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.

The Acupuncture Profession, News and Analysis

Three dedicated AAAOM Board members and AAAOM (super-qualified, knowledgeable, and committed) Executive Director, Denise Graham (my last hope that things could get better) resigned recently.

One board member spoke of an uncomfortable and increasingly controlled board environment, a declining membership (now less than 2% of the profession), and poor relationships with national and state leaders. Another stated that the AAAOM doesn’t have the support, revenue, or credibility to make progress towards legislative goals.

This isn’t the first time AAAOM has been on the ropes. If it hadn’t been for money from the AAC and support from other organizations, I doubt they would have survived this long. Somehow, though, they still manage to control the conversation.

In other news, NCASI, the National Center for Acupuncture Safety and Integrity, has appeared on the scene. NCASI’s list of “10 Facts” should be titled “10 Things We Insist are True and/or Important.”  Dry Needling by PT’s is legal in many states. Review my past posts on dry needling and scope for more background. We take real risks when we files lawsuits like these.

For twenty years, the acupuncture organizations have insisted that our success depends upon —

  • Increasing credentials/educational requirements/scope. It doesn’t matter if the old education, credentials, and scope worked fine. It doesn’t matter if it increases practitioner expense, decreases practitioner flexibility, or prevents some LAcs from utilizing techniques available to any other citizen.
  • Getting someone else to pay for acupuncture. Fight for third-party payment systems even if other professions report they make good medicine more difficult and practice less enjoyable. Ignore the hypocrisy of participating in a system that requires discounting services while also criticizing LAcs who offer low-cost or discounted treatments directly to patients. Insist that practitioners who don’t want to participate won’t be impacted, and turn a blind eye to the fraud that many practitioners engage in to make the $’s work.
  • Demanding a monopoly.  There’s no need to earn your market share by providing the best product — instead establish it through litigation and turf battles. Don’t worry if this requires you to disparage your fellow health providers or contradict your message that the public should be able to choose their providers.

After twenty years many LAcs struggle to stay in business, and most voluntary acupuncture organizations struggle to survive. Got questions about ADA compliance, insurance billing, privacy issues, advertising questions, disciplinary actions? You won’t get answers from the AAAOM and you probably won’t get them from your state organization.

It’s time to change our strategy. We have enough training, clients who seek our services, and other providers who respect the medicine so much they want use it themselves. Yes, we always need be aware of and informed about the regulatory/legislative landscape, but we also need business skills, PR, positive marketing, and an easing of the regulatory burden.  We need a good hard look at the cost of education. We need legal advice and business tools and positive interactions with potential referral sources and colleagues. We don’t need more legal battles, more regulation, more legislation, more degrees that further divide us.

When our organizations provide these things, we’ll have successful organizations, and successful practitioners. (If you don’t believe me, ask POCA.)

 

LAcs = Tea Party & Acupuncture Today = Fox News?

The threat to acupuncture from dry needling is like the threat to “traditional” marriage from gay marriage. That is, the real threat is our obsession with the issue and our willingness to make any argument, no matter how ridiculous, to keep people from connecting with the provider of their choice.

Despite thousands of years of experience and a big head-start, we didn’t establish ourselves as the undisputed experts of this method of pain relief. Having failed to convince the PT Boards that PT’s performing dry needling is a danger to the public, or that LAcs should get to determine the appropriate training for this technique, we are now arguing that we’ll accept it, as long as it hurts.

The November 2013 issue of AcupunctureToday included Dry Needling: Averting a Crisis for the Profession, here is my response to AT —

Dr. Amaro’s “obvious solution” to Dry Needling, that PT’s be judicially mandated to use a hypodermic needle, is awful. Has it come to this? Despite our 2,000+ year head-start our plan for success is to require other providers to use a tool that causes tissue damage and pain? There is no non-political reason for a board to require its licensees to use an unnecessarily harmful tool. To present it as a possibility is an embarrassment to the profession.

While some auto insurance and worker’s compensation will reimburse for dry needling, for the most part Trigger Point Dry Needling is not a billable service when performed by a physical therapist. It is considered “experimental and unproven” by Medicare and major medical insurance companies. And, if it were true that PT’s were getting rich on reimbursements for this technique, is that an argument against allowing them to perform an effective procedure? Don’t we support people getting relief from pain, regardless of who is paying the bill?

It would be tragic if we were successful in requiring everyone using a filiform needle to use the term acupuncture while losing the battle to prevent non-LAcs from performing the technique. Given various rulings of state AG’s, and of the regulatory boards responsible for other professions, this is a strong possibility. Then, we will have lost our ability to distinguish what we do from what others do. (And, ironically, would help PT’s obtain reimbursement.)

We had decades to establish ourselves as the experts in this technique. We didn’t, and, frankly, many of us are unpracticed with it and uninterested in making it a major part of our clinic offerings.  Addressing unfair reimbursement scenarios is reasonable. Respectfully presenting evidence-based concerns about risks to the public is part of our civic duty. Our ongoing panicked response to TPDN, with arguments based on misinformation or a misunderstanding of such basic topics as scope and the regulatory process, culminating in the argument in Acupuncture Today – that it’s okay as long as it hurts –  is the real threat to our reputation and our future.

I encourage you to read all of my posts on this topic (you can get them via the categories or tags on the homepage) and on scope of practice. It is time for the acupuncture profession to stop shooting itself in the foot.

News Update

and a bonus at the end —

October 1st, NCCAOM, Facbook —

 NCCAOM has received a significant volume of responses, and the results of this feedback will be taken into consideration during the development of the final policy and standards, as NCCAOM continues to strive for increased customer satisfaction. We are always eager to hear your suggestions for changes that will benefit you, the Diplomate, and the AOM profession overall. It is with your feedback that we can continue to meet your needs.
We are listening!

