NCCAOM/Dry Needling/A Young Profession

A survey about the possibility of a new NCCAOM certificate in Facial Rejuvenation showed up a few days ago. The online conversations were a reminder that many of us are confused about the NCCAOM — what their role is, what we want their role to be , what their role “should” be.  The topic deserves its own post, but, in short, the NCCAOM is a credentialing agency. They design, administer, and maintain the process by which most of us are able to be licensed.  There are loads of consequences of their power within our profession, especially because we have not had, for some time, a truly effective or well-functioning national professional association.

There were many complaints that the NCCAOM hadn’t done more to “stop dry needling.” That, combined with yesterday’s urgent petition regarding legislation on the Governor’s desk in Delaware, made we think I’ve got to try, one more time, to explain where we are with the issue and why what we’ve been doing won’t work. My post to my alumni group is out of context, but I hope still worth sharing (somewhat edited for clarity) —

Since Dry Needling is the issue that keeps coming up as a major focus for the profession, I wanted to give a little more info about the “court rulings” in our favor.

The one that received the most notice and attention was the case in Oregon regarding Chiropractors and Dry Needling.  The outcome of the case was widely misrepresented within the acupuncture community. Various stories indicated that the courts said that dry needling was acupuncture or that it had been determined that the training programs were insufficient.  This was not the case.  You can read a fuller explanation of the outcome of the case here – http://theacupunctureobserver.com/a-practical-next-step/. The gist of the ruling is that dry needling does not meet the implied definition of physiotherapy within the Oregon code.

Other states have also had rulings (usually informal) from the Attorneys General stating that dry needling is not within PT scope.  These rulings have typically been much celebrated within the acupuncture community, but we haven’t been hearing what happens next.  For instance, some time ago Utah was celebrating such a ruling.  Since that time, legislation added dry needling to the scope of physical therapists.  Similar legislation passed in Arizona.  When the AG recently ruled that dry needling was not within PT scope in Tennessee, the ruling included phrasing that basically said, PT’s will need to address this legislatively, as was done in Utah.  (You can get the link to the ruling here — http://theacupunctureobserver.com/late-july-acupuncture-news/).  Illinois is another state where the AG’s latest opinion agreed with the argument that dry needling was not within PT scope, but where the PT groups are already preparing legislation for the next session.

There will probably be states where the acupuncture community is large enough and well-connected enough (and Maryland might well be one) where similar legislation would not be successful, but if you look at the numbers in most states, the PT’s (who also often have business connections with the medical establishment) are likely to prevail.

Today I received a notice of a petition regarding DE HB 359, adding dry needling to the scope of PT’s in Delaware.  HB 359 passed by overwhelming majorities in the House and Senate and needs only the Governor’s signature.  Among the “gems” in the petition – “Accordingly, HB 359 will potentially place the general public in significant danger of injury and harm due to unsafe and unqualified needle practices.”  There are about 800 PT’s in DE, and even more PT Assistants.  There are 45 LAcs.  The odds of the Governor exercising his veto are slim, the odds of pissing off 800 PT’s?  Pretty good, considering we’ve just stated they are putting the public in significant danger.  Interestingly, one of the authors of this petition is the same person who pushed for the requirement of the NCCAOM OM credential in DE, putting practice off limits to about 70% of US acupuncturists.  Isn’t it ironic that the profession’s self-imposed restrictions on licensure in Delaware have left the LAcs scrambling to block action by an overwhelmingly larger group?

Had LAcs been more willing to work with the PT’s from the start, I suspect that in many jurisdictions we’d have come out ahead.  We’d have built relationships and understanding and had some influence, perhaps, on how this modality is practiced.  By sending PT’s to the legislative fix (that’s what “we” said right from the beginning – if they want to do this they should do it legislatively) we’ve taken ourselves out of the process.  As they succeed with changing the law we’ve lost any influence on the procedure.

Of course, trying to work together might not have changed anything.  Professions (including our own) are universally unhappy about outsiders coming in to tell them what they should do and how they should do it.

I will add three things in response to the previous post.  1) While I appreciate the frustration felt by LAcs when dry needling and acupuncture are spoken about as being equivalent, hasn’t it been our insistence that dry needling IS acupuncture that led to this? Wouldn’t we be better served by clarifying the distinction between the two? (Of course, that would undermine our argument that we have a right to regulate the procedure.)  2) There are many cases of patients not wanting to report harm suffered at the hands of providers.  This happens among acupuncture patients too. Even LAcs can cause a pneumothorax.  3) The cease and desist orders can’t help but remind me of the stories from decades ago of acupuncturists being threatened with arrest for practicing medicine without a license.

It hasn’t taken long for us to go from being the scrappy upstarts just wanting to help people with a simple technique, and frustrated by the establishment that was trying to shut us down, to acting like the establishment.  We’ve got our ever-increasing credentials, and maybe specialties soon, and are increasingly able to participate in the bureaucratic system of figuring out which set of codes gets us a reimbursement we can live with. Now, in Maryland, LAcs can interfere with a citizen’s ability to choose what treatments they get from which providers, and can throw their weight around in the provider community.

