Tag Archives: scope

Dry Needling Updates for LAcs

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Not again! Yes, again.

[If nothing else, read: NC AG Opinion, NC Order and Opinion, Henry v NCALB, and TX AG Opinion. If you have an opinion on dry needling, and you want it to be an informed opinion, these documents are necessary reading.]

North Carolina has been a major DN battlefield. It’s been a rallying cry for strong action elsewhere. How’s it going?

Not well.

Some history –

In 2011, the North Carolina Acupuncture Licensing Board (NCALB) requested an opinion from the NC Attorney General regarding the North Carolina Board of Physical Therapy Examiners’ (NCPTE) decision that Dry Needling was within the PT scope of practice. The AG opinion was that the NCPTE could make this determination if it conducted appropriate rule-making.

Subsequent to that decision, but before the NCPTE concluded the rule-making process, the NCALB sent “cease-and-desist” letters to PT’s practicing dry needling, accusing them of illegal activity. And, in 2015, the NCALB filed a complaint, demanding a ruling that DN was the unlawful practice of acupuncture, and insisting that the PT Board inform its licensees that DN was not within the scope of practice of PT’s.

Given the AG opinion it’s no surprise that the NCPTE (and individual PT’s who had received the cease-and-desist letters) weren’t ready to roll over for the NCALB.

On August 2nd, the Court issued this NC Order and Opinion affirming the NCPTE’s decision that dry needling is within scope for PT’s, and that it is distinct from acupuncture.

(Again, please read the documents. They are critical to understanding why our arguments aren’t leading to more wins.)

In January the court ruled that Henry v NCALB could proceed. This is not good news for the NCALB and its members, who may be found (subsequent to the NC Board of Dental Examiners Supreme Court ruling) guilty of antitrust violations.

My top takeaways —

  • Don’t request an AG opinion if you won’t accept the answer. (A colleague recently wrote that he’s gearing up to “CRUSH dry needling” in Texas. Here’s the Texas AG opinion.)
  • If it’s determined that a PT Board has the power to pursue rulemaking on dry needling, we should make a good faith effort to offer respectful input. We should focus on minimizing risk to the public, while accepting that we don’t get to call the shots. Obstructing the regulatory process or making unrealistic demands puts the public at greater risk. (Also, we should make well-informed arguments. Insisting that dry needling is outside of PT scope after it’s been ruled otherwise, for example, doesn’t help our case.)
  • Don’t use dud ammunition. NCASI and others still argue, for example, that it’s illegal for anyone other than acupuncturists to possess acupuncture needles. The court wrote (highlighting mine)

¶¶ 16–20.) In particular, the Acupuncture Board contends that the needles used in dry needling “must carry a specific FDA warning as required under 21 CFR §880.109(b)(1), stating ‘Caution: Federal law restricts this device to sale by or on the order of a [qualified practitioner of acupuncture licensed by the law of the State in which he practices to use or order the use of the device.]’” (Petition ¶ 19) (brackets
and emphasis in original).
50. The Petition takes glaring liberties with the cited regulation, however. The full text of the regulation requires medical devices, such as the solid filament needles at issue here, to include a label bearing: The symbol statement “RX only” or “℞ only” or the statement “Caution: Federal law restricts this device to sale by or on the order of a ____”, the blank to be filled with the word “physician”, “dentist”, “veterinarian”, or with the descriptive designation of any other practitioner licensed by the law of the State in which the practitioner practices to use or order the use of the device[.]
21 C.F.R. § 801.109(b)(1). As such, the cited regulation does not support the Acupuncture Board’s argument that the needles used in dry needling are “medical devices” only for use by acupuncturists.

  • Our professions’ news sources are full of misleading, inaccurate, and incomplete information. This AT article, this NGAOM post, and this blog post, are inaccurate – repeating the false needle argument, misstating the finding of the NC rules review commission, and/or misrepresenting what the NCPTE told licensees. We need to do better.
  • Long-term, there may be a few states where PT’s are not permitted to do dry needling, just as there are a few states still not open to LAcs. There is already PT DN in most states. Making the argument that dry needling is acupuncture, as the NCCAOM did in their recent statement, is a terrible mistake. Do we want the PT next door to advertise “now offering acupuncture”? Our statements encourage them to do so. We need to adjust to the current reality.