Spin?

October 2nd, date of scheduled AAAOM Town Hall, AAAOM website —

Legislative Town Hall

CALL POSTPONED – DATE TO BE DETERMINED

No additional news.

October 9th, Richmond, VA, Meeting of Virginia Acupuncture Advisory Board.

Agenda includes discussion of an alternate path to licensure due to conflicts between Virginia law and the NCCAOM proposed policy changes.

The representative from the state association (ASVA) was against any discussion of the NCCAOM issues. ASVA stated  — “lowering of standards…would do harm to both our profession and the public.” Who mentioned lowering standards? Is there evidence that anyone is harmed in states that do not rely on the NCCAOM credential?  Here is my post-meeting email to the association  –  ASVA comments.

The NCCAOM rep at the meeting was clear — the proposals were just proposals, stakeholder comments will be taken into consideration, any language referring to the effective dates of the changes was referring to effective dates for the proposed changes, not the actual changes. I envisioned someone pedaling backwards.

Questions of the Day — We attack when another profession “interferes” with our practice (DVM’s “stealing animal acupuncture”, PT’s “stealing acupuncture”, MD’s wanting to see our patients) even when we have little or no power to change anything. Why are we unwilling to even discuss it when an organization supported by our money, controlling our profession, at our request, takes action that costs us or limits us? We made a difference this time (we hope) – why aren’t our professional associations helping?

Here is a new page on Legislation and Regulation. It contains important and valuable information. Please, read it and pass it on.

I’ll be working on a page about the Acupuncture orgs (the alphabets) and another for potential acupuncture students in the coming weeks.

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.

To Wit, Hypocrites with Double Standards?

This will be it (I hope) regarding dry needling for a while.  Just these last few points which are pertinent to other discussions.

Will Morris concluded his AT article with this  — “To wit: let us pursue a collaborative process of developing inter-professional competencies. Remove biomedicine and herbal medicine courses from the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) standards. Then, take what is left over in acupuncture programs as the starting place for a dialogue for portable competencies….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.”

My comments  –

1)    Collaborative processes don’t start with a one-sided statement of the starting point.

2)      Why stop with removing only biomedicine and herbal medicine from the ACAOM standards?  An incomplete list of things I was taught in my ACAOM accredited program that seem unnecessary for the education of a licensed PT who wants to use an acupuncture needle to stimulate a trigger point: tai chi, qi gong, pulse diagnosis, tongue diagnosis, point location, point indications, the officials, the five elements, business development, TCM principles, and the Classics. I have yet to find a colleague who could come up with more than 40 hours of content – Day 1: contraindications, risk factors, areas in the vicinity of forbidden points, reasons to refer.  Day 2: Clean needle technique, Day 3-5: Needle technique, practice and a review of reasons to refer. Seems like anything more and we are encouraging these practitioners to move beyond trigger point release.

4)      As a member of a regulatory board, I believe it is important to hear from educators when exploring issues of scope, or really, any issue. On the other hand, when NCCAOM sent two representatives to a Virginia board meeting to explain why requiring licensees to maintain current NCCAOM Diplomate status was critical to protect the public I did feel it was self-serving. So, to those making this argument, will you agree to it across the board? If there is any exploration about licensure requirements for LAcs will the schools, NCCAOM, ACAOM, and any other organization that “stands to profit” keep silent on behalf of the common good?  Some may say this violates the First Amendment, but as long as everyone agrees to abide by this limitation, I’m willing to give it a try.

Who is a Word-Trickster?

Will Morris, in Acupuncture Today, writes — ” ‘Word-tricksters’ – as I like to call them – change language in order to gain personal advantage.”

I haven’t received much input on my questions about nomenclature, but in my conversations with practitioners around the country I haven’t found any agreement or clarity about where acupuncture begins or ends.

I do have a question for Dr. Morris and the others who have been so insistent that the other professions should use “acupuncture” rather than “dry needling” or any other term. Would folks be happy with an outcome in which all professions agreed to use the term acupuncture for anything that used a filiform needle, but in which the LAc community still had no say in the regulations, education requirements, and scope for those professions?

The acupuncture community would not see that as a win. I believe that the people arguing for the global use of the term acupuncture are doing so because they think it will give them control over the procedure — that is, to gain personal advantage.  Doesn’t that make us the Word Tricksters?

In the meantime, based on youtube videos and discussions on various list serves, my colleagues are very interested in being able to draw distinctions between how they use needles and how the PT’s and others use needles.  Wouldn’t insisting on the use of the term “Dry Needling” help?

 

 

A Rose, Redux!

Again, there has been an issue with my last post not being sent to subscribers or showing up on the media sites.  Because I want community feedback before posting part 2 I’m hoping this attempt will fly through cyberspace as intended.  Thanks for your patience.

A Rose?

I would love to leave the TPDN/Dry Needling issue behind. I also believe that if we explore why what we’ve been doing hasn’t been working we’ll end up empowered rather than defeated.

Many colleagues have been referring to this Will Morris article in AT. I hope you’ll bear with more frequent posts over the next few days as we spend some time pondering his points.

A question for the community – is a key factor here the use of an acupuncture needle?

When an MD injects cortisone into a sore spot, is that acupuncture?  Is a vaccination acupuncture? What if a syringe is used to draw fluid out of an area – is that acupuncture?  Is the injection therapy done by some LAcs acupuncture? What about use of a tuning fork or a laser at a point – is that acupuncture?

What about the use of an empty hypodermic needle to stimulate a sore spot?  At what point does the use of a syringe become acupuncture? Or, is the use of the filiform needle the thing that makes a procedure acupuncture?

I’ll see if you have any input before I share my thoughts.