Fulfilling CE requirements can be a daunting and confusing task. Chiropractic Products talks with four industry experts about the best approaches for this all-important aspect of state licensure.

“Never stop learning.” More than just a popular adage, state licensing boards require it in almost every state for doctors of chiropractic, according to the Federation of Chiropractic Licensing Boards (FCLB). If you do not comply with state regulations, you could lose your license—and miss out on the benefits of learning the newest and latest trends and procedures in chiropractic care. But finding continuing education (CE) courses and deciding which ones to take and how to take them can sometimes feel as though it necessitates a class of its own.

Chiropractic Products spoke with several professionals in the industry to discuss what every chiropractor should know about CE requirements: Kent S. Greenawalt, president and CEO of Foot Levelers Inc, Roanoke, Va; Kathy Jensen, CMP, director of conventions and seminars for the California Chiropractic Association (CCA), Sacramento, Calif; Paul D. Powers, DC, DABCN, is the site editor of Chirocredit.com, an online source that provides chiropractic CE credits sponsored by the University of Bridgeport College of Chiropractic, Conn; Gregory D. Thurston, DC, DIBCN, is a licensed chiropractic physician and neurologist in Northbrook, Ill, and a diplomate of the International Board of Chiropractic Neurology, and he provides interpretations for Edward J. Herba, MD, & Associates, SC.

What are the requirements for CE credits that all chiropractors should know?
Greenawalt: Almost every state requires DCs to obtain CE credits. Requirements vary from state to state ranging from 12 hours annually to 60 hours every 2 years. All other states fall somewhere in between. With such a vast variety of requirements, it is always smart to check with your state association for accuracy.

“If you are seeking CE credits, make sure the topic meets the requirements for your state. Some topics qualify in one state and not another.” –Kent S. Greenawalt

Jensen: California-licensed doctors of chiropractic must annually complete 12 hours of CE course work approved by the California Board of Chiropractic Examiners (CBCE) in order to qualify for active license renewal. The 12 hours of CE must include 4 hours in adjustive technique. CE course work must be completed prior to license expiration, as there is no grace period for CE course completion.

Powers: CE requirements vary greatly from state to state. They run from a low-end requirement of 12 hours per year to the highest requirement of 50 per year. The requirements are statutes enabled by the legislature, and then rules and regulations are set by the chiropractic boards whose members are appointed by the governor. The legislative intent of CE is all too clear: to protect the public by requiring doctors to engage in ongoing education.

The terminology used to describe the types of CE requirements varies greatly from state to state. In general, most hours in most states require formalized, structured courses. States with larger hour requirements often require some of the time to be formalized and structured. Distance-based learning programs can offer CE in many ways, one of which is via the Internet. Depending on program design and sponsors, these programs may be classified as formal or informal type CE.

Thurston: Chiropractic physicians should know the rules regarding continuing medical education (CME) as it pertains to their particular state. States differ on this, and the responsibility is on the DC to make sure he/she is in compliance. Maintain records of credits earned. In Illinois, where I practice, each DC is to maintain records on the honor system subject to random audit. The requirement is 150 credit hours within a renewal period (3 years) or 50 credits per year. Check with your state to get specific details on what its requirements are and how to properly document these credits so you will not be caught short.

What are the most important aspects to look for when deciding on classes or topics?
Greenawalt: You should always choose something that is relevant and useful for you and your practice. If you are seeking CE credits, make sure the topic meets the requirements for your state. Some topics qualify in one state and not another. You certainly want a topic that interests you but also a speaker that will hold your attention. There is nothing worse than a boring presentation.

“DCs should be sure the courses they attend are presented by reputable CE providers so they will receive CBCE-approved CE credit and will be able to receive copies of their CE forms if needed.”–Kathy Jensen, CMP

Jensen: In California, there are 54 CBCE-approved CE providers. Any given weekend, more than 20 CBCE-approved courses are offered. With so many options to choose from, DCs should not only be mindful of the convenience of the date and location, but also the price and content. Most importantly, DCs should pay attention to the credibility of the CE provider.

Powers: Some states require a minimum amount of hours in a specific topic. For example, some states require a certain amount of hours in AIDS training, while others require specific hours in risk management or physical diagnosis. Outside of mandatory requirements, doctors should try to choose topics that interest them the most. When doctors choose topics that interest them most, the educational experience is personalized, which increases the likelihood of retention.

Thurston: Make sure that the instructor(s) are approved by the state licensing board. Usually, if that state board approves the instructor(s), your state will accept the credits as well. Second, try to pick seminars/classes that are new, will advance your knowledge, and will hold your interest. This is obvious, but I think every DC at one time or another has made the mistake of selecting a seminar too quickly without really thinking about what the benefits will be. Thus, seminars can be an expensive waste of one’s time if not carefully scrutinized before making the arrangements.

What should DCs be wary of?
Greenawalt: Watch out for deals that are too good to be true and speakers who do not have a proven track record. Think of going to a seminar like you would hiring your chiropractic assistant. Get referrals from other DCs and research the speakers to ensure credibility before committing to a class.

Jensen: DCs should be sure the courses they attend are presented by reputable CE providers so they will receive CBCE-approved CE credit and will be able to receive copies of their CE forms if needed. The CBCE randomly audits licensees for compliance with the CE requirement. Failure to have proper CE documentation will result in the issuance of a citation.

Powers: Doctors should be sure that the course they choose to take—through whatever delivery mechanism—is accepted for credits in their state. Most states do not accept practice management courses toward CE requirements.

What are the most popular classes or hot topics right now?
Greenawalt: The most popular topics relate to adjustments and techniques. DCs are always in search of new ideas to take back to their practices. Hands-on training is also a great tool for teaching. Attendees appreciate taking an active role when learning a new technique.

