Tag Archives: acupuncture

It’s Not Fair!!!

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

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

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

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

2)     Why can’t LAcs do manipulations?

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

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

 

A House Built on Shifting Sand

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About eighteen years ago, as we were advocating for a practice act in Virginia, a big upset was that MD’s, DC’s, and DO’s (and podiatrists within their scope) could practice acupuncture with only 200 hours of training.  Time and again, acupuncturists complained (and continue to complain) about this — after all they say (and we said to the legislators and staff at the Department of Health Professions) acupuncture is far more than sticking a needle in the body.  Acupuncture is a complete system of healing, a theory, a philosophy, a paradigm, a system of diagnosis.  A doctor may be able to safely stick a needle in a point (though these are, after all, very special needles, nothing like a crude hypodermic), but they aren’t doing “acupuncture.”  Mention MD’s and DC’s “with limited training” doing acupuncture to most LAcs today and you’ll get anger and complaints.

What gets LAcs (or OMDs or CAcs) even more incensed today — Physical Therapists (or DC’s) sticking a needle in a point and saying it isn’t acupuncture.  After all, we say to the regulatory boards (and even more loudly to each other), they’re sticking an acupuncture needle in a point.  We don’t care whether the PT is thinking only that a trigger point causing pain could be released by this needle.  Or that they know nothing of the theory of Chinese medicine.  All we know is that if they are sticking a needle in a point they are doing acupuncture, they darn well better not call it anything else, and they ought not be allowed to do it.

I’ll save the in-depth conversations about TPDN, scope of practice (it doesn’t mean what you think it means), and coalition building for other days.  For today, I just want to ask that our profession show some consistency.  Consider the implications of insisting that acupuncture is defined as a needle in a point, or the implications of insisting it is far more than that, and especially consider the implications of changing the definition to suit a short term need.  Consider the implications on what you do in your treatment room, as well as the impact on our battles with other professions, our interactions with regulators, our involvement with third-party payer systems, and perhaps most importantly, on how we build our brand.  Above all, remember that like a house built on shifting sands, a profession built on shifting definitions is unlikely to stand the test of time.