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Complementary and Alternative Therapies for Cancer Patients APPENDIX C: EDUCATION, TRAINING, LICENSING AND ACCREDITATION OF HEALTH CARE PRACTITIONERS Finding a quality health care practitioner can be a confusing and lengthy process. Health consumers may want to research the background, qualifications and competence of potential health care providers whether a “mainstream” physician or a practitioner of alternative and complementary health care. An informed referral is a good place to start. One of the best referral sources is a professional in a related field. For instance, chiropractors often know the best acupuncturists in the local area, and vice versa. Appropriate state licensing is one way to check that the practitioner you selected is competent in his/her field. You can contact a state or local regulatory agency with authority over practitioners who practice the treatment you seek. The practice of CAM is not as regulated as the practice of conventional medicine. However, licensing, accreditation and regulatory laws are increasingly being implemented. For some specialties, licensing requirements are determined at the state level. In others, the individual county or city governments determine the level of education and training necessary for a license. Local and state medical boards, health regulatory boards and consumer affairs departments can provide information about a specific practitioner's license, education, accreditation and whether there are any complaints lodged against the practitioner. Most types of complementary and alternative practices also have national organizations of practitioners that are familiar with legislation, state licensing, certification or registration laws. Usually, to gain membership to one of these professional organizations, the practitioner must meet the minimum licensing law requirements for his/her state. These professional organizations often have referral services and can recommend a qualified practitioner in your area. In the absence of licensing laws, there is no precise way to determine the relative competence of a CAM practitioner. However common sense can provide some general direction. For instance, it is better when practitioners have had extensive training in their trade and show an interest in continuing education. Do not let a practitioner's professional initials dictate your decision. It is in your best interest to select an acupuncturist with thousands of hours of traisning and a long list of postgraduate seminars over a medical doctor who has only taken a weekend training course. Experience is another useful guideline. Just as medical doctors improve with practice, so too will alternative practitioners. Be sure to find out the number of hours of training the practitioner has had in the technique in which you are interested. In addition, you should ask him/her about board or organizational certifications of completion and competency. Acupuncture No specific criteria can determine who is a good acupuncturist as the field of acupuncture is very diverse. There are many distinct styles of acupuncture which include traditional Chinese medicine, Japanese Manaka style, Korean hand acupuncture and the Worsley method. Advocates of each field tend to believe that their method is better than all others. There is no national licensure for acupuncture, and educational requirements, licensure and regulations regarding the practice of acupuncture vary from state to state. This inconsistent licensure at the state level makes it difficult to judge an acupuncturist’s credentials. Legislation in at least 35 states plus the District of Columbia regulate the practice of acupuncture, and about a quarter of these states grant licenses to practice acupuncture. In unregulated states, acupuncture is technically illegal unless performed by a physician. Even titles vary as an acupuncturist may be “licensed,” “certified,” “registered” or considered a “doctor” of acupuncture or Oriental medicine. To make matters more confusing, these titles do not have a consistent relationship to educational requirements. A practitioner may have some of the following titles: Ac.T. = masters level acupuncture therapist, LAc.= Licensed acupuncturist, Mac. = Masters of Acupuncture, OMD or DOM = Doctor of Oriental Medicine. One can be assured that they have found a trained and board certified acupuncturist if they have these designations after their name. The Accreditation Commission for Acupuncture and Oriental Medicine (301-608-9680) sets national standards for acupuncture schools and can send you a list of accredited schools. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) administers a standardized examination testing mastery of acupuncture. An acupuncturist must pass this exam and meet continuing education requirements every two years in order to retain certification. At a minimum, an acupuncturist should be licensed in the state where he/she practices, if such licenses exists, and have received NCCAOM certification. If the practitioner does not have a license, he/she should have graduated from an accredited acupuncture school and/or satisfied the requirements of the National Commission for the Certification of Acupuncturists (NCCA). In the state of California, an acupuncturist must have graduated from an approved school, completed four academic years of education and obtained a state license. The state licensure process consists of qualifying and passing California's written and clinical examination administered by the state Acupuncture Board. California does not recognize out-of-state licensing for practice within its state lines. Medical doctors can practice acupuncture, though physician-acupuncturists are seldom as fully trained in the art compared to non-physician licensed acupuncturists. A board-certified acupuncturist is required to have over fifteen hundred hours of training while a medical doctor may have just attended a weekend course in acupuncture technique and treatment. Ask the physician-acupuncturist about his/her training and experience in the field. Physician's Assistants can perform acupuncture under the supervision of a physician. Qualified acupuncturists can be recommended by one of the national associations below. They can provide names of practitioners who meet competency standards. American Academy
