In the April issue, Acupuncture Today provided the opinions of more than 15 schools and associations on Assembly Bill 1943, a highly-debated piece of Oriental medicine legislation that has been introduced in the California legislature (see "Political Storm Brewing in California").
Due to editorial deadlines, some organizations were unable to submit their statements in time for publication. In the interests of the profession, those statements that were received after the April issue's deadline are included in this issue for review.
The National Certification Commission for Acupuncture and Oriental Medicine
The job of certification and accreditation organizations is to distinguish among individuals and institutions in an objective fashion. Accredited certification programs such as the NCCAOM's use job analyses and other psychometric procedures that have been established by the industry as the appropriate formula for setting standards and testing individuals. Accreditation organizations such as ACAOM that are approved by the U.S. Department of Education likewise follow set protocols as they establish standards. Specifically, highly regarded panels of educators, after years of study and countless opportunities for public comment and testimony, set standards that are deemed fair and sufficient for safe and effective practice. Certification and accreditation programs must also continually demonstrate autonomy from the pressures that typically come from societies that represent the interest of the profession. It has been historically recognized that professional societies have interests that can at times compete with the goal of protecting the public welfare. For example, in an effort to protect the financial interests of its members, a society might make an entry-level exam more difficult or increase the number of hours deemed necessary to practice in an attempt to limit the number of people entering the profession. For these reasons, certification and accreditation programs that undergo peer review, that set standards using a prescribed, consensus process, and that remain at arm's length from the profession, are viewed as the best reference for state legislatures as they define and update practice acts and related eligibility standards.
Christina S. Herlihy, MA, PhD Chief Executive Officer
Five Branches Institute
First, I would like to pay tribute and honor the pioneers, the grandfathers and grandmothers, that worked over the last 30 years to establish the profession of acupuncture and oriental medicine in the US. Visitors from China are impressed on what we have accomplished in 30 years: licensure standards; a national certification exam; degree granting status for colleges of acupuncture and Oriental medicine; and standards for a doctoral level education. And I would like to pay tribute to China, which over 60 years ago made the powerful statement of asking that traditional and modern medicines walk together and in parallel, thereby bringing traditional Chinese medicine from the villages and individual practitioners into their universities and hospitals.
Today, I especially wish to honor the individuals who invested time and energy to define and establish the standards of our 4,000-hour doctoral program. This level of education translates into giving deep roots to our profession and the possibility of a bright future with high-level healthcare in acupuncture and Oriental medicine.
On the topic of Assembly Bill 1943, while we concur that the development of our profession requires us to increase the hours of training, we need to do this on a solid foundation. This foundation is now available through the national 4,000-hour doctoral accreditation standards. Bill 1943 does not build on this foundation. We support raising the present standards of the master's degree requirement to 2,600 or 2,800 hours, and we support establishing our profession at a 4,000-hour doctoral level in the future. But for this, we first need to lay the foundation and have the majority of California colleges with accredited doctoral programs. Galileo may have wished to fly to the moon, but without modern science education, it was impossible. We can be licensed as doctors of Oriental medicine, but for this we need accredited doctoral level education.
Ron Zaidman, MBA, MTCM Chief Executive Officer
Editor's Note: The following is a copy of a letter sent to Assemblywoman Chu on March 7, 2002.
American Federation of Government Employees, Local 2391 (AFL-CIO)
We are in support of AB 1943. This bill will assure patients of greater safety, improved research and training for better effectiveness, and gives acupuncturists educational equity with all other medical providers thus paving the way for increase participation in the American healthcare system and enabling our profession to help more people.
Barbara Brandt President
Pacific College of Oriental Medicine
I am very concerned about the recent introduction of AB 1943 by Representative Chu. Not only does this bill circumvent the charge of the California Acupuncture Board's Task Force on Educational Competencies, it seems to be counterproductive to recommendations emanating from the Joint Legislative Sunset Review Committee, headed by Chairwoman Senator Liz Figueroa. These two efforts along with others have concluded that Oriental medicine is not only safe, but it is cost-effective and has a very supportive consumer base. The message is simple: acupuncture works, and the colleges are doing an outstanding job of bringing this Asian medicine to our culture! This bill would push us in a direction that is dangerous, and it should be withdrawn at this time.
