I asked the Federal Trade Commission to investigate the NCCAOM

My fellow acu-punks, 

In July, I attended a Zoom meeting held by our Federal Trade Commissioners.  I had one minute to tell them why I wanted them to investigate the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM).  In a nutshell, I spoke about their anti-competitive practices and consumer monopoly over the national certification of acupuncturists.  

I want you to join me in this effort.  All you need to do is send an email. Personal stories are optimal, but if you don’t know what to say, Jersey Rivers and I have taken care of that for you.  (More on that below.) 

Why am I asking you to do this? It’s because I don’t know what the NCCAOM is.  I mean that sincerely.  Are they a certifying body, creating a test of acupuncture competency to ensure public safety? Or are they a trade association, bringing acupuncturists together to advance their common business interests through lobbying and public relations campaigns?  What they really seem to be doing is advancing the interests of the NCCAOM.  

The Cause IQ  website gives us pertinent information about non-profits.  The NCCAOM is categorized as a professional association.  Which means that in my state, and many others, acupuncturists are required by law to pay a trade association to renew our state licenses long after we passed their exams. You can see from the website that Chief Operating Officer, Mina Larson, makes almost $205,000 a year.  This isn’t as much as the outgoing COO, Kory Ward-Cook, whose outgoing salary was around a quarter of a million dollars a year. This Wikipedia article defines what trade associations do. Providing certification (and re-certification) is not one of the things.  At the state level, the entity that provides your state’s acupuncture license is not the same as a membership based acupuncture professional association.  Those two things should not overlap at the state level, so why do they overlap at the national level?  

The California exam is known for being more rigorous than the NCCAOM’s exams.  Shouldn’t this mean that California certified practitioners are eligible for licensure parity in any other state?  One would think. For the time being, most states require acupuncturists to have taken the NCCAOM exams.  Even acupuncturists that live in states that do not require continuous recertification with the NCCAOM as a condition for renewing a state license, will stay current with the NCCAOM in order to obtain a license in another state.  We need acupuncture licensing boards to clean up state laws and make licensure reciprocity much easier. 

California acupuncturists are working to accept the NCCAOM exam in their states. I think we all agree that this is a good thing.  But they are forced to do so.  Otherwise, California acupuncturists who are not NCCAOM certified are not eligible to apply for federal jobs in their own state.  By federal law,  NCCAOM certification is required in order to work for the Veterans Administration and other federal facilities.   The NCCAOM lobbied Congress for this shitty policy.  Our recertification fees provided the funds for them to do so.

There are many ways to practice acupuncture.  The NCCAOM exam focuses on TCM.  This discriminates against Five Element practitioners and other lineages and styles of acupuncture.  The founders of People’s Organization of Community Acupuncture had a long term vision for an alternative exam that would focus more on acupuncture safety, less on theory.  Maybe that exam, and all the extra fees that go with it,  won’t cost $2000.  

President Joe Biden feels the same way that I do.  He wants the Federal Trade Commission to boost the labor market by cutting burdensome red tape surrounding professional licensure and support portability of state licenses. Biden put Lina Kahn, an AntiTrust Legal prodigy, in charge of the FTC. Because of Khan,  the FTC has monthly open meetings. They invite the public to make comments, like I did.  They offer the options to submit comments by video* or email.  

We could have a shot at this if we get involved and ask acupuncturists beyond POCA to get involved.  The FTC may be able to do something about the NCCAOM if enough of us can push them to act.  But, be warned, if you want fairness in licensure reciprocity you will have to start talking to lawmakers in your own states. If there is enough interest, I am happy to talk about this at a Zoom event for POCA members. 

Are you with me?  You can also write a letter sharing your own story of how NCCAOM’s anti-competitive practices have made it hard for you to practice acupuncture or get a job at a federal facility.  That would be ideal.  OR just copy, paste, and don’t forget to personalize the letter below to antitrust@ftc.gov.  

If you want to read more about antitrust, you can check out the FTC’s website: https://www.ftc.gov/faq/competition/report-antitrust-violation  

Sincerely, Elizabeth Ropp, Diplomate of Acupuncture and Traditional Medicine (NCCAOM)


* If you would like to speak at a meeting with the FTC or submit a video, talk to me. I can help you make that happen.

