Acupuncture Organizations 2015 – State of the Profession

The 40ish days between January 1st and the Lunar New Year are perfect for reviewing the past year and preparing for the next year. What worked, what didn’t? What direction will we go in when the days warm, the yang rises, and we spring forward?

There is much to consider when evaluating our practices and our profession. To understand how it all fits together we need to dive into the weeds. It’s going to take a few posts, but it will be shorter than the tax code!

Associations/Organizations/Guilds —

AAAOM (The American Association of Acupuncture and Oriental Medicine): Historically, our national professional association. And, historically may be all. The website shows no action items since 3/13/14, and no President’s blog post since 10/9/14. Is there anybody there? Is the AAAOM still alive?

ACAOM (The Accreditation Commission for Acupuncture and Oriental Medicine: Graduation from ACAOM-accredited schools is a requirement in many states. 2015 ended with an announcement of a Degree Titles and Designation Project. This should be interesting – there are already graduates of and students in the existing range of programs and there are widely varying state rules. Better late than never? (Wouldn’t it be easier for the public if we were all Acupuncturists?)

ANF(Acupuncture Now Foundation): Finally, there is an international charitable organization dedicated to educating the public, other health care providers, and those who work in health care policy. For too long we’ve relied on piecemeal efforts to educate others.The ANF is just getting started and needs our support to provide a visible, accessible and positive message about who we are and what we do.

ASA(American Society of Acupuncturists): This non-profit collaboration of state associations launched in 2015. The ASA has potential, and challenges. One challenge – “six degrees of separation” between individual practitioners and the group. A planned website should help bridge the gap. Of greater concern – at the state level, the ASA defers to the preferences of the state association. If an ASA-member state association supports a law or regulation that serves its current members to the detriment of all other LAcs, too bad, so sad for the profession as a whole. There are good people involved with this group so I remain cautiously optimistic. I hope that, before too long, the member groups will see that a victory that disadvantages other Acupuncturists isn’t a win.

CCAOM (Council of College of Acupuncture and Oriental Medicine): The membership association for schools and colleges of AOM with ACAOM accredition or candidate status. They administer the NCCAOM required CNT course, and released an updated (available free!) CNT manual this month.

IHPC (Integrative Health Policy Consortium): The IHPC “advocates for an integrative healthcare system with equal access to the full range of health-oriented, person-centered, regulated healthcare professionals” and has been working to build enforcement of Section 2706 of the ACA to end insurer discrimination against classes of licensed health professionals working within their scope. I don’t know of any LAc that doesn’t support this group’s mission, so it is odd that many LAcs support legislation that would create this sort of discrimination.

NCASI (National Center for Acupuncture Safety and Integrity): One individual? Silent for many months now.

NCCAOM (National Commission for the Certification of Acupuncture and Oriental Medicine): The NCCAOM “validates entry-level competency in the practice of AOM through professional certification.” Their vision is that AOM “provided by NCCAOM credentialed practitioners will be integral to healthcare and accessible to all members of the public.” They are powerful, organized, effective, and better funded than any other acupuncture group. They have had a major role in the path to licensure in many states. However, if you are not an NCCAOM diplomate, feel that the credentialing process is out of hand, and/or if you value traditions other than TCM, the NCCAOM is probably working against your interests.

NGAOM (The National Guild of Acupuncture and Oriental Medicine): A professional medical society organized as a guild under the OPEIU, affiliated with the AFL-CIO. The NGAOM list of 13 VP’s includes the VP, Immediate Past President,Treasurer and one additional board member of the AAAOM and following in that tradition there is significant mystery around their membership and their decision-making process. They want the profession of acupuncture to be more like other health professions. Many LAcs affected by their work aren’t pleased with the consequences. You’ll learn more in upcoming posts.

POCA (The People’s Organization of Community Acupuncture): Mission — “to work cooperatively to increase accessibility to and availability of affordable group acupuncture treatments.” 708 Punk (Acupuncturist) members, 138 clinic memberships, and 1348 patient members. Minutes of meetings posted in their forums, 8 free CEU’s for practitioner members, loads of member support, and a school (POCA Tech) working towards ACAOM accreditation and currently accepting applications for the third cohort of students. This is a successful acupuncture organization.

State regulatory boards are not professional organizations or associations. Their mission is to protect the public, not promote licensees.

An exploration of acupuncture education, events in the states, legislation and regulation, and other items of interest, including more about these organizations, will be coming soon.

 

AOM Leaders?