According to the most valid and recent survey data (i.e., California Occupational Analysis Study, 2002), the percentage of biomedical tasks and competencies currently being used in practice is reported as approximately 8-9 percent of the total tasks and knowledge required to practice acupuncture in the state of California. The current curriculum requires 558 bioclinical hours, which is approximately 24 percent of the required training for biomedicine/clinical sciences. The newly introduced AB 1943 would increase the biomedical hours by another 34% (to 750 hours) by 1/1/2003, and 79% (to 1,000 hours) by January 1, 2007! It is obvious to me that this is unwarranted!
Although licensed practitioners are trained as primary care providers within their scope of medicine in California, this does not mean they are trained or required to practice Western medical procedures. For example, they do not have hospital privileges nor do they prescribe drugs or do surgeries as well as many other procedures that even MDs have to be board certified (to do) before they can safely practice or be admitted within a hospital context. A licensed acupuncturist should only be trained in the basic Western medicine procedures and nomenclature that help them to be better Oriental medicine practitioners. Those LAcs who want to practice advanced biomedicine competencies should complete appropriate medical certification training programs. As indicated, this is common in Western medicine (i.e., board certification in over 10 specialties), and we are starting to do this in our medicine (i.e., NCCAOM certification in acupuncture, Oriental medicine and, recently, bodywork). Why not put our combined efforts into developing a certification program in biomedicine for OM? An integrative certification program would accomplish the objectives in this area.
The decision to increase bioclinical hours is partially based upon political motivations, but I do feel there is a justified need for advanced training in biomedicine as it relates to our field. However, this does mean we need to force this training upon those practitioners that do not want to expand into Western medicine. My concern is that if we do this, then these procedures become part of the scope and every licensed acupuncturist in the state will have to be competent in these procedures, whether they want to or not. The liability ramifications are enormous! Our field is expanding with new translations and research information forthcoming daily. Let's reserve our training hours for our own medicine, which has much less liability attached to it!
My final observation about our field is that more and more naturopathic and chiropractic colleges are offering OM programs. With this 79% increase in Western medicine within our programs, the naturopathic and chiropractic colleges stand to benefit greatly because they already have the faculty and the facilities in Western medicine. As the economics increase in our field, these colleges will be more motivated to take over the OM field. We need to stick to what we do best: teaching this wonderful Asian medicine.
In summary, AB 1943 does have some positive language that should be considered, e.g., inclusion of the "Oriental medicine" language, omitting "human" in the law, and the changing of how herbal "medicine" is treated within the language. However, this bill should be withdrawn if the intent is to mandate hours without substantial evidence that such hours are needed. It will detract from what we in the field need to be concentrating on and that is the development of legitimate doctoral programs in Oriental medicine.
Tom Haines Director of Academic Affairs
In addition, the Council of Colleges of Acupuncture and Oriental Medicine has issued a response to the "Open Letter to the Profession" authored by Ted Priebe, president of the National Guild for Acupuncture and Oriental Medicine, which follows below.
Dear Mr. Priebe:
The comments below are in response to your "Open Letter to the Profession" dated March 2, 2002.
In this letter, you make several erroneous comments. These comments are consistent with those made by a few practitioners, and not consistent with the view of many in our profession, including many licensed acupuncturists. In addition to pointing out the errors listed below, we would like to strongly encourage you to be more accurate, and communicate in a way that will encourage dialog, rather than continue to publish the divisive and acrimonious innuendos that makes up much of your letter.
The first problem concerns communication with elected officials. In a democratic society, communication with elected or appointed state officials does not constitute undue influence of that official. It is the obligation as well as the right of members of our society to communicate with elected and appointed officials in our government about how we feel. If we feel that a position, proposed legislation or any other issue is a threat to our profession, we have an obligation to point this out to those in a position to impact our profession. There has been no attempt by any member of the Council of Colleges to hide our position on any issue, unduly influence any state officials beyond educating that individual regarding our position on issues within our profession. Nor is it a conflict to employ the services of a lobbyist, something you clearly cannot object to since there is a lobbyist supporting your position.
