Regulation of acupuncture

Regulation of acupuncture is done by governmental bodies to ensure safe practice.

Australia

In 2000, the Chinese Medicine Registration Board of Victoria, Australia (CMBV) was established as an independent government agency to oversee the practice of Chinese Herbal Medicine and Acupuncture in the state.^[1] In 2005 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.^[2] 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 was 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. Currently acupuncturists in NSW are bound by the guidelines in the Public Health (Skin Penetration) Regulation 2000^[3] which is enforced at local council level. In 2012 the CMBV became the Chinese Medicine Board of Australia, and in 2013 established an interim accreditation standard for the profession in partnership with the Australian Health Practitioner Regulation Agency.^[4] 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.

Canada

Acupuncture is regulated in five provinces in Canada: Alberta, British Columbia, Ontario, Quebec, and Newfoundland.

In British Columbia, the practice of acupuncture and Chinese Medicine has been professionally regulated since 1996 by the College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia (CTCMA). As of April, 2003, a valid professional license issued by the CTCMA was required to practice acupuncture.^[5] In Quebec, the practice of acupuncture has been regulated since 1995 by the Ordre des acupuncteurs du Qué bec(OAQ). In Ontario, the act which regulates the practice of acupuncture is the Traditional Chinese Medicine Act, 2006, S.O. 2006, chapter 27.^[6] which came into full force and effect on April 1, 2013.^[7] The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (TCMPAO) regulates the profession in Ontario.

France

Since 1955, the French advisory body Académie Nationale de Médecine (National Academy of Medicine) has accepted acupuncture as part of medical practice.^[8] Acupuncture is also routinely reimbursed by social security when performed or prescribed by a doctor or practitioner.^[9]

Germany

Following the German Acupuncture Trials from 2006 to 2007, the Federal Joint Committee (an agency similar to the National Institutes of Health in the United States) passed a law which allows the reimbursement of acupuncture treatment by the public health insurance system for the following ailments: Chronic lower back pain^[10] and chronic Knee pain caused by osteoarthritis.^[10] In 2006, German researchers published the results of one of the first and largest randomized controlled clinical trials.^[11] As a result of the trial's conclusions, some insurance corporations in Germany no longer reimburse acupuncture treatments.^[11] The trials also had a negative impact on acupuncture in the international community.^[11]

New Zealand

Traditional/lay acupuncture is not a regulated health profession. Osteopaths have a scope of practice for Western Medical Acupuncture and Related Needling Techniques.^[12] The state-owned Accident Compensation Corporation reimburses for acupuncture treatment by registered health care practitioners and some traditional/lay acupuncturists that belong to voluntary professional associations.^[13]

United Kingdom

Acupuncturists are not a nationally regulated profession in the United Kingdom. Acupuncture practice is regulated by law in England and Wales for health and safety criteria under The Local Government (Miscellaneous Provisions) Act 1982, which has been recently amended by the Local Government Act 2003. Each local authority implements its own policy in accordance with the Act. For example, the London boroughs use the London Local Authorities Act, 1991/2000. Premises and each practitioner offering acupuncture must be licensed. As there is no formal certification of acupuncture, practitioners are exempted from licensing by virtue of being current members of approved acupuncture associations such as the British Acupuncture Council. Physiotherapists are also required to be current members of an approved acupuncture association as body piercing is not part of the entry level curriculum for state registered physiotherapists regulated by the Health Professions Council. The approved acupuncture organisations have rigorous codes of practice and educational requirements and members are covered by the appropriate indemnity insurance. 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 and other statutorily regulated health professionals belong to the British Medical Acupuncture Society. Some 2,650 physiotherapists belong to the Acupuncture Association of Chartered Physiotherapists and 250 nurses belong to the British Academy of Western Acupuncture. There are also practitioners of Traditional Chinese Medicine who belong to one or more associations.^[14]

The principal body for professional standards in traditional/lay acupuncture is the British Acupuncture Council,^[15] The British Medical Acupuncture Society^[16] an inter-disciplinary professional body for regulated health professional using acupuncture as a modality. The Acupuncture Association of Chartered Physiotherapists.^[17]

United States

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.^[18][19]

As of 2004, nearly 50% of Americans who were enrolled in employer health insurance plans were covered for acupuncture treatments.^[20][21]

Acupuncturists in the United States are required to attend a three or four-year graduate level, accredited program to be licensed. While some schools are regionally accredited, most professional training programs are accredited by the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). Forty-three states require certification, by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).^[22] A variety of titles are granted:

• Licensed acupuncturist (L. Ac), in most states
• Oriental Medical Doctor (OMD), This is a title that was conferred to individuals who completed Post-Masters degree Doctoral programs prior to the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) receiving recognition by the United States Department of Education in l998. All OMD programs were discontinued when ACAOM became the Accreditation agency for all schools and colleges in the US that were teaching Acupuncture and Oriental Medicine. All doctoral programs were eliminated in order to offer an Accredited Masters Degree. Presently, an OMD degree by an individuals name would signify that they were one of the early leaders in this field who completed a additional doctoral program prior to l990. ≠
• Acupuncture physician, used in Florida
• Doctor of oriental medicine (DOM), used in New Mexico
• Doctor of acupuncture (DAC) in Rhode Island
• Diplomate of acupuncture (Dipl. Ac), a NCCAOM board certification in acupuncture^[23][24]
• Diplomate of oriental medicine (Dipl. OM), a NCCAOM certification which includes acupuncture and Chinese herbology^[25]
• Diplomate of the American Board of Medical Acupuncture (DABMA), a certification provided by the American Academy of Medical Acupuncture for physicians trained in medical acupuncture^[26]
• Doctor of acupuncture and oriental medicine (DAOM), a degree offered by the Oregon College of Oriental Medicine and Bastyr University as a ACAOM-sponsored terminal degree in the field^[27]

Acupuncturists are usually required to obtain continuing education credit to retain their licenses. In most states this is handled by the NCCAOM, which awards PDA points towards re-licensure for approved courses and requires Diplomates (licensed acupuncturists with NCCAOM certification) are required to obtain 60 PDA points every four years to re-certify.

California and Florida each have their own unique requirements and regulatory agencies. The State of California Acupuncture Board (SCAB) governs the re-licensure of all California licensed acupuncturists and requires fifty continuing education units (CEU’s) every two years.^[28] 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.^[29]

References