Acupuncture Scope of Practice and Professional Nomenclature Considerations in Washington State

By George Whiteside, IV, MS, LAc, President WAOMA

While we have enjoyed a broad scope of practice here in Washington state for over 23 years, a move to clarify and further strengthen our scope of practice has begun gaining momentum. Changing our title in particular has become one of our considerations. 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 professional titles as well as 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. The pitfall, according to our attorney here in Washington state, is that by using two terms to describe our medicine, we can inadvertently create vulnerabilities for the professional in practice. 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". The use of the term "Oriental medicine" by our educational institutions has inadvertently blurred the true distinction.

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 here. 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 many who use Acupuncture primarily, but also many other modalities, as a way to apply the theories of Oriental medicine.

In Washington state, we are now attempting to create a universal term that is a better "umbrella" for the medicine than "Acupuncture" and are finding this a bit challenging. In our current statute, "acupuncture" is defined simultaneously as a series of modalities and a system of medicine. Our statute describes acupuncture to mean 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 those us who understand this medicine, the modalities are simply a way of applying the system, but to health law attorneys, its technical interpretation opens up a can of worms. Using a procedure to be synonymous with other modalities and at the same time with a system of medicine is unusual for a health profession and problematic in establishing a solid identity both legally and ideologically, according to our attorney. As the boundaries of the term "acupuncture" appear to becoming more distinct from the term "Oriental medicine", we are attempting to correct the focus of our title onto the true system rather than the term that is best used to describe a single modality. There has been great debate as to whether "Asian" or "East Asian" should be the term but "Oriental medicine" has been deemed appropriate in this context and the ideal term given it's prevalence 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 modalities and practices, including herbs. I think it is critical for our profession's leaders to complete the transition 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. By clarifying in statute and rule, states can assure that we can all continue to use the term "acupuncturists" and not loose 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 the more simple 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 the following year. He is currently the president of the Washington Acupuncture and Oriental Medical Association (WAOMA.org) and practices at the University Health Clinic, an integrative care facility in Seattle (theUHC.com).