2010: Making Media and Culture

I don’t want to distract any attention from the conversation going on below, but I’ve only got 2 more days to finish this 2010 retrospective on the CAN blog, before we’re into 2011 and retrospectives start to look a little silly. So! Not only was this past year full of fascinating interactions with the acu-establishment, but it was a great year for making media.

I don’t mean being IN the media. We’ve had better years for that, for instance, I’ll take our Marketplace story over the New York Times one any day. I mean making our own communication materials that help establish and reinforce our own culture. This year WCA made and posted a video of Dr. Michael Smith’s talk at last year’s CAN Board meeting;  Jessica of the Turning Point and Jackie Cutler of Media Awakenings created the fabulous CAN video; Andy and Manchester Acupuncture Studio produced their splendid book, Why Did You Put That Needle There — complete with a free AUDIO download version; and Brian Lindstrom, an honest-to-God award-winning filmmaker, started work on the CAN documentary.  And so many of you comrades kept buying (and selling) the Noodles book that WCA was able to contribute $2000 towards the filming of the Philadelphia segment of the documentary.

It’s starting to seem like a long, long time ago that I used to lie awake at night and despair of ever being able to explain to anybody what this was all about.

It’s easy to underestimate the value of materials like books and videos and films and blogs once you have them; it’s easy to take them for granted. But they are building blocks for the movement, and looking back, it’s amazing how they build on each other. The first real means of communication our movement had was the original Little Red Book, basically a zine, written by me and Skip in a burst of frustration after reading this article. We copied them at Kinko’s and I used to go to the post office and mail them out one at a time; I couldn’t wait until I got a bunch of them because I was just so excited about each individual order. The Little Red Book led, indirectly, to the articles in Acupuncture Today; I figured if I could write this zine-like thing in a few weeks, I could write a 1,000 word article every other month. The articles in Acupuncture Today led to the idea of CAN and the CAN website, which led to the CAN blog (that was entirely Skip’s idea, by the way). The more stuff we made, the more it became clear what pieces were missing, and  dedicated comrades stepped up to create what we needed. And then they shared them! The CAN video is free for anyone who practices community acupuncture to put on their website so that patients know what to expect. $1 of every sale from Why Did You Put That Needle There goes to CAN. The agreement that CAN has with Brian Lindstrom is that half of all sales of the completed documentary DVD will also go to CAN — which will, of course, help us create the next round of media.

Media supports culture. Community acupuncture as a movement, without its distinctive culture, would mostly be about the business model, and that isn’t enough. Obviously the business model is important when you are talking about the difference between acupuncturists being able to make a living by being acupuncturists, as opposed to barely working at all and having to support themselves with other non-acupuncture employment. And the business model is what provides the reality of acupuncture, as opposed to the idea of acupuncture, to our tens of thousands of patients (we might be getting towards hundreds of thousands of patients at this point). But what always mattered the most to me about the business model was the vision of it being implemented widely, which would mean — as Jade wrote — that acupuncture could truly become a common everyday thing in our communities. And for the business model to be implemented widely would require the support of a culture which was radically different than anything that existed in the acupuncture world at the time that I was lying awake and fretting about how to communicate the vision.

We needed a culture that promoted transparency, simplicity, and sharing. We needed a culture that was charged with passion and enthusiasm and a willingness to try stuff out; in which acupuncturists were genuinely free to celebrate each others’ successes and cheer each other on and learn from each others’ mistakes.  We needed a culture that FELT completely different from the professional culture we had. Because culture isn’t just about concepts and conversation; it can make things happen, or prevent them from happening.

And lo, we got the culture we needed. This makes me teary, comrades. I wanted this so badly and I had no reason to believe it could actually happen and yet here you all are. Thanks to you, I live in an entirely different world than I did when we wrote the first Little Red Book.

So that’s mostly what I wanted to say when I was originally thinking about this post last week, but now I have an addendum based on the conversation that happened as a result of Larry’s post. An idea occurred to me.

I can still remember, without having to go back and look it up, the first sentence of the original Little Red Book. It was, “There have always been a lot of different ways to practice acupuncture.” I guess it’s easy to remember because I still believe that’s one of the most important things about acupuncture — that there is no one right way to do it.

As you all know, because I keep talking about it, one of the other big things going on in my life is what’s happening with my church. We are grappling with the changes in the Catholic church as a whole and with what that means on the ground for our beloved, 100-year-old, working class, mind-bogglingly multicultural little parish.  Obviously we are not the only parish or faith community that has to come to terms with these forces. There is an idea which is being talked about and written about extensively among Catholics, that a church is not simply a community but “a community of communities”. This is important because it suggests, among other things, that a strong and healthy church is not based on uniformity, a.k.a. people of color having to assimilate to the dominant white culture. Here is a really good article about it, written by a Mexican American priest, “When Worlds Collide”.  It includes a short, clear, non-academic definition of “culture”, which I found helpful to read after wading through the discussion that followed Larry’s post. For another perspective on the idea of “a community of communities” here’s an article written by a Dutch priest about working to expand it into an inter-faith context, in a wildly diverse district of the Hague.

So I was thinking of these things when I read Michael Jabbour’s comment:

“In my view there are only LAcs. It is unfortunate that our community has
become so fractioned and communications have become so
difficult/intolerable that we have to classify ourselves as CAN-LAcs,
NADA-LAcs, Biomed LAcs, etc.
It is important that we work together to elevate the discussion and
re-establish a value system and professional infrastructure among those
that care that we can pass on to the next generation of practitioners.
It is not sustainable for any of us or beneficial to our patients to
pass on the 3 decades of in-fighting regarding educational and practice
model disagreements. Let’s find a consensus-building path and expand our
views on what we think is professionally possible, regardless of how
long it will take or what it looks like.
Our profession has gone through enough radical changes in the last 20
years, the lack of stability seems completely reasonable to me.
Regardless, I think it is completely possible for us to influence each
other globally as practitioners and find stability if we are able to
engage each other in an independent and publicly accessible discussion
group and stay in that room long enough to build respect for each
other’s humanity and professional achievements.
I would gladly welcome additional moderators to the AOM Community Forum
if you feel that is what is preventing contributors from joining.
Additionally, ACAOM is looking for commissioners, AAAOM is looking for
new directors, and state associations across the country are looking for
volunteers. The profession needs new leadership to take over and build
the future. Too few are willing to put in the time or energy to do the
work that makes our profession possible and everyone is willing to
complain ad nauseam, let’s change that together.
As I have mentioned before publicly many times, it doesn’t matter to me
which alphabetical configuration we use for our professional association
but we need to support and build one that will advance and protect our
profession (thereby our patients) according to the basic values and
structural considerations we can all agree on.
We need people who can moderate difficult discussions and hold people
accountable without excluding, censoring, or demeaning. Feel free to get
in touch with me privately if you or others have alternative ideas of
how we can dialogue with each other about controversial issues and
professional futures.”

What if it’s NOT unfortunate that acupuncturists classify themselves as CAN-L.Acs, NADA L.Acs, Biomed L.Acs, AAAOM L.Acs, Tai Sophia L.Acs, or whatever else? What if that weren’t a problem? Maybe that’s just what diversity looks like, and is not surprising given the extremely diverse evolution of acupuncture itself; maybe we can’t build consensus around the things that other professions build consensus around.  But maybe we could still find a way to become “a community of communities”.

So one thing I know is that the AAAOM would very much like to become a kind of umbrella organization, and count CAN and our 1,000 or so members under its umbrella. That makes sense. But clearly, it’s not going to happen. The cultural issues are a deal-breaker. Even though everyone in the discussion on Larry’s post was speaking English, we still don’t speak the same language. I am going to suggest that the AAAOM might contemplate what it would look like for it to become, not the one and only representative of the profession, THE organization for acupuncturists, but a community of communities.

There are, after all, a few things that CAN L.Acs and AAAOM L.Acs actually both need, and benefit from. I wracked my brains and I could think of exactly 3. 

1) Independent licensure. I don’t care about MDs or DCs or anyone else doing acupuncture, but I do care that people should not have to become MDs or DCs or whatever else IN ORDER to do acupuncture.

2) Access to safe, sterile, affordable needles. Nuff said.

3) Infrastructure. More on that in a minute.

It’s important to acknowledge that most of what the AAAOM has currently and historically worked towards has little or nothing to do with what CAN needs. Insurance coverage? Insurance parity? The vast majority of our patients are never going to have insurance that covers acupuncture. Access to herbs? Important to some of us within CAN but not really necessary to a lot of others. Acknowledgement from MDs and the biomedical establishment? For what purpose? Access to patients? WCA gets tons of referrals from MDs and RNs and even hospital social workers. I got a fax the other day that I saved just because I thought it was so funny; it was a prescription for 8 acupuncture visits from a physician I’ve never met for a person who is not yet a patient at WCA. A prescription — it’s like they’ve figured out that we are like a low cost pharmacy, and so they send their patients to us for something they want their patients to have. I’m happy for WCA to be a low cost pharmacy. Respect from MDs leading to jobs in hospitals? We don’t want to work in hospitals, we want to work in our own communities, keeping people OUT of hospitals. And we can create our own jobs, thanks. So far, AAAOM, you’re not giving us much incentive to have a relationship with you. What exactly would we get out of it?

Ah, let’s talk about infrastructure. The needles and the laws are by and large non-issues for all of us at this point, but the infrastructure isn’t.

Infrastructure is part of what makes my church hold together as a “community of communities”. All of us Catholics who live in the Cully neighborhood need some of the same things, as Catholics. We need a place to celebrate the sacraments; we need a priest celebrant; we need the administrative staff and the infrastructure that allows us to be a church — to keep the lights on, make coffee after Mass, to teach the kids our faith, to organize the volunteers and the donations to feed the people in our parish who need food, and pay their utility bills when they can’t, and visit them in hospitals and nursing homes. And we all get it, that there are not enough European-American/white Catholics in Cully to do that alone; there are not enough African American Catholics in Cully to do it alone; not enough Eritrean Catholics, not enough Micronesian Catholics, not enough Hispanic and Latino Catholics, not enough Liberian Catholics, not enough Vietnamese Catholics — you get the picture and so do we. We need each other. Because infrastructure is expensive and none of us have any money to speak of. This is very different from an academic understanding of cultural competence, by the way; this is about depending on each other. 

The equivalent infrastructure in the acupuncture world is made up of the NCCAOM, and the ACAOM, and the schools. I get that it was a big deal to create that infrastructure and that it’s expensive to maintain, and I get that plenty of people in the acupuncture establishment are mad that CAN isn’t grateful for it. The problem, of course, is that nothing about the infrastructure meets our needs. We don’t want to help support it or maintain it, give it money or volunteer energy, because it doesn’t do us any good. That could change, of course, if the people whom the infrastructure DOES benefit decided that it was worth it to them to adapt it enough so that it did serve us, and so that we would be willing to pitch in. The alternative for us, obviously, is to create our own infrastructure, which is expensive and labor intensive and time consuming. We can do it if we have to, of course — just like you in the establishment did.

That’s one big thing that CAN would need to participate in a community of communities with the AAAOM: some tangible, practical benefits. Another thing, even bigger, would be a structure in which we were not being asked to give up our culture, our ways of doing things and of communicating, as a condition for participating. We worked hard for our culture; we’re not interested in assimilating. This post is too long already, so I won’t go into more details. I’m just curious whether this idea of a community of communities for acupuncturists has any resonance with anyone. Thoughts?

Author: lisafer

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


  1. Quick Update on sales of ‘Needles’

    Not including sales in our clinic here in Manchester, or copies purchased directly from Amazon.com, we’ve sold 1000+ copies to other clinics (CA and private-roomers) since April.

    Feedback from practitioners and patients over the US, Canada & Australia has been very positive.


