Acupuncture News

We lack a national news source for the profession and so we are often in the dark about the forces shaping our future.

Here is some state-level news with national implications —

California: 

In January 2016 the NGAOM joined with CAOMA and nearly advanced AB758. This would have overturned last year’s legislation which moved California to the industry standard of ACAOM school accreditation rather than depending on the troubled CAB.

Connecticut:

The NGAOM successfully fought for legislation mandating Malpractice Insurance for all LAcs. Practitioners in CT report this was done without consultation with the state association. Malpractice insurance is a significant expense, and a needless one for licensees not in active practice.This new requirement doesn’t seem to benefit anyone other than insurance companies and the NGAOM (which gains members through discounted coverage) despite the NGAOM’s pro arguments.

Delaware:

Regular readers know that the DE Acupuncture Advisory Council has generally refused to use their waiver power to license practitioners lacking the full NCCAOM herbal credential. The BOM knows that depriving the public of qualified practitioners is not a public service and is proceeding with draft legislation (text not yet available) that would establish tiered licensure. While it’s not the best solution, it’s an improvement. New Council members are taking their seats in the next few months. Let’s hope we can all work together to grow the profession in Delaware.

Nevada:

The Nevada Board continues to push for an increase in educational requirements far beyond the Masters level. Having again ignored the advice of Nevada’s Deputy Attorney General they are now moving to hire their own counsel, perhaps explaining why Nevada’s fees are the highest in the country.

 

Acupuncture Today didn’t just miss these important news items, history shows AT is willing to selectively hide some developments within the profession.

After a series of well-received columns in 2007 author Lisa Rohleder received a letter from Executive Editor Crownfield — “After several conversations with my publisher and others, we are concerned about continuing your column under its current “theme”, for lack of a better word. While the concept of social entrepreneurship, particularly the “pay according to what you can afford” aspect, is admirable, it has dangerous potential from the perspective of professional advancement.” Yes, AT considered affordable acupuncture dangerous. (The ideas did have potential. The ideas Lisa presented developed into POCA. POCA has established a school, helped clinics provide millions of treatments, helped practitioners establish successful businesses, and provided free CEU’s and many other benefits, to members.)

The Acupuncture Observer may change a bit over the next few months. But until the profession develops a reliable source for news delivered in a timely fashion, TAO will do what it can to keep you in the know. Let’s keep each other informed. Are you aware of news of importance to Acupuncturists? Is there regulation that could keep Acupuncturists from practicing in your state? Is a group pushing for change that seems detrimental to the practice environment?  Email editor@theacupunctureobserver.com with your news. Let me know if you’d like to write a guest post. And subscribe to TAO (box on the upper right of the home page, your address will not be shared or sold) for news updates.

 

 

Acupuncture Education 2015 – The State of the Profession

If we want people who want acupuncture to receive it from an Acupuncturist, acupuncture education deserves our attention.

There aren’t good statistics on how many Acupuncturists or acupuncture students there are in the US. But those handy maps printed in Acupuncture Today can give us some idea. The December 2013 issue (with an article on AT’s unprecedented growth) showed 24,342 Acupuncturist and 3,124 student issues mailed. In December 2015 – 24,231 Acupuncturist and 2,624 student issues mailed. That’s not growth. The 2014 NCCAOM Annual Report (the most recent available) also reveals – we are not a growing profession.

There is a lot of churn in Acupuncture education — schools close, schools open, programs merge, new degree programs are established. New Gainful employment rules adopted in late 2014 may well contribute to that churn. They require for-profit schools (about 50% of acupuncture programs) to provide at least some debt and jobs data to prospective students.

Small class sizes can skew the data. Still, check out these reports (selected because they came up first in Google): Emperors, ACAOM (the school not the agency), Arizona School of AOM, Midwest, AIAM, and Colorado School of TCM.

Only two schools reported job placement, at 50% and 67%. Median loan amount (omitting a 1.5 million figure given by Midwest that must be a mistake) ranged from 17K to 72K. A real eye opener was the percentage of students completing the program in the expected time frame. The average across all 6 programs was 55%. Omit the 100% reported by Arizona, currently on probation with ACAOM (the agency), and it’s 46%.

It’s not encouraging. Add student uncertainty that the degree they obtain will enable them to practice and it is no surprise our profession isn’t growing.

Imagine if we could tell prospective practitioners –  “A Master’s Degree in Acupuncture from any ACAOM accredited program will fulfill the educational requirements to practice in any state.”

