New93 role standards, now public
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Role standards

Therapy and rehabilitation

Chiropractor

What a newly licensed doctor of chiropractic must do safely on their own: examine a neuromusculoskeletal complaint well enough to find what does not belong to them, treat what does with informed consent, and refer the red flags that need someone else. Drawn from the NBCE Part III test plan and the CCE meta-competencies.

Practice this assessmentHire for this role
Expectations
10
Safety red lines
5
Sources
3
Version
1

Built from National Board of Chiropractic Examiners, The Council on Chiropractic Education. Reviewed by clinicians, last on .

01What the role is measured on#

Every verdict is made of the same five dimensions. Each is scored on its own, so a candidate sees where they are strong and where to work.

  • Clinical skillsThe hands-on and judgement work of the role: recognising what matters, acting in the right order, and knowing when something cannot wait.
  • Workflow and toolsGetting the work done in a real setting: the systems, records, equipment and handoffs the role runs on, used correctly and on time.
  • Patient communicationHow the role talks with patients, families and colleagues: listening, explaining plainly, and confirming what was understood.
  • Compliance and safetyThe rules that protect people: privacy, consent, infection control, reporting duties and the safety checks the role is accountable for.
  • Role knowledgeKnowing the job itself: what the role is responsible for, where its scope ends, and who to bring in when it does.

02What a ready hire does#

What a competent chiropractor does on day one, dimension by dimension.

Clinical skills

  • Takes a focused history and performs the neurological, orthopaedic and general examination the complaint calls for before treating.
  • Selects manipulation, mobilisation or soft tissue technique to the patient's findings and risk, and adapts or withholds thrust where it is unsafe.

Workflow and tools

  • Documents each visit so the record shows the findings, the reasoning, the consent and the response to care, and supports exactly what was billed.
  • Orders imaging and tests only when the result would change management, and acts on what they show.

Patient communication

  • Explains the proposed treatment, its material risks and the alternatives in plain words, and treats with agreement that can be withdrawn.
  • Explains the problem and the plan honestly, and teaches self-management that reduces dependence on care.

Compliance and safety

  • Screens every complaint for serious pathology, and changes course the moment the picture stops fitting a mechanical cause.
  • Refers to the right clinician with the right urgency, and co-manages without losing track of the patient.

Role knowledge

  • Treats within the chiropractic scope of their jurisdiction and leaves medication, surgery and non-musculoskeletal disease to the physician.
  • Appraises evidence well enough to tell patients honestly what chiropractic care can and cannot be expected to do.

03Safety red lines#

Any one of these keeps a candidate from Ready Day One, whatever the rest of the score. They are published so nobody meets them for the first time in the assessment.

  • Would manipulate a patient with radiating limb symptoms, recent trauma or neurological complaints without first performing a neurological examination.

    A progressive deficit, cord compression or unstable injury goes unrecognised, and manipulation can turn it into permanent damage.

  • Treats with manipulation or routine care, or defers referral, a patient with signs of cauda equina syndrome, cervical artery dissection, fracture, spinal infection, malignancy or aortic aneurysm, instead of stopping and referring with the urgency the finding requires.

    These conditions cause paralysis, stroke or death within hours to days, and the harm comes from the delay.

  • Would clone notes, document examination findings, subluxations or services that were not performed, or alter a record to support a claim.

    Every clinician after them acts on a false record, and billing on it is healthcare fraud.

  • Performs manipulation, especially of the neck, without having explained what it involves, its material risks and the alternatives, or proceeds after the patient has declined.

    Treating without informed consent is battery, and it removes the patient's chance to weigh a rare but serious risk such as stroke.

  • Advises a patient to stop or reduce a prescribed medication, or to decline recommended medical treatment or vaccination.

    Stopping a medication or declining treatment on advice from outside the prescriber's scope can cause uncontrolled disease, rebound effects or preventable infection.

04Outside the role#

Knowing where the role stops is part of the standard. Going past it is not extra credit.

  • Does not prescribe, stop or change prescription medication, or perform surgery.Refers medication questions to the prescriber and surgical questions to the appropriate physician. New Mexico lets certified advanced practice chiropractic physicians prescribe from a limited board formulary; elsewhere in the US chiropractors do not prescribe, and the local law applies.
  • Does not treat serious or non-musculoskeletal disease, or keep treating a patient whose presentation no longer fits a mechanical problem.Stops treatment, refers with the appropriate urgency, and co-manages only once the physician has assessed the patient.
  • Does not manipulate where thrust is contraindicated, such as suspected fracture, instability, cord compression or vascular injury.Uses no treatment or non-thrust techniques as appropriate, and refers for imaging or medical assessment.
  • Does not practise beyond the scope of their licence: US chiropractic scope, including imaging, laboratory testing and supplements, varies by state and differs again outside the US.Works to their own jurisdiction's practice act, and checks it before offering a service they have not offered there before.

05How it is assessed#

  • A spoken assessment

    An examiner talks the candidate through realistic cases from this role, and follows up the way a senior colleague would.

  • Five dimensions

    Each answer is read against the expectations above and rated on the same four-level scale.

  • The 70 bar

    Every scorecard shows the score against 70, overall and for each dimension, with the reason for the verdict.

  • Safety first

    Crossing one of the safety red lines holds a pass back, however strong the rest was.

The four levels

  1. Not yet
  2. Developing
  3. Proficient
  4. Exemplary
How a verdict is made

06Sources and review#

Drawn from the certification frameworks and practice standards below, and reviewed by clinicians. Version 1, last reviewed .

Cited as sources. Not an endorsement by the organizations named.

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