AB 1116

[Guest guest]

This is interesting. Some objections are noteworthy, but this really

seems like a case of be careful what you wish for, doctors. :-)

 

 

April 20, 2005

 

Request that AB 1116 is withdrawn

 

Dear Assemblyman Yee and Committee members:

 

This letter is to request that you withdraw AB 1116. This bill will be

devastating for our students. There are acknowledged national

educational national standards for our field. They have been

established by ACAOM, the Accreditation Commission for Acupuncture and

Oriental Medicine, the U.S. Department of Education recognized national

accrediting commission for our field. ACAOM does not have a required

residency, nor is it considering one. M.D.’s have paid residencies in

hospitals. D.C.’s and N.D.’s do not require residencies. Therefore, it

will not work in our field – at this time in history -- to have a

required residency.

 

For your information, there are over 50 colleges in the USA; most of

them are out-of-state. All other medical fields recognize national

standards. Only the California acupuncture licensing board does not

recognize the national standards that exist in our field. It is vitally

important for the well-being of our field and for our colleges that we

in California recognize these national standards and support the LHC’s

and Joint Committee’s reports.

Reasons to Withdraw this Bill

 

AB 1116 that would require completion of a post-graduate residency

requirement in order to obtain a license to practice acupuncture in

California will have a devastating effect on our students and on our

colleges.

 

In essence, AB 1116 would raise the hours of education for graduates

of our schools. The Little Hoover Commission’s report clearly states

that “the new 3,000-hour educational requirement is adequate to prepare

entry-level practitioners and to protect the public safety” (Finding

2). This bill is a restraint of trade and will simply prevent new

graduates from entering the field in a timely manner. Education should

not be politicized. This bill needlessly increases the training hours

for acupuncture students and thereby would unduly restrict access to

the practice of this profession in California. The number of hours and

presumably the more detailed standards that would constitute the

residency would be set by the state acupuncture board through

regulation. A licensed acupuncturist would have to supervise the

residency, which under the bill means that the licensee must be

physically present in the treatment facility during the performance of

acupuncture treatments.

 

In principle, few would deny the benefit to a recent graduate in any

health care field of a mentorship with a qualified and experienced

practitioner, especially, if these were paid positions. Indeed, some

acupuncture colleges in the state have arranged limited externships in

hospitals, medical clinics, and HMOs, and a few acupuncture licensees

are even employed by these institutions. However, this bill – which

requires a residency - would indeed have a devastating affect on our

graduates and our colleges. We cannot force hospitals or clinics to

take our graduates. And, preceptoring with private practitioners will

not result in our graduates being more prepared for their practice.

Private practitioners who are not faculty members at our colleges are

not trained clinical supervisors.

 

For the following reasons, there are some exceedingly serious problems

in requiring completion of a post-graduate residency as a condition of

acupuncture licensure:

 

(1) Disparity in knowledge. Most already licensed acupuncturists have

less training than current graduates. Furthermore, as a result of the

state-wide implementation in California of the new 3000-hour standard

of education in 2005, all graduates will have significantly more

training than most currently licensed acupuncturists. Under the bill,

however, any licensed acupuncturist would appear to be legally

qualified to supervise these highly trained graduates. The bill is

silent as to what a minimum standard of preceptor competency should be.

 

(2) Absence of accepted clinical or business procedures in the

profession. Under a compulsory residency requirement, acupuncture

graduates would be subjected to idiosyncratic practices in the course

of their supervision. Because of the above-mentioned disparity in

knowledge between graduates and current licensees, these graduates may

be subject to the inaccuracies, biases, and bad habits of some existing

practitioners. Unlike clinics in academic institutions, where standards

of practice are scrutinized and debated by academic deans, department

chairs, and peers, the proposed preceptorships are subject only to the

good, or bad, unchecked judgment of the preceptor.

