It’s Not Fair!!!

A Virginia colleague asked – “How is it that Chiropractors can do acupuncture and LAcs cannot do manipulations?”

Exploring why things are the way they are (here in Virginia, anyway) might help us move beyond the usual “we’re getting the short end of the stick again” attitude and could teach useful lessons about how the system works.

1)     How is it that DC’s can do acupuncture?

DCs, MDs, and DOs were doing acupuncture in Virginia, without incident, prior to licensure for LAcs. You can imagine the strong opposition that would have arisen from that powerful lobby if, despite our position that acupuncture was safe and effective, we now attempted to pass legislation that would have removed this technique from their scope. The role of regulation is to protect the public from danger, not ensure that people are limited to the “best” care. When the Dieticians introduce licensure legislation in Virginia (not yet successfully) – the Advisory Board on Acupuncture indicates that support of the Acupuncture community depends upon the LAcs retaining the ability to make dietary recommendations. The Dieticians might think our training in this area is grossly insufficient, but we can show a history of safe practice, and the state has no compelling reason to choose a winner and loser among professions in this case.

2)     Why can’t LAcs do manipulations?

The Virginia legislation specifically rules out PT, Chiropractic, and Osteopathic manipulations.  Since acupuncture training does not typically include Osteopathic, Chiropractic or PT adjustments, and since our exams don’t test knowledge of these techniques, it would have been difficult to counter the arguments of the existing providers that this should be excluded from our scope.  When the ND’s introduce legislation for licensure (so far unsuccessfully and not fully supported even within the ND community) the Advisory Board on Acupuncture always reports that support is dependent on language that would specifically exclude acupuncture from the ND scope.

If a Licensed Acupuncturist could show evidence of education in Tui Na manipulation techniques, included the technique in their informed consent, and was careful with insurance coding it would probably be acceptable.  A few years ago I would have suggested that a formal request be made to the Advisory Board to explore whether Tui Na manipulations were within scope. The board could have explored the issue and developed recommendations regarding education and documentation that would have put practitioners on solid ground.  However, our profession’s recent behavior regarding the PT Board’s similar discussions on TPDN have given our fellow health care providers many arguments they might be itching to throw back in our direction. You might want to check out Scope and Dry Needling for more background. This is probably not the best timing for requesting a formal ruling.



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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.

4 thoughts on “It’s Not Fair!!!

  1. Thank you for your voice of reason on this issue. I know a lot of people in our profession don’t like this because they feel it threatens their livelihoods, and they are quite possibly right. History is tragic and no one is entitled to a job by virtue of their license. Going forward, people are going to have to realize that the acupuncture profession is not on a level playing field with the other healthcare professions and we just don’t have the weight to throw around to bend them to our will. Better to innovate and find a way to serve people’s needs within our current constraints rather than trying to constrain others.

    • Thanks for your thoughts, Frank. I agree with much of what you say, though I’m not sure how true it is that we aren’t on a level playing field. It’s true that we don’t have the numbers or the money as some other professions, but I think the much bigger problem is that we don’t really understand how the system works, and we spend the resources we do have on things that aren’t very helpful. I think our constraints are primarily, or at least significantly, self-imposed. I’ll be talking about some jaw-dropping examples of that soon.

      • Hi,
        Here is why I think we are not on a level playing field:
        Exogenous factors
        1) Licensing. Not every state even licenses acupuncture, and of those not all include the scope of practice (herbs,nutrition, tuina) that people are taught in school. As far as I know, every state licenses PT.
        2) Money. PT is a $30 billion industry. A lot of the big clinics are funded with private equity money. They use aggressive Starbucks style positioning and can run clinics at a loss in hopes of pushing other big clinics out of business. Plus, they can fund advertising campaigns that make PT seem like a normative activity, and of course they can generously donate to candidates.
        3) Access. It is now standard practice for patients to have MD referral and insurance paid course of treatment for every surgery, car accident, and work injury. In some cases, this treatment can go on for years at $250-300/visit. Acupuncture is occasionally referred to but is mostly discretionary and paid for with discretionary income.
        Endogenous factors
        4) The insistence of our profession on our right to maintain a system of diagnosis and treatment which is totally outside of contemporary biomedicine while insisting that they accept us on our own terms.
        5) Inability of our profession to recognize the concept of competitive advantage, that is the things we can do better or at a lower cost; finding what is valuable to patients and providing it rather than asserting that others accept what we find valuable.
        Well, anyway I could go on, but let me just add, what are the odds of a newly graduated PT getting a job for 100k vs a newly graduated acupuncturist? Not that I’m bitter!!!

        • You touch on many good topics here. I think the conversation is valuable enough that I am going to move it from the comments to a post of its own, so more soon!

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