Scope of Practice
Little Hover Commission 2004
Regulation of Acupuncture: A Complementary Therapy Framework
In SB 1951, the Legislature asked the Commission to:
"Review and make recommendations on the scope of practice for acupuncturists."
Finding 1: While the legal scope of practice clearly defines the modalities that acupuncturists can use, the statute is silent on issues that are important in defining their role as health care providers.
The legal scope of practice is the foundation on which health care regulation is built. The scope determines the minimal educational requirements that will be necessary for a practitioner to enter the field. The scope of practice defines the breadth of the licensure examination. And the scope of practice provides boundaries that are necessary to enforce the limits imposed by regulation.
Generally speaking, the boundaries established by a scope of practice also are lines of demarcation in the battles between various professionals, with licensees often trying to expand their own authority or limit the authority of a potential competitor. While these debates are usually voiced in terms of public benefit or public safety, an economic interest is at stake in virtually every polemic involving scope of practice.
In recent legislative proposals, as well as the review of the Acupuncture Board by the Joint Legislative Sunset Review Committee, policy-makers have been confronted with issues that ultimately related to the scope of practice for licensed acupuncturists. Debates over the limits of the legal scope of practice have made these issues difficult to resolve. And that confusion or disagreement was the basis for requesting the Commission to "review and make recommendations on the scope of practice."
In terms of treatments, the legal scope of practice is quite clear. However the legal evolution of the role of acupuncturists in the health care system, as well as how that role may be defined in the future, appears to be one of the most significant sources of tension.
The scope of practice for acupuncturists, contained in the Business and Professions Code, is fundamentally a list of modalities and services provided to patients by traditional practitioners in China, Korea, Japan, and now around the world. The modalities are listed in the box.
In addition to the statute, the Acupuncture Board has adopted Standards of Practice in regulation, which further define the practice of acupuncture in California. And the Department of Consumer Affairs has issued a series of legal opinions, often in response to specific questions, that attempt to clarify what acupuncturists can and cannot legally do. The Acupuncture Board also has adopted "for reference" a document prepared by a professional association describing "standards of practice" for California acupuncturists. That document varies in some instances from state statute and regulation.43
Many practitioners - such as podiatrists, optometrists and dentists - are limited to treating specific parts of the body. Acupuncturists are not limited in this way. Other practitioners - such as physical therapists - are limited in the assessments and therapies they can provide. Still others must practice under the supervision or referral of a physician.