C hallenges in Higher Education

1. Challenges in Higher Education John Scaringe, DC, EdD President / CEO Southern California University of Health Sciences

2. The U.S. Higher Ed System is Broken The U.S. Healthcare System is Broken

3. Influences Challenging Higher Education Ecosystem Ancient Ed. Practices Financial Pressures Governmental Policies Global & National Trends Economic Forces Technical Innovations Demographic Changes Decreased Access Enrollment Challenges Inconsistent Quality Increased Closures Expenses Outpacing Revenues Slow to Adapt IncreasedCompetition Increased Cost of Ed.

4. Over 4,300 Colleges 20 Million Students 4,600 Ave Enrollment Doctoral Universities Master’s Colleges & Universities Baccalaureate Colleges Associate Colleges Special Focused 2 & 4 Year Colleges Tribal Public Non-Profit Private Non-Profit For-Profit

5. Special Focused Four-Year: Other Health Professions Schools 261 Total Institutions 286,000 Students 1.4% Total Enrollments 1,016 Ave Enrollments 5 Public 114 For Profit 142 Private Non-Profit 117,000 Students 825 Ave Enrollments

6. High School Graduates • 40% of colleges/universities 1,000 students or less • Between 2006-2017, 43-66% of All Colleges Missed Enrollment Targets • 25% of All Private Non-Profits Operating in Deficits • Rapid  in Closures & Mergers • 15 Private Non-Profit Closures in 2019 • Equals All of 2018

7. Enrollment < 1,000 No complete online degree programs Annual tuition increases > 8% Tuition discounting > 35% Tuition dependency > 85% Ratio of endowment to expenses < 3:1 Debt service > 10% of expenses Risk Factors Predictive of Closures

8. “Small colleges are like little kids. They seem so healthy one moment, so sick the next.” Campbell, FG. Trustees and small colleges. AGB, 2013.

10. WHAT ARE THE DISTINCTIVE ROLES OF EDUCATION, ACCREDITATION AND REGULATION? FCLB Annual Conference May 2, 2019 San Diego, CA Joseph Brimhall, D.C., President and CEO University of Western States, Portland, OR

11. CHIROPRACTIC EDUCATION • STUDENT FOCUSED (student learning outcomes) • Acquisition of knowledge, skills, and attitudes • Demonstration of competencies • Assessment is both formative and summative • Transformative—shaping a student into a competent professional • Students discover how to learn; embrace life-long learning • Acquire skills to evaluate scientific studies and clinical experience • Includes both the art and the science of chiropractic health care • Disruption in education is being driven by: • changes in technology • expectations of the public (market)

12. ACCREDITATION • PROGRAM FOCUSED (DC degree education program) • Concered with quality and integrity of educational programs • Emphasis on process and sustainability • Outcomes-based versus prescriptive requirements • Resource for licensing boards and other agencies • Who accredits (recognized) the accreditor? • United States Department of Education • CHEA • Disruption is being driven by: • Changes in regulations • Expectation of the public

13. CHIROPRACTIC LICENSURE AND REGULATION • PUBLIC FOCUSED • “Public protection” • Assure access to safe and competent professional services • Provides for consumer (patient) and public protection • Minimal competency standards for licensees • Compliance with requirements in statutes, regulations and rules • After initial licensure, compliance is largely complaint driven • “Licensure is a privilege, not a right” • Often relies on external experts (e.g. NBCE, accreditation, professional associations, etc.) • Involves ethical issues of practice

14. Questions to consider • Who establishes chiropractic scope of practice? • Some laws reference what is taught in chiropractic college • Does competency drive scope definitions and changes? • Court rulings • Who establishes the definition of chiropractic? • ACC Paradigm? • NBCE? • CCE? • Curriculum of chiropractic colleges?