  2. Thanks!!

    Finaly some sense!  And to think some people call you devisive!

    CAN is a community and one that I belong too.  AAAOM has its goals for what acupuncture should look like.  Tai Sophia has its own.  These are the 3 that I have been exposed to and I am sure there are others.

    What a different world we would be in if the infrastructure aspects of the proffession were more flexible.  Not sure how all the details would work out but clearly the different groups have different needs and some are not being met. Needs not being met often translates into ANGER!

    This is like voter apathy.  Our professional organizations need
    participation to flourish.  To get that participation they need to reach
    out to those that have been ignored.  If they dont they will continue
    to crumble. 

     CAN has time on our side though.  We are growing faster and treating more people than anybody else.  We will get what we need eventually!



  3. I like this a lot —

    It makes a ton of sense to me.  It explains why I feel like I keep having the same conversations over and over again — because there are too many different cultures with too many different priorities, and what helps one community does not help, and may hurt, others.  And yet, each group has been convinced that, if they got what they wanted, it would fix everything.

    I did wonder, while reading, so, if AAAOM wanted to focus on the things that would serve all the communities what would that be, and it is hard to get much beyond the three Lisa refers to.  I did think, well, getting licensure in those states that don’t have it.  But, even then, I’m not sure — it seems that some here prefer no licensure because with it comes the authorities determining what you have to know and what tests you need to take.  Even public education — well, what CANners would want to say about acupuncture would probably be very different from what a lot of non-CAN practitioners would want to say.

    I suppose one bit of common ground is that distinction between what the practitioners need — and how that matches/or doesn’t  — what the other alphabets would like.  That distinction has been lost in the shuffle for far too long.  A group that would be very clear that it served the providers of acupuncture, which might encompass various different groups — instead of serving the educators or regulators, etc., would be a good thing.

    One thought that also came up — perhaps CAN is so full of enthusiasm and zest and cameraderie partially because it is still so young.  Don’t get me wrong, it is great and I love it — and I remember 18 years ago, when I was a student, the love that was shared, the enthusiasm — it was still us against the world, we were going to change the world, revolutionize health care, the whole bit.  It is only now that we’re older that we’re bitter and burned out and have history we carry around.  I don’t mean it in a “just you wait sonny” finger-pointing sort of way.  Just thinking that perhaps the community of communities idea would work especially well so that, if an issue does arise that brings about a split, instead of making it a battle with a winner and loser. it could be, okay, we need a new community in the fold.

     Once again, I’m floored, Lisa.  Now that you’ve said it, it seems obvious.  Whatever enables you to see ways to fix what is broken — I want some.


  4. The reason about the fight below…

    is clear that the commitments to our profession are so different at this point in time.  Will Morris feels no need to apologize for his opinion and neither does Larry; it’s like the unmoveable force meeting the unstoppable force (this is written in a non-offensive tone).

    What seems apparent is that none of the respective alphabet groups (including CAN) being discussed has any common ground for “real” dialogue at this point.  More importantly, as you said in a different way, there is no incentive for common ground except that creating all types of different infrastructures is expensive.  It would be cheaper to find the common talking points that address the infrastructure issue.  

    The problem with the infrastructure issue is that the acupuncture establishment wants legitimacy in terms of 3rd party payor reimbursement and they want a FPD to replace what I consider to be too much educational barriers to access acupuncture.

    And so we go round in circle.  The FPD was only tabled, not thrown out.  It will come round again.  The schools want that money and they think themselves justified in getting it.  They don’t want a simplified, streamlined education for practicing acupuncture with a more graduated structure.  By more graduated I mean that some acupuncturists may want to take a more academic route by seeking more education; but others will just want to be practitioners with large volume practices that are reasonably priced to reach 70% of the population.

    The acupuncture establishment thinks that barriers to access will be broken through the insurance companies.  CAN is not waiting for that. 

    As I write this I had one somewhat original thought.  One area in which we can “all get along” lies in working towards improving the employment arena.  There are a number of us business owners who would like to offer full employment to other acupuncturists but there seems to be lots of barriers to finding acupuncturists to fill those positions.  We have discussed this ad nauseum but I think it’s useful to put this out in the non-restricted forum.

    This is all rolled into expectations for employment, costs of education (the higher it costs the more you expect in employment compensation) and the fact that owning a business has caused many acupuncturists to fail at this profession. 

    How can we address this issue?????  

    Another common ground perhaps is the recognition that most acupuncturists never really become acupuncturists.  Can we agree that is because 70% of the population would never seek acupuncture due to cost barriers and the fact that there are so few acupuncturists out in the world???  To me that means the system currently in place to educate and subsequently employ acupuncturists does not function properly.

    Tess Bois (formerly McGinn)

    One World Community Acupuncture

    Fitchburg, MA

  5. yep – the issue of emplyment that you bring up is tied up intimately with the schools, as they are the ones that claim to train us for emplyment and (supposedly) working as acupuncturists. as it has been mentioned  on CAN many times, many of us find that schools are doing a lousy job with this. plus many acupuncture school students do not go to school with a strong purpose of coming out as a worker in the field, as someone who is trained to work hard to use acupuncture to help many people. CAN’s conflict with the schools is not necessarily about how much schooling people are required to go through but the content and cost of that schooling and the fact that acupuncture education industry is not being held accountable for the fact that they make money by teaching a practice model (boutique / expensive treatments) and a practice mind-set and culture (appeals mainly to upper-middle class) that is obviously not possible for most to utilize to serve the majorilty of population. look at all the community acupuncture clinics here on CAN that want to hire and cannot find a qualified practtitioner. acupuncture employment situation will change when acupuncture training will become more practical and realistic.

  6. more culture!

    lisa – awesome post – it is impressive to see all that media stuff listed together

    a few other exciting media / culture things i want to mention: our newsletter, The CAN Opener and CAN Facebook group (741 members), as well as the Opposition to FPD Facebook Group (1051 members). all these are part of our culture development through media.

    and! i want to add that fashion is definitely part of our culture 🙂 and in 2010 CAN has outfitted its members and friends in over 50 CAN shirts – that’s over 50 folks out there parading the CAN logo for everyone to see! we also have a new forum for folks to exchange their clinic shirts and a whole trend (see, that’s culture!) of punks wearing various community clinic shirts while they treat patients in their own clinics (as opposed to those stiff white coats or the fancy “oriental-ish” garb, which obviously represent an entirely different culture).

    last month we also began a fundarising campaign for the documentary that distributes CAN buttons and have already distributed over 50 of those as well (did you get yours?) more fashion culture on display!


  7. Worker Owned Cooperatives

    How many CA businesses out there are managing the business as a worker-owned cooperative? The UN defines a cooperative as an autonomous “voluntary association of people who unite to meet common economic, social and cultural needs and aspirations, through a jointly owned and democratically controlled enterprise.  In general, they contribute to socio-economic development.” Sound familiar?

    As a student of acupuncture who would like to earn a living in my field and be doing work I believe in politically, the community acupuncture model makes sense. However, working for $20 -25 an hour for a CA business owner does not make sense. How many CA clinics out there bring new hires into the financial fold as equal partners? 

    Yes, experience is experience and new graduates do not have it. However, we have fresh eyes and a lot of energy to put into our practice. We are not burnt out. In a worker-owned cooperative model (which there are many styles) the overarching theme is that each person brings something that is equally important to the business. Easier said than done, but not impossible.  

    Taking it one step further, are there any CA models out there that have pooled the collective student debt of the business and added it to the bottom line? Not in theory, but in practice. With the Income Based Repayment (IBR) plan the US government has instituted, the collective debt (for example) might mean the business pays $150 or less monthly for each employee.  Sharing the burden of debt and responsibility saves mental space, time, and adds value to the business.  Why? Because when workers feel taken care of, supported, valued, and financially rewarded the community is stronger. 

    An infrastructure that supports those things is what I would like to see instituted.  As far as I have observed on CAN, in school, and among BA acupuncturists we are an opinionated gaggle of minds. Why change a personality trait? Rather, do something more difficult: run a socialist democratic cooperative where everyone gets one vote and is rewarded exponentially with community, paid bills, and a thriving practice. Again, easier said than done, but not impossible. 


  8. My mind is whirling

    …has been since I read this yesterday.  Thanks so much Lisa; these two retrospective posts have been great, but while the last one made me feel sort of tired just reading it, this one also leaves me teary, as well as grateful and hopeful.  It’s very moving to me how generous you WCAers have been since the beginning (I can still remember what a lifeline that first LRB was!) and also how so many folks have so generously pitched in to co-create CAN’s culture.

    Looking at how much CANers have created in terms of cultural artifacts—no, let’s call them “tools”—makes it that much funnier to think about Will Morris’ obsession with our mission statement, posting policy, bylaws etc.  It seemed (and I may be wrong, because despite what he said below I’m not sure I “get” his way of thinking at all) that he wanted very detailed, traditional documentation, that would precede and prescribe any act or statement that came afterwards.  He doesn’t seem to get that part of our culture is to build the road as we travel, together, with thought and action, words and deeds, constantly informing each other.  Indeed, not only do we DO an awful lot (first and foremost open a lot of clinics and treat a lot of people), but as you demonstrate we’ve created a ton of documentation.  But apparently blogs don’t count; self-published books and zines and self-produced videos don’t count; forums and websites don’t count; – perhaps relationships don’t count, or not as much as institutions (especially that sacred chimera, The Profession).
    Speaking of relationships, I loved your links, especially the “When Worlds Collide” interview.  The bit about “egocentric” vs. “sociocentric” cultures felt like a neat summary of the cultural differences between the mainstream U.S. acupuncture institution culture and the culture CAN has been creating.  (If I am allowed one more dig at Will Morris, Father Riebe-Estrella’s discussion of the ways different cultures conceive of and value time was so much more astute and helpful than Morris’ sweeping statements–e.g. “Time is important in some cultures and not others”–in his AT article.)  I also was struck by Riebe-Estrella’s thoughts about the perceived “aggressiveness” of U.S.-born Latinos, especially this: “This is our church as much as anybody else’s, and therefore we tend to stand up for ourselves more, which is not usually appreciated by church authorities.”  Indeed.
    It would be nifty if folks from the mainstream institutions read your post and were inspired to make sincere efforts to be more practically helpful to CAN members and CA patients (instead of just trying to bring us into the fold); I’m not holding my breath, but who knows what the future holds.  In the meantime: onward to 2011!

    (P.S. to Tatyana–you know I love the “fashion is part of culture” point!  Well put!  And Andy–1000+ copies! that is so awesome!  People just love that book.)

