Practicing AOM in Hospital Settings: A Synopsis of Questionnaire Responses

By Felice Dunas, PhD, LAc

The following six page document is a synopsis of responses to a questionnaire that I sent out during the fall of 2007. My goal was to help practitioners move into hospital settings, if they chose to do so, by showing them how their colleagues had done the same thing. Fortunately, dozens of acupuncturists working in medical clinics and hospitals responded. Below you will find the most interesting and educational of those responses. Each bullet is an answer given by an individual practitioner to the questions listed above it. I hope you find this material helpful. Felice Dunas, PhD

1. Please tell us about your current position at a hospital or formal medical venue: What is the name of the hospital or medical center? How long have you been working there? What do you do there? Are you on staff? On salary? In what department(s) do you work? Must you work under another practitioner's medical license to serve in this venue? Do you have your own patients in the hospital or are you working under MDs or DOs? Do you work independently or as part of a multidisciplinary team?
   • In PA, I needed to work under the supervision of an MD (The MD did not have to be on the premises, but was within phone reach if needed). I was fortunate to have a neurologist sign my documents, otherwise I would not have been allowed to practice while I was living there.
   • I know a colleague who has a DO friend who has allowed her to accompany her to a hospital one afternoon a week (or something like this) for several years. But she has been volunteering her time, learning from the DO and teaching her Toyohari techniques (which are mainly non-insertive), and nobody has ever offered her a position to be part of the hospital staff or receive a salary.
   • I currently run a community-style clinic at Craig Hospital, a spinal cord rehabilitation hospital in Denver. We have only been operating for 1 week. We bring in our own needles and charts. The patients pay us directly, on our sliding scale, and we are paid directly at that time. In other words, the hospital provides us the space and the referrals and don't dip into our payment. That being said, we currently give back 2% of our profits to a CAM fund which provides acupuncture and massage to patients who could not otherwise afford it. (This percentage may be adjusted in the future). We primarily see outpatients, their family, and staff.
   • I am currently in private practice in Bay Harbor, Florida (Miami Beach). It is a multidisciplinary medical center of which I am a partner. My partner is Dr. Nancy Scheinman. She is the former head of alternative medicine at Miami Heart Hospital in Miami Beach. The Miami Heart Center is no longer in existence as 10 years ago it was too progressive for Miami. I have been in private practice for over 10 years. Our group practice also includes a DO psychiatrist and an MD trained in integrative medicine under Andrew Weil, MD. I am an AP and an LAc. My specialty is nutrition, women’s health, and auto immune disorders. I was originally trained by Andrew Weil 17 years ago. I attended the Natural Gourmet Cooking School in NYC. I do not work under a medical doctor although we have protocols for co-treatment among various psychologists, physiatrists, MDs, and physical therapists. Florida is a great practice area for acupuncturists.
   • I work 2 days a week at East West Acupuncture in Indianapolis, and I work 2 days a week at Bloomington Hospital's Advanced Pain Center in Bloomington, Indiana. I have been with the Pain Center for 4 years. The Pain Center is a small building owned and operated by the hospital but not attached to the hospital. There are 2 anesthesiologists/pain specialists who also practice at the Pain Center on alternating days. The MDs and I are contracted employees who provide services for Bloomington Hospital. The hospital has the contract with East West Acupuncture. East West pays a small rent, $300 a month, and the patients pay at time of visit; checks are payable to East West Acupuncture. I don't have to work under an MD's license, and I'm not associated with an MD.
     
     I specialize in pain, but I also have a lot of TCM referrals, infertility, female issues, GI stuff, etc. Almost all the patients are referred by their MD. I've worked in 4 different hospital clinics in the last 16 years. The other 3 gigs hired me as a consultant to help put together a CAM clinic. All the other clinics closed after about 2 years due to different things. This is Indiana.
   • I am at Hoag Memorial Hospital Presbyterian, Newport Beach, CA. My contract began September 1, 2007. I provide Asian medicine including acupuncture, cupping, moxibustion, etc. I am able to discuss and prescribe herbs, but they must be dispensed from my private practice office. I am considered allied medical staff. I am paid per patient visit and reimbursed for any expenses I incur for supplies, etc. I am housed in the wellness center but can provide services to any department within the hospital. I work under my own license. The patients are referred to me from physicians and departments within the hospital as well as from the community at large. Patients can see me at Hoag or they can also come to my Tustin office. Likewise, I can also see my Tustin patients at Hoag. I am independent in the sense that someone can just see me for acupuncture but I am also part of the wellness center at the hospital and thusly am seen as part of their multidisciplinary team.
2. Please tell us how you achieved your position: Was it through a personal contact (did you "know someone") or through a traditional application process? Were you interviewed for this position, and if so, by whom? Have you moved up or been promoted in any way? Are there statutes or regulations in your state that have permitted you to hold the position you hold? If you were mentoring someone who was trying to attain your position in a similar venue, what advice would you give? How would you coach a colleague to acquire a position comparable to yours?
