Scope of Practice: Summary and Recommendation
Little Hover Commission 2004
Regulation of Acupuncture: A Complementary Therapy Framework
Summary
The existing scope of practice is both precise and insufficient. To provide an adequate framework, lawmakers will need to go beyond listing some traditional Oriental modalities to define in statute what is meant by traditional Oriental medicine.
The policy choice to give patients direct access to acupuncturists was clear, but the statutory intent to regulate acupuncturists as a "primary care health care profession" is not. The term has many potential meanings. While some people may turn to acupuncturists first for everything that ails them (one potential meaning), it is difficult to see how practitioners of an alternative healing paradigm can be responsible for coordinating care with biomedical specialists (another potential meaning).
Finally, while the direct access policy provided choice, it did not provide for informed choice. And unless the government wants to regulate a healing profession based on proven efficacy, it will need to take steps to make sure that patients understand the potential limitations as well as the benefits of a particular therapy.
Recommendation 1: The Governor and the Legislature should clarify in statute the role of acupuncturists in the health care system. Specifically the statute should:
- Keep licensure focused on traditional Oriental medicine. Consistent with existing "intent language" and legal opinions, the statute should clarify that licensure is for the practice of traditional Oriental medicine as an alternative and a complement to Western medicine. Practitioners interested in mastering both Eastern and Western methods should continue to seek licensure under both systems.
- Define primary care practitioner. The statute should make it clear that acupuncturists are primary care practitioners within the context of traditional Oriental medicine, and are responsible for referring patients to primary care practitioners in the conventional medical system when appropriate. The law should make it clear that the definition does not impose requirements on health care providers regulated by the Knox-Keene Act.
- Authorize and define traditional Oriental diagnosis. The scope of practice should include an explicit authorization to conduct traditional Oriental diagnosis. Practitioners who are already licensed and choose to perform biomedical tests in making any diagnosis should be required to complete specific continuing education requirements and take a supplemental examination.
- Require disclosure of critical information. Patients should receive information on the benefits of coordinating care with MDs and accurate information on the efficacy of traditional therapies. They should receive safety precautions, for example, about single-use disposable needles, alcohol preparation of skin, herb-drug interactions and the potential for herbal contamination. Practitioners should be required to report malpractice settlements.
- Allow for acupuncture-only licensure. To ensure public access to acupuncture services - for instance, to promising addiction therapy - a separate category of licensure should be created for professionals who provide only acupuncture, and not the array of traditional Oriental therapies. A reduced educational curriculum and examination would have to be developed and implemented.