By Stuart S. Shipe, RPh, DOM, Dipl. Ac & CH (NCCAOM)
This is the intention for which I feel some acupuncturists long, with phrases such as "We need to be recognized as an equal in the profession," or "We should be given the same stature as an allopathic physician." Should we be responsible for bringing our Western medical knowledge up to a level equal to that of a Western medical physician? Very few allopathic physicians who I know feel the need to know what I do as an acupuncturist, let alone speak my language of Chinese diagnoses. Yet, acupuncturists pursue practices and education that model the Western paradigm and when it doesn't fit just right, become discouraged and feel suppressed.
I recently attended a seminar on infertility given by an advocate fellow of the American Board of Oriental Reproductive Medicine. Prior to registering for the seminar, I had read the discourse in Acupuncture Today on the creation and necessity for specialty boards in Oriental medicine, both pro and con. I registered for the seminar due to the fact that I have patients currently in my practice with infertility issues. I am always interested in looking for ways to improve my skills and success in creating balanced healing. Thus with an open mind, I attended the seminar. It was a review lesson in Western reproductive theory and an attempt to correlate Chinese medical theory to fit into the Western paradigm. The speaker voiced his belief that specialization in this type of medicine was needed to ensure that both the public and MD would view board-certified reproductive acupuncturists as having specific knowledge in reproductive therapy, as proven through testing and some sort of elevated stature among our peers. The second reason to become board-certified was to be able to identify those acupuncturists who could be used as referral sources within "the group" for any patient seeking infertility treatments.
What may just happen is that the message being sent to the public is that acupuncturists are beginning to look just like a Western medical specialist. Think about this "what if"; In order to become reimbursed by insurance companies in the future for infertility treatments, you must be board-certified. You may be held liable as a board-certified traumatology acupuncturist or board-certified pediatric acupuncturist if you treat a dysmenorrhea gynecology case. You can now bill more for your care because you're a specialist, making your care out of the reach of most patients. There are now very few board-certified "family practice" (oops, this is a specialty too) acupuncture physicians out there because no one will see patient Joe Smith for a common wind-heat invasion. You'll have to refer that headache to a neurological acupuncturist for fear of not knowing enough about the pharmacology of herbs that dilate or constrict cerebral vascular vessels because you are a sports medicine acupuncturist. Or would that be your board-certified Chinese herbalist acupuncturist? See where we've already begun. I took my optional NCCAOM boards in herbology because I predicted that once insurance companies started paying for herbal therapy, they would only pay for therapy prescribed by a board-certified herbalist. I've been down this road before.
I have been registered as a pharmacist in Florida for more than 22 years, practicing acupuncture for only the last eight years. I envision my profession in acupuncture beginning to head in the same direction as pharmacy. We now have a clinical doctoral entry-level degree program in pharmacy that wasn't there 20 years ago when I graduated with a bachelor's degree. There are board certifications in nutrition support, geriatrics and oncology. If you want to be reimbursed for diabetes care from an insurance payor, you now need to be certified as a diabetes educator. I thought to myself, upon graduation as a pharmacist, "I once was quite capable of taking care of a diabetic patient, but now that there's a certification. Am I no longer capable?"
There are retail pharmacists (both chain-store and independent), hospital pharmacists, consultant pharmacists, nuclear pharmacists, etc. The profession has become so fragmented that no one can agree on what direction the profession is going. One year, the Florida State Pharmacy Association attempted, through their house of delegates, to present a resolution to the state legislature for ratification and there was so much disagreement as to the vision that the legislature rejected any resolution from the organization, instructing them to come back when they had a unified voice. Is this where the profession of acupuncture is heading? Do you want to go there?
The Tao of Chinese philosophy states to forge your own way. Do not be a follower but a leader and learn from the past. I love acupuncture because it really is an art. An art that is so versatile that it can be crafted by practitioners from many different schools of Chinese medical theory, all arriving at a healing destination for their patient. The Chinese belief is that there are many roads that lead to the same destination. If I want to be skilled in a certain area of medicine such as herbal therapy, geriatrics or infertility, I will attend selected seminars, or read various journals or books regarding the topic. The books are not written by specialty board-certified acupuncture physicians. They are written by acupuncturists who perhaps have an affinity for, or gain repeated experience in, treating one certain disease pattern over another.
I have been fortunate enough to spend time in China, having done rotations in various Chinese hospitals. I've used this experience to understand the foundational premise of Oriental medicine; to capture its spirit. In China, a graduate resident in medical school often does not have a choice of residency. They are placed under a seasoned physician to train in various departments of gynecology, surgery, dermatology, tuina, acupuncture, etc., and then placed wherever there is availability in a department of preference. I did not see specialists or a fragmented medical discipline in China. I only heard of practitioners who were famous in various disciplines due to extensive work or research in that area. A resident was lucky to be assigned to a famous physician for training especially if the physician was experienced in the resident's department of interest. The Chinese physician will be in post-secondary school for up to 11 years, having options to stop at a master's level and teach or continue on to a doctoral research level. Upon graduation, the Chinese physician has been trained in the balance of yin and yang, Western and Eastern medical theory and practice, and writing for drug and herbal therapy.
In the United States, the Western yang medical principles practiced by allopathic and osteopathic physicians are very well-balanced with yin Eastern medical principles practiced by licensed acupuncturists. Those who seek to study the herbal classics and further advance their clinical skills or research interests are applying for doctoral (DAOM) programs. I see this as a mirror of the current education system in China; an attempt not to seek specialization but to hone clinical skills in various applications, investigate research that further strengthens Oriental medicines efficacy claims, and develop new indications for ancient treatments. These practitioners are also learning to work as an interdisciplinary team members in institutional care and perhaps will seek to become educators of our profession for the future.
I will continue to educate interested Western medical physicians about the type of care that I deliver in a holistic, balanced, patient-centered manner. I will eagerly await the day I hear an allopathic physician say, "I want to be an acupuncturist." It will be on that day that the allopathic physician will be recognized as an equal in my world. There is a saying in Chinese: "Zhi ji zhi bi, bai zhan bai sheng" that translates as "If you know (understand) yourself very well and also know (understand) the other party (enemy), you will always succeed (have a hundred fights and a hundred wins.)
Dr. Stuart Shipe is an acupuncture physician in private practice in Port St. Lucie, Fla. He is also a consultant pharmacist with experience in allopathic Western medicine.