123 - Should Medical Acupuncture Training Be More Widely Available Among Physiatry Residency Programs?

Objectives: Acupuncture has been used for over 2,500 years in East Asia to treat various medical conditions, but did not make its way to North America until the second half of the 19^th century. In the late 20^th century, Western research began to demonstrate links between opioid analgesia and acupuncture treatments. Over the last 2 decades, the demand for acupuncture has grown exponentially. In January 2020, CMS started covering acupuncture for Medicare patients with chronic low back pain. Despite this, few physiatry residency training programs offer exposure to medical acupuncture. The goal of this study is to provide support for increasing exposure to acupuncture among physiatry residency training programs.

Design: This is a retrospective cross-sectional study of alumni who graduated over the last 5 years from one urban, academic physiatry residency program with its own resident-run acupuncture clinic. Data collected via survey asked participants to: rank their opinions about usefulness, value and satisfaction with acupuncture training during residency on a 5-point categorical scale; comment on challenges incorporating acupuncture into their practice; and identify the most common chief complaints they treat with acupuncture.

Results: Among those who reported practicing acupuncture, the majority found value in learning acupuncture during residency, agreed that acupuncture was a marketable skill, and were satisfied with having acupuncture as an additional treatment modality. Low back pain, other musculoskeletal joint pain, and arthritis were among the most common conditions participants reported treating with acupuncture. Time and billing/reimbursement were among the most commonly identified challenges. Post-hoc analysis of programs via Internet search showed that among 94 PM&R residency programs in the US, 13 offer exposure to acupuncture, 2 offer the ability to get licensed during residency, and 1 has a formal resident-run acupuncture clinic.

Conclusions: Given the results of this study and the growing demand for acupuncture among patients suffering from chronic pain, more physiatry residency programs across the country should offer training in medical acupuncture. Future research should collect more data from graduates of this program, look more closely at which practice settings graduates have successfully implemented acupuncture, and the effects of fellowship and/or job types pursued post-residency and patient population.

Scientific Paper Best Paper Award Abstract:

Objective: Acupuncture use has been well-documented for over 2,500 years in East Asia to treat various medical conditions. It began to make its way into European medical literature as early as the late 1700s, but it was not until the end of World War II that acupuncture became incorporated into French medical education and schools as part of the educational curriculum. It took another 100 years before acupuncture began to make its way to North America, especially for conditions like low back pain, neuralgia and rheumatism. Acupuncture has been mentioned in major medical textbooks and utilized in the US military as early as the American Civil War. It was not until over a century later, in the 1970s and 1980s, that Western research began to demonstrate links between opioid analgesia and acupuncture treatments, and, in the 1990s, that acupuncture needles finally became recognized as “medical instruments," with their use slowly becoming more legitimized. Over the last 2 decades in particular, the demand for acupuncture has grown exponentially, in parallel with an aging population and a shift towards optimizing non-opioid chronic pain management. Interestingly, while most VA Health Systems have been providing acupuncture services since the early 2000’s, it was not until January 2020 that CMS started covering acupuncture for Medicare patients with chronic low back pain, with many other insurances soon following suit. Despite the aforementioned trend, few residency training programs offer exposure to, and/or the ability to get training in, medical acupuncture. Most that do are among Family Medicine based training programs with integrative health tracks or Integrative Health fellowships. While at first glance this makes sense given the wide array of conditions Family Medicine physicians are trained to treat, one might consider that as general pain and functional medicine doctors, Physiatrists should also be offered such opportunities during their training. The goal of this study is to provide support for increasing (or even standardizing) exposure to acupuncture, as an additional therapeutic modality, during Physiatry residency training.



Design: This is a retrospective cross-sectional study of alumni (N=23) over the last 5 years, who received formal training and certification in medical acupuncture from one urban, academic physiatry residency program with its own resident-run acupuncture clinic. This residency program’s current iteration of the resident acupuncture course started in 2016. In partnership with a local medical college that offers a licensing course in medical acupuncture for physicians, the residency program allows its participating trainees to fulfill 100 clinical hours under the supervision of 3 board-certified physiatrists with dual certification in medical acupuncture, while they fulfill the required 200 hours of class instruction at the partner institution. Data was collected via survey questions focused on the meaningfulness of acupuncture for these alumni and their current practice setting(s). Participants were asked to rank their opinion to questions regarding usefulness, value and satisfaction with acupuncture training on a 5-point categorical scale, ranging from strongly disagree (1) to strongly agree (5). They were also asked to comment, via fill-in response, on any challenges they have experienced incorporating acupuncture into their practice and the most common chief complaints they use acupuncture to treat.

Results: Data collected was, overall, uniformly positive. Among the study participants who reported using acupuncture in their practice, the majority found value in learning acupuncture in residency (72% responded agree or strongly agree), agreed that acupuncture was a marketable skill when seeking fellowship or employment (63% responded agree or strongly agree), and were satisfied with having acupuncture as a tool in their procedural/management arsenal (100% responded agree or strongly agree, 75% responded strongly agree). Low back pain, other musculoskeletal joint pain, and arthritis were among the most common conditions participants reported treating with acupuncture 100%, 91.7% and 66.7%, respectively). Time and billing/reimbursement were among the most common identified challenges for incorporating acupuncture into one’s practice. Post-hoc analysis of programs via Internet search showed that among 94 PM&R residency programs in the US, 13 offer some form of exposure to acupuncture, only 2 offer the ability to get licensed during residency training, and only 1 has a formal resident-run acupuncture clinic.



Conclusion: Given the results of this study and the growing demand for acupuncture among patients suffering from chronic pain, one could argue that moving forward, more physiatry residency programs across the country should offer training in, or at least exposure to, use of medical acupuncture to its residents as an additional treatment modality. Future research should aim to collect more data from graduates of this program, and more closely look at what type of practice setting graduates have found success implementing acupuncture in, the effect of fellowship and/or job types pursued post-residency, and patient population demographics. Future research might also consider comparing responses to similar questions from physicians who obtained their medical acupuncture license after graduating from residency.