Oriental Medicine & N.P. Combined Practice?

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Hi all. I am new to this forum. I am a National Board Certified Licensed Acupuncturist with an M.S. in oriental medicine, anticipating my first practice this coming Spring.

There are some colleges in the U.S. offering a "bridge program" to become an N.P. within two years if one has previously attained their Master's degree. I thought it would be neat to offer both western and eastern diagnosis and Tx. to my patients, allowing them to receive the best from both type medicines.

My main concern in becoming an N.P. is the following:

I fear that some aspects of the N.P. scope of practice might inhibit practice as an oriental health professional due to the possibility I might have to act under the somewhat strict protocols of the N.P. profession.

If an oriental Tx. or approach would seem to be better than the western one, I might be forced to act based on the constraints of the western model, or risk sanctions from regulatory bodies overseeing the N.P. arena. Can anyone elaborate on any of this?

Also, if the above circumstances would not come into conflict, would I be allowed to practice independently as an N.P. in my own oriental medical practice without prior hospital or clinical, (employment), as an N.P?

Thank you very much for sharing any thoughts on this matter.

Mike Eidson, LAc.

P.S. I posted this thread on the Introductory/Greeting forum, but this forum sounded more appropriate to my question. Please advise if this is considered "spammimg" on this site.

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Congrats on the "non-traditional" approach to caring,

While I cannot answer your specific questions, I would like to offer support: there are several MD's/DO's in my area that combine western and TCM - very successfully.

My husband is a vet and practices both, also.

I think, in today's medical climate, the biggest problem would be insurance reimbursement - that seems to have fallen by the wayside for TCM... even tho the beneficial effects of "alternative" medicine is being recognized.

I am very excited for you in this endeavor. Even my acupunturist, a gentleman from China (and training there...) says the best treatment is the combination of both.

Good luck!

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Hi Mike,L.Ac

I'm in the same boat. I've been an RN for like 15 yrs, and also in private practice as an acupuncturist (I also got my MSOM from Tri-State in NY).My biggest challenge so far is these are separate licensed professions. I guess the important thing is to distinguish the boundaries of your scope of practice. If you offer Dx and Tx based on the biomedical findings and results of lab tests that would constitute a Western approach. However, if you use O.M. diagnostic filters, you cannot Dx or Tx in Western terms. You're treating patterns of energetic imbalances, and disharmonies, which of course in real clinical practice correspond to a Western model of label Dx. My advice is keep them separate, and document accordingly. Also maintain your for both. Generally doctorate level MD/DO have much easier time getting reimbursed from insurances as a certified, but not licensed acupuncturists. And they only require max of 300 hours (NY) to practice acupuncture :angryfire vs my education in excess of 4000 hours.But for doctors it is still practicing medicine, and certification is just an extension of their medical license. But as an NP or an RN you are crossing over to another licensed profession. So be very careful with that.

Anyway Remember:

NP= primary care

L.Ac=not a primary care (with some exceptions in California)

Package your products and services accordingly.

Good Luck

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Hi Mike,L.Ac

I'm in the same boat. I've been an RN for like 15 yrs, and also in private practice as an acupuncturist (I also got my MSOM from Tri-State in NY).My biggest challenge so far is these are separate licensed professions. I guess the important thing is to distinguish the boundaries of your scope of practice. If you offer Dx and Tx based on the biomedical findings and results of lab tests that would constitute a Western approach. However, if you use O.M. diagnostic filters, you cannot Dx or Tx in Western terms. You're treating patterns of energetic imbalances, and disharmonies, which of course in real clinical practice correspond to a Western model of label Dx. My advice is keep them separate, and document accordingly. Also maintain your malpractice insurance for both. Generally doctorate level MD/DO have much easier time getting reimbursed from insurances as a certified, but not licensed acupuncturists. And they only require max of 300 hours (NY) to practice acupuncture :angryfire vs my education in excess of 4000 hours.But for doctors it is still practicing medicine, and certification is just an extension of their medical license. But as an NP or an RN you are crossing over to another licensed profession. So be very careful with that.

Anyway Remember:

NP= primary care

L.Ac=not a primary care (with some exceptions in California)

Package your products and services accordingly.

