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Doctor of Acupuncture and Oriental Medicine: A Decade in the Making

by Jack Miller, L.Ac., M.A. (Ed.), President of Pacific College of Oriental Medicine

In April 1990, Robert Duggan and Rick Feit presented to the National Council of Acupuncture Schools and Colleges (now the Council of Colleges of Acupuncture and Oriental Medicine) its first report on the doctoral degree. In the report’s November 1990 update, the Council considered 11 statements and extensive elaboration. The following are the 11 summary statements:

1. The field of traditional Oriental medicine has a sufficient body of knowledge and level of skill beyond the master’s level to justify awarding a doctoral degree.
2. Master’s-level training does not represent the highest possible level of formal education and training in the field.
3. The recognition of the need for doctoral programs does not imply that the patients of master’s-level graduates are receiving a secondary level of service.
4. Doctoral training is distinct from continuing education.
5. The awarding of the doctorate represents acknowledgment of mastery, as well as significant contribution to the profession’s knowledge, understanding, and training. It also represents effective communication to the culture and the public.
6. Doctoral training follows upon the Master’s-level programs in acupuncture and Oriental medicine.
7. Doctoral programs will vary in detail from institution to institution, depending on the specific interests and objectives of the school.
8. Doctoral training is interdisciplinary in scope and specialized in focus.
9. The awarding of the doctorate is based upon generally accepted standards of written and oral demonstration of mastery.
10. Doctorate must be conferred by institutions, at the recommendation of individuals recognized and credentialed, as having at least the level of training required of the doctoral candidates whom they assess.
11. Institutions granting doctorates must be approved to do so by the appropriate licensing and regulatory agencies.

After ten years, it is remarkable how closely the final proposal reflects the intention expressed by each of these statements. It makes one wonder what took so long for the profession to reach consensus on its doctoral standards. While these statements accurately predicted the eventual standards, the original report was much less prescient in its proposed timeline for implementation:

• Summer, 1990 – First draft of doctoral program guidelines from initial Council discussions
• October, 1990 – Discussion of first draft of doctoral program guidelines. Circulation of recommendations to faculty and outside consultants
• February, 1991 – Drafting of core doctoral curriculum
• April, 1991 – Formal acceptance of doctoral program guidelines by Council member schools. Formal request to National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine (now, Accreditation Commission for Acupuncture and Oriental Medicine) to expand its scope to include doctoral programs
• Summer, 1991 – Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) submits proposal to expand its scope to include doctoral programs
• Spring, 1992 – Department of Education acts on ACAOM proposal for change of scope

At the Fall 1990 meeting, the Council impaneled its Doctoral Committee to consider the Duggan and Feit report and to construct standards and criteria that could be presented to the full Council for approval. As a relatively new and certainly naïve member of the Council, I volunteered to chair the Committee. From the beginning, one of the most difficult conceptual challenges was distinguishing the doctorate from master’s programs and thereby justifying its existence. ACAOM believed that the Department of Education would require this. Would the doctorate simply be more of the same or would there be qualitative difference in the doctorate’s educational outcomes? At the committee’s first meeting in March of 1991, Paul Karsten, Rick Feit, Michael Zeng, Norman Bleicher, and I grappled with such dichotomies as Master’s level “competence” versus doctoral level “expertise” as distinguishing features. We considered the various reasons why the profession needed doctors, e.g., to raise the level of teaching, research, and specialization. We asked whether the colleges should offer a clinically based, professional doctorate, an academic doctorate or both.

The initial report of the Doctoral Committee contained the following recommendations:

1. The Council schools should focus their attention on a clinically-based Doctor of Oriental Medicine (D.O.M.) rather than Ph.D. programs.
2. The Council schools would not offer a separate Doctor of Acupuncture degree.
3. The curriculum of the doctorate would ensure a graduate possessed expertise in acupuncture, diagnosis, clinical skills, and medical referral and competence in herbology, orthopedic evaluation, counseling, physiotherapy, nutrition, research, and treatment of chemical dependency.

The committee presented these and other recommendations at a public session of the Council’s Spring 1991 meeting. The college members expressed concern about the inability to award a Doctor of Acupuncture degree, the level of herbal knowledge required, and the specificity of some of the curriculum areas, particularly orthopedics and chemical dependency. The Doctoral Committee was directed to solicit further input on these issues.

