On February 8 2008 ACAOM (Accreditation Commission on Acupuncture and Oriental Medicine) announced it would discontinue efforts directed toward a professional doctorate as the entry-level degree for the acupuncture profession; the result of an "absence of consensus from educators and other communities of interest". Link here to the announcement.
In 2002 ACAOM approved and sponsored a post-graduate degree called the DAOM (Doctor of Acupuncture and Oriental Medicine). Two DAOM programs have been accredited and one has been advanced to candidacy status. The world of doctorate degrees in health professions practically requires an advanced degree to comprehend the distinctions. There is much at stake when a health profession strives to attain "doctor" status. Putting things simply, many physicians feel their degree erodes with every non-physician profession that claims the doctor title. By contrast, non-physicians who can now become "doctors" with their first-professional, entry level degrees believe they have attained greater stature. [MDs attained pre-eminence in medicine - a profession at least 4,000 years old - less than 100 years ago].
Who are these non-physician doctors? They are not PhDs therefore they are not academic. Their degrees are considered clinical, professional or terminal. Terminal degrees are purposeful only for their profession. They represent professional or clinical expertise, as compared to academic degrees which represent the ability, even the responsibility, to create knowledge in a given field. Professional or clinical doctorates in health professions include PsyD, DPT, DNP, AuD, DDS, DO, OD and MD.
What does it mean when a profession such as acupuncture pursues then abandons the entry-level professional doctorate degree? What is the difference between the DAOM and the first-professional degree that might have been?
The DAOM is a post-graduate degree for licensed acupuncturists who wish to pursue "advanced" knowledge. If the "communities of interest" had enthusiastically endorsed the first-professional degree this would have necessarily phased out all existing degree programs, including the DAOM. All existing schools would have been compelled to "move up" to the new standard. If this sounds logistically untenable consider that Audiology just completed this exact process over a seven year transition phase. Today there are more than 100 AuD programs.
There are approximately 50 AOM colleges. Many of their representatives spoke at an October 2007 public hearing to comment on the new ACAOM standards for accreditation. Here are some of the key issues that emerged (from the transcript).
The new standards (available through the ACAOM website, you need to create a login) are considerably more rigorous than the existing standards for the Master degree (the current entry-level degree) and the existing post-graduate doctorate. The proposed guidelines would have raised the bar considerably in many areas outside academics such as Governance (CEO must have appropriate experience and credentials) and Board membership (public members must have no links to profession or other members, especially as family or associates). Most comments were directed towards educational standards. My comments are highlighted.
1. Educators expressed concern that three years of college be a prerequisite for admission. Maintaining the current level at two years was supported by more than one speaker. Shouldn't the preliminary degree at least be a bachelor?
2. There was strong resistance against moving closer to integration with "western" medicine. For example, one speaker recommended that instead of requiring doctorate students to "practice" with the "multi-disciplinary team" that the bar instead be lowered to only having to "communicate" with this integrated team. A faction within AOM reads any movement toward integrative medicine as an attack on Chinese Medicine.
3. One speaker questioned the purpose in raising the bar by strengthening students' research knowledge. Research, especially evidence-based medicine, is a sensitive issue. There is a considerable literature in CAM (Complementary and Alternative Medicine) and AOM. However, it is almost exclusively generated by PhDs and MDs with acupuncturists conspicuously absent.
The profession of acupuncture is not ready to turn out doctors. The field does not have consensus to do what is necessary to raise its own educational standards. Objections to tightening in favor of maintaining loose admissions standards, opposition to training graduates to work in mainstream medicine, and low regard for the value of building a cadre of home-grown researchers, all point to the field's unwillingness to meet doctors' standards. The post-graduate DAOM, anemic and malnourished, is further marginalized.
Ultimately, this was an exercise in trying to direct the profession towards higher and more conventional standards in health professions education. ACAOM lost this round. Who won?