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.
© 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.
Great article! I attended the workshop where these changes to the regulations were discussed and on at least two occasions, individual Board members let slip that their practices could be busier in response to the opinion that NV needs more, not fewer OMDs, and they responded with confusion that those of us who were already licensed did not agree with the restrictions. Clearly they’re failing at their misguided attempt at a monopoly on acupuncture.
Glad you approve! I think they are going to have a real problem getting the LCB to move forward with regs — especially since the LCB already wrote up regs for the last set of proposed revisions. This move is not reflecting well on the board members.
This is what I love about this trade. The state boards decide who gets to practice what and where all done to “protect” the providers and the public in the respective states. Elaine, you bring up the notion of the public being “underserved” I disagree. What the various practice acts mean (eg, Nevada, CA) is that the providers have to protect their business interests by restricting practice–in other words, there has to be a definite need for services. If there is little need, those in power must protect their own interests to maintain what they have. AOM licensure is expensive and not portable. Sure one can pack up and move to a state that accepts the NCCAOM Dipl. Ac board, but how long would it take to establish a practice to even generate the national median income?
It’s really quite entertaining: AOM cannot even agree among themselves who gets to practice what and where, yet are so staunchly opposed to anyone else (eg. PTs, DCs, MDs) practicing dry needling or medical acupuncture. There is zero confidence in the national organization that has very low membership–perhaps 1/3 of the practitioners in the U.S. are members? (I stopped following this years ago) Do the state associations fare better than AAAOM in terms of membership? (does anyone really care–or are practitioners so invested in just trying to maintain their practices because they have an acu mortgage that they just can’t get caught up in this silliness?)
The infighting within the very tiny AOM community will bring about its downfall. Perhaps it is already occurring. Unfortunately, the AOM community brought this upon themselves.
I’m not sure what you mean about the practice acts being there to protect practices. A practice act is there to define what is needed for a profession to be licensed to serve the public safely. A regulatory board exists to get into the specific details of regulation with the mission being to protect the public. There is no notion of any regulatory board or practice act to be there to protect an individual’s business interests. The need for services does not figure into it.
the very reason why such regulations exist in nevada is to protect the business interests of the the practitioners on the board and in the state. in this cases where portability is concerned, it is purely self-interest. If one is licensed in say, Wisconsin, or Michigan, or Va, licensure in CA is not possible without having to return for remediation and examination. why? to protects the interests of the providers in CA. There is just not enough need for AOM services.
The reason why regulations exist in Nevada is SUPPOSED to be — “we’ve got people in this state who want to provide this service, and we need to figure out what training is needed so that the service can be provided safely.” Some states, as part of their process, determine that X amount of education is needed, or a, b, and c exams need to be passed. The justification is always intended to be for the public safety. Yes, some professions manipulate the process to serve their own interests or visions of what the medicine should be, but that is no the intent of practice acts.
For example, many states are now saying that abortion clinics should meet certain stringent requirements that they have not met before. Those advocating for the changes always say that is to protect the health of women, but it is widely known that this is not the case. The new stringent requirements are passed to close clinics and limit the availability of the service to meet the wishes of a certain group.
Yes, groups are manipulating the regulatory process to serve their own needs. It is not how the process was intended to work, and it is not how it should work. That’s my point.
I understand your point. however, that is not how it always works. Look at the various restrictions in the acupuncture trade imposed by various state boards–that you’ve reported on. It is not a huge leap to conclude that the restrictions are more about protecting the interests of the providers in the state and less so about protecting the public. Look at it this way, dry needling is approved in Nevada, but AOM practice is severely limited. The argument among AOM providers is that dry needling is “dangerous” and “puts the public at risk.” But the Nevada AOM board is restricting the practice of AOM. I do agree with vetting the education (because, let’s face entry into a free standing AOM school was predicated on being able to pay (or qualify for financial aid), in addition to breathing, graduating high school or having a GED, and having 60 hours of college credit.
Let’s face it, in Nevada (and perhaps CA), the restrictions of practice only benefit the existing providers in the state (and by benefiting them, it thereby protects their interests–NOT the interests of the AOM Trade). that is the reality. Again, the AOM community (if there really is one) is dysfunctional and undermines itself.
