Regulation of acupuncture

Regulation of acupuncture is done by various governmental bodies to ensure safe practice, and varies among and within countries.

Acupuncturists may also practice traditional Chinese herbal medicine or massage ("Tui Na"), or may be medical acupuncturists, who are trained in modern, evidence-based medicine but also practice acupuncture in a simplified form. License is regulated by the state or province in many countries, and often requires passage of a board exam.

United States

In the US, acupuncture is practiced by a variety of healthcare providers. Those who specialize in Acupuncture and Oriental Medicine are usually referred to as "licensed acupuncturists", or L.Ac.'s. Other healthcare providers such as physicians, dentists and chiropractors sometimes also practice acupuncture, though they may often receive less training than L.Ac.'s. L.Ac.'s generally receive from 2500 to 4000 hours of training in Chinese medical theory, acupuncture, and basic biosciences. The amount of training required for healthcare providers who are not L.Ac.'s varies from none to a few hundred hours, and in Hawaii the practice of acupuncture requires full training as a licensed acupuncturist. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) [http://www.nccaom.org/aboutus.htm] tests practitioners to ensure they are knowledgeable about Chinese medicine and appropriate sterile technique. Many states require this test for licensing, but each state has its own laws and requirements. Some states use titles besides L.Ac. for licensed practitioners specializing in acupuncture: "D.O.M." (Doctor of Oriental Medicine) in New Mexico, "D.Ac." (Doctor of Acupuncture) in Rhode Island, and "A.P." (Acupuncture Physician) in Florida. Some states, such as California and Florida, legally treat acupuncturists as primary care providers. Most states allow acupuncturists to practice without a referral from another medical practitioner.

The abbreviation "Dipl. Ac." stands for "Diplomate of Acupuncture" and signifies that the holder is board-certified by the NCCAOM [http://www.nccaom.org/aboutus.htm] . Professional degrees are usually at the level of a Master's degree and include "M.Ac." (Master's in Acupuncture), "M.S.Ac." (Master's of Science in Acupuncture), "M.S.O.M" (Master's of Science in Oriental Medicine), and "M.A.O.M." (Master's of Acupuncture and Oriental Medicine). As of 2007, the Accreditation Commission for Acupuncture and Oriental Medicine [ [http://www.acaom.org/ ACAOM - Acupuncture & Oriental Medicine Professionals ] ] (ACAOM) is beginning the process of accrediting the "Doctor of Acupuncture and Oriental Medicine" (DAOM) degree, and this new degree will represent the terminal degree in the field. The Oregon College of Oriental Medicine [http://www.ocom.edu/] and Bastyr University were the first two institutions in the United States to offer the DAOM. The titles "O.M.D." (Doctor of Oriental Medicine) and "C.M.D." (Doctor of Chinese Medicine) are sometimes used by graduates of Chinese medical schools who have received the Bachelor of Medicine and Surgery degree. "O.M.D." may also signify a degree, granted by certain American schools, indicating a year or two of study beyond the Master's level. The O.M.D. and C.M.D. are not recognized by the ACAOM.

Acupuncturists are required to obtain continuing education credit to retain their licenses. There are three bodies that approve continuing education courses for re-licensure: the California Acupuncture Board [ [http://www.acupuncture.ca.gov/ State of California Acupuncture Board ] ] , the Florida Board of Acupuncture [ [http://doh.state.fl.us/mqa/acupunct/index.html Florida Board of Acupuncture - Board Overview ] ] , and the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). The NCCAOM awards PDA points towards re-licensure for approved courses and requires Diplomates (licensed acupuncturists with NCCAOM certification) to obtain 60 PDA points every four years to re-certify. The California Acupuncture Board governs the re-licensure of all California licensed acupuncturists and requires fifty continuing education units (CEU’s) every two years. The Florida Board of Acupuncture governs all licensed acupuncturists in Florida and requires acupuncturists to complete 30 continuing education credit hours (CE’s) every two years. The NCCAOM and Florida Acupuncture Board calculate continuing education credit hours based on the calculation that sixty minutes of course time equals one continuing education point or unit. The California Acupuncture Board calculates that one continuing education unit is awarded for fifty minutes of course time and limits distance education to fifty percent of total CEU’s.

In 1996, the Food and Drug Administration changed the status of acupuncture needles from Class III to Class II medical devices, meaning that needles are regarded as safe and effective when used appropriately by licensed practitioners [ [http://www.fda.gov/fdac/departs/596_upd.html Updates-June 1996 FDA Consumer ] ] [ [http://www.fda.gov/cdrh/pmapage.html US FDA/CDRH: Premarket Approvals ] ] .

