News Update

and a bonus at the end —

October 1st, NCCAOM, Facbook —

 NCCAOM has received a significant volume of responses, and the results of this feedback will be taken into consideration during the development of the final policy and standards, as NCCAOM continues to strive for increased customer satisfaction. We are always eager to hear your suggestions for changes that will benefit you, the Diplomate, and the AOM profession overall. It is with your feedback that we can continue to meet your needs.
We are listening!

Spin?

October 2nd, date of scheduled AAAOM Town Hall, AAAOM website —

Legislative Town Hall

CALL POSTPONED – DATE TO BE DETERMINED

No additional news.

October 9th, Richmond, VA, Meeting of Virginia Acupuncture Advisory Board.

Agenda includes discussion of an alternate path to licensure due to conflicts between Virginia law and the NCCAOM proposed policy changes.

The representative from the state association (ASVA) was against any discussion of the NCCAOM issues. ASVA stated  — “lowering of standards…would do harm to both our profession and the public.” Who mentioned lowering standards? Is there evidence that anyone is harmed in states that do not rely on the NCCAOM credential?  Here is my post-meeting email to the association  –  ASVA comments.

The NCCAOM rep at the meeting was clear — the proposals were just proposals, stakeholder comments will be taken into consideration, any language referring to the effective dates of the changes was referring to effective dates for the proposed changes, not the actual changes. I envisioned someone pedaling backwards.

Questions of the Day — We attack when another profession “interferes” with our practice (DVM’s “stealing animal acupuncture”, PT’s “stealing acupuncture”, MD’s wanting to see our patients) even when we have little or no power to change anything. Why are we unwilling to even discuss it when an organization supported by our money, controlling our profession, at our request, takes action that costs us or limits us? We made a difference this time (we hope) – why aren’t our professional associations helping?

Here is a new page on Legislation and Regulation. It contains important and valuable information. Please, read it and pass it on.

I’ll be working on a page about the Acupuncture orgs (the alphabets) and another for potential acupuncture students in the coming weeks.

Dry Needling, Herbs, and Scope — How to Regulate a Profession

A regulatory Board is contacted.  Your licensees are doing X, that isn’t (or, is that?) in your scope.

Ask a PT Board about Dry Needling and the answer usually goes something like this — We trust our licensees. Many learn this technique and it helps their clients. We find room in our regulation to include this in our scope.  We have a few concerns and suggest that those who want to utilize this technique have some additional training and take additional precautions. Our existing system for addressing unsafe practice is sufficient to address risk to the public.

Ask an Acupuncture Board or organization about herbs and the answer usually goes like this. We are being threatened again!  We’d better legislate, and fast! Help! Thanks NCCAOM and schools. We are so grateful for your efforts to ensure that any acupuncturist who wants to utilize this dangerous aspect of our medicine add your $20,000 education and your formal $800.00 seal of approval to their already extensive education and credentials. In fact, in the name of raising standards we should require that from all LAcs. It might prevent some of our most qualified practitioners from practice, but, hey, it is a step toward getting the respect we deserve.

Is something wrong with this picture?

It’s a radical idea, but how about we respect ourselves. Let’s recognize the safety of our medicine and the depth of our education.  Let’s trust our colleagues’ professional judgement and open doors rather than close them and let’s stop deferring to those who profit from our love of this medicine.

For additional reading, check out an example.  In this case, I agree with Dr. Morris when he wrote,

To avoid conflicts of interest, no individual who stands to profit from seminars should determine competencies and educational standards, nor should they testify in legislature on behalf of the common good.

(Of course, he was talking about the PT’s when he wrote it, so maybe in this case he doesn’t agree with himself.)

You have until Monday, 9/30, to comment on the NCCAOM’s “proposals.” Does the current CEU arrangement put the public at risk? Are the states incapable of effective regulation?

One more thing — during the great FPD debate, many expressed concern that once the degree was available the NCCAOM could, by fiat, require it for entry level practice. We were assured that would be impossible. Informed by history, it seems very possible indeed.

You Can Make a Difference

Many LAcs do their best to ignore the “politics” of acupuncture. The experience of participating in professional dialogue can be disheartening and discouraging. It isn’t easy to participate even when we want to — things are happening at the state level, with schools and ACAOM (the coming FPD), or with credentialing (proposed changes at NCCAOM), for example. All too often the debate gets heated and divisive. It is hard to get the whole story and figure out the possible consequences of a change or know what action might be effective. When the licensure legislation was developing in DE few outside of the state were involved. Some of my colleagues in DE had concerns, but they eventually gave up what felt like a fight for a better bill.

