Why You Should See An Acupuncturist for Acupuncture

 

In recent years medical doctors (MDs), osteopaths (DOs), physical therapists (PTs), and chiropractors (DCs) in North Carolina have all written acupuncture into their scope of practice, giving themselves legal permission to offer this therapy to their patients. Unfortunately, some of them require no additional training to do so while others only require very little. As it stands, Neither MDs, DOs, PTs, nor DCs need to have any supervised clinical hours, nor are they required to keep up with any continuing education. Though there are certification classes available for them, physicians are not required to have any additional training (www.ncmedboard.org). Physical therapists must be certified in acupuncture to practice it, though they are only required to take 54 hours of class (www.ncptboard.org). Chiropractors are required to have more education than that, but they still only need 200 hours of class to be certified, and that's only if they were licensed after 07/01/2008. If they were licensed before then, it's 100 just hours (www.ncchiroboard.com). In contrast, licensed acupuncturists must attain a postgraduate master's degree from an accredited college with a minimum of 1,800 class hours, 650 of which must be supervised clinical training, must take the Clean Needle Technique course, pass four national board exams, maintain a state license, and complete forty continuing education credits every two years (www.ncalb.com). As a Doctor of Acupuncture and Chinese Medicine, I have fulfilled all of the above requirements and more, with a total of 3,090 hours of training.

 

Acupuncturists are licensed to practice acupuncture, while MDs, DOs, PTs, and DCs are only certified in it. What's the difference? A license is a mandatory credential issued by a government entity verifying that an individual has met the minimum educational requirements needed to practice a particular profession within a designated scope of practice. In many professions, it is illegal to practice without a state license. A certification, on the other hand, is a voluntary credential issued by a private entity verifying that an individual has completed a certain training. Certifications are not regulated by government entities and do not have minimum educational requirements. This means that legally, because they are only certified in acupuncture, not licensed, MDs, DOs, PTs, and DCs are not allowed to use the official titles Licensed Acupuncturist or Doctor of Acupuncture and Chinese Medicine, nor can they refer to themselves professionally as an acupuncturist. Since MDs, DOs, PTs, and DCs are not required to study acupuncture to practice according to their licensure, it is only an additional voluntary certification for them. Confusing this further is the use of certain terms, like "medical acupuncture" by physicians or "dry needling" by physical therapists, the former incorrectly suggesting a special level of expertise and training when the opposite is true, and the latter suggesting that there is a clinical distinction between acupuncture and dry needling when there isn't one.  

 

As an acupuncturist, it is very interesting for me to see how PTs have added acupuncture to their legal scope of practice. In some ways, it is a welcome acknowledgment by them as to the efficacy of this wise and ancient healing art. In other ways, though, it is a complete dismissal of its underlying theoretical foundation. This is especially so when you look at how little training their board requires them to have to practice acupuncture. For example, there are over 350 acupuncture points, each with a specific anatomical location and correct depth and angle of insertion. Just this critical basic information took me 60 class hours to learn, more than their minimum requirement of 54. Another issue is that they use acupuncture needles, put them in acupuncture points, and use this therapy clinically to treat pain just like acupuncturists do. So what's the difference between acupuncture and dry needling, other than in the term they use to describe it? I would say nothing, though in court the North Carolina Physical Therapy Board argued that dry needling is completely different because physical therapists use it according to a  different theoretical understanding of how it works. In response, I would say that it is impossible to correctly use a tool if you do not understand the underlying theory of how it works. It is not just the needle that is the cure, it is the whole philosophy of Chinese medicine and its alternate paradigm of chi, energy channels, yin and yang, and the five elements behind it that make them so effective. To reduce this medicine to the simple mechanical application of a needle where it hurts, to adopt the tool but not the theory that it grew out of, is limiting at best and dangerous at worst. Acupuncture points have the same actions, indications, and contraindications whether the person inserting the needle has studied these things or not. In fact, the practice of dry needling by PTs is illegal in four states (New York, Oregon, California, and Hawaii), representing 20% of the American population. Furthermore, there are three physician groups that have published formal position papers against it.

 

Please click here to read the American Medical Association's position paper against the practice of dry needling by physical therapists on the grounds that "dry needling should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice."

 

Please click here to read the American Academy of Medical Acupuncture's position paper against the practice of dry needling by physical therapists on the grounds that "this procedure should be performed only by practitioners with extensive training and familiarity with routine use of needles in their practice and who are duly licensed to perform these procedures."