2016 Acupuncturist Landmarks in Focus
Public Policy Committee
The CDC recommends nonpharmacologic therapy as frontline treatment for chronic pain.1
Acupuncture is more effective than intravenous morphine in the Emergency Department, 2 according to a study published in the Journal of Emergency Medicine.
A recommendation to establish a new code for this distinct occupation, “29- 1291 Acupuncturists,” is made by the Bureau of Labor and Statistics (BLS) Standard Occupational Classification Policy Committee (SOCPC). 3
When providing services in health system and hospital facilities within 43 states, licensed acupuncturists are credentialed as Licensed Independent Practitioners to be in compliance with The Joint Commission quality assurance standard for healthcare system accreditation. 4
46 states regulate the profession [47 as of 3/6/2017], clearly defining educational, credentialing, and practice standards.5
The Kansas Acupuncture Practice Act is signed into law by Governor Brownback in May 2016. 6 [Governor Matt Mead signs the Wyoming Acupuncture Practice Act into law on 3/6/2017].7 Proposed acupuncturist licensing laws are considered in the three remaining unregulated states.
The American Association of Acupuncture and Oriental Medicine (AAAOM) historic federal bills debut in the U.S. Congress as the “Acupuncture for Heroes and Seniors Act of 2015.” Sponsor Congresswoman Judy Chu champions the proposed law which permanently opens access to qualified licensed acupuncturists by veterans, military, seniors, disabled, and more.8
Congress and the United States Department of Veteran Affairs modify the operating parameters of the temporary VA Choice Program, and TriWest receives approval in January 2016 to extend clinically authorized episodes of care as appropriate for certain conditions, from the previous 60 days, up to one year. 9 [Claim payments are brought current in January 2017.] 9
1. Center for Disease Control. 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. [Online]. [Cited: January 9, 2017.] https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
2. Grissa, Baccouche, et al. Acupuncture vs intravenous morphine in the management of acute pain in the ED. American Journal of Emergency Medicine. 2016;34(11):2112-2116.
3. Bureau of Labor and Statistics (BLS) Standard Occupational Classification Policy Committee Standard Occupation Code Docket 2018 Response. [Online] [Cited: January 9, 2017.] https://www.bls.gov/soc/2018/soc_2018_docket_responses.pdf
4. Gale, M. Hospital Practice: Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP) Meridians. 2016; 3(4): 11-16. [Online] [Cited January 9, 2017] http://www.meridiansjaom.com/files/MERIDIANSJAOM_A003.4.pdf
5. Gale, M. Ho Hospital Practice: Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP) Meridians. 2016; 3(4): 11-16. [Online] [Cited January 9, 2017] http://www.meridiansjaom.com/files/MERIDIANSJAOM_A003.4.pdf
6. Kansas Acupuncture Practice Act 2016. [Online] [Cited January 9, 2017] http://www.kslegislature.org/li_2016/b2015_16/measures/hb2615/
7. Wyoming Acupuncture Practice Act 2017 [Online][Cited March 7, 2017] http://legisweb.state.wy.us/2017/Enroll/HB0165.pdf
8. H.R.3849 (114th): Acupuncture for Heroes and Seniors Act of 2015. [Online] [Cited January 9, 2017.] https://www.govtrack.us/congress/bills/114/hr3849/text
Guest Blogger: Steven H. Stumpf, EdD
COMPARISON OF THE TWO “BEST” ACUPUNCTURIST WORKFORCE SURVEYS
The 2015 OA and the 2013 NCCAOM Job Task Analysis are state of the art when it comes to describing how acupuncturists go about earning a living. Knowledge of acupuncturist work habits has been slightly better than hearsay. My co-authors and I prepared a manuscript that compares the findings from the two surveys. Findings were not too unlike what myself and co-authors found in our 2010 publication on the same topic.
Before we get to the findings I would like to discuss why these are so important now. The US Bureau of Labor and Statistics (BLS) recently announced that acupuncture would receive its own SOC – Standard Occupation Classification. There has never been a singular SOC for acupuncture before, the reasons for which are not relevant now. The “award” of our own SOC is important because (i) acupuncturists are now recognized as a distinct medical/health profession, and (ii) the profession must collect its own workforce survey data.
If acupuncturists had jobs along the lines of nursing, physical therapy or imaging technology then the federal government would collect the data. However, because three quarter of all acupuncturists work in a private practice of some kind we must collect our own data; at least if we do not want to wait until five or six years when the IRS will collect our data from individual tax returns. I suppose we have waited more than thirty years we can wait another half dozen. However, waiting that long would delay benefits available to health professions that can help and improve work prospects for the profession. An example would be eligibility for training funds to support expansion, especially into the mainstream.
Our paper Comparing Workforce Outcomes for the Two Most Recognized Acupuncturist Workforce Surveys has been accepted for publication in an integrative medicine journal. We spent almost two years pulling together the original data from the two surveys: NCCAOM and the California Occupational Professional Exam Services. There are drawbacks with both surveys which I will not discuss here. I am waiting for a timeline to publication.
