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AAOM Challenges Chiropractic's 300 Hour Acupuncture Certification PDF Print E-mail
Written by John Weeks   

AAOM Challenges Chiropractic's Standard on 300 Hour Acupuncture Certification

Summary: Amidst allied health and CAM discipline organizing against the AMA's campaign to restrict scope expansions of others, a national acupuncture and Oriental medicine organization fires a salvo across the CAM bow at the chiropractic profession's 300 hour acupuncture certification program. The focus is on respecting educational standards which can be the basis of competencies. Is there a way for CAM professions to resolve these differences without battling state-by-state?

Image The press release from the Association for Acupuncture and Oriental Medicine (AAOM) on acupuncture by chiropractors arrived with almost comedic timing.

Nurses, psychologists, chiropractors and diverse CAM fields are focusing significant energy on fighting the so-called Scope of Practice Partnership of the
American Medical Association. (See related IBN&R story and links.) Colleagues in diverse CAM disciplines are considering  formal alliance with nurses and allied health colleagues through the Coalition for Patient Rights. (See related IBN&R story and links.)  Many feel that the AMA, by focusing on the practice scopes of other professions amidst the huge problems facing US health care, has chosen the wrong battle at the wrong time.

Then, across the internet, from the AAOM came the following heading:

"Chiropractic Community Attempts to Expand Scope of Practice."

The AAOM presented the issue to its members as follows: "The Chiropractic Community is attempting to expand Chiropractic Scope of practice with legislative campaigns for 300 hour programs." The heart of the mailing is the AAOM Position Paper: Expanding Chiropractic Scope. The paper notes that the American Chiropractic Association (ACA) has estabished its own College of Chiropractic Acupuncture (ACA CCA), asserting that the ACA has done so "without the application of established standards." For the last two years, the ACA CCA has been offering an annual acupuncture conference. The AAOM raises the specter of "substantial public health risk" through poorly trained chiropractors using needles, providing ineffective treatment and potentially driving up the cost of acupuncture care.

________________________________

AAOM Position Paper: References on Education Standards for
the Practice of Acupuncture

Organization         Hours       

World Health Organization:      
Basic Standard of training
 
2500 
World Health Organization:
Specialty Training for a Conventionally-
Trained Medical Doctor

1500 
National Certification Commission on
Acupuncture and Oriental Medicine:
Acupuncture only

 1905
National Certification Commission on
Acupuncture and Oriental Medicine:
Acupuncture and Oriental Medicine
 2625
 
UK Department of Health: Practice by
a Conventionally Trained Person

Standards as
set by the
Acu profession

Note: All references are included the position paper accessed through the link to the AAOM
Position Paper, above.

________________________________

Image
Will Morris, DAOM, LAc, MEd, AAOM President
IBN&R
contacted AAOM president Will Morris, DAOM, LAc, MEd, the lead signer of of AAOM Position Paper, to learn more about the timing and intent. Morris revealed that the AAOM is "spending an extraordinary amount of time and energy responding to state association requests when they see bills introduced for 100-300 hours of training for chiropractors." He notes that members of his profession are faced with legislation on chiropractic scope expansion, based on the 300 hour standard, in New Mexico, Ohio and Washington, DC.

Morris defended the action as "not about turf," but rather about educational standards: "We basically wanted to provide our members with information which they could use to educate legislators in their states about the accepted standards of education for acupuncture and Oriental medicine practice." Morris pointed my attention to the parts of the Position Paper which note recommendations on training of the World Health Organization (WHO) and others.


"This is not a turf war.
The AAOM supports the
notion of chiropractors

practicing acupuncture,
with appropriate training."  

Will Morris, DAOM,
LAc, MEd

 
Morris makes clear that the AAOM doesn't view this as a "turf war." He states: "The AAOM supports the notion of chiropractors practicing acupuncture, with appropriate training. The issue here is not a turf war. Rather, it is a call for the use of expert consensus panels to set up a legitimate process for creating standards." He adds: "We are acting on the requests of our membership. We put together a resource which our members can use to inform legislators prior to the writing of any bills. We offer to provide assistance in developing appropriate standards, We are getting a lot of feedback from our members that is very positive."

