Student Debt: How the NBCE Uses Exam Fees to Buy Silence Across the Chiropractic Profession
Originally published: 2025-04-30
The NBCE isn’t just a testing agency. It transforms federally-backed student loans into strategic payouts that protect its monopoly.
Each year, chiropractic students take on tens of thousands of dollars in debt—not just for tuition, but for a battery of mandatory NBCE exams that can cost upwards of $5,000 per student over the course of their education. These exams are required by nearly every U.S. licensing board, not because of proven outcomes, but because the NBCE has hardwired itself into state law through decades of political influence and lobbying.
According to the NBCE’s 2024 Annual Report, the organization currently controls $49.7 million in total assets—an empire built largely on student loan money. In that same year, the NBCE distributed over $1.16 million in grants, donations, and sponsorships to organizations and individuals within its network in the profession.
To put this in perspective: NBCE’s 2024 “contributions” represent just 2.3% of its asset base. A pittance for them, but a powerful tool of control for keeping critics in check.
A Financial Pipeline Built on Student Debt
Let’s be clear: this is not charitable giving. It’s strategic redistribution of federal loan money, funneled through student exam fees into a carefully curated network of institutional partners who help maintain the NBCE’s privileged position. Here’s where the money went in 2024:
$823,000 to the Federation of Chiropractic Licensing Boards (FCLB) — the very entity that helps enforce NBCE's exam requirements at the state level.
$170,000 to student programs and leadership groups — a small gesture to deflect from the $15+ million in exam fees collected.
$156,000 to chiropractic colleges and educational associations, many of which rely on NBCE alignment for accreditation and Title IV funding.
$74,000 for research support and journal sponsorships aimed at legitimizing NBCE's testing model.
$18,000 to PR and advocacy groups like Women Chiropractors and F4CP.
$11,000 in token charitable donations.
$10,000 to international chiropractic organizations.
Meanwhile, the NBCE’s board-controlled investment accounts exceed $35 million, with millions more in cash, property, and real estate holdings.
The Annual FCLB Meeting: Where Student Debt Becomes Political Capital
At the heart of this scheme is the NBCE-FCLB Annual Meeting, a lavish affair where state regulators, NBCE executives, and association leaders meet behind closed doors. There, funded with student loan debt, decisions are made that will affect thousands of chiropractic graduates—but students and anyone who questions them have no seat at the table.
Instead, they foot the bill for the networking, lobbying, and quiet policymaking that keeps the NBCE at the top of the licensure pyramid.
Students Are Paying to Be Silenced
The outrage is growing—and rightfully so. Students are forced to fund a system that not only drains their wallets but works against their interests.
There is no transparency, no competition, and no clear evidence that NBCE exams produce better chiropractors or safer outcomes despite NBCE claims. Yet the organization has successfully used its massive war chest to buy loyalty, silence opposition, and maintain regulatory capture of the chiropractic profession.
It’s not just unethical—it may be illegal.
Time for Investigations—and Accountability
The NBCE’s financial disclosures raise serious questions:
Is federal student loan money being misused to prop up a private testing cartel?
Are these payouts a form of institutional bribery to secure political protection and regulatory preference?
Are students being exploited in violation of federal education funding laws?
These are not abstract concerns. States and federal agencies should begin investigating whether NBCE’s financial practices constitute misuse of public funds, and whether chiropractic colleges are complicit through their mandatory participation in this closed-loop system.
With $49 million in the bank, NBCE could cut exam fees in half tomorrow. But they won’t—because their power depends on keeping students dependent, voiceless, and in debt.
Chiropractic students deserve better. So does the profession. The NBCE’s stranglehold on licensing must be broken, its financial dealings must be investigated, and the voices of students must finally be heard.
Take Action: Sign the Petition to End NBCE Part IV
The time for silence is over. Chiropractic students and professionals are calling on state boards and regulators to modernize chiropractic licensure by removing the outdated, costly, and unnecessary NBCE Part IV exam. This exam no longer reflects clinical reality, places an unfair financial burden on students, and serves only to prop up a broken system.
Join the movement and sign the petition here:
👉 change.org/modernize-chiropractic-testing
Your voice matters—help bring transparency, fairness, and accountability back to chiropractic licensure.