In 2013 I wrote Imagine, or, How I Learned to Stop Worrying and Love the Bomb. I can still only imagine where we’d be if we had spent the last four years doing those 11 things, instead of what we’ve done (and continue to do). Let’s stop doing what we’ve done. We can get something better if we understand what’s gotten us here.

 

 

 

Current Events for Acupuncturists, Spring 2016

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Regulatory activity, licensure laws, and organizational news impacting LAcs –

Regulatory and Legal Round-Up:

In April the Washington State AG determined that Dry Needling was not within PT scope as currently written. The legislative session ended without success for either of  two competing bills to add DN to or restrict DN from PT scope. This fight is likely to continue in future sessions.

The North Carolina Acupuncture Licensing Board’s lawsuit against PT Dry Needling was dismissed  “without prejudice” on April 26th with a ruling that the NCALB has not exhausted its administrative remedies and so the Court lacks subject matter jurisdiction. A member of the NCALB distributed an email blast disagreeing with the ruling that seemed to have been written prior to reading the opinion. The NCALB (and anyone else crying foul) should study the Court’s ruling before pursuing the legal battle (and asking for money to fund it).

On May 9th the Texas Attorney General issued an opinion that the Court would likely conclude that the Board of Physical Therapy Examiners has the authority to determine that trigger point dry needling is within the scope of Physical Therapy.

The Virginia Board of Physical Therapy moved forward with regulatory language regarding Dry Needling. The proposed language (which will still go through a public comment period) specifies topics to be covered in the training but not required hours of training. Did the ongoing battle over number of hours in other states play a role?

A rare area of national bipartisan agreement is that Occupational Licensing has gotten out of hand. The right dislikes the burden it places on business, the left dislikes the burden it places on the working class. Add last year’s Supreme Court ruling regarding regulatory boards, and we should expect ongoing efforts to ease licensure routes and to diminish the power of active market participants on regulatory boards.

For example, the Governor of Tennessee (R) just signed The Right to Earn a Living Act, which requires agencies to limit entry requirements to those that are necessary to protect the public, and makes it easy for anyone to challenge professional entry regulations. The Governor of Delaware (D) has created a Regulatory Review Commission to review professional regulations. A North Carolina bill to disband many regulatory boards (including the NCALB) was defeated this session, but it won’t be the last we see of such efforts. (No, the PT’s had nothing to do with the bill.)

Licensure Laws:

KsAOM’s hard work paid off. The Kansas Acupuncture Act became law and licensure will begin in July 2017. The final language was a compromise that includes dry needling within both PT and LAc scope after the initial DN language almost derailed the bill. You can see the text here (see pages 11-17).

The Delaware AAC’s unwillingness to waive the requirement for all LAcs to have full herbal credentialing, even for those uninterested in prescribing herbs, has been an ongoing problem. Legislation has now been introduced which would create tiered licensing (and remove the word Oriental from the law). Tiered licensing puts acupuncture-only practitioners at a disadvantage to all other health care providers, but would nonetheless be an improvement.

Other News:

Last, but not least, CCAOM has voted to remove Oriental from the name of the organization. No word yet on the new name.

 

The Acupuncture Observer aims to inform all Acupuncturists of developments in the profession. Fallout from the previous Observer post leaves me without access to several of the newsiest FB groups. I’ll say more about that in a few weeks. In the meantime, if you know of news that deserves to be heard, let TAO know and I’ll get the word out. And, please, share this post with any groups, on Facebook and elsewhere, that could benefit.

 

 

Dry Needling and Acupuncture 2015 – The State of the Profession

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Dry Needling wins again – it receives “the greatest threat to the profession” practitioner’s choice award.

In recent years, Acupuncturists have devoted more resources to this issue than to any other.

A (fairly accurate) review of legal and regulatory actions shows that we’re not having much success. (Here’s another review, APTA’s Dry Needling Resource Paper.)

Even our wins have been temporary. For example –

– the Georgia Acupuncture Board added language stating that Dry Needling is acupuncture. The PT’s then added Dry Needling to their scope via legislation. (Could Georgia PT’s now advertise they’re doing acupuncture?)

