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 The AAAOM website currently has no news of the recent elections, the board information is outdated, and there is still no whistleblower protection policy.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.

 

 

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.

 

 

 

What’s your Acupuncture Degree Worth?

Answer: Less than it used to be.

(Please, sign the petition.)

If you earned an MAc and Dipl. Ac (NCCAOM) twenty years ago, you thought you had it made. You could get a license in almost all states with licensure. The schools and the NCCAOM touted the caliber of the education and credentials. You knew you had plenty to learn about this medicine, but you could practice safely.

In the gainful employment letter ACAOM points to the (supposed) earnings of those long-ago grads to minimize the financial struggles of recent grads.

But in 1995 the NCCAOM added the Herbal exam, and later the OM. Some states now require those additional credentials of all practitioners. ACAOM has increased hourly requirements for school accreditation several times. And the NCCAOM has put additional limits on who can take their exams.

Some of our most esteemed teachers do not meet the current requirements for sitting the exams. Many practitioners are trapped, unable to relocate.

By increasing the range of degrees and credentials available before our “brand” was established and our profession was strong, the alphabets increased division and confusion. No wonder the public can’t figure out how an LAc’s education compares to that of other providers.

And here comes the First Professional Doctorate. With this new degree, my alma mater announces,

“[graduates] will be recognized as doctors, both professionally and publicly, and will have increased credibility and standing.”

If graduates with an FPD have increased credibility and standing, what has happened to the credibility and standing of graduates of Masters programs?

According to ACAOM’s gainful employment letter, licensure requirements just happen, and practice success is a simple matter of practitioner choice.

Really, though, the “alphabets” have played a significant role in the expansion of requirements and credential creep, and most of the schools do little to teach students how to make wise business choices.

If, as ACAOM wrote, the graduates of twenty years ago do so well, why have entry level requirements been increased so much? Why are grads struggling to pay off existing loans encouraged to return to school to maintain their credibility? Will the NCCAOM require an FPD to sit their exams? Will the alphabets encourage states to require it for licensure?

ACAOM/NCCAOM/CCAOM/AAAOM — if you represent us, defend the value of our degrees and credentials. Your “options” too often become a requirements.

Colleagues, did the gainful employment letter represent your views? If not, sign the petition. 129 people have, which means ACAOM etc. can still claim to represent 32,871 of us.

For additional information and analysis about educational costs and value, check out this from The New York Times and two posts from Dr. Phil Garrison

 

 

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 Careers

ACAOM gainful employment — This deserves its own post.  I don’t have the head-space to write such a post at the moment.  I don’t even have the time to fully read and digest this document.  The little bit I can digest is making me sick to my stomach. I’m betting some of my readers would like to dig into this. I’d love to hear what you think.

NCCAOM/Dry Needling/A Young Profession

A survey about the possibility of a new NCCAOM certificate in Facial Rejuvenation showed up a few days ago. The online conversations were a reminder that many of us are confused about the NCCAOM — what their role is, what we want their role to be , what their role “should” be.  The topic deserves its own post, but, in short, the NCCAOM is a credentialing agency. They design, administer, and maintain the process by which most of us are able to be licensed.  There are loads of consequences of their power within our profession, especially because we have not had, for some time, a truly effective or well-functioning national professional association.

There were many complaints that the NCCAOM hadn’t done more to “stop dry needling.” That, combined with yesterday’s urgent petition regarding legislation on the Governor’s desk in Delaware, made we think I’ve got to try, one more time, to explain where we are with the issue and why what we’ve been doing won’t work. My post to my alumni group is out of context, but I hope still worth sharing (somewhat edited for clarity) —

Since Dry Needling is the issue that keeps coming up as a major focus for the profession, I wanted to give a little more info about the “court rulings” in our favor.

The one that received the most notice and attention was the case in Oregon regarding Chiropractors and Dry Needling.  The outcome of the case was widely misrepresented within the acupuncture community. Various stories indicated that the courts said that dry needling was acupuncture or that it had been determined that the training programs were insufficient.  This was not the case.  You can read a fuller explanation of the outcome of the case here – https://theacupunctureobserver.com/a-practical-next-step/. The gist of the ruling is that dry needling does not meet the implied definition of physiotherapy within the Oregon code.

Other states have also had rulings (usually informal) from the Attorneys General stating that dry needling is not within PT scope.  These rulings have typically been much celebrated within the acupuncture community, but we haven’t been hearing what happens next.  For instance, some time ago Utah was celebrating such a ruling.  Since that time, legislation added dry needling to the scope of physical therapists.  Similar legislation passed in Arizona.  When the AG recently ruled that dry needling was not within PT scope in Tennessee, the ruling included phrasing that basically said, PT’s will need to address this legislatively, as was done in Utah.  (You can get the link to the ruling here — https://theacupunctureobserver.com/late-july-acupuncture-news/).  Illinois is another state where the AG’s latest opinion agreed with the argument that dry needling was not within PT scope, but where the PT groups are already preparing legislation for the next session.

