Introduction

A prominent chiropractic historian and a faculty member at Logan College of Chiropractic, Dr. Patrick Montgomery once stated the need to upgrade the status of chiropractic specialists.

Another area to build on is upgrading the status of diplomates of the various sub-specialties and promote them to the public and integrate them with other health professions. During the times before the Wilk trial, the chiropractic profession had to create its own specialty organizations. These organizations established extra training programs, testing procedures and promoted these new specialists as having extra skills to help those patients that needed that something extra that general practitioners could not provide. Currently, these specialists do not receive the proper recognition from other professions or from third-party payers. They sometimes receive recognition of their skills from personal-injury trial lawyers, as they can see the benefits of having those DCs on board for their clients.1

In order to upgrade the status of diplomates (chiropractic specialists), the chiropractic profession must comprehend the definition of a Diplomate and the process to become a chiropractic specialist. First of all, chiropractic is not a specialty but a profession.2 Oftentimes, medical organizations hire chiropractic physicians and refer to chiropractic as a specialty rather than a profession. Unfortunately, many chiropractors claim they are board certified by the National Board of Chiropractic Examiners (NBCE). This is so common that the NBCE has clarified on their website that the NBCE does not provide licensure or board certification to chiropractors.

The NBCE does not certify/license chiropractors. As a testing organization, the NBCE prepares and administers examinations that state licensing boards use in their evaluation of a doctor for licensure. It is the state board, in the state where he/she will practice that reviews each candidate’s transcripts, scores and other pertinent documents from a variety of sources to determine licensure eligibility and then issues a license to practice. Please contact the state licensing board where a doctor practices to verify licensure/certification.3

Similar to medicine, chiropractic specialization is an elective choice and not a mandatory requirement to practice. Currently, less than 20% of the chiropractic profession complete postdoctoral training and attain specialty status as a Diplomate.4 An even smaller number of chiropractors pursue residency training, whereas, more than half of active physicians (MD/DO) in America are board-certified specialists.5

Discussion

As stated, chiropractic is not a specialty but a profession. Chiropractic clinicians may pursue specialty status with postdoctoral training including resident training. Completion of the postdoctoral training qualifies the doctor to apply for specialty board examinations.6 A chiropractic physician that passes these examinations earns the status of “Diplomate” and is considered to be chiropractic specialist.7

The medical (allopathic) profession clearly defines a Diplomate as a medical specialist.8 The American Chiropractic Association and the American Board of Chiropractic Specialties clearly lists the chiropractic specialties and uses the “Diplomate” designation.9 While it is common for some chiropractors to claim they are board certified by the National Board of Chiropractic Examiners (NBCE), this claim is incorrect and possibly fraudulent. The NBCE has succinctly stated that the organization does not license chiropractors or certify them.

A chiropractic physician that passes board certification examinations earns the status of “Diplomate” and is considered to be a specialist. As a result of attaining Diplomate status as a board-certified chiropractic specialist, opportunities to integrate into medical organizations may become a reality.

Chiropractic clinicians with specialty certification have the training and credentials necessary to apply for medical staff privileges within coordinated care organizations, such as Accountable Care Organizations, Community Health Centers and Patient-Centered Medical Homes.10

During 2011, the Community Health Center, Inc. of Middletown, Connecticut (CHCI) invited the University of Bridgeport – College of Chiropractic (School of Chiropractic) to integrate chiropractic services into their Federally-Qualified Health Center primary care sites. Subsequently, a pilot study began at one clinical site in January 2012. After completing the pilot study and gaining approval from the Health Resources & Services Administration (HRSA) to expand scope of services to include chiropractic specialty services, CHCI agreed to credential chiropractic specialists as members of the medical team.

In order to provide chiropractic specialists for CHCI, the University of Bridgeport (UB) created a post-doctoral program in orthopedics and neuromusculoskeletal medicine. This program made chiropractic specialty treatment for CHCI patients with chronic pain available through the Health Sciences Postgraduate Education Department. Subsequently, the University of Bridgeport developed a three-year, full-time residency course in Orthopedics and Neuromusculoskeletal Medicine within Federally Qualified Health Center facilities. This is the only three-year, full-time, chiropractic residency offered within a community healthcare center credentialed by Health Resources and Services Agency (HRSA) as a Federally Qualified Health Center (FQHC) that leads to board certification. This resident training program prepares chiropractic clinicians to become Diplomates in Neuromusculoskeletal Medicine.11

The board certification process for chiropractic clinicians offered by the International Academy of Neuromusculoskeletal Medicine (IANM) verifies the chiropractic physician to be a chiropractic specialist with a Diplomate. The IANM grants the Diplomate (DIANM) to licensed chiropractic physicians that successfully pass the two-part board examinations.12

Federally Qualified Health Centers

The Health Resources and Services Administration (HRSA) permits Federally Qualified Health Centers (FQHC) to offer chiropractic services as specialty services. Hence, participating chiropractors are required to be board certified as chiropractic specialists to offer those services within FQHCs.13

It is now more common for hospitals,14 medical centers,15 FQHCs,16 and Rural Health Centers (RHC) to offer chiropractic services.17 The medical organizations perform a credentialing process, which normally requests information concerning postdoctoral training and specialty status.18

For several reasons, chiropractic physicians interested in serving within medical organizations should seek postdoctoral training and board certification as a chiropractic specialist. The additional training enhances clinical skills, which improves quality of care and patient outcomes. The Diplomate status as a chiropractic specialist will meet the credentialing requirements of FQHC and RHC organizations. Based upon my experiences with chiropractic specialists, medical organizations including the Veterans Administration (VA) prefer chiropractic specialists. Finally, there is a probability that a chiropractic specialist with ample clinical experience will gain a higher salary at the VA than a chiropractor without postdoctoral training.

Conclusion

The chiropractic profession must recognize and acknowledge that it is not a specialty but a profession. Chiropractic physicians should realize the value of becoming a Diplomate. It elevates their status to that of a chiropractic specialist, which enables them to become credentialed as such within medical organizations, including Federally Qualified Health Centers. Chiropractic clinicians should discontinue the fraudulent use of the title of Diplomate of the National Board of Chiropractic Examiners.