Distribution of licensed acupuncturists and educational institutions in the United States in early 2015

Author: Arthur Yin Fan, Sarah Faggert08/01/2018

Distribution of licensed acupuncturists and educational institutions in the United States in early 2015

Arthur Yin Fan^1,2, Sarah Faggert¹

1. McLean Center for Complementary and Alternative Medicine, PLC., Vienna, VA 22182, USA

2. American Traditional Chinese Medicine Association, Vienna, VA 22182, USA

ABSTRACT

In recent decades, acupuncture has been used more widely and extensively in the United States (U.S.). However, there have been no national surveys or analyzes reported in academic journals on the number of practicing or licensed acupuncturists. This study was conducted to identify the approximate number of licensed acupuncturists active in 2015. The Board of Acupuncture or Board of Medicine in each state or U.S. territory was contacted to collect data. Online license information searching was also performed in order to get accurate numbers of licensed acupuncturists for those states in which a board was unable to be contacted. The study found that the number of licensed acupuncturists in 2015 in the U.S. was 34 481. Of this, more than 50% were licensed in three states alone: California (32.39%), New York (11.89%) and Florida (7.06%). The number of licensed acupuncturists increased 23.30%, and 52.09%, compared to the year 2009 (n = 27 965) and 2004 (n = 22 671), respectively; increasing about 1 266 per year. There were 62 and 10 accredited acupuncture institutions providing master’s and doctoral degrees, respectively. The West Coast comprised 51.39% of degree granting programs, while the East Coast comprised 29.17%; together the coastal states housed more than 80% of all programs, with the remainder sprinkled across the southern (9.72%), northern (8.33%), and the middle/central states (1.39%). Forty-four states and the District of Columbia regulated acupuncture practice by law at the time of data collection. Acupuncture continues to be a quickly growing profession in the U.S.

Keywords: acupuncturist; acupuncture educational institution; acupuncture regulation; oriental medicine; United States

Citation: Fan AY, Faggert S. Number of licensed acupuncturists and educational institutions in the United States in early of 2015. J Integr Med. 2018 Jan;16(1):1-5. 2017 December; Epub ahead of print.

http://dx.doi.org/10.1016/S2095-4964(link is external)(17)60371-6

Received June 1, 2017; accepted August 14, 2017.

Correspondence: Prof. Arthur Yin Fan, CMD, PhD, LAc; E-mail: ArthurFan@ChineseMedicineDoctor.US(link sends e-mail)

1  Introduction

Acupuncture, as an important component of Chinese medicine (CM), was formally introduced in the United States (U.S.) in 1972. Two of the first states to have acupuncture or Oriental medicine (AOM) licensing laws were Nevada and Oregon; Chinese Medicine falls under—and is often used synonymously with—this classification. There are now many licensed acupuncturists and doctors of acupuncture and/or Oriental medicine in the United States. The first schools of AOM were Taoist Studies, New England School of Acupuncture and California Acupuncture College.^[1–11]

In an analysis published in 2007, the National Health Interview Survey found that over six percent (or 14 million) of Americans were using or have used acupuncture as part of their health care regiment; only around 8 million Americans utilized acupuncture in 2002.^[12] Multiple resources have shown that this number has only continued to increase over the past ten years. Today, acupuncturists are one of many important healthcare providers at various reputable medical establishments.^[13–16] In recent years, with the implementation of the Affordable Care Act, more than 54 million Americans have received acupuncture coverage under the Essential Healthcare Benefit.^[17] On June 1, 2016, the governor of Kansas signed the Acupuncture Practice Act into the law, making Kansas the 47th state to have acupuncture regulation (Alabama, Wyoming, Oklahoma and South Dakota are the four remaining states that do not license acupuncturists).^[18] On July 22, 2016, the U.S. Department of Labor issued a  Standard Occupational Classification code for acupuncturists.^[19] With more and more people turning to acupuncture as an integrative therapy to their traditional healthcare, or even as a partial replacement for their previous healthcare, the number of actual AOM practitioners in the U.S., along with statistics on the number of accredited schools and programs from which these practitioners emerge in each state are of increasing interest. There was no published survey or analysis reported in academic journals regarding the actual number of acupuncturists, even though acupuncture has been used more and more widely and extensively in the U.S. in recent decades.^[12–22] Our investigation aims to find as accurate a number as possible for the number of licensed acupuncturists, as well as the number of accredited programs and schools in each state of the U.S.

2  Materials and methods

2.1  Inclusion criteria

For finding the number of acupuncturists, this investigation included in it the numbers of licensed acupuncturists in the states with acupuncture or Oriental medicine licensing laws. The numbers represent the information as of January 1, 2015.

