Medical Acupuncture and
Traditional Chinese Medicine
What Licensed Acupuncturists Need to Know
About the Training and Qualifications of
Physicians Providing Medical Acupuncture
by Lisa Hanfileti, LAc © (2007-2013)
There is a lot of misinformation out there regarding Medical Acupuncture provided by Physicians and Traditional Chinese Medicine provided by Licensed Acupuncturists.
To my knowledge, no one has ever gathered the facts in one place so that accurate conclusions can be made regarding the qualifications of medical acupuncturists and licensed acupuncturists.
What I do know, is that licensed acupuncturists are outraged by the "fact" that doctors "take a weekend acupuncture workshop" or "get 200 hours of videotaped acupuncture instruction" and are then deemed fully qualified to practice acupuncture. Why shouldn't doctors have to go through the same rigorous training (over 2000 hours of in-person and hands-on instruction) as licensed acupuncturists?
The collective grievances by licensed acupuncturists are that doctors who perform medical acupuncture:
- Are not as well-trained as licensed TCM practitioners.
- Take patients (and therefore income) away.
- Mislead the public that doctors are better acupuncturists.
- Are "stealing our medicine", as I once heard a classmate lament.
The argument always seems to boil down to this comment by licensed acupuncturists; "We are not permitted to practice internal medicine (or any other medical specialty) after 200 hours of videotaped instruction, so why should doctors be able to practice acupuncture with only 10% of our required education?"
The problem with all of these concerns is that the facts are missing. There does not seem to be a collective understanding of how medical acupuncturists are trained, and more specifically why their training differs from licensed acupuncturists.
In an effort to gain a greater understanding about the similarities and differences between medical acupuncturists and TCM acupuncturists, I have provided educational information about ABMA board certification in medical acupuncture and NCCAOM board certification in TCM /AOM acupuncture.
Acupuncture Training Requirements?
The World Health Organization (WHO) put forth the guidelines on basic training and safety in acupuncture. That's right. The WHO and the World Federation of Acupuncture and Moxibustion Societies (WFAS) drafted the WHO and WFAS Guidelines on Basic Training & Safety in Acupuncture in 1996 (printed in 1999). It is an important document that every acupuncturist should read in order to understand why the educational requirements differ between physician and licensed acupuncturists.
The WHO and WFAS determined what the minimum requirements for training and education in acupuncture should be and based on:
Intended application of acupuncture
In order to adequately address the unique variables of a student's prior education and intended application of acupuncture, the WHO and WFAS suggested four distinct categories of acupuncture practitioner training. These guidelines are summarized below with their concomitant recommended minimum hours of training as follows:
- Prior education,
Category 1. People with no prior medical training. (This is for licensed acupuncturists.) = 2000 hours.
Category 2. Physicians who want to practice only acupuncture. (This is rare since it implies a physician who would not use any conventional treatments or techniques from their western medical specialty.) = 1500 hours.
Category 3. Physicians who want to add acupuncture to their medical specialty. (This is 99% of Medical Acupuncturists.) = Not less than 200 hours.
Category 4. Health care personnel who want to specialize in a certain aspect of acupuncture treatment. (This is, for example, for Nurses or social workers who become Acupuncture Detoxification Specialists.) = Hours & requirements are variable depending on specialty and use.
The WHO and WFAS took into account previous training and experience as well as the proposed use of acupuncture by those providers already in their specialties. If acupuncturists (licensed or medical) have a problem with these minimum hours, complaints should be directed at the WHO and WFAS, not the organizations, institutions, and schools who developed training programs (that actually exceed these minimum requirements) and certainly not at the practitioners who are trained and certified through these programs.
However the WHO and WFAS created these categories and guidelines as recommendations, not requirements. The actual legal requirements for specific hours and type of acupuncture training are decided by each state. States have the right and authority to determine legal standards for all health care practitioners, including licensed acupuncturists and medical acupuncturists. For acupuncturists, most states have legal requirements based on the guidelines put forth by the WHO and WFAS, however there is variability between states.
Board certification standards proposed by the NCCAOM for licensed acupuncturists and the ABMA for medical acupuncturists have made it easier for states to recognize acupuncture as a legitimate health care system and adopt a legal structure for acupuncturists to get licensed.
Currently, each state decides their standards, minimums, and requirements for all acupuncturists. That is, politicians and lobbyists who influence politicians, write the bills and laws that ultimately determine specific educational, training, and licensing requirements. These are then enforced by each state's Board of Health. In essence, complaints about any educational or licensing requirements need to be directed at state legislatures, politicians, lobbyists, and yourself since you are a voter and (hopefully) an active member of your national and local acupuncture organizations. But before you complain, read further.
Medical Acupuncture Training
What exactly is "Medical Acupuncture"? If you read the Definition of Medical Acupuncture on the American Board of Medical Acupuncture (ABMA) website you will learn:
- “Medical acupuncture is a medical discipline having a central core of knowledge embracing the integration of acupuncture from various traditions into contemporary biomedical practice.”, and
- “A Physician Acupuncturist is one who has acquired specialized knowledge and experience related to the integration of acupuncture within a biomedicine practice.”