of Medical Acupuncture American Association
of Oriental Medicine Pacific College
of Oriental Medicine Acupressure Currently, there is no national, state licensure or widely accepted, standard credentialing agency for acupressure. Acupressure is administered by a wide variety of practitioners, from acupuncturists to massage therapists. An acupressure practitioner should have an educational background in traditional Chinese medicine and the hundreds of acupressure points of the body. There is a certification program for practitioners of Oriental bodywork therapy, but it is a relatively new program and few practitioners have received certification. Referrals can be obtained through the American Oriental Bodywork Therapy Association or the American Association of Oriental Medicine. American Association
of Oriental Medicine American Oriental
Bodywork Therapy Association Alexander Technique While there is no national licensure or certification requirements, the North American Society of Teachers of the Alexander Technique has well-established programs and will certify teachers with at least 1,600 hours of training over a three-year period. The Society will give referrals of certified teachers. American Society
for the Alexander Technique Allopathic Medicine All medical doctors (MDs) are educated and trained in accredited U.S. medical schools or foreign medical schools and must pass the three parts of the United States Medical Licensing Examination (USMLE). Training for competency in alternative treatments is not yet an integral part of standard medical education. The American Holistic Medical Association (AHMA) is sensitive to the fact there are no national standards of competency in alternative treatments for medical doctors and has recently established the American Board of Holistic Medicine for the purpose of certifying physicians as practitioners of holistic medicine.[13] In addition to the board examination, the certification process for the American Board of Homeotherapeutics requires an interview, a self-administered test of holistic health and evidence of board certification in a medical specialty. In many states, medical doctors, just by the broad scope of their license to practice medicine, can offer alternative treatments to their patients in which they have not demonstrated competency. However, there is a growing trend to protect health care consumers from untrained medical doctors who offer several types of alternative treatments such as acupuncture, Chinese medicine and homeopathy. Currrently, California law does not require medical doctors to possess a specialized license to offer you the alternative therapy that you desire. American Holistic
Medical Association Aromatherapy There is no national or state licensure for aromatherapy. Without standards for training or certification, it is an essentially unregulated practice. The National Association for Holistic Aromatherapy (NAHA) is developing educational standards for certification that will provide national guidelines for students and teachers. The National Association
for Holistic Aromatherapy (NAHA) Art Therapy Educational and professional standards for art therapists are regulated by the professional organization, American Art Therapy Association, Inc. The Art Therapy Credentials Board (ATCB) is an organization established to protect the public through maintaining and developing standards of practice for art therapists. The designation Art Therapist Registered (ATR) is granted by the ATCB to individuals who have completed the required educational and professional experience. Board Certified (ATR-BC) art therapists are individuals who have passed the national certification examination. American Art Therapy
Association Art Therapy Credentials
Board Ayurveda Currently, there is no national licensure of Ayurvedic practitioners in the United States. A small number of schools offer minimal training in Ayurvedic principles but there are not any colleges offering the five years of training that is the educational standard in India. Some medical doctors, chiropractors, or nutritionists may include Ayurvedic methods in their treatments. As you would with any doctor, check into your practitioner's training and experience. Biofeedback There is no national licensure for biofeedback, nor are biofeedback practitioners required by law to be certified. States which license psychologists and nurses have mandated that this license is all that is required to practice biofeedback. Biofeedback technicians may work under their employer's license. There are training programs certified by the Biofeedback Certification Institute of America (BCIA). Practitioners who wish to be certified must have a bachelor's degree in a health care field, completed a required number of hours of biofeedback education and undergone supervised clinical training. Association for