The number of education programs for acupuncture and Oriental medicine included active and accredited programs providing masters, as reported by the U.S. Department of Education.^[23] The numbers represent the information as of January 1, 2015.

2.2  Exclusion criteria

The investigation excluded acupuncturists who have retired, moved or no longer renewed their license with state boards, as well as active acupuncturists practicing in states without acupuncture or Oriental medicine licensing laws, as of January 1, 2015. Exclusions were made based on state records showing that the practitioner was retired or located in a state without licensing laws.

The investigation also excluded any inactive schools of acupuncture or Oriental medicine which closed due to various reasons before January 1, 2015.

2.3  Methods

2.3.1  The statistics of acupuncturists

A search was first conducted of publicly available records accessible from the internet to find the number of licensed acupuncturists in each state. This number was then verified by calling the corresponding board of acupuncture or board of medicine for each the U.S. state, as well as the District of Columbia, Guam, Puerto Rico and the Virgin Islands. Discrepancies were resolved by staff who maintains the acupuncture licensing databases for each state or territory; we adopted these data validated. If there was online information available, and a clerk could not be reached, then the number found from online information sources as used. If there was no online information available, and the clerks could be reached, the information from clerks provided was used. In cases where no information was available online and a clerk could not be reached, we report that the “Information is not available.”

To determine numbers of acupuncturists from previous years U.S., we searched PubMed.gov (Medline), scholar.google.com and google.com, using the following search words: “acupuncturist”, “acupuncture practitioner”, “licensed acupuncturist”, “number”, ”statistics” and “U.S.”.

2.3.2  The statistics of schools or programs in acupuncture and oriental medicine

To identify acupuncture and oriental medicine schools or programs, searches were conducted from google.com and used the following search words: “acupuncture”, ”Oriental medicine”, “acupuncture and Oriental medicine”, “complementary and alternative medicine”, “integrative medicine”, “school”, “program” and “U.S.”.

2.3.3  The investigation timing

This study was conducted in February 2015.

3  Results

3.1  Acupuncturist numbers in each state

There were 22 states that had online information about the number of licensed acupuncturists; among them, 3 state board clerks in charge acupuncture licensing could not be reached by phone. For those 3 states, the unverified data were used. For all other states or territories, whether they had online data information or not, the number provided by the clerks was used for the study. There were no states for which no data were available.

There was a total of 34 682 practicing acupuncturists in the U.S. at the beginning of 2015. This number included 34 481 licensed acupuncturists practicing in 44 states and Washington, D.C. and 201 unlicensed acupuncturists practicing in the 6 states without acupuncture licensing law at that time (Alabama, Kansas, Oklahoma, North Dakota, South Dakota and Wyoming) as well as in Guam, Puerto Rico and Virgin Island (Table 1). The nine states with the largest number of acupuncturists included California, New York, Florida, Colorado, Washington, Oregon, Texas, Massachusetts and Maryland. The number of practitioners was more than 1 000 for each of these states. There were 24 954 licensed acupuncturists in these nine states, representing 72.36% of all U.S. licensed acupuncturists. Among them, the largest three were California 32.39%, New York 11.89% and Florida 7.06% which represented over half of all practicing acupuncturists at 51.34% (Table 2).

It should be noted that five states license acupuncturists at the doctor or physician level, such as in Nevada and New Mexico, in which the licensed acupuncture and Oriental medicine professional get the title of Doctor of Oriental Medicine (OMD, or DOM). In Rhode Island and Utah, a licensed acupuncture professional’s title is Doctor of Acupuncture (DAc); in Florida, licensed acupuncture professional’s title is Acupuncture Physician. In California, licensed acupuncturists have been treated as primary care physicians when they provide services for Medi-Cal (a program similar to Medicaid, which is for low income patients in other states). All of these titles refer to those practitioners who received licensure in acupuncture from their state. However, in general these practitioners are called Licensed Acupuncturists (LAc) and a majority of states give this title. This title is also used by insurance companies to refer to those who solely provide acupuncture and/or Oriental medicine through an acupuncture license. As an occupation, the U.S. Department of Labor recognizes this profession as “Acupuncturists”.^[19] In Louisiana, the Acupuncturist title was originally only for Western physicians who learned acupuncture through short term training in acupuncture. In other states these physicians would be called Medical Acupuncturists or Physician Acupuncturists, while licensed traditional acupuncturists were called Acupuncture Assistants. Current regulation has changed the titles to Physician Acupuncturist and Licensed Acupuncturist, respectively.^[26]