– the October 2014 ruling in Washington State against dry needling was widely celebrated. Now the PT’s have introduced bills which would add Dry Needling to their scope. With almost 5,000 PT’s in the state, and about 1,100 LAcs, it’s likely they’ll eventually succeed.

We say the PT’s:

  • are stealing our medicine! (But we don’t own it.)
  • are illegally expanding their scope. (The majority of states have ruled it is in the PT scope. Modifications to scope are common in health care.)
  • are using Regulation to do what should be done Legislatively. (Scope clarification is often done via Regulation, which gives the public and other professionals the opportunity to weigh in and is preferable to politically driven legislative action. The public is protected through regulation. The PT’s have been successful in passing Legislation allowing dry needling.)
  • are pursuing this because their own techniques don’t work. (Even if true, 1) why does that matter, and 2) does the argument apply to us when we add techniques lasers, essential oils, e-stim, herbs –  to our scope?)
  • can’t possibly know enough to do this technique safely. (Many clearly do.)
  • can’t possibly be providing good treatments. (Their patients disagree.)
  • wrongly say that dry needling isn’t acupuncture. (Is it better if they say it is? Is there a legal reason our definition should prevail?)
  • make the public fear acupuncture. (Insisting this technique is acupuncture will contribute to the problem. Don’t we have the same problem when we use the technique?)
  • should use hypodermic needles. (Does that show concern for public safety?)

We can continue the fight to stop dry needling – getting caught in the cycle of suit (complaint) (never-mind the SCOTUS ruling) and counter-suit (NC PT lawsuit). We can fight state by state, and attack any Acupuncturist who suggests anything other than “the PT’s must be stopped.” We can keep insisting that if we just devote more resources and fight harder, we’ll win.

Or, we can learn from our history and the history of all of the other professions that have fought to maintain a monopoly on technique or turf.

We could be fighting for strong regulations. Mandated adverse effect reporting, strict definitions of what dry needling is and what it isn’t (other than whether or not it is acupuncture), requiring direct supervision for all clinical hours, requiring PT’s to post their hours of training, requiring registration with the PT Board, requiring physician referral for dry needling – all of these are possible.

A PR campaign promoting acupuncture and helping the public find an Acupuncturist? That’s possible too. Supporting ease of licensure so that people in every state can find an LAc? We can work for that. Support for new practitioners so that the public can actually find an Acupuncturist? That’s a great goal. Building collaborative relationships with other professionals who want to decrease pain and suffering? That would serve everyone.

Putting our energy into stopping dry needling? Not so much. It’s our obsession with stopping dry needling that is the greatest threat to the profession.

 

 

9 Reasons why Acupuncture Regulations There Matter Here!

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Changes in acupuncture regulation in any state matter to each of us individually, and to the profession as a whole.

Here are 9 reasons why —

  • We don’t know what the future holds. Unexpected moves happen.
  • You may need to hire practitioners or sell your practice. Can interested parties easily move to your state?
  • Your patients might move and want a practitioner just like you. Will one be available?
  • Growth in the profession is not keeping up with demand. Regulatory uncertainty diminishes the appeal of the profession.
  • High educational and credentialing costs interfere with business growth. If the requirements vary from state to state, the impact is multiplied. (See this report on Occupational Licensing.)
  • Regulatory differences lead to divisions within the profession. With fewer than 25k acupuncturists in the US unity is critical.
  • What happens in one state impacts every state. States look at what has happened elsewhere when considering regulatory changes.
  • Changes in one state can lead to changes for everyone. When CA increased required educational hours every school and ACAOM soon changed as well.
  • Different regulations, training requirements, and titles make it difficult to educate the public about our qualifications, draw contrasts with other professionals, or advocate for our profession as a whole.

Staying informed is not easy. Neither is getting involved. We are all busy, we don’t always know how to assess the pros and cons of a possible change, and things can get heated and unpleasant when there are differences of opinion.

And, the future of our profession and our businesses is greatly impacted by regulatory changes – even those happening across the country.

Please, stay involved.

Forgive two posts in quick succession, but regulatory changes are on the way. You’ll hear from me again soon.