Who decides the future of the profession?

Did you know about the meeting of the Acupuncture and Oriental Medicine “leaders” last weekend?

Who represents working acupuncturists at these meetings?

These meetings started in 2005. You can read about previous meetings herehere, and in CCAOM newsletters. Attendees typically include reps from ACAOM, CCAOM , NCCAOM, SAR, NFCTCMO, CSA, AAAOM, AOBTA, and sometimes COMRE. It’s good (I think) that these groups are communicating. It’s not good that most acupuncturists in the US are several degrees of separation away from representation there.

There’s not yet a publicly available report of the 2015 meeting. I do know —

The AAAOM continues to be invited and to attend, despite being out of compliance with their bylaws for years. The AAAOM website currently has no news of the recent elections, the board information is outdated, and there is still no whistleblower protection policy. Word is that the current board overlaps significantly with the board of the NGAOM. Michael Jabbour continues to fill the board position of Immediate Past President (what happened to the real immediate past President Don Lee?) and was present at the AOM Leaders meeting. Membership numbers of the organization are a mystery and I hear the AAC continues to provide much of their funding.

The others present at these meetings know that the AAAOM is a deeply troubled organization that represents only the smallest handful of practitioners. Why, oh why, does the AAAOM rate a seat at the table?

Representatives of the Council of State Associations are also in attendance at these meetings. I am glad that the CSA exists, working to mitigate the damage done by the lack of a functional national organization. I’m concerned, though, that few practitioners have any direct knowledge of this group and what they have to say at the AOML meetings. If you are involved with a state organization, and if the state organization participates in the CSA and communicates back to the membership, then you’ll find out about the CSA. Otherwise, you’re in the dark.

Why isn’t POCA invited? I don’t suppose they’d enjoy being there, but if the AAAOM with their mystery membership is invited, and the NFTCTCMO is invited, why isn’t POCA?

It’s difficult to find the right tone for this post.  I know the groups representing acupuncturists depend on volunteers who are doing their best. I also know that working practitioners too often find themselves at the mercy of the “good ideas” of credentialing agencies, accreditors, schools, and a few powerful colleagues. To make it worse, most practitioners have been misled about what actions are likely to be effective and create positive change.

When I look at who is invited to the AOM Leaders meetings, and how far most of us are from what happens there, it’s no surprise that so many of the developments within the profession seem to work against the best interests of acupuncturists. It reminds me of Congress, and that’s not a good thing.

 

 

Who Speaks for You?

ACAOM’s letter to the Department of Education regarding the proposed gainful employment rules begins —

On behalf of the Commissioners of the Accreditation Commission for Acupuncture & Oriental Medicine (ACAOM), and in partnership with the Council of Colleges of Acupuncture & Oriental Medicine (CCAOM), the National Certification Commission for Acupuncture & Oriental Medicine (NCCAOM) and the American Association of Acupuncture & Oriental Medicine (AAAOM), we write to offer comments…. Collectively, we represent over 33,000 students and graduate acupuncturists in the United States, and 56 colleges of Acupuncture & Oriental Medicine.

Are there 33,000 students and graduate acupuncturists? Where did they get that number? Do they represent me? Reading the rest of the ACAOM gainful employment letter confirmed it – their letter doesn’t reflect my position on the proposed rules, or on the state of the profession.

ACAOM‘s existence depends on the schools and a steady flow of students, CCAOM represents the schools, and the NCCAOM‘s income depends primarily upon new graduates taking credentialing exams.  Once these groups get their money the future of acupuncture school grads is of little consequence to them.

Of course they would make the case for maintaining the status quo, but they should not be telling the DOE that they represent me.

I’ve just sent this email to the ED of ACAOM (mark.mckenzie@acaom.org) with CC’s to the leaders of NCCAOM, CCAOM, and AAAOM (kwardcook@thenccaom.org; executivedirector@ccaom.comcastbiz.net; DonLeelac@gmail.com), and to ashley.higgins@ed.gov (of the DOE) and bduran@mpamedia.com (of Acupuncture Today) —

 

ACAOM’s May 23rd letter to the DOE regarding the proposed gainful employment rules includes this phrase —

“Collectively, we represent over 33,000 students and graduate acupuncturists in the United States.”

Neither ACAOM nor any of the other organizations mentioned represents me.

The only organization listed that even pretends to serve graduate acupuncturists is the AAAOM. Their professional and student membership is a thousand or so, optimistically, and they were not in partnership with you for this letter.

