CCAOM Entry-Level Standards Committee Issues Interim Report on Position Papers

The Council of Colleges of Acupuncture and Oriental Medicine's Entry-Level Standards Committee has released the results of its call for position papers on the issue of a possible change to entry-level doctorates for acupuncturists.

The committee was formed in May 2003 and charged with the task of developing and implementing a plan for soliciting proposals for possible changes in entry-level to the profession of the independent Oriental medicine provider and independent acupuncture provider. The call for position papers was sent to all Council member colleges, as well as to AAOM and the AOM Alliance, and was published in Acupuncture Today and Traditional Chinese Medicine World. The call invited individuals and organizations to submit written position papers and implementation proposals for possible changes in entry-level standards to the professions. Papers were submitted through April, 2004.

In all, 116 position papers were received. Of these, three were from accredited or candidate colleges; one was submitted from the AOM Alliance; two were from state organizations; 18 were from students currently enrolled in the Oregon College of Oriental Medicine's postgraduate doctoral program; and the remainder were from private individuals. Of those sent by private individuals, 52 had nearly identical text. These are referred to as "petition letters."

The following table summarizes the results. The responses were tabulated by the constituency of the responder and whether they opposed any change, opposed a change but supported an optional postgraduate doctorate, supported an eventual change to doctoral level (often with multi-tiered entry), or favored a complete change to a doctorate for entry-level.

Summary of Responses

Constituency	Oppose change in entry-level	Oppose change in entry-level: "petition letter"	Oppose change in entry-level but support optional doctorate	Favor transitional change in entry-level	Favor change in entry-level
Practitioner	16	12	4	0	0
Patient	2	1	0	0	0
Massage therapist	0	1	0	0	0
Student	7	0	1	0	0
Faculty	1	0	3	0	0
State organization	1	0	1	0	0
LAc with other advanced degree (MD, ND)	3	0	0	0	0
Accredited or candidate college	0	0	2	1	0
Unaccredited college	0	1	0	0	0
Unknown	0	37	1	0	1
State Lobbyist	1	0	0	0	0
Professional organization	0	0	1	0	0
DAOM candidates	0	0	13	3	2
Total	31	52	26	4	3

Opposing a Change in Entry-Level

Principal points mentioned by those who oppose any change in entry-level and support the current Master's-level standard were divided into several areas.

Representative comments regarding the current positioning of the profession included:

• The current level provides safe, effective, affordable care to patients. More education will not result in better treatment for patients.
• It is too early to really to have a discussion in entry-level change since no graduate has yet completed a postgraduate doctoral program.
• Increasing standards has closed the entry into states by our most experienced practitioners.
• Diversity of traditions taught will be lost.

Representative comments regarding increasing biomedicine training and scope of practice included:

• Increasing scope requires more years of training than is being proposed to be truly proficient.
• Patients and practitioners are not asking to receive or provide primary Western care.
• Increasing Western training is actually diluting the depth of training in our own modality.

Representative comments regarding financial issues included:

• Increasing cost of education will raise fees to patients, resulting in cost-prohibitive availability.
• Increasing cost of education limits new practitioners from entering the field. Decreasing the available acupuncturists is dangerous to our profession.
• Increasing scope will increase malpractice claims and insurance rates.

Supporting an Optional Postgraduate Doctorate

Thirteen responses supported a doctoral program as an option for those who wish to pursue it. All of these opposed a change from the master's as entry-level. One position paper described the pursuit of the doctorate program as progression in educational excellence, yet stated that there is a difference between the freedom of educational institutions "to adopt standards substantially above those of its peers" and a legislative mandate for "education beyond what is required for public safety." Other representative comments included:

• A postgraduate doctorate reflects growth and development of the profession.
• The option of a doctorate-level practitioner gives consumers more choice. Allow the marketplace to determine whether first professional doctoral degrees are more viable.

Transitional Approach to the Doctorate as Entry-Level

One submission described a vision of an eventual move to an entry-level doctorate, while in the transition, maintaining current master's programs as entry-level. One suggestion within this proposal was to add a year of residency to the master's curriculum in order to bring it to a doctoral level. The principal points in the position paper were:

• We should be continuously improving our programs, and the move to the doctorate would be an extension of this.
• Keep the curriculum the same as the master's degree and add one year of residency.
• Both the master's degree and doctorate will exist simultaneously until financial aid and state approval for the advanced degree is obtained.

