Las Vegas Sun

July 22, 2018

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Sticking point: Acupuncturists seeking practice in Nevada thwarted by ‘closed market’

Cameron Bishop performs acupuncture at a prestigious Florida spa owned by casino mogul Donald Trump, but the native Las Vegan cannot practice in Nevada.

Neither can Las Vegas resident Michael Labrum, even though he graduated from a nationally accredited Oriental-medicine program, holds a California license and has been a chiropractor since 1983.

They are part of a growing number of individuals who want to practice acupuncture and other forms of Oriental medicine in Nevada but cannot because the state has the nation's most stringent licensing requirements.

Critics say the situation is exacerbated by the Nevada Board of Oriental Medicine, the licensing body they accuse of protecting the state's 27 licensed practitioners by refusing to open the market.

"There's huge money there, but it's a closed market," Bishop said of Nevada. "Next door, there are thousands of Californians who practice acupuncture, and many are trying to get into Nevada, but the board won't let them in."

But board President Dr. Hak Eun Rhee and member Dr. Sae Eun Lee, both licensed practitioners in Las Vegas, strongly disagreed they are stifling competition. While conceding that Nevada's licensing requirements could be relaxed, they said other states should follow Nevada's lead and adopt more stringent laws.

"We need experienced doctors to protect the patients," Lee said. "Why should we go from good standards here to lower standards like other states? But it's up to the (Nevada) Legislature to change the law, not us."

Acupuncture -- a treatment in which the body is punctured by needles at strategic points -- was developed in ancient China to help relieve pain and cure disease. Oriental medicine also uses herbs and minerals for treatment.

Although many American physicians have taken crash courses in Oriental medicine, full-time practitioners argue that it is too complex to grasp in a short time.

Of the 39 states that license practitioners, Nevada's board is the only one that requires post-graduate experience in the field -- and for a minimum of six years. Because Nevada has no accredited Oriental-medicine school, a person not only has to leave the state for training, but must also go elsewhere to obtain experience.

"Individuals who would be qualified in any other state cannot get a license in Nevada," said Barbara Mitchell, director of the National Acupuncture and Oriental Medicine Alliance in Olalla, Wash. "At least 12 students or graduates of accredited programs have complained to me about Nevada. Occasionally they have even had difficulty getting in touch with the board or getting an application for the exams."

When Nevada passed the nation's first Oriental-medicine licensing law in 1973, the required experience was 10 years. That was later reduced to six years. Lee said he would accept a compromise of one or two years' experience if applicants have the proper educational background.

Sharon Roth thought she had what it took to meet the requirements in her native Nevada. A graduate of the nationally accredited Pacific College of Oriental Medicine in San Diego, she obtained her California license in 1997 and performs acupuncture on about five patients daily in San Diego

Her three-year apprenticeship while in school and three years of post-graduate work meets Nevada's six-year experience requirement, she believes. But the board has interpreted the law to mean six years of post-graduate experience are necessary, and on Jan. 20 denied Roth's application to be a licensed practitioner.

Lone assistant

Roth is the only person licensed by Nevada to be an acupuncture assistant, but that means she would have to work under a licensed practitioner and would be prohibited from performing many tasks she already does in California. There also is no guarantee that any of Nevada's practitioners would hire her, since none have licensed assistants.

"I was hoping the reasonableness of my position would have struck them (board members)," Roth said. "The six-year law is arbitrary because you still don't know the quality of that person's practice. I am disappointed."

Bishop, who has four years of experience, said he would never have moved to Florida had he been able to obtain a Nevada license after graduating from a nationally accredited school.

"I basically resigned myself to the fact that I could not get licensed in my home state and live in the city where I was raised," Bishop said. "The six-year requirement is ridiculous. That's beyond any standard in the world, including China and Japan. No (Western) medical doctor would even have to go through that."

In most professions that require state licenses, individuals take exams shortly after earning their degrees, Labrum said.

It's unfair to wait six years to fulfill the experience requirement before taking Nevada's exam because one could forget things they learned in college, he said.

Board members use "the thin veil that they are protecting the public's safety, but they're driving off some fine practitioners who would like to practice in Nevada," Labrum said.

Critics of Nevada's law include Assemblyman Bob Beers, R-Las Vegas, who is drafting a bill to relax the state's requirements. A 1997 bill that would have eliminated the six-year requirement died in the Assembly, as did 1999 legislation supported by the board that would have reduced post-graduate experience to four years.

Relaxing requirements

Beers said he is confident he can convince fellow lawmakers this year to relax the requirements. Nevadans who want to be certified public accountants, for example, need only two years of experience in addition to their education and can meet that requirement before they earn their degrees.

"If the legislation goes the way I hope, trained practitioners who grew up here and had to go somewhere else for school would be able to come back home to be with their families and practice here," Beers said. "I would imagine that a majority of the existing board would oppose what I'm doing.

"Just look at their operating record. They are stingy giving out licenses."

One board member who supports Beers is Tom Stewart, a Reno herbal store owner. Stewart, one of two lay members, said he is often opposed by the three licensed practitioners on the board. All five are volunteers appointed by the governor.