(Note — I advocate for standardizing and simplifying the regulatory process for acupuncture licensure. I am not advocating for standardizing the medicine itself. Our diversity is powerful indeed.)

Herbal Regulation and the Acupuncture Profession – A Better Way.

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We’ve got competition. PT’s, MD’s, and DC’s are excited about filiform needles and LAcs are freaking out.

While our energy has been focused on that competition (our training and skills are superior, right?) we haven’t been paying attention to increasing restrictions on our ability to practice the fullness of our medicine. Adding insult to injury, the restrictions on practice are “coming from inside the house.”

I’m talking about restrictions on our use of herbs.

Yes, herbal medicine is powerful and complex and carries both potential risk and potential benefit. Yes, it takes many thousands of hours to come close to mastery of this branch of our medicine. Yes, people have been harmed by the improper use of herbs and supplements. And, yes, at some point the damage done by the misuse of herbs may result in stricter regulation. We may indeed lose access to more herbs.

It’s good that we want to be proactive, protecting the public and the profession from harm. It’s not so good if our actions don’t have the desired result. And not good at all if our actions increase risk to the public and the profession.

Let’s consider the terrain —

  • What portion of harm from herbs/supplements is the result of poor practice by Acupuncturists?
  • What portion of harm from herbs is from the use of raw herbs, what portion is from pre-made herbal formulas?
  • Does preventing certain LAcs from recommending herbs or supplements limit public access to these products?
  • Is the average LAc, even without herbal training, likely to have a positive or negative impact on client’s proper use of herbs and supplements?
  • Which are better tailored to the individualized treatment that is a hallmark of Chinese Medicine — pre-made/patent formulas or raw herbs?
  • Which are more likely to be contaminated with banned substances or prescription medicine – patent formulas or raw herbs?
  • Is it possible to draw a bright line between dietary therapy and herbal therapy?
  • Does limiting LAc recommendation of herbs interfere with the ability of other health care providers or salespeople to recommend or sell herbs or supplements?

See where I am going with this?

Anyone can get Chinese herbs, even dangerous ones. Increasing the regulatory burden on Acupuncturists would make sense if it would protect the public or our access to the full pharmacopoeia on an ongoing basis. It would make sense if LAcs were routinely endangering the public through unregulated use of herbs.

It doesn’t make sense for a subset of our profession to become the only group of health professionals not able to recommend herbs to their clients.

If the only groups weighing in are the schools and NCCAOM, formal (and expensive) training and credentialing will be increasingly required.

Let’s stand united against unnecessary restrictions. LAcs have an excellent safety record. Stay tuned for real-time developments and your opportunity to weigh in on the regulation of herbal medicine for Acupuncturists.

 

Acupuncture Licensing and Regulation – The Future

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Imagine that your acupuncture license meant you could easily practice in every state.

Imagine that licensure exams focused on the skills and knowledge needed to practice safely.

Imagine that acupuncture schools used the time spent teaching things “you won’t need in practice but they’ll be on the exam” to teach things that you really will need in practice, including all that business stuff.

Imagine that acupuncture boards, associations, and organizations worked to make it easier and less expensive for practitioners to obtain and maintain licenses and practice within their skill set.

I wish I could say “it’s easy if you try” – but for most of us it isn’t. (Unless you look to other professions.)

The Florida Acupuncture Board now requires all new practitioners to spend thousands of hours and tens of thousands of dollars on additional education and testing to become Board-certified in herbs. Even though there was no evidence of public harm under the previous rules, and even for those who won’t use herbs in practice.

The Nevada Board is trying to change the regulations to require a DOM or DAOM of all applicants (about 40K on top of an 80K MAOM). Not because there is evidence of public harm, but because that’s the way it is in China. And never mind that the entire state is served by fewer than 50 acupuncturists.

In July 2015 the White House released Occupational Licensing: A Framework for Policymakers. While acknowledging that licensing can provide health and safety protections to consumers and benefits to workers, it concludes,

“State legislators and policymakers should adopt institutional reforms that promote a more careful and individualized approach to occupational regulation that takes into account its costs and benefits, and harmonizes requirements across States. If they are successful, the collective effect of their efforts could be substantial: making it easier for qualified workers to find jobs and move where they choose, increasing access to essential goods and services, and lessening heavy burdens on certain populations….”

