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Physical therapists are at odds with acupuncturists over an Oregon bill that Gov. Tina Kotek said she may veto this week.
The legislation, sponsored by Rep. Kim Wallen and passed with bipartisan support, would expand the scope of work physical therapists are allowed to perform under Oregon law. But the specific provision Kotek’s staff says she is scrutinizing—and which has drawn scores of often-critical public comments—concerns a particular acupuncture-like therapy.
It’s called “dry needling,” and a core question in the fight over House Bill 3824 is exactly how acupuncture-like it is. Many Oregon physical therapists want to be allowed to use the technique as a non-pharmacological treatment for pain and to facilitate movement, just as their colleagues are already permitted to do in the vast majority of U.S. states.
Acupuncturists, who like PTs have long fought for respect and legitimacy from the medical establishment, say they welcome such needle-driven interventions—which they see as a primitive form of acupuncture—but only as long as those who perform them meet training standards comparable to those required of Oregon acupuncturists.
Instead, licensed acupuncturists like Danielle Reghi say their input has been ignored and their profession disrespected as proponents of the bill argue that the therapy dubbed “dry needling” is not acupuncture and thus not subject to equivalent state requirements.
“They’re using the same needles. They’re placing them into the same points. They’re creating a physiological response that has to do with pain management and rectifying dysfunction, which is acupuncture, and they’re saying, ‘This isn’t acupuncture,’” said Reghi, a board member with the Oregon Acupuncture Society. “You can say whatever you want. It’s fucking accupuncture.”
Scope of practice debates on this and other issues are nothing new, including in Oregon. Just a few years ago, chiropractors waged, and lost, a similar fight to be able to practice dry needling.
Before he came to Oregon, physical therapist Justin Dunaway saw a similar debate play out in Arizona. State by state, he said, the acupuncture community always makes the same arguments—this is about training and safety—which he doubts should be taken at face value.
Physical therapists get the bulk of the necessary education for dry needling in school, he said, and can fill in the rest through subsequent continuing education courses. Plus, he said, the fact that 39 states now affirmatively let PTs do dry needling—and still more are silent on the issue —means that if there were a real safety or training issue, it would have emerged by now.
Dunaway said the core acupuncturist arguments against the Oregon bill mask what is really going on here: legislative gatekeeping in order to maintain market share.
Still, he added, history shows this effort to keep out competitors would itself be misguided. “It’s not that when a physical therapist dry needles, all the acupuncturists in town go out of business,” he said, adding that patients seek out providers that align with their beliefs. “At the end of the day, the philosophy between the two professions is wildly different.”
Reghi said she is all for more people practicing acupuncture. She was drawn to the field in part for the same reason some physical therapists advocate for dry needling: She wanted to help people manage pain without the addiction risks tied to pharmaceutical painkillers.
Her and her colleagues’ concern, she said, is that with insufficient required training, under-qualified PTs will effectively be practicing bad acupuncture, which is not only unfair to those who have devoted significant time and resources toward mastering the practice, but could also endanger patients and tarnish her profession’s hard-won image in places like Oregon, where alternative medicine has uncommon sway. She pointed at research which she said suggested dry needling at the hands of physical therapists resulted in a higher rate of adverse events than similar therapies performed by licensed acupuncturists. In bad cases, she said, a misplaced needle can stick through an organ like a lung.
“Patients deserve to be able to walk into a provider’s office and have confidence that this provider has proper training,” Reghi said in a follow-up email, adding that, among other things, providers who wish to perform dry needling in Oregon should receive at least 300 hours of needle based training, with a proper board exam to test for competency and safety. “Anything less than that is unacceptable.”
The question of whether the acupuncture profession’s concerns are legitimate or self-interested now rests with the governor. Kotek and her staff are “working to better understand the training and safety requirements for dry needling to inform her final decision,” said a staffer by email this week. The governor has until Friday to issue her decision.