I may not love the ACAOM standards but I’ll accept them to help the profession. Is there a downside to offset the upside?

NGAOM you have a stated goal of establishing uniform standards, yet are fighting to keep California schools out of the ACAOM system. Please explain.

We had some significant losses in Acupuncture education in 2015.

Spring brought news that Dianne Connolly and Bob and Susan Duggan would no longer teach or be part of the program at MUIH (which Bob and Dianne founded in 1974 as The Maryland College of Chinese Acupuncture). Bob and Dianne are part of the foundation of this medicine in the US. They profoundly influenced my acupuncture journey and it is a significant loss that they won’t be part of every MUIH student’s education. I am glad they are continuing to teach and share their wisdom in other settings.

Bob Duggan played an integral role in establishing acupuncture standards, credentials, agencies, and commissions. His goal in so doing was to enable this safe and effective medicine to be legally available to more people. He shared in a personal communication his ambivalence at how things turned out – that though his work enabled so many people to be healers and to be healed, “If I had real courage I’d have gone to jail and insisted this was the people’s medicine and we shouldn’t allow it to be professionalized.”

2015 closed with another loss, the death of Dr. Richard Teh-Fu Tan. Dr. Tan was an excellent teacher, deeply committed to teaching. Directly, and through his students, he eased the suffering of countless patients. Dr. Tan made no secret of his doubts about the caliber of acupuncture education most of his students received in their degree programs. Many seminar attendees reported learning more about effective acupuncture in four days with Dr. Tan than in four years of acupuncture school.

Attention must be paid.

 

 

 

 

 

 

Act Now – Help the Acupuncture Profession With Sensible Regulation

We have a little more than a week to influence regulations that will impact our profession. The regulatory and legislative process typically includes long periods of incremental movement suddenly replaced by small windows of major activity. One of those windows is open in the District of Columbia, but only until December 26th.

The proposed regulations are especially important because Washington DC is the seat of our Federal Government. If Acupuncturists hope to influence policy at that level we’ll need a strong community of practitioners, the more experienced the better, ready to serve in our governmental agencies.

The good news is that a small group of practitioners worked diligently to move the regulatory activity in a positive direction over the past three years. The bad news is that amidst the positive proposed changes are a few problematic sections. The additional bad news is that we are now late in the process. But maybe not too late. It would be good for the profession and for individual practitioners if we were able to correct those problematic sections. Let’s try.

You can see the text of the new regulations here. Comment by clicking on the blue “Make Comment” box at the bottom of the page (the tab at the top doesn’t seem to work). The comment form will only accept 500 characters, which meant a boatload of editing and three separate comments for me. Feel free to borrow my Three Issues DC2 language for your comments.

In addition, I’ve sent this Dear NCCAOM letter to Mina Larson, (MLarson@thenccaom.org) and Kory Ward-Cook (kwardcook@thenccaom.org) asking for their assistance. Again, the more letters the better. Feel free to use my letter as a template.

Remember, a regulatory change anywhere sets a precedent for changes everywhere. If we want people to get their acupuncture from LAcs, we need to remove obstacles to licensure. Please submit comments and share this post with other’s who would like to weigh in. It doesn’t cost anything except a little bit of time. Imagine what we could do if we took the energy and funds used to battle other professions and focused more on improving our own situation.

I limited my comments to the issues I consider most problematic and easiest to correct.

As I discussed in this post, these regulations will impact us all. Some of our colleagues thought it best to keep these proposed changes from the greater community, and that’s a shame. We need to be in the loop. The more we know, the more we can do to bring about positive change.

 

9 Reasons why Acupuncture Regulations There Matter Here!

Changes in acupuncture regulation in any state matter to each of us individually, and to the profession as a whole.

Here are 9 reasons why —

  • We don’t know what the future holds. Unexpected moves happen.
  • You may need to hire practitioners or sell your practice. Can interested parties easily move to your state?
  • Your patients might move and want a practitioner just like you. Will one be available?
  • Growth in the profession is not keeping up with demand. Regulatory uncertainty diminishes the appeal of the profession.
  • High educational and credentialing costs interfere with business growth. If the requirements vary from state to state, the impact is multiplied. (See this report on Occupational Licensing.)
  • Regulatory differences lead to divisions within the profession. With fewer than 25k acupuncturists in the US unity is critical.
  • What happens in one state impacts every state. States look at what has happened elsewhere when considering regulatory changes.
  • Changes in one state can lead to changes for everyone. When CA increased required educational hours every school and ACAOM soon changed as well.
  • Different regulations, training requirements, and titles make it difficult to educate the public about our qualifications, draw contrasts with other professionals, or advocate for our profession as a whole.

