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




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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.

11 thoughts on “It’s Like Herding Cats

  1. Hi Observed,

    Are you also referring to organizations like ABORM? In that case I see the point of over regulation. We all studied those subjects in school and it is over-kill in my opinion or for some individuals to make money off of us. There are a few more I can think of off the top of my head. Instead of focusing on restrictions for acupuncturist shouldn’t they focus on the schools? I think they need more regulatory function than we do? I do agree on those issues. You are right about our regulatory boards firing at acupuncturist rather than advocating for us. I have never seen such a thing? It is truly amazing to watch. I would never believe it if I did not see it with my own eyes.

    • Well, as far as I know ABORM is completely voluntary, so I don’t see it as the same thing. No one is forcing practitioners to hand over their money. A practitioner is certainly welcome to go get whatever additional training they want, and if someone decides that training enables them to say they are certified by the Association of Truly Spectacular Oriental Medical Practitioners, or whatever, that’s fine with me. It becomes a problem if a regulatory board, or a credentialing agency, or an insurance company, or a malpractice provider says I must be part of ATSOMP in order to get a license.

      My issue is the boards of states like FL, NM, DE, CA have decided that I can’t get an acupuncture license if I don’t get an NCCAOM herb credential even if I don’t want to actually use herbs in my practice and when anyone who isn’t an LAc in a state can use, sell, suggest herbs. Or when a state decides that ACAOM accreditation isn’t enough, the school needs to be specifically approved by the state. (I think this is the case in Nevada, NM, CA, TX.)

      Voluntary additional training is fine. But requiring extra-special things for basic licensure — not fine.

      • In the cases you describe I agree with you. Thank you for the clarification. I don’t know about the other states but CA has a lot of regulations aimed at acupuncturists rather than protecting them. About 15 years ago they did have a big problem with many of the asian practitioners. Every month they would list all the practitioners that lost their license to practice in CA. Some of it might be due to those issues but some is completely unnecessary. CA has many problems these days. Out of the 9,000 licensed less than half are actually practicing these days according to my friends that still live there.

  2. Hi All,

    I have a question on your stance of less restriction of acupuncture by states regulatory boards. I think if we don’t have access to insurance benefits then we see less of the population at large. The economy is not getting better. There is more poverty today than 20 years ago. I just think we limit our ability to treat more people when we don’t have access to insurance.

    On the other hand, I do believe insurance is garbage personally. In certain states where people educate themselves on health care options acupuncturists seem to do Ok but in rural places acupuncture is not embraced. By cutting ourselves off from insurance will effect our ability to become accepted by the general population. It is a true concern.

    I believe as heroic the efforts are of some of those state associations I think they are too late to incorporate significant change. Change should have occurred 12 years ago.

    • I’m not sure if you are referring to my stance or Ryan’s. I do believe licensure of acupuncturists is appropriate, and where you have licensure you have regulations. As long as there is licensure there should be no impact on insurance reimbursement.

      So far, in the states with acupuncture as an Essential Health Benefit we are seeing limitations on treatment or reimbursement rates. I’m not convinced that insurance will be helpful in terms of people accessing acupuncture. Community clinics seem to be better able to reach people. Time will tell.

      It’s not too late for change. In fact, change continues to happen — it’s just that so far it is change to make things more restrictive. If the profession changed what it wanted, change could move in different directions.

  3. ” 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.”- Bingo. This is what I, and others, advocated for for years. We could have created profession modeled on the principals of the medicine. Instead, its development has slowly been constrained under the auspices of “raising standards!” All in the name of insurance reimbursement and professional titles. There is an homogenizing, least common denominator effect of materialism that is having the same effect in the profession as it has had in the arts and education. These forces have been too strong and many leaders have just simply lacked the creative vision to have constructed a profession inspired by principals of organization beyond the status quo. In short I agree with the sentiment of your piece.

  4. Very profound article. There needs to be a constant input from those who can contribute to the fractured reality that also divides us as practitioners. So many of us, especially in the state of Florida have isolated views of what our reality is. For example, the Florida State Board of Acupuncture is not in existence to regulate the profession on our behalf, but to protect the public from harm by only licensed acupuncturists. The actions of Chiros, PTs, MDs and other professions are regulated by their boards. Second, the Florida State Acupuncture Board will never increase it’s requirements because of two reasons. The first is that the board has not been able to bring legislation to the floor for 10 years because too many other unrelated items get attached to the legislation as it makes it to the floor so every year we were told there would be no opportunity for legislation. The second is more profound, every time we open our statutes of acupuncture to make changes the joint procedures committee that oversees all legislative changes will strike down existing rules about acupuncture as invalid even though they were voted in over 20 years ago. This committee is under the direct influence of the Florida State Medical association (FMA) which wants the clock turned back and all laws regarding acupuncture in the state repealed. Therefore to ensure continuation of the profession the rules and statutes must remained sealed as they are and there will not be any new changes to the profession in this state. To the FMA it’s just good business until the public finally starts caring enough to make them change their minds. They are getting picked on by hospital corporations so they have to have someone to pick on. My advice is for ll of us to stop wringing our hands and go out there and build solid businesses so some of us can eventually get elected to represent our state in the legislature. Then we will have clout.

    • Frank,

      But the Florida Acupuncture Board HAS increased its requirements! As of October, all LAcs will be required to have an NCCAOM credential for herbs — either the CH or OM, with no exceptions for anyone who is not already licensed in the state. I have asked FSOMA to advertise this change, to no avail. I have been unable to find anyone to tell me who was behind the change. Unless I begin the process of obtaining my FL license now, and maintaining it for the next however many years, I will be unable to practice there without returning to school. Even if I have no interest in using herbs as part of my practice. And even though non-LAcs can continue to use/sell/prescribe herbs. Truth is stranger than fiction.

      In general, regulatory boards seem to have lost touch with their mission of existing to protect the public. Or, I should say, have gotten wise that they need to spin any change as being in the public’s interest. It will be interesting to see how the Supreme Court rules regarding regulatory boards —

  5. Tuna should also be not just the least restrictive+safe avenue for LICENSEING requirements, this avenue is mostly for BA and CA practitioners in the US. Licensing for many other providers who seek to use acupuncture protocols and techniques to help people is inherently putting up a barrier for underserved groups to have access to them. Tuna should be some sort of regulatory environment that meets the requirements, period, even if it’s loosely organized, self-regulated (like within the military and VA or reservation where state licenses are less applicable). If there’s no license in the picture, one less thing posing a barrier.

    • Ryan,

      What you say might be reasonable in terms of getting more treatment to more people. However, the cats I am appealing to here are folks who spent loads of money obtaining an education and credentials to do what they/we see as a complex system of medicine. Also, many have spent years fighting to obtain insurance coverage for their services. That isn’t something that appeals to me, and isn’t something I see as a great development for the medicine, but for those who believe that is the way to go, licensure is a critical part of the process. An unlicensed world might be tuna for folks who aren’t licensed providers. For most of my readers your suggestion stinks, and not in a tuna sort of way. Sorry!

      • Not sure what you mean by “the medicine”. That sounds intimidating. Sorry to stink up the forum. Currently there are many examples in the US and Canada of non-licensed environments in which providers offer safe, effective and at times third-party reimbursable services. This should appeal to everyone who cares about acupuncture.

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