Category Archives: defintions

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

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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.

Lighthearted?

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Take a look at this fun video that pertains to a serious (and not fun) issue for the profession.  (The specific circumstance is in Great Britain.)

A House Built on Shifting Sand

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About eighteen years ago, as we were advocating for a practice act in Virginia, a big upset was that MD’s, DC’s, and DO’s (and podiatrists within their scope) could practice acupuncture with only 200 hours of training.  Time and again, acupuncturists complained (and continue to complain) about this — after all they say (and we said to the legislators and staff at the Department of Health Professions) acupuncture is far more than sticking a needle in the body.  Acupuncture is a complete system of healing, a theory, a philosophy, a paradigm, a system of diagnosis.  A doctor may be able to safely stick a needle in a point (though these are, after all, very special needles, nothing like a crude hypodermic), but they aren’t doing “acupuncture.”  Mention MD’s and DC’s “with limited training” doing acupuncture to most LAcs today and you’ll get anger and complaints.

What gets LAcs (or OMDs or CAcs) even more incensed today — Physical Therapists (or DC’s) sticking a needle in a point and saying it isn’t acupuncture.  After all, we say to the regulatory boards (and even more loudly to each other), they’re sticking an acupuncture needle in a point.  We don’t care whether the PT is thinking only that a trigger point causing pain could be released by this needle.  Or that they know nothing of the theory of Chinese medicine.  All we know is that if they are sticking a needle in a point they are doing acupuncture, they darn well better not call it anything else, and they ought not be allowed to do it.

I’ll save the in-depth conversations about TPDN, scope of practice (it doesn’t mean what you think it means), and coalition building for other days.  For today, I just want to ask that our profession show some consistency.  Consider the implications of insisting that acupuncture is defined as a needle in a point, or the implications of insisting it is far more than that, and especially consider the implications of changing the definition to suit a short term need.  Consider the implications on what you do in your treatment room, as well as the impact on our battles with other professions, our interactions with regulators, our involvement with third-party payer systems, and perhaps most importantly, on how we build our brand.  Above all, remember that like a house built on shifting sands, a profession built on shifting definitions is unlikely to stand the test of time.