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Acupuncture Statute Clarification and Professional Nomenclature Considerations in Washington State

January 31, 2009

(A similar version of the following article was recently submitted to the AAAOM's Qi Unity report. It is being listed here to help give some background to the current bill WAOMA has introduced.)

By George M.Whiteside, MS, LAc, Certified Chinese Herbalist, President, WAOMA

While we have enjoyed a broad scope of practice here in Washington State for over 23 years, a move to clarify our statute and further strengthen our scope of practice has begun gaining momentum; changing our title in particular has become one of the first steps in this clarification process. This focus on our title has prompted us to examine the broad trends in the use of professional terms that define who we are, what we do, and how we practitioners are perceived by regulators, other professions and the public. The use of the umbrella term "acupuncture"—in state and national organization names—began shifting in the late 1990's to "Acupuncture and Oriental medicine." Almost everyone championed this change as a step forward, since we have been practicing the system of Oriental medicine through acupuncture and the many other modalities we commonly have in our scope of practice. Both Acupuncture and Oriental medicine are common terms in in the laws that govern Acupuncturists and both are found in our statute here in WA state. The pitfall, according to our attorney here is that by using two terms to describe our medicine, we inadvertently create vulnerabilities for the professional in practice and confusion for the public. As we have considered simply adding "Oriental medicine" to our title, we have been warned that retaining the word "Acupuncture" and adding the word "and" could risk inadvertently creating a legal and ideological distinction between Acupuncture and the broader term "Oriental medicine". Legally, the word “and” does not mean “synonymous with” or “includes”, as many people think it does. The use of the term "Oriental medicine" by our educational institutions is also inadvertently creating a distinction between the terms.

To many educational institutions, "Oriental medicine" has come to be a convenient way to refer to the addition of herbs in training. "Oriental medicine" is a title more and more often reserved for diplomas for those who graduate with education in acupuncture and in depth training in herbs. As our meetings with the Department of Health have revealed, regulatory bodies have begun seeing this as a change in the standard of practice and questioning whether those who do not have "Oriental medicine" on their diploma really do practice Oriental medicine. This is creating potential for a new spin on the interpretation of legal boundaries, making it less clear as to whether Acupuncturists practice a series of procedures or a system of medicine. To many of us it's plain and simple, we all practice Oriental medicine, but, according to our attorney, not having a single overarching term in our professional title to reflect this is likely to become increasingly restrictive over time, particularly when we go to expand our scope to new modalities, as we are now setting out to do in the next year. While the profession makes the transition from the use of the term "acupuncture" as a system of medicine to "Oriental medicine", we must be sure that making this transition does not inadvertently downgrade acupuncturists to the role of technicians, as this would be a disservice to the majority of us who have been using Acupuncture and many other modalities as a way to apply the theories of Oriental medicine all along.

In Washington State, we are now attempting to create a better "umbrella" term for the discipline we practice than “Acupuncture”. In our current statute, "acupuncture" is seemingly defined as a series of modalities and simultaneously as a system of medicine. Our statute describes acupuncture as a system based on Oriental medicine as well as the practices of acupuncture, moxibustion, acupressure, cupping, dermal friction techniques, infra-red, sonopuncture, laser puncture, point injection therapy, and dietary advice (which most practitioners assume includes Chinese pharmacopoeia up to the level of their education, and a late 90's unofficial AAG opinion concurs). To practitioners of this medicine, the modalities are simply a way of applying the system, but to health law attorneys, the technical interpretation of our statute has the potential of opening up a can of worms, as technically even though our statute states our system is “based on” Oriental medicine, it does not necessarily mean it includes the system. Part of the problem lies in the original choice to make a procedure (Acupuncture) synonymous with other modalities and at the same time with a system of medicine. This is unusual for a health profession and problematic in establishing a solid identity both legally and ideologically, according to our attorney. Our attorney has urged us to fix this once and for all. As the boundaries of the term "acupuncture" become more distinct from the term “Oriental medicine”, we are attempting to correct the emphasis of our title to the true system rather than the term that best describes only a single modality. There has been great debate as to whether "Asian" or "East Asian" should be the term that describes the system but "Oriental medicine" has been deemed appropriate in this context and the ideal term given its positive historical context in the industry.

I understand there were many reasons for leaving the term acupuncture in the various national and state organization titles, and it was probably the right thing to do at the time. However, I see "acupuncture and Oriental medicine" as a bridge term now--a way to transition the emphasis to the system of medicine practiced through acupuncture and many other practices, including chinese herbal medicine. I think it is critical for our profession's leaders to complete the transition fully to “Oriental medicine” so as not to get "stuck on the bridge" and inadvertently divide our profession. Let us not forget that acupuncture was an umbrella term. As we make this transition in graduate and doctorate titles, professional organization names, and professional titles, let's keep everyone under the same umbrella of "Oriental medicine", regardless of which specialties they study and choose to practice. For a professional title we are advocating a change to the term “Oriental Medicine Practitioner” because we believe it better captures the nature of what we do. By clarifying in statute and rule, states can assure that we can all continue to use the term "acupuncturists" and not lose all the valuable branding we have invested in the term, while at the same time, assuring that adequate education is required for the practice of additional modalities.

After all I have witnessed during the last five years of being a board member of this state's professional organization, I have become a strong advocate for the profession finishing the transition to "Oriental medicine" in all professional titles and organizations to further help the profession be more unified. A change to a single term "Oriental medicine" would assure that we are all understood for who we really are: doctors/practitioners of Oriental medicine, no matter which modalities we wish to focus on in practice or how high up the educational ladder each of us aspires to climb.

Let us be sure that as the profession grows and changes that this tide of change unifies and lifts us all!

George M. Whiteside IV, MS, LAc, graduated from Bastyr University in 1997 with a MS in Acupuncture and completed Chinese herbal certification in 1998. He is currently the president of the Washington Acupuncture and Oriental Medical Association (WAOMA.org), a member of the AAAOM presidents council and practices at the University Health Clinic, an integrative care facility in Seattle WA (theUHC.com).