| --Type Summary Here-- |
| Questions and Answers |
| Note: Some questions may no longer pertain to the amended version of the bill. For example, the bill now specifies 3,000 hours, and not 3,200 hours. |
| Have there been any studies or empirical data indicating a need to increase hours of training for acupuncturists? |
| Yes. Multiple surveys of licensees have demonstrated that they feel they lack the requisite skills necessary to begin practice; that they are not getting adequate training in the existing programs. The 1996 Occupational Survey conducted by the Acupuncture Board; The 2000 student survey conducted by the California Student Association of Oriental Medicine;The 2001 Survey Conducted by the California Health Institute; the 2001 Occupational Survey conducted by the Acupuncture Board; the 2001 Survey conducted by ACAOM. 20-25% of graduates never pass the exam because they are insufficiently trained. 30% of licensees stated that that their education was insufficient to prepare them to enter practice, and 50% recommended further education before being allowed to practice. |
| Do any studies indicate that there is a specific minimum number of hours of education that is adequate? How was that determined? |
| The profession, surveys, and panels of experts have determined that 4,000 hours is a recommended minimum level of training. This is done by reviewing curriculum and the commonly accepted hours that this coursework entails. Comparative analyses with similar education in other professions, in Asian countries of origin, in in other parts of the world indicate that 5,000 hours and five years should be the minimum. |
| How are hours for education normally determined? |
| Educational standards are generally determined by state legislatures, which are the only authorities which can license occupations and professions. The state regulatory agencies authorize the practice of medicine and health care, and determine the standards that are required to benefit their citizens. |
| In the health care professions, organizations or federations of state regulatory agencies meet to determine what standards and competencies are required to enter the profession. In the case of medical doctors, the United States Medical Licensing Examination (USMLE) used to assess a physician's ability to apply knowledge, concepts, and principles that are important in health and disease and that constitute the basis of safe and effective patient care. The USMLE is sponsored by the Federation of State Medical Boards of the United States, and the National Board of Medical Examiners, who determine the exam content. Results of the USMLE are reported to medical licensing authorities in the United States and its territories for use in granting the initial license to practice medicine. The Liaison Commission for Medical Education (LCME), in turn determines programatic standards that will assure that graduates of its accredited schools can meet those criteria for licensure. |
| At vairous levels of the process, the profession is surveyed to determine changing needs and qualifications to enter the profession, and this data is used to adjust future requirements. |
| How would currently licensed acupuncturist be affected by the increased hours? Would they be required to go back to a school and complete the difference in hours or would they be able to participate in MCE and count hours in filed practice? |
| Currently licensed acupuncturists could be required to attend increased continuing education courses, but not to the full extent of the increased curriculum. When the scope of practice was expanded and an extra one thousand hours added in the early 80's, practitioners were required only to attend an extra 80 hours of continuing education. |
| Why should the state Legislature legislate minimum hours when it is the Board of Acupuncture's jurisdiction to establish licensing criteria? |
| The Acupuncture Board has, in fact, determined that a need exists for higher educational standards. However, vested interests (representatives of schools) have effectively blocked this increase by providing confusing and misleading testimony before the Acupuncture Board, and to adminstrators and bureaucrats with Board oversight authority. The Council of Collges has threatened legal action, hired lobbyists, and some schools themselves have sent numerous lobbyists to Board meetings to oppose such changes. |
| Does the Governor support the proposal? |
| Governor Davis likes to be known as the "educational Governor," and has privately expressed support for our educational proposals. |
| How many acupuncturists would this bill affect? |
| There are about 6,800 Licensed Acupuncturists in California. Approximately 800 graduates sit for the licensing exam each year. Approximately 600 new licenses are issued each year. |
| Have there been any anecdotal cases of death or injury due to under trained acupuncturists? |
| Yes. These cases have involved missed diagnoses, but there have been a few punctured lungs and other organs, wrongful death lawsuits, and serious illnesses caused by the incorrect use of Chinese herbs. There is evidence to suggest that acupuncturists are safer practitioners of acupuncture than physicians, in spite of the physicians greater skills and training in overall medicine. However, acupuncturists are generally careful, and do not commonly treat patients in life-threatening situations, and are not forced to make the same decisions that hospital physicians make. |
| The opponents claim that this bill would cost students an additional $12 million in tuition. How do you respond to this allegation? |
