Four years of state legislative effort by acupuncturists of Rhode Island
have resulted in all insurance companies in the state being obligated to
provide optional coverage for acupuncture by April 2000. This will give
the general public much better access to acupuncture benefits. Insurance
companies that offer better coverage for acupuncture possess a considerable
marketing advantage and likelihood of great savings to their organizations.
There are 35 jurisdictions (34 states and DC) that have passed a statute
regulating acupuncture and Oriental medicine. Local political philosophies
and needs create considerable variance in the laws from state to state.
Eleven states have independent boards. In twelve others, acupuncturists
are under the board of medical examiners. In the last third,
acupuncturists are regulated by the Department of Commerce, regulatory
agencies, health, professional regulation, or occupational licensing.
Rhode Island's acupuncturists are regulated by the Department of Health.
Rhode Island's Educational Standards
The RI Department of Health recently proposed a regulation for educational
standards for acupuncture practice. The requirement states that physicians
who want to practice acupuncture will need 300 hours of formal acupuncture
education and training. Acupuncturists are required to have 2,500 hours of
education and 20 hours of continuing education per year. This makes Rhode
Island a model for the highest educational standards for acupuncture for
both physicians and acupuncturists.
Although Rhode Island does not require patients to receive prior diagnosis
or referral, one-third of the states require some form of western medical
intervention prior to, or in conjunction with, Oriental medical treatment.
This intervention is usually a referral or prior diagnosis by or
collaboration with an MD, DO, DDS, or DC. New York requires that the
acupuncturist advise the patient as to the importance of consulting with a
This type of language in statutes is usually the result of unfamiliarity
with the safety record of the acupuncture profession. This language is
becoming less popular with legislators who view it as a restriction on
consumer access. Medical boards also are increasingly scrutinizing this
language under the theory that it may place their licensees in a legally
vulnerable position by requiring them to supervise or refer to a practice
that is not included within their normal professional training. Maryland
and Massachusetts have removed these requirements from their law.
Pennsylvania, Virginia, and Texas have introduced bills to do so.
Rhode Island's acupuncturists practice in a wide variety of settings around
the state. There are practitioners with small, home-based offices, as well
as those with a traditional medical clinical setting. Regardless of the
diversity of their practice, all are subject to rigorous license
requirements, education, and standards of practice overseen by the
Department of Health.
The incredible progress in Rhode Island's state regulation in the last 25
years is a tribute to the quality and enormous hard work of our fellow
professionals. As we discuss our vision of the future, we must take into
account what is politically and legislatively realistic as well as to
responsibly examine the impact on practitioners and patients.
Benefits of Acupuncture
There are more and more models of protocols used in mainstream medicine
that engage acupuncture to treat conditions such as chronic pain, asthma,
hypertension, back pain, and spinal related conditions. They clearly
demonstrate that the same or better results can be achieved in combination
with less invasive "alternative" approaches for a fraction of the cost.
Early acupuncture intervention can reduce the number of back surgeries by
half with better outcomes, and can dramatically reduce the number of
admissions of asthma patients to emergency rooms. Acupuncture also has
proved to be effective for nausea and other side effects of chemotherapy.
University Anesthesiologists Inc. (UAI) Pain Management and Acupuncture
Center is the first serious attempt to integrate acupuncture into medical
practice in Rhode Island. This integrative approach, enacted through the
vision of Kathleen Hitner, MD, is cost effective and clinically efficient,
and returns the patient to the center of healthcare. The protocol for
management of postoperative nausea and vomiting, developed by UAI, has
a good chance to be put into practice at Roger Williams Medical Center,
where I have the privilege to be an acupuncturist on staff.
Chronic pain is the perfect field to implement integrative medicine. It is
logical, effective, and perhaps the only way to achieve positive results
and avoid haphazard, chaotic treatment.
Coordination of care takes commitment and willingness to be open minded
about therapies that physicians are not accustomed to. Acupuncturists must
develop medical terminology and language to better communicate with
physicians, and physicians would benefit from a greater understanding of
the concepts of acupuncture. It is time to put aside the struggle of
paradigms and focus on the benefits to the patient.
Alex Tatevian, DA
Southern New England Health Care Review; 2000;