3.2  Comparison of the numbers in history

Records of numbers of practicing acupuncturists from 1992 to 2004 were published on the webpage of the National Acupuncture Foundation.^[21] There were also records of acupuncturist listed by the People’s Organization of Community Acupuncture in 2007 and 2009.^[22] Over the past 23 years, the number of practicing acupuncturists increased steadily. In 1992 there were 5 525,

Table 1  Statistics of active acupuncturists and schools in each State of the United States at the beginning of 2015

AT#: the magazine Acupuncture Today; *: the state did not have acupuncture practicing laws in 2015; **: U.S. Territories.

while in early of 2015 the number increased to 34 481, a 6.24 fold increase. Compared to the number of 2004 (22 671), the number of licensed acupuncturists increased 52.09%; compared to the number of 2009 (27 965), the number of licensed acupuncturists increased 23.30% (Figure 1, 2). The linear regression indicates the rate of increasing about 1 266 per year (r² = 99.38%).

Table 2  The largest States in acupuncturist numbers

Figure 1  The number of acupuncturists in the United States from 1992 to 2015

Figure 2 Regression chart of acupuncturists in the United States from 1992 to 2015

3.3  Schools or programs of AOM

There are two major accreditation agencies in the AOM field: The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM),^[24] which operates nation-wide, and the California Acupuncture Board (CAB),^[25] which is focused on California and some surrounding states. The number of schools accredited by ACAOM was much greater than that accredited by CAB, and it included all schools accredited by CAB. Based on the information from the ACAOM, in the beginning of 2015, there were 62 master’s degree and 10 doctoral degree programs or schools in the U.S. In these 72 active accredited schools or programs, the West Coast (California, Oregon, Washington, Colorado, Nevada, Hawaii) was home to 51.39%, the East Coast (Connecticut, Massachusetts, New York, New Jersey, Pennsylvania,  Maryland, Virginia, North Carolina, Florida) 29.17% (West and East coast total represented 80.56%), the South(Arizona, Texas, New Mexico) 9.72%, the North(Wisconsin, Minnesota)  8.33%, and the middle of the country (Ohio) had only 1.39%. There were 11 states that had more than three schools or programs: California (23), Florida (6), New York (5), Washington (4), Arizona (3), Colorado (3), Hawaii (3), Illinois (3), Oregon (3), Texas (3), Virginia (3). These 11 states provided 81.94% (59) of all accredited schools or programs in the country. Among them, the first three states represented 47.22% (Table 1).

4  Discussion and limitations

The difficulties in finding accurate acupuncturist numbers are various. Firstly, there is no specific or official national agency dedicated to conducting a survey on licensed acupuncturist numbers at this time. During the first and second decades of acupuncture’s professional beginning, Dr. Ralph Coan, a major leader of the American Association of Acupuncture and Oriental medicine,^[5] did maintain a record of licensed acupuncturists in the U.S., but he did not formally publish his data. Currently, the National Acupuncture Foundation is the only semi-official agency to have data from six surveys (conducted from 1992 to 2004). Although other organizations tried to conduct further surveys, none of them formally published the information in an academic journal; we did not find journal articles in the database of Pubmed.gov or scholar.goole.com. Secondly, there are fifty states, one district and several territories comprising the U.S.; the board in-charge of acupuncture (or AOM providers) in each state or territory government may use different statistical methods. Some of them also include in their data certified acupuncturists, such as medical doctors or chiropractors who take short classes in acupuncture to earn a certificate in medical acupuncture or chiropractic acupuncture.^[26,27] Aware of this, in the current survey, the numbers of acupuncturist included were only traditional acupuncture professionals and not other physicians credentialed in acupuncture through the short-term training programs. Stated differently, when possible, we did not include only practitioners who received degrees from an accredited acupuncture school, the CAB exams, or the National Certification Commission for Acupuncture and Oriental Medicine.^[24,25,27] Thirdly, the data on active practitioners vary depending on the source, and how the data were originally obtained. For example, on Acufinder.com, the current website states that there are 18 000 acupuncturists licensed in the U.S. and that around 12,000 are actively practicing.^[28] Acufinder.com is a website that allows consumers to find acupuncturists; however, the only acupuncturists indexed in that database are those who registered themselves with the website. Therefore, their numbers may underestimate the actual number of licensed acupuncturists in the U.S. as there is no requirement to register with Acufinder.com. The same can be said about any of the sites searched for acupuncturist numbers, like Acufinder.com, and even of some of the acupuncture and/or Oriental medicine organizations, foundations, or boards. In the current survey, our data were also compared with the circulation number of Acupuncture Today, ^[29] which many people have used for representing the number of licensed acupuncturists in the U.S., during the same time frame. While some acupuncturists with difference malpractice insurance or even non-acupuncturists may subtribe to this journal, most subscribers are those who use the same malpractice insurance (American Acupuncture Council) . ^[29] Total circulation was 26 055, comprising 75.56% of the population of actively licensed acupuncturists (34 481). Based on our number of acupuncturists compared to the circulation number of Acupuncture Today, this data means there were 75.56% acupuncturists who bought malpractice insurance from American Acupuncture Council; the other 24.44% may have either bought malpractice insurance from other insurance providers or are without malpractice insurance.