Five years after the DE legislation went into effect, there are approximately 35 LAcs serving a population of over 900,000 people and many of those practitioners were either grandfathered in or granted a waiver. Two years went by without a single non-waivered approval. Clearly, the legislation is not giving the people of DE access to qualified LAcs. As I wrote about in my last post, I know of two excellent practitioners who have recently been denied licensure even though their credentials surpass those of many practitioners in the state.

In the long run, the Delaware legislation should be changed. Rules that exclude the majority of NCCAOM credentialed Acupuncturists make no sense, especially when acupuncture can be done by other professionals with far less training. In the short run, the Acupuncture Advisory Council should acknowledge the record of safety of NCCAOM AC practitioners and consistently grant waivers to those with that credential.  In the very short term, the Council should grant waivers to Virginia LAc Sharon Crowell and Maryland LAc Sue Berman.  To facilitate those short term goals I ask that all of you write to the Acupuncture Advisory Council expressing your support of such a waiver.  Please mail your letters by August 22nd!  Feel free to post a copy of your letter in the comments section to inspire others. Email a copy to de@theacupunctureobserver.com. That will help if further action is necessary.

You can see the letter I sent (and borrow from it if appropriate) —  DE Observer Letter.  I’ve also generated a DE LAc sample letter that you can personalize. You could add some of these Possible concerns or your own concerns (please share any additional concerns in the blog comments). The letter can be modified for clients or others who are interested. If you’d like an excuse to visit Dover, DE, the next Advisory Council meeting is September 12th. It should be lovely at that time of year – but don’t count on being able to find an LAc in town :).

 

Our Worst Enemy

How do you feel about a regulatory situation that increases the odds that patients will receive acupuncture from minimally trained, non-LAcs while making it difficult for extensively trained LAcs to practice?  Is it better or worse if it is a state’s very own LAcs who are creating this situation?

The Delaware Acupuncture Council recently refused to grant a license to one of the most excellent practitioners I know.  This Virginia LAc,  a NCCAOM AC Diplomate and a Nurse, has had a very successful practice for over 13 years.  She is a former president of the Acupuncture Society of Virginia and has studied Medical Qi Gong extensively for the past three years.  The three LAcs on the DE Council present for the June meeting refused to grant her a license because she does not have NCCAOM OM Diplomate status.  Although the Council was reminded that they could grant an exception, they refused to do so.

It appears that only one of the four LAcs on the Council has the full NCCAOM OM status and one has NCCAOM AC status.  A third LAc has no formal acupuncture education or NCCAOM status, holding a degree in ayurvedic medicine granted for overseas study. I could not discover any information about the fourth LAc on the Council.

Delaware passed legislation related to the practice of Acupuncture in 2008, which you can read about here.  The legislation required full NCCAOM OM certification, including herbs but included three caveats, as noted in the AT article:  1) acupuncturists practicing in the state at the time the legislation was passed, regardless of education and credentials, were grandfathered in;   2) the legislation did not interfere with the activities of other professionals who were allowed to perform acupuncture; 3) the Acupuncture Council was expressly allowed to waive the requirements as appropriate.

Remember – herbs are not regulated by the FDA, and products containing Chinese herbs are available in the grocery store (see Airborne), or on-line, and are available to the public without prescription or the involvement of any health care professional.

Delaware currently has about 35 LAcs serving a population of about 1 million people. According to my research, there are 9 NCCAOM AC Diplomates in DE, and another 6 OM Diplomates.  The decision of the Council only increases the odds that the people of Delaware will receive treatment from non-LAcs.

The way I see it, it isn’t the lack respect from the western world, competition from other professions, or inequities in insurance reimbursement that are the biggest problems facing the profession.  It is a system in which small groups of LAcs in various states have determined that more credentials and education are necessary, even for those who are already extensively trained in Acupuncture and Oriental Medicine. They work for laws and regulations that increase the cost and time necessary to obtain an acupuncture degree and limit practice opportunities for LAcs.  This increases the odds that the public will receive treatment from providers who are not LAcs.

With friends like this….

A Level Playing Field

This was a comment to It’s Not Fair.  You can see the beginning of the exchange there.  Frank raises some great issues, so I’ve cut and pasted his comment below, along with my responses in italicsI’ll split it into a few posts to keep the length under control.

Frank writes:  Here is why I think we are not on a level playing field:

(I’m not a sports fan,so my analogy is probably off, but there is a difference between a non-level field and not knowing how to put together a team or play the game to your advantage.  My position is that while there are things that put us at a disadvantage we could still develop a winning strategy and a winning team. Underdogs can and do win.)