Your assertion that AB 1943 will "assure greater safety, improved training for better effectiveness, and gives acupuncturists educational equity with all other medical providers thus paving the way for increased participation in the American healthcare system" is also clearly incorrect. The first error is the assumption that the number of hours, or the increase in the number of hours, will result in increased competency of a graduate. Competency is based on the quality of the education, not the number of hours devoted to it. What is done during those hours, how the curriculum is conceived, managed and executed, and the quality of the teaching is of paramount importance. It is also not true that arbitrarily increasing hours to 3,200 hours or even 4,000 hours will result in parity or increased participation in the healthcare system. The participation we enjoy in our healthcare system, and the respect we enjoy from our colleagues, is dependent on the quality of our work and the satisfaction of our patients, not on statutory changes in the hours required to graduate in one state.
Your renewed assertion that the members of the Council of Colleges of Acupuncture and Oriental Medicine are opposed to improving our profession is a clear statement of your lack of understanding of this profession. The educational institutions that make up the Council of Colleges reflect the diversity and richness of our profession. Those of us who are involved in the educational institutions in acupuncture and Oriental medicine are made up of acupuncturists, educators (and) researchers, all who put many hours, often unpaid, into improving the education our graduates receive, and our profession at large. The results are clear and unambiguous. Our patient satisfaction level is high. Our safety record is unparalleled in the healthcare industry. The recognition of the Accreditation Commission for Acupuncture and Oriental Medicine by the United States Department of Education and the recognition of the National Certification Commission for Acupuncture and Oriental Medicine by the National Commission for Certifying Agencies of the National Organization for Competency Assurance reflects that very high standard that ACAOM and the NCCAOM have set for our education and certification of our graduates.
Our participation in the California Acupuncture Board Competencies and Outcomes Task Force does not reflect a belief on our part that our curriculum is deficient or not in compliant with current California law. Our participation is representative of our ongoing effort to participate in dialog with other members of our profession on the issues affecting all of us, and to continue our ongoing efforts, efforts that long predate the task force, to assess and where needed improve our institutions and our profession.
We must once again correct your assertion that your interpretation of "primary care provider" requires massive changes in the current educational requirement. As was pointed out by Donald Chang, attorney for the California Acupuncture Board, our status is based on a statute that requires us to be able to assess and treat based on the principles of Oriental medicine, and make an assessment for the basis of referral, a requirement consistent with independent provider status. The nomenclature in the current acupuncture law reflects this point. We as acupuncturists are independent providers. This position was again supported by statements made to the task force by Stephen Rosenblatt, MD, LAc, one of the framers of the current acupuncture law. Your implication that the educational institutions are not currently training independent providers is not correct. Your misinterpretation of current California law is a disservice to the profession and the public.
The position of the Council of Colleges of Acupuncture and Oriental Medicine is that the people of the state of California are best served by the following.
All California approved schools should be required to have accredited or have candidate status with the Accreditation Commission for Acupuncture and Oriental Medicine. This is the best way to insure that all candidates for licensure have the best possible education in acupuncture and Oriental medicine.
There is no demonstrated need to raise educational hours. Our graduates are very competent, patient satisfaction is high, and the field's safety record in California and nationally is superb. The adverse financial impact on students, institutions and patients would be very high should the hours be raised to the 3,200 to 4,000 hour level.
Licensure should in part be based on the successful completion of the acupuncture and herbal exams administered by the National Certification Commission for Acupuncture and Oriental Medicine.
Acupuncturists should continue to assess their patient within the scope of acupuncture and Oriental medicine, and a limited biomedical assessment for the purpose of making referrals to biomedical practitioners and insurance billing.
Liza Goldblatt, PhD, President, Portland OR Jack Miller, MEd, LAc, Vice-President, San Diego, CA Barbara Ellrich, Treasurer, Columbia, MD Lixin Huang, MS, Secretary, San Francisco, CA Shen Ping Liang, PhD, LAc, Member-at-Large, Houston, TX Steve Given, LAc, Member-at-Large, Seattle, WA
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In anticipation of the discussion Assembly Bill 1943 is sure to generate, Acupuncture Today has created a special AB 1943 section on its discussion forum. To visit the AB 1943 section, type www.acupuncturetoday.com/forums on your Web browser, click on the "Open Forum" link and select Assembly Bill 1943. You must register before you can post a message or reply.
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