Staying informed is not easy. Neither is getting involved. We are all busy, we don’t always know how to assess the pros and cons of a possible change, and things can get heated and unpleasant when there are differences of opinion.

And, the future of our profession and our businesses is greatly impacted by regulatory changes – even those happening across the country.

Please, stay involved.

Forgive two posts in quick succession, but regulatory changes are on the way. You’ll hear from me again soon.

(Note — I advocate for standardizing and simplifying the regulatory process for acupuncture licensure. I am not advocating for standardizing the medicine itself. Our diversity is powerful indeed.)

How we Grow – The Acupuncture Profession in 2015

One Physician per 371 non-institutionalized civilians was the US average in 2012.

One Acupuncturist per 20,000 non-institutionalized civilians was the US average in 2014.

NCCAOM’s 2014 Annual Report is an important read for anyone who cares about Acupuncture in the US. From it we learn:

  • Applications for certifications dropped from 1744 in 2013 to 1494 in 2014.
  • The number of new certifications dropped from 1144 in 2013 to 972 in 2014.
  • 532 of those new certifications were in Oriental Medicine. Another 16 were for Chinese Herbology (likely existing LAcs choosing or being required to add the Herb certification).

I don’t know how many practitioners are leaving the profession, but many of my peers who were licensed 20+ years ago are stepping back from active practice.

Several current initiatives, including HR 3849 and state-level efforts to mandate insurance coverage of acupuncture would increase demand for acupuncture. (There are 49,435,610 Medicare beneficiaries in the US and 5.5 million Gulf War Vets.) If fully trained Acupuncturists aren’t able to meet the demand, who will provide those services?

At this rate, how long will it take to grow the profession to even one Acupuncturist per 2000 people?

Shouldn’t we focus on that?

I’m baffled. We’ve sued, signed petitions, and marched in the street, all to try to stop the “greatest threat to our profession” – other professions wanting to use the acupuncture needle.

But there’s been silence, or even approval, when Florida (with one DOM for every 17,760 people) changed their regulations in 2014 to require all 4 NCCAOM exams for licensure. Ditto in NJ where new practitioners will need the NCCAOM herb exam to use herbs in their practice. (How many citizens had been harmed by use of herbs by practitioners without the herbal credential? Was regulation needed?) In Nevada (approximately 1 Acupuncturist for every 47,000 citizens) the Board of Oriental Medicine is moving to require a DAOM of all licensees. Meanwhile, many insurance plans are limiting their provider pool to those with active NCCAOM certification, even in states that don’t require that credential. (After all, the vision of the NCCAOM is that “Acupuncture and Oriental medicine provided by NCCAOM credentialed practitioners [emphasis mine] will be integral to healthcare….”)

If we want the public to obtain services from well-trained Acupuncturists we need to make sure providers are available. One thousand new practitioners a year and growing self-inflicted restrictions on where and how we can practice aren’t going to do it.

The greatest threat to our future is an Acupuncture workforce insufficient to meet demand or effectively advocate for ourselves. Allowing or supporting credential creep, educational bloat, and practice restrictions are sowing the seeds of our demise.

Can we please focus on growing our profession?

 

Demographic Information From:

Acupuncture Today Density Map

Physician Data

Population Data

Medicare Data

Veteran Data

November ’15 Acupuncture News Update, Chapter 1

It isn’t easy keeping up with Acupuncture News. Now and then a “clear the decks” post (or two, or three) is needed. Here goes:

HR 3849: Representative Judy Chu (CA) introduced “The Heroes and Seniors Act ” which would add acupuncturist services to Medicare and would increase the availability of acupuncture to members of the military and Veterans. The bill has a long list of endorsing organizations. Supporters should share their analysis of what would happen in the twenty states with fewer than 100 LAcs*. In a business with competitors, creating demand for a service without the ability to provide it is a bad move.  I’d be more worried if I didn’t agree with govtrack.us – there is a 0% chance of the bill being enacted.