  9. great post

    Hi Lisa, great post. I see 5 distinct ideas in your post and the comments so far, just wanted to share my thoughts. Feel free to slice and dice. 1. Community of Communities, Independence, and infrastructure:  Yes. This is what the future of the AAAOM is likely to become. Our mission is to be a unifying force for acupuncturists. For me, we just need to come to a more granular agreement on what an “acupuncturist” is exactly. AAAOM’s current definition and every state lawmaker and regulator but CA defines entry-level as NCCAOM – the only nationally recognized and regularly normed and independently regulated certifying body. (This doesn’t absolve any of the organizations including the NCCAOM of their issues.) The AAAOM and its state components represent the LAc and their sole role has been to protect and advance that independent infrastructure. The current AAAOM has two types of members: individual members (LAcs and others) and organizational (NFP and for profit) members. LAc members and verified state components are the only voting parties. The voting is weighted strongly on the LAc side. They decide the present and the future of what the AAAOM “is” and “does.”  Medicare, Herbs, CA, etc. They are communities within the profession. We have only had the collective strength so far to protect the lowest common denominators, independence, access, etc. Certain communities in the recent history for whatever reason took an oppositional stance to the infrastructure instead of working to refine, redefine, or expand it, NADA, CAN, etc.  This current board and myself, we are expanders. We want the house to get bigger, the consciousness to become more aware. We are ready for that but it takes two to tango. Personally, I think the easiest and fastest path to agreement is by building consensus on entry level training standards, the deflating of and reconceptualizing of the Masters degree (which is already in process) is probably the beginning of that path. 2. Culture: We are probably one of the most diverse professional and medical cultures in the world. We do have some uniformity, that is by definition entry level training and certification as described above. Our board has no interest in deconstructing cultures, rather in protecting cultures. The question still remains as to what is entry level, safe, and effective training. Safety speaks for itself, efficacy not so much. We need to take a deep look into our diverse training, deep into our schools, and figure out which training programs are creating effective and successful practitioners (generally those two go hand in hand). Once there is complete agreement on what is entry level (which I think we kinda almost have), the ONLY thing we should be fighting about is what to prioritize our funds and volunteer resources to do.  3. Patient access to practitioners/clinics: Yes. Media Media Media. Who are we, how does it work, how will it help. Repetition. Repetition. Repetition. Media Media Media. (rinse and repeat) 4. Products and Services that benefit the lowest common denominator: Products and services are created by the “ground swell.” CAN is a perfect example of this. If the profession wants something from their professional organizations, continuing education, discounts on practice supplies, books, whatever… – its the ground swell of communication and volunteers who step up that stimulates the creation and the organization that distributes. This happens in every [functioning] organization. 5. Commonalities and the profession: Beauty is in the eye of the beholder. Each of us will practice differently indefinitely. Groups of us will get together and form communities based on common vision, we are lucky to have leaders who step up to create those communities within communities. We need to have the courage now, particularly given our level of diversity, to find the commonalities that unite us within that diversity. The commonalities will include but not be limited to values, interests, opportunities, training, etc. One of the things I recently noticed about our profession at an international meeting in Japan, is that the level of diversity we have is actually becoming quite chaotic and it isn’t limited to the US. Every country had different titles, levels of training, values, interests, etc. So that led me to truly question the point of a profession. The profession and the medicine are two different things. My goal is to make the profession a large enough and strong enough vessel that it could contain the level of diversity we have in our profession without breaking. Medicine really got one thing right and that was the vessel. “to diagnose and treat disease by any means” That is their scope of practice.

  10. Tess, we have two of our

    Tess, we have two of our board members that are strictly focused on employment and workforce planning. It is a part of restructuring the education and more difficult the culture to create employable practitioners. The enemy is not actually the FPD, it is the current very bloated Masters degree. What we currently have is unfortunately the FPD. My entire position during the FPD debate was let’s fix the Masters standard and call what we currently have what it ACTUALLY is. Many, myself included, already made the investment of time without working and away from family and loans to take that program – so we can’t take it back. Workforce planning needs to be done with clinic and hospital administrators which are mostly MDs/DOs. Our entire workforce is but a blip within medicine, given a proper argument and some very basic continuing ed – we could create those jobs. Who has even attempted to do this with integrity in our profession on a national scale in mainstream healthcare? As Tatyana is saying, this is the responsibility of the schools to educate the next generation with these competencies – as an FYI, they are in the draft FPD standards. Schools have been educating the profession to be entrepreneurs and open their own practices, this is clearly not a model that works for us.

  11. Lots of good ideas here

    There are a bunch of CA clinics with some form of workers cooperative either in operation or planning to be. Same with consumer coops. At this point we don’t keep track though I can imagne doing so in the future. Or not. Depends on how CAN evolves.

    I will say that you would do well to ask these types of question in the forums, where you can start a thread or two and get responses specific to your questions rather than here where the blog post is not about co-ops so much and is more general in scope.

  12. Michael

    There are 75 job vacancies posted here.  (There were nearly 100 until I deleted the very small handful which had been filled.)  Community Acupuncture clinics are currently the biggest creator of new jobs for acupuncturists, and we cannot find competent employees.

    Workforce planning needs to be done with Community Acupuncture clinic owners…not “clinic and hospital administrators.”  CAN has done more to create jobs in the past three years than any acupuncture organization has done in the past three decades (excluding jobs created by the schools, but that’s another blog post).

    You currently have a group of acupuncturist-employers who are bitching about the crop of grads that acu-schools are producing, and your response is that “workforce planning needs to be done with clinic and hospital administrators which are mostly MDs/DOs“?!  What part of this conversation are you not getting?!?


    You wrote: “Our entire workforce is but a blip within medicine, given a proper argument and some very basic continuing ed – we could create those jobs.”  UUUUUGGGGGHHHHHH!!!!!!!!  We have already created the jobs!  You are not listening.

    You wrote: “Who has even attempted to do this with integrity in our profession on a national scale in mainstream healthcare?”  Please.  Who among you has even attempted to talk to us about what we employers need from the schools to help us fill our jobs and serve our communities? 

  13. “oppositional stance” & a couple of other things

    1. “We have only had the collective strength so far to protect the lowest common denominators, independence, access, etc.”  What do you mean here by access?  Do you mean acupuncturists getting access to doctors, hospitals, licenses, insurance?  Or do you mean patients getting access to acupuncture?

    2. “Certain communities in the recent history for whatever reason took an
    oppositional stance to the infrastructure instead of working to refine,
    redefine, or expand it, NADA, CAN, etc.”  I don’t think of CAN and NADA as being primarily oppositional, so much as perhaps opting out, or doing an end-run.  I think the “opposition” is in the eyes of the beholder.  This might seem academic but it’s kind of important as it determines how folks hear what other folks say.

    3. “It takes two to tango” – indeed, that’s exactly what Lisa’s saying.  The problem is the other alphabet orgs always want to be the lead.  

    4.  “the deflating of and reconceptualizing of the Masters degree (which is already in process”–I for one would like to hear more about that.

    5. “Patient access to practitioners/clinics: Yes. Media Media Media. Who are
    we, how does it work, how will it help. Repetition. Repetition.
    Repetition. Media Media Media. (rinse and repeat)”–are you saying access happens through media?  I hope you are just making two different points in one paragraph.  And how are we to agree on what the media say?




  14. Minor (?) quibble/clarification

    Aren’t there states (Maryland for instance) that do not require NCCAOM for licensure?  How do those folks fit into the entry-level conversation?

    I am somewhat uncomfortable with giving one particular group (NCCAOM) so much power over who can become an L.Ac., though I accept that we may have to live with that for the time being.

  15. I know that if one graduates

    I know that if one graduates from Tai Sophia then one is automatically licensend in the state (and thank goodness, because we certainly are not prepared to pass the national exam at graduation).  DC has its own exam procedure that one can do instead of the national exam (as far as I know this is still the case) but the national exam is accepted here in order to be licensed. A friend of mine is about to open a practice in Michigan and I believe they do not yet require the natl. exam yet either.

  16. Diversity for the BENEFIT of the patients


    “It is not sustainable for any of us or beneficial to our patients to pass on the 3 decades of in-fighting regarding educational and practice model disagreements. Let’s find a consensus-building path and expand our views on what we think is professionally possible, regardless of how long it will take or what it looks like. “I really disagree with this comment, because it’s really missing the bigger point. It’s beneficial for patients to have a diversity of education and practice models.  I don’t talk to my patients everyday about the debates going on with the profession. But the CA models enables different access, from a BA model, and from a public health NADA model. We NEED Diversity for ACCESS! 



  17. kansas

    yeah we dont have any licensing in ks.  in fact acu is quasi legal.  it is tolerated but there are basically no laws here directly saying it is ok to practice or not.  dont license massage therapists either.  

     the local KAOM group is preparing a push for licensing that would bring in the NCCAOM etc.  





  18. Could we say

    that the diversity is beneficial for patients and still acknowledge that the in-fighting in and of itself has not been?  Or, at least, that if there were a more collegial and respectful way of moving forward while maintaining diversity it would be better?  The times when I have been involved in the battles are times that my patients have not been at the heart of my practice.  I have felt that I’ve had to fight so that I can protect what will benefit them (maintaining diversity) in the long run, but in the short-term they’ve gotten short-shrift.  I’d certainly like it, and think they would benefit, if the development of the profession happened in orderly, respectful, and honorable ways — so that I knew my position would be respected and heard withot my feeling obligated to dive into blog wars, frantic response generation, etc.

  19. I really loved the “When Worlds Collide” piece, too.

    I thought the “Aggressive” section was a perfect parallel for a lot of CAN’s unpopular behaviors as perceived by the rest of the acu-community.

    And doesn’t this just sum-up our experience of trying to retrain acu-school graduates to work in our community clinics? “We’re going to end up with folks who will have to unlearn their negative…experiences before you can bring them into a new experience. That’s twice as much work as if you had just taken care of them right from the start.” 

    I am trying to imagine how a community of communities would look.  How would our CAN-culture be accepted?  Do we still get to be angry and loud-mouthed if we feel so inclined?  Would folks like Will Morris stop trying to set the playground rules for CAN members’ communication?  Would we be subjected to more of Neal Miller’s poetry readings?  (That might be a deal breaker for me.)  This from the WWC struck me: “But you also have power relationships at work…which need to be identified and sorted out. Even if you understand the other culture really well, you might still think, ‘Well, we’re still in charge.’ It’s not a matter of intellectual insight, but rather a question of ‘How are we going to balance this parish?’ Also, how do we deal with prejudice? You might know all about someone’s culture and still not like them. We’ll also have to figure out how we create reconciliation in this parish. Have there been run-ins that go back a long way? How do we reconcile those?” Would acupuncture school presidents cease to hold positions of influence with ACAOM?   Would the current acu-org leadership step down to share power with a different culture, a culture which they clearly don’t understand? 

    I too would need to hear A LOT more about any “tangible, practical benefits” that a changed infrastructure would provide for us. 

  20. And also

    it is perhaps better for our patients and our profession when we can honor that diversity by saying, there are a lot of different folks doing different types of acupuncture, and here is what I can do for you.  What we often get, is, there are a lot of different folks doing different types of acupuncture, and their type is better for simple things, or those folks are money-grubbing heartless folks, for example.

  21. From my limited experience

    I’d offer that for a lot of our history, the vast majority of our acu-org leadership has not been in that position because they have any great desire to be in charge.  My experience is that, often, the jobs are not wanted by anyone — some poor soul eventually steps up thinking better me than no one.

    No doubt, some of us communicate in ways that are easier for others to hear — whether that’s someone’s stream of consciousness poetry or someone’s angry rant.  I try to put principles above personalities and do my best to skim over the stuff that I know will do more harm than good if I don’t.

  22. I don’t want to practice in a hospital!!!

    Isn’t the point to avoid patients from having to go to the hospital in the first place??

    We will never be in the club with MDs and DOs anyhow. Because WE ARE NOT DOCTORS!!!  The medical model is broken, healthcare rates are skyrocketing, why jump into a broken system?  We have created our own and we are actually treating patients. Lots of them.

    I also want to point out that patients are rarely aware of what training we do have.  They don’t care if I have a Masters or a Doctorate.  Or an associates degree. They just care if I’m licensed by the state board and competent to stick in a needle.  The FPD wouldn’t wow anything except the acupuncturists ego.

  23. Yes, and,

    there are certainly some within our community of communities who want to provide treatment to those whom despite treatment still end up in hospitals — or those would didn’t have the opportunity to receive treatment before.   And our income figures wouldn’t be so bad if there were more opportunities.  There is a huge community of folks participating in hospital care, not just MD’s and DO’s.  I don’t really want to be in that club either, but it doesn’t hurt me, I don’t think, to support those who would like to do so.  Turns out CA probably isn’t for me either, but I do my best to help it when I can, and support it when others might want to get in its way. 

