The Bottom Line on Acupuncture
By John Amaro, LAc, DC, Dipl. Ac.(NCCAOM), Dipl.Med.Ac.(IAMA)
With the majority of the states now licensed or seeking legislation to license the
practice of acupuncture, there seems to be a growing resentment between
acupuncturists and medical/chiropractic physicians who are also engaged in the
practice of acupuncture.
In most states, in order to be awarded a license to practice as a “licensed
acupuncturist” (LAc), a practitioner must possess a graduate degree from an
acupuncture college in excess of 1,850 hours, and be certified through
examination by the National Commission for the Certification of Acupuncture and
Oriental Medicine, which has become the standard for the profession. After
putting so much time, money and effort into school, graduating, completing the
national examination, and preparing to embark on a career of healing in
acupuncture and Oriental medicine, it can be quite disheartening for the
acupuncturist to see medical and chiropractic physicians utilizing acupuncture
after completing a seemingly disproportionate number of hours in the academics
of Oriental medicine.
It is important to understand that the licensed acupuncturist (LAc), having
attended and graduated from a typical school in the United States, has had the
majority of his or her education centered around acupuncture – not just as a
modality, but the theories, philosophies and procedures of the entire system
known as “Oriental medicine.” (“Traditional Chinese medicine” [TCM] is the most
commonly used term to describe the practice of Oriental medicine in America.)
The acupuncture profession, relative to the “LAc,” as opposed to the
medical/chiropractic physician who utilizes acupuncture, has set its practice
description in stone through the naming of its national organizations. Every
national organization, and the vast majority of colleges, have the words
“Oriental Medicine” or “Chinese Medicine” in addition to “Acupuncture” in their
names. This shows a definite descriptive distinction between the practice of
“acupuncture” and “Oriental medicine” as it is always listed as
a separate and distinct entity. The word “and” becomes
extremely significant in terms of general description and scope of practice.
The Accreditation Commission for Acupuncture and Oriental Medicine
(ACAOM), established in 1982, acts as an independent body to evaluate
first professional masters and certificate/diploma programs in Oriental medicine
with concentrations in both acupuncture and herbal therapy. The commission is
recognized by the U.S. Department of Education. A definite distinction is drawn
between acupuncture and Oriental medicine, as its name implies.
The ACAOM was established in 1982 by the Council of Colleges of
Acupuncture and Oriental Medicine (CCAOM), which was established to
advance the status of acupuncture and Oriental medicine in the U.S. The council
has developed the academic and clinical guidelines and core curriculum
requirements for master’s-level programs in both acupuncture and Oriental
medicine. Curricula for doctoral-level programs have been developed for both
acupuncture and Oriental medicine. Again, the distinction between acupuncture
and Oriental medicine must be noted in its name.
The National Certification Commission for Acupuncture and Oriental
Medicine (NCCAOM) was also established in 1982, to promote nationally
recognized standards of competence for acupuncture and Oriental medicine. It was
originally known as the National Commission for the Certification of Acupuncture
(NCCA). The words “and Oriental Medicine” were added several years later to more
accurately depict the commission’s full scope. NCCAOM certification is the basis
for licensure in more than 90 percent of states that have set standards for the
practice of acupuncture. It is imperative to note the clear-cut distinction
between acupuncture and Oriental medicine in its name.
The Acupuncture and Oriental Medicine Alliance is a national
professional membership association founded to represent the diversity of
practitioners of acupuncture and Oriental medicine practitioners in the U.S. A
clear-cut distinction between acupuncture and Oriental medicine
is seen in this national organization’s name.
The American Association of Oriental Medicine (AAOM),
established in 1981, is a professional organization whose mission is to promote
excellence and integrity in the professional practice of acupuncture and
Oriental medicine. Membership in the AAOM provides Oriental medicine
professionals with the opportunity to achieve full recognition of professional
status from the medical community at-large through involvement with AMA policy
issues and lobbying of Congressional members. It is important to note that this
organization does not have “acupuncture” in its name; however, it does draw a
clear-cut distinction between acupuncture and Oriental medicine
in its mission statement.
Most states allow acupuncture by medical professionals through proprietary
license: the license to practice any medical procedure, regardless of
educational background in that field. The chiropractic profession has, on its
own merit, established 100-300 hours of postgraduate education for the practice
of acupuncture as an adjunct to chiropractic. The chiropractic profession has
been intimately involved with the academics and practice of acupuncture since
1972, through the postgraduate department of nine federally recognized
chiropractic colleges. It has never focused its attention at any academic level
on the practice of “Oriental medicine” until the development of the three-year
acupuncture and Oriental medicine programs offered by several of the respected
chiropractic colleges that have added the full program to their curriculae.