Dry Needling: In late September the North Carolina Acupuncture Licensing Board filed a complaint in the General Court of Justice against the North Carolina Board of Physical Therapy Examiners, asking the court, among other things, to declare dry needling the unlawful practice of acupuncture. In early October the North Carolina Board of Physical Therapy filed their counter suit in US District Court seeking triple damages for the NCALB’s illegal and anticompetitive acts. Not surprisingly the same LAcs who cheered on the NCALB suit were outraged that the NCPTE would return fire. Given the SCOTUS ruling from this past year I believe the acupuncture community is in a risky place. If the PT’s prevail it will be a game changer nationwide. Did the AG’s office (which had previously ruled that Dry Needling could be within PT scope) advise the NCALB on their complaint? Are all North Carolina Licensees picking up the legal tab for what looks like outside counsel?

In other news the acupuncture community has been touting the revised AAMA Policy on Dry Needling. The Middle Eastern saying “The enemy of my enemy is my friend” comes to mind. It’s a strategy that can win battles, and can create more of them. I don’t think of Medical Acupuncturists or PT’s as enemies. I do remember our insistence that the 200 (or 300?) hour training of the MD Acupuncturists is insufficient. And I wonder whether the PT’s could increase their training to 200 (or 300?) hours and then argue that all of acupuncture is open to them.

Nevada: The minutes of the November 5th Nevada Board of Oriental Medicine haven’t yet been posted, but I understand from attendees that the Board is planning to hire legal counsel, the cost of which will fall on existing licensees. Why does the Board need to hire legal counsel? Because they continue to pursue actions that go against existing code and legislation, rejecting the counsel of the Attorney General’s office. The news from Nevada is a reminder that having an independent acupuncture board isn’t necessarily great for the public or the profession.

Looks like there will be at least one more “Clear the Decks” post. Coming soon  – news about: acupuncture and insurance, NCCAOM’s annual report and more, ACAOM’s hot news, regulation in the District of Columbia, Lamar Odom and the future of herbal regulation, and what’s happening in the AAAOM.

 

* I use LAc to refer to all professionals holding the proper government license to provide primarily acupuncture and TCM services. Having no clear way to refer to, define, or describe this group of individuals is representative of our challenges!

Acupuncture and Oriental Medicine in Nevada, What’s the Deal?

A regulatory board working against the best interests of the public and the profession  — it’s tragic, and it happens too often.

It has never been easy to become an acupuncturist in Nevada. Despite having the country’s first licensing law, passed in 1973, there are only about 50 individuals now practicing in Nevada, the 7th largest state.

It’s not only the $1,000.00 application fee, or the $1,000.00 practical exam fee. In the 2001 the press explored how Nevada’s unique rules caused problems for the profession.  The regulations may have changed, but similar issues remain.

Given the excellent safety record of practitioners licensed in states with less stringent educational requirements and via the widely accepted NCCAOM credential, it’s long overdue for the Nevada Board of Oriental Medicine to change their regulations, making it possible for the citizens of Nevada to get access to the safe and effective acupuncture and Oriental Medicine services that are available in so many other states.

The board is moving to update the regulations. To make it harder, not easier, to get a Nevada license. Not in response to harm to the public, not to bring the process in line with other states, but, because “the degree of MSAOM is odd and absurd.” Look for the “Justifications to amend,” on page 18 in this set of Nevada workshopdocs. You’ll shake your head.

The workshop docs show two sets of proposed revisions. The set dated June 16, 2014, was proposed by a previous Board, has made its way through the regulatory process, and could quickly be officially adopted after two more public meetings. However, the newly appointed Board members have decided not to act on those regulations, and have proposed new revisions. The lawyer in the Attorney General’s office isn’t quite sure what will happen now — it seems that “our” Board is unique in introducing a new set of revisions at this point in the process. (See ** below for more info on the Nevada Regulatory Process.)

The Nevada 2014 proposed regulations would have been somewhat problematic. The Nevada 2015 proposed regs would be a disaster. The reasonable aspects of the 2014 proposed regs are discarded and more restrictive provisions are introduced. The “grandfathering” provision, specifically excluding CEU’s from the 3000 hour requirement, takes away the one avenue for licensure available to most experienced practitioners. The insistence on a DOM or DAOM for all graduates after November 2017 is a significant financial burden for practitioners.