PT’s will outnumber us for a long time to come.  It’s a shame we’ve pissed in that particular well.

 

Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2018. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

10 thoughts on “NCCAOM/Dry Needling/A Young Profession

  1. Here’s a history of the multiple hypocrisies of our profession regarding dry needling:

    1980’s — PT’s and MD’s badgered about the use of hypodermic needles in dry needling; told they should be using acupuncture needles. They eventually complied.
    1990’s — PT’s told that dry needling was not “true” acupuncture because they didn’t utilize meridians or pattern diagnosis. PT’s eventually agreed: Dry needling was NOT acupuncture.
    2000’s — PT’s told that dry needling WAS acupuncture after all, especially since they were using acupuncture needles (which we had told them to use in the first place).
    2014 — As state after state passes laws to allow dry needling by PT’s we are now launching a publicity campaign to say once again that dry needling is NOT acupuncture.

    • I recall our arguments, back in the day when we wanted licensure, that people should be able to choose their preferred health providers. Now, people need to be protected or they will choose an unsafe provider. Also, we felt strongly that we should be able to regulate ourselves. Now we argue that of course we can’t expect a profession (other than our own) to regulate itself. There are so many hypocrisies to choose from!

      • It is a sign of psychological maturity to progress through denial, anger, bargaining, depression, and acceptance. I think some individuals are moving towards acceptance on this issue but there are some for whom the collective enables them to continue oscillating between denial and anger. There is a fundamental mismatch between how the acupuncture profession views itself, how other professions view us, and how the public at large views us.

      • This might be getting farther afield from the original topic, but since we’re talking about hypocrises:

        One of the most frustrating things that I’ve encountered is the acupuncture profession’s attitude about acupuncture itself. In my TCM school I was taught that acupuncture really doesn’t do anything, really isn’t worth much: it’s herbs and lifestyle counseling that matter. If you’re not doing herbs and lifestyle counseling and heck, Tui Na, you’re just “sticking needles in”; you’re not a TCM doctor, you’re just a descendent of barbers/tooth-pullers/worm-expellers (thanks, Peter Deadman). Acupuncture by itself is low-class. I have friends who went to 5 Element school who told me that they were taught the only purpose of acupuncture was to “anchor the conversation”.

        So, OK, acupuncture profession, if you value acupuncture itself so little, why are you so mad about other practitioners using it? Why are you so mad at us, your fellow L.Acs, for “devaluing the profession” by doing lots of it in low-cost, high-volume settings with people who can’t afford all the herbs and lifestyle counseling and Tui Na and spiritual conversation? How can we devalue something that you already don’t value? Does “just sticking needles in” work, or doesn’t it?

        And if it does work, as we believe it does, why aren’t you more excited about people experiencing healing? I posted this patient story last night: https://www.pocacoop.com/prick-prod-provoke/post/goodwill-drive-post-4-let-the-needles-do-the-work and I know other acupuncturists are going to get mad about it. They’re going to get mad that a pain specialist MD stuck a couple of needles in a patient’s ear — and then referred her to a community acupuncture clinic; they’re going to get mad that the patient got an enormous amount of very simple acupuncture. Notably, this is the kind of patient that I was taught in my acupuncture school to kick out of my practice because she “wasn’t willing” to make lifestyle changes, and God forbid I just stick needles in people who weren’t making lifestyle changes. (Again, why? If acupuncture isn’t any good without the patient making lifestyle changes, why do you care how it’s used?) Acupuncture, whatever you call it, however you do it, whoever does it, HELPS PEOPLE.

        Sorry for the rant. If we can’t make up our minds about what acupuncture itself does or doesn’t do, are we a “young profession” or are we just a bunch of opportunists who will say anything based on our own perceived advantage?

        • Seeing how we respond to stories of patients getting relief from dry needling or from MD’s using acupuncture it’s clear that we don’t want to accept that sticking needles in is enough. I’m not sure that comes from a perceived advantage though — my sense is that it comes from a sense of feeling threatened. If sticking needles in is enough, then my extensive education and credentialing were a big waste of time and money.

          I can’t help but think that if we felt confident in our advantages than we could rest easy doing what we do, and not respond to almost everything as “the most significant threat to acupuncture ever.”

  2. I saw it and my response was that it was a waste of time for them to pursue the certificate. They needed to focus on promoting our profession in other ways. I am not sure now what I said exactly but I was disgusted. It seems it is the same old lame attempts.

  3. Elaine, where did you see the survey about the NCCAOM facial rejuve certificate? Who sent it?

    As credentialing agency in charge of the national board examinations, NCCAOM’s job isn’t issuing certificates for ‘specialties’. There are plenty of NCCAOM PDA approved certificate programs various styles of acupuncture and specialties, including for facial rejuvenation.

    As a credentialing agency, neither is the NCCAOM’s place to fill in a political void left by our inability as a profession to create a viable national organization.

    • Kathleen — I received an email from NCCAOM with a link to the survey. I do not know if they attempted to distribute it to everyone or to only a group of us, but many people I spoke to received it. I do not see any mention of it on the NCCAOM web site.

      And, yes, I agree with you.

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