It was Twenty Years Ago Today

….. that I was granted my Virginia Acupuncture License (#4). I’d been licensed in Maryland for a few months, but the Virginia License was special. Throughout my years of acupuncture school I’d been involved with the Acupuncture Society of Virginia, working to establish a practice act. We were finally successful in 1994, and my documents were ready and waiting when the regulations were promulgated.

I’m happy I found this wonderful medicine when I did. I feel lucky to be doing this work, and look forward to continuing to practice for decades to come. And yet, these days, I’m mostly sad about the acupuncture profession.

Back in the day, when only MD’s could do acupuncture in Virginia, we argued that the public should have the right and the ability to choose their provider.

We discussed how our medicine could treat the whole person, and that treatments were uniquely tailored to the individual.  We didn’t see patients as a collection of ailments, to be sent from one specialist to the next.

We talked about the good value of our medicine and our belief that it could reduce health care spending.

We got used to the medicine being dismissed by the medical establishment, but held out hope that, some day, they would see the value of what we did.

We knew that this medicine would require lifelong study and learning, but experience told us that about 1500 hours of training was sufficient to produce competent practitioners.

We were happy when we were finally able to receive student loans to attend acupuncture school.

We had concerns about relying on one standardized exam as a precursor to licensure, especially one that was based primarily on one tradition. But we knew that it would relieve some of the burden on the states, and so might help with national acceptance.

It was a time of promise.

Now, my Facebook feed is full of rants — we’ve now decided that, just as the MD’s wanted to protect the public from us, we now must protect the public from the PT’s.

Rather than celebrating the professionals who see the value in this medicine and want to offer it to their clients, we scream that they are stealing our medicine and must be stopped.

We’ve justified our increasing fees (after all, if the MD’s deserve it, we deserve it), and, then chased the insurance dollar so that our patients can afford our services. We’ve adopted the billing games that come along with that, fudging fees, adding services, figuring out what diagnoses to use to get reimbursement, and expressing outrage when we’re called on our behavior. Some of us have gone so far as to attack those who have designed a system to make acupuncture truly affordable to the majority of the population.

We decided that more education would get us more respect, and so increased and increased, and increased again the hours required for entering the profession.  The number and complexity and cost of the exams increased. In a solution to a problem that didn’t exist, practitioners in some states decided an acupuncture education was not enough.  Acupuncturists now must also learn and be tested on herbal medicine, whether they want to use it or not. Various states added additional requirements, so any relocation runs the risk of shutting a practitioner out of the profession. The student loans we celebrated enabled schools to ignore the disconnect between the cost of the education and the likely income of graduates.

I could go on. I won’t.

Shaking my head at the missteps we’ve made, I comfort myself with the confidence that the medicine will survive, even if the profession won’t. Happy Anniversary.





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© 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.

20 thoughts on “It was Twenty Years Ago Today

    • Thanks, Pete. I haven’t read it yet, but when I heard about it I was fairly certain I was going to be linking to it.

  1. You are right. Individuals who are only acupuncturists are unaware of that concept. OT’s and PT’s are consistent into each other’s scope and most of the time are OK with it.

    • Massage as an example of scope of practice overlap. Massage therapists, PTs, OTs, nurses and acupuncturists all use massage techniques in their practice. No one profession “owns” it nor can they prevent another profession from using it.

  2. Happy anniversary! Another great post, Elaine. As someone who is both a licensed acupuncturist and licensed physical therapist, I do appreciate your thoughts on the dry needling issue and the “turf wars” that are waging. It is rare to read rational discussions on these issues of “scope of practice.”

    • Thanks so much for joining the conversation. I shudder to think of how PT’s are viewing LAcs these days. Such a shame when a relationship that could be mutually beneficial becomes, instead, a series of battles in which no one emerges the winner. I keep waiting for LAcs to approach PT’s to let them know, not only could we do the deep needling technique you call dry needling, we also have a lot of other skills that could benefit your patients — let’s work together.

      • As the research into the effectiveness of dry needling for myofascial trigger points continues I feel that both professions can benefit. It must be remembered that American physical therapists are far behind their international counterparts in the use of dry needling. Dry needling has been used safely for decades by physiotherapists in the UK, Canada, Australia, Ireland, New Zealand and South Africa. As someone with intimate knowledge of the education background of both professions , I find the current demonization of the physical therapy profession by some acupuncturists to be unsettling. There will always be overlap in the scope of practices between professions.