The proposed changes would slow access to and increase the expense of acupuncture in Nevada. They won’t help the schools meet those new gainful employment figures. The proposal dismisses the attempt (for better or worse) to defer to ACAOM for school accreditation, instead establishing an expensive and closely held accreditation process. A change which would allow applicants to sit the practical exam (offered only twice yearly) while their training and background is being vetted is discarded. The regs allow for an increase to $1,000.00 to the license renewal fee, rather than $500.00, and deletes a section on professional ethics from the current regulations. It’s hard to imagine that such awful regulations were written by our colleagues, not acupuncture-hating skeptics. Amazingly, the President of the Board certifies that, “having made a concerted effort” to determine the impact of these regulations on small businesses, there is none.  (See the workshop docs.)

My suggestions on what the profession could and should do in response to these regulations will come soon in a separate post. In the meantime, review the documents and consider how the changes would impact the profession Even those of us who don’t know a soul in Nevada and expect that we’d never practice there will see problems. At the moment, the LCB has not put these proposed revisions on the agenda.  Stay tuned.

 

** Nevada regulatory process —  the Legislature meets only every other year, for 120 days. Nevada law establishes a Legislative Commission, made up of 6 legislators from each house, that can approve regulations when the legislature is not in session. See more here, (generalize since this was written for a particular commission). Regulatory changes do not need to be approved by either the governor or the full legislature.

 

FPD/DAOM required, Schools, ANF, Dry Needling — and more Acupuncture News….

New news:

Word is that the Nevada acupuncture board is poised to require an FPD (or is it a DAOM?) for licensure, even though citizens there are already under-served. I’m trying to get more information. Stay tuned for updates. State actions that limit our profession tend to stay under the radar until it is too late.

The acupuncture school landscape is changing. Last week brought news that Bob Duggan and Dianne Connelly will no longer be part of MUIH faculty or staff. For those who have been paying attention as The Traditional Acupuncture Institute morphed into MUIH, it shouldn’t have been a surprise. But it is sad. While TAI had its good and its bad, many who attended did so because of Bob and Dianne’s contributions. The announcement was quickly followed by a letter, in perfect TAI-speak, that, for the sake of the students, we shouldn’t get caught up in stories about this. As in, don’t even ponder what it is we aren’t telling you.

This week also included the news that NESA is merging with MCPHS, and ACTCM is merging with CIIS.  (Thanks, Integrator Blog.) Is the age of the stand-alone acupuncture school coming to an end?

Have you heard of The Acupuncture Now Foundation? They aren’t a membership organization, and they don’t want to get involved in acupuncture-politics. They just want to educate the public about our training, our skills, and the great results from our medicine. Please, support ANF! Marketing the medicine shouldn’t have to be an individual effort.

Older News:

Developments in dry needling, with the hope that we might learn from history:

  • Louisiana joined other states with an AG opinion that dry needling is within scope for PT’s and DC’s. Other AG opinions can be seen here.
  • Tennessee’s Governor signed Legislation formally adding dry needling to scope for PT’s, joining Utah and Arizona which saw similar legislation in 2014.
  • The Maryland Acupuncture Society came out in strength behind HB 979 and SB 0580 that would have set limits for dry needling by PT’s and DC’s. The bills went nowhere, perhaps a blessing in disguise as “success” would have opened a can of worms.  (The bills did not define dry needling, MAS support put the acupuncture community’s stamp of approval on a 200 hour standard for acupuncture training that had been previously unacceptable, and the wording opened the door for PT’s with 200 hours of training to argue that they were now, indeed, doing acupuncture.)

The AAAOM website has been updated with board bios and a revamped committee list, but still no answers for any of my sixteen questions for the AAAOM.

ACAOM responded to the petition in response to their Gainful Employment letter in the ACAOM Fall Newsletter.  The good news — they heard us. The bad news, they continue to believe that significant student debt is helpful for those who want to serve low-income communities.

There you have it, at least some of the news you aren’t seeing in Acupuncture Today.

 

Acupuncture Safety, and, a Matter of Fairness

Protecting the public safety is a good reason for regulation.

People have been injured by PT’s or Chiropractors doing dry needling.  When we see a story about that we share it. So I understand the comments on the previous post.

And, there were two recent threads on Facebook that caught my attention.

An LAc posted a question about whether it was possible to cause an infection by needling CO4. He’d treated a patient who later developed redness at the area. The patient visited an MD and was prescribed an antibiotic. I was surprised at the practitioner’s question, and surprised and mortified at the responses.  Which included: The MD is just trying to cover his ass, they just like to prescribe antibiotics, not if you used sterile needles, not if you used an alcohol swab on the area first, people freak out all the time, etc. A day or two later, the initial questioner reported that the patient was now hospitalized with a staph infection.