    Also, patients might not be aware of the training we do have, but many would say they should be aware — whether it is so they can be more informed advocates for increased access or so that they can protect themselves from unscrupulous scammers.  I’m no fan of the FPD myself, fought against it even, but what if it could become a step towards fixing the broken education system?

    The overall idea, I think, is what if we had a community of communities where those who wanted to work in hospitals could be helped in making that happen and those who wanted to make sure group treatment rooms were okay in the regs. were helped, and those who wanted to make sure students weren’t be sold a bad product were helped.  I think that’s what we are trying to figure out — instead of screw them, I don’t want that, perhaps we could build a community that would reply, that’s not for me and instead of shouting that it is a terrible, stupid idea, what if I could help come up with a plan that would help them get what they want, while protecting what is important for my community.

  24. Well obviously. Elaine,

    Well obviously. 

    Elaine, there needs to be a definition of collegiality that’s workable for all parties. So far collegiality means that we act like Morris, MJ, you and your crowd and that has driven our profession into the ground. To start WCA, to start CAN, we took that definition and stood it on its head. That’s why we are successful.

  25. Ouch,

    my crowd?  Who is my crowd?  Where have I driven things?

    And, yes, we need to define collegiality that’s workable for all parties.  I hoped that was what we were trying to do here.

  26. its not about treating in a hospital per se

    I don’t believe the push to be able to treat in a hospital is coming from the desire to help a patient in a hospital bed. I believe it comes from looking where the money is and then trying to get a piece of that.  There is such unbelievable waste and ineffeciency in our current medical system, why would anyone want to be a part of that unless there was… money for them?  How else could $75-$100 treatments be supported? Because the patients sure as heck can’t afford them.  Well, the insurance companies pay out thousands for surgeries, acupuncture is much less than that so I should be getting my fair share.  And that would further bankrupt the system and bankrupt this country. So yes, I do care if people are money grubbing because it affects all of us.  Community acupuncture proves what the market rate for an acupuncture treatment is, somewhere between $18-$20.  

    Most people don’t know what acupuncture is or what it does.  How does it best serve the patient to sit them down with a lecture about how much training we have and our list of degrees?  This past week I heard about 5 different stories from patients about condescending health care professionals, one of which was an acupuncturist!

    Regarding the last paragraph you wrote, that is not what I understood from Lisa’s original post.

  27. it truly isn’t about treating in a hospital

    Jessica, I think we are missing the point. I am happy for you that you have created jobs in CA clinics. Just like you don’t want to work in a hospital, I don’t want to work in a community acupuncture clinic (or a hospital for that matter). I apologize if I missed the letter you sent to the AAAOM asking for us to help CA create more CA jobs as we have no problem helping the CA network, promoting the CA model, or even including you in the workforce planning. You have made yourself overtly clear that you have no interest in helping acupuncturist that don’t buy in to the CA model and that is fine, but there is no reason to attack an acupuncturists because they want to work in a hospital, public health institution, medical research, or even practice for free as a volunteer. CAN is not a franchise (yet), is not an employer, and has not asked the AAAOM to do anything to help CAN. There are many synchronistic opportunities for acupuncturists if we stop struggling internally and start creating something better and bigger than what we have.
    By patients having access to acupuncture in emergent or emergency situations (stroke, respiratory distress, GI distress, severe fevers, influenza, pain and a host of other conditions) which are just about all seen in the hospitals and safety net clinics we could have an exceptionally powerful effect on that person’s quality of life, recover and rehabilitation, and a potentially significant decrease of utilization of prescriptive medication and surgery. Faster we see them the better. Given what we know helps people both empirically and through research are we really prepared to DENY patients those treatments WHEN and WHERE they need them most? I am visualizing a world where hospital, private practice, and community clinics are important and full.
    Meaghan, one can be in the system and not need to be a part of the broken aspects of the system. Medicine is a massive industry an the entirety of the system isn’t broken. You are correct we have done little as professional organizations to market our degrees, take a stance on mechanisms, and make it easy for folks to understand what we do. I disagree that the FPD wouldn’t do more but wow the acupuncturists ego, but that is a different topic altogether. Your assertion and assumption regarding who works in hospitals and their motivations for doing so is exceptionally vilanizing to millions of healthcare workers and is both reckless and unnecessary. There is a percentage of the system that is rich and gets richer, everyone else in healthcare is either like you and me or modestly above you and me. CA and even AOM as an entire medicine is not an adequate answer to the woes of our ailing in the US or any country for that matter. JMHO.

  28. curiosity killed the cat

    ACAOM has been calling for commissioners, AAAOM and all state associations for board members. Dare I ask how many CAN members have stepped up to serve? to do the renovation work? All I have heard from the beginning of our discussions more than a year ago are lots of people willing to do the demolition. Please correct me if I am wrong. Demolition is fun, rebuilding – not so much.

  29. demolition man

    Nicely put Skip. Everyone, but you and your crowd and people that buy into your perfection, is imperfect and unsuccessful and completely incapable of innovating (aka: your understanding of turning the universally accepted definition of collegiality and mutual respect on its head). News flash: we are all responsible for holding people and organizations that represent us accountable and nobody is completely perfect or imperfect for that matter. Where were all the CAN members 10, 15, 20, 25 years ago? How did they serve? what did they do? Which of you created a viable alternative training and licensure infrastructure that won in the marketplace of students? The “crowd” that has “held the profession back” as I have heard it, is the group of people that stepped up to lead in a community of generally introverted anti-leaders. They (myself included) paid out of pocket to lead on behalf of these generally poor organizations and practitioners. Maybe you and your crowd aren’t afraid to call foul publicly, that I will give you.

  30. From Lisa’s blog:

    “We don’t want to help support it or maintain it, give it money or volunteer energy, because it doesn’t do us any good. That could change, of course, if the people whom the infrastructure DOES benefit decided that it was worth it to them to adapt it enough so that it did serve us, and so that we would be willing to pitch in.”

  31. You and your crowd, defined

    Elaine, I define the phrase, “you and your crowd” as those people who emphasize the need to be collegial before saying anything of substance. Within that group seems to be people as diverse as you, MJ, and Will Morris, to pick three people who have been on the blogs lately. Definitely you three are very different people but at this point, you three seem to be taking a similar stance, a stance that is different from what drives CAN.

  32. Michael, the past is done.

    Michael, the past is done. What we care about is what is in it for us now. Right now.  See what Lisa wrote on the first page to you. We want specific answers from you. 

  33. Michael

    You are missing our point. 

    Tess wrote: “There are a number of us business owners who would like to offer full employment to other acupuncturists but there seems to be lots of barriers to finding acupuncturists to fill those positions.  We have discussed this ad nauseum but I think it’s useful to put this out in the non-restricted forum.”

    Your response to Tess goes on to detail workforce planning with MD’s, DO’s, clinic and hospital administrators.  You further discuss how a “proper argument” and “continuing ed” could “create jobs.”

    That’s so fucking disrespectful. 

    You’ll talk to MD’s and DO’s about jobs you want to create, but you won’t answer Tess about her problem filling existing vacancies in her busy clinic?! In your response to her, you did not in any way demonstrate that you even heard her complaint as an employer about her challenges in finding acupuncturist employees.

    I tried to spell it out for you with more words, but you are still not hearing the problem: workforce planning with hospital administrators does nothing for Tess’ problem hiring punks in her clinic.

    Why aren’t we writing letters to AAAOM?  We have lost faith in the acu-orgs to address our issues.  Your response above does nothing to re-establish credibility.  Therefore, we are working to address the problems on our own.  We have dozens of able-bodied punks in our ranks who are willing to volunteer time for something we believe in. 

    You are the one who wants us folded in your organization, remember? You will have to try harder, if you want to win us over.  Because frankly, at this point in the game, I’m not sure what exactly you can offer us which we can’t do for ourselves.

    Tess identified a problem.  Hear her and address it.  Don’t feed her some bullshit about your work with hospitals and MD’s.  That’s insulting.

    BTW: You are correct that CAN is not itself an employer.  We are fully staffed by volunteers.  We do, however, represent a consortium of employers.  And while that may not be significant to you, the USDE has made it clear that they are interested in our position. (USDE 602.13 Authority: 20 U.S.C. 1099b)

  34. I would think that if you

    I would think that if you are not waiting for hospitals to send your organization a letter asking for help in creating jobs for acupuncturists, that expecting such a letter from CAN would be similarly misguided.  If you are working to create inroads to establish employment possibilities for the profession, it would behoove you to look at *all* possible employers – CA clinics being one set- instead of waiting for them to come to you.  In addition, it seems that instead of being happy for Jessica and/or CAN for creating jobs in CA clinics, that it would be better to be happy for the profession that those jobs exist, given how difficult it seems to be to make a living at acupuncture for so many in the profession. 

  35. Backing up

    Michael, I’m assuming this is you. I feel like you are still missing the point of Jessica’s response. We don’t need the AAAOM to help us create jobs. We are creating jobs. We do need support as employers but that support is something we are going to create for ourselves; the AAAOM couldn’t help us with that anyway. What we do need that we can’t yet create on our own: licensed acupunks who are trained in such a way that they are valuable employees. What would help us: acknowledgment from the AAAOM that current training does not meet the needs of the one publicly organized group of employers in the acupuncture world, that jobs for acupunks are going unfilled because of a lack of appropriate and appropriately priced training, and a willingness to open a specific, solution-focused dialogue around that. Can you do that?

  36. The naming of things

    Funny, but it strikes me when reading through all of this that you all are engaging in debate akin to that of a high school debate team. What exactly is the desired outcome of that kind of debate, other than, of course, scoring points off each other?

    Diversity is predicated upon the acceptance of the unavoidable fact that creation includes many races, creeds, and preferences in all things. Why is it then that diversity of opinion, though invited and supposedly welcomed is met with nothing other than aggressive opposition and debate style commentary?

    I happen to believe there is room for many types of acupuncture in the current social system, both here in the United States and elsewhere in the world. Whether the practice is dictated by business model structures or ideological conviction or both; as long as there is skill and good intent, the outcomes cannot possibly be so bad as to necessitate such fierce opposition between players on the same team?

  37. sure they can, guest

    People’s lives are being ruined.

    “Title IV Funding for Acupuncture and
    First Professional Degree Acupuncture school is a scam that ruins
    students lives forever. There is no way for me to ever pay off my
    student loans. I am too old to start over. I cant find a way to work
    it off and I am exhausted from trying for the last 13 years. This was
    my last shot at a life and a career. Acupuncture ate my life and has
    destined me to a life of poverty and nothing to retire on. Please
    stop this abuse and destruction of students lives. There is no living
    to be made in acupuncture because there are no jobs. You might as
    well learn martian geology for all the good it will do you as a
    business. Ongoing costs of maintaining licensing, certification,
    malpractice, CEU’s all feed somebodys pocketbook but mine is empty.”

  38. Let me see if I’ve got it —

    me and my crowd have done our best over the years.  However, given our ignorance and blindness, and perhaps greediness and some other horrible traits, it turns out we effed things up horribly.  Our best sucked.  We now know that we’ve made mistakes.  We’d like things to be better, but given that we are still ignorant and blind and clueless, we’d like the assistance of those who are less clueless than we are.  However, those folks don’t want to participate — they don’t need anything from us, well, they would like “my crowd” to fix the educational thing, but, they don’t trust us and, hey do that substantial thing for us, and then we’ll maybe talk to you.  Of course, I’m still the clueless bloke I use to be.  So, I need your help, but you don’t want to help, you just want to tell me, again, how clueless and ignorant and blind I am.

  39. specificity

    Hi Lisa and JFW, most importantly, I can’t figure out how to make paragraphs on my posts. Ack! I am going to respond to this in the other post that LIsa just made.

