Monopoly Without Metrics: Examining Chiropractic Attrition, Oversight Failures, and the Cost of Control
Originally published: 2025-01-18
In the heart of chiropractic’s regulatory maze lies a troubling paradox: the entities tasked with safeguarding public safety and ensuring clinical competency lack the outcomes data to justify their existence. From the Council on Chiropractic Education (CCE) to the National Board of Chiropractic Examiners (NBCE), the institutions that hold a monopoly over the profession have built a fortress of accreditation standards, licensing exams, and oversight that burdens students and practitioners—yet they are unable to produce evidence proving their value.
Attrition: A Crisis Ignored
A narrative review published in the Journal of Chiropractic Humanities highlights the profession’s attrition crisis, reporting rates ranging from 4.5% to 28%. This startling variability reflects a deeper issue: a near-total absence of meaningful research into why chiropractors leave the field. The limited data suggests multifactorial causes, including dissatisfaction, stress, and lack of professional autonomy, yet the CCE and NBCE appear indifferent to the human cost of their mandates.
Rigney, C.T., Grace, S., & Bradbury, J. (2023). Chiropractic Profession Attrition: A Narrative Review of Studies Over the Past 30 Years. Journal of Chiropractic Humanities, 30, 9-15
The review’s authors issued a "clarion cry for intraprofessional introspection," calling for urgent investigation into the profession’s sustainability. But instead of addressing these challenges, the chiropractic cartel continues to impose rigid accreditation rules and costly exams that offer no measurable assurance of improving safety or clinical outcomes.
The Cost of Monopoly
For chiropractic students, the price of entering the profession is steep. They must navigate a labyrinth of requirements, from CCE-accredited programs to the NBCE’s costly and opaque testing regimen. These tests—purportedly designed to ensure competency—are widely criticized for their lack of transparency and failure to reflect real-world practice.
Despite controlling every step of the pipeline, the NBCE cannot produce data demonstrating that its exams correlate with better patient outcomes or reduced malpractice claims.
CLICK HERE for more on that shocking scandal
Similarly, the CCE, which dictates the curricula of chiropractic colleges, has no evidence to support its accreditation standards as a predictor of clinical success.
This regulatory overreach extends to the Federation of Chiropractic Licensing Boards (FCLB), which reinforces these monopolistic practices at the state level. Together, these entities form a self-reinforcing cycle of control, stifling innovation and imposing financial burdens on students and practitioners alike.
Borrowers Defense Claims and Oversight Failures
Adding to the controversy is the rise of Borrower Defense claims from chiropractic graduates saddled with insurmountable debt and limited career prospects. These claims underscore the disconnect between the promises of chiropractic education and the harsh realities of practice. Graduates often find themselves ill-equipped to navigate a healthcare landscape dominated by insurance requirements, bureaucratic hurdles, and limited public awareness of chiropractic’s role in health and wellness.
Outcomes Data: The Missing Metric
The crux of the issue is this: the chiropractic cartel’s monopoly exists ostensibly to protect the public, yet it cannot produce the outcomes data to justify its authority. If these organizations cannot demonstrate that their accreditation standards, licensing exams, and oversight mechanisms lead to better patient care or professional sustainability, then their legitimacy must be called into question.
The absence of data is not merely an academic oversight—it has real-world consequences. Chiropractors are leaving the profession at alarming rates, students are burdened with unnecessary costs, and patients ultimately suffer from reduced access to care.
The Path Forward
The chiropractic profession stands at a crossroads. To ensure its future, the cartel’s grip on accreditation, testing, and licensing must be reevaluated. This begins with demanding transparency and accountability from the CCE, NBCE, and FCLB.
Policymakers, educators, and professional organizations must collaborate to collect and analyze data on attrition, exam efficacy, and accreditation outcomes. Research must inform decisions, replacing the current system of unsubstantiated claims and arbitrary mandates.
Moreover, the profession must embrace its role in addressing the growing demand for musculoskeletal care by prioritizing innovation, reducing entry barriers, and supporting practitioners. This includes rethinking educational requirements, lowering the cost of entry, and fostering a culture of professional autonomy.
Conclusion
The chiropractic cartel has long wielded its monopoly without scrutiny. But as evidence mounts of its failure to deliver on its promises, the profession must confront the unsustainable burden it imposes on its own members. Only through transparency, accountability, and a commitment to outcomes-based reform can chiropractic reclaim its potential to improve public health and ensure its long-term viability.
