A Call to Action

We have an opportunity to help Californians, and all acupuncturists, but we need to act now. As I’ve written before, states setting their own super-special requirements for acupuncturists seeking licensure is expensive and limiting for practitioners and the profession. I’ve never seen evidence that the public benefits from such requirements.

California has been one of the worst offenders. An exploration of the unique educational requirements can wait for another day, but we now have an opportunity to do something about the exam.  (Please note – much of what follows is based on my best understanding of the situation from respected colleagues in California.  I have not been personally able to fully research the California situation.)

The California exam has had problems for years, among the lowlights — a California Acupuncture Board (CAB) chair sent to prison for selling the exam; a point location exam shown to be so subjective that the State mandated that the CAB cease using it; incidents of extremely high failure rates and serious scoring errors; and CAB’s refusal to compare two exams for possible unfair scoring.

A recent Sunset Committee is turning up the heat on the CAB. Senator Lieu, the Sunset Committee chair, may support a bill that will allow potential licensees to take the NCCAOM exam rather than the California state licensing exam. It is time to let the Senator know that this change would benefit the people of California and all acupuncturists.

Please send emails this week to:

marty.block@Sen.ca.gov, ted.lieu@sen.ca.gov, tom.berryhill@sen.ca.gov,
ellen.corbett@sen.ca.gov, cathleen.galgiani@sen.ca.gov, ed.hernandez@sen.ca.gov,
jerry.hill@sen.ca.gov, alex.padilla@sen.ca.gov, lark.park@gov.ca.gov, Anna.Caballero@scsa.ca.gov, Denise.Brown@dca.ca.gov, Tracy.Rhine@dca.ca.gov, Sonja.Merold@dca.ca.gov, LeOndra.Clark@sen.ca.gov, kimberleywoo@sbcglobal.net, bluelotushealth@gmail.com, blueheartacu@gmail.com, crystal.clk@gmail.com, Spencer.Walker@dca.ca.gov

Some possible language —

I formally request that the Sunset Review Committee mandate that the CAB and staff use the national certification exam (NCCAOM) as the main exam for California Acupuncture licensure.

The NCCAOM exam is widely known to be a fair and comprehensive exam. It is relied upon in almost every state except California. Those practitioners who are credentialed by the NCCAOM have an excellent safety record. To require a unique exam for California, especially one shown to have ongoing problems, increases expenses for all California practitioners, costs which are ultimately borne by the public.

I urge you to require the use of the NCCAOM exams as the main exam for CAB licensure.

Thank you for your consideration.

We will all be better off when meeting one set of standards allows us to practice anywhere in the country. Changing the situation in California would be a wonderful step in the right direction.


Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2033. 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.

15 thoughts on “A Call to Action

  1. You know from our previous exchanges that I do not support laws that make it difficult or impossible for qualified practitioners to work in any jurisdiction they choose. That is why I and both of my apprentices fought against the institution of the requirement that Delaware acupuncturists be required to achieve NCCAOM OM certification. There are many very good reasons for opposing this kind of lawmaking. This is a very long story and does not need to be repeated here. I am writing simply to request that we all exercise some caution in how this matter is handled. As you may know 11% of the current California licensing examination is on “Prescribing Herbal Medicinals” (http://www.acupuncture.ca.gov/students/exam_content.shtml). I would anticipate that if the NCCAOM exam is accepted that there will be arguments made from some stakeholders that it is the OM standard that should be required. In 2004 the Little Hoover Commission (http://www.lhc.ca.gov/studies/175/report175.html) recommended, among other things, that state law in California should develop a means of allowing for acupuncture-only licensure–a move that would require separate testing and the establishment of separate educational standards. No action has been taken by the board on these recommendations. The report is an interesting read for many other reasons and I definitely do not agree with all of their findings and recommendations.

    In any event I think we can reasonably anticipate that if the NCCAOM exam were accepted there would be a coalition of forces within California that would require OM certification. This could set a very bad precedent for the future of acupuncture-only licensing everywhere. There is now a very robust literature documenting that when licensing laws and regulations are written by representatives of the occupation being licensed, the boards created and populated by them tend to use their authority to restrict entry into the trade and reduce competition. We can and must do better than this if we are serious about moving our trade forward. So I would suggest that we keep all of this in mind as we compose our letters.