| Whether they are using new math or old math, their arguments just don't add up. In fact, they may already be bilking students for millions of dollars without any justification or oversight. There are approximately 800 new examinees per year. We cannot account for drop-outs or failure rates; it is up to the schools to weed out poor students and to retain quality students for the duration of the programs. Schools have been required to teach 2,348 hours since 1985. Tuition currently averages $11 per hour, and schools are averaging over 3,000 hours, according to voluntary surveys completed by the schools at the request of the Acupuncture Board. . AB 1943 would require 3,200 hours beginning in 2003, and 4,000 hours beginning in 2007. |
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| As you can see from this table, schools are currently charging students 27% extra for unstandardized education. AOM Schools currently take in over $26 million in tuition from students that actually complete their education. The 3,200 hour regulation would increase tuition by 6%, or less than two million dollars per year. |
| What about students who graduate and don't get licensed in California, but take the NCCAOM exam and move to another state? |
| These students had a choice of which school to attend, and generally found that California Acupuncture Board approved shools have a better reputation for quality education. They had a choice of attending other schools, especially those who knew they wanted to practice in states where they have lower standards of health care, are not allowed to prescribe herbs, or require prior diagnosis or supervision to treat patients. Think about it this way: Why hold all physicians to the same high standard of training and care if you only want them to practice in the poor neighborhoods and rural areas, where some people might be willing to accept a lower standard of care? |
| How many acupuncture students are currently studying annually in California? |
| This question is best answered by the schools, as they do not generally advertise retention, graduation, or licensing rates. There could be as many as 5,000 at any given time, with 1,250 new students entering each year. With 800 taking the exam, that would be a 36% attrition rate. |
| What is the rationale behind the hours? |
| The long term goal for our profession is to have a first professional doctorate as entry into the profession, just as it is in the Asian countries of origin. We started in California with 1350 hours and only acupuncture. Then, herbs, massage, and other procedures were added, and hours increased to 2350 hours. The next intermediate step is 3200 hours, and finally, to 4000 hours. The changes must take place sequentially, as you cannot keep legislating or regulating changes every year. All the time, entry level requirements should be increasing too, starting with no college prerequisites for the 1350 hour programs, and by the time we reach the 4,000 hour professional doctorate, most students should be entering with a bachelors degree, or at least three years of college, similar to medical, chiropractic, and other professional doctorate programs. |
| What is the rationale behind the implementation dates? |
| There are two reasons for this. First, the change is long overdue, therefore it cannot be soon enough. Historically, the recommendation has been anywhere from 3,600 hours to 4,800 hours, with a goal of 4,000 hours by the year 2000. The Acupuncture Board has been openly discussing this since at least 1991, and announced their intentions in early 2000 to implement the changes in 2003. Many schools have sent participants to task force meetings involved in the issue. Second, given the rate that schools are increasing their programs, at about fifty hours per year, they will be averaging 3,200 - 3,400 hours by the time the first students graduate in 2007 under the new 3,200 hour standard. The dates of implementation seems a good compromise that should not adversely impact the schools. However, it would be reasonable to set the date back a year, to give the smaller or lower hour schools a chance to catch up. |
| How would a state increase in minimum hours affect the national accreditation or licensure process? |
| Licensing is a process that is left up to states. There is no such thing as "national licensure until such time that a Constitutional Amendment is passed. Likewise, education is left up to the states. Accreditation is an alternative method whereby the Federal government exerts indirect influence on education by limiting Federally subsidized student loans and grants to schools accredited by private agencies that it approves. It is not meant to influence licensing standards. An increase in curriculum imposed by states could possibly improve national accreditation standards, since accreditation is supposed to designed to assure that schools provide programs that meet state licensing requirements. Other states have higher standards. Unfortunately, they have not affected accrediation yet. |
| Accredited tirst professional doctorates (medicine, podiatry, chiropractic, dentistry, etc) generally require 3-4 years of prior college education, with preference for a Bachelors Degree. Masters degree programs generally follow Bachelors degrees in the same field of study, so the Masters degree is the the fruition of 5-6 years of college. Unfortunately, some acupuncture schools accept students with only one year of college, and allow them to finish in less than three years. So, some graduates from schools in other states have a Masters degree in acupuncture that only represents three and one-half years of college, less than California schools were requiring twenty years ago. They are out of step with our profession and with higher education in general. |
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| Further Discussions on the Issues |
| Comment: Oriental Medicine has an excellent safety record. The public is not harmed and thus do not need to increase the training. The NCCAOM has never even had to take action against a diplomate for harming a patient. |
| Reply: The claim of an excellent safety record is derived by comparing the number of complaints between the Acupuncture Board and the Medical Board. This comparison is flawed due to several factors. |