  40. skip and racheline

    Skip, as the requests get more specific I will respond to them more specifically. Lisa just made a specific request that I think I can answer and I am going to do that in a moment in that post thread. Hard for me to keep track of the multiple threads in multiple directions without some kind of thread notification, am I missing something with the technology? Racheline, when the profession moved from the certificate/diploma program to the masters standard and get the program approved by the USDE for Title IV funding way back when, ACAOM needed to show a geographically diverse group of programs that graduated students successfully. This is the “marketplace of students” I was referring to. Let’s just say the profession creates and optional doctorate called the “DAOM,” and the students decide NOT to “consume” those programs – the marketplace of student has therefore rejected the “product,’ and the USDE will allow ACAOM to continue accrediting those programs but will NOT allow them to use Title IV funding for those programs. Does that make sense? Feel free to call and I might be able to explain it more clearly on the phone 347-879-5777.

  41. lord have mercy

    Hi Lisa, et al – sorry I am not used to this type of forum and sometimes leave my name/email out (it isn’t purposeful). Since I can’t create paragraphs or do any kind of formatting for some reason, I will just try to do numbers and quotes.

    1. “acknowledgment from the AAAOM that current training does not meet the needs of the one publicly organized group of employers in the acupuncture world” – The AAAOM has already acknowledged this with its sister organizations. We are aware that the current educational structure needs to be reformed, not just for CAN but for all. Practitioners that are experts in program design and administration on the Education Committee will represent the profession in this dialogue (versus simply school administrators or any particular org blend of practitioners). We have done this because the data we have (which is clearly a work in progress) is pointing to the fact that our current structure isn’t working for employment (or even self-employment possibly). We have made quality data collection and workforce planning a priority as mentioned so our decisions moving forward regarding structure are more informed and fact-based.

    2. “that jobs for acupunks are going unfilled because of a lack of appropriate and appropriately priced training” – Please clarify. Are you saying that you want a training program (curriculum and price) to be created that works for your business model? Or are you saying that acupuncturists don’t want to work in CAN clinics at CAN reimbursement rates because of the cost of training? Is there any program that exists that is close to what you are envisioning? Has CAN considered opening a training institution? Would reforming the masters degree or allowing extenders work for your model? Can we separate this out into it’s own discussion thread? Can we do it on the ACOM Community discussion group or even better the Education Committee? I think this discussion would be informative for all.

    3. “a willingness to open a specific, solution-focused dialogue around that. Can you do that?” This we can definitely do and we are always doing in the AAAOM. It might be difficult in the beginning to get everything out on the table, but when we have gotten all the specific needs and wants out there, we will be able to have constructive dialogue. I don’t think the infrastructure is so inflexible that it can’t answer the needs of your specific community.

    4. “Your response to Tess goes on to detail workforce planning with MD’s, DO’s, clinic and hospital administrators. You further discuss how a “proper argument” and “continuing ed” could “create jobs.” That’s so fucking disrespectful. You’ll talk to MD’s and DO’s about jobs you want to create, but you won’t answer Tess about her problem filling existing vacancies in her busy clinic?! In your response to her, you did not in any way demonstrate that you even heard her complaint as an employer about her challenges in finding acupuncturist employees.” –JFW, I explicitly said workforce planning needs to be with “clinic and hospital administrators.” Before you launch gratuitous digital attacks on me (or anyone else for that matter), you should ask for clarification. I have never opposed including CA reps, 5e reps, school admins, left handed licorice loving acupuncturist, or any LAc in any dialogue they want to be a part of. We have one simple requirement at the AAAOM to be a part of the internal dialogue, membership, same as CAN and any other membership organization.

    5. “You are the one who wants us folded in your organization, remember? You will have to try harder, if you want to win us over. Because frankly, at this point in the game, I’m not sure what exactly you can offer us which we can’t do for ourselves….Tess identified a problem. Hear her and address it. Don’t feed her some bullshit about your work with hospitals and MD’s. That’s insulting.” –JFW, you seem to have completely misunderstood my “wants” in this dialogue. I have no interest in “folding” your community into the AAAOM. Membership in the AAAOM, and membership in CAN are two entirely different things in my opinion. I think every LAc should have membership in one professional organization, that can be our home to collectively develop tools and resources for each there. If there is a need for highly specialized work, it is sometimes possible to create a workgroup, taskforce, or committee (for permanent structures in the profession). If those vehicles for change and organization don’t work out, other organizations tend to form. Anyhoo, this post is way way way longer than I wanted it to be and it is now 3am – two hungry children and a wife are going to wake up in three hours.

    6. It is probably needless to say, but everything said on this forum is my opinion and my opinion alone. I have no intention of and am not authorized to represent the AAAOM.

  42. chaotic diveristy

    We must separate the medicine from the profession. The profession is a vehicle to deliver the medicine. I am asking that we create a universally understood and acceptable profession (internally as well if humanly possible). This activity, and this activity alone, protects our ability to have true diversity in our practices. What we have now is chaotic diversity. I know more about optometry and chiropractic than I do about our profession. There need to be a limit to the chaotic diversity we currently have for the protection of our patients and our brand. My understanding (which could be wrong) is that model and brand integrity and stability are very important to CAN as a community, as a group of businesses, and as an organization. If I have missed your point, please clarify.

  43. thanks for being specific

    as for #2: “Has CAN considered opening a training institution? Would reforming the
    masters degree or allowing extenders work for your model? Can we
    separate this out into it’s own discussion thread? Can we do it on the
    ACOM Community discussion group or even better the Education Committee?”

    I will put up a separate post on the blog, and address your questions, later today. I’ll also cross-post at the AOM group. Like you, I am not authorized to speak for anybody; we’re just discussing here.

    As far as the Education committee — I am not a member of the AAAOM. I was in the past. I didn’t renew my membership because 1) the culture drove me crazy; and 2) I couldn’t justify the expense based on the fact that I got no discernible benefits out of being a member.  BTW, the same thing is true for my state association, for which I was volunteered as well. I did not renew my membership for the exact same 2 reasons. You are going to have a hard time selling membership in the AAAOM to most people reading this blog, no matter what the abstract benefits to the profession, unless you are able to address those issues.

    I think we can continue to use this thread to talk about culture and the idea of community of communities, and I’ll branch the education issues off.

  44. Elaine

    I know you mean well, but some of your responses here are completely infuriating. For example:

    “that the diversity is beneficial for patients and still acknowledge that
    the in-fighting in and of itself has not been?”

    YOU can say that because you have certain kinds of privilege which you are not acknowledging. Specifically: you were able to implement the practice model you learned in your school without having to make a choice between the professional culture you learned there and being able to treat anyone who was like you, your family and friends; anyone you could relate to culturally. You did not have to enter into a enormous internal conflict in order to be able to work at all as an acupuncturist; you didn’t have to create “a new rift in the profession” simply by the act of opening your clinic. The acupuncture profession and education is set up to address the needs of middle-middle class and upper middle class people; it’s not set up at all to address the needs of lower middle class people, working class people, or underclass people. Whatever you have had to deal with in your professional life, you have not had to challenge your own professional culture essentially telling you that you had no right to exist as an acupuncturist in your own community. So when you promote being collegial and respectful in response to Jade’s post, I (and others) get the feeling that you are telling us what to do when you have no lived experience of what we are dealing with. Jade said something concrete, you said something abstract. Some of the concrete details of life for us as acupuncturists have been challenging in a way that they will never be for you. “The times that I have been involved in the battles are times that my patients have not been at the heart of my practice” — yeah, you are clueless and ignorant and blind if you don’t see that that makes you LUCKY. Fortunate. Privileged. If I didn’t get involved in the battles (internally and externally) I wouldn’t get to have a practice, or patients, at all. Same for Skip. That’s why he’s mad at you.

    You also wrote: “it is perhaps better for our patients and our profession when we can
    honor that diversity by saying, there are a lot of different folks doing
    different types of acupuncture, and here is what I can do for you.” If we lived in the same town, you could say that to your patients, and it would be true; your patients could see you if they want what you have to offer, or they could see me if they want what I have to offer. If I said that to my patients, it would be kind of disingenuous. The version of what you wrote that I could say to my patients that would be precisely true is, “There are a lot of different folks doing different types of acupuncture, and none of those types of acupuncture except community acupuncture is accessible to you in the real world”. If my patients want what you have to offer, they can’t have it. Do you see? You get to “honor diversity” because your patients have choices and options that my patients don’t have.

    And you want our assistance in understanding this. Yeah,we all need help with some stuff, and that’s not a problem. But part of the dynamic here is that there’s stuff you don’t see because you never HAD to see it, your life didn’t force you to see it and deal with it. That’s privilege. When you have privilege in a situation relative to other people, one way to enrage them is by helpfully telling them how they should be more like you. That’s what your comments sound like to us.


  45. another sign of privilege

    is demanding that other people TEACH you, otherwise you have no choice but to remain passively ignorant and clueless, and that can also be infuriating.  Jesus Jenny, we’ve been having this conversation publicly for – what, at least 4 years now?  Or did you miss the whole part in Lisa’s post about all the media CANers have created?  CAN is like a huge effing CLUE TRAIN, and if you can’t/won’t/haven’t gotten on board, I don’t know how to help you.

  46. Renovation

    Michael, did you really not read Lisa’s post above, about all the stuff CANers have built – ON TOP of all the clinics we’ve opened, the jobs we’ve created, and the treatments we’ve given?  And what have we actually demolished?  Sincerely, tell me ONE thing that we’ve demolished (besides some illusions).  Anything else that’s crumbling was built on a shoddy foundation.

  47. If I may..  My

    If I may..  My understanding of the CAN and other alphabet division is this: 

    The others are hell bent on carving out a market that does not currently exist.  It would put acupuncturist on parity with doctors.  Whether that be the ability to see patients in the hospital, be a PCP, have insurance parity or even just use the title of Dr.

    They think that acupuncturists are worthy of this and dont want to degrade the profession to anything less.  They think that if this is achieved then people will have access.  

     CAN doesnt want to wait for that to happen.  It has been 30+ years.  What if it never happens!?  You say acupuncture can reduce the cost and need of surgery and medical intervention.  Do you know how much money is made off of those things?!  There is in fact a medical industry and the people who are making the money there do not want to see their share of the cash go down.  There is little incentive to change.

    CAN doesnt care about acupuncturists being on the same level as doctors.  This is a class division.  We dont think that acupuncturist need to be upper middle class professionals.  This is just a dream right now anyways.  It is sold to the students at the schools but for most of us it does not exist!!!!  It was a LIE!  

    CAN looks at what is possible right now.  There are a lot of people to treat that can pay a little bit of money and create living wage jobs for acupuncturists.  Thats what is happening all over the country.  These opportunities do exist and we are having a hard time meeting demand because the acu establishment is stuck in dreamland.

    We need help making working class “professionals”.  Less like doctors and more like nurses.  Not nurse practitioners but RNs.  We need punks with inexpensive and short bachelor degrees or associates degrees and we need a lot of them.  They need to expect to be busy and be ready to treat a lot of patients.

    One of the problems with the schools is that the students graduating have been sold the acu dream lifestyle that does not exist.  They have a lot of debt, would like to repay it.  They think they deserve to be in the upper middle class and make 100k.  40k is an insult.  They have not woke up yet and realized that for most of us this dream is unattainable.

    There are not enough rich people to support us all.  And us working class, lower middle class people don’t appeal well to rich people as practitioners anyways.   So we had even less of a chance at living the ASDL (acu-school-dream-lifestyle).

    What I am hearing from Lisa, Jessica, Skip and Tess is a call.  You say you want to help us.  Give up on the dream of making us like doctors.  Help us be like nurses.




  48. But the profession sucks, MJ

    For 30+ years this Profession has not delivered what you say it should. The alphabet organizations and the schools have all been looking to make sure that they are comfortable and attack anyone who threats that.

