The U.S. Council on Chiropractic Education (CCE) has been at the center of a years-long battle among various factions of chiropractors who have competing ideas of just what chiropractic is and what chiropractors should, and should not, do. This ranges from straight, subluxation-based chiropractic practitioners all the way to the equally absurd chiropractor-as-primary-care-physician clique.
Because the CCE must establish common educational requirements for all U.S. chiropractic schools, it has been forced to try to accommodate these competing factions. Today, we take a look at the CCE’s 2026 Accreditation Standards and see how it tries to thread the needle this time.
But first, we’ll review a bit of the history of this battle for the soul of chiropractic and CCE’s role in it.
As explained in my last post (on the crisis in “naturopathic medicine”), the U.S. Department of Education farms out accreditation of higher education institutions to private organizations which, by law, are supposed to ensure that those institutions meet “acceptable levels of quality”.
Unfortunately, as we shall see, the Department does not require a science-based education to meet its “quality” benchmark, even for purported health care professions. Hence, the CCE is free to include pseudoscience in its standards. (And, as we shall also see, it does.)
To become a licensed chiropractor, states require graduation from a CCE-accredited chiropractic school. Thus, whatever the CCE decides is a “quality” chiropractic education gets foisted upon the rest of us, via the magic of Legislative Alchemy. Some state practice acts even more fully embrace the CCE’s dictates, incorporating whatever chiropractic schools teach into their legal scope of practice. (More on this in a moment.)
The War
With that, let’s go to war.
We begin way back in 2010, in a post titled The DC as PCP?:
The long-simmering internecine wars among various factions of chiropractic recently reached a full boil when the . . . (CCE) had the audacity to eliminate the word ‘subluxation‘ from its draft 2012 ‘Standards for Doctor of Chiropractic Programs.’
In an update, I reported:
As you may recall, the CCE . . . stood accused of removing the subluxation from its standards for accreditation, so that chiropractic students would no longer be required to learn how to ‘detect’ and ‘correct’ the putative vertebral subluxation. . . . This brouhaha was raised by the more traditional wing of the chiropractic community, called ‘straights,’ whose practice (and livelihood) is based on convincing patients that their spines need ‘adjustments’ to remove these subluxations under the threat of ill health should they be left unattended. The straights were also upset at the move by another faction of chiropractic seeking to rebrand chiropractors as primary care physicians who diagnose and treat a wide variety of diseases and conditions.
The “straights” went so far as to register their complaints with the Department of Education during its review of CCE, which gave the Department an opportunity to officially announce its apathy towards science. Removal of the term “subluxation” from CCE standards, it said, was
a professional issue within the chiropractic community. Staff concludes that it is beyond the purview of the Department to dictate to any [accrediting] agency what its curriculum requirements and accreditation standards should be.
Subsumed in the argument over retaining the subluxation were skirmishes over what to call it and how to “correct” it.
One CCE draft proposed “subluxation/neuro-biomechanical dysfunction”, which, a mere two years later, it changed to “subluxations/segmental dysfunction”. A sect whose motto is “Vertebral Subluxation . . . Nothing More . . . Nothing Less . . . Nothing Else” didn’t like either one.
And then there was the controversy over exactly how to remove these non-existent subluxations. Regarding a draft of CCE standards proposed for 2013:
For the first time, apparently, the CCE has included what they call a ‘meta-competency’ requirement in adjusting/manipulation, which pleases the ICA [the International Chiropractors Association, an organization of ‘straight’ chiropractors.] The fly in this ointment is that the skill required is not just ‘adjustment’ but ‘adjustment/manipulation.’ According to the ICA, they are not the same thing. The ICA is correct. ‘Adjustment’ has always referred to a method of ‘correcting’ the phantom subluxation. Other professions perform manipulation, or, as the ICA would prefer to call it, ‘other forms of manual care,’ but, as the ICA says, ‘only doctors of chiropractic administer chiropractic adjustments.’ The reason is that no other profession believes the chiropractic subluxation exists or, obviously, that it can be ‘adjusted,’ but they don’t bring this up.
And so the battle raged, for years, with groups and sub-groups within groups, coming together in common cause when convenient to their mission, then splitting and reconstituting their alliances as their special interests dictated. Along with the ICA, the American Chiropractic Association, the International Federation of Chiropractors and Organizations, the International Chiropractic Pediatrics Organization, the Association of Chiropractic Colleges, state chiropractic associations, the incongruously-named DaVinci Group (“a coalition of ‘at least’ 70 chiropractic organizations”), The Summit (another multi-group coalition), the Cartel (a derogatory name bestowed by one group on another), and so on, all duked it out.
And all this over what to call, and how to treat, a condition that doesn’t exist, and whether to teach this phantom phenomenon to students.
Primary care
As hard as the “straights” have pushed to preserve the subluxation, another faction of chiropractors has dedicated itself to the ridiculous notion that chiropractors are “primary care physicians”, which, as noted above, infuriated the straight chiropractors. The American Chiropractic Association (ACA), the lobbying and PR arm of the chiropractic industry, has been at the forefront of this effort.