Both surveys are primarily focused on something other than collecting workforce information. Both surveys use different scales for key items such as income ranges and part time versus full time work. We need a standard survey focused on acupuncture practice. Fortunately, there are standard models for such a survey favored by the BLS. We could easily adapt these to create a standard acupuncturist workforce survey. Such as survey would have to demonstrate endorsement of the profession. Anyone who has worked with our collection of professional groups that claim to represent acupuncturists will understand how challenging it can be to forge consensus.
The findings are not encouraging, especially when compared to other health professions. I also believe they will not be unfamiliar to working acupuncturists.
There are more findings and much more useful discussion in the paper which I hope everyone will read. These findings are very similar to those described in our 2010 publication which compared survey reports – not actual data - from the same sources. It is puzzling to me that there seems to be only minor interest in this information. I wonder if this has something to do with the view many acupuncturists have that acupuncture is an alternative medicine and not part of the mainstream. I am fairly certain income and practice time is driven down because so few acupuncturists seem to participate in the medical mainstream. It would appear a substantial number of acupuncturists leave the profession altogether within ten years. Is this because they just give up on earning a living?
What does the future hold for the acupuncture profession? We are in a seminal moment. Gainful Employment guidelines which focus on for profit schools - have placed enormous pressure on acupuncture schools - most of which are for profit. Whatever it is that is taught in acupuncture schools would seem to be uncorrelated with earning a living This is the gist of gainful employment. The President of ACAOM has announced twice in the past 18 months that a third to half of all acupuncture schools will close under pressure from the federal the gainful employment initiative. This federal initiative known as Gainful Employment squarely aims at predatory vocation schools and programs whose graduates are unable to earn a living sufficient to pay down their federal loans. What will that mean for the future of training programs and the profession? How well prepared are AOM schools to demonstrate successful workforce outcomes for their graduates? What does it mean for the current and future workforce if 20 to 30 schools close by late 2018?
I hope to cover these questions in a future post.
Steven H. Stumpf, EdD
NGAOM Vice President Research and Education
One of our favorite projects in the field is a volunteer group called Global Acupuncture Project (GAP). They are doing innovative work to help people around the world to fight HIV/AIDS and other debilitating diseases affecting the indigenous cultures. GAP is a nonprofit organization, and always looking for volunteers. We at AAAOM have such respect for their work, so we wanted to highlight GAP and their needs. Below is a description of their mission, work, and needs. We hope that this helps to spread awareness.
Here are their current works:
1. We have partnered with Kisoro Hospital, Kalisizo Hospital, and Biikira Health Center and successfully created a permanent acupuncture department in each. Our next partnership will take place in a city called Mbale, where we are working with the District Health Officer to create permanent acupuncture departments in facilities within this district. We will continue to train providers and expand the creation of acupuncture departments across the country. All of this work is accomplished in partnership with the Ugandan Ministry of Health.
2. We have partnered with Shanti Uganda to train their midwives and secure acupuncture's permanent place within women's healthcare.
3. We helped our Trainees create the Uganda Society of Acupuncture Protocol Specialists (USAPS), the first such association within Uganda. USAPS will keep acupuncturists in contact with one another to provide mutual support, educate the public, and advocate for the integration of acupuncture within the health-care system. GAP will continue to provide support for USAPS.
From Global Acupuncture Project:
GAP teaches local healthcare workers how to use simple and effective acupuncture techniques that enable them to treat the symptoms associated with HIV/AIDS, malaria, TB, dengue, and other debilitating conditions.
The first training program conducted by the Boston-based Global Acupuncture Project was the culmination of two years of preparation and the expression of a dream to bring acupuncture to people in Africa who are struggling with HIV/AIDS. In 2003, three licensed acupuncturists from the United States began an intensive, two-week acupuncture training program in Kampala, Uganda. The trainings were conducted at the KISWA Health Centre, a clinic that focuses on care for those who are HIV+. The Trainee class of 13 local health-care providers included midwives, physiotherapists, a traditional healer, and medical doctors.
In 2013, GAP partnered with Doctors for Global Health (DGH) to conduct its first training in Tehuantepec, Oaxaca, Mexico. Our shared approach and philosophy is to serve communities through health promoter training and sharing of cultural knowledge, to address not only specific disease states, but also the individual, social, and economic factors that affect health.
Today, GAP has trained over 300 health-care workers in Uganda and southern Mexico, provides ongoing support and training to participants and advocates for better integration of alternative therapies into health-care systems. Since its founding, more than 80,000 people have been treated by GAP-trained health workers who incorporate acupuncture into their patient care.
2. GAP services and needs.
GAP encourages community empowerment and wellness by training local health-care providers and health promoters to use simple, effective acupuncture protocols to treat the symptoms of HIV/AIDS, malaria, tuberculosis, dengue, and other debilitating conditions. Treatments, as provided by the Trainees, serve to reduce pain and suffering and improve quality of life. GAP works with local governmental and nongovernmental agencies and health-care facilities to improve access to and effectiveness of care through collaboration with Western and traditional health-care modalities. Since 2003, GAP has trained more than 300 local health-care workers in Kenya, Mexico, and Uganda. These Trainees provide more than 50,000 treatments per year.