The acupuncture programs offered by both the medical and chiropractic
profession have come under criticism by the general acupuncture profession,
primarily because of their length. Course content and core curriculum have never
been an issue regarding professional acupuncture programs – only the length of
the classes. At 100-300 hours per program, most acupuncturists who have attended
a 1,850-hour college program find this disgustingly inadequate.
However, it should be noted that the didactic and clinical acupuncture
programs offered in either the medical or chiropractic profession focus
specifically on the practice of acupuncture, not the complexities of “Oriental
medicine.” It is the study of traditional Chinese medicine and “Oriental
medicine” that adds the vast majority of hours to the curriculae of the
acupuncture schools. Medical and chiropractic programs have historically been
interested in general acupuncture as their primary focus.
For a medical or chiropractic physician to even enter into a postgraduate
program for acupuncture certification in the United States, he or she must have
accrued at least 4,250 hours of science-based curriculae with the attainment of
a “doctorate” degree. These programs specifically deal with “medical/clinical
acupuncture” and are geared as an adjunct for the Western-based practice.
Within the past two years, the chiropractic profession has established a
national certification in acupuncture through the National Board of Chiropractic
Examiners (NBCE). The NBCE has been the undisputed standard for the examination
process in the chiropractic profession for more than 40 years and is recognized
by every state licensure board in the U.S. This examination is offered to
practitioners who have completed a recognized postgraduate acupuncture
certificate program that includes bloodborne pathogen awareness. The examination
is a 200-question examination, the same length as the exam offered by the
NCCAOM. The NBCE acupuncture examination will be the standard for clinical and
educational competence for doctors of chiropractic practicing acupuncture in
this country.
The American Chiropractic Association recently formed the “College of
Acupuncture,” creating the status of “diplomate” for those who have excelled in
the field of acupuncture through additional postgraduate hours of education, in
addition to passing the rigorous final competency examination. This
certification is in addition to that administered by the NBCE.
The DCs and MDs who currently practice acupuncture, and the thousands who
will join the ranks of practitioners in the next three to five years, have all
taken comprehensive, accelerated, academically complete programs in clinical
acupuncture which have made them formidable practitioners. Their knowledge is
significant of Five Elements, point selection and location, auriculotherapy,
musculo-tendino and Extraordinary Meridians, and stimulation modalities, along
with the myriad general acupuncture principles. Even though it is impossible to
present an acupuncture program without entering into the realm of “Oriental
medicine,” this is not the focus of these programs.
Those medical and chiropractic practitioners who utilize acupuncture (which,
incidentally, have numbered in the tens of thousands since 1972) have shown
little interest as a profession in practicing the complexities of “traditional
Chinese medicine.” It is here where the contemporary practitioner (LAc) will
have the most significant impact in cooperation with the medical and
chiropractic professions.
Since few in the medical or chiropractic professions have an academic or
clinical interest in exploring the full range of “Oriental medicine” to add to
their busy practices, it would be advantageous if the acupuncture profession did
not distance itself from those who can help it the most – through referrals. In
speaking to many of my medical and chiropractic colleagues, I have found a
considerable number who have experienced total animosity from the acupuncture
profession, because the acupuncturists feel their professional training and
education to be superior. “Why should they be able to practice with so few
educational hours?” is a common complaint. In the meantime, due to strained
relationships experienced through the legislative process in the attainment of
state licensure, the acupuncture, medical and chiropractic professions have put
up walls of defense in an attempt to distance themselves from each other.
This is exactly the opposite of what should be happening. Acupuncturists
today should make the stand that they are the experts in “Oriental medicine,”
recognizing that there are physicians who are likewise performing acupuncture.
It is the “Oriental medicine” qualification that makes them so much different
from the other professions. If this were to occur, there would be a newfound
relationship between the medical and chiropractic practitioners and the
acupuncturist – resulting in increased respectability and referrals for all.
The Bottom Line
There are, without question, a number of styles of acupuncture that are
easily assimilated into medical and chiropractic clinical practices as an
adjunct to already existing practices. Few, if any, medical or chiropractic
practitioners want to become acupuncturists (or specialize in Oriental medicine)
as their sole focus. If DCs and MDs are using acupuncture, it is in conjunction
with an existing Western-style practice. Acupuncturists should hold themselves
out to be the uncontested authorities in “Oriental medicine,” as every
organization and most schools have those words and mission in their names. MDs
and DCs practicing acupuncture are not going to give up their right to utilize
acupuncture, and more states will undoubtedly allow doctors of chiropractic the
right to practice acupuncture. With the aforementioned NBCE certification in
acupuncture in place, this is a given.
We can all coexist and thrive together as professions, as long as we are able
to put aside the animosities that have inundated us from the beginning. There is
absolutely no room for name-calling or discrediting one another, especially at
the legislative level. It is my wish for 2004 that the professions move forward
with peace, harmony and mutual respect. By doing so, each of us will see an
increase in patient base and personal satisfaction.
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