Favoring a Change in Entry-Level

One response detailed a multi-level approach, including the creation of certificate programs for acupuncture specialists such as detoxification practitioners. This system could more precisely target the individual needs of patients and be attractive to public health institutions in integrating cost-effective acupuncture services. The principal points in this position paper were:

• Tiered levels of practitioners provide affordable levels of care according to patient need.
• A doctoral-level Oriental medicine provider or acupuncturist could provide some additional medical services at a fee not much higher than the standard acupuncturist's fee is today.
• With recognition by insurance companies (of doctorates), acupuncture services become more affordable to more people who no longer have to pay out of pocket.
• The public health sector can utilize detox specialists specific to their patient needs, at an affordable cost.

Position Papers From Current Doctoral Students

The Entry-Level Standards Committee received 18 position papers from current postgraduate doctoral students. These are reported separately since they were received from practitioners actively engaged in pursuing a doctoral level of education. Thirteen supported the master's degree as entry-level with the option of a postgraduate doctorate; three supported a transition from the master's degree to a doctorate, and two supported a change to doctorate as entry-level.

Doctoral Students Supporting an Optional Postgraduate Doctorate

Although these 13 submissions supported no change in entry-level and the development of postgraduate doctorates, many suggestions were given if a change were to occur. Of the 13 that supported an optional postgraduate doctorate, four further elaborated on a multi-tiered system that would include detoxification specialists, master's-level practitioners and postgraduate doctoral-level practitioners.

Representative comments regarding the current positioning of the profession:

• There is no evidence that the current educational standard does not produce practitioners with the basic skills and competencies necessary for entry-level practice.
• Establishment of doctoral programs offsets the notion that acupuncture can be learned in 100-hour courses.
• A doctoral degree has just been launched. It should be given 10 years to operate before any changes are contemplated.

Representative comments regarding issues of increase in biomedicine training/scope:

• Increase educational standards by requiring a pre-med degree to enter our master's programs.
• Westernizing our medicine should not be our goal.
• Increasing acupuncture education to a doctoral level still would not give us the same level of training as Western physicians in terms of Western diagnosis.
• There is no need to have allopathic diagnostic skills; rather we need to recognize allopathic reasons to refer.

Representative comments regarding financial issues:

• Increased cost of education required for entry-level inflates the cost of treatment, and denies care to the working poor.
• Doctoral entry-level standards will increase our malpractice liability. Paying increased educational costs means that you will not have time to listen to your patients, which our patients feel is one of the strongest reasons for them to see a practitioner of Oriental medicine.

Recommendations for implementation of entry-level doctorates:

• The doctoral level should focus on research and training researchers.
• The doctorate should be for faculty in our schools.
• Restrict entry-level doctorates to states with primary-care physician status.
• The focus of doctoral programs should be diverse, with research, clinical specialty, and TCM literature among the possibilities.

Doctoral Students Proposing a Transitional Approach to the Doctorate as Entry-Level

Three position papers supported a change to a doctorate as entry-level, but urged that this change would be transitional, over 8 to 10 years, from the master's to a doctorate level. The principal points were:

• The change must be comprehensive, and all practitioners of AOM (such as MDs) should come up to this common standard.
• The transition must be fostered for those with significant clinical experience (10-20 years).
• An enlarged scope would include point injections, prescriptive authority for controlled herbs, micro-knives, laser treatment, etc.

Doctoral Students Favoring a Change in Entry-Level

Two position papers supported a change to a doctorate as entry-level. The principal points were:

• Increasing educational requirements will improve quality of care.
• Increasing educational requirements will improve our credibility.
• The system in Korea is 6 years for entry, 2 years for a master's degree and 3 years for a PhD. In China, it's 5 years to entry, 3 years for a master's degree and 3 years for a PhD.
• There needs to be the same degree for all practitioners since our expertise is borne out of practice. Many additional years of schooling ceases to have meaning. Everyone should graduate with a doctoral degree in as little time as possible.

The release of these positions papers should not be construed as a quantitative analysis. The full text of the Entry-Level Standards Committee's report can be viewed at the CCAOM's Web site, www.ccaom.org.

Few results were received from the segments of our profession that have been promoting a change in entry-level standards. The committee wishes to continue to promote dialogue and reiterates that all points of view are welcome. Position papers and implementation proposals will continue to be received at ccaom@aol.com through March 1, 2005. In addition to continuing to solicit proposals from those within the profession, the committee is working to inform the profession about the impact of any proposed change in entry-level standards by discussing these issues with relevant bodies outside our profession, such as state regulatory agencies and educational commissions. The committee is currently engaged in surveying state educational commissions concerning the ramifications of a change in educational standards and reviewing the entry-level standards of other health care and human services professions.