Applied Psychophysiology and Biofeedback Biofeedback Certification
Institute of America (BCIA) Chiropractic There is national licensure for chiropractic to which all fifty states plus the District of Columbia and Puerto Rico adhere. A licensed Doctor of Chiropractic (D.C.) must have completed a four-year chiropractic college accredited by the Council on Chiropractic Education (CCE) and/or approved by a state board. National exams and various state assessments are also required. Chiropractors can legally do more than manipulate and align the spine. They will usually take a medical history, perform a physical exam and order lab tests and X-rays to arrive at a diagnosis. Federation of Chiropractic
Licensing Boards Energetic Healing There is no national licensure for energetic healing, and licensing laws are inconsistent at the state level. In general, energetic healing is an unregulated practice. Several schools offer certificate programs in what they call energetic healing. These are usually hybrid programs which combine color therapy, flower essence therapy, magnetic therapy, aromatherapy, hypnotherapy, laying on of hands, meditation and sound healing. Environmental Medicine Environmental medicine practitioners are generally physicians, M.D.s or D.O.s, who have been trained by other physicians and/or have taken advanced courses in the prevention, evaluation, management and treatment of environmental illnesses. The American Academy of Environmental Medicine offers such courses to licensed physicians and will provide referrals. American Academy
of Environmental Medicine Guided Imagery There is no national or state licensure for guided imagery, and like many mind-body therapies, it is an unregulated practice. Workshops in guided imagery are open to professionals in the counseling field, such as psychologists, certified counselors and social workers. However many hospitals, health organizations, books and videos offer self-help courses in guided imagery. Herbal Medicine There are several different approaches to using herbal medicine in the United States. While there is no national licensure for herbal medicine, a practitioner must have a license to practice naturopathy or traditional Chinese medicine in order to prescribe herbal preparations. Only on Native American reservations can a nonmedically trained herbalist prescribe herbs. If a herbalist does not have a state license, legally he/she can only be an herbal "consultant." The National Commission for the Certification of Acupuncturists recently developed an examination process for the certification of practitioners as Diplomates of Chinese Herbology. Unfortunately, outside of state and local licensing regulations, there is no national or professional association that regulates or accredits herbal medicine education. Because of the unregulated nature of this practice and the potential for contraindications, consumers should be careful in selecting an herbalist. If you plan to take Chinese herbs, make sure any mixtures you use have standardized content and are processed under the direction of a licensed health professional familiar with their medicinal effects. Homeopathy Nationally, any licensed medical doctor or osteopath can prescribe homeopathic remedies in the United States. Because there are no national standards of competency in alternative medicine for allopathic doctors and osteopaths, the American Board of Holistic Medicine administers written and oral examinations to interested M.D.s and D.O.s. Those who successfully pass the examination are awarded the Diplomate in Homeotherapeutics (D.Ht.). In some states, naturopathic physicians may also practice homeopathy and may take a board certification examination (Homeopathic Academy of Naturopathic Physicians Board Certification Examination) to become certified in homeopathy. Training in homeopathy for other health care providers in the United States is usually three years in length, typically meeting one weekend per month during the training period. A number of certification programs are available. The Council for Homeopathic Certification (CHC) administers a certification examination and awards successful candidates a certificate stating they are Certified in Classical Homeopathy (C.C.H.). The National Board of Homeopathic Examiners (NBHE) offers diplomate status to candidates with a Ph.D., D.C., M.D., D.O., P.A., N.D. or O.M.D. and certificate status to candidates without a doctorate. There is inconsistent licensure at the state level, and other heath care and CAM practitioners may or may not be allowed to prescribe homeopathic medicines. You should contact the National Center for Homeopathy for information on specific state regulations. American Institute
of Homeopathy Council for Homeopathic
Certification Homeopathic Academy
of Naturopathic Physicians The National Board
of Homeopathic Examiners Hypnotherapy Currently, there is no national or state licensure for hypnotherapists. Anyone can legally offer their services to the public. The International Medical and Dental Hypnotherapy Association will certify hypnotherapists if they meet the minimum eligibility requirements and provide referrals. International Medical
