Dry Needling, Herbs, and Scope — How to Regulate a Profession

A regulatory Board is contacted.  Your licensees are doing X, that isn’t (or, is that?) in your scope.

Ask a PT Board about Dry Needling and the answer usually goes something like this — We trust our licensees. Many learn this technique and it helps their clients. We find room in our regulation to include this in our scope.  We have a few concerns and suggest that those who want to utilize this technique have some additional training and take additional precautions. Our existing system for addressing unsafe practice is sufficient to address risk to the public.

Ask an Acupuncture Board or organization about herbs and the answer usually goes like this. We are being threatened again!  We’d better legislate, and fast! Help! Thanks NCCAOM and schools. We are so grateful for your efforts to ensure that any acupuncturist who wants to utilize this dangerous aspect of our medicine add your $20,000 education and your formal $800.00 seal of approval to their already extensive education and credentials. In fact, in the name of raising standards we should require that from all LAcs. It might prevent some of our most qualified practitioners from practice, but, hey, it is a step toward getting the respect we deserve.

Is something wrong with this picture?

It’s a radical idea, but how about we respect ourselves. Let’s recognize the safety of our medicine and the depth of our education.  Let’s trust our colleagues’ professional judgement and open doors rather than close them and let’s stop deferring to those who profit from our love of this medicine.

For additional reading, check out an example.  In this case, I agree with Dr. Morris when he wrote,

To avoid conflicts of interest, no individual who stands to profit from seminars should determine competencies and educational standards, nor should they testify in legislature on behalf of the common good.

(Of course, he was talking about the PT’s when he wrote it, so maybe in this case he doesn’t agree with himself.)

You have until Monday, 9/30, to comment on the NCCAOM’s “proposals.” Does the current CEU arrangement put the public at risk? Are the states incapable of effective regulation?

One more thing — during the great FPD debate, many expressed concern that once the degree was available the NCCAOM could, by fiat, require it for entry level practice. We were assured that would be impossible. Informed by history, it seems very possible indeed.

Control

Who determines your professional future? First, read An Example of one person, wearing two hats, limiting opportunities for LAcs. (He’s received honors for the work he’s done.)

We have one week to comment on the NCCAOM’s “proposed” policy changes. Do that here. Some of us think these changes are wise, some of us wouldn’t be personally impacted. We all should participate in the conversation. Ask your professional communities to comment. (You can see the NCCAOM’s response to my initial comments here.)

My follow-up comments are below. The NCCAOM is the most powerful organization in our profession. I have seen them, with our help, control regulation (or essentially subvert it) and legislation. Our interests may overlap, but don’t think your future is their primary concern.

Dear NCCAOM and Ms. Basore,

Thank you for your response regarding the proposed policy changes.  Here are some additional questions and comments.

  1. You wrote “The Criminal Background Screening Program for new applicants will not take effect until January 2014.” Has the final decision to implement these policies been made?
  2. The Criminal Background Check and language requirements go beyond your mission as a “national organization that validates entry-level competency.” These policies usurp the role of state regulatory boards. (For example, Virginia exempts those serving certain communities from our language requirements.)
  3. Many states use the NCCAOM exams but do not require the NCCAOM credential. Establishing background checks and language requirements as part of the testing application circumvents those states’ specific desire to maintain an independent credentialing process.
  4. How many students responded to the assessment regarding the foreign language exams and what were their responses? Please define the demand “sufficient to offer a psychometrically valid defensible examination.”
  5. Is it significant to an applicant if the background check fee goes to the NCCAOM or to a third party? Could NCCAOM staff involvement ultimately increase exam costs?
  6. Can you describe the criminal background check appeals process? Would the NCCAOM risk legal liability if applicants were allowed to sit the exam upon appeal?
  7. Is there any documented case of harm from practitioners who had a criminal history at the time of sitting the exams?
  8. If public protection is the justification for requiring the background check prior to examination, should it be required prior to school admittance? This would protect individuals from making a huge investment in a career they will ultimately be unable to practice.
  9. Could the recertification process be simplified by trusting Diplomates to use their best judgment regarding continuing education?  Has there been any documented patient harm as a result of unreviewed or unmonitored continuing education?

 

I believe that for much of the past twenty years the NCCAOM has provided a net benefit to the profession while honoring its commitment to the public welfare.  More recently the NCCAOM has repeatedly acted out of self-interest, choosing control over the profession and the attendant financial rewards ahead of either the profession or the public. Your push for the full OM credential as a requirement for licensure in DE is a prime example of action that served the NCCAOM at the expense of all others. The stakeholder comment you request is routinely disregarded.

Re-consider these proposals. Acupuncture practitioners have an incredible record of safety. The imposition of additional de facto regulation is unnecessary and burdensome.