Jensen: CCA is a well-respected player in the California workers’ compensation scene, so our workers’ compensation seminars (IDE certification, report writing and QME relicensing) are always popular. To satisfy the wide range of interests among DCs, CCA presents a variety of classes at each convention and exposition.

“I would like to see a national agency or organization in charge of     approving CE programs/sponsors. It is quite a burden to have to obtain approval in so many different states every time a course is offered.”–Paul D. Powers, DC, DACBN

Powers: Chirocredit.com finds that there is a fairly equal distribution of usage between the 12 topics listed on the website. Topics include AIDS, interactive anatomical dissections, biomechanics/orthopedics, diagnostic imaging, manipulation/physical therapy/rehabilitation, neurology, nutrition, occupational health, pediatrics, physical/differential diagnosis, risk management/malpractice, and sports medicine. I think this demonstrates that individual areas of interest are greatly varied between doctors.

Thurston: Popular topics and class content having to do with ethical practice management, risk management, and sound business strategies continue to be the most popular seminar topics from a CME point of view. Additionally, diplomate modular residency programs are probably one of the most pure CME-related course choices, since these programs instruct doctors on academic topics most directly related to becoming better doctors. Other academic topics, such as diagnostic examination review courses—including but not limited to, physical examination proficiency, imaging, electrodiagnosis, SOAP notes, report writing, physical therapy, nutrition, and public health—are certainly hot and relevant right now.

Describe the ways that DCs can fulfill their CE requirements.
Greenawalt: Attending classes is the most popular way to get CE credits. There are some Internet courses available in which DCs can earn a small number of credits, and some states allow a portion of credits to be obtained by watching educational videos or reading chiropractic materials.

Jensen: For California-licensed DCs, the only way to fulfill CE requirements is through a CBCE-approved CE course. Distance learning is not an approved method.

Powers: Most states require formal CE requirements by programs that are sponsored by a CCE accredited college. In all states, this includes live programs, and more than half of the states now accept CE credits through online programs. Informal activities can be achieved with such activities as journal reading, study groups, and nonstructured self-study.

“Make sure that the instructor(s)        are approved by the state licensing board. Usually, if that state board approves the instructor(s), your state will accept the credits as well.”–Gregory D. Thurston, DC,

Thurston: Most states now have formal and informal credits. Formal credits are obtained by attending board-certified or approved classes/seminars only. Informal credits have fewer stipulations, are at the doctor’s discretion, and make up the difference of 90 hours for a total of 150 hours [in Illinois]. Some examples of formal credit options are CD-ROM, audiotape, or videotape programs; recorded review courses that are sanctioned by medical/chiropractic governing bodies; journal club activities; self-assessment activities; and journal-based CME. Examples of informal credit hour options are consultations with peers and experts concerning patients, use of electronic databases in patient care, small group discussions, teaching health professionals, medical writing, seminars, teleconferences, preceptorships, participation in formal peer review and quality assurance activities, and preparation of educational exhibits.

What do you wish to see happen to improve the methods, logistics, topics, speakers, or governing body(ies) of CE?
Greenawalt: Many DCs hold multiple licenses and are forced to keep track of what each state’s requirements are. Standardization would make it simpler for license renewal. In the long run, this would benefit the profession as a whole by giving us a more unified method of teaching and learning.

Jensen: CCA looks forward to the day when California CE can be offered through distance learning, which would allow CCA to present course work online, by audiotape, by videotape, and through publications. In addition, with the increasing number of CE providers in California, CCA also looks for increased oversight of CE providers to assure the requirements of the CBCE are fulfilled. Associations like CCA and the chiropractic colleges are uniquely suited to present CE courses and have a long, successful tradition of doing so.

Powers: There are two things that I think need to happen. The first is approval of the ability for chiropractors to obtain online CE in all states. As we live in a time when the current state of higher education includes the ability to obtain a bachelor’s degree, a master’s, and a PhD online, coupled with the fact that medical doctors may obtain all of their required CE online in all states in which there are requirements, there is no rational reason why chiropractors cannot. Chirocredit.com continues to pursue all state boards for approval of online CE for chiropractors so they have the same choices and options as medical doctors and almost all other professionals.

Second, I would like to see a national agency or organization in charge of approving CE programs/sponsors. It is quite a burden to have to obtain approval in so many different states every time a course is offered. There should be a set of requirements that are accepted nationally. This is the case in the medical profession with the Accreditation Council for Continuing Medical Education (ACCME), where, if a program sponsor has passed their accreditation process, their courses are accepted in all states. It seems that an organization like the FCLB or the National Board of Chiropractic Examiners (NBCE) could take the lead in this area. All individual states could simply adopt rules to yield to the national organization for accreditation of programs.

Thurston: EDX or electrodiagnostic testing is an interest/concern of mine in the context of assessing peripheral neurological deficit as it pertains to chiropractic physicians documenting and assessing patient neurological conditions to be able to make better treatment recommendations and thus, positively influence treatment outcomes. When properly used by a knowledgeable chiropractic physician, it can be a very valuable asset not only in making treatment decisions, but also in justifying to a third party that a patient indeed has a neuromuscloskeletal condition. This is something DCs should embrace and become very knowledgeable about—who is a candidate, when it should be performed, and what will be gained from the performance of the test. It should, as with any diagnostic modality, be used judiciously and only when appropriate.

I would also like to see the relatively new technology of teleconferencing be used more widely, as it appears to be a solution to the problems of inexpensively and quickly disseminating information to large groups of people with real-time feedback, and it eliminates logistical concerns, such as conflicts with travel and time away from the office. CP

Kelly Stephens is the associate editor of Chiropractic Products.