    The AAAOM and the AAOM and AOM Alliance were and are fundamentally weak organizations, delivering nothing of value to the Profession’s practitioners.  There have been committees and people working in those organizations for decades now and nothing has come out of them. Why? Because most acupuncturists leave the field within a few years because they can’t make a fucking living and so have no time for volunteer work. THAT’S why you have so few members, why membership has never been even mediocre, and why membership is never gonna be high. Getting a few of CAN’s leaders to participate in a few committees will do nothing to change this. 

    Why is that? Two reasons:

    1) You promote a bad business model, the Boutique model.  By definition being a Boutique only reaches a small segment of the population. Acupunks can’t find enough patients. This business model will never ever work for almost all of the practitioners. 30+ years of futility should tell you that. And yet when Community Acupuncture comes along we get attacked from day one till the present day. 

    2)  You promote the acu schools in their attempts to get as much money as they can at the expense of the future of the field. When graduates now are averaging $85K in debt, they can’t earn a living and at any rate they have no time for silly AAAOM committees while they are (usually vainly) trying to keep their head above their sea of red ink. Yet you promote initiatives like the FPD which are designed to restrict the numbers of practitioners instead of helping the practitioners already in the field. 

    The way the Profession is going, the profession will render this type of medicine basically extinct within a few more decades because the policies that the Profession follows are designed to restrict the numbers of people entering the profession in a vain attempt to keep the incomes of those already in the profession viable. The only way to change that outcome is for the profession to fundamentally change its core beliefs. And you are giving no impression here of being interested in doing that regardless of how much you yell. 

    So in summary, the Profession blows. So blow the fucking thing up, MJ. Only when you clear some of the dead wood can you make progress. 

  49. I hardly recognize myself —

    because I wasn’t able to implement anything until I fought for it.  While in school there was the big AAOM/Alliance split/fight which was really about whether all licensure would go through the NCCAOM and be based on TCM style acupuncture and whether folks other than L.Acs. would be able to use acupuncture.  So, for the most part, if people are practicing without NCCAOM that was something I worked for.  Then, of course, when I was in school, it was illegal for anyone other than an M.D. to use acupuncture in Virginia.  So, for almost every citizen of the state, regardless of class or financial status, acupuncture was not an option.  So I fought for licensure.  Even after we got licensure people were still required to get a referral from a physician before they could legally receive treatment.  Lots of physicians did not want to refer, not to mention that was an added expense for folks, so, I fought for open access so that people could make their own choice as to whether they wanted treatment.  We still had very burdensome English requirements for licensure, so many in the Asian community could not practice legally, so I fought to change the requirements to improve access for those communities.  Meanwhile, once I could legally practice in Virginia, I did lots of “pro bono” work and had many years when I spent a half-day week treating terminal patients at home for free. 

    Yes, I know that all my efforts did not focus on addressing the needs of the still underserved working class folks, that I was ignorant.  I’m grateful CAN is there, and since my eyes have been opened I’ve done my best to support you and encourage colleagues to consider opening CA practices.

    I’m not demanding that anyone teach me, but, I’ve found in life that a good teacher can make all the difference in the world, so I have asked for help in those areas in which I am ignorant.  I have tried  to do what I can so that the schools will pay attention to your needs and the needs of your communities and do a much better job of producing graduates who are ready and willing to support your practice model.  If my efforts are suspect and attacked because I have not fought your fight, well, I can’t change that, should stop trying to make things better? 

    Yes, I have been privileged.  I acknowledge it.  I haven’t fought your fight.  I’ve fought my own.

  50. I don’t think I will need to call you

    DAOM aside, I was just making sure you were, in fact, publicly crediting yourself and your organizations with success in creating crushing student debt. I like CAN because it was NOT there 15, 20 or 25 years ago to create this beast that has doomed the future of its profession through debt that cannot be repaid with what the average acupuncturist can make if they are lucky enough to start a practice $100,000 in the hole.


  51. give credit where it is due

    Racheline, CAN might not have been around but CAN members sure have. Everyone is responsible for what we have today included those that bought in and drank the juice – caveat emptor. Each of us needs to take responsibility for the decisions we made in life and the research we did or didn’t do with regard to the viability of the profession we thought we were going into. We can cry about spilled or correct what we know is problematic – to each their own.

  52. tangible membership benefits

    We have done some focus groups and preliminary analysis on what current students, practitioners, organizations, and supporters want from us. You are absolutely correct, it will be exceptionally difficult to instantly create the tangible membership benefits we want to give them, however we feel that we are at a place where we can at least start to create some of the those products they need and want to feel right about their membership. In my mind, if we are “selling” a product, be it membership or what have you, it should be worth far more than you pay for it (in order to sell it). i.e. if you are paying $300 for a business seminar, we as consumers should expect to reap $3k over a certain period of time (ie. a year)…. if you are taking a loan of $100k to consume a program, one should minimally be able to reap $$?? over their career. Maybe we should do some cross-profession analysis of what their total loan-load is (including interest over time) and career-payout is. The new US Bureau of Labor and Statistics (as of the beginning of the year) has some great data on professions, employment, etc. We are VERY close to getting them to track our profession which would be AMAZING, because then they don’t even need to do regular old studies – they dive straight into our global tax returns and start distinguishing between signal and noise. Anyhoo, yes, abstract membership benefits have been removed – tangible benefits are in our sights. This has already begun and will only get better from here.

  53. Caveat Emptor

    Michael!  I can’t tell if you’re posting this bullshit in a purely inflammatory manner or if you seriously mean that!?  On its website, the Council of Colleges states: “A recent estimate, which is based on job postings, reports an annual income range between $30,000-$60,000 and notes that gross annual income can be as much as $105,000.”  Please.  WTF  is up with qualifying the six-figure income with a  comment about it being gross, but not noting that the $30,000 – $60,000 IS GROSS TOO!  A more factual statement would be this:45% earn less than $20K annually from their AOM activities.”  Or this: “more than 80% of part timers working less than 30 hours earn less than $60,000.”  If you’re going to include a six-figure income, qualify the statement appropriately with something like this, please: “9% have gross incomes ‘from their AOM activities’ of $125,493.52 (including educators, administrators, those with an active MD license, and those owning herb companies or working the CEU circuit).” 

    How do you expect the Buyer to Beware when the CCAOM deliberately posts misleading information about income potential for prospective students??? 

  54. inflammation

    Jessica! I don’t post things simply to inflame. I had no idea what the CCAOM even was until I was forced to take the CNT. I surely didn’t look at CCAOM for salary information when I was considering the profession, hell, my school didn’t even have a website and their brochures were photocopied on a barely working copier but I liked the school more than its competitors. It is good that you reminded me of that CCAOM web page (certain schools reproduce that page on their site), I will ask them for sources and see if we can’t figure out what the purpose of that page is. One would think they might need some kind of justification. In regards to data, the fact is that I personally don’t have a great deal of confidence in the NCCAOM, CAM, or CAB data at the moment so bad and good reports about the status of the profession are suspect, jmho.

  55. Michael!!

    When you state this: “Everyone is responsible for what we have today including those that bought in and drank the juice – caveat emptor. Each of us needs to take responsibility for the decisions we made in life and the research we did or didn’t do with regard to the viability of the profession we thought we were going into.”

    And then state this: “I had no idea what the CCAOM even was until I was forced to take the CNT. I surely didn’t look at CCAOM for salary information when I was considering the profession, hell, my school didn’t even have a website and their brochures were photocopied on a barely working copier.”

    And then you say: “I personally don’t have a great deal of confidence in the NCCAOM, CAM, or CAB data at the moment so bad and good reports about the status of the profession are suspect, jmho.”

    How can you cite “Caveat Emptor”?  First you blame the consumer for being uneducated about the product they purchase, then you state that the consumer shouldn’t be expected to take salary information from one of our industry’s organization’s at face-value, and finally you state that you don’t have confidence in the industry data (duh)…where exactly does Buyer Beware come from?!  Surely you didn’t expect buyers to rely on the US Bureau of Labor & Statistics, b/c the USBLS hasn’t yet even identified acupuncture as a real profession (double-duh). 

    Should prospective buyers have consulted the I-Ching before they “drank the juice”?!   

    I feel like I need a synonym for What-the-Fuck?!@

  56. oy dream killer

    Hi Nick, you seem to be a bit overly pessimistic, maybe I am misreading you. We already have doctorates in this medicine, that chapter is thankfully closed. We already have acupuncturists (not loads) employed in over 10 hospitals around the country that I know of, that chapter is closed thankfully. We already have herb protection, insurance mandate, and parity in many of our states, that chapter is closed. We have almost complete independence in 46 states with 2 more on the way. What we don’t have is a good, cost-effective educational system and opportunities in one jurisdiction have fully transported to other jurisdictions. There is nothing to “give up on.” There was no lie and no weird conspiracy theory just very poor communication, organization and governance (from what I can tell). What we didn’t have was money, power, industry, institutional partnerships, and a host of other things that could have solidified the profession faster. It took medicine a couple hundred years, we are 27 years in, I am optimistic about our future I suppose and will continue to fight for opportunities for acupuncturists be then in CAN clinics, safety net clinics, hospitals, research institutions, or what have you.

  57. Jessica!!

    Yes, it might have been more effective to consult with the I-Ching in our case before choosing a school, seems culturally relevant too. If I had an I-Ching handy, I might be able to finally understand the AOM profession. Maybe the AAAOM should start distributing pocket I-Ching and Ouija Board sets for determining their annual salary. You seem shocked that the VP of the AAAOM is not completely satisfied with our data, infrastructure, or current information being produced by our professional organizations… we all drank the juice, let’s accept it together and fix the mess we inherited together.

  58. yes the profession sucks, many professions suck

    Skip, I see we have found the eternal optimist in you my friend. Yes, for 30+ years this profession has not delivered what we collectively wanted from it. The alphabet organization did the best they could given their weak governance, leadership, and accountability structure-as you state. A group of people may have controlled the conversation to ensure that it benefited them but the members of these organization let this happen unfortunately. Can’t cry over spilled milk, we have the present and the future for us to deal with now. The way to fix this is by being present, asking the hard questions, and being ready to step up into the conversation – not withdraw from the conversation. For whatever reason our evolution/maturation has led us to where we are now, let’s embrace it.

    #1) CA business model has never to my knowledge been attacked by the alphabet soup.
    #2) I haven’t promoted any particular blend of business model be it boutique or CA or hospital. I personally believe to each their own and opportunities should be abound for all.
    #3) I have promoted a sane, universally respected educational infrastructure. I have never (that I remember) promoted a single existing school let along “promoted the acu schools in their attempts to get as much money as they can at the expense of the future of the field. When graduates now are averaging $85K in debt, they can’t earn a living and at any rate they have no time for silly AAAOM committees while they are (usually vainly) trying to keep their head above their sea of red ink.”
    #4) Acupuncturists leave the field after a few years just as many professionals leave their trade after a few years. Let’s get some hard cross-professional data and see where we line up and go from there.
    #5) We already have blown the thing up but it will take some time for the shockwave to hit everyone. We did this only because we were willing to stick around to rebuild it. The vast majority of the dead wood has already cleared but as more and better structure is in place and new people are willing to step up and lead, that last of it will finally clear.
    #6) yelling is not my style

  59. response to Michael’s education questions

    I know I said I’d put up a new post above, but my comrades posted blogs I love too much to post yet another one. This is cross-posted at the AOM google group.

    Hi Michael,
    here’s my response to your questions:
    you saying that you want a training program (curriculum and price)
    to be created that works for your business model? Or are you saying that
    acupuncturists don’t want to work in CAN clinics at CAN reimbursement
    rates because of the cost of training?