  3. So, amid much weeping and gnashing of teeth by both the acupuncturists and chiropractors, the PT profession marches on undeterred:

    It looks like the comments have been deleted, but there were many familiar complaints from chiropractors: not in your scope, unsafe, untrained, stealing our medicine, etc. Just substitute “spinal manipulation” for “dry needling” and you get the idea.
    Sure, it’s galling to devote decades to something, barely eking out a living, and then the very people that denounced you suddenly co-opt your technique, rebrand it, and start making the big bucks. That’s life in the big neoliberal economy. Acupuncturists are hardly the first group that this has ever happened to, and we won’t be the last. Nor will the story end any differently for us than it ever did for anyone else in history. In the end, this rag-tag band of dry-needling opposition will succeed in generating a lot of ill will, but that’s about it. Some will adapt and improvise and continue to survive.
    Regarding Steven’s premise, re: going into functional medicine, it’s interesting but the challenge is I don’t see any advantage as using an acupuncture degree as an entry into that field. For someone interested in functional medicine, it seems like naturopathic or chiropractic gives you a much larger suite of tools to work with. For someone interested in physical medicine, physical therapy now gives you full access to all the tools in the acupuncture and chiropractic toolbox, (with the exception of herbal medicine, although I’m sure the day will come when weekend seminars in herbal “supplements” for PT’s are offered). So, for someone making a decision today about what field to pursue, what is the advantage of choosing acupuncture? You can choose a profession where you get saddled with a huge debt for a field that offers few jobs, most low paying; is disorganized and full of antagonism, isn’t fully accepted and still seems “strange” to a lot of people. Or you could get into a profession where you can practice acupuncture (let’s be honest), spinal manipulation, bodywork, exercise therapy (tai chi and yoga included), mind-body techniques (note to acupuncturists, we do not hold a monopoly on all things “holistic”), find a job anywhere, and be paid handsomely. Even if you are a true TCM enthusiast, there are still avenues to learn that outside of acupuncture school. I guess if you don’t have the academic chops to go to PT school, it makes sense, but that kind of speaks for itself. I could see “needle technician” as a viable option, if not too costly for the education. I’m just saying, if you want to work in the mainstream, better to get into a mainstream healthcare profession than one that is still on the outside and hoping to get in.

    • I’d love it if I could get more of my colleagues to focus on the harm done by state licensure changes, or to see the damage their doing with the way they are addressing the dry needling issue. But if I was able to make that happen I would have done it already. The only thing I know how to do at this point is to continue to address the issues, and hope that, as more of us are willing to speak up we can change the conversation. I did my time in the system, doing what I could. Do you have any ideas about what next?

  4. Happy Anniversary!!! One thing I have recently learned. Be the professional you are and try not to worry about the rest. Enjoy what you do everyday and show people who we are and what we can do. The only control we have is over ourselves and no one or nothing else. That must be our focus. It has been a hard lesson for me.

    • Susan, I do that as best I can. But do I sit back and do nothing when I learn that, soon, I may lose my chance to be licensed in DC because of upcoming changes. Do I keep sending money to groups who say and do things that reflect poorly on all of us? Part of why we’ve gotten to this place is because the people who know better know enough to keep the focus on themselves, which puts the power in the hands of those who can’t leave well enough alone.

  5. Elaine – Nice post. You hit many hot buttons. Congrats on your anniversary. The business of acupuncture faces the same hurdles overcome by other health professions. Recent research I have been conducting shows the USDE attack on for-profit, student loan gouging schools has been going on for a decade. The real USDE target is the private super accreditation bodies (CHEA, CAAHEP) that punch the tickets of “local” accred bodies (e.g., ACAOM) who in turn give passes to schools whose income is 90% plus student loans. The targets, I have learned, are much bigger than ACAOM and acupuncture. Acupuncture is too small to attract attention outside the profession. ACAOM and NCCAOM and the schools they serve simply get swept up in stronger tides. I feel confident the profession will survive and that the “medicine” will change. Acu will become a part of the mainstream and treatment will fall within medical guidelines. The survivors will be those working in the mainstream as certified needling therapists – and licensed acupuncturists – treating functional illness (not primary care). I met someone recently who works in health finance. He told me he gets acupuncture from an LAc who only accepts cash. He gives her $135 for massage and needling. She does not believe in insurance or mainstream medicine. How did he get the referral I asked? From other members at his golf club who she has helped. Finding a honey pot like that is great for her! It is much simpler to learn how to work in the mainstream. I keep running into more and more LAcs who figured it out.

    • Well, Steve, I’m pretty sure that your vision saves the profession, but loses the medicine. And, the reports from my colleagues in those places where they were “successful” in getting mandated acupuncture coverage is that, surprise, the number of clients willing to pay out of pocket plummets. Of course, some of us will make it. But why, oh why, couldn’t we learn from the experience of the other professions.

  6. So we’ll put, Elaine. I wish I’d used my anniversary to write something as elegant. Thank you for your service to your patients and our profession.

    • You are welcome, Kate. I wish I could do more. The state of the profession and so much of what our colleagues say and do has become a heartbreak to me.

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