I am not surprised that organizations that profit off students and new graduates would write a self-serving letter avoiding responsibility for the number of acupuncturists struggling to pay off huge educational debt.

I am not even surprised that you would claim to represent me. But I am angry that you did so.

Unless you can provide documentation that you do represent 33,000 students and graduate acupuncturists please retract your statement to the Department of Education and make clear that you are speaking on behalf of your organization, which depends on schools and a steady flow of students to survive.

Speaking for myself,

Elaine Wolf Komarow, LAc

In coming weeks I’ll explore more of the distortions and spin in the ACAOM letter. But for now I hope you agree that standing by while these organizations claim to speak for us is a mistake.

Borrow my text or use your own, but, let ACAOM and the other alphabets know they don’t represent you — and make sure the Department of Education knows that too.

Acupuncture in Louisiana

If a resolution is passed and no one is listening, does it still impact the profession?  Sadly, in this case, yes.

I wasn’t planning to write today, but then I came across Louisiana SCR 22 which has been moving through the legislature. It may have passed already (I’m trying to find out), though according to the information here it is still in a House Committee. (5/21, verified, this is not YET a done deal, there are still two opportunities for the resolution to be amended!) You may know that in Louisiana only MDs and DOs can be Acupuncturists.  An individual who has gone to acupuncture school or passed the NCCAOM exam can apply to be an “Acupuncture Assistant” and work under the supervision of an MD. This resolution would establish The Practice and Regulation of Acupuncture and Oriental Medicine Review Committee, and could have been a terrific opportunity to make the practice environment in LA more amenable to LAcs.  It gets off to a great start –.

WHEREAS, the practice of acupuncture and oriental medicine provides important health benefits to the residents of this state; and

WHEREAS, the practice of acupuncture and oriental medicine has become a well established, widely-used, viable modality across the United States; and

WHEREAS, when practiced as a whole medicine, by a fully trained practitioner, the practice of acupuncture and oriental medicine satisfies a missing niche that includes a prophylactic approach that allows the patient or a referring medical director a proactive avenue towards health when neither symptoms nor severity of disease warrants other forms of treatment; and

WHEREAS, oriental medicine often becomes a valuable way to identify those in need of a referral to a western medical provider.

THEREFORE, BE IT RESOLVED that the Legislature of Louisiana does hereby direct the Department of Health and Hospitals to create the Practice and Regulation of Acupuncture and Oriental Medicine Review Committee

But, look at the language for the committee membership  —

(1) The secretary of the Department of Health and Hospitals or his designee.
(2) The Senate president or his designee.
(3) The speaker of the House of Representatives or his designee.
(4) The executive director of the National Certification Commission for
Acupuncture and Oriental Medicine or his designee.
(5) The executive director of the American Association of Acupuncture and Oriental Medicine or his designee.
(6) The executive director of the Louisiana State Board of Medical Examiners or his designee.
(7) The executive director of the Louisiana State Medical Society or his designee.
(8)A chiropractor designated by the Chiropractic Association of Louisiana who is certified as a diplomat of the American Board of Chiropractic Acupuncturists or has completed equivalent training in acupuncture.
(9) A physical therapist designated by the Louisiana Physical Therapy Association.

 

So, eight members, including a DC and a PT, but no fully-trained acupuncturist. The AAAOM doesn’t even have an Executive Director at this point, and probably doesn’t have the funds to hire one, and in any case represents only a tiny portion of the profession.  The NCCAOM should be on our side, but their input in Delaware, for example, wasn’t positive for the majority of LAcs.  Once upon a time we might have looked to the PTs as allies, but our speech and actions regarding dry needling destroyed that.

I did send this Letter to Senator Mills today (which you can borrow from), but if the resolution is engrossed it is too late. The best we can do then is advocate for acupuncture friendly designees, make sure to stay in touch with the eventual appointees, and hope we can show them that the public would be served by allowing those trained as acupuncturists to be acupuncturists.  I’m sorry that this one got by me (I’ve got a practice to maintain), and sad that we don’t have a national organization to track and act on such things. AAAOM, where were you? I have high hopes for the CSA, but, without a state organization, Louisiana probably wasn’t on their radar. This was a missed opportunity.

It’s Like Herding Cats

It’s a common refrain about reaching consensus in the acupuncture profession. But why try to herd cats? I learned a long time ago that opening a can of tuna would bring kitty running.