So then why focus on the chiropractors? The typical standard for acupuncture training for medical doctors in the US is the 220-300 course founded by Joseph Helms, MD, and offered through UCLA Continuing Medical Education. Morris' answer was simple: "They already have it." When pressed, Morris noted that Helms had successfully argued before the WHO that a second, lower standard of 300 hours for MDs would be acceptable but only "for extremely limited procedures."

Clearly, the AAOM's concern is that wide acceptance of a 100-300 hour standard for chiropractors would also set a precedent on scope which other professions might seek to adopt. Who would be next? Advance Practice Registered Nurses? Naturopathic Physicians?  Physical Therapists?

Regarding the juxtaposition of the AAOM and AMA scope of practice campaigns, Morris referred me to a column he wrote on the AMA campaign in the AAOM newsletter. Morris' column ends with this call:
"Given the history, methods and outcomes of the Flexner Report and the (AMA) Committee on Quackery, the AAOM calls for an unbiased group with no conflicts of interest or economic incentives related to the outcomes of the study to evaluate the following: qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes, and peer review of qualified professional providers of acupuncture and Oriental medicine."

Comment
: The black comedy of this scope skirmish among two CAM fields, amidst the broader scope battle pitting the AMA against virtually every other discipline, provoked a dark comedic suggestion of my own. Morris is a colleague. We work together on the National Education Dialogue to Advance Integrated Health Care: Creating Common Ground. Morris is also an educator, serving as president of the Academy of Oriental Medicine at Austin.

Image
Pamela Snider, ND, suggests using the PEW guidelines
Seeing the AAOM release, I got Morris on the phone and said: "Will, maybe you AOM folks just need to find some ancient Chinese scroll which shows that AOM practitioners have been doing spinal manipulation based on a 300 hour apprenticeship with a Master. Let the ACA know that you have a new 'AAOM College of Spinal Manipulation.' Tell them you assume they wouldn't have any problem with this, would they. See how that goes over." Morris laughed: "It exists. Chinese medicine does have a history of spinal manipulation ..."

After he gave me the perspectives noted above, we mulled the larger questions:

  • When and how will this turf-battling ever end?
  • Is it possible for the CAM disciplines, at least, to take a lead in a more reasonable pattern of inter-disciplinary relationships?
  • Can the National Education Dialogue (NED) or the Academic Consortium of Complementary and Alternative Health Care (ACCAHC) which NED helped birth potentially be a forum for taking up some of these differences? 

Morris knew, as I did, that turf and scope battles between the disciplines are viewed by many healthcare observers as major obstacles to quality healthcare reform. I told him of the email I had recently received from my colleague Pamela Snider, ND. I had forwarded the notice of the AAOM Position Paper to her and colleagues from other disciplines who were actively exploring joining the coalition opposing the AMA's efforts to "thwart" the growth of other professions' scopes. She immediately sent me the 1996 list of PEW Taskforce Commission Recommendations for Regulation of the Health Care Workforce. (A separate IBN&R article will detail these core recommendations.)

Image
ACCAHC Chair Reed Phillips, PhD, DC, promoting dialogue
Morris, who has a Masters in Education as well as a Doctorate in Oriental Medicine, was aware of the Pew Commission's seminal work between 1994-1998. I reminded him that Snider, another of our colleagues in the National Education Dialogue, is also executive director of the CAM educator consortium, ACCAHC. Perhaps ACCAHC might play a role here. I suggested that the two of them get into dialogue on this.

They have. Snider reports that, Reed Phillips, PhD, DC, ACCAHC chair - and president of Southern California University of Health Sciences, a multi-disciplinary institution which boasts programs in both chiropractic and AOM - strongly supports the idea of ACCAHC, the CAM educator consortium, taking up this issue. Stay tuned!

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