and Dental Hypnotherapy Association Massage Therapy and Bodywork Massage and bodywork therapies encompass acupressure, Alexander technique, applied kinesiology, aromatherapy, craniosacral therapy, deep muscle therapy, deep tissue massage, Feldenkrais method, hydrotherapy, qigong, reflexology, reiki, Rolfing®, Swedish massage, therapeutic touch and others. There is no national licensure and inconsistent licensure at the state level. Many states have no educational or training requirements for massage therapists. Whether or not state laws are in place, local or county laws may apply. The American Massage Therapy Association (AMTA) can provide current information on a specific state's massage laws. The AMTA is also the largest accrediting organization in massage training. Unfortunately, only one-fourth of U.S. massage schools have been granted accreditation. The National Certification Board for Therapeutic Massage and Bodywork administers a certification examination and an increasing number of states use this as their licensing exam. It is important to make sure your therapist is properly qualified and membership in the AMTA is the best evidence that your therapist has had the proper training. The AMTA also keeps a national list of trained massage therapists for referrals. American Massage
Therapy Association National Certification
Board for Therapeutic Massage and Bodywork Meditation There is no licensing or certification procedure for teachers of meditation. There are a number of “universities” around the country, run by the Maharishi Vedic Education Development Corporation, which teach the transcendental meditation method. Hospitals, clinics, private practices and fitness centers may have relationships with meditation instructors to whom they refer patients. Look for someone with whom you feel comfortable and who has experience. Naturopathy There is no national licensure for naturopathy, and at the state level, licensure is inconsistent. Currently only a few states (Alaska, Arizona, Connecticut, Florida, Hawaii, Maine, Montana, New Hampshire, Oregon, Utah, Vermont and Washington) and Washington D.C. and Puerto Rico have licensing laws, and they differ considerably. If you reside in one of the states listed above, your naturopath should have a degree from one of the four accredited, four-year Naturopathic medical schools (Bastyr; National College of Naturopathic Medicine in Portland, Oregon; Southwest College of Naturopathic Medicine in Scottsdale, Arizona; and the Canadian College of Naturopathic Medicine in Toronto, Ontario) and have passed the national board exam, Naturopathic Physicians Licensing Examination (NPLEX). The Council on Naturopathic Medical Education (CNME) is recognized by the U.S. Department of Education to accredit naturopathic schools and programs. Graduates from these schools are granted the title Naturopathic Doctor (ND) and are usually affiliated with the American Association of Naturopathic Physicians (AANP). In California, your naturopath may or may not have a ND. In the states without a Naturopathic Doctor licensing board, N.D.s also have to be certified in a licensed type of bodywork to make it "legal" for them to do musculo-skeletal work. Other practitioners of Naturopathy are called Naturopathic Practitioners and they attended and received training from a non-accredited naturopathic college. Naturopathic Practitioner is a specific, state-approved vocational designation that enables graduates of non-accredited colleges to legally provide naturopathy to health care consumers. These naturopaths are usually affiliated with the American Naturopathic Medical Association (ANMA). In several states, Naturopathic Practitioners can sit for a national board certification test to get their N.D.s. American Association
of Naturopathic Physicians American Naturopathic
Medical Association Osteopathy The Doctor of Osteopathic Medicine degree (D.O.) is legally equivalent to that of a M.D., and osteopathy has, for the most part, been assimilated into the larger stream of conventional medicine. All physicians (both D.O.s and M.D.s) must pass a national and state medical board examination in order to obtain a medical license and practice medicine. The National Board of Osteopathic Medical Examiners can give you information about the status of an osteopath's medical license. National Board of
Osteopathic Medical Examiners Polarity Therapy There is no national licensure of polarity therapists, and licensure at the state level is inconsistent. In some states, polarity therapy is considered a form of massage, and therapists are subjected to the same licensing laws as massage therapists. In other states, polarity therapy is unregulated. The American Polarity Therapy Association accredits educational programs and grants practitioners certification and registration. Practitioners who have completed 155 hours of training receive certification as an Associate Polarity Practitioner (A.P.P.) and those with 615 hours of training receive certification as a Registered Polarity Practitioner (R.P.P.). American Polarity
Therapy Association Reflexology There is no national licensure for reflexologists. Practitioners do have the option to become certified by the American Reflexology Certification Board. American Reflexology
Certification Board Traditional Chinese Medicine (TCM) See acupuncture. Yoga Because yoga instructors are not medical professionals, no national licensure or standard certification is required. However, some yoga schools do certify their graduates. Becoming a yoga instructor or yoga therapist requires much more personal dedication than other CAM practitioners. To be admitted to most training programs, prospective yoga instructors must have been practicing yoga for daily for six months to a year, abstain from drugs, alcohol and tobacco and follow a vegetarian diet. Seeking a referral from your health care provider and asking other patients undergoing yoga therapy for recommendations are good ways to find an experienced and qualified yoga therapist.
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