January 2004

COCSA asks FCLB to suspend PACE action

In its annual meeting, held in Nov. 2003 in Las Vegas, the Congress Of Chiropractic State Associations (COCSA) heard a report from the Federation of Chiropractic Licensing Boards (FCLB) on its plan for centralizing the continuing education approval process.

The FCLB joined forces with the Council on Chiropractic Education (CCE) to develop the program dubbed "PACE Chiropractic" (Providers of Approved Continuing Education ‑ Chiropractic), which 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 last year.

According to a report from COCSA, The Congress has closely monitored the development of PACE over the past year, and received an introductory report on the proposed program in 2002 and met with FCLB officials in Orlando to discuss state association concerns.

"When Dr. Laurel Cowie, Chair of FCLB's PACE Committee, failed to adequately address specific state association questions during her presentation in Las Vegas, members of the Congress officially voiced their concerns on the proposed program by unanimously adopting (a) resolution" on the issue, a report from COCSA noted.

Although the resolution says that the "concept of a centralized continuing education approval process has merit and potential for solving certain problems of continuing education certification," it goes on to state that the group has concerns about the program.

The group pointed specifically to:

***  Financial impacts on programs and conventions.

***  Loss of or reduced control over what is taught in state chiropractic association continuing education programs and conventions.

***  Potential philosophical differences between PACE‑approved courses and state associations and their programs and conventions.

In addition, the resolution noted that the Congress expressed concern over the "individual state boards of examiners ceding their authority to approve continuing education credits to PACE, especially in the states who have combined medical/chiropractic boards," and "the individual state boards of examiners having the choice to approve non‑PACE approved continuing education credits."

The resolution concluded by stating that the Congress "advises a rigorous review of the potential impact on our member state associations of implementation and acceptance of the FCLB PACE program of continuing education approval," and recommended "that the FCLB not proceed any further with the implementation of PACE until all of the concerns of COCSA and its member associations are positively resolved."

As soon as it was revealed, the PACE program came under fire by chiropractic organizations and doctors around the country. The program was vigorously opposed by the members of the Chiropractic Coalition, including the World Chiropractic Alliance.

The WCA strongly objected to the entire concept of allowing the CCE and FCLB to regulate the CE process, pointing to two sections of the proposed PACE criteria as prime examples of the potential damage to the profession that the program could cause.

Criterion 17 of the PACE program 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 most widely criticized was 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 also 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."

After learning of the COCSA position, Rondberg said he hoped the resolution would "sound the death knell for this ill‑conceived and blatant grab for power by the CCE and FCLB."