Acupuncturists are the policymakers in our profession. Wouldn’t it be great to determine what’s truly needed for public safety and to adjust educational and licensing requirements accordingly? Rather than blaming others for our difficulties, wouldn’t it be more productive to direct our energy to changing the things we can control? We can demand that the insurance companies pay us more because our education cost so much, or we can make our education less costly. We can sue the PT Boards to try and protect our turf, or we can make sure that anyone who wants acupuncture is able to access convenient and affordable services from an acupuncturist.

I’ll be sharing actions you can take to change our practice environment for the better. Like the Acupuncture Regulation US page on Facebook and stay tuned in here, at The Acupuncture Observer, for updates.

 

 

 

NCCAOM Code of Ethics & Grounds for Professional Discipline, Part II

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The NCCAOM’s call for comments on the Code of Ethics and Grounds for Professional Discipline ends September 12, 2015 .We owe it to ourselves and our profession to share our thoughts with them.

Here’s what I’ll tell them —

Dear NCCAOM,

Thank you for the opportunity to comment on the Code of Ethics and Grounds for Professional Discipline. My significant concerns with these documents can be traced to three overarching issues —

  1. The NCCAOM credential is required to maintain state licensure for many acupuncturists. You advocate for this arrangement. Yet the current Code of Ethics is more suitable for a voluntary exceptional standard adopted by choice.
  2. States that require NCCAOM credentials have their own regulatory boards, ethical codes, and disciplinary process. The NCCAOM Grounds for Professional Discipline empowers you to pull a practitioner’s credential, removing them from practice, even when a state board would allow continued practice for the same violation. This turns the NCCAOM into de facto regulators and creates double jeopardy for practitioners.
  3. The NCCAOM reserves the right to take disciplinary action against any practitioner who violates the Code of Ethics. The Code covers behaviors ranging from serious threats to the public safety to those in the realm of Public Relations. The NCCAOM should explicitly limit the use of disciplinary action to violations that risk the public safety.

A few specific examples —

  • “Exceeding the scope of practice as defined by law or certification” is grounds for discipline. Scope is defined by the state, and may not be accurately determined by written language in code or regulation. Since state regulatory boards ultimately rule on whether or not a procedure is within scope, and since that board would determine proper discipline for any violation, no action from the NCCAOM is needed. References to scope should be removed from the NCCAOM document.
  • “I will continue to work to promote the highest standards of the profession” is listed in the Code. Must practitioners promote the FPD or DAOM, the addition of herbal exams to licensure requirements, and the expansion of the NCCAOM credential requirement to all states? Who determines the highest standard? This language is coercive at best.
  • The Code of Ethics requires credential holders to report peers who violate the Code. It is untenable to expect Diplomates to report every peer in violation of any aspect of this far-reaching code, and it is unfair to wield the power to hold us responsible for any failure to do so.

I support rigorous professional ethics and respect the NCCAOM’s intent to establish high standards for the benefit of our patients and our profession. However, your role for the profession is to validate entry-level competency. Much of the current Code of Ethics and Grounds for Professional Discipline goes far beyond this role. Continued overreach into areas best left to regulators and voluntary affiliations puts at risk the NCCAOM’s position as a credentialing organization.

Thank you for your consideration of these comments,

Elaine Wolf Komarow, L.Ac, Dipl. Ac. (NCCAOM)

Those of you who would like more background on the role of the NCCAOM in our profession should look at Part I of this post.  I encourage those who are interested in another viewpoint of the NCCAOM and its impact on the profession to review these comments and consider signing this petition.

Acupuncture Safety, and, a Matter of Fairness

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Protecting the public safety is a good reason for regulation.

People have been injured by PT’s or Chiropractors doing dry needling.  When we see a story about that we share it. So I understand the comments on the previous post.

And, there were two recent threads on Facebook that caught my attention.

An LAc posted a question about whether it was possible to cause an infection by needling CO4. He’d treated a patient who later developed redness at the area. The patient visited an MD and was prescribed an antibiotic. I was surprised at the practitioner’s question, and surprised and mortified at the responses.  Which included: The MD is just trying to cover his ass, they just like to prescribe antibiotics, not if you used sterile needles, not if you used an alcohol swab on the area first, people freak out all the time, etc. A day or two later, the initial questioner reported that the patient was now hospitalized with a staph infection.