Another LAc wrote that a patient reported she’d had a pneumothorax from a treatment and was now asking for financial compensation for a portion of the medical expenses and several weeks of missed work. What should the practitioner do? Of course, getting some documentation makes sense, but the responses also included: if it really happened why doesn’t the patient have a lawyer, if you’d given her a pneumothorax you would have known it immediately, she must have had some sort of underlying medical condition so you aren’t responsible, etc.

Personally, I know some amazing practitioners who have firsthand experience with pneumothorax(i?) on both ends of the needle.

I don’t believe we have sufficient record keeping to know the relative safety records.  Dry Needling does involve a deep and aggressive needle technique and so is more likely to do damage.  That’s true even with an LAc holding the needle.

When a story comes out that involves harm done by an LAc, we make all sorts of excuses and focus on our generally good safety record. When we find out about damage done by a PT or DC, we trumpet the news, and make smug and superior comments.

When it comes to fairness, most of the things I hear LAcs complaining about are either self-inflicted or, sometimes, imagined.  The length of our training — we’ve been behind the increase. The differing insurance reimbursement — is that insurance thing working out for anyone?

This post is mostly blogger’s prerogative to give what is really a comment on the previous thread a higher visibility.  I won’t make a habit of it.  But hwds’ are one of my pet peeves — that’s hypocrites with double standards, and when our response to what happens at the pointy end of the needle seems to vary so much depending on who is at the handle, I think that term applies.

 

 

It was Twenty Years Ago Today

….. that I was granted my Virginia Acupuncture License (#4). I’d been licensed in Maryland for a few months, but the Virginia License was special. Throughout my years of acupuncture school I’d been involved with the Acupuncture Society of Virginia, working to establish a practice act. We were finally successful in 1994, and my documents were ready and waiting when the regulations were promulgated.

I’m happy I found this wonderful medicine when I did. I feel lucky to be doing this work, and look forward to continuing to practice for decades to come. And yet, these days, I’m mostly sad about the acupuncture profession.

Back in the day, when only MD’s could do acupuncture in Virginia, we argued that the public should have the right and the ability to choose their provider.

We discussed how our medicine could treat the whole person, and that treatments were uniquely tailored to the individual.  We didn’t see patients as a collection of ailments, to be sent from one specialist to the next.

We talked about the good value of our medicine and our belief that it could reduce health care spending.

We got used to the medicine being dismissed by the medical establishment, but held out hope that, some day, they would see the value of what we did.

We knew that this medicine would require lifelong study and learning, but experience told us that about 1500 hours of training was sufficient to produce competent practitioners.

We were happy when we were finally able to receive student loans to attend acupuncture school.

We had concerns about relying on one standardized exam as a precursor to licensure, especially one that was based primarily on one tradition. But we knew that it would relieve some of the burden on the states, and so might help with national acceptance.

It was a time of promise.

Now, my Facebook feed is full of rants — we’ve now decided that, just as the MD’s wanted to protect the public from us, we now must protect the public from the PT’s.

Rather than celebrating the professionals who see the value in this medicine and want to offer it to their clients, we scream that they are stealing our medicine and must be stopped.

We’ve justified our increasing fees (after all, if the MD’s deserve it, we deserve it), and, then chased the insurance dollar so that our patients can afford our services. We’ve adopted the billing games that come along with that, fudging fees, adding services, figuring out what diagnoses to use to get reimbursement, and expressing outrage when we’re called on our behavior. Some of us have gone so far as to attack those who have designed a system to make acupuncture truly affordable to the majority of the population.

We decided that more education would get us more respect, and so increased and increased, and increased again the hours required for entering the profession.  The number and complexity and cost of the exams increased. In a solution to a problem that didn’t exist, practitioners in some states decided an acupuncture education was not enough.  Acupuncturists now must also learn and be tested on herbal medicine, whether they want to use it or not. Various states added additional requirements, so any relocation runs the risk of shutting a practitioner out of the profession. The student loans we celebrated enabled schools to ignore the disconnect between the cost of the education and the likely income of graduates.

I could go on. I won’t.

Shaking my head at the missteps we’ve made, I comfort myself with the confidence that the medicine will survive, even if the profession won’t. Happy Anniversary.