    Yes and yes. Also,
    acupuncturists graduating from school 88K in debt (median debt from last
    year’s graduating class at OCOM) are in no position to start a business
    using ANY business model, so it’s an issue for opening clinics as well
    as filling jobs. Looking at the results of the NCCAOM JTA, the cost of
    training is ridiculously out of scale for what an acupuncturist can
    expect to earn, regardless of the business model.Is there any program that exists
    that is close to what you are envisioning? Has CAN considered opening a
    training institution? Would reforming the masters degree or allowing
    extenders work for your model?

    No, yes, and possibly. I’ve
    been poring over the ACAOM Structure, Scope and Standards document for
    over 2 years. There are two issues: the curriculum and the structure of
    ACAOM accreditation.
    There would be no point in us opening a school unless we could
    charge significantly less than other schools do. My goal would be for an
    entry level training program for a community acupuncturist to cost
    about $25K total — such that students could fund their education from
    savings rather than loans. The ACAOM accreditation requirements are
    clearly designed for free-standing schools, which means that each school
    needs its own administrative infrastructure. Just meeting the
    requirements for the infrastructure, such as a chief administrator with ”
    a higher education degree and substantial higher education
    administration experience”; a professional librarian ” with expertise in
    issues of library development, management, and computer on-line
    research”; and the utterly vague requirement that “Financial resources
    must be adequate so that continuing operation of all professional
    programs in Oriental medicine are assured at an acceptable level” makes
    it impossible to charge a reasonable rate for students. 
    Stephen Potter is a community acupuncturist working in Victoria, BC,
    where he relocated from the UK. He told me that very recently,
    acupuncture training became located in the public education system
    there; as a result, he completed his own training without any debt. He
    suggested, and I think he’s right, that having acupuncture training
    programs in regionally accredited institutions such as state
    universities and/or community colleges is a good solution to the high
    cost of acupuncture education. However, many state laws are written such
    that licensing depends on graduation from an ACAOM-accredited program
    or foreign equivalent. Sitting for the NCCAOM also requires graduation
    from an ACAOM-accredited program or foreign equivalent. Our only
    accreditation standards are written for free-standing acupuncture
    schools, which are necessarily prohibitively expensive.
    The ability to offer a bachelor’s degree or an associate’s degree in
    acupuncture in a public institution, which could serve as an entry
    level requirement in the same way that it does for nurses, would also
    help with the recurrent problem of people going to acupuncture school
    simply because they are fascinated with the medicine, not because they
    want to use it to earn their living by taking care of actual human
    beings.  I got my bachelor’s in classical Greek, but the classical Greek
    wasn’t the point; I got good training in writing and critical thinking
    at a liberal arts college, and my area of focus just happened to be
    Greek. Why should studying Chinese medicine only be available at a
    (highly dubious) Master’s level? Why not learn from the nursing
    profession, which has multiple entry level points at both public and
    private schools?
    The minimum requirement of 1905 hours of training in acupuncture
    alone is not necessarily an issue. If we really wanted to ensure that
    graduates were fully prepared to practice clinically and to run their
    own business, we could easily spend 1905 hours doing so. However, the
    proportion to classroom hours vs. clinic hours is a problem. That an
    intern can currently graduate having performed only 250 treatments in
    clinic is appalling from my perspective as an employer — especially
    considering how much that intern has paid for a supposed “Master’s”
    degree. What community acupuncture employers want are graduates who are
    competent in high volume clinic settings, which means lots and lots and
    LOTS of clinical practice — with real people as opposed to other
    acupuncture students. The community acupuncture movement also needs
    graduates who are genuinely prepared to open businesses, which means
    that they would know what a high volume clinic looks like and how it
    functions; they would have real world skills in book-keeping and a
    working knowledge of how to be an employer. Currently, however, most
    graduates only have experience of working in school clinics which only
    continue to exist because they are indirectly subsidized by student
    loans, not because they could function as free-standing businesses.
    Which means they graduate having no idea what to do to succeed.
    Obviously, reforming the standards would be a huge help to us. We
    don’t need graduates with Master’s degrees; a training program is
    perfectly adequate, provided its graduates are competent. The other huge
    help to us would be a program whose didactic portion could be delivered
    via distance learning. We have potential employers all over the country
    with a possible pool of future employees among their patients — but
    very few of those patients are in a position to relocate for 3 years to
    another city. We have a great need for community acupuncture clinics in
    the South and in the Midwest; the ideal people to open those clinics
    already live there and just need access to training.
    I can be more specific about an appropriate curriculum for community
    acupuncture which would roughly correspond to current ACAOM entry level
    standards, if you like. But there is no point in designing a curriculum
    if the tuition is unaffordable due to the need to replicate

  60. Oh yawn MJ

    You seriously expect me to take what you are saying here at face value? You sound like a hack politician here and actually you sound like that on several other places on this thread too. Big statements, generalizations, and empty promises. 

    But enough of that, when are you gonna actually do something? Or just to take one phrase in your speech above, what does, “We already have blown the thing up” mean? 

  61. How is this different than

    How is this different than what thousands of others face in this touch economy? Acupuncturists certainly are not the only ones left with unserviceable student debts. Also, I read somewhere that many acupuncturists are 2nd profession students (meaning they have had other jobs before going into acupuncture). At which point does a person hold personal responsibility for researching the market they are going into before taking on student debts they cannot manage? Foreclosures, investment debts, student loans and other financial fiascoes are plaguing a large percentage of the nation’s population at present. I agree with you that the situation is untenable and needs to be looked at, but I vehemently disagree with the usage of in-group sarchasm, cynicism and verbal violence in the effort at getting there. No matter what the “others” do.

  62. I’m curious about that same thing.

    (also Michael, just FYI, you can make paragraphs if you click “input format” below the comment box and select “Full HTML.”)

  63. “Verbal violence”? Please.

    Tone policing will not work here.  Please stick to addressing the content and not the style in which it was delivered.  

  64. AOMC

    Hi Lisa, thank you very much for this thoughtful reply. It will take a bit to think through this and reply but I will do so in the AOMC as it is easier to follow an entire conversation there for me. As I have mentioned before, I don’t think these problems are unsolvable or even that difficult to solve necessarily from an infrastructure perspective. Take care.

  65. Skip, what I am “promising”

    Skip, what I am “promising” here? transparency? work? be specific about the “empty promises.” In terms of structure, we have completely redone from scratch our entire bylaws (14 month project of regular weekly work/analysis/review), committee/taskforce structures and participants, are finalizing a financial and governance audit, removed all previous staff and hired new staff, brought on new directors, have asked student organization volunteers to attend and CONTRIBUTE to full board meetings. This is but a portion of what we did do and it took a team of us a good 18+ months of regular work to complete. Annual Conference is still happening, International representation still happening, community dialogue still happening, membership is finally growing again, actively pursuing licensure in remaining states, legislative/regulatory monitoring, pushing for educational and governance reform, amongst other things either in progress or not being listed. These are things that I am personally involved with, I am sure there is more and this is only the beginning given the small team of volunteers and staff rebuilding the current structure.

    So…. what have you done for the profession? does it make you feel empowered to call volunteers political hacks? How about educators, school owners, acusupply company owners, boutique acubusiness owners? regulators? researchers? which attacks makes you feel the best, I am curious. Has it been working for you? What have you accomplished through your attacks?

    Nora, thanks for the tip regarding “input format! Very helpful – I wonder if there is a way to make HTML the default input format.

  66. Same old same old, MJ

    Its been studied to death that when a new regime comes into a workplace they make all sorts of changes but they almost never actually change what happens. This is what you are doing-feeding your ego but not actually doing anything.  And now when I ask you what you mean by one specific phrase you do the simplistic hack politician thing of trying to attack your questioner.  But I am not the issue here. You are your promises are.

    MJ, the Profession is in a state of perpetual reorganization because it has no money. (Or I should say the Acupuncture Profession is that way. The similar Acupuncture Education is pretty rich and relatively much more powerful though they are disorganized also.) Dozens and dozens of people like yourself have tried to improve things over the 18 years that I’ve been an acupuncturist who has made his living solely by you know, actually needling patients. My two clinics now see a combined 650 patients a week and are still growing. Several years ago I got tired of all the posturing and failure and actually did something: co-founded CAN. You, on the other hand, are just the latest hack politician to come along. Like many before you, you went after the target (AAAOM) that was and is one of the weaker organizations and also one that has almost no power associated with it. Now you think you are important. You haven’t even started.  Part of me is inclined to pat you on the head, say, “there, there”, chalk you up for being yet another fool, and move on. But hey, I might as well give you a warning here. 

  67. thanks dad

    You are entitled to you opinion Skip. I am curious as to where and how this has been “studied to death.”

    Btw, those unwilling to go in and fix professional structures love starting new organizations. State, national, what have you. We (our profession) can continue spawning new organization until the end of time and we will end up straight back in the place we started.

    Btw2, the vast majority (almost all of us) that volunteer in the professional space are making our money treating patients. The number of patients you see per week doesn’t really mean anything for me in terms of your service to the profession.

    Btw3, go ahead and continuing patting me on the head dad, thanks for the lecture/warning.

  68. yes we already have alot of

    yes we already have alot of what you said but what we dont have is a lot of room at that level for employment and it does not seem to be expanding.

    i would argue that spending all or even the majority of time and resources promoting “advanced practice AOM” is a waste as this is a small market.  it has little to do with patients and more to do with ego.  It leads to an educational product that is not sound.

    yes consumer beware AND the AOM world has a reponsibility to offer a strong educational product.

    my suggestion is to refocus on an area that is expanding rapidly.  and that is CA clinics.   to maximize growth in this area we need- as others have said- cheaper and more accessible education that is focused on application of acupuncture and not theory.

    i hope that is more clear.



  69. ???

    Michael, you say “the number of patients you see per week doesn’t really mean anything for me in terms of your service to the profession.”  If treating (lots of) people with acupuncture is NOT the raison d’etre of the profession, what is?  Seriously.  I need help understanding.  I suppose, without an emphasis on patients, the profession could be a kind of Preservation Society…is that what you want?

  70. and there it is!

    MJ sums it up best:

    he believes: “we must separate the medicine from the profession”

    and we believe: that it’s time to get the medicine back INTO the profession, in the form of people actually getting it.


    “the number of patients you see per week doesn’t really mean anything for me in terms of your service to the profession.”

    wtf?? which “profession” are we in without the medicine? without serving patients?

    or is that the crux of it, some like to be in the profession of “being in the profession?”



    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  71. Wow MJ

    It sounds like you don’t value the core of the profession, which is taking care of patients. How can you be leading an organization supposedly for practitioners?

    It’s a short distance from that place to just looking to accrue power by supporting the FPD.


  72. Now we’re talking!

    This is great information. Thanks for this post Lisa.

    With Jerry Brown back in office  (the governor who signed acupuncture into law during his first stint) California is ripe for another bellwether change in the profession! State schools here we come. 



  73. what on earth is a profession

    Hi Nora, thanks for asking for clarification instead of rushing to take my trachea out.

    “service to the profession:” literally meant to me service to your professional organizations (in context). Here is the wikipedia version:

    definition: “A profession is a vocation founded upon specialised educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain.”

    formation: “A profession arises when any trade or occupation transforms itself through ‘the development of formal qualifications based upon education, apprenticeship, and examinations, the emergence of regulatory bodies with powers to admit and discipline members, and some degree of monopoly rights.'”

    The purpose of any profession is two fold in my simple view: 1) to protect the economics and branding of a trade and 2) to create a structure for engaging patients with globally understood, high ethical, educational, and regulatory standards.

    There are exceptional practitioners in a variety of medical systems and traditions that don’t claim to be a Licensed Acupuncturist or a licensed anything for that matter. They practice outside a professional infrastructure. It is truly up to the patient to protect themselves from scam artists, sexual predators, and the like.