The implicit distinction from TCM is that medical acupuncture is to be integrated within a doctor's medical specialty. A specific example might be an anesthesiologist who uses medical acupuncture for anesthesia. Or an orthopedist who uses medical acupuncture for pain management.
Although the WHO and WFAS Guidelines on Basic Training & Safety in Acupuncture suggest "not less than 200 hours" of medical acupuncture training for doctors, the actual Medical Acupuncture Board Certification Requirements far exceed that minimum.
Most physicians seeking training in acupuncture want the education and designation of Board Certification. This not only provides doctors with a recognizable title for their (often skeptical) physician colleagues, but also gives medical acupuncturists some protection from possible litigation, which is a valid concern in this era of "defensive medicine". To acquire board certification, physicians must receive instruction through one of the 8 Acupuncture Training Programs (6 in the US and 2 in Canada) approved by the American Board of Medical Acupuncture (ABMA).
A detailed account of medical acupuncture education and these specific training programs is provided in the following informative documents:
An Overview of Medical Acupuncture by Joseph Helms, MD, and
American Board of Medical Acupuncture Certification Requirements
and the 200-Hour Myth
Summarized below are the required prerequisites and hours of actual training and education that physicians who obtain board certification in acupuncture (as most do who are serious about incorporating acupuncture into their practice and advancing the profession) receive:
- General Prerequisites: = MD or DO from USA or Canada. Must have a valid medical license and be board certified in their medical specialty (e.g. anesthesia, pediatrics, OB/GYN, et cetera).
- Acupuncture Education & Training = 300 hours of systematic acupuncture education through an ABMA Approved Training Program; 200 hours of which meet the standards set forth by the World Health Organization (WHO) and 100 hours of acupuncture-specific clinical training given over the time period specified by those training programs.
- Experience After Didactic Education = not less than 2 years of medical acupuncture experience with case histories of 500 clinical acupuncture treatments. The acupuncture practice should include two or more of the following acupuncture disciplines: Auricular, Scalp, Korean Hand, and other styles not necessarily taught in the course curriculum (like TCM, Five-Element, etc.).
- Board Examination = National Board Exam based on Acupuncture Energetics within the Biomedicine model. (This is the medical acupuncture equivalent of the NCCAOM exam.)
To be clear, this is a 2 to 3 year time commitment for any physician seeking board certification in medical acupuncture. This is very far from the "200 hours" or "weekend course" that most licensed acupuncturists assume physicians receive in order to begin treating patients with acupuncture.
In comparison a TCM student who attends an ACAOM accredited Acupuncture and Oriental Medicine (AOM) school will need a total of 2625 hours of the following courses to become a licensed acupuncturist:
- 705 Hours in Oriental Medicine Theory, Diagnosis, and Treatment Techniques in Acupuncture and Related Topics
- 450 Hours in Didactic Oriental Herbal Studies
- 870 Hours in Integrated Acupuncture and Herbal Clinic Training
- 510 Hours in Biomedical Clinical Sciences
- 90 Hours in Counseling, Communication, Ethics, and Practice Management
Most of the 2625 hours required for AOM training consists of herbal medicine (450 + 870 hours). Herbalism and the vast Chinese medical pharmacopoeia are not topics covered in the medical acupuncture training. There is an additional 600 hours (510 + 90) from areas of biomedicine and clinical management. This is information that doctors already have acquired in courses taken in Medical School prior to attending a medical acupuncture program. So the primary difference between TCM / AOM trained acupuncturists and medical acupuncturists seems to be the 705 hours in "Oriental Medicine Theory, Diagnosis, and Treatment Techniques in Acupuncture and Related Topics", and the 300 hours plus 500 treatments within 2 complete years of clinical experience that MDs receive.
It is difficult to base a direct comparison of acupuncture training on educational hours alone since physician acupuncturists are trained in a style of acupuncture that is unique. It is not TCM (and does not claim to be) and utilizes such assessment methods as the "Biopsychotypes" and such treatments methods as the "Principle Meridian N-->N+1" and "Trigrammatic Management". These are all complete systems unique to medical acupuncture's theory, diagnosis, and treatment.
The Economics of
Financial, Social, & Political Implications
The greatest misperception of all may be around the financial "benefits" doctors receive by providing acupuncture. The reality is that most physicians who choose to get trained and provide medical acupuncture as part of their medical specialty take a pay cut. The simple fact is that acupuncture requires time and physicians are paid more or less based on the number of patients they can see each hour. Most hospitals and HMOs do not support treatment rooms being used for patients resting with acupuncture needles placed for 20-30 minutes when those same rooms can be used for 3 to 6 regular patient visits in the same span of time.
