The Federation of Chiropractic Licensing Boards (FCLB) and the Council on Chiropractic Education (CCE) have joined forces to develop a program that could take control of the profession's continuing education process.

The program, dubbed "PACE Chiropractic" (Providers of Approved Continuing Education -- Chiropractic), imposes CCE criteria for continuing education programs. The two regulatory agencies spent four years developing the program, according to a press release distributed by the FCLB.

Although the release noted that "we have received some terrific guidance from many people with an interest in CE," there was no indication that any input was solicited or accepted from the profession in general. In fact, most doctors were totally unaware of the program until it was revealed in December, shortly after the CCE announced proposed changes in its standards and policies.

PACE criteria will be established and maintained by the CCE and applied by the PACE Committee of the FCLB. The CCE would be given the authority to use its own criteria to approve -- or reject -- continuing education programs presented to doctors around the country. CE providers would submit their application to CCE/PACE, with a $1,500 initial application fee. If the program meets all CCE/PACE criteria, it will receive the official CCE/PACE "seal of approval" and be allowed to use the PACE logo.

While touted as a "voluntary" program, most observers assume boards will feel obligated to defer to the CCE-controlled PACE program. Boards dominated by medically oriented doctors will no doubt be pressured to use that program rather than make their own decisions about the worthiness of the proposed CE course.

In time, the voluntary nature will likely degenerate into a mandatory status, similar to the situation with the CCE.

In the past, most states did not require license candidates to be graduates of CCE-accredited schools, since there is no legal mandate for such requirements. Although many states still do not prohibit non-CCE school graduates from taking the licensing examination, the CCE has made the "voluntary" criteria virtually mandatory.

Already, some boards are holding off making decisions on CE programs until they can turn the task over to the CCE/PACE, and the PACE program hasn't even officially been started.

The World Chiropractic Alliance (WCA) voiced its strong opposition to the program, particularly to two sections of the proposed PACE criteria.

Criterion 17 notes that: "Continuing education programs must address topics and subject matter areas that are pertinent to the contemporary practice of chiropractic and well balanced in presentation. Subject matter must be evidence-based, professionally credible, and educationally sound."

WCA President Terry A. Rondberg, D.C. warned, "Since CCE is running the program, it will determine what 'evidence-based' content is permissible. We saw the same thing happen with the Mercy guidelines. A small group of medically oriented chiropractic 'physicians' tried to dictate to the profession how we should practice. We all banded together and soundly rejected Mercy and we must just as aggressively reject PACE, which is merely another tactic being used to turn chiropractic into a medical discipline."

Christopher Kent, D.C., member of the WCA Board of Directors echoed Dr. Rondberg's concerns.

"CCE may establish criteria that severely limits the content of CE programs," he noted. "Specifically, we can anticipate credit will be restricted to courses presenting a limited concept of evidence-based practice, such as temporary relief of acute mechanical back pain and medical diagnosis."

The other section causing the most concern is Criterion 26, which states: "An evaluation mechanism must be provided at each program for the purpose of allowing all participants to assess their achievement in accord with the program's learning objectives."

Dr. Kent cautioned, "This means testing. If this proposal goes through, I predict that it will become mandatory to attend a medically oriented seminar, and pass a test on this material to renew a license. Of course, this will then become the standard of care."

Other organizations have already raised their voices in alarm and opposition.

The International Chiropractors Association (ICA) expressed doubts about the proposal. Ronald M. Hendrickson, ICA executive director, stated, "This proposal has a host of potential difficulties and will likely be fought by a majority within the profession, including the ICA."

Richard E. Plummer, D.C., FSCO chairman, offered his organization's grave concerns, "not the least of which is the [FCLB's] partnering with CCE...attempting to alter and redefine a chiropractor's role in the chiropractic educational institutions. ...FCLB, which is a voluntary membership, quasi-government organization is overstepping into states rights' issues with this attempt to control continuing education."

The American Chiropractic Association (ACA) has issued no official statement about the proposal. Since the CCE and FCLB are listed as "related organizations" on the ACA website, indicating the group's close alliance with these agencies, it is assumed the ACA will not object to the program, even if it fails to give overt approval.

"I wouldn't doubt that, although they might applaud PACE in private, the ACA will lay low on the issue," stated Rondberg. "They've been losing a lot of members lately because of their blatant medical bias, and they might not want to risk an exodus if they show they are strongly in favor of controlling the state CE process."

Rondberg did, however, find himself agreeing with the FCLB on one point: the difficulty in the current CE process.

According to the FCLB announcement, "Colleges and providers are frustrated by the expense, time delays, and varied processes required by licensing boards for approval. The boards are equally frustrated in their attempts to approve and ensure quality CE, and the requisite expense, time, effort, and expertise necessary to do this."

Yet, while Rondberg concurred with this assessment, stating, "It's true that the current process is cumbersome and time-consuming," he stressed that the solution isn't to hand the job over to the CCE.

"If state boards do that," he pointed out, "they are merely abdicating their responsibility to their doctors. They are taking what seems to be the easy way out, but at the expense of their own authority and independence."

He added that the solution to the dilemma lies in transforming the CE system into a "marketplace of ideas" with less red tape and fewer restrictions.

"Too often, programs are judged not on the basis of their merit or the qualifications of the provider, but on the political inclinations of the board member," he noted. "Broad-scope board members routinely disallow programs not in compliance with what they think chiropractic should be, or what Mercy says it is. And I'm sure the reverse is sometimes true when more conservative chiropractors are in office. This has got to stop. If we created a more open-minded atmosphere of learning, growing and tolerance, we would eliminate many of the procedural headaches involved in the process."

In the meanwhile, the profession must band together to fight the PACE program, as it did in the case of the Mercy guidelines. There are three steps every doctor should take immediately to oppose the FCLB/CCE program:

*** Contact the FCLB and CCE and voice your objections to the PACE program.

*** Contact your licensing board and insist it remains in control of the state's CE process and not participate in the PACE program.

*** Join and support the organizations fighting the CCE/FCLB/PACE program (the WCA, ICA, FSCO, and DECE).

In urging doctors to act now, Dr. Kent stressed, "CCE's effort to change the nature of the chiropractic profession is a cancer that must be aggressively fought. It has been the driving force behind the medicalization of chiropractic for three decades. Without CCE's coercive authority, chiropractic education would be driven by free enterprise -- not a political agenda."