A hot topic here in the UK is over whether acupuncturists should specialise. On the one hand, therapists argue that certain areas call for specialist knowledge over and above standard college teaching. On the other, people argue that acupuncture is a holistic system that is antithetical to specialisation. So, should acupuncturists specialise?
The British Acupuncture Council (BAcC), the lead professional acupuncture body in the UK, has been considering an application from a group, specialising in paediatrics (the treatment of children), to argue that this should be an area of specialisation. The BAcC has concluded that:
” This time feedback reveals that there is no ‘resolution’ to the generalist/specialist debate. Members’ opinions fall in either camp, depending upon their beliefs about acupuncture practice and their own clinical experience. The BAcC works not to restrict members’ practice but rather to promote best practice and make sure that patients are in receipt of the best care possible. In the absence of statutory regulation, we still have the dual role of protecting the public as well as representing members’ interests. The paediatrics guidance notes will be rewritten based on your feedback, bearing in mind that practitioners are committed to working within the limits of their competence, know when to refer to a practitioner with more experience when necessary, and that some guidance on self-assessment to help answer the question ‘How do I know what I don’t know?’ may be helpful.”
My own feeling is that there is certainly scope for specialisation in acupuncture and Chinese medicine, and as the BAcC say, we should be aware of our limits of competence. I have a special interest in the areas of pain and fertility. Around 5 years into practice we held a joint audit at my main practice. We had 5 acupuncturists working there at the time, and a very large percentage of our patients were presenting with pain conditions. This motivated me to go on a long journey of studying the understanding of pain from both a Western medical and traditional Chinese perspective. This has certainly made me a more effective practitioner in this area. As an example, in the past, if a patient presented with pain on their shoulder, I would have treated the points over the pain; say L.I. 14 and L.I.15. Nowadays I might still needle these points, but I would check for and treat myofascial trigger points in muscles which might refer pain to this area, such as the scalenes, supraspinatous, pectoralis major & minor, biceps brachii, and corabrachialis. Many of these trigger points will correlate with traditional acupuncture points, but classical acupuncture might not suggest that they could be helpful for this patient’s presentation of shoulder pain.
Fertility is another area ripe for specialization. The methods of treating women according to the phase of their menstrual cycle, supporting IVF cycles, etc are not taught at college. A lot of specific technical knowledge about the process of IVF is required. My interest in this area is a personal one, having had to overcome my own problems with infertility.
Paediatrics is another area requiring specific extra knowledge. Children’s energetics are very different to adults and I invariably refer any children to my colleague, Colin Rogers, who has undertaken substantial extra training in paediatrics.
So do I believe acupuncturists should specialise? Well, yes and no. On a practical level, for many acupuncturists, there just isn’t the demand, in their area, to be able to work full-time and specialise in one area. I think for acupuncturists working in large cites this might be an attractive option though, and it could work well for their patients.
Personally I love working as a generalist with certain areas in which I have a special interest. The model I think which is relevant to this is that of the medical General Practitioner (GP). At least in the UK it is common practice for GP’s to have an area of specialisation; whether that be orthopaedics, dermatology or whatever. They will do one or two sessions a week at the local hospital working in a specialist capacity. The rest of the week they work as a generalist in their own practice. This, in my view, is a great model for us as acupuncturists.
I initially published this post on my ‘All about acupuncture’ blog, but now that I’ve added this WordPress blog to my website I’m closing that blog down. I posted ‘Should acupuncturists specialise?’ as a discussion on Linked In and it generated a terrific response. You can see the comments here.