How is it that my RN license combined with my APN and Controlled Substances licenses all cost less than my acupuncture license? How is that I can take all 3 licenses to pretty much all 50 states with minimal restrictions? How is it that I can take my RN license to NZ, Australia, or Canada, obtain licensure in those 3 countries with education documentation, proof of licensure, and work history with minimal effort? (not to mention be able to obtain a work visa and potentially a path to citizenship if I choose to do so?). But yet the more expensive acupuncture license limits me to handful of states, little to no chance of obtaining a work visa in another country, let alone obtain licensure? As you’ve said before, acupuncturists are their own worst enemy.
Yes, we are in agreement. The AOM Boards, made up of AOM providers, are mis-using their position as regulators to advance what they believe are their own best interests. This is both improper, and dumb. As you point out, the many ways the Boards restrict licensing ends up working against the profession. That is exactly the problem.
The restrictions in Nevada don’t even benefit the existing providers — it means that most of the people using acupuncture needles in Nevada are not acupuncturists, they are MD’s and PT’s. As long as there are only a handful of practitioners they have no power. And they can’t even get the public on board since such a small number of people actually have access to their services.
That’s why I write the blog — to try to educate the profession, so they can understand that it is often ourselves and our colleagues that are working against our success.
its all about the old Korean acupuncturists there. they are destroying the state, they are rude, dysfunctional, and horrible people. they do everything in their power to stop, limit, expel, fire, kick out and stop anybody or anything from doing acupuncture in that state. I have set with them, I have heard them, I have heard their conversations and their phone calls.
they tool over the board and wont let anybody in…
its all because they don’t make any money and are scared more acupuncturists will already take away from their weak patient loads and little money them make.
Exactly right! This Board is a disgrace. and they are not new – they just rotate positions. They dishonor the profession and they abuse their position. They need to be fired and NV needs to go to a National Board that operates professionally.
Do you know whether other individuals submitted their names for consideration the last time there were openings? Have other DOM’s gotten to know their Legislators who may have some influence on the appointments process? Have the concerns about the board been shared with the Governor?
As for a National Board, there is no such thing as a national licensure board. From a regulatory perspective, eliminating the board might not be helpful in the long run for the people of Nevada. But it should be possible to impact who is on that board, though I fear the most recent opportunity may have been lost. Also, I understand the Board has a new Executive Director. That person works for the board, so the may not have much power. But if they have any experience as a regulatory board ED, there may be some chance they could be helpful.
I will write soon about some actions I can suggest. I think this has gone on so long because there has been so little awareness outside of Nevada, and perhaps because those who are aware haven’t figured out an effective way to address the problems. I will do my best to help with that. In the meantime, for anyone in Nevada, get to know your state legislators. That is always helpful. Show up to their town halls or meet and greets, let them know you are a constituent and a small business person in their district. No need to raise the board issue at your very first contact….
Thanks for posting this, Elaine. We acupuncturists focus on creating harmony, but we need to be aware of the entities who are attacking our profession today. It is difficult for the small populations of acupuncturists in states like Nevada to protect their profession. That is one reason I hope an effective national organization will be created that can provide assistance where needed.
Diane – in this case, the entities attacking the profession are acupuncturists. We have met the enemy and s/he is us! And it is the acupuncturists on the board who are responsible for the small number of practitioners in Nevada. No one is doing this to us, we are doing this to ourselves.
And, yes, it would be great if we had a national organization that could address this sort of thing.
Wow….modern day mafia. Gotta give them credit. Way let competition in when you can keep the market closed and have a packed practice? It’s the pinnacle of dysfunction.
It’s sad, that’s for sure.
There’s no accountability. Thats why they get away with it. Governor appoints them then washes his hands of it. Attorney general is stunned but does nothing about it. Pitiful…
No protection for the applicants that followed all the rules, jumped through all the hoops, met all the criteria and then were blocked for taking the boards for no legitimate reason. Sickening that no one has stepped in to end the problem – eliminate the NV Board.