"Nevada has not kept up with the rest of the country because this has been a closed system among the people who already have a practice, and they have kept other people out," Stewart said. "A lot of these practitioners who have trouble keeping patients tend to be protectionist. They usually can't get patients because they aren't any good."

Most states require applicants to have a post-graduate degree in Oriental medicine from an accredited school, but they do not ask for additional experience. There are 37 such schools nationwide that have been approved by the Accreditation Commission for Acupuncture and Oriental Medicine in Silver Spring, Md., which is recognized by the U.S. Education Department. Nine others are on the verge of gaining accreditation.

"The six-year practice requirement has the practical effect of excluding graduates from accredited and candidate programs from ever getting licensed in the state of Nevada," commission Executive Director Dort Bigg said.

But Nevada's board has no guidelines for schools it will recognize. In fact, applicants have been ordered to pay as much as $300 apiece on background checks that include an investigation of their schools. Critics say a lot of the investigation could be avoided if the board simply recognized all nationally accredited schools.

Labrum graduated from the nationally accredited American College of Traditional Chinese Medicine in San Francisco. But he said a former board employee told him he had no chance obtaining a Nevada license because he did not meet the experience requirement.

"When I initially tried to reach the board (members), they never returned my calls," Labrum said. "I had to go through the attorney general's office to get them to respond to me. The way the board operates -- it's all self-serving and about keeping the market to themselves. They have never licensed anyone who has studied in the United States."

Questions on training

But Lee said the board has not recognized all accredited schools because of questions on whether they are providing adequate scientific training or sufficient classroom time.

The board, in turn, has been criticized over its licensing exams. There are 36 other states that administer standardized tests from the National Certification Commission for Acupuncture and Oriental Medicine in Alexandria, Va. Someone who passes those tests in one state will be recognized as a practitioner by the other 35. But Nevada has its own exams, which no other state recognizes.

"Our exam meets the highest psychometric standards," said Christina Herlihy, chief executive officer of the certification organization. "Our exam also guarantees mobility for the practitioner. If you take our exam, you will not have to retest in states that accept the exam."

Lee complained that the certification commission does not require individuals who have graduated from an Oriental-medicine school to take the test. There is a loophole that allows individuals with at least 4,000 hours of apprenticeship but no college background to take that test. Some states consequently have licensed practitioners who have only a high school degree.

But Lee said he would be open to standardized testing if Nevada law required all licensees to hold college degrees plus additional classroom training in acupuncture and Oriental medicine.

Beers said he would like to see Nevada adopt the standardized tests because he doesn't think the board has the time to do a thorough job drawing up the exams.

"If our board has to sit down and create a test every time someone has to take it, it's reasonable to expect mistakes in the questions," he said.

When Nevada began licensing Oriental-medicine practitioners in 1973, there weren't any accredited schools or standardized tests.

The licensing requirements adopted by Nevada were taken mostly from Asia, where aspiring practitioners often complete the same amount of education and residency required of physicians who practice Western medicine. That's why Rhee and Lee said some post-graduate experience should remain in Nevada's law.

Calling them 'doctors'

That's also why Nevada is one of only five states to call its licensed practitioners "doctors." Rhee and Lee defended that title because they said they perform tasks similar to those of Western physicians, such as lab work and drawing blood.

"How can you be a doctor if you have only three or four years of education?" Lee said. "The people who want to eliminate the six-year requirement want to eliminate 'doctor' as well."

It so happens that all licensed practitioners in Nevada have either Chinese or Korean surnames, and most were educated in Asia.

But Mitchell said national acupuncture organizations frown on the use of "doctor" for acupuncture or Oriental medicine because there are no doctorates in that field in the United States. The title, therefore, may be misleading.

"In 1973, before the national organizations developed, Nevada's law was a reasonable law to write," Mitchell said. "There were no national standards to base things on. Acupuncture was virtually unknown in the United States at the time, so states were looking to protect the public."

Antiquated law

But as U.S. accredited schools and standardized tests emerged, Nevada's law became antiquated, critics argue. Of the 39 states with Oriental-medicine licenses, only four have fewer practitioners than Nevada, and two of those just began licensing last year.

"The Asian community operates within itself, and people on the outside initially weren't too concerned with what the board was doing," Stewart said. "But now there are about 40 schools in the country, and people have started to pay attention to the board."

There were 14,000 licensed U.S. Oriental-medicine practitioners last year, more than 2 1/2 times as many as the 5,500 in 1992, Mitchell said. But the number of licensees dropped in Nevada from 30 in 1992 to 27 last year despite its stature as the fastest-growing state.

"We have not allowed our body of practitioners to grow with the population," Beers said. "The board is simply protecting its existing (licensed) members. (It has) eliminated people from competing. I would characterize it as a regulatory apparatus run amok."

Rhee said he believes there are enough practitioners in the state to serve existing demand. He said there would be a need for more only if insurance companies and federal programs such as Medicare began covering Oriental-medicine treatment.

But Labrum disagreed, arguing that Nevada's population is grossly underserved. These include low-income residents, AIDS patients and individuals attempting to recover from substance abuse, he said.

Labrum said the other consequence of the limited number of practitioners is that it keeps prices high. Acupuncture treatments are less expensive in California than in Nevada, he said.

"If there were more practitioners, the prices would be more competitive," he said.

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