Distribution of licensed acupuncturists and educational institutions in the United States at the start of 2018.

This study was conducted to identify the approximate number and density of actively licensed acupuncturists, as well as the number of schools in acupuncture and oriental medicine (AOM) by January 1, 2018 in the United States (U.S.). We contacted the appropriate department governing acupuncturists, such as the Board of Acupuncture or Board of Medicine, etc. in each state and U.S. territories, to collect the data. We also conducted online license information searches in order to collect the most accurate numbers of licensed acupuncturists, especially for those states in which a board could not be reached. We found that the number of actively licensed acupuncturists as of January 1, 2018 in the U.S. was 37,886. The ten states with the largest number of acupuncturists (28,452 or 75.09% of the U.S. total), in order by total, included California, New York, Florida, Colorado, Washington, Oregon, Texas, New Jersey, Maryland and Massachusetts. The number of practitioners was greater than 1000 for each of these states. Among them, the largest three were California (12,135; 32.03%), New York (4438; 11.71%) and Florida (2705; 7.13%). These three states accounted for more than half of the overall total. The number of total licensed acupuncturists has increased 257% since 1998. The overall acupuncturist density in the U.S. - measured as number of acupuncturists per 100,000 - was 11.63 (total number of licensed acupuncturists: 37,886, divided by the total population: 325,719,178 at the start of 2018). There were 20 states with an acupuncturist density of more than 10 per 100,000 population. Hawaii (52.82) was the highest, followed by Oregon (34.88), Vermont (30.79), California (30.69) and then New Mexico (30.27). There were 62 active, accredited AOM schools which altogether offered 100 programs: 32 master degrees in Acupuncture, 53 master degrees in Oriental medicine, 13 postgraduate doctorate degrees and 2 entry-level doctorate degrees. Among these active accredited schools, institutions in the West and East Coast states comprised 77.42% of the national total. California, Florida, and New York represented 41.94%. There were 48 jurisdictions (47 States and the District of Columbia) with acupuncture practice laws in place. States without acupuncture laws included Alabama, Oklahoma and South Dakota. The data suggests that acupuncture profession has steadily grown in the United States.

Can a science-based definition of acupuncture improve clinical outcomes?

Research on acupuncture has been muddled by attempts to bridge the ancient with the modern. Barriers to effectiveness research are reflected in recurring conflicts that include disagreement on use of the most basic terms, lack of standard intervention controls, and the absence of functional measures for assessing treatment effect. Acupuncture research has stalled at the "placebo barrier" wherein acupuncture is "no better than placebo." The most widely recognized comparative effectiveness research in acupuncture does not compare acupuncture treatment protocols within groups, thereby, mutating large scale effectiveness studies into large scale efficacy trials. Too often research in acupuncture attempts to tie outcomes to traditional belief systems thereby limiting usefulness of the research. The acupuncture research paradigm needs to focus more closely on a scientific definition of treatments and outcomes that compare protocols in terms of prevalent clinical issues such as relative effectiveness for treating pain.

Comparing outcomes from the two most recognized acupuncturist workforce surveys.

OBJECTIVE: To determine the informational consistency produced by the two most recent independent surveys and draw a conclusion whether the data would be sufficient for the National Center for Health Workforce Analysis and Bureau of Labor and Statistics consideration. METHODS: This paper compares workforce outcomes collected by the two most prominent acupuncture entities that have produced the most useful acupuncturist workforce data (California Acupuncture Board 2015 Occupational Analysis and the National Certification Commission of Acupuncture and Oriental Medicine® 2013 Job Analysis) at national and state levels. RESULTS: Findings based upon the most compatible survey questions showed the following: more than 70% of acupuncturists work fewer than 40 hours weekly; approximately 76% work in solo practice or in shared space with other acupuncturists; more than 70% of the national sample have been in practice 15 years or less; and median income is between $40 000 and $50 000. A preponderance of acupuncturists is less than 50 years of age, and fewer than 15% of all respondents have been in practice more than 20 years. CONCLUSION: Basic workforce information is a necessary precursor for conducting workforce projections. It is useful to track the expansion or contraction of any given profession. Tracking influences subsequent planning for the profession based upon reliable and valid information about its growth. The ability of the profession to collect its own workforce data is paramount to workforce projection models. Any future survey should be a shared project that follows guidelines supported by the National Center for Health Workforce Analysis.

Acupuncture practice acts: a profession's growing pains.

State legislation that authorizes any healthcare profession is known as the Practice Act. In order for a profession to establish a recognizable national presence and be integrated into mainstream medicine, all the state Practice Acts must evidence consistency. The extent to which state Practice Acts fail to exhibit consistency can inhibit the ability of the profession to grow and become successful. We looked at the histories of other health professions, along with the 45 acupuncture Practice Acts in the USA, in order to understand the time worn paths that lead to integration in the mainstream and how the acupuncture profession might benefit.

Bilateral integrative medicine, obviously.

Unstated and unacknowledged bias has a profound impact on the nature and implementation of integrative education models. Integrative education is the process of training conventional biomedical and traditional Chinese medicine practitioners in each tradition such that patient care may be effectively coordinated. A bilateral education model ensures that students in each tradition are cross-taught by experts from the 'other' tradition, imparting knowledge and values in unison. Acculturation is foundational to bilateral integrative medical education and practice. Principles are discussed for an open-minded bilateral educational model that can result in a new generation of integrative medicine teachers.

Online continuous quality improvement for diabetic retinopathy tele-screening.

Non-mydriatic digital fundus cameras constitute the key component for diabetic retinopathy tele-screening. This study investigated whether image capture skills acquired by non-professional photographers in a 1-day seminar and applied in a community setting may be reinforced and strengthened over time using an online continuous quality improvement (CQI) protocol. Approximately 20 amateur photographers from 13 independent sites were trained to capture images according to the recommended protocol: one 45 degrees image per eye, centered between the macula and the optic nerve, without dilation. In total, over the 19-month project period, 58 non-professional photographers captured and submitted 2,917 images. A professional photographer evaluated each image online assigning a CQI score. CQI scores indicated acquisition, and maintenance of skills was sustained over the study period. Over 93% of the images were scored as sufficient for clinical grading. Exposure and focus proved to be the most difficult skills. Skills needed to operate the digital cameras were acquired with relative ease. The online CQI protocol reinforced photographer skills over a significant period of time even when considerable turnover was experienced. The use of digital fundus cameras is easy to learn for the non-professional photographer. Their use saves the cost of a professional photographer. An online CQI protocol is also an effective tool for reinforcing and ensuring skill transfer, especially when considerable turnover in photographers can be expected.