The California Senate is Concerned with How the California Acupuncture Board Functions

March 14, 2012

On March 12, 2012 the Senate Committee on Business, Professions and Economic Development conducted a hearing under its Sunset Review function during which the California Acupuncture Board (CAB) Chair and Executive Director were advised, in the opinion of the committee, the CAB was “too caught up in professional issues.” The CAB was instructed to respond to the committee’s Background Paper [click here Acupuncture Board Background Paper 2012TRUNC], which is a worthwhile read for those interested in California acupuncture or in the legislative oversight process. The very brief 20 minute hearing ended with the committee letting the CAB Chair and Executive Director know the committee was “concerned about how the board functions.”

What are the substantive issues that led the committee to send this warning shot across the CAB bow?

The CAB does not function well because it does not use the information it has to function independently and responsibly. The committee listed ten issues in the Background Paper. In the March 12 hearing the Chair and Executive Director offered little explanation. The CAB now must respond to the Background Paper in specifics.

If there is one particular criticism that becomes clear upon attending a few CAB meetings it is that the CAB fails to uphold its mission despite the mission being fairly simple.

“The mission of the Acupuncture Board is to benefit, educate and protect the public through regulation of licensure; development of education standards; provision of consumer information; and enforcement of the Acupuncture Licensure Act.”

One of the most important CAB functions is to approve acupuncture training programs so that their graduates are permitted to sit for the California Acupuncture Licensing Exam – CALE. The CAB has approved approximately 36 “schools”, including 20 located in California. The CAB rarely removes a training program from its approved list which keeps growing despite very strong evidence that many of the approved schools are doing a terrible job preparing graduates to pass the CALE. There are at least seven schools with less than half their graduates able to pass the CALE. Four of these programs have pass rates below 40%!! One might conclude the CAB is more interested in approving schools than realizing the CAB vision which includes “ensuring excellence in practitioner training and education.”

Why CALE pass rates matter. The rate at which graduates of a training program pass the licensing exam is the first and foremost indicator of the quality of their training. Most healthcare professions including Physical Therapy, Nursing, Physician Assistant and Physician, have pass rates above 85%. Even Licensed Vocational Nurses pass at a rate higher than 70%. The average pass rate for acupuncturists on the CALE across a decade (2001 and 2010) was 61%. [ed. these data are from the CAB website]. A pass rate this low means passing the licensing exam is almost the same as flipping a coin.

There are only a few explanations for a pass rate this low: the exam is “too hard”, the exam is poorly constructed (e.g., it is does not test what people study), or the people taking the exam are simply not well prepared. The CAB has had testimony from the state’s own testing department that there is noting wrong with the CALE as a measurement tool. The test is not irrelevant (although some might argue CALE does not test enough conventional medicine topics). The test is not too hard (certain groups historically perform much better than other groups as pointed out in the Background Paper, pg. 15). That leaves one conclusion. Many graduates – as in 40% on average – are poorly prepared. That leads to only one other conclusion. Some schools do not actually exist to train acupuncturists.

Different conclusions would merit consideration if the evidence of academic failure among so many training programs was short term. It is not. Here is the real question. With so much strong evidence in its hands why has the CAB failed to take any action to protect the public by doing a better job at ensuring the quality of training by removing at least the worst performing schools from its list?

The CAB approves schools that have testified to the CAB they are not in the business of training acupuncturists. In 2008 one school president testified that he expected his graduates would work as missionaries. Despite being visibly alarmed the Chair voted with the other CAB members to approve the school provisionally for three years. While this school clearly should not have been approved the idea of granting provisional approval is a good one that should form the basis of a new policy.

The Senate Committee on Business, Professions and Economic Development appears to be ready to replace the CALE with the national certifying exam (NCCAOM), and remove the CAB’s school oversight function by deferring to the national certification body (ACAOM). These are both bad ideas because they simply kick the problem outside the state. ACAOM and NCCAOM serve the very schools that are problems in our state. If the CAB wants to avoid the removal of their licensing and approval functions then the CAB has to begin functioning according to its mission and initiate a program that uses CALE data to guide its school approval process.

In responding to the Background Paper the CAB should recommend the following new policy for evaluating currently approved schools and new schools that are applying for approval.

1. All new schools seeking approval must meet new criteria (to be drafted by a qualified health professions educator experienced with mainstream programs). New schools can only receive provisional approval for no more than three years. The school must achieve a 70% pass rate by year two and maintain it in year three.

2. All currently approved schools must achieve a 70% pass rate by 2014.

Training programs that do not hit these marks should be removed from the list.

There is one more issue; the number of graduates from any school that actually sit for the CALE. The CAB should require that each school on its approved list must annually report the total number of graduates and the number of graduates that took the CALE each year. The threshold of graduates who take the exam should be 80%.

3. Any school with fewer than 80% of its graduates who register for and take the CALE should be placed on one year probation to achieve the standard. If that standard is not met then that school should be removed from the list of CAB approved schools. The school may reapply after five years and significant reorganization.

The CAB does not function well because it does not use its own information available on its own website (!!) to function independently and responsibly. The Background Paper covers other issues including board approval of Continuing Education courses clearly not aligned with acupuncture and scope of practice questions. In previous Sunset Review years (e.g., 2001, 2003 and 2004) the CAB has repeated familiar explanations. If the CAB repeats this strategy once again it might result in a significant loss of authority which would not be good for the CAB, the profession or the public.

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