Along the way, the “primary care” proponents have used a variety of tactics to push their agenda.
The ACA created an ersatz “board certification” for “diplomates” in “chiropractic internal medicine”, calling practitioners “chiropractic internists”. To become a “diplomate”, a chiropractor attends 300 hours of weekend courses, mostly online, taught by faculty ridiculously unqualified to teach the offered subject matter, like cardiovascular disease, gastroenterology, endocrinology, and dermatology.
In addition, chiropractors have pushed for expansion of state scope of practice laws beyond manual manipulation of the spine to correct “subluxations”, to include diagnostic testing and health (including nutrition) advice, which can be parlayed into a “functional medicine” practice.
Another tactic is to amend their scope of practice to include anything chiropractors are taught in chiropractic school, a pet project of the ACA, which at one time was vigorously lobbying to include prescription privileges in practice acts as well.
Some schools are fully on board. The National University of Health Sciences (NUHS) chiropractic program claims, for example, that it
prepares students to become first-contact, primary care physicians fully qualified to diagnose, treat and manage a wide range of conditions.
NUHS offers “specialty” concentrations in “Functional Medicine” and “Women’s Health”.
Let’s pause for a moment and state the obvious here: the notion that chiropractors are appropriately educated and trained to practice as primary care physicians is ludicrous. The late, great Dr. Harriet Hall, an actual primary care physician herself (family practice), demolished that notion back in 2012 in the aptly-titled Chiropractors as Family Doctors? No Way! and again the next year in her review of Chiropractic Education for Primary Care.
Yet by 2012, the “DC as PCP” model had won out. According to the CCE:
An accredited DCP [Doctor of Chiropractic degree Program] prepares its graduates to practice as primary care chiropractic physicians . . .
The CCE further defined “primary health care” as:
Care that is provided by a health care professional in the patient’s first contact within a health care system that includes an examination and evaluation, diagnosis and health management. A Doctor of Chiropractic practicing primary health care is competent and qualified to provide independent, quality, patient-focused care to individuals of all ages and genders . . .
But just 6 years later, in the 2018 standards, the term “primary care” disappeared from the accreditation standards, although its ghost lingered in language used to describe what chiropractic students must be prepared to do in practice, and “meta-competencies” that must be taught.
Accreditation requirements . . . prepare DCP graduates to serve as competent, caring, patient-centered and ethical doctors of chiropractic/chiropractic physicians qualified to provide independent, quality, patient-focused care to individuals of all ages and genders . . . managing the patient’s health care and integrating health care services including treatment, recommendations for self-care, referral and/or co-management.
So, without limitation to the musculoskeletal system in general or the spine in particular, the chiropractic student must be able to compile a patient history, examine “body regions and organ systems”, and perform and utilize diagnostic studies, all “for the purpose of constructing a differential diagnosis” and “develop a management plan appropriate to the diagnosis/es”.
To be sure, examination and evaluation of “any subluxation/segmental dysfunction” (as it is called at this point) and delivery of “appropriate chiropractic adjustments/manipulations” is included, but nothing limits the chiropractic student to those tasks.
Thus, the CCE gave chiropractic programs plenty of wiggle room to teach some ersatz version of primary care, or at least venture well beyond the musculoskeletal system, without actually using the term “primary care”.
And today?
In January, the CCE released yet another version of its accreditation standards (there was also a new version in 2021).
Note: Before we get to the matter at hand, and although not the subject of this post, interestingly, in 2026 the CCE dropped its GPA minimum from 3.0 to 2.75 if the applicant has 24 science credits among the 90 credit hours required for admission without an undergraduate degree. Alternatively, a bachelor’s degree (in no particular subject) is acceptable without any minimum GPA. And, for the first time, a hard number – 1,000 hours – was added for clinical training.
The standards retain the slippery language of former iterations, permitting non-musculoskeletal differential diagnoses (including diagnostic testing) and treatment for “all individuals of all ages and genders” and “managing the patient’s health care”, but with no mention of “primary care”. In sum, the CCE-accredited NUHS and like-minded schools have nothing to fear in promoting chiropractors as PCPs.
And the subluxation lives on! As with previous standards, an entire “meta-competency” requirement is devoted to “CHIROPRACTIC ADJUSTMENT/MANIPULATION” because “Doctors of chiropractic employ the adjustment/manipulation to address joint and neurophysiologic dysfunction”, so they must be able to “identify subluxations/segmental dysfunction of the spine and/or other articulations”, one of two mentions of the subluxation in the entire document. Yep, let’s educate like it’s 1895!
The CCE, again as with previous versions, signals that it doesn’t care if a school chooses to teach straight-up, Palmerian, subluxation nonsense:
The CCE values educational freedom and institutional autonomy. The CCE does not define or support any specific philosophy regarding the principles and practice of chiropractic, nor do the CCE Standards support or accommodate any specific philosophical or political position. The Standards do not establish the scope of chiropractic practice.
So, basically, something for everyone. More of the same. And nothing good for the public.
