Acupuncture in the Era of Curriculum Reform and Affordable Care: A Time to Act

Those of us who live in the United States are currently in the midst of a period of exceptionally rapid and unprecedented change in the manner in which health is both taught and delivered. In fact, there is an increasing paradigm shift, with an even greater emphasis being placed on health versus health care. Stated another way, there is increasing emphasis on preserving health and avoiding the need for interventionally based health care.

What does this mean for the discipline of medical acupuncture? Well, the short answer is that we no longer need to wait until the proverbial planets align for acupuncture to assume a more prominent role in both, the preservation of health and in the delivery of health care. The more expansive answer relates to the fact that two major developments in American medicine are now converging in a manner that could herald a period of exceptional growth and opportunity for the field of medical acupuncture in particular and the domain of integrative medicine in general. What are these two developments? One development involves the realm of curriculum reform—a sweeping change in how both allopathic and osteopathic medical students are taught, while the other development relates to the emerging implementation of the Obama administration's Affordable Care Act. Let's take a closer look at these topics and see how they might relate to medical acupuncture.

While North American medical schools have been engaged in varying degrees of curricular reform for well over 20 years, it was the 2010 release of the Carnegie Foundation's report entitled “Educating Physicians: A Call for Reform of Medical School & Residency,”^1,2 which was cited by Cooke et al. in that same year, ² that truly galvanized the effort. Released in conjunction with the 100th anniversary of educator Abraham Flexner's (1866–1959 ad) landmark report on the state of medical education in U.S and Canadian medical schools, ³ the 2010 Carnegie Report^1,2 identified four key tenets that should underlie modern medical school education. As described in the report, the tenets emphasize the importance of: (1) standardizing educational outcomes, with individualization of learning processes: (2) fostering integration of clinical and basic sciences; (3) cultivating lifelong habits of scientific inquiry and innovation; and (4) developing and cultivating each student's professional identity as a physician (and healer).

While all four tenets are intertwined, it is the increasing emphasis on integrating instruction in the basic sciences with examples of actual clinical practice that may herald the greatest opportunity for emerging medical school graduates, to gain a more deliberate, and expansive introduction into the appropriate utilization of acupuncture and related technologies. At the Uniformed Services University of the Health Sciences (USUHS), in Bethesda, MD, the manner in which military medical students attain their medical degrees has been completely reformatted. No longer are there stand-alone “courses” in anatomy, pathology, pharmacology, clinical reasoning, and clinical medicine. Rather, these conventional disciplines are now presented in an integrated, organ-system based, modular fashion, delivered over a period of 18 months, versus what had been the more conventional or “2×2” format for medical school education (this refers to 2 years of preclinical classroom-focused education coupled with 2 years of clinic- and/or hospital-based training). Although some aspects of the reformatting are still being finalized, the advent of curricular reform has provided several new opportunities to integrate deliberately and introduce medical students to the concept of integrative medicine in general and acupuncture in particular.

Take for example, students who, in their first few months of medical school, are involved in the study of the musculoskeletal system. Included in this 8-week, organ-system–based module are plans to expose first-year students to a panel discussion in which alternative approaches to commonly presenting medical cases are presented. These may include scenarios involving (1) an otherwise healthy aircraft maintainer who develops acute low-back pain and (2) a severely wounded combat veteran with phantom-limb pain. In addition to discussing the pros/cons of various pharmacologic regimens, the use of yoga and other modalities, we plan to expose students to ways in which acupuncture can actively treat or ameliorate these conditions—at a fraction of the cost and with minimal-to-no side-effects. The latter is especially significant in light of the growing appreciation that an overreliance on pain medications—and the risk of subsequent abuse—has been linked to a resurgence in heroin use. ⁴

As many as 57 North American medical schools ⁵ currently include elements of complementary and alternative medicine in their curricula—with many institutions even offering full-fledged elective rotations in this domain. ⁶ At USUHS we have begun offering formal instruction in Richard Niemtzow's (MD, PhD, MPH) Battlefield Acupuncture (BFA) technique ⁷ to all senior medical students. The idea is that they can literally take this technique with them as an additional “tool” in their proverbial “tool kits,” to whatever internships and residencies they may ultimately pursue, thereby expanding the inculcation of medical acupuncture even further!

While few people would dispute the fact that introducing medical students to the art and science of acupuncture is of significant value, how does this relate to the implementation of the Affordable Care Act? Simply stated, the Affordable Care Act has the potential to generate as many as 30 million newly insured consumers in an already beleaguered economy and in an environment in which there is already a substantial shortage of physicians. This means that more and more health care will need to be delivered in collaborative, team-based environments. The opportunities are immeasurable, as acupuncture truly represents a safe and cost-effective means of addressing a wide range of health concerns. Moreover, the expansion of the Affordable Care Act could herald an expanded opportunity for conventional Western-based medicine to become more fully integrated with Traditional Chinese Medicine (TCM), with the ultimate outcome being cost-effective care that alleviates suffering and promotes healing.

So, what does this mean for the community of acupuncture? In this time of change, there are a number of unique opportunities. Included among them are:

• New and/or expanded venues for American Academy of Medical Acupuncture members to expose medical (and other professional students) to what acupuncture can offer—by offering an on-site demonstration to a student-interest group, participating as a panel member focusing on integrative medicine, or by participating in a medically oriented health fair ⁶ —the latter being an example of an approach used at Duke University's School of Medicine

These are just a few of the many new and exciting possibilities that lie ahead, but between the sweeping curricular reform involving North American medical schools and an increased emphasis on affordable and integrated care, there's no question that now is indeed the time to act!