Good Luck

Hi Papadoc,

Thanks for replying. Some other replys posted seemed favorable towards a combined eastern/western practice. It was mentioned that some doctors are doing just that. You brought up a great point though. It is an extension of western doctor's practice to combine, but unfortunately due to scope of practice concerns, we may well need to keep the practices separate.

If we do separate the practices, just how would one accomplish that? Could one Tx & Dx in TCM documenting such on S.O.A.P. notes using only TCM formatting/charting, and then Tx & Dx the same patient with the Western model using western formatting/charting? The only other way I can see would be to offer each patient a choice of either eastern or western treatment and document accordingly...but that sounds...yechhh!! Appreciate any thoughts.

Mike LAc.

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Hi Papadoc,

Thanks for replying. Some other replys posted seemed favorable towards a combined eastern/western practice. It was mentioned that some doctors are doing just that. You brought up a great point though. It is an extension of western doctor's practice to combine, but unfortunately due to scope of practice concerns, we may well need to keep the practices separate.

If we do separate the practices, just how would one accomplish that? Could one Tx & Dx in TCM documenting such on S.O.A.P. notes using only TCM formatting/charting, and then Tx & Dx the same patient with the Western model using western formatting/charting? The only other way I can see would be to offer each patient a choice of either eastern or western treatment and document accordingly...but that sounds...yechhh!! Appreciate any thoughts.

Mike LAc.

Hi MikeLAc

The best way is to consult with an attorney in your State.

Points to consider:

Are you going to be practicing solo or within the medical group?

How are you getting your referrals and for what? traditional (NP) vs OM

Again for now I would keep them separate but under one roof.

I wish that someone who is an NP practicing both would comment on it. So far I have not found any coherent answers to this. The conflict comes from being licensed in two separate professions. Some suggested to get certified in the Holistic Nursing :uhoh3: whatever it means. I've researched them a little bit. It's a nice social club with lots of touchy and feely stuff,and represents no real legal authority, or billing privelleges. They use some OM theories, but main conflict here is your M.S. in O.M is way more advanced than a cert in holistic nursing. You are LICENSED to practice Oriental Medicine.

I am now in the med school. Just took some time off to catch a breath. I understood that anything less than that would be looking for a shortcut, which in reality does not exist. Please don't take it as I'm debasing NPs. No, I was looking for answers. If you work for or with a holisticly, and nutritionaly oriented physician you may be able to pull "mixed" practice. This is one of those rare,but nevertheless bitter realities when having more education hurts your chances of doing what you want. The privellege to be certified is extended only at the physician level. NPs can do many of the things that doctors do in conventional model, but when it comes to practicing acupuncture, as well as many other modalities, they have to get lincensed just like everybody else. It sucks, but it's the reality.

Good Luck

Hope it helps.

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Hi MikeLAc

The best way is to consult with an attorney in your State.

Points to consider:

Are you going to be practicing solo or within the medical group?

How are you getting your referrals and for what? traditional (NP) vs OM

Again for now I would keep them separate but under one roof.

I wish that someone who is an NP practicing both would comment on it. So far I have not found any coherent answers to this. The conflict comes from being licensed in two separate professions. Some suggested to get certified in the Holistic Nursing :uhoh3: whatever it means. I've researched them a little bit. It's a nice social club with lots of touchy and feely stuff,and represents no real legal authority, or billing privelleges. They use some OM theories, but main conflict here is your M.S. in O.M is way more advanced than a cert in holistic nursing. You are LICENSED to practice Oriental Medicine.

I am now in the med school. Just took some time off to catch a breath. I understood that anything less than that would be looking for a shortcut, which in reality does not exist. Please don't take it as I'm debasing NPs. No, I was looking for answers. If you work for or with a holisticly, and nutritionaly oriented physician you may be able to pull "mixed" practice. This is one of those rare,but nevertheless bitter realities when having more education hurts your chances of doing what you want. The privellege to be certified is extended only at the physician level. NPs can do many of the things that doctors do in conventional model, but when it comes to practicing acupuncture, as well as many other modalities, they have to get lincensed just like everybody else. It sucks, but it's the reality.

