When you walk into a chiropractic physician’s office, you expect safe, competent care — whether you’re in Denver or Dubai. The problem is that in many countries outside the U.S., “chiropractic” can refer to practitioners with widely varying levels of education and training. Without consistent standards and testing, the gains we’ve made in public safety and professional credibility are at risk.
Organizations like the National Board of Chiropractic Examiners (NBCE) play an important role in safeguarding that progress. By supporting consistent standards and rigorous assessments, they contribute to the credibility and trust that enable chiropractic to grow both nationally and internationally.
Why Competency Standards Matter
Patients don’t walk into a chiropractic office with a list of questions about training hours, clinical rotations, or board exams. They assume that any doctor of chiropractic, anywhere, has the knowledge and skills to provide safe and effective care. That assumption must hold true if the profession is to maintain and build public confidence.
In the early years of chiropractic, practitioners in some regions risked arrest simply for treating patients. Over decades, the profession has earned licensure in all 50 U.S. states, gained recognition within the broader healthcare community, and built meaningful trust with patients. That trust is hard-won and fragile. It must be protected through ongoing competency standards.
By supporting rigorous standards, NBCE helps to ensure that chiropractic is not only safe but also respected. Consistency in training and evaluation builds credibility, allows for professional integration into healthcare systems, and positions chiropractic for even greater acceptance in the future.
The bottom line is that competency standards aren’t about gatekeeping. They are about ensuring public safety, elevating credibility, and creating a baseline of excellence.
Challenges of Global Inconsistency
According to the World Federation of Chiropractic (WFC), chiropractic is practiced in approximately 90 countries. However, regulatory frameworks vary widely. Twelve countries, including South Korea and Austria, explicitly prohibit chiropractic, while 10 others, including Spain, Italy, and Turkey, do not formally recognize it as a healthcare profession.
Educational standards also differ significantly. While some programs align with the World Health Organization’s (WHO) minimum recommendation of at least 4,200 instructional hours, including 1,000 hours of supervised clinical training, others offer only short courses lasting a few days or weekends. Despite these disparities, individuals from both types of programs may legally identify as chiropractors, depending on national regulations.
This inconsistency presents several challenges:
- Patient confusion regarding practitioner qualifications.
- Safety risks, including misdiagnosis and unsafe treatment practices.
- Limited accountability, as practitioners disciplined in one jurisdiction may continue working elsewhere without restriction.
Without consistent global standards, chiropractic risks fragmentation, diminished trust, and restricted integration into broader healthcare systems.
Advancing Global Standards in Chiropractic Competency
In collaboration with the WFC, the International Board of Chiropractic Examiners (IBCE) has built a new international exam to assess chiropractic competency. The International Test of Competence (ITC) is an assessment designed to evaluate the knowledge, clinical reasoning, and professional competencies of chiropractors seeking to practice in jurisdictions without formal regulation. The ITC establishes an internationally recognized benchmark for professional competence, promoting patient safety, accountability, and global confidence in the chiropractic profession.
Designed for global use, the ITC establishes a shared foundation for evaluating the knowledge, skills, and clinical readiness.
- Creates a universal benchmark for professional standards in chiropractic care.
- Promotes alignment and consistency across education and regulation.
- Encourages comparability of qualifications across international borders.
As healthcare systems become increasingly interconnected, this exam marks a vital step toward a common international standard of practice.
How Chiropractic Is Protected in the U.S.
For more than six decades, chiropractic in the U.S. has been safeguarded by a system of consistent regulations and standards.
- Rigorous Training: According to the Council on Chiropractic Education, the chiropractic curriculum aligns with the WHO’s instructional hours.
- Alignment With Regulation: Licensing boards across all 50 states set passing criteria that are grounded in accredited curricula and real-world practice demands. This ensures that new chiropractic physicians enter the profession with a verified baseline of competence.
- Checks and Balances: Academics and state board members are actively involved in the development of exam questions and the establishment of passing score criteria.
Together, these safeguards have created a model that protects patients, builds trust, and secures the profession’s credibility within the broader U.S. healthcare system.
The Road Ahead
In the coming years, the NBCE will continue strengthening the validity and relevance of its assessments—evolving beyond traditional multiple-choice formats toward technology-driven evaluations that measure not only knowledge but its application in real clinical contexts. Case simulations and performance-based testing will increasingly define competency standards.
At the same time, global momentum is building to align chiropractic qualifications across borders. As practitioner mobility grows, the NBCE, in collaboration with our partners, is positioned to help harmonize international standards.
The vision for the next decade is clear:
- Broader adoption of chiropractic regulation and registration worldwide.
- Greater reciprocity and professional mobility across jurisdictions.
- Unified public confidence that chiropractic care meets consistent, high standards globally.
If chiropractic is to thrive globally, every stakeholder must commit to a profession defined by trust, consistency, and excellence—anchored by assessments that uphold competency and preserve credibility without compromise.
About Dr. Norman Ouzts, D.C.
Dr. Norman Ouzts, D.C., is a licensed chiropractor with over 25 years of experience and a commitment to advancing excellence in chiropractic care and regulation. He has held numerous leadership roles, including President of the National Board of Chiropractic Examiners, President of the South Carolina Board of Chiropractic Examiners, and Chairman of the Chiropractic Summit. Since 2017, he has served as CEO of NBCE, leading efforts to establish and maintain uniform, high standards for the profession worldwide.
