Pragmatic Use of Acupuncture
According to physician census data compiled by the Federation of State Medical Boards (FSMB) in 2018 there were 985,026 physicians with Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) degrees licensed to practice medicine in the United States and the District of Columbia.(1) The American Academy of Medical Acupuncture has close to 900 members. If there were five times that number of medical acupuncturists in the country, members of the AAMA or otherwise, that would still only make up 0.5% of all physicians in the United States.
In 2016, the CDC analyzed National Health Interview Survey data and concluded: “An estimated 20.4% (50.0 million) of U.S. adults had chronic pain and 8.0% of U.S. adults (19.6 million) had high-impact chronic pain, with higher prevalences of both chronic pain and high-impact chronic pain reported among women, older adults, previously but not currently employed adults, adults living in poverty, adults with public health insurance, and rural residents.”(2)
The opioid crisis has faded into the background in light of world events, but it has not gone away. Many communities are being overwhelmed by the prevalence of opioids on the streets. Turning to opioids for relief of pain is a common pathway to addiction. Medical acupuncturists can have a great impact not only on individuals in pain but on our society, as well.
If every physician in the United States saw one patient with some sort of chronic pain a day, five days a week or 20 days a month over the course of one year that would account for 98,502,600 visits where pain was a complaint. Not all physicians have a clinical practice. Not all physicians are practicing medicine. Even taking these factors into account and conservatively halving this number, there would still be nearly 50 million patient visits a year during which chronic pain was a factor.
If all 900 medical acupuncturists treated one patient with chronic pain a day, 20 days a month for a year, 216,000 treatments would be performed. In this fictitious model, which grossly underestimates the prevalence of pain, only 0.4% of patients presenting to a physician with a complaint of pain would be offered acupuncture as a solution.
In today’s world, prior authorization for treatment and referral, wait times, transportation issues, and financial issues regarding co-pays and deductibles all stand in the way of delivering care. This leads to patients suffering with continued and often debilitating untreated pain. Ideally, when a patient presents with any pain, the physician would be able to address the complaint directly and efficiently in real time with a simple acupuncture treatment. Instead, what often happens is delay of treatment while care is deferred to yet another provider and the patient leaves the physician encounter in pain with frustration.
It is not likely that all 984,126 U.S. physicians have the time or desire to commit to 300 hours to become certified in medical acupuncture. Perhaps, however, some number might be interested in having the skills to treat a painful joint, headache or neuropathy if given the ability to do so. If, once a month for 10 months, every AAMA member taught simple skills to 10 other physicians, at the end of 10 months there would be 90,000 physicians, or 11% of the current physician population, in the country with rudimentary acupuncture skills sufficient to provide on the spot treatment for many common pain syndromes. The impact on the quality of patient care and patient satisfaction could be immediate and profound.
Physician students of acupuncture begin training with a large knowledge and experience base. Many already have attempted if not mastered the skills of placing IVs, arterial lines, central lines, chest tubes and endotracheal tubes, as well as drawing blood gases, injecting local anesthesia and suturing. Acupuncture is minimally invasive and carries much less risk than most procedures physicians learn and practice daily. I propose that teaching needling techniques and key acupuncture points on the face and extremities to such a group of students could prepare them to safely treat several types of common pain complaints. They could then, as Bruce Lee said: “Absorb what is useful. Discard what is not. Add what is uniquely your own.” If taught during training, residents and fellows could early in their careers gain experience and appreciate the power of even a few simple acupuncture treatments.
Fully trained medical acupuncture physicians need to act now. There are about 68,000 chiropractors in the United States (3). “As of 2019, there were 312,716 licensed physical therapists and 127,750 licensed physical therapist assistants in the United States, according to data from the Federation of State Boards of Physical Therapy”(4).Physical therapy and chiropractic organizations support their members learning acupuncture and incorporating those skills into practice. Physicians establish a relationship with patients as soon as they are together in an examination room. During that time the physician takes ownership of all the patient’s problems. All physicians should be offered the chance to learn simple acupuncture techniques in a few hours. In my facility, at least six of 20 (30%) physicians and advanced practice providers who learned BFA in 2015 continue to use the treatment regularly. All would readily commit to the 300-hour training if given the time and financial support. If 30% of the theoretical 90,000 physicians taught rudimentary acupuncture technique by AAMA members went on to be fully certified in medical acupuncture, that would be 27,000 potential new members of the AAMA.
In 2018 there were reported to be 37,866 licensed acupuncturists in the country (5). The point being made does not regard the availability of acupuncture in the community, either from LAcs or PTs or DCs or MDs or DOs. Rather, if all these practioners with a variety of levels of training and experience are sticking needles in people, then it makes no sense that there should be barriers to physicians incorporating simple treatments into any visit when indicated. There is plenty of pain to go around. It’s like stopping a child and asking them to pick up trash when it’s right there in front of them. We should implant in the psyche of physicians if you see it (pain), you own it and it’s your responsibility to deal with it.
The pure thrill and gratification of holding the needle that made a patient feel better will be enough to inspire many physicians trained at an elementary level to seek out more extensive acupuncture training. Even simple acupuncture techniques employed by a physician knowledgeable about a patient’s issues can have a great outcome. Training for physicians to perform acupuncture should be more accessible and ubiquitous or the art of medical acupuncture will fade into obscurity. Nonphysician acupuncturists with a different perspective of disease will be the only source for treatment.
Michael Freedman, MD, FAAMA
AAMA Board of Directors
References:
1: Young A, Chaudhry HJ, Rhyne J, Dugan M. “A Census of Actively Licensed Physicians in the United States, 2010,” Journal of Medical Regulation, Vol. 96, No. 4: 10-20, 2011
2: James Dahlhamer, PhD1; Jacqueline Lucas, MPH1; Carla Zelaya, PhD1; Richard Nahin, PhD2; Sean Mackey, MD, PhD3; Lynn DeBar, PhD4; Robert Kerns, PhD5; Michael Von Korff, ScD4; Linda Porter, PhD6; Charles Helmick, MD Morbidity and Mortality Weekly Report September 14, 2018 / 67(36);1001–1006
