Friday, October 9, 2015

Dual License L.Ac.s and Hospital Practice

10.9.2015 draft
keywords:  credentialing, privileging, hospital sponsor, PCM, KSAs, biomedical training, hospital culture

Related topics:  Hospital Sponsor

Author/Editor:  Megan Kingsley Gale
Contributing authors:  Fujio McPherson, DAOM, ARNP 
If you are a dual-licensee reading this, please chime in on the comments section.  Would love to hear form you!

Dual-licensed L.Ac.s and strength brought to EAM Hospital Work

A dual-licensed L.Ac. brings great strength to his/her work in the hospital.  Because she also has a Western medical health care license (MD, DO, DC, ARNP), she has a foot in both worlds.  She understands hospital culture and can be a wonderful advocate for single-licensed L.Ac.s into hospital setting.  These dual-licensees, in practice have often been the first L.Ac.s into hospitals.  They have been hired under their non-L.Ac. health care license.  Some have slowly incorporated more EAM work into their clinical practice (when hospital culture was right, they added acupuncture and EAM procedures to their “delineation of clinical privileges”).  Some, in the case of some VA/VHA L.Ac.s, were hired under their non-L.Ac. license for the job of an L.Ac.  i.e. an RN-L.Ac. hired to do full-time L.Ac. work, but no current occupational code existed in hospital system for hiring L.Ac., so hired and credentialed under RN licensed, but position description is entirely L.Ac., not RN and practice work is all L.Ac.  Same example for PA and DC.

Dual-licensees make great primaries on hospital Integrative Medicine research projects.

Negatives to dual-license L.Ac.s in hospital practice

When push comes to shove, these L.Ac.s often find themselves doing more of the non-L.Ac. healthcare work because that is (area of need) where hospital needs them first.  This is less common with RN-L.Ac.s.  Very common with MD-L.Ac.s and ARNP-L.Ac.s.  Non-dual licensees do not have this pull toward two-jobs-in-one.  An L.Ac.-only can not have his time divided into other health care duties.  So, an L.Ac.-only is time and cost-efficient.  Less education expenses to pay back.  Can be counted on to provide only EAM services (not also injections, PAP smears, surgery, etc) to a dedicated clinic.  Having a dedicated L.Ac. clinic is essential to consistent patient care and outcomes.

Dual-licensee distinctions

PCM-L.Ac. and non-PCM-L.Ac.

Non-PCM dual-license L.Ac.
Ex:  MD-L.Ac., ARNP-L.Ac., DO-L.Ac,
These are occasionally PCM, depending on state law:
D.C.-L.Ac, ND-L.Ac, PA-L.Ac.
Definite non-PCM dual-modern medicine licenses that seem to help in L.Ac. hospital practice:
RN-L.Ac.—RNs are not providers
PsyD-L.Ac.—clinical psychologist who is also an L.Ac.
MPH-L.Ac.—one of most common dual-licenses for L.Ac.s.  Master of Science in Public Health is a nice fit for EAM providers.  In hospital setting you are likely to work in admin positions or in positions where you are creating community health programs.  Not always clinical work.
PCMs are clearly providers, based on their non-L.Ac. license (MD, DO).
The non-L.Ac. license seems to help these “duall-ees” understand hospital culture and navigate the system.  Sometimes the non-PCM first license has caused confusion when these duallees want to work clinically as L.Ac.s.  The clinical work of an L.Ac., while not PCM, is provider level 2 work.  If the non-L.Ac. license is not in provider work, it may be counter to duallees first position description to do L.Ac. clinical work.  (example:  RNs do not have acupuncture in their scope of practice.  The RN-L.Ac., to do acupuncture, must be hired under L.Ac. PD to be clearly able to do so.  Trouble arising when their PD does not give credit for their L.Ac. background.
A PCM-L.Ac. is usually hired under the PCM license and gets the L.Ac. scope added/granted as part of his/her clinical privileges, sometimes called "extended privileges"

Recommendation to L.Ac. education leaders—making Dual-licensees more common!!

We know dual-license L.Ac.s are door-openers for our field of EAM in:


More jobs

Federal work

Hospital work

Integrative medicine clinics

Specialty clinics

Inpatient work

So, what can we, as a profession, especially at our education institutions, do to make dual-licensees more common?

The discussion continues in comments section, email list, and in our social media groups.  

If you found this information helpful or interesting, please considering donating to or sponsoring the project and joining the email list.

EAM--East Asian Medicine.  I current favor this term over the following to describe our modern practice:  TAM (traditional Asian Medicine), AOM (Acupuncture and Oriental Medicine).  In May 2016, President Obama signed a bill to eliminate the term "oriental" from all federal documents because the term is derogatory.
VA/VHA--veteran's administration or veteran's health administration
IM--integrative medicine
PCM--primary care manager
L.Ac./EAMP--state license titles for Acupuncturists.  "Licensed Acupuncturist (L.Ac.)" and "East Asian Medicine Practitioner (EAMP)".  L.Ac. is the most common state title.
PCMH--patient-centered medical homes


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