power of the state laws behind them, they slowly forced the schools to remove traditional chiropractic courses by mandating increases in the number of required medical courses and procedures. Many schools have been fearful to resist their demands because of the possibility of loss of accreditation."

The reaction by doctors around the country has been so fierce that the CCE took the unusual step of releasing an "Open Letter" to the profession in response to the criticism. The letter, published in the Dec. 2002 issue of The Chiropractic Journal, argued that the group is non-political and diverse.

"Yes, a small number of individuals still complain about their loss of political control, but CCE has moved past such pettiness to place itself where an effective and credible educational accrediting body must be -- above and beyond the politics of the profession," the letter claimed.

The DECE isn't buying that explanation.

Neither is the Life University administration, which has slapped the CCE with a lawsuit alleging that the agency, among other things, "adopted Standards for Doctor of Chiropractic Programs and Institutions that strongly favored the liberal branch of chiropractic philosophy at the expense of the conservative branch," and "violated Life's common law due process rights by conducting a flawed and biased process for reaffirmation."

Rondberg stressed that there are several options to consider.

"We will be working closely with the other organizations to take forceful actions to prevent the CCE from overstepping its authority and dictating educational content at the college and post graduate levels." He added that the WCA has already looked into the criteria that the CCE must meet in order to continue being recognized by the DoE as an accrediting agency.

One criteria states that an accrediting agency "must demonstrate that its standards, policies, procedures, and decisions to grant or deny accreditation are widely accepted in the United States by educators and educational institutions; and licensing bodies, practitioners, and employers in the professional or vocational fields for which the educational institutions or programs within the agency's jurisdiction prepare their students."

If the abuse by the CCE continues, one option to be explored will be to have its federal recognition withdrawn and a new accrediting agency established.

"We will not make any decisions about the best course of action until we have examined all the facts and spoken with our contacts in the federal government," Rondberg stated. "But let no one doubt that the WCA will do what it feels is in the best interest of the chiropractic profession as a whole."

Emphasizing the determination of concerned doctors, Rondberg made it clear that the CCE is not going to get a pass on these crucial issues.

"We will not be intimidated, threatened, or bullied into remaining silent," he vowed. "We will act, and we look to doctors around the country to join us and the other groups fighting for the survival of our profession."