Current Status of Licensing and Education for Acupuncturists in Japan
1. Licensing system
Only licensed physicians, licensed acupuncturists, and licensed moxibustionists may provide acupuncture and moxibustion treatment in Japan. The license of an acupuncturist or moxibustionist is specific to that person and to that field of practice. (Legislation No. 217, Article 1, 12 December, 1947)
2. Licensing requirements
Applicants must have graduated from an acupuncture and moxibustion school recognized by the Japanese Ministry for Health, Labor, and Welfare (MHLW) or from a university or college (or in the case of the visually impaired, from a school for the blind or a center for the visually impaired) recognized by the Ministry of Education, Culture, Sports, Science, and Technology. These graduates must also pass an examination by the MHLW.
3. Current status of the national examination
Although there was local qualifying examination conducted by each prefectural government, presently the national examination is given under the auspices of the MHLW, and is administered by the Foundation for Training and Licensing Examination in Amma Massage-Acupressure, Acupuncture, and Moxibustion. [Foundation for Training and Licensing Examination in Amma Massage-Acupressure, Acupuncture, and Moxibustion, http://www15.ocn.ne.jp/~ahaki/index.html ]
The first national examination was given in 1993, and examinations have been offered annually since then. The examination, which is given at 50 locations throughout Japan, consists of 160 multiple-choice questions. A score of 60% is required to pass.
The national examination does not include any practicum testing, which is left to the discretion of each school. A number of provisions are made to increase the fairness of this examination for visually impaired applicants, who are permitted the use of Braille and tape recordings, and who are allowed extra time to complete the examination (1.5 times longer than for sighted students). The ratio of sighted to visually impaired examinees is approximately 9:1.
The examination covers the following areas.
Topics for the acupuncturist examination (general medical treatment, sanitation, public health, related legislation, anatomy, physiology, general pathology, introduction to clinical medicine, particulars of clinical medicine, rehabilitation medicine, general theory of Eastern medicine, general theory of the meridians and acupuncture points, clinical theory in Eastern medicine, acupuncture theory).
Topics for the moxibustionist examination (general medical treatment, sanitation, public health, related legislation, anatomy, physiology, general pathology, introduction to clinical medicine, particulars of clinical medicine, rehabilitation medicine, general theory of Eastern medicine, general theory of the meridians and acupuncture points, clinical theory in Eastern medicine, moxibustion theory).
Recent pass rates are shown below (Table 1)
Table 1. Recent pass rates of national examination
||Pass rate (%)
4. Current status of education
In April 2009 there were 6 universities and 93 acupuncture schools for the sighted in Japan, of which 47 (2 universities and 45 private vocational schools) were members of the Japan College Association of Oriental Medicine and 48 were unaffiliated. In 1999 there were only 28 schools throughout Japan, but this number has increased since the system was reformed in 2000.
There are 69 schools in Japan for the visually impaired (1 university and 68 publicly funded schools for the blind or centers for the visually impaired), with approximately 300 students. These schools except university offer a 3-year program in preparation for the acupuncturist/moxibustionist examination, with the option of also studying simultaneously for the examination for Amma massage/shiatsu massage therapist. Students also have the option of enrolling in the program preparing for the Amma massage/shiatsu massage therapist examination only.
The schools for sighted students have an enrollment capacity of approximately 8000 students in programs preparing for the acupuncturist/moxibustionist examination.
Required courses and credits (hours) in the 3-year-course acupuncture school is shown in Table 2. Credits are calculated on the basis of specifications established for Japanese universities (1 lecture credit = 15 to 30 hours, 1 seminar credit = 30 to 45 hours, 1 practicum credit = 45 hours).
The current curriculum was expanded in 2004, and at the same time the credit system was introduced and the former lists of categories and detailed descriptions of course contents were eliminated. These changes were made in order to encourage original thinking, creativity, and independence in each school.
The Japan College Association of Oriental Medicine and the National Association of Presidents of Schools for the Blind are working together to develop educational guidelines, publish standard textbooks, standardize educational content, and maintain high standards of quality.
Table 2. Courses and credits in 3-year-course acupuncture school
|Basics of scientific thought, social studies
|Foundation for field-specific studies
|Structure and function of the human body (anatomy, physiology)
|Advances in disease prevention and recovery (pathology, sanitation, rehabilitation medicine, introduction to clinical medicine, particulars of clinical medicine)
|Philosophy of acupuncture and moxibustion in relation to health, medical treatment, and welfare (general medical treatment, related legislation)
|Acupuncture in society
|Practicum (including hands-on clinical experience)
(equivalent to approximately 2800 hours)
5. Current status of students and graduates
Two surveys were performed by the Japan College Association of Oriental Medicine. First survey was performed in 1998 and second survey in 2001
1) The ratio of women students rose in 2001 (male-female ratio 1.67:1, in comparison to 1.97:1 in 1998).