Exogenous factors  (All have endogenous aspects.)

1) Licensing. Not every state even licenses acupuncture, and of those not all include the scope of practice (herbs,nutrition, tuina) that people are taught in school. As far as I know, every state licenses PT.

If you haven’t seen my post about Scope, please read it. Most of our “leaders” don’t seem to understand the term, and, subsequently, we spend a lot of time and energy fighting unnecessary battles. A technique does not need to be specified in your legislation to be within your scope. Herbs, for example, are unregulated by the FDA and so anyone, including the check-out guy at the 7-11 can sell them.  (Check out the ingredients of Airborne, for example.)

Sometimes I wonder whether licensure has done more harm than good (a discussion alive in the ND community) but, accepting, for the moment, the conventional  wisdom that it is a good thing, shouldn’t we focus on licensure in all 50 states before pushing for Medicare coverage?  Shouldn’t we pay attention to reciprocity, agreeing on a mutually agreeable minimal set of requirements for licensure so that qualified and experienced LAcs in one state are likely to be able to practice in all states? (I’ll be posting more on this, but I find it tragic that within the profession we are setting rules that exclude so many of our colleagues!)

2) Money. PT is a $30 billion industry. A lot of the big clinics are funded with private equity money. They use aggressive Starbucks style positioning and can run clinics at a loss in hopes of pushing other big clinics out of business. Plus, they can fund advertising campaigns that make PT seem like a normative activity, and of course they can generously donate to candidates.

Yes, there are more PT’s and it is an industry. I don’t know enough about the specific business practices to comment, but I do know that many investors in PT practices are MD’s, powerful allies to have.  They also seem to have a strong national association.  Meanwhile we’ve got associations which have been promising they’ve turned the corner for years.  And we’ve spent so much energy fighting with other providers over our fear that they will “steal” our medicine that we’ve made enemies rather than friends (check out Love the Bomb). From what I can tell, there are enough people open to acupuncture that it is normative.  WebMD talks about it on a regular basis. Folks often report the great results they’ve seen when their pets receive treatment, for example. Our problem is that we have been unable to make good use of the positive buzz that is out there.

As for advertising, again, we have the money to do this, we just do it poorly. The AAAOM spent two years coming up with information cards that were intended to carry a positive message about our profession.  Instead, the first line reads — “Many healthcare providers are performing unlicensed therapies similar to acupuncture, but each state licensed acupuncturist has extensive training in an accredited college that ensures their dedication to providing excellent healthcare.”   We can’t even start on a positive note without casting aspersions on professionals who could be allies. This one sentence contains several inaccuracies/inconsistencies:  a) professions are licensed, not therapies, b) hasn’t the profession been arguing (foolishly imo) that these therapies are not similar to acupuncture but are acupuncture,and c)not all licensed acupuncturists graduated from accredited schools — it depends on the state and on whether they attended a US school. I’m no advertising executive, but that isn’t a helpful introductory line.  How many MD’s or PT’s (who could refer to us) would agree to display a card like that in their office?

It doesn’t take necessarily take big bucks to influence legislation — it does take a winning strategy, choosing issues wisely and building alliances whenever possible. We have not done that.

You Keep Using That Word. I Do Not Think It Means What You Think It Means.

Scope of Practice. We use the phrase often. However, the term does not, as Inigo Montoyo would say, mean what you think it means.

When a jurisdiction determines that a particular profession should be licensed, it defines a range of activities that it considers to be a part of that profession.That is what we think of as the scope of practice.

For a super-great exploration of scope of practice I strongly, strongly, urge you to read this and this.  Based on these sources, my own experience on a regulatory board, and additional reading and experience —

  1. Scope does not give a profession a monopoly or a copyright. Scopes overlap. Convincing the public that TPDN is acupuncture will not prevent PT’s and other professionals from adding the technique to their scope.
  2. Something does not have to be formally listed within a profession’s scope to be legally used by licensees. It is not necessary to legislatively add Tui Na or herbs to a scope for it to be permissible for qualified practitioners to use those modalities, as long as their scope does not expressly forbid it.
  3. Adding a technique to a formal scope can increase the educational and testing burden on all licensees, not just those who intend to use the technique.  The acupuncturist who has no intention of incorporating herbs into his or her practice, but who can’t obtain a license without also spending years and tens of thousands of dollars studying and obtaining herbal certification is an acupuncturist whose livelihood is unnecessarily threatened with no benefit to the public.

Our superficial understanding of scope of practice leads us into battles that we will ultimately lose, limits our opportunities, and distracts us from efforts that could better serve the profession and the public.  What a shame.