Another LAc wrote that a patient reported she’d had a pneumothorax from a treatment and was now asking for financial compensation for a portion of the medical expenses and several weeks of missed work. What should the practitioner do? Of course, getting some documentation makes sense, but the responses also included: if it really happened why doesn’t the patient have a lawyer, if you’d given her a pneumothorax you would have known it immediately, she must have had some sort of underlying medical condition so you aren’t responsible, etc.

Personally, I know some amazing practitioners who have firsthand experience with pneumothorax(i?) on both ends of the needle.

I don’t believe we have sufficient record keeping to know the relative safety records.  Dry Needling does involve a deep and aggressive needle technique and so is more likely to do damage.  That’s true even with an LAc holding the needle.

When a story comes out that involves harm done by an LAc, we make all sorts of excuses and focus on our generally good safety record. When we find out about damage done by a PT or DC, we trumpet the news, and make smug and superior comments.

When it comes to fairness, most of the things I hear LAcs complaining about are either self-inflicted or, sometimes, imagined.  The length of our training — we’ve been behind the increase. The differing insurance reimbursement — is that insurance thing working out for anyone?

This post is mostly blogger’s prerogative to give what is really a comment on the previous thread a higher visibility.  I won’t make a habit of it.  But hwds’ are one of my pet peeves — that’s hypocrites with double standards, and when our response to what happens at the pointy end of the needle seems to vary so much depending on who is at the handle, I think that term applies.

 

 

NCCAOM/Dry Needling/A Young Profession

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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.

 

Five Important Dry Needling Developments

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Yes, more on dry needling.  More about education will have to wait.

Five things to know —

  1. The Oregon Ruling did not (despite the Acupuncture Today headline) determine that “Dry Needling is Acupuncture.”  For a full exploration of the case, read this post. In summary, the ruling of the court was that Dry Needling is not physiotherapy.
  2. On April 1st Utah Governor Gary Herbert signed HB 367, legislatively adding Dry Needling to the scope of Physical Therapists.
  3. On April 24th Arizona Governor Jan Brewer signed SB 1154, legislatively adding Dry Needling to the scope of Physical Therapists.*
  4. On March 25th Massachusetts HB 3972 advanced. This redraft of acupuncture bills HB 2051 and SB 1107 was necessary because the bill could not advance with the language that “dry needling is acupuncture.”
  5. At the end of April the Illinois Department of Professional Regulation issued an informal ruling that dry needling was not within the scope of practice for Physical Therapists “as the acts are currently written.”  That last phrase is important. From what I can tell there are about 550 LAcs in IL and over 9,000 PT’s.  The PT’s aren’t ready to call it quits. Time will tell if the victory for the LAcs is a lasting one. The PT’s could well look to Arizona and Utah and work for a legislative change.

(A colleague practicing in Delaware recently told me of the urgent phone calls and emails she’s been receiving — she must get involved in the fight against PT Dry Needling! Delaware is a state in which a few LAcs on the Advisory Board refuse to grant licenses to qualified acupuncturists. There are so few LAcs (less than 40) that they can’t maintain an association and citizens are far more likely to get acupuncture from a DC or an MD than an LAc. Now the profession wants to take on the PT’s? If there’s an urgent need for action from the LAcs of DE, perhaps it should be action to bring LAcs to the state?)

For those who insist we must do something about this serious risk to our profession, here are some suggestions. They would do far more to benefit our profession than this ongoing battle with the PT’s.

* One of the acupuncture profession’s strategies from the start of the Dry Needling issue was to argue, as the AAAOM wrote in their 2013 position paper,– “the addition of TPDN to physical therapy practice is being determined by physical therapy regulatory boards, deleteriously circumventing transparency and public health safety protections provided by standard legislative process.”  This was a mistake. Given the relative political strength of the PT profession and their MD supporters legislative victories are likely. Had we been willing to work with our health-care colleagues in the regulatory arena we might well have had input and influence in the use of this procedure.