 

(3) Extreme regulatory oversight challenges. Effective regulatory

oversight of the approximately 1000 preceptorships that would be needed

to accommodate graduating students is nearly unimaginable. It is wholly

unrealistic to assume that the state acupuncture board will be able to

verify the credentials of so many preceptors accurately and ensure that

the preceptorships are functioning in accordance with applicable

standards. Moreover, as previously noted, the bill does not specify

even a minimum standard of preceptor competency other than bare

licensure. The California Acupuncture Board currently has very serious

problems as noted in both the LHC and the Joint Committee report. This

board does not have the expertise or ability to properly oversee a

required residency. Furthermore, there are several out-of-state

California-approved Acupuncture Colleges. The board cannot possibly

properly monitor either the in-state or out-of-state preceptorships.

 

(4) Shortage of qualified preceptors. It is generally acknowledged

that time in practice is itself no guarantee of a qualification to

teach and mentor. The state acupuncture board has proposed regulations

requiring that even a continuing education unit (CEU) provider should

have at least two-years of teaching experience in the provider’s area

of specialty. To acquire similar preceptor experience, an acupuncturist

would, in most cases, need to be a faculty member at a college or have

a similar background. Clearly, there are not a sufficient number of

faculty members statewide to provide such services. The bill, however,

does not recognize the importance of teaching experience.

 

(5) Potential for Significant Liability. Under the language of the

bill, unlicensed individuals in a residency program could perform

acupuncture outside the bounds of an accredited degree program and

possibly with very limited supervision. The bill specifies that

“supervision” is adequate so long as a licensee is physically present

somewhere “in the treatment facility” during the performance of

acupuncture treatment by the graduate. The potential liabilities

inherent in such a vague supervisory standard are significant. Would

current malpractice providers cover this situation under these

circumstances and, if so, at what cost and to whom?

 

(6) Inaccurate comparisons to other Medical Providers. The report of

the Little Hoover Commission and the proponents of this bill have

suggested that because medical doctors have residencies, it is a good

idea for acupuncturists. The naturopaths do not have a required

residency; the chiropractors do not have required residents. And, at a

recent state acupuncture board meeting on March 10, 2005, however,

board member Dr. Steven Tan, L.Ac., M.D. correctly pointed out that

medical residencies are required to continue specialized training (and

these are paid positions). It is one thing for an acupuncture college

to support the development of specialties and optional, voluntary

specialty certificates within the profession. However, such

specialization is uncommon in acupuncture and should certainly not be a

requirement for an entry-level practitioner of acupuncture.

 

(7) Student loan burden. Preceptorships that occur outside of

accredited academic programs would not allow the deferral of federal

student loans and would thus accelerate student loan payments while

potentially delaying licensure. Furthermore, students would undoubtedly

have to pay the preceptor. Together with high student loans, these

payments would create a financial burden that graduates would simply

not be able to handle. It would be a different situation if acupuncture

graduates could be paid during the residency as medical residents are;

however, in these situations, the preceptors usually require payment.

 

(8) Similar experience is currently allowed by law. Under current law,

acupuncture students are allowed to continue their clinical experience

in the college clinic following completion of formal coursework but

prior to the state examination. Again, however, this is not a

requirement.

 

(9) Residency Placement Limitations. The Little Hoover report suggests

that preceptorships could be arranged at hospitals, HMOs, and other

settings, NOT in private practitioners’ offices. While some of our

acupuncture colleges have arranged limited externships in such

facilities, there is no chance of accommodating 1000 students annually

in these facilities. We cannot force hospitals or clinics to accept our

graduates. It is simply impossible to assure our graduates of

post-graduate work in these environments.

 

(10) This bill would raise the cost of education in our field; such

costs will ultimately be passed onto the students’ future patients. The

colleges have very consciously kept the educational costs low so that

more people can access our medicine. This bill will raise the costs for

both the students and the patient treatments.

 

 

Please withdraw AB 1116. Thank you for your attention to this most

urgent matter.

 

Cc: Business and Professions Committee members

Gloria Negrette McCleod, Chino

Shirley Horton, San Diego

Karen Bass, Los Angeles

Dario J. Frommer, Los Angeles

Paul Koretz, W. Hollywood

Bill Maze, Visalia

Joe Nation, San Rafael

Van Tran, Westminster

Juan Vargas, San Diego

 

 

 

 

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