There will probably be states where the acupuncture community is large enough and well-connected enough (and Maryland might well be one) where similar legislation would not be successful, but if you look at the numbers in most states, the PT’s (who also often have business connections with the medical establishment) are likely to prevail.

Today I received a notice of a petition regarding DE HB 359, adding dry needling to the scope of PT’s in Delaware.  HB 359 passed by overwhelming majorities in the House and Senate and needs only the Governor’s signature.  Among the “gems” in the petition – “Accordingly, HB 359 will potentially place the general public in significant danger of injury and harm due to unsafe and unqualified needle practices.”  There are about 800 PT’s in DE, and even more PT Assistants.  There are 45 LAcs.  The odds of the Governor exercising his veto are slim, the odds of pissing off 800 PT’s?  Pretty good, considering we’ve just stated they are putting the public in significant danger.  Interestingly, one of the authors of this petition is the same person who pushed for the requirement of the NCCAOM OM credential in DE, putting practice off limits to about 70% of US acupuncturists.  Isn’t it ironic that the profession’s self-imposed restrictions on licensure in Delaware have left the LAcs scrambling to block action by an overwhelmingly larger group?

Had LAcs been more willing to work with the PT’s from the start, I suspect that in many jurisdictions we’d have come out ahead.  We’d have built relationships and understanding and had some influence, perhaps, on how this modality is practiced.  By sending PT’s to the legislative fix (that’s what “we” said right from the beginning – if they want to do this they should do it legislatively) we’ve taken ourselves out of the process.  As they succeed with changing the law we’ve lost any influence on the procedure.

Of course, trying to work together might not have changed anything.  Professions (including our own) are universally unhappy about outsiders coming in to tell them what they should do and how they should do it.

I will add three things in response to the previous post.  1) While I appreciate the frustration felt by LAcs when dry needling and acupuncture are spoken about as being equivalent, hasn’t it been our insistence that dry needling IS acupuncture that led to this? Wouldn’t we be better served by clarifying the distinction between the two? (Of course, that would undermine our argument that we have a right to regulate the procedure.)  2) There are many cases of patients not wanting to report harm suffered at the hands of providers.  This happens among acupuncture patients too. Even LAcs can cause a pneumothorax.  3) The cease and desist orders can’t help but remind me of the stories from decades ago of acupuncturists being threatened with arrest for practicing medicine without a license.

It hasn’t taken long for us to go from being the scrappy upstarts just wanting to help people with a simple technique, and frustrated by the establishment that was trying to shut us down, to acting like the establishment.  We’ve got our ever-increasing credentials, and maybe specialties soon, and are increasingly able to participate in the bureaucratic system of figuring out which set of codes gets us a reimbursement we can live with. Now, in Maryland, LAcs can interfere with a citizen’s ability to choose what treatments they get from which providers, and can throw their weight around in the provider community.

PT’s will outnumber us for a long time to come.  It’s a shame we’ve pissed in that particular well.

 

Late July Acupuncture News

CCAOM has released two new position papers regarding Clean Needle Technique. (No mention on the AAAOM or CCAOM sites about this important news.)  We practitioners are responsible for knowing the latest standards for safe practice, so here are the new position papers on the use of gloves and skin preparation for your convenience.

 

NCCAOM has finally released the report on 2013 Demographics from the JTA survey. 52K as the median pre-tax income is not good news, especially since most of us get no benefits (no paid sick leave, no paid vacation, no disability or health insurance, no retirement savings plan). (Then again, many of us seem to be working part-time, often by choice. So maybe the figure isn’t so crazy?)  Math lovers among my readers — feel free to share what additional number-crunching reveals. I’m not a numbers person, but I’m pretty certain that the average income will be below the median income figure.

67% of respondents hold only the NCCAOM AC credential.  If this accurately reflects the overall credential distribution within the profession the states requiring the OM credentials are off-limits to 2/3 of practitioners. That can’t be a good thing. (I’m still waiting for someone to explain the public health issues that led to the upcoming change in FL. And I sure wish FSOMA and the Florida Board would do a better job of spreading word of that change.)  Do those with the OM credential have a higher median income to offset the additional education and credentialing costs? The NCCAOM should collect that data next time.

The NCCAOM survey is designed to gather information from acupuncture practitioners so there is no data on how many acupuncture school grads have left the profession. I hope the CCAOM will soon require schools to track those numbers.