    Just so everyone knows I have far more hours of formal training in East Asian herbal medicine than are currently required to sit for the NCCAOM examination and have been in practice for over 30 years. However I do not support the NCCAOM certification process. I am certified in acupuncture only because I anticipated that it would at some point become the basis of licensure in most states. I refuse to further support a system that I consider essentially corrupt by paying them for more unnecessary certifications. There is no credible evidence whatsoever that NCCAOM certification produces statistically significant improvements in either patient safety or clinical outcomes. If you claim there is I challenge you to produce it (this is not addressed to you Elaine–just to be clear). Let’s end the pretense.

    • I appreciate and share your concerns. The crazy part is that it is our fellow LAcs who have insisted on adding OM requirements. Of course, the NCCAOM is all too happy to send out folks to support this change, often making specious arguments to do so, as we saw in Delaware. I wish those practitioners who support credential-creep could see that far from increasing respect for the profession it instead paves the way for non-LAcs to provide services.

      I think the NCCAOM -may- be getting it that the profession is NOT growing, partially as a result of these ever increasing requirements. Perhaps some wisdom will follow? Honestly, if you are interested in herbs why go to acupuncture school at all these days — open an herb shop and you need no formal education and no credential at all. (Rhetorical question.)

      • “Honestly, if you are interested in herbs why go to acupuncture school at all these days — open an herb shop and you need no formal education and no credential at all. (Rhetorical question.)”

        Exactly. While I do not object to some knowledge of East Asian herbal traditions being part of the education of an acupuncturist I believe it is absurd to require “National Board Certification” in Chinese Herbal Medicine to practice acupuncture. There is absolutely no evidence to suggest that those trained in herbal medicine make better practitioners of acupuncture and certainly no evidence to document that either safety or clinical outcomes are improved by requiring the additional certifications. These are nothing more than barriers which restrict our freedom to practice in the jurisdiction of our choosing while conferring no measurable benefit to society as a whole. Many arguments against adopting these standards were presented and supplied to Delaware practitioners before this law was passed yet they chose to support the law as it currently exists. This despite the fact that the majority of practitioners (who were to be grandfathered in) would not meet these standards. In fact, a number of these practitioners were not even NCCAOM certified in acupuncture. Now perhaps they feared being unable to practice in Delaware without a law. I myself had practiced in Delaware since 1984 without incident or threat. I don’t believe the threat was real. I believe this law was supported despite knowing that it would set up a ‘closed shop’ in this state. None of this makes ethical or practical sense and until we start caring for each other how can we claim to have the best interests of everyone in our hearts as we try to move forward.

  2. Hi Elaine,

    Are the people above in the area you said to send email to: Are those all the people I should send my email to? Sorry for the weird wording.

    • I have been told that those are the folks that should receive the emails. I just removed one name as I got a reply that they were no longer there. I also had to replace all the commas with ; for my email system. Hope that helps!

  3. Hi Elaine,

    I think you should definitely write a letter. I will sign it!!!! I took that horrible exam. It does not prove anything. All it proves is that you guessed correctly. We had to identify the herbs by sight and they looked nothing like the herbs we studied. They would trick you so that they intentionally would have a low pass rate. It is completely disgusting. I hope it does change. It seems we are our own worst enemy. We need to make things easier on ourselves. I agree. I would keep talking about how we only hurt our profession not make better practitioners. Years ago, about ten to be exact the California board has a list three pages long with all the practitioners that lost their licenses. How does that test improve those numbers? Just food for thought. Thanks!!!

    • Susan — rather than sign my letter (which will be an email since time is of the essence) how about you write your own. I give you permission to cut and paste the text from the blog post — though since you have actual experience with the test your own words would be even better!