The most common age range for male students was 25 to 29 (61.4% in 2001, down from 72.8% in 1998). The ratio of male students was lower for all age groups in the 2001 survey. The most common age range for female students was 21 to 24 (43.1% in 2001, in comparison to 36.1% in 1998). The ratio of women also rose in the group 25 to 29 years of age (from 26.6% in 1998 to 30.9% in 2001), while decreasing in all other age brackets. The largest number of students was in the group 25 to 29 years of age, with the largest number of men in their late 20s and the largest number of women in their early 20s. Mean age of students was 32.9 years in the second study, nearly the same as the first study (32.6).
2) The 2001 survey showed 84.5% of graduates practicing professionally, nearly the same as the 1998 study (84.2%).
A higher percentage of male graduates (87.3%) were in professional practice than their female counterparts (80.4%). The most common age group represented was 40 to 44 years of age (87.2%).
Graduates not in professional practice accounted for 14.7% of the total, down slightly from the first survey (15.1%). A major change was noted in working circumstances. Considerably more graduates were running their own practice in 2001 (32.4%) than in 1998 (21.4%). Those working alone accounted for 71.5% of the total in 2001, down from 86% in 1998, while the percentage with 1 employee rose from 5.6% in 1998 to 12.3% in 2001. The average number of patients treated per day by self-employed practitioners was 9.6, down from 11.1 patients per day in 1998.
Graduates who were employed by a clinic or hospital accounted for 30.4% of the total, up significantly from 19.4% in 1998. A total of 27.8% worked in acupuncture-related treatment clinics, up from 18.9% in 1998. Those employed in a treatment facility with a judo-orthopedist numbered 27.7%, up from 18.9% in 1998.
Employed acupuncturists saw on average 16.1 patients per day in 2001, down from 18.6 patients per day in 1998. Thus there was a clear trend toward seeing fewer patients per day, both for those acupuncturists in private practice and for those employed in hospitals and clinics. Although detailed information was not available on the exact nature of responsibilities for the acupuncturists working in these medical institutions, it seems quite possible that this trend may continue.
3) A survey of earnings or salary showed an average monthly income of USD 1650 (JYN 201,000) in 2001, about the same as findings of USD1700 (JYN 204,000) in 1998.
Even considering the fact that many of these practitioners only graduated 1 to 5 years ago, and are still learning their art, at an average age of 32.9 years, this monthly income is still quite low. There is a clear need for effective measures to address problems with national health insurance coverage, and to take advantage of the current booming interest in health care, healing, and alternative medicine.
4) Conditions of patients who came for acupuncture treatments are summarized in Table 3.
Back pain was the most common complaint, followed by shoulder stiffness, knee joint problems, leg pain, shoulder joint problems, cervicobrachial syndrome, indefinite complaints and symptoms of autonomic imbalance, general health maintenance, headache, sports injuries, and obstetric-gynecological conditions. There was little change between the two surveys except for the increase in indefinite complaints and symptoms of autonomic imbalance.
5) Membership in professional associations was low, both for academic organizations (19.6%) and business-related groups (21.3%).
Table 3. Conditions of patients who came for acupuncture treatment (%)
|Knee joint problems
|Shoulder joint problems
|Indefinite complaints and symptoms of autonomic imbalance
|General health maintenance
6. Number of licensed practitioners and number in actual practice
After passing the national examination, acupuncturists must register with the MHLW in order to apply for a license. As of April 2005, the MHLW rolls showed 127,110 registered acupuncturists and 125,960 registered moxibustionists in Japan. However, these numbers are considerably inflated because of overlap from the earlier system of local (prefectural) registration, and because not all deaths have been recorded. A survey by the MHLW indicates that there are approximately 75,000 acupuncturists and moxibustionists working in Japan today. However, it is likely that this figure is also inaccurate. The actual number of working practitioners is probably closer to 40,000.
7. Acupuncture in relation to Social Security policies
Acupuncture is almost never covered by health insurance, but instead is considered as discretionary treatment. The cost varies considerably by region and practitioner, but is generally in the range of USD 26 (JPY 2,500) to USD 63 (JPY 6,000) per session. The market is considered to be approximately USD 2.1 (JPY 200) billion per year.
Some acupuncture care is eligible for payment under the present National Health Insurance system, but this accounts for only USD 105 million (JPY 10 billion).[The JPY/USD exchange rate on May 2009 is approximately 95.]