 

The California Board came in for some media scrutiny recently.  If the extra attention helps eliminate some of the extra hoops (which equal extra costs) necessary to practice in California, it will be a silver lining. I hear there might be some trouble on the New Mexico board as well (no details, though). Have independent boards been a winner for the profession?

 

It wouldn’t be an update without a little Dry Needling talk. The vocal segment of our community obsessed with the practice hasn’t been crowing about the Tennessee AG Dry Needling ruling that IMT/TPDN is not within the current scope of Physical Therapy. (Thanks National Policy Group for keeping us informed!) No doubt the concluding paragraphs referring to a legislative fix, as happened in Utah, tempers the celebration. And while I’m on the subject, here is a legal analysis of the faulty argument that the use of acupuncture needles by non-acupuncturists is illegal.  Can we please stop saying that now?  (As of Spring 2015, acupuncturists were unable to get needles from California suppliers, due to labeling of acupuncture needles as dangerous devices.  Around that time the NCASI FDA complaint became hidden on the NCASI site.  Here’s a copy NCASI – dry-needling-violations.)

I suppose this is enough to keep everyone busy for a while….

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.

A Call to Action

We have an opportunity to help Californians, and all acupuncturists, but we need to act now. As I’ve written before, states setting their own super-special requirements for acupuncturists seeking licensure is expensive and limiting for practitioners and the profession. I’ve never seen evidence that the public benefits from such requirements.

California has been one of the worst offenders. An exploration of the unique educational requirements can wait for another day, but we now have an opportunity to do something about the exam.  (Please note – much of what follows is based on my best understanding of the situation from respected colleagues in California.  I have not been personally able to fully research the California situation.)

The California exam has had problems for years, among the lowlights — a California Acupuncture Board (CAB) chair sent to prison for selling the exam; a point location exam shown to be so subjective that the State mandated that the CAB cease using it; incidents of extremely high failure rates and serious scoring errors; and CAB’s refusal to compare two exams for possible unfair scoring.

A recent Sunset Committee is turning up the heat on the CAB. Senator Lieu, the Sunset Committee chair, may support a bill that will allow potential licensees to take the NCCAOM exam rather than the California state licensing exam. It is time to let the Senator know that this change would benefit the people of California and all acupuncturists.

Please send emails this week to:

marty.block@Sen.ca.gov, ted.lieu@sen.ca.gov, tom.berryhill@sen.ca.gov,
ellen.corbett@sen.ca.gov, cathleen.galgiani@sen.ca.gov, ed.hernandez@sen.ca.gov,
jerry.hill@sen.ca.gov, alex.padilla@sen.ca.gov, lark.park@gov.ca.gov, Anna.Caballero@scsa.ca.gov, Denise.Brown@dca.ca.gov, Tracy.Rhine@dca.ca.gov, Sonja.Merold@dca.ca.gov, LeOndra.Clark@sen.ca.gov, kimberleywoo@sbcglobal.net, bluelotushealth@gmail.com, blueheartacu@gmail.com, crystal.clk@gmail.com, Spencer.Walker@dca.ca.gov

Some possible language —

I formally request that the Sunset Review Committee mandate that the CAB and staff use the national certification exam (NCCAOM) as the main exam for California Acupuncture licensure.

The NCCAOM exam is widely known to be a fair and comprehensive exam. It is relied upon in almost every state except California. Those practitioners who are credentialed by the NCCAOM have an excellent safety record. To require a unique exam for California, especially one shown to have ongoing problems, increases expenses for all California practitioners, costs which are ultimately borne by the public.

I urge you to require the use of the NCCAOM exams as the main exam for CAB licensure.

Thank you for your consideration.

We will all be better off when meeting one set of standards allows us to practice anywhere in the country. Changing the situation in California would be a wonderful step in the right direction.

Smart Policy for the Acupuncture Profession

That’s my agenda —  to help acupuncturists and their affiliated organizations (AAAOM, NCCAOM, ACAOM, state organizations, schools, etc.) explore and analyze policy choices to help identify smart and effective policies and to avoid knee-jerk wild goose chases and unintended consequences.

My agenda is not to overthrow the NCCAOM, undermine the AAAOM, or to create conflict and division.

We are suffering from a professional auto-immune disease. How many subjects have been the greatest threat to the profession? How many LAcs have walked away from professional affiliations disheartened at the amount of energy spent attacking other professions or colleagues? How many of us react with outrage the moment we hear of some challenge, ready to mount an attack before we have all the information?

As acupuncturists, we see the suffering that results from an overactive immune system. Let’s stop making that mistake.

Last month I shared my email to my state association regarding their comments at an Advisory Board meeting. Here is ASVA’s response, and here is my reply. (I include the documents to show how challenging it can be to have non-triggered dialogue on an issue facing the profession. Rest assured, I am grateful to those who serve.)