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 licensed physician.

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; Vol. 10-10.