   • Before I finished acupuncture schools I had several offers from plastic surgeons in Miami and South Florida. For the first 2 years of private practice, I worked with the past president of the Florida Academy of Cosmetic Surgery using Chinese medicine and integrative medicine to cut healing time in half, improve results, and reduce side effects. I did not interview for my current or past positions, as my training with Dr. Weil and my school and board scores have opened many doors. I met my partner very serendipitously 8 years ago.At the time, very few acupuncturists had the training in integrative medicine like I did, so we became very good friends and now we practice together. If I was mentoring someone I would encourage them to join a medical practice since it is bar-none the best training ground working with MDs and other Western practitioners. I have learned so much from my colleagues and garnered a tremendous amount of respect from the medical community. It is imperative to “speak their language.” Our integrative team approach enhances compliance and helps patients heal much more rapidly. I also take many of my CEU courses from medical schools which further help me understand Western medicine and what is currently happening regarding research, techniques, etc. Believe it or not, many doctors are very accepting and welcoming.
   • I recently spoke to the administration at my local community hospital about getting privileges. They asked me to find another privately owned community hospital in GA that already had already granted privileges to an AP so they could find out how they had set it up, managed it, etc. While I was working on it, unbeknownst to me, my request was put on the agenda for their next MEC (Medical Executive Committee) meeting. The committee voted not to consider my request. I was not made aware of the meeting, either before or afterwards. I had no opportunity to build support among MEC members. I plan to resubmit my request once I have been able to build support for the idea.
   • I work on the board of a non-profit organization to get alternative healthcare available to people with physical disabilities. The director of the CAM program at Craig Hospital found out about my community clinic through the non-profit and wanted to offer more affordable options for her patients. I was not interviewed; the director had met me a few times, she visited my clinic, and I attended a few CAM meetings at the hospital as a possible outside referral. I had TONS of paperwork to do and it took them almost 3 months to approve me.
   • Bloomington Hospital contacted me 8 years ago because they knew about my experience with hospital clinics, and they were considering a CAM wellness center. They were referred to me by Columbus Regional Hospital; their CAM center was successful, but it still had to close. Bloomington Hospital gave me an office in another building at first because the MD I was working with died suddenly and I had nowhere to practice. Within a year, they encouraged me to move into to the pain center. I'm happy; it's a great fit. All hospitals and clinics are different, and Indiana is different than the East and West coasts. If I were advising someone who was interested in a hospital job, I would warn them about not being able to use moxa and herbs in most clinics, and how to communicate with the Western-minded people, how to dictate, what not to say, etc.
   • I had been discussing a joint venture with a colleague who was, at the time, president of ACOG as well as OB/GYN division director at UCI. She left that position and became head of women's services at Hoag Hospital, and I approached her in her new capacity to bring acupuncture to the wellness center. They had previously been referring out to someone in the community and that process was not working well for them. I had to put together a description of services I would offer, provide a survey of fees for the area to justify my fees, and then was interviewed by the chief of staff and several other medical staff committee members. The application, etc., went to committee and was finally approved after several months of review. Hospitals, more now than ever, are being forced to develop wellness programs that offer their patients broader options for their health and wellness. I would recommend to my colleagues that you do your homework, find out who is in charge of your local hospital's wellness efforts and meet with them to find out what they are already offering and how you may be able to complement it or bring something unique to their program. Be prepared with studies on the efficacy of Asian medicine. Perhaps offer to develop or be part of a specific program such as heart health, breast cancer recovery, women's issues, etc. The main thing is to do your homework, be prepared, and be confident. Be creative about where you can offer something that will help them to attain their goals for their programs.
   • After graduating, my vision was to bring acupuncture into the hospital setting. I picked up the telephone and contacted St. John's Hospital in Santa Monica as well as Daniel Freeman Hospital in Marina del Rey (Los Angeles County, CA). St. John's Hospital stated that privileges for acupuncturists weren't in place yet, but I felt excited when I spoke with Daniel Freeman. The voice on the other end informed me that one week prior to my calling they had just approved the requested privileges. I had to follow the typical application process, which I did. The application process involved references. I included Emperor's College since I was a graduate as well as a clinical supervisor at the time. Following the above, Emperor's College got involved in the process and an "Acupuncture Intern Program" was founded. I became clinical director of this program. It was supervised by an MD (Steve Krems). Several licensed acupuncturists participated and students, under supervision, were allowed on a daily basis and at a specific time to go to the hospital and treat patients. The individual patient's MD had to write "an order" which was placed into the patient's file; the attending RN contacted us, and we went to see the patients. Notes were kept in the patient's file. We were only allowed to perform acupuncture, use the TENS unit and massage. No exceptions. The insurance coverage had to be $1million/3million. We were also allowed a specific time (if no patients needed to be seen) to treat employees of Daniel Freeman Hospital at no cost to them. Many patients were educated and followed through with further acupuncture treatments after being discharged by the hospital. One of the biggest problems about working in a hospital setting is the fact that the average stay per patient is 2.3 days. Unless the patient and the physician are educated about the way acupuncture works and about its treatment process it can by quite a task.