In addition, the reimbursement for office visits and minor office procedures which are covered by insurance, are at least 2-3 times greater than for acupuncture, which often is not covered by insurance. This creates a double risk situation where not only is income per unit time lower, but the chances of receiving actual payment is diminished by the insurance industry's ability to discount or deny payments altogether.
In order to practice acupuncture successfully, doctors must often remove themselves from the conventional medical environment, or forego practicing acupuncture altogether. Bear in mind that few doctors have adequate business management and marketing training to successfully take on such an endeavor. According to an October 2006 AAMA Newsletter report entitled, Survey Profiles Typical AAMA Member, those physicians not using their interest or training in medical acupuncture cite such reasons as, "training time and cost, low reimbursement from third parties, reduced demand, length of treatment, lack of hospital facilities", and other obstacles. These challenges are not that different from those faced by licensed acupuncturists. The survey further states that on average physicians use acupuncture for only 25% of their clinical cases while relying on conventional methods for the other 75%.
Physicians who do stay in their conventional medical environments often pay a political and social price. Depending on the relative acceptance of acupuncture as a legitimate medical modality, medical acupuncturists may be regarded as outcasts within their field and discipline. Right or wrong many MDs still regard acupuncture as "quackery".
The truth is Medical Acupuncturists are pioneers and they are paying the political, social, and economic prices of forging new territory.
Physicians trained in medical acupuncture are at the forefront of expanding patient access to acupuncture services. For instance, the Medical Acupuncture website provides steps for physicians to petition their local hospitals to extend privileges to medical acupuncturists. The Guide for Physicians Seeking Hospital and HMO Privileges by Russell J. Erickson, MD is a brilliant collection of referenced data demonstrating the economic advantages of providing acupuncture in a hospital setting. (Of course the effectiveness of acupuncture for patients is also included.) Physicians in any community can utilize this guide to request the consideration of acupuncture to be included as an approved procedure in their hospital.
For example, Peter Hanfileti, MD, DABMA, a pediatrician board certified in medical acupuncture, used these exact steps to establish the official process for acupuncturists to apply for hospital privileges at the Southwest Washington Medical Center hospital in Vancouver, Washington. But here's the best part: Dr. Hanfileti was sure to include within these procedures steps for the hospital to approve privileges for licensed acupuncturists as well. Had Dr. Hanfileti not been informed about the rigorous training, education, and competence of licensed acupuncturists and only been exposed to the rhetoric, he may not have made the extra effort to recommend that licensed acupuncturists be included in the process of applying for hospital privileges.
There are many other physicians who have taken steps to advance the acupuncture profession as a whole, however it becomes problematic when there are those licensed acupuncturists who criticize physicians for their "inferior training" as medical acupuncturists. You can see how this can create an unnecessary and ultimately harmful divide between two disciplines within the same health profession.
Medical acupuncturists are often at the forefront of acupuncture research, public education, and policy making. Many TCM acupuncture schools have physician acupuncturists on their staff and on their Board. The same is true for many physician acupuncture training programs where licensed acupuncturists teach and contribute significantly to the core curriculum.
According to Dr. Joseph Helms, the Helms Medical Institute's Medical Acupuncture for Physicians course, has graduated over 85% of the physician acupuncturists currently practicing in the United States. Since 1983 over 5000 doctors have completed the training in medical acupuncture. The Helms Medical Institute has an ongoing co-sponsorship by the UCLA School of Medicine and the Stanford University School of Medicine, and is committed to advancing acupuncture research, understanding, and access.
Perhaps licensed acupuncturists should stand on the vast common ground we share with physician acupuncturists and join forces for the good of the entire profession, and our patients.
The Acupuncture Profession
as a Whole
The amazing thing we should all take note of is that despite our different diagnostic, theoretical, and treatment approaches, acupuncture works. Whether the style of acupuncture is TCM, Medical, Japanese, Five-Element, Auricular, or any of the many other types used around the world, the one thing that we can all agree on is that acupuncture is an effective healing system. Study after study in every discipline of acupuncture researched shows consistent benefit to patients. The argument that one acupuncture system's practitioners are better trained, qualified, or effective is not supported by research. (Read, "A Comparison of Physician and Nonphysician Acupuncture Treatment for Chronic Low Back Pain" by Kalauokalani D, Cherkin DC, & Sherman KJ; Clin J Pain (2005).
If licensed acupuncturists fear that the American Medical Association (AMA) will use its political might to prevent us from practicing acupuncture (as it has done in the past to Homeopaths and Naturopaths), then we should certainly be vigilant in preventing that from happening. Having a strong national organization such as the American Association of Acupuncture and Oriental Medicine(AAAOM) to represent licensed acupuncturists and further solidify our legal and professional status is essential. But medical acupuncturists may be the best allies we have in preventing such a thing from happening.
Much can be gained from joining forces in the spirit of the acupuncture profession as a whole. That's good news for patients who only want access to a health care system that is safe and effective. After all, acupuncture belongs to the people, not the practitioners.
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All rights reserved. Lisa Hanfileti, LAc © (2007-2013)