| The Acupuncturist treats different conditions than the MD. How many acupuncturist deliver babies, perform open heart surgery, prescribe medications, resuscitate a patient in cardiac arrest. The insertion of an acupuncture needle into key body points is inherently safe given certain therapeutic guidelines. |
| Also, the acupuncturist see on average 30 patient visits per week compared to three times this amount for the MD's. The more patient seen increases the possibility of an unhappy patient who complains to the board. |
| Hospitals and malpractice carriers are required to report physicians, accounting for about 15% of the complaints filed against physicians. They do not report cases against acupuncturists. |
| Another point is the list to file a complaint with the Medical Board is much larger than the acupuncture Board. One patient can make more complaints about one practitioner if it is an MD than an acupuncturist. |
| The NCCAOM is a private company, taking their exam is voluntary, and maintaining membership is voluntary. Like any professional organization, they have no legal authority over their members. |
| Comment: We do not want to be MD's. The students are given enough training to know when to refer and when to treat. |
| Reply: The training should be to become a first contact primary care provider as stated in the Acupuncture Legislative Act. This means the acupuncturist have enough training to do a basic history and physical exam, common to all primary health professionals. Based on a 2001 study, conducted by the California Health Institute in conjunction with researchers from UCLA and USC, there is a definite lack of training in key clinical areas. Specifically, Physical Exam Skills; Laboratory and Diagnostic Imaging; Physical Medicine Therapies; and Office/Practice Management. The students are not given even a basic level of training to recognize a condition when it is sitting in from them let alone know when to refer it. This and other studies support the same conclusion that more training needs to be done. |
| Comment: Prove to those opposing the Bill that Oriental Medical education needs to have these hours increased. |
| Reply: Based on a 2001 study, conducted by the California Health Institute in conjunction with researchers from UCLA and USC, there is a definite lack of training in key clinical areas. Specifically, Physical Exam Skills; Laboratory and Diagnostic Imaging; Physical Medicine Therapies; and Office/Practice Management. The students are not given even a basic level of training to recognize a condition when it is sitting in from them let alone know when to refer it. This and other studies support the same conclusion that more training needs to be done. |
| Comment: The Bill micro manages the colleges and dictates the content and type of teaching. The colleges have academic freedom and can set their own educational programs without it being done legislatively. |
| Reply: The bill allows for academic freedom within the structure of academic and clinical content appropriate for an Acupuncturist who is a primary care professional. The colleges have the flexibility to design the curriculum around the stated legislative goals. What the bill does achieve is consistency between the colleges so the California public is assured that the acupuncturists graduating from different colleges have similar training. Without the bill, the acupuncture colleges are designing programs which are not meeting the professional goals. |
| Comment: The students want quality education and not quantity education. |
| Reply: The current curriculum does not allow for excellence and quality in the education because of the large volume of material needed to be covered in a reduced time period. Many instructors and students feel that more time is needed to cover all the material necessary. By having more hours to present the material, instructors can then teach more of the vital topics left out due to time constraints. Most schools are additionally accredited, and claim that accreditation assures the student of a quality education. However, the accreditation commission is not in the law enforcement business, and is streched beyond its capacity just to keep up with new schools and re-accreditation. Clearly, additional oversight is required by the State of California. |
| Comment: If these increased hours are implemented, then students will not enroll in California schools and opt to attend out of state schools. Many California schools will close. |
| Reply: The vast majority of students are from inside California and not from other states or countries. Many of the California schools who have a large number of training hours are at capacity and need to expand. If this argument was true, the schools with fewer hours of training should have the most enrollment. The converse is true. People are willing to pay for quality education. Most people will not waste their time attending a program that is not quality. Also, looking at health care history, as the academic and clinical training increases, there are more people attracted to the profession. Enrollment drops for one to two years but rises to higher levels than before. |
| Comment: The increase in hours is a financial burden the students and the California people who will ultimately pay higher treatment fees due to the higher student loan debt incurred with the curriculum increase. |
| Answer: Studies have looked at this issue regarding financial burden on the students and the California people. The financial impact on the California public is approximately 5 cents per visit. This is calculated with the following parameters: The acupuncturist amortizes the student loan payment out over 20 years; sees approximately 30 visits per week; and incurs approximately $30,000 in student loan debt in a 3200 hours program. We beleive that California consumers can readliy afford 5 cents more per visit to receive the quality care they deserve. |