Good Luck

Hope it helps.

Thanks again Papadoc! I greatly appreciate your insights and leads and the value they possess in helping me make the right decision. :)

Sincerely,

MikeLAc

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Hey MikeLAc!

Best of luck to you too.

Keep looking. I know with some efforts you'll find your answers. One such thing for starters could be finding a busy doc with an acupuncture certification. From my experience most of them don't want to be bothered with that as a provider. But they sure would like to get paid for it. And that's your golden opportunity to get your foot in the door. Legally MD/DO with an acu cert can hire, or subcontract another L.Ac. Remember, basically if there is no law stating clearly you cannot do something specific, then more than likely you can. It's especially important when practicing O.M. We don't use linear thinking, and got to preserve that.

All righty then. Please stay in touch. You can always pm me if I could be of anymore help.

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Hi,

There are practitioners that I am aware of that incorporate TCM or other alternatives into their practices. The first thing I would do is go the the college of nurses (or board) and find out what there position is. Many have very clear guidelines. Also check out what is available in other states - they can be useful guides. It would be very difficult to try & separate the two and legally & ethically, you are required under both to treat each client using all of your training. You can't ignore either side/view when trying to treat your patients. It can be tricky but you are not the first to be faced with this challenge. There are guidelines out there. I have taken a course on medical acupuncture and we were instructed on how to incorporate it into our nursing practices (there were MDs, PTs in the class as well).

Good luck,

J

Thanks again Papadoc! I greatly appreciate your insights and leads and the value they possess in helping me make the right decision. :)

Sincerely,

MikeLAc

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Hi,

There are practitioners that I am aware of that incorporate TCM or other alternatives into their practices. The first thing I would do is go the the college of nurses (or board) and find out what there position is. Many have very clear guidelines. Also check out what is available in other states - they can be useful guides. It would be very difficult to try & separate the two and legally & ethically, you are required under both to treat each client using all of your training. You can't ignore either side/view when trying to treat your patients. It can be tricky but you are not the first to be faced with this challenge. There are guidelines out there. I have taken a course on medical acupuncture and we were instructed on how to incorporate it into our nursing practices (there were MDs, PTs in the class as well).

Good luck,

J

Hi Ehresources!

You bring up an interesting points. But as far as I know the term "medical acupuncture" applies to physicians only. In NYS many other professions tried to get on board practicing it with little or no training at all. I know podiatrists and chiropractors have been defeated so far, Thank G-d. I personally think that nobody should be allowed to practice another LICENSED PROFESSION,with some minimal exposure, and practically no supervision. Of course it is nothing more than another medical turf war, a pi$$ing match over territory. I really don't know what qualifies doctors, and other allied health folks to practice clinical medicine, which is totally diferrent from any med school curriculum. I had to bust my a$$ for 3 years, attended multiple grand rounds, did internship at the school clinic, also multiple externships with master practitioners, and study separately chinese herbology. Yet MDs could put C.Ac after their names (which means they watched some videos on acupuncture), and that makes them an expert :angryfire ? Not only that, most insurances, no fault, and workman's comp will reimburse to C.Ac with as little as 50 hrs training, but Licensed acupuncturist with Master's degree. I wounder if an acupuncturist with 300 hrs (max) training could practice Western medicine. But follow the money. AMA will fight anyone tooth an nail, if it's bad for business. They'd rather keep public misinformed.Who even cares C.Ac vs L.Ac. Most ppl don't even know what it means anyway. But I was trying to say earlier is that doctors who are certified DO NOT practice another profession, because they do allopathy or osteopathy first (primary care or specialty), then they may offer to complement with what they think they could do. I can't tell you how many people I've treated, who told me "I tried acupuncture, it doesn't work" after one of these "experts". But if you are not a physician you are absolutely obligated to tell the pt that now you are seeing them as an acupuncturist, but not as a nurse. Furthermore, many States require a referral (not an order) from the doctor (MD/DO only). One made by NP will not fly.

So Ehresources, if you could provide some links, or just point me in the right direction I'd really appreciate it. Because everything I've learned thus far as for "mixing" your roles was not very reassuring, unless you work for a doctor, and do not bill directly.

Thanks

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