Oaxaca is home to the largest number of indigenous peoples in Mexico, with more than 16 different ethnic groups, each with their own unique language and culture. Yet, with all the richness in culture, the state of Oaxaca trails behind the rest of Mexico in its health and economic indicators. It is one the poorest regions in the country, with the average daily income less than half of the national average. Oaxaca faces challenges in literacy, sanitation, unemployment, and access to healthcare services. Indigenous communities in Mexico have an infant mortality rate that is 58 percent higher, a life expectancy five years lower than the national average, and there is only one hospital bed per every 1,000 residents. This severely stretched health infrastructure underscores the need for less expensive, more community-based and grassroots-led network of health care providers. The promotion of traditional healing practices as natural and inexpensive alternatives to conventional medicine is the cornerstone of our vision to empower communities to strengthen their own health and wellbeing.
To best serve Tehuantepec and the surrounding communities, GAP has created a new program: El Proyecto Acupuntura del Pueblo. This program will include a clinic and training center in Tehuantepec, with satellite clinics spread out throughout the surrounding areas. GAP/PAP will continue to train and support its previous Trainees at this clinic, and the clinic will also employ the Trainees to run the clinic and its satellites. Volunteer licensed acupuncturists from GAP will provide ongoing trainings for new providers and advanced trainings for its certified Trainees.
GAP Trainers teach new providers the basic principles and techniques of acupuncture. The program consists of three week-long sessions spread out over a year during which time they learn safe, effective, protocol-based treatments. An examination is given at the end of the first week to determine if the Trainee has gained the necessary skills and understanding to become a certified Acupuncture Protocol Specialist.
Between each training session, Trainees are expected to practice and improve their skills by providing acupuncture to patients. After the 3rd training, Trainees continue to provide acupuncture treatments at the main clinic in Tehuantepec and at satellite clinics throughout the surrounding communities. GAP provides Trainees with the necessary acupuncture supplies and conducts periodic refresher and advanced-training sessions. GAP maintains access to these Trainees via email, text messaging, and the local coordinator.
3. The Project’s target population.
Indigenous communities in Mexico live on the margins of Mexican society, with higher levels of poverty, poorer health outcomes, lower life expectancies, and poor academic performance (Sevran-Mori et al, 2014). Their clothing and food often have cultural and traditional ties and that they have a strong affiliation towards community, local organizing, and traditional forms of medicine. They also have a preference for traditional healers such as herbalists, massage specialists and spiritual healers.
Over the course of one year, GAP will train new health-care workers, who will then provide care for approximately 3,000 people in Oaxaca over one year. GAP will also provide advanced training for previous participants. One hundred percent of Trainees will be from the communities in which they will ultimately serve.
4. Specific objectives and outcomes of the program. How we evaluate the impact of our services.
Empower thousands of residents of Tehuantepec, Oaxaca, Mexico and surrounding areas to live healthy, prosperous, autonomous lives by improving access to culturally-sensitive, integrated acupuncture education, care and support in the communities where they live. Specific objectives are:
1. Empower program participants with basic acupuncture skills through three one-week training sessions led by volunteer licensed acupuncturists;
2. Increase access to effective and affordable acupuncture at both community and city levels, including providing 3,000 treatment sessions each year;
3. Provide the skills and expertise for certified Trainees to earn a living wage by offering low-cost acupuncture treatment in the communities they serve.
1. Increased access to and usage of acupuncture as a means to relieve the burden of acute, chronic, and environmental health concerns.
2. Increased understanding of preventative health, and indigenous peoples’ right to quality health care services.
3. Improved economic stability for Community Health Workers.
To monitor progress and evaluate overall project impact, GAP will design a comprehensive, monitoring and evaluation plan to be an essential management tool to support GAP’s commitment to accountability, efficient use of donor resources, and effectiveness of interventions. Through a combination of quantitative and qualitative methods, GAP will monitor progress towards project objectives.
Biannual statistics will be collected on Trainees and their patient interactions, consultations, and utilization of acupuncture services. Periodic testing to evaluate subject matter retention will be conducted, in addition to providing regular opportunities for current and former trainees to share best practices with other program participants and practitioners.
Earlier this month we were contacted by a reporter from the O magazine looking for information on innovative Acupuncturists volunteering their time and helping at-risk people that would otherwise not have access to our care. We reached out to our members and to Acupuncturists on Facebook, and the response was overwhelming! So many of you are contributing countless hours and your time/treasure/and talents toward helping others. I think that is one of the aspects of our profession that is so unique and amazing--our compassion and willingness to help others. Not that other professions do not do this, but over and over again you will meet acupuncturists giving of themselves without any expectation of return or glory. Due to this, I thought we could take some time to highlight the individuals that were brought to our attention (keep in mind, there are many, many more). If you know of someone that should be on this list that has a unique volunteering project, please contact us.
**If you would like more information or would like to volunteer and are looking for connections, please contact us at firstname.lastname@example.org**
In no particular order, here is some of the great work going on in the field:
"American Association of Acupuncture and Oriental Medicine" is a 501(c)6 non-profit organization.
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