Acupuncture and Dry Needling – Part 3
If dry needling is acupuncture, why don’t we just call it acupuncture? Semantics or licensing – pick your poison. Today, in many states, physical therapists are performing ‘dry needling’. They call it dry needling because if they called it acupuncture, they’d have to be licensed as acupuncturists to perform the procedure.
So why don’t physical therapists obtain acupuncture licenses? Seems a simple solution to the issue. Well, not so fast. Now we are, again, into territory involving information the average person may not possess and, honestly, has no reason to possess. In fact, I’m sure most folks don’t know because I’ve had this conversation many times with many people on many platforms.
There exists a common misconception about what’s required to become a licensed acupuncturist. Most folks seem to think it’s a 12-18 month certification process similar to massage therapy schooling (not to denigrate any massage therapists who might be reading this post). I’m not sure why people think this is the case, I’ve even met MDs who thought acupuncture was some sort of short certification program.
Let’s set the record straight on this issue. I currently practice in Missouri. I have practiced in Kansas and Colorado. The licensing requirements for these states, and for most states in the US, are substantially similar (there are exceptions, but I’m not going to delve into those here). Here’s what it takes to get an active license to practice acupuncture.
Most states require board certification through the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). This consists of qualifying for, taking, and passing at least 3 psychometrically evaluated board exams and then maintaining this credential through continuing education. How does one qualify for boards and subsequent credentialing? First you need a Clean Needle Technique (CNT) certification. This is a written test and practical exam where candidates must demonstrate their ability to maintain a clean field and observe universal precautions while inserting and removing needles in a living person. If I’m remembering correctly, I’d been in school for maybe a year before I qualified to take the CNT exam.
Secondly, for most US candidates, you must complete at least 1905 instructional hours and have at least 500 documented supervised patient contacts – usually in a student clinic associated with the school. For most schools this is a master’s degree (there is one school I’m aware of that grants a master’s certificate but the educational floor in terms of hours and patients is the same). In other words, in most of the US, there is no practicing licensed acupuncturist with anything less than a master’s degree. Let me say that again for folks in the back: it takes at least a master’s degree to get a license to practice acupuncture. Most programs are well over the 1905 minimum. Most schools are moving to doctorates.
Would a PT have to take the entire course-load? Assuming they are licensed and currently practicing, probably not. Is there a significant overlap between PT programs and Chinese medicine programs? Yes and no. I can’t speak for the schools, but it wouldn’t surprise me if a PT was still looking at 1.5 to 2 years of classwork and work in the clinic before they’d qualify for NCCAOM – assuming they went full-time.
Historically, both physical therapists and licensed acupuncturists had master’s degrees. Both programs are moving towards doctorates as the minimum education. A typical doctorate in physical therapy ranges from 113 to just over 120 credit hours. A typical doctorate in Chinese medicine ranges from 140 to over 150 credit hours.
Both programs overlap in terms of western science. We both take pharmacology, pathology, anatomy & physiology. Candidates for both programs are better served if they have some sort of STEM undergrad degree. As part of their core coursework, DPTs do not take any classes in needle safety, needle theory, or needle technique – this is all done after graduation, usually in a short series of weekend classes. For a student of Chinese medicine, on the other hand, needle safety, needle theory, and needle technique are core curriculum. We’re evaluated on these things continuously while in school, and a significant portion of boards are devoted to needle safety and needle theory.
I sat down one time and added up the total number of hours on my master’s degree that were devoted to needle theory, needle technique, and needle safety. The number I came up with was around 1,000. This includes supervised practice in student clinic (500 documented patient contacts, remember?) Not particularly surprising since acupuncture is a core technique of Chinese medicine.
I bring this up because, as I mentioned earlier, chiropractors can usually practice “acupuncture” with about 100 hours of instruction. PTs practice dry needing with 60-90 hours – depends on the state. There is no nationally recognized dry needling credential or certification, and no continuing education hours are required to maintain any certification or credential.
They do not study any aspect of Chinese medicine or the theory/diagnostics that underpin its practice. In fact, many physical therapists use this as a selling point for their practice – they deliberately ignore the underlying theory and diagnostics. Their claim here is that acupuncture is ‘unscientific’ and because they’re operating under a different assumption, the effect of their needling is different.
If this doesn’t constitute magical thinking, I don’t know what does. First, there is a tremendous amount of science underpinning the practice of acupuncture. In fact, over the last 10-15 years there have been more studies done on acupuncture than either physical therapy or chiropractic (1). Second, either the point functions as described, or it doesn’t. What any individual practitioner happens to be thinking when they insert that needle is irrelevant.
In the end, either acupuncturists are dramatically overtrained (an assertion I would entertain), or chiropractors and physical therapists are not nearly trained enough. To simplify, who do you think has the greater knowledge about safely applying solid needles to solve a health problem – the person with 60-90 hours delivered over a weekend or two OR the person with 1,000 hours of training and hundreds of supervised patient contacts prior to graduation?
Let’s use another example to drive this home. In the US there is an acupuncture certification available to medical doctors (MD) and doctors of osteopathy (DO). The organization is the American Board of Medical Acupuncture (ABMA) and they offer an ABMA certification to physicians. To obtain this certification, a physician needs to have 300 classroom hours of instruction in some form of acupuncture followed by 500 documented case studies where they utilized acupuncture to treat a patient (2).
So, if an MD/DO wants to be ABMA certified, they have more educational requirements than a PT or a DC? In what world does this make sense?
1. Cochrane Library (2000-2023). Retrieved from https://www.cochranelibrary.com/central
2. American Board of Medical Acupuncture. Retrieved from http://www.dabma.org/requirements.asp