Following debate and consideration, the committee decided that there was no legitimate academic, professional, or public health issue that should prevent the awarding of a Doctor of Acupuncture degree following its corresponding master’s. There is a sufficient body of knowledge in the field of acupuncture alone to justify advanced study leading to a degree. Thus, the Doctoral Committee suggested that the herbology requirement for students in the Doctor of Acupuncture programs could be limited, at the discretion of the program, to that which is necessary for referral to the appropriate practitioner.

From the end of 1991, the Doctoral Committee’s proposal was widely circulated to members of the profession. The Council took public comment in writing through the winter of 1992 and oral testimony at its Spring 1992 meeting in Fort Lauderdale. Concerns expressed by licensed practitioners included the availability of doctoral programs in remote areas and the ways in which practitioners without master’s degrees could meet the entrance requirements of the doctorate. Some practitioners thought there should be a way to earn the doctorate through assessment of experience.

The Committee seriously considered these concerns and subsequently designed prerequisite standards that would allow current practitioners without master’s degrees to demonstrate master’s equivalency through challenge examinations sufficient to allow them to enter the doctoral programs. Additionally, the current standards allow for just under one-half of the program to be delivered by distance education. It is the hope of the colleges that this will allow practitioners to complete doctoral studies without unreasonable inconvenience, however, all students should recognize that advanced study, almost by definition, involves some inconvenience.

In subsequent meetings, the committee and Council set about creating more specific curriculum content and criteria for faculty, library, and institutional infrastructure. While the colleges, with input from the community, refined and attempted to finalize the doctoral standards, the profession as a whole engaged in a debate over the role of the doctorate in the profession. The central questions were whether the doctorate should become the entry-level degree for licensure and whether there should be two doctorates, i.e., acupuncture and Oriental medicine, or just one in Oriental medicine. At this point, the standards maintain the master’s degree as entry-level to licensure. However, at its November 1996 meeting in Palm Beach, the Council decided to temporarily suspend work on standards for a doctorate in acupuncture in hopes of expediting the approval of the doctorate in Oriental medicine. The Council has recently convened a separate committee to establish standards for the acupuncture degree.

At a special meeting in Albuquerque in 1993, the Council approved for the first time a draft of its doctoral standards for submission to ACAOM. In response, to that draft, in November 1993 ACAOM asked the Council for the following:

1. More justification for the need for a postgraduate doctoral degree
2. Specific differences in competencies between the master’s level and the doctorate
3. Whether the doctorate would require specialization
4. What types of institutions would be able to offer the degree
5. What the impact of allowing assessment of prior learning for senior
practitioners would be on the degree’s credibility
6. Better definition of the biomedical
curriculum
7. Clarification of the Chinese language requirement
8. Whether there should be a specific number of clinical hours prescribed
9. Whether it was realistic to require a majority of faculty to possess doctorates during the early stages of offering the degree.

For the next three years, the Council considered the above issues. While that seems like a long time and at times it seemed like an eternity, the Council meets just twice a year, so progress can be slow, even with non-controversial issues. The doctorate has never been non-controversial. Nonetheless, in 1997, the Council submitted yet another “final” draft of its doctoral standards to ACAOM. This time ACAOM voted to begin work on developing accreditation standards. It established a task force with members from the two professional associations, the Council of Colleges, and ACAOM. The task force met three times. During the same period ACAOM facilitated community-wide, public hearings about the doctorate. Comments from the public and task force were considered as ACAOM created accreditation standards from the base of the Council’s original proposal. I am happy to say that after a decade of work, ACAOM is ready to consider applications from schools describing their plans for a doctorate of acupuncture and Oriental medicine.

Pacific hopes to be at the forefront of this exciting new development in the field. The college hired Tom Haines, Ph.D. and Gordon Saxe, M.D., Ph.D. to direct and finalize what has been an ongoing discussion of the faculty of Pacific College. Our proposed doctoral curriculum maintains the Chinese language component that was minimized in the final ACAOM standards. It presents specialization in integrative medicine as well as the classical approach to Chinese medicine. We also recognize the need for quality research in our profession if we are to meet the challenge of full acceptance in our culture. Pacific’s doctoral graduates would be ready to meet that challenge.

Please note that as of this writing no doctoral program, including Pacific’s, has been approved by ACAOM. None of the articles pertaining to the doctorate in this issue of Oriental Medicine is intended to solicit applications to the degree program. Rather, they are intended to inform the community of this exciting new phase in our professional development. Since any curriculum is continuously evolving, if you have any feedback on what type of doctoral level training would best serve your needs, please let us know at Pacific College.