There are some limitations in this survey. One of these is the difficulty of finding out the number of acupuncturists who are licensed in multiple states, although it is the researchers’ personal opinion that the number of acupuncturists licensed in multiple states is a very small number. Notwithstanding, the reported numbers of licensed acupuncturists may be inflated due to individuals holding licensed in multiple states. As mentioned earlier, the numbers in this survey do not currently include physicians and chiropractors credentialed via a short course in acupuncture. This number, however, may contain chiropractors, physical therapists, medical doctors, etc. who are also licensed acupuncturists via an accredited institution. This does not affect the number of licensed acupuncturists that we are looking at as we only want those who are legally licensed, not simply trained, certified or practicing another form of needling. For example, in Virginia the Department of Health has a list of every licensed acupuncturist who took the national examinations and was given an acupuncture license. Some of these names include those who do practice other healthcare modalities. A more accurate survey should be conducted in the future that checks to see whether any individuals have been counted more than once due to dual licensure or whether those with a license in acupuncture also have other.

5  Conclusions

At the beginning of 2015 in the U.S., there were 34 682 practicing acupuncturists, in which 34 481 were licensed acupuncturists; the three states with the largest acupuncturist numbers found in California, New York and Florida comprising over half of the nation’s acupuncturists. Compared to the number in 2004, the number licensed acupuncturists increased 52.09%; compared to the number of 2009, the number of licensed acupuncturists increased 23.30%. There were 62 master’s degree and 10 doctoral degree programs or schools. In these 72 active accredited schools or programs, institutions in West and East Coast states comprised 80.56% of the national total. There were 44 states and the District of Columbia that had acupuncture practice laws in place. Acupuncture has been a very fast-growing profession in the U.S.

6  Acknowledgements

Dr. Arthur Yin Fan is a major researcher of this project in designing, implementing and the manuscript drafting. Dr. Sarah Faggert was partially involved in collecting the information, drafting and editing.

7  Competing interests

The authors declare that they have no competing interests. Due to the limitation of the authors’ personal experience and perspective, this article may have some omissions and errors; comments or corrections are welcomed and appreciated.

REFERENCES

1  Reston J. Now, about my operation in Peking. New York Times. 1971-07-26.

http://acupunctureworldheadquarters.com/1971acupuncture.pdf(link is external)

2  Li YM. Acupuncture Journey to America. Beijing: People Health Press. 2011. Chinese.

3  National Center for Complementary and Integrative Health. Acupuncture: in depth. [2016-08-23]. https://nccih.nih.gov/health/acupuncture/introduction(link is external).

4  Lu DP, Lu GP. An historical review and perspective on the impact of acupuncture on U.S. medicine and society. Med Acupunct. 2013; 25(5): 311–316.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/24761180(link is external)

5  Fan AY, Fan Z. Dr. Ralph Coan: a hero in establishing acupuncture as a profession in the United States. J Integr Med. 2013; 11(1): 39–44.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/23464645(link is external)

6  Fan AY. Dialogue with Dr. Lixing Lao: from a factory electrician to an international scholar of Chinese medicine. J Integr Med. 2013; 11(4): 278–284.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/23867246(link is external)

7  Fan AY. The earliest acupuncture school of the United States incubated in a Tai Chi Center in Los Angeles. J Integr Med. 2014; 12(6): 524–528.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/25412671(link is external)

8  Fan AY. Nevada: the first state that fully legalized acupuncture and Chinese medicine in the Unites States – in memory of Arthur Steinberg, Yee Kung Lok and Jim Joyce who made it happen. J Integr Med. 2015; 13(2): 72–79.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/25797637(link is external)

9  Fan AY, Faggert S. Dr. Gene Bruno: The beginning of the acupuncture profession in the United States (1969–1979)—acupuncture, medical acupuncture and animal acupuncture. J Integr Med. 2015; 13(5): 281–288.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/26343098(link is external)