      • I just filled out an NCCAOM survey about insurance…I’m sure most of you have received. One of questions asked for patient contact information b/c the NCCAOM wanted data from them. This is a major HIPPA violation. NCCAOM has no jurisdiction to ask for such information. My response that this question is inappropriate and violates HIPPA and that I will be reporting the NCCAOM to my state for soliciting patient contact information (yes, i know this is off-topic).
        This whole discussion; insurance, NCCAOM, CCAOM, AAAOM, the for-profit trade school system (only a few are regionally accredited), credential creep, educational hours creep, etc really got me thinking that perhaps it is time that this trade be dismantled. The only way to get rid of the corruption of the alphabet orgs, review boards, schools is to practice AOM under at least a DPT, PA, or NP license. It would be great if everyone retooled their skill sets to these licenses and advocated practicing AOM under theses license. All have strong lobbies, access to research dollars, access to insurance (if desired), the ability to practice independently, the ability to earn an actual income. Look at the job counts: http://www.bls.gov/ooh/healthcare/physician-assistants.htm
        These are actual professions, not trades (like acupuncture). The saddest part is the number of jobs in 2012 for PAs was greater than the number of LAc’s in the U.S. (something like 27,000?).
        I have zero confidence in letter writing campaigns and petitions (recall the white house petition to include acupuncture as an EHB? that was magical thinking). Unfortunately, as it seems to be proven time and time again, LAc’s cannot (and probably will not be able to) govern themselves. I believe everyone will do better with retooled skill sets as well as having the ability to practice this form of healthcare. The DPT, PA, NP organizations are strong and effective, the leaders of these organizations have a long professional history (unlike the current and acting AAAOM presidents–one just graduated from acupuncture trade school, another does not even practice full time–look at the AMA, ANA, PT and PA org presidents–what do they have in common? they ALL have well established career track records in their respective fields, many have been PIs on research), and these organizations have financial backing of their members.

        • Scott, thanks for your comments —
          1) I believe NCCAOM is just passing along a survey prepared by IHPC, the Integrative Healthcare Policy Consortium. The wording of the request for patient contact made it sound like they want you to get permission from the patient before sharing the info. If you do that, there is no HIPPA violation, at least that is my understanding. And it is the IHPC that is doing the soliciting.
          2) As to the greater point, it’s becoming increasingly clear to me that we have only the shortest of time to save the profession. There will be no need for a formal dismantling. Our numbers are not enough to sustain us (12 new LAcs in Virginia in 2013.) While we could be marketing and building demand we instead fight battles we have no hope of winning, burning bridges and increasing our isolation on a daily basis. Word is getting out to potential students that the education they receive will not be worth the 70K+ it will cost (unless they go to POCA Tech). And those who pay any attention to the politics would still rather support those who talk about unifying to fight rather than listen to those who understand the politics. We don’t have long to turn it around.

  4. This conversation is going on in a few places, so let me review a few things that have come up elsewhere —

    Here is the California Sunset Review for those who are interested —

    Also, I am not great fan of the NCCAOM. However, I am a fan of making it easier for LAcs to move from state to state. I know there have been problems with the California exam. For those who are unwilling to further strengthen the hold of the NCCAOM on the profession perhaps requesting that California allow either exam for licensure would be a good compromise.

  5. I saw similar things with the NJ Exam prior to them accepting the NCCAOM Board. Board members can be corrupted. At minimum, appearances of protectionism and outright obstructionism should be closely monitored. Sent the emails and as always hope critical mass can be achieved! 😉

  6. Elaine, I definitely will make the calls. I experienced something similar 10 years ago while trying to get a license in Nevada…one of the board members there told me he’d spoken to the man who had written the NV exam. He said the man had bragged that no one could pass the test because there were two correct answers to each question…if an applicant chose one of the correct answers it would be marked wrong and said that the other correct answer was “more correct.”

    I’m not a huge fan of the NCCAOM but I do think their exam is the best we have for the moment…..

    • It was definitely a change for me to be writing something praising the NCCAOM, but I still think it is preferable to CALE.

      I have heard the situation in Nevada is pretty awful. It certainly is expensive to try and get a license there — combine a $1000 application fee with the stories about the exam and it explains the small number of practitioners there. How can anyone think that is good for the people of Nevada?

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