Last month, I shared questionnaire responses from colleagues working in hospital settings. I hope you enjoyed the piece and gained some insight for your own career. This month I am continuing to share what acupuncturists working in traditional medical settings are saying about building practices and being successful.

Are there aspects of OM care that you are not permitted to bring into the hospital setting, and how does that limitation impact your practice in this venue? What, if anything, have you developed to compensate for this challenge? Do you perform additional diagnostics or healing practices?

• I cannot moxa patients, as my entire building would go crazy from the smell, so I send it home with patients. I do a lot of medical triaging as taught to me by my mentor, Andrew Weil. I use Chinese dietary therapy with all my patients, and nutrition is one of my specialties. I also do quite a bit of pre-op work, as I am familiar with surgery from my experience working with the plastic surgeon. I use herbs and supplements, but, moreover, I encourage my patients and tell them that they have the power to heal themselves when I provide them with appropriate tools for lifestyle and dietary change. The nice thing about my practice is I am the boss, so I can do whatever I feel is necessary. I don't perform lab work. For that, I believe it is best to refer patients to their primary care physician or one of my integrative MD partners in my office, as I prefer to stay within the scope of OM.
  
  
• I use almost solely acupuncture. Mostly distal points.
  
  
• I can't use moxa at the pain center, but I do use herbs. I have control over that. In some hospital settings, you can only use Western herbs that have been approved for MD use. I sometimes order MRIs, but most folks already have them.
  
  
• The only limitations are that I am unable to dispense herbs on the premises, and I am not permitted to treat a pregnant or laboring mother. I can discuss and actually prescribe herbs; however, I must dispense them from my private practice. The hospital's stance on pregnancy is not that they feel acupuncture is dangerous or risky but that pregnancy is legally high risk as it is, without adding another component. The hospital doesn't want the risk.

What are the most difficult challenges you face? What are the greatest rewards? Is there a position for which you are striving or a niche you are trying to create, for yourself and other acupuncturists, through your work at this hospital/medical setting? Is there anything else you'd like to share with colleagues who, like you, are striving to expand our national patient base?

• My sole purpose for undertaking this effort is to expand the knowledge about the benefits of OM into the local community. I strive to offer people who may have never even considered OM a safe haven to venture out and try something outside the mainstream and validate our medicine. I do whatever it takes to increase awareness. The biggest challenges I face now are getting the word out that I'm there at the hospital. Hospitals are large, cumbersome institutions that typically aren't very organized with regard to promoting and/or utilizing resources to their fullest. It will largely be up to me to get the word out initially.
  
  
• In Florida, we are actually going through a crucial time for our profession, because motor vehicle accident (MVA) insurance claims, which were an important part of our contribution as pain-management providers, were stopped temporarily in October 2007 and are now being reconsidered. There is a proposition written on the favor of MDs, DOs and chiropractors to be the only ones allowed to treat MVA patients that became effective in January 2008. It will mean our acupuncture practice could be in serious jeopardy, not only regarding MVA insurance claims, but possibly even by private health insurance claims (presently we have the privilege of being able to bill several insurance companies as out-of-network providers). I believe many acupuncture physicians in Florida are not aware of this situation or are intimidated to speak up or do anything about it. I do not think the state Oriental medicine association even has a plan to help us show government representatives how important our contribution in the management of pain is.
  
  
• My personal goal is to further the concept of integrative medicine where all practitioners recognize their own boundaries and appreciate the contributions others can make in their patients' health. Just as MDs and DOs are moving down this continuum, it is imperative for alternative/complementary practitioners to become more adept at triaging patients and appropriately referring patients to physicians within their local medical community.
  
  
• I feel the most difficult challenge I face is that many people come to me with bad advice from practitioners of other "alternative" modalities. They are discouraged from integrating their care or they were told not to return to their regular doctor. They may have had a million unnecessary tests solely for the financial benefit of the practitioner. I appreciate the wonderful skills we have learned, but we must integrate and interface with the medical community properly and efficiently. I also feel we need to have a better understanding how to use our friends in the medical community and stay within the scope of our practice. I see many OM practitioners and other "doctors"' abusing their patients for financial gain.
  
  
• I treat many women of all ages, and I try to teach them how to age gracefully, and accept and love their bodies. I would like to co-write a book about this with my partner at some point in time. I try to be a role model for my patients, many of whom are working moms like me. Every day is a huge reward going to work as I get to help touch the lives of people and help them help themselves. My business partner and I are both moms, along with all the other female doctors in our office. I am incredibly proud of this, as I feel it sends a big message to our patients and colleagues about integration and balance in both our professional and personal lives.
  
  
• I personally think that it may benefit us more at this point to educate the medical practitioners and patients and ensure ourselves a significant and respected position by supporting our work with valid research. Research will be the key factor for the future.

I hope you take these thoughts to heart, that they inspire you to be true to yourself, your dreams and your practice. Through creativity and imagination, you can move our industry forward in unique and important ways. Each one of us has the potential to make significant gains for all of us. You are an important person professionally and your professional ancestors know it. I know it, and, if you look into your own heart, you know it. Go out there and make your mark, stand for your vision, create that which is new and good and distinctively yours. The world will be better for it.

Click here for more information about Felice Dunas, PhD.