10  Fan AY. Dr. William Prensky: The birth of the acupuncture profession in the United States (1969–1979)—the Institute for Taoist Studies and the National Acupuncture Association. J Integr Med. 2016; 14(1): 5–11.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/26778223(link is external)

11  Fan AY. The legendary life of Dr. Gim Shek Ju, the founding father of the education of acupuncture and Chinese medicine in the United States. J Integr Med. 2016; 14(3): 159–164.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/27181122(link is external)

12  Zhang Y, Lao L, Chen H, Ceballos R. Acupuncture use among American adults: what acupuncture practitioners can learn from National Health Interview Survey 2007? Evid Based Complement Alternat Med. 2012; 2012: 710750.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/22474517(link is external)

13  Mayo Clinic. Acupuncture: why choose Mayo Clinic. [2016-08-23]. http://www.mayoclinic.org/tests-procedures/acupuncture/care-at-mayo-clinic/why-choose-mayo-clinic/prc-20020778(link is external).

14  Massachusetts General Hospital. Meet the team: acupuncture. [2016-08-23]. http://www.massgeneral.org/cancer/supportservices/acupuncture.aspx(link is external).

15  Wick JL, Walter Reed AMC Public Affairs. Warrior Clinic reduces pain medication use. [2017-08-27]. https://www.army.mil/article/55754/Warrior_Clinic_reduces_pain_medication_use.

16  American Acupuncture Council. Big news for acupuncturists, the US army is looking for you! [2017-08-27]. https://www.youtube.com/watch?v=mMvRqGjPGOk.

17  Fan AY. “Obamacare” covers fifty-four million Americans for acupuncture as Essential Healthcare Benefit. J Integr Med. 2014; 12(4): 390–393.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/25074889(link is external)

18  Clark M. After pins-and-needles wait, acupuncture finally will be regulated in Kansas. [2017-03-12]. http://www2.ljworld.com/news/2016/jun/28/acupuncture-be-regulated-kansas/(link is external).

19  Bureau of Labor Statistics; United Sates Department of Labor. Standard occupational classification: alphabetical list of SOC occupations. [2016-08-23]. http://www.bls.gov/soc/2010/soc_alph.htm(link is external).

20  Nahin RL, Barnes PM, Stussman BJ. Insurance coverage for complementary health approaches among adult users: United States, 2002 and 2012. NCHS Data Brief. 2016; (235): 1–8.

[PubMed] https://www.ncbi.nlm.nih.gov/pubmed/26828643(link is external)

21  National Acupuncture Foundation. Chronology of first acupuncture practice laws and reported number of licensees in each state. 2005. National Acupuncture Foundation online documents. [2017-03-12]. http://nationalacupuncturefoundation.org/images/no_of_licenses_chart.pdf(link is external).

22  People’s organization of community acupuncture. Survey says: 27 965 licensed acupuncturists in the U.S. as of July 2009. (2009-08-04) [2017-03-12]. https://www.pocacoop.com/prick-prod-provoke/post/survey-says-27965-licensed-acupuncturists-in-the-u.s.-as-of-july-2009(link is external).

23  The U.S. Department of Education. The Database of accredited postsecondary institutions and programs—accreditation, agency list. [2017-03-12]. http://ope.ed.gov/accreditation/agencies.aspx(link is external).

24  The Accreditation Commission for Acupuncture and Oriental Medicine. School directory. [2015-02-03]. http://www.acaom.org/find-a-school/default.aspx?state=All&dicipline=unde…(link is external).

25  California State, Department of consumer affairs, Acupuncture Board. Approved training programs. [2015-02-03]. http://www.acupuncture.ca.gov/students/schools.shtml(link is external).

26  Louisiana State Board of Medical Examiners. Application & Instructions for Initial Licensure – Physician Acupuncturist/Licensed Acupuncturist. [2017-07-10].

http://www.lsbme.la.gov/content/application-instructions-initial-licensu…(link is external).

27  Bartlett K. Licensed vs. Certified acupuncturists. [2017-07-10]. http://www.bartlettacupuncture.com/acupuncture/licensed-vs-certified-acupuncturists(link is external).

28  Acupuncture.com. Questions about Acufdinder.com—How many acupuncturists are there? [2017-03-12]. https://www.acufinder.com/Acupuncture+Faqs(link is external).

29  MPA media. Acupuncture Today—circulation. [2015-01-1]. http://www.mpamedia.com/products/at_circulation.php(link is external).