There is a place for the acupuncture profession within primary care. Nationwide, community clinics that serve the population of under- and uninsured persons are facing a tremendous shortage of primary care practitioners. Marginalized health care professions, that is, acupuncture, chiropractic, and naturopathy, are being drawn into a primary care role. An unanticipated workforce opportunity exists to fill the caregiver gap in community clinics. This transition can be quickly realized in states such as California where statutory code states that acupuncture is to be regulated and controlled as a primary care profession, but the requisite training has yet to be provided. Specific clinical experience in primary care settings would help overcome long-standing barriers that have resulted in the marginalization of the profession, high under- and unemployment among acupuncturists, and result in greater access to acupuncture treatment. A 1-year primary care training program for licensed acupuncturists (LAcs), which features clinical and didactic training, akin to what a physician assistant receives, would prepare acupuncturists to work in mainstream medicine. With appropriate training and biomedical collaboration skills, the participation of acupuncturists in mainstream medical settings can be accomplished with support from the acupuncture profession and mainstream medicine.
Acupuncture was first legalized in Maryland in 1973. By the end of 2009, regulatory legislation had passed in all but six states. The growth of acupuncture is most commonly measured by its welldocumented demand as a treatment modality and the rapid increase in the number of licensees. Much less documented is a puzzling stagnation in work opportunities and income. As many as half of all licensees, on graduation and licensure, may be unable to support themselves by working in their chosen profession. However, unlike other well-established complementary and alternative health professions, such as chiropractic and massage, acupuncture is conspicuously absent from the Bureau of Labor and Statistics occupations manual, with only a handful of secondary and incomplete studies available, which together provide an inexact picture of the workforce. In this article, the authors review seven reports that provide limited information including hours worked, income, and practice type. Although data from these published articles are not standard, it can be reasonably concluded from the available information that, over the past decade, 50% of the licensed acupuncture (LAc) workforce is working less than 30 hr weekly; 50% are earning less than $50,000 on average; and the number of LAcs working independently in practice, either in their own office or sharing one, has increased from approximately 75% to 90%. Suggestions are presented for conducting a much needed comprehensive analysis of the acupuncture workforce.
The Chinese called it ‘needle therapy’ which the West later interpreted as ‘acupuncture’ based on impossible ideas of energy and blood circulation via invisible meridians introduced in the late 1930s. Lack of understanding the original Chinese discoveries, which made needling a useful therapeutic approach, has made it difficult to correct these misconceptions. Willem ten Rhyne provided the first clues in 1683 that Chinese concepts involved continuous blood circulation and nerves. The oldest Chinese texts on blood vessel theory date to ca. 168–150 BC while needle therapy was introduced in the Yellow Emperor’s Internal Classic (ca. 200–100 BC), along with a description of nerves. It introduced the ideas of longitudinal body organization along with segmental dominance that is fundamental to all vertebrates. The Chinese divided the body into 12 longitudinal regions on each side that contained the skeletal muscles, blood vessels, and neurovascular nodal pathway. Muscular distributions and nodal pathways were mapped out by observation of propagated sensation in sensitive responders to needling. Discovery of organ-referred pain led to understanding the role of spinal segmental dominance. Use of these features allowed development of repeatable treatment protocols using the concept of local and adjacent (segmental dominance), proximal, and distal nodes (longitudinal effects).
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