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

 

 

Late March Update

The weekend is winding down and I didn’t make it to my planned “The Biggest Problem Facing the Profession” post.  However, there is lots of news in Acu-World. Here are some items to keep you busy until I get back to the keyboard.

  • Want to support the profession in a positive way? You may have contributed to funds for inter-professional squabbles or federal legislation. That money hasn’t helped us in a lasting or tangible way. Support POCATech and you’ll be supporting an acupuncture school committed to providing an affordable education. How would your practice be different if you didn’t have educational debt? Check it out here! POCATech will help more people get acupuncture from acupuncturists — it is a win/win.
  • ACAOM is considering changes to the post-Graduate Doctoral Program and they want to hear from you.  The survey took me about 15 minutes, most of that for reading. Personally, I support a Doctoral track open to those who have an acupuncture-only education. There is a long history of practitioners choosing one specialty.  The movement in some states to insist on complete OM or Herbal training and credentialing is discriminatory against acupuncturists and expensive! It is important that we all weigh in, whether or not we plan to pursue a doctoral degree. Deadline for response — April 17th.
  • In January NCASI was celebrating a ruling they believed meant PT’s would not be able to do dry needling in Utah. In March, Utah HB 367, legislation which would add dry needling to PT scope of practice, went to the Governor’s desk for a signature. Shouldn’t be a surprise to anyone. Utah has fewer than 100 LAcs and about 4000 PT’s.
  • Likewise, “despite the warning” of AZSOMA, SB 1154, which would add dry needling to PT scope of practice, has passed the Senate and made it through two committees of the House. The votes have not been close.
  • Last, and maybe least, the AAAOM collapse continues.  Acupuncture Today printed part II of their article, now with updates. The AAAOM came out with a response (prior to the latest updates). Given the latest updates it probably isn’t worth the time to go through the AAAOM response. Suffice it to say, it contains plenty of spin and quite a few inaccuracies. Mostly, I continue to note that we’ve heard nothing from the AAAOM about who is currently in charge there. And, no practitioners really seem to care.

That should be enough to keep everyone busy.  Back soon, with “The Biggest Problem Facing the Profession.” (No, it isn’t Dry Needling.)

A Practical Next Step

Okay, I’ve heard the critics — too much blaming the profession and focusing on mistakes, not enough positive things we can do now.  So, here goes —

A very practical next step, or maybe the most important thing to do to prepare for a next step, is getting your bearings. Any confusion about where you are now and your next steps might be in the wrong direction.  So let’s take a look at where we are with our old friend Dry Needling —

On January 23, 2014, the Court of Appeals of the State of Oregon issued a ruling regarding the practice of dry needling by Chiropractors. Surfing the web I’ve read “the issue came down to whether chiropractors could perform dry needling after having 24 hours of training,” and “The Oregon Court of Appeals ruled “dry needling” is acupuncture and not within the scope of practice of chiropractic medicine” and “This ruling sets a precedent which can have far-reaching effects beyond Oregon. It becomes part of the record for each state acupuncture Association to use in it’s own fight for appropriate licensure, training, and practice.”

It is certainly correct that the ruling does set a precedent, so let’s be sure we understand what that precedent is. I encourage all of you to read the ruling, linked above.  It isn’t long and it is interesting. You can see a nice summary here. Most critically —

  1. The ruling does not say that dry needling is acupuncture.  I don’t believe it includes any mention of the word acupuncture.
  2. The ruling does not consider how much training is necessary to practice this technique safely. Hours of training are irrelevant to this ruling.
  3. Patient safety is not explored or addressed in this ruling.

The Court focuses on the Chiropractic Board’s argument that Dry Needing is Physiotherapy and rules that it is not, based on the understanding of the word in 1927, when Physiotherapy was added to Chiropractic scope in Oregon.   (The Court clearly states that it does not find that Physiotherapy is the same as Physical Therapy.)

So, if you are in a state in which the PT Board or Chiropractic Board has argued that Dry Needling is Physiotherapy, and if Physiotherapy was added to that Board’s scope in the late 1920’s, this ruling sets a very important precedent.  I’m guessing the ruling may not quite live up to its reputation as a game-changer.

In other news, while NCASI is celebrating the Utah DOPL’s decision that dry needling is outside the scope of practice for Physical Therapists, there is a bill (HB 367) moving through the Utah House that would add Dry Needling to the Physical Therapy scope. (There are fewer than 100 LAcs in Utah, and several thousand PT’s). Similarly, Arizona S.B. 1154, legislatively adding dry needling to Physical Therapy scope has passed the Senate.

So, that’s where we are. And if you don’t buy my argument that knowing where we are counts as a practical next step, here, on its one year anniversary, but so relevant it could have been written today, are not ten, but ELEVEN, positive, practical, and fulfilling next steps.

“Join your Acupuncture Organization!”

We’ve all heard it, along with “we are doing the best we can with the resources we have” and, “if you participate you can help set our direction.” Heck, I’ve said those things.

Yet membership in most organizations is steady or declining. News of trouble in the AAAOM was met with a yawn. Many acupuncturists are active, involved, motivated people in general, so why do so many of our voluntary organizations struggle?

In a Facebook conversation regarding the AAAOM a current board member wrote “…if we were to have had one failure as an organization … it has been our challenges in staying in touch … to keep everyone up to date about what we’re doing, what we’re facing and how we’re being successful. I can see how not hearing from us creates space for concern and allows the possibility to misinterpret truth from reality.” If there has been one failure??

Another board member dismissed the recent resignations as a necessary step in getting “like-minded” folks on the board. Then, as the day follows the night, the conversation pivoted to a plea for unity, so we could get the big things done, like the FPD. (There’s a unifying topic.)

Having served on the board of my state association for years I remember the difficulty of trying to do much with little. Yet my recent offer [early 2014] to teach members about strategic policy planning was quickly dismissed with “no one would come, but if you write something we’ll distribute it.”  And my recent attempts to communicate with board members (whom I consider to be my friends and respected colleagues) about some of the association’s positions were dismissed with “the membership elects the board and the board sets the agenda” and “I know there are differences but I don’t care about the details.”

Is it any surprise that struggling practitioners aren’t convinced that joining and participating in these organizations will produce results?

One membership organization is doing well. As of February 15th POCA had 1569 members, including 242 clinic memberships (which each include one practitioner membership) and an additional 653 practitioner memberships. It isn’t easy to get membership figures for other acupuncture organizations, but I’ll go out on a limb and say that POCA currently has the largest practitioner membership of the national voluntary acupuncture organizations. (POCA’s 895 patient membership isn’t too shabby either.) POCA doesn’t claim or try to be the organization for everyone, but it has one heck of a mission and is clearly doing a few things right.

Here’s a real kick in the gut — did you know that a group of AOM Leaders has been meeting since 2005 to “promote the general interest of the acupuncture profession”? The next meeting will be held in just a few weeks. Look at the list of past attendees. Who is representing your needs and interests to this group?  Who decides on the participants? Has POCA been invited? Have any of the participants investigated why so few practitioners (who invested in the expensive education, sat for the expensive exams, maintain the expensive credentials) join their acupuncture organizations?  It is not because we are a young profession and it is not because we are cats, difficult to herd.

Is the message that the interest of “the profession” doesn’t include the interests of practitioners?

Last week’s poll was a tie, so this post is a mash-up.  There is plenty to explore regarding our acupuncture organizations. For now, it’s time come up with a plan.  How do we get the “leaders” to consider the needs of those they claim to lead? Don’t say by joining groups that don’t seem to care.