Recent Political and Educational Events [Summer 2004]

The article that follows was initially written over the summer of 2003 and, although submitted then, never was published in The Point. Because some of its predictions and evaluations have been shown to be accurate, it is appearing now, by invitation of the Editor of The Point. Should additional education also eventually be required for senior practitioners, all of the article's major predictions and statements about likely results of current actions will have been proved correct. The first quote cited is from the 2003 Spring-Summer issue of The The Diplomate and the statistics on acupuncturists' income levels are from an article entitled “ Acupuncture Statistics…Very Interesting! ” by John A. Amaro, D.C., (still posted, as of 6/15/04)

Recent Political and Educational Events
By Léonie Rosenstiel, Ph.D., D.O.M.

Early in August 2003, the NCCAOM announced the details of its “Oriental Medicine” certification. This new credential is designed to unite acupuncture, herbology, Asian bodywork and basic Western biomedicine (or “Western industrial medicine” as some of my colleagues have begun to refer to it,) under in one diplomate status. The stated intent of the NCCAOM is to “encourage applicants to certify in all areas of OM, including Chinese herbology…an action that is in the best interest of the public.” In other words, the NCCAOM is urging all practitioners—in the strongest possible terms—to go back and take the herbology exam ASAP. While there may never have been a single complaint against anyone practicing Chinese herbology, the current concerted efforts to regulate herbs bespeak the creation of a climate of fear relating to herbs and other food supplements (Ma Huang/Ephedra is the most recent example).

If this negative publicity campaign continues, within a few years we'll be lucky if we're permitted to prescribe herbs even though we may have completed hundreds of hours of study and have also passed a certification exam! Furthermore, regulation of supplements is a priority of the Codex Commission, so we need to be able to demonstrate in some tangible way that we are safe practitioners of herbology, as opposed to those untrained people who go around using Ma Huang irresponsibly as a stimulant rather than as a sudorific or bronchiodilator.

An interesting feature of this new certification is that it rejects as unacceptable any and all of the allopathic/biomedicine courses a practitioner may have taken more than 6 years ago. In such cases, rather than certifying a diplomate on the basis of transcripts from accredited institutions, the practitioner is required to demonstrate proficiency by passing a new examination created and administered by the NCCAOM. Or, alternatively, the practitioner may prove a similar level of competence in the subject by going back to school for 45 hours of new training. Fifteen contact hours equal one credit hour, so this is the equivalent of one single three-credit, one-semester college lecture course.

Because some NCCAOM diplomates are also nurses and medical doctors and dentists who have long had strict recertification requirements for their professions, including biomedicine continuing education courses, they will not suffer in any way from this new requirement. All of them will have already taken adequate—and adequately recent--hours of Western medicine continuing education courses to satisfy the new NCCAOM biomedicine requirements.

Among acupuncture and Oriental medicine practitioners who graduated 6 years ago or more, however, not all may have felt drawn to take more biomedicine after certification. Now, those who may have chosen to delve more deeply into the traditional aspects of their profession rather than into Western sciences, will find that they are no longer “senior practitioners.” Now, they need to go back to school for 45 hours of classes in allopathic medicine in order to remain “at the top of their field” (in terms of status) by the figuring of the NCCAOM. Or alternatively, they will need to take the newly-devised biomedical exam to see whether they have “entry level proficiency” in this field, according to the new NCCAOM standards. We also have numbers of Chinese-trained practitioners working and teaching here, some for a decade or more, who have taken far more hours of biomedicine than most U.S.-trained practitioners have completed. It will be instructive to see how they receive the news that they need to be retested on biomedicine or, alternatively, that they are now required to take another 45 hours of classes.

The Asian bodywork requirement, therapeutic exercise requirement and nutrition requirements have no time limit. Practitioners may satisfy Asian bodywork requirements by having completed 21 hours of study in any form of bodywork, diet and/or exercise at any time of their lives. As a result, it appears that there is a bias in favor of biomedicine at the expense of any in-depth study of bodywork, nutrition and exercise. You might actually qualify for “diplomate” status in a combination of diet, bodywork and exercise by simply taking a single day of continuing education in each subject. Not only are more hours of biomedicine required, they also must be recent hours.

