I recently had the privilege to be on the presenting faculty of the annual conference for integrative medicine for health care organizations. The theme was "Toward Creating Optimal Healing Environments." This presented a unique opportunity to interface with other medical providers from all other medical professions, as well as the people managing these facilities.

It was wonderful to see that almost every state was represented. Living in California, we sometimes forget that there is life and health care in other parts of the world. We tend to believe the saying, "As California goes, so goes the United States." Former President Bill Clinton rephrased it somewhat in that he said: "As California goes, so goes the world." This statement might be a little broad, but it does remind us that we have an awesome responsibility to think ahead, react with care and dignity and use professional manners at all times and in every situation.

I was invited to speak, along with Acupuncture Today columnist Sam Collins, on the topic of "Practicalities of Employing CAM Providers, Hiring, Licensing, Billing and Reimbursement." It proved to be an interesting session, in that many questions were asked and much interest was exhibited. Both Sam and I advocated for the acupuncturist to be in an integrated setting. The attendees were interested in the education, professionalism and possibility of these settings becoming more available to patients. The consumer and the aging of our population are driving this market. The inclusion of acupuncture into the biomedicine field is here. The question then becomes, is the profession ready?

The Medical Culture

Medicine is an art of medical culture and the professional wants to fit into the context of hospitals and multispecialty clinics where an acupuncturist might want to work. In the beginning, the acupuncturist must learn how to fit into this medical culture and context. Within the hospital, there are two areas to consider: 1) hospital staff privileges and 2) clinical privileges. Staff privileges are acceptably defined as to when a hospital grants or gives you permission to see patients within the hospital setting. Clinical privileges are defined as to what you can or cannot do while working within the hospital setting. Thanks to David C. Kailin, MPH, PhD, for explaining and defining in his book, Quality in Complementary and Alternative Medicine, many of the regulatory issues the profession must know in order to succeed in the world of biomedicine.

One of the biggest concerns regarding the acupuncture profession was that of professionalism, including standards of dress; politeness and manners; social skills; the ability to give and take information; the ability to listen and not think they know it all; possessing and demonstrating the ability to have interactions when consulting and referring patients; keeping accurate and complete records; understanding the ground rules for referrals; knowledge of state and federal laws and regulations; ability to communicate about the world of acupuncture, which is coming into the biomedicine world; and finally, the ability to provide in-services while using good public speaking techniques.

The hospital and integrated medical clinics must examine and ask questions in the following areas:

• Will the acupuncturist be accepted as a professional and can both parties establish a mutual working relationship?
• What are the risks? This is fairly low in the acupuncture profession. Burns and collapsed lungs are the biggest issues in the field.
• Is the acupuncturist HIPAA compliant?
• Is there scientific research including indications, contraindications, clinical outcomes and cost/benefits of acupuncture?
• What is the legal and regulatory status of acupuncture? This will vary from state to state.
• What is the public acceptability for this medicine? This is a consumer-driven medicine and thousands of new patients are trying these procedures every year.
• What is the profitability of the business relationship? Approximately 50 percent, (70 percent on the west coast) will cover some amount of reimbursement for acupuncture services.
• What are the personal qualifications and attributes of the acupuncturist?

Thanks again to David C. Kailin's input as to what hospitals and clinics should ask.

The medical culture also has a responsibility to help the acupuncturist so the process of working together becomes a win-win situation for them. The hospital must help to educate the acupuncturist, as well as other medical providers in defining the criteria for seeing and referring patients to the acupuncturist.

Important questions to ask are:

• What conditions or circumstances would require further consultation or referral?
• Is the acupuncturist invited or required to attend meetings or educational sessions with other medical providers form the facility?
• Will there be signage letting potential patients know there is an acupuncturist available?
• Is the facility willing to work with the acupuncturist to establish a workable set of clinical privileges?
• What is the chain of authority and with whom should the acupuncturist work at the beginning of this relationship?
• Will the facility help the acupuncturist to meet and know the other medical providers who have an interest in CAM medicine?

Thanks to Mike Clauson, LAc, a provider at Kaiser and Health Concerns, for input as to the responsibility of the hospital, as well as the acupuncturist.

You might be asking yourself, where do I even begin? How do I start the process of working with a hospital? The following list provides you with a guide of what to think about if you want to work in a hospital or integrated medical setting:

• Find someone in the context that is willing to help with your cause. You need to find someone who can introduce you to the right people and who believes in what you do.
• Be sure to watch for signs of problems or potential problems.
• Listen carefully.
• Proceed with caution - this process will take time.
• Be a good follower and learn the protocols and rules.
• Teach carefully and quietly.
• Make suggestions with careful wording and explanations.
• Always look and dress professional (clean, white and pressed clinic coats are appropriate).
• Remember you are bridging the world of medical cultures.
• Respect and professionalism go hand-in-hand with both patients and other medical providers.

The time is now. Patients want what this profession offers and hospitals are looking for your medicine. Acupuncturists have the responsibility to share their knowledge and skills for the betterment of mankind.

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Click here for more information about Marilyn Allen, Editor-at-Large.

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