If there were an attainable action that would:

  • Increase patient access to Licensed Acupuncturists,
  • Assist in national marketing for the profession,
  • Decrease educational costs and student debt,
  • Decrease licensing expenses,
  • Increase political power,
  • Expand professional opportunities, flexibility, and mobility, and,
  • Increase the value of your practice,

Would that be like tuna to a kitty?

(Whirrr of can opener)

Tuna for me = Identifying the least restrictive licensure requirements necessary to protect the public and create successful practitioners and working to establish that as a standard in all states.

Before panic ensues, consider some of the situations I’ve heard about in the past few years:

  • Highly experienced and qualified LAcs unable to obtain licensure, even in states where there are so few LAcs that the public has little choice but to get their acupuncture treatment from Chiropractors.
  • Practitioners who want to sell their practices but have a limited pool of buyers because of the unique licensure requirements in their state.
  • Practitioners travelling many, many hours in order to practice, or leaving the profession, because life has taken them to a state in which they can’t obtain a license.
  • Practitioners and students who have no interest in using herbs being required to spend tens of thousands of dollars and thousands of hours learning herbal medicine in order to obtain an acupuncture license.
  • Acupuncturists supporting discriminatory laws or regulations such that the only group of people in a state who can not practice herbal medicine are other Acupuncturists.
  • Practitioners having to maintain licenses in multiple states because changing regulations mean that if they give up a license they will be unable to obtain it in that state again.
  • Acupuncturists being unable to advance reasonable state or national legislation because restrictive practices keep practitioner numbers so low that political support is unavailable.
  • The profession being unable to effectively educate the public about their excellent education and credentials because those credentials vary so much from state to state.
  • Acupuncturists struggling to build a practice in overserved areas, but unable to obtain licensure in nearby underserved areas.
  • Acupuncture organizations fighting for inclusion in managed care and federal health programs, even though many states have too few LAcs to serve the population. (Demographic data can be found at these links: Acupuncture Today LAc Map, US Population, Physicians per State.)

The current system in which some states require graduation from particular schools, others have their own exams, and others have their own educational requirements does not serve us as a profession. The situation is getting worse, not better, as states like Florida increase their requirements. Yes, states have differing scopes. (Those who advocate for scope changes should be required to consider and advertise the impact the changes will have on licensure requirements.) Yes, it is in the interest of the public and the profession to insist that practitioners limit their practice to the tools and skills in which they have been trained. Additional, optional, training can always be required for those who wish to practice more advanced techniques or modalities. The least restrictive licensure requirements have shown themselves to be sufficient for safe practice.

Limited, standardized, licensure requirements would lower practitioner expenses, promote mobility, ease national marketing, and help the profession grow. It sounds great — as good as tuna smells to a cat. Does it make you make you want to come running? Many changes in licensure requirements could be made at the regulatory level and are within our reach. It does not depend on establishing reciprocity. One problem — the LAcs within a state have the power to make or block change, and, especially in restrictive states, the small group that set up the rules is often in power. Another problem — many LAcs don’t care about this until they are directly impacted.

This is a place where national coordination is needed. I hope the CSA sees that this is a place where they could make a positive difference. Let your state association know if you support a more standardized and simpler licensure environment. It should not require any herding.

Cat Food

Cat Food

 

 

A Very Important Question

Dear NCCAOM,

Will feedback received influence your proposed(?) policy changes?  Ms. Basore’s comments to my previous post indicate the changes are a done deal. Please let the readers of The Acupuncture Observer know so that we can effectively use our qi.

Thank You.

Dear Readers,

I’ll send my many questions and comments about the policy changes to the NCCAOM (and post them here) if our input matters.  In the meantime, please  —

  • Contact NCCAOM via Facebook to weigh in on the proposed(?) changes. (Are they listening?)
  • Contact AAAOM via Facebook to share your thoughts on the NCCAOM’s proposed(?) changes.
  • Respond to the AAAOM’s latest Call for Comments (deadline September 19th), and let them know if you think they should be focusing on the proposed(?) changes.
  • Contact your state professional association to point out that the proposed(?) changes interfere with the state regulation of acupuncture and ask them to get involved.
  • Ask your state association to raise this topic with the Council of State Associations. (There doesn’t seem to be any way for the average professional to contact that group directly.)

That’s a good start while we wait to hear back from the NCCAOM. Oh, and spread the word!

P.S.:  Here’s a story about background checks.  Keep in mind, in the NCCAOM’s proposal, the poor applicant wouldn’t even be allowed to sit the exams.