Canada

In the province of British Columbia the "TCM practitioners and Acupuncturists Bylaws" were approved by the provincial government on April 12, 2001. The governing body, College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia [ [http://www.ctcma.bc.ca/index.asp CTCMA ] ] provides professional licensing. Acupuncturists began lobbying the B.C. government in the 1970s for regulation of the profession which was achieved in 2003.

In Ontario, the practice of acupuncture is now regulated by the Traditional Chinese Medicine Act, 2006, S.o. 2006, chapter 27 [http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/06t27_e.htm] . The government is in the process of establishing a College whose mandate will be to oversee the implementation of policies and regulations relating to the profession. Practitioners of Traditional Chinese medicine will be permitted to use the title 'Doctor of Traditional Chinese medicine'. In addition, they will be permitted to communicate a diagnosis to patients based on Traditional Chinese medicine techniques for diagnosis. Other regulated Health Care Professionals, such as naturopaths, physicians, physiotherapists, chiropractors, dentists, or massage therapists can perform acupuncture treatments when they fulfill educational requirements set up by their regulatory colleges. It is noteworthy, however, that the school (philosophy and approach) and style of acupuncture differs depending on the training of the practitioner.

United Kingdom

Acupuncture practice is currently not regulated by law in the UK. Many practitioners belong voluntarily to acupuncture organisations which have rigorous codes of practice and educational requirements. An estimated 7,500 practitioners practise acupuncture to some extent and belong to a relevant professional or regulatory body. About 2,400 are traditional acupuncturists who mostly belong to the British Acupuncture Council, which requires its members to be trained in both traditional acupuncture and relevant biomedical sciences. Approximately 2,200 registered doctors belong to the British Medical Acupuncture Society. Some 2,650 physiotherapists belong to the Acupuncture Association of Chartered Physiotherapists and 250nurses belong to the British Academy of Western Acupuncture. There are also practitioners of Traditional Chinese Medicine who belong to one or more associations.citation|url=http://www.ehpa.eu/pdf/ARWG_report_2003.pdf|title=The Statutory Regulation of the Acupuncture Profession|date= September 2003|publisher=Acupuncture Regulatory Working Group]

Australia

In Australia, the legalities of practicing acupuncture also vary by state. In 2000, an independent government agency was established to oversee the practice of Chinese Herbal Medicine and Acupuncture in the state of Victoria. The Chinese Medicine Registration Board of Victoria [ [http://www.cmrb.vic.gov.au/ Welcome to the Chinese Medicine Registration Board of Victoria ] ] aims to protect the public, ensuring that only appropriately experienced or qualified practitioners are registered to practice Chinese Medicine. The legislation put in place stipulates that only practitioners who are state registered may use the following titles: Acupuncture, Chinese Medicine, Chinese Herbal Medicine, Registered Acupuncturist, Registered Chinese Medicine Practitioner, and Registered Chinese Herbal Medicine Practitioner.

The Parliamentary Committee on the Health Care Complaints Commission in the Australian state of New South Wales commissioned a report investigating Traditional Chinese medicine practice. [ [http://www.parliament.nsw.gov.au/prod/parlment/committee.nsf/0/CA78E168CE1B6FA2CA2570B400200A34 Final Report, Report into Traditional Chinese Medicine - NSW Parliament ] ] They recommended the introduction of a government appointed registration board that would regulate the profession by restricting use of the titles "acupuncturist", "Chinese herbal medicine practitioner" and "Chinese medicine practitioner". The aim of registration is to protect the public from the risks of acupuncture by ensuring a high baseline level of competency and education of registered acupuncturists, enforcing guidelines regarding continuing professional education and investigating complaints of practitioner conduct. The registration board will hold more power than local councils in respect to enforcing compliance with legal requirements and investigating and punishing misconduct. Victoria is the only state of Australia with an operational registration board. [ [http://www.cmrb.vic.gov.au Welcome to the Chinese Medicine Registration Board of Victoria ] ] Currently acupuncturists in NSW are bound by the guidelines in the Public Health (Skin Penetration) Regulation 2000 [ [http://www.health.nsw.gov.au/public-health/ehb/general/skinpen/skin_pen_reg_2000.pdf PUBLIC HEALTH (SKIN PENETRATION) REGULATION 2000 ] ] which is enforced at local council level. Other states of Australia have their own skin penetration acts. The act describes explicitly that single-use disposable needles should be used wherever possible, and that a needle labelled as "single-use" should be disposed of in a sharps container and never reused. Any other type of needle that penetrates the skin should be appropriately sterilised (by autoclave) before reuse.

China

In China, acupuncture and other modalities of Traditional Chinese medicine are incorporated into standard medical education, and regulated accordingly; only doctors may practice.

Many other countries do not license acupuncturists or require them be trained.

References