In most states, the great majority of practitioners do far more bodywork than biomedicine. In some states, using most if not all biomedicine techniques is actually forbidden to us. For those reasons, this emphasis is, to say the least, puzzling. (And yes, I do understand that we need to know when a patient is presenting with an emergency and we also need to know when to refer, but these concepts hardly require 45 hours to learn.) If we are going to use biomedicine so little that we are bound to forget it within a few years, why do we need to know it in the first place? And this is even truer if the use of it is actually forbidden to a Dipl. Ac., a Dipl. C.H. or a Dipl. ABT. Or is it that the NCCAOM is trying to tell us that knowledge in our field remains fixed and unchanging, whereas biomedicine advances? Is the projected message that our field is totally stagnant but biomedicine is progressive? The plethora of journals devoted to our field and its new developments and refinements both in the Western world and in the Orient handily disprove this conclusion. So now, in order to become a Diplomate in Acupuncture or Chinese Herbology, each applicant must pass a biomedicine module as well. The good news is that, should you fail a module, you can now take only that module again. However, after June of 2004, if you fail a test three times, you will now need to take 15 hours of related courses and/or “supervised clinical experience” in order to qualify to retake that module. Practically speaking, that would probably delay your achievement of Diplomate status in that subject area by one calendar year. Also, the item allocation (proportion of questions in each category) will change, beginning, again, in June 2004. The costs of retaking exams will also rise to $75 per exam in addition to the examination fee. Therefore, it will greatly benefit all of us to pass our exams the first time!

Initial fees are another matter. Do you want to take the Oriental Medicine tests and apply at the same time to take them all? Beginning in December 2003 that will cost you a $550 application fee. Total fees will be $1,550. For the first 2 years only, the NCCAOM will “subsidize,” in the amount of $150, those who already have acupuncture certification and want to take the herbology exam, thereby reducing the cost of the exam itself to $110. And vice versa. (It appears that the application fee will remain at $400, for a grand total of $510 for acupuncture diplomates.) Confusion will probably reign at the beginning, as it is likely to do during any transitional period. The good news is that, once you have taken the biomedicine module, you don't need to take it again; nor do you need to take the point location exam for Asian bodywork if you have already taken it with your Acupuncture exam series. What benefits are there to Oriental Medicine certification? Is there any benefit to the new modular certifications? Reduced renewal fees for one thing, are designed to benefit OM diplomates. There is a hefty financial benefit in the long run to taking the “complete” certification program. As of December, the new fees for taking the acupuncture test will be $1,105 and $1,060 for the herbology test. So the total, if taken individually and without discounts, would be $2,165. Taking the Oriental Medicine option instead would give you a hefty discount—a total of “only” $1,550, according to the latest issue of The Diplomate, if I am reading it correctly. However, the OM certification is still fairly pricey in a field where it has been reported that 49% of all full-time practitioners make $30,000 or less (and that's gross!) per year.

Another inducement to current diplomates to complete all NCCAOM certification exams is the graduated and shrinking exam fee for existing diplomates as of December 1, 2003. (For those who become diplomates after that date, the graduated fees will not apply.) Furthermore, there will be only a two-year window of discounts for this testing. So, if a diplomate already has one or two certifications, s/he will get a nice price rebate on further exam prices, and particularly so for the first two years. Any diplomate with three certifications will temporarily receive the remaining exams free. However, even if the exam fee (that might originally have been $150 or $250) goes down to zero, the application fee may remain as high as $400.

There are some of us in New Mexico (and in other states as well, probably) who were initially required to have passed the NCCAOM tests in order to be allowed to practice but have not kept up active certification. In order to remain in practice, all might be required by the relevant state boards to retake relevant exam(s).

“Impossible!” you think. Well, what about deciding after-the-fact that apprenticeship-trained people are ineligible for Oriental Medicine diplomate status? This retaking of exams might get a little pricey. However, without it, even long-term practitioners might not be able to maintain their autonomy and, with the increasing pressure to restrict the use of herbs to only certified practitioners, maintaining diplomate status in Oriental medicine is likely to become even more urgent.

In New Mexico, there has been discussion for the last few years of our need for an examination in entry-level biomedicine. Now that the NCCAOM has instituted one, why do we need our own? Is there any need to reinvent the wheel? Why not just use theirs and save the state a lot of money?

There is yet another serious issue raised by the current situation. Apprenticeship training is no longer accepted for those seeking Oriental Medicine certification. It will only be accepted for modular certifications. And the NCCAOM is now seeking comments on whether to phase out acceptance of apprenticeship totally in 2007. Should that happen, only formal training in a school will be acceptable? And all apprenticeship-trained practitioners will be relegated forever to secondary status. Because apprenticeship is a time-honored way to learn our profession, some of us may view this as dishonoring the venerable traditions of our field and bringing it ever closer to the mindset of Western industrialized medicine.

My best guess is that this new certification helps and hinders simultaneously. If one is certified in acupuncture or Asian bodywork or herbology, one may begin to earn money and pay off loans and pay other bills. (If, that is, the states institute the same modular licensing or permit those with modular licenses to operate as assistants under the “supervision” of someone certified in Oriental Medicine.) One might even begin to build a patient base that way. On the other hand, there is a risk that those so certified in modular fields will be primarily considered technicians.

Within the next few years, those with the newly-defined “ultimate” certification as NCCAOM Diplomates in Oriental Medicine will be considered the only “true practitioners.” Which leaves us with the extremely odd situation that some of the most senior practitioners in our field will, in a single stroke, be relegated to the status of “technicians” by an action taken ostensibly to “advance” the profession.