Dear Federal Trade Commissioners,

(Introduce yourself, name, where you live, how long you have been practicing acupuncture)

My colleagues and I are writing to inform you about the anti-competitive practices of the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM).  According to this link with CauseIQ, they are listed as a business and professional association.  However, they act as the acupuncture profession’s gatekeeper by offering the only national certification exam for acupuncture and herbal medicine. From their website: “Established in 1982, NCCAOM is the only national organization that validates entry-level competency in the practice of acupuncture and Oriental medicine (AOM) through professional certification.”

All but four US states use or require the NCCAOM Exams for initial licensure; roughly half of the state laws require ongoing credentialing from practitioners, which means that, in addition to state licensing fees, we must pay the NCCAOM to maintain current status every four years, long after we have passed their exams. Even though we are subject to an expensive national credentialing requirement, we do not enjoy license portability across state lines. Our relationship with the NCCAOM is all cost, no benefit, and absolutely mandatory if we wish to legally practice our profession.

NCCAOM functions with no oversight in terms of fees or their lobbying efforts in Washington, DC, or at the state level. Over time, their lobbyists have expanded the NCCAOM’s scope of influence to have more and more states: 1. Require their exams; 2. Require ongoing active diplomate status; 3. Require their Herbal Medicine exam in addition to the three others most states require. The only oversight provided by the NCCA, their accrediting body, relates to testing content. While I believe that tests are necessary for public safety, the costs (and content) of the NCCAOM exams contribute to the high cost of entering the acupuncture profession and do very little to protect the public.

I would like to ask the FTC to review the practices at the NCCAOM and initiate changes that will reduce their power to create barriers to entering and continuing practice as a licensed acupuncturist.

Signed,

(Your name here)

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Responses

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      1. Thank you SOOOOO much for contacting the FTC and for sharing with your student group so they can do the same.

    1. Thank you, Sierra. Please share this with other acupuncturists and ask them to contact that FTC. I don’t know how many acupuncturists it takes to get the FTC to investigate, but I am going to guess that we’ll need quite a few.

    1. Here’s what I submitted:
      My complaint concerns the National Commission for Certification in Acupuncture and Oriental Medicine (NCCAOM).
      This certifying body for the acupuncture profession has over the past 20 years added 3 new exams to their offerings. Back when I graduated acupuncture school in 1999 there were 2 exams: acupuncture and Chinese herbal medicine. Now the acupuncture module is broken into acupuncture, points and location and Oriental Medicine.

      In many states, including my home state of RI,the licensing statute references only “the examination by the NCCAOM”. However NCCAOM now regularly contacts state professional licensing offices to provide “updates.” The result is unfair and additional burden on licensing applicants to take additional examinations, even when they have already been licensed and practicing in other states already. It is no longer enough to simply pass the exams that existed when you graduated. NCCAOM is lobbying for all licensees to keep adding more exams. This decreases portability for licensing and has the consequence of limiting access for consumers, and driving up costs for services.

      NCCAOM has supported legislation to require “active” certification in states that already have CEU requirements of their own. This “active status” requirement that has now been enacted into law in several large states, including Florida. This effectively keeps those licensees who have already successfully passed their exams tethered to NCCAOM for continued re-certification and payment of additional fees to NCCAOM, for state licensing renewal.

      NCCAOM has no regulatory authority in any state, yet their business practices and bottom line are directly impacted by the legislation that they seek and support. This is clearly a conflict of interest between protecting the public by providing a measure of competency via their certification exam, and continuing to add products to their line and to require these new products, as well as “active” status for obtaining licensure or licensure renewal in many states.

      1. Thank you for sending this, Cris, and thank you for posting it here.

        The deadline to get a comment in for this weeks meeting with the FTC is 8pm today. But anyone can send an email at anytime to antitrust@ftc.gov.