3. Please tell us about the kinds of work you do: Are there aspects of OM care that you are not permitted to bring into the hospital setting (moxa, laser machines, TDP lamps, herbs, etc.) and how does that limitation impact your practice in this venue? What, if anything, have you developed to compensate for this challenge? Do you perform additional diagnostic (blood work, MRI, etc.) or healing practices (healing touch, chiropractic, etc.) in this medical setting?
   • I cannot moxa patients as my entire building would go crazy from the smell, so I send it home with patients, although as a private practitioner there are of course no restrictions. I do a lot of medical triaging as taught to me by my mentor, Andrew Weil. I use Chinese dietary therapy with all my patients, and nutrition is one of my specialties. I also do quite a bit of pre-op work as I am familiar with surgery from my experience working with the plastic surgeon. I use herbs and supplements, but, moreover, I encourage my patients and tell them that they have the power to heal themselves when I provide them with appropriate tools for lifestyle and dietary change. The nice thing about my practice is I am the boss, so I can do whatever I feel is necessary. I do not perform lab work. I believe it is best to refer patients to their primary care physician or one of my integrative MD partners in my office as I prefer to stay within the scope of OM.
   • I use almost solely acupuncture. Mostly distal points.
   • I can't use moxa at the pain center, but I do use herbs. I have control over that. In some hospital settings, you can only use Western herbs that have been approved for MD use (like Thorne, NewChapter, and Metagenics). I do order MRIs sometimes, but most folks in Bloomington already have them.
   • The only limitations are that I am unable to dispense herbs on the premises, and I am not permitted to treat a pregnant or laboring mother. I can discuss and actually prescribe herbs, however, I must dispense them from my private practice in Tustin. The hospital's stance on pregnancy is not that they feel acupuncture is dangerous or risky but that pregnancy is legally high risk as it is without adding another component. The hospital doesn't want the risk.
4. Finally, please add any additional details on your experience and ambitions: What are the most difficult challenges you face? What are the greatest rewards? Is there a position for which you are striving or a niche you are trying to create, for yourself and other acupuncturists, through your work at this hospital/medical setting? Is there anything else you'd like to share with colleagues who, like you, are striving to expand our national patient base?
   • My sole purpose for undertaking this effort is to expand the knowledge about the benefits of OM into the communities of Orange County. I strive: to offer people who may have never even considered OM, a safe haven to venture out and try something outside the mainstream and to validate our medicine....."If an institution as conservative and highly regarded as Hoag is offering acupuncture....it must be okay." I do whatever it takes to increase awareness. The biggest challenges I face now are getting the word out that I'm there at the hospital. Hospitals are large, cumbersome institutions that typically aren't very organized with regards to promoting and/or utilizing resources to their fullest. It will largely be up to me to get the word out initially.
   • In Florida, we are actually going through a crucial time for our profession, because auto insurance claims, which were an important part of our contribution as pain management providers, were stopped temporarily in October, 2007, and are now being reconsidered. There is a proposition written on the favor of MDs, DOs and chiropractors to be the only ones allowed treating motor vehicle accident patients that became effective in January, 2008. It will mean our acupuncture practice could be in serious jeopardy, not only regarding MVA insurance claims, but possibly even by private health insurance claims (presently we have the privilege of being able to bill several insurance companies as out-of-network providers). I believe many acupuncture physicians in FL are not aware of this situation or are intimidated to speak up or do anything about it. I do not think FSOMA even has a plan to help us show the government or state representatives how important our contribution in the management of Pain is.
   • My personal goal is to further the concept of integrative medicine where all practitioners recognize their own boundaries and appreciate the contributions others can make in their patients’ health. Just as MDs and DOs are moving down this continuum, it is imperative for alternative/complementary practitioners to become more adept at triaging patients and appropriately referring patients to physicians within their local medical community.
   • I feel the most difficult challenge I face is that many people come to me with bad advice from practitioners of other “alternative” modalities. They are discouraged from integrating their care or they were told not to return to their regular doctor. They may have had a million unnecessary tests solely for the financial benefit of the practitioner. I appreciate the wonderful skills we have learned, but we must integrate and interface with the medical community properly and efficiently. I also feel we need to have a better understanding how to use our friends in the medical community and stay within the scope of our practice. I see many OM practitioners and other “doctors”’ abusing their patients for financial gain.
   • I treat many women of all ages, and I try to teach them how to age gracefully and accept and love their bodies. I would like to co-write a book about this with my partner at some point in time. However I am a mom, which is a demanding job and requires balance. I try to be a role model for my patients, many of whom are working moms like me. Every day is a huge reward going to work as I get to help touch the lives of people and help them help themselves. My business partner and I are both moms, along with all the other female doctors in our office. I am incredibly proud of this as I feel it sends a big message to our patients and colleagues about integration and balance in both our professional and personal lives.
   • I personally think that it may benefit us more at this point to educate the medical practitioners and patients and ensure ourselves a significant and respected position by supporting our work with valid research. Research will be the key factor for the future!