Sincerely,

Elaine Wolf Komarow, LAc (VA)

NCCAOM Diplomate (Ac)

A Very Important Question

Dear NCCAOM,

Will feedback received influence your proposed(?) policy changes?  Ms. Basore’s comments to my previous post indicate the changes are a done deal. Please let the readers of The Acupuncture Observer know so that we can effectively use our qi.

Thank You.

Dear Readers,

I’ll send my many questions and comments about the policy changes to the NCCAOM (and post them here) if our input matters.  In the meantime, please  —

  • Contact NCCAOM via Facebook to weigh in on the proposed(?) changes. (Are they listening?)
  • Contact AAAOM via Facebook to share your thoughts on the NCCAOM’s proposed(?) changes.
  • Respond to the AAAOM’s latest Call for Comments (deadline September 19th), and let them know if you think they should be focusing on the proposed(?) changes.
  • Contact your state professional association to point out that the proposed(?) changes interfere with the state regulation of acupuncture and ask them to get involved.
  • Ask your state association to raise this topic with the Council of State Associations. (There doesn’t seem to be any way for the average professional to contact that group directly.)

That’s a good start while we wait to hear back from the NCCAOM. Oh, and spread the word!

P.S.:  Here’s a story about background checks.  Keep in mind, in the NCCAOM’s proposal, the poor applicant wouldn’t even be allowed to sit the exams.

Proposed(?) NCCAOM Changes

September 30th is the deadline to submit feedback on the NCCAOM’s proposed(?) policy changes.  These changes will impact the profession and may impact you. Don’t be taken by surprise and don’t let the profession change without your input. Weigh in! (Why the question mark after the word proposed? Because according to the latest NCCAOM spotlight, the criminal background check is already in effect.)

There are Four Proposed(?) Policy Changes.  As you prepare your feedback you will benefit from reading the NCCAOM’s Summer Newsletter for information on the NCCAOM’s role in the profession (which I will write more about soon) and for details of the proposed(?) criminal background check policy.

Here is my input to the NCCAOM (my email bounced back, so I’m sending via snail mail) —

As an NCCAOM Diplomate in Acupuncture, a member of the Virginia Advisory Board on Acupuncture, and a past board member of the Acupuncture Society of Virginia and the AAAOM, I share the following input on your proposed policy changes (which reflect my personal views and not the opinion of any board or organization)….

1)      The public and the profession would benefit from requiring a reasonable degree of English proficiency of NCCAOM Diplomates.  This goal is best met by requiring an intermediate score on the TOEFL or by other documentation of proficiency.  The NCCAOM should continue to offer the credentialing exams in other languages.  Many experts in this medicine were educated and trained in foreign languages.  Many great scholarly works are not available in English and much is lost in translation. Continuing foreign language testing, while requiring documentation of English proficiency would ensure that NCCAOM Diplomates can communicate effectively with regulatory boards and the public, while also allowing the study of the medicine in the language which best serves the practitioner.

(Since writing this I realized that all of the language requirements fall outside the NCCAOM’s mission of determining competency. Language requirements should be left to the states.)

2)      Based on the Summer NCCAOM News, input regarding criminal background checks for applicants is being requested after the policy change has been implemented. That is unfortunate.  Reporting that the “appropriate” staff will review each case is not helpful.  Who is the staff and what is their training?  Is this policy change in response to specific failings of the current credentialing and licensing process, or is it a preemptive jump on the bandwagon? In the absence of evidence that harm has occurred that would have been avoided had the policy been in place it is unnecessarily invasive and potentially discriminatory and should not be implemented.

3)      The PDA Provider Categories policy changes, especially the changes that seem to have been already established for 2015, will be detrimental to the profession and the public. While many professions trust licensees to obtain CEU’s useful to the needs of the practitioner, the NCCAOM’s increasingly restrictive policies seem designed to benefit only the coffers of the NCCAOM.  I have not found NCCAOM PDA providers to offer a higher caliber of class or to provide the range of classes that would be most useful to my practice.  I resent the degree of control the NCCAOM has over my continuing education through these changes and the hidden “tax” you will receive from every PDA point I earn.

These proposed changes contribute to my increasingly strong opinion that states should move away from requiring ongoing Diplomate status. (Since writing this I realized that because these policy changes impact who can sit the exams, getting away from the NCCAOM ongoing credentialing won’t address the issue.  Until the NCCAOM ceases the standard inflation that has begun to feel like a shakedown, I’ll support states developing an alternate path to licensure that doesn’t depend upon the NCCAOM.)  While I see the benefit in establishing a minimal level of education through the NCCAOM exams, your proposed policy changes work against the diversity that is an important part of Asian Medicine. Tightening the stranglehold on acupuncturists benefits neither the profession nor the public as increasing numbers seek our services.

Sincerely,

Elaine Wolf Komarow, LAc, NCCAOM 005020