  1. Elizabeth, you posted this a few days ago into the acupuncturists’ FB group, but have not responded to a single comment. I think this was a very misinformed pursuit, especially considering you single handedly took this opportunity to speak for all of us in this profession. This is not supported by the mass majority of acupuncturists and frankly it is very dangerous, dare I say foolish, for our profession. If you feel strongly about this, I invite you to rejoin the conversation you started here: https://www.facebook.com/groups/22073416402/posts/10157836530076403/?comment_id=10157839433311403&reply_comment_id=10157839436066403&notif_id=1634834900833773&ref=notif&notif_t=group_comment_mention

  2. This is absurd. You clearly do not understand the role of a certifying agency or how professions are managed in this country. You are also damaging all of the work EVERYONE has put into building this profession to make it viable for the past 30 years. It is time you and everyone else learned the history before you attempt to destroy it. Talk to the elders in the profession and not the students who are reaping the benefits of many years of difficult work. This is sadly ignorant.

  3. There is a lot to unpack here Elizabeth. Some of what you write is factual, some is not. That’s really a problem.

    The NCCAOM is a certifying organization and that information is readily and easily available. The ASA is a professional trade association. There was a brief time when there existed an acupuncture academy, They were told it was a conflict of interest and it has been suspended for years.
    The NCCAOM is the sole Certifiying organization because EVERY profession has ONE national certifying organization. There is only ONE NCLEX exam for nurses. There is ONE exam for MDs: The United States Medical Licensing Examination® (USMLE®) is a three-step examination for medical licensure in the U.S. The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease.”

    Let’s be incredibly smart: let’s address the fact that if you’re not licensed in your state and your state doesn’t have a license, you need to be NCCAOM certified to work in the VA. We need national standards.

    We can not expect to be considered essential healthcare providers without having standards and meeting them and be examined to demonstrate competency and the ability not to harm.

    I understand that POCA does not believe that we need to have masters degrees or doctoral degrees. That is a choice. Obtaining one’s masters degree or doctoral degree or terminal degree in one’s field is a choice. It’s a choice that many of us make.

    From the NCCAOM website:Forty-seven states (and the District of Columbia) have practice acts in place to define and regulate the practice of acupuncture. Of these, 22 require NCCAOM Board Certification to issue an acupuncture license. Twenty-six more use NCCAOM examinations as at least a portion of the licensure requirements. NCCAOM believes in the importance of the NCCAOM Board-Certification process and our examinations as a demonstration of achievement, quality and competence in the practice of acupuncture. Our state-level advocacy work continues to focus on the improvement of state licensure requirements to protect patients across the country, and we work closely with state governments to provide information and support for any developments with acupuncture practice acts.

    Let’s be aware that many states, except for California, Require NCCAOM exams and/or initial certification.

    To ask for such an inquiry without there being another organization that has demonstrated the ability to set and meet national standards and examine potential students and licensee is to meet those standards is shooting ourselves in the foot. It’s one thing to be upset about some thing, it’s another to undermine the profession in which you make your living.

    You don’t like the system? Change it when you have a national profession, that has a listing on the BLS, the bureau for labor statistics, you need to have a Plan B before you try and kill Plan A.

    It is an incredibly bad time to do this as we are looking to become providers under Medicare. Let’s remember that whether or not you personally want to take Medicare, CMS Medicare covers the procedure of acupuncture. License acupuncturists are not covered. Timing is everything. Process is everything. This is grandstanding.

    There’s a lot of feedback on a post that you dropped this piece on an Acupuncturists on Facebook. There are many folks asking for you to come back and clarify some points they asked about. That would be valuable.
    Respectfully,
    Amy

  4. You could not possibly be more wrong in your approach. That would be the end of us as a profession. When you have no power you unify as one unbreakable force and only then do you have a chance to make a change. You form a union, etc… NCCAOM may need some changes but they need to be strengthened not weakened. You are like a worker trying to destroy a union because you don’t like to pay the dues and you don’t like being forced to join. All you will do is undermine the collective strength of the workers. Next time you want to post something like this please get consensus from other acupuncturists first. I sure hope the dry needlers and the MDs don’t jump on the opportunity you just handed to them, because that would be the end of our profession and they will take control.