    A profession as defined above is a community entrusted by society to train, regulate, and in some cases police itself. That is the concept of professional licensure, etc. People are going to school to practice needling, that would be stupid. I would tell them to go to school to be a nurse or a tattoo artist. They are going to learn the practice of the medical art of acupuncture as we understand it in 2011.

    The reason why people drink the juice and go through the pain of becoming professionals is because they want the society right (and economic reward -haha) to hold themselves out as practicing that trade. The trade that is globally know by those standards. It is a relatively simple system that is designed to be contained and worked on by the practitioners. So, volunteer service to the profession can manifest in many ways. 1) a practitioner can be on the state board either determining regulators or hearing cases on practitioners that have done something wrong and need their license revoked, 2) a practitioner can serve in a professional society that generally speaks on behalf of the professional infrastructure/establishment and like a union of some sorts is supposed to fight for better economic/working conditions for their community, 3) a practitioner could serve on a committee/task force/workgroup assisting with peer review of policy, procedures, research, articles, or other products, and 4) volunteer to sit as a director on an organization that stewards an adjunct organization to the professional association like ACAOM or the NCCAOM to ensure that standards for training and public safety are completed to the highest possible level.

    When one is in a profession/trade and they are seeing patients, they are serving two parties – the practitioner and the patient. When seeing patients one might contribute to the overall well being of the patient, possible impacting the overall health of society, and if they are reinforcing the profession might even be serving the profession but the core two stakeholders remain the same – the patient and practitioner. So, yes Melissa- the “medicine” and all the knowledge, patient goodness, traditions, and society advancement is indeed separate from the “profession,” the vehicle for the trade.

    Hello there Skip, feel free to continue writing all the conspiracy theory you like about myself, the FPD, the alphabet ors, Startrek, and the like. I am not asking people to trust me here or anywhere for that matter, everyone has the internet and is welcome to do the research and come to their own conclusions regarding professional and educational infrastructure and the like.


  74. Been catching up on this dialogue; hopefully on point here…

    Michael J, do you not see what Skip, etc. are attempting to shed light on?

    The Professional Acupuncture World and its associated legalese is inconsequential to the people for whom it simply does not exist – the much-mentioned 70% of the population.

    These are the people who CANers give the most shit about. Period.

    As I have witnessed it over the last 10 years as a licensed punk, it has not been the national orgs, nor state assoc’s who have made this value system priority No. 1 – and so as others have mentioned, trust and faith and interest in these orgs has collapsed.

    Offering up your own expanded definitions are entirely beside the point. Instead we value *concrete action* on behalf of our patients/communities/populations heretofore invisible-to-The-Profession.

    When we see this – with consistency – you can count on CAN to begin showing a great deal of interest and support.

  75. Michael, you say:

    “pushing for educational and governance reform” – what do you mean by reform?  What kind of educational reform, specifically?  Because you can see that *might* be one of the few areas where we could possibly, POSSIBLY work together.  What’s your platform, specifically?

  76. 10 year report

    10 years ago I wasn’t even thinking about acupuncture because I couldn’t afford it, didn’t know anyone who could afford it, and didn’t know of anyone getting acupuncture.  And that’s when I was hanging out in Boulder, CO, right next to Blue Poppy and an Acupuncture school, spending time running around with a bunch of Naropa students and other new-agey fringe culture types who you’d expect to support such exotic activities as acupuncture.  The first I heard much about acupuncture was reading about NADA through my interests in harm reduction and drug policy.

    Further, since it seems you’re getting the wrong idea, no one here thinks Skip is perfect.  I mean, he’s a decent enough guy and all, but perfect?  C’mon!

  77. defanged

    Hey Andy, my perception is that I understand their point. Let me try to flesh this out a bit.

    I could be wrong, and would like to have real dialogue about this, but my sense is that the structure/profession/whatever we want to call it – is only irrelevant because the structure hasn’t been right and the right people haven’t been running it. This is why I spend so much time attempting to restructure and recruit those poor passionate souls willing to fix it with me.

    Here is what I understand to be community perceptions of the professional associations, feel free to add/subtract: The professional associations are somewhat irrelevant/unimportant to acupuncturists, one indicator is the sheer number of members
    Little to no tangible valuable membership benefits (aka: products) have been created/deployed let alone been consumed
    The professional associations are locked into the broken business models being encouraged by the trade schools
    The professional associations have not brought accountability to the educational institutions that create poorly constructed programs that have little care or regard for the students they graduate and the success of those students
    Certain members of the establishment have abused the system and practitioners for considerable personal gain
    The practice of the medicine and patients/practitioners isn’t the core focus of the profession but rather the training of professionals has been the focus

    CAN approach as I understand it:
    create a working business model or franchise model that creates jobs and brings access to an underserved group (working class)
    encourage frank debate and dialogue on issues that the profession has been unwilling to engage
    induce enough chaos into the system in order to break up the stagnation
    burn the establishment to the ground and rebuild something entirely new

    Jabbour approach as I am living it:
    create a variety of working business and jobs to bring access to a host of underserved populations
    encourage frank debate and dialogue on issues that the profession has been unwilling to engage
    induce enough controlled chaos into the system in order to break up stagnation
    gut the structures, restructure, rebuild to be strong, competitive, and globally accepted

    Have I missed something? -MJ

  78. dream killers say:

    Why do you establishment folks always think we want to burn you to the ground and rebuild?  Can’t you see we’re already busy building?  We can’t be bothered with destroying what we don’t absolutely have to.  If nothing changes The Profession will destroy itself of its own accord.

  79. MJ yes, you have.

    I don’t see CAN burning down the establishment in any way – or even keeping the status quo from spinning its wheels. Rather I see this org moving ahead in its own image, based on a value system partially aforementioned and fueled by groups of people who are *interested* in what we are up to.

    Michael, here’s what ‘controlled chaos’ means to me:
    using the familiar but week-old wilted spinach, as opposed to trying the just-picked, fresh swiss chard for the first time.

    CAN is stepping out to ultimately serve a dish that we are happier with. This is what we are wired to do.

    The MJ approach is to warm up the leftovers because it’s safer and it’s what yr wired to do.

    If paths should cross and we can help one other w/o losing sight of our organizational goals & interest, so it shall be.

  80. “High expectations are the key to everything.”-Walton

    I am going be going through this in detail with Lisa in the AOMC. The structure needs to be rebuilt. My current take (not completely informed by focus groups) is that normal entrance criteria (probably a BA/BS with parts of premed), remove poorly taught biomed and unnecessary AOM competencies from Masters standard – that should keep it sub-two years. Then formalize what we currently have as the a professional doctorate but include systems-based medicine and again remove the ungrad work. FPDers will probably need to have extenders in order to make a variety of models work, this is however unsubstantiated.

    Either way, I am not attached to the structure – I am only attached to creating an open, transparent process for restructuring that includes in that structure the highest possible levels of education for those who are willing and able to consume (aka: post grad clinical and research work).

    If you have any preliminary thoughts or reactions feel free to share them.

  81. burn baby burn

    1.If you are busy building then I suppose you are the establishment folks.

    2. I think burning the structure to the ground is something we can collaboratively agree probably needs to happen at different levels and in different areas. Some burning is controlled and some not so much.

    3. I agree completely, if nothing changes the profession will just finish itself off and will need no help from any of us.

  82. controlled chaos

    Your perception of my approach is not accurate nor is your perception of my definition of controlled chaos.

    In my view controlled chaos is watering the building down and asking the residents next door to evacuate before you implode the building.

    The board depends heavily on the perspectives of those that just graduated and students but uses the experience of the older guard and institutional memory to not repeat mistakes of the past.

    Recycling an entity and restructuring an establishment is not comparable to warming up leftovers Andy.

  83. MJ, I don’t intend to throw barbs for its own sake…

    …I’m just using an off-the-cuff metaphor.

    …and responding to the points you make that are off the mark, IMO.

    I know you care a helluva lot about what you see is the best way moving ahead. CAN-folk do as well.

    We just seem to have a different sets of compasses and methods of doing so at the present time.

  84. preliminary thoughts on entry level requirements

    We have such great acupuncturists working at WCA that I hate to use superlatives about any of them, but I have to say here that the person who has historically been our most valuable employee — or at least set the standard for everyone else (gets great clinical results, patients love him, consistently treats 100+ patients a week, spectacular work ethic, volunteers behind the scenes for CAN) — does not have a bachelor’s degree. He went to a non-US acu-school very soon after graduating from high school. Not having a bachelor’s degree in no way limits his effectiveness as an acupuncturist. If we could clone him, we would not need to worry about anything else.

    Another pressing issue is that community clinics desperately need acupuncturists who represent the communities we are working in. We need more acupuncturists with working class backgrounds, we need more acupuncturists of color. Diversity goes up when barriers go down. I am going to insist that our current requirement of 2 years post-secondary education is quite sufficient. We don’t need a Master’s degree. We need a training program — call it a certificate or call it nothing at all, I don’t care.  I got all the premed requirements myself because I was going to go to med school; organic chemistry and physics and calculus were fun, but they don’t make me a better acupunk.

  85. clarity

    I get that Andy, my sense is that you aren’t a person creating chaos for the hell of it. If you feel comfortable to dialogue this way, let’s take the points presented and try to clarify them further in plain English. I want want to represent the CAN position and I wouldn’t want someone that has never spoke with me in depth representing my position on any particular issue. Let’s try to nail down positions, paths, and compasses in plain language and see where we go from there.

    Even though I use digital communications including e-mails and forums like they are going out of style, there is nothing that could replace in person discussions and dialogue. The one thing I want to try to hammer out is some basic principles driving us apart because I just want to be as sure as I can be that there is some fundamental difference and it is not just in how my colleagues and I message versus how your community messages.


  86. entry level requirements

    I completely hear you. In terms of Organic Chem and Calculus, let’s take that off the table now rather than later. Personally, I think if you are in health care – having quality bio, chem, and physics is a good idea. The PreMed name I think is generally misleading, it is more like PreLife in that they teach the fundamentals of understanding how the world works (again jmho, not using these ideas to set policy).

    In terms of having BA/BS level clinic assistants, that is likely the definition of an extender for a person with the highest level of professional training we have. One side concern in my mind is that I wouldn’t want to put someone through any form of lengthy training and than have that not apply to the doctoral level training – meaning the entrance criteria should be as consistent as we can possibly make it.

    Community medical clinics have Medical Assistants that basically have a similar kind of education at the 400 – 600 hour training level and it seems to be working globally in the workforce (no need to reinvent the wheel), the only caveat is that they are very very limited in what they can do for a physician.

    Physicians/surgeons/specialists that have gone through extended residency programs and fellowships, research, etc. (15 – 20,000 hours of medical education) use PAs as medical assistants/extenders because physicians are too expensive and medical assistants don’t know nearly enough.

    We don’t need to follow medicine completely, but there seem to be certain structural elements that are working over there. Whatever structure we would adopt

  87. Michael,

    In your metaphor: “burning the structure to the ground is something we can collaboratively agree probably needs to happen at different levels and in different areas. Some burning is controlled and some not so much.” 

    What do you think needs to be burned?  At what levels?  In what areas?  What burning needs to be “controlled” and what burning should “not (be) so much”? 

    In what ways do you see the profession “finishing itself off”?

    Please be specific in your answers.  I would like to see where we are in agreement here.  (And just start a new, bigger comment box.  Click on the “Add New Comment” button directly under Lisa’s blog, to post your reply.  We’ll all find it.)

  88. whew!

    I haven’t been able to breathe very deeply for the last 4 pages of this post and its ensuing comments, but now, whew, finally, I have taken a deep breathe.  A fresh breath of air. Thank you, Lisa.

    Julia, AA, BA, MA, MSOM, ABD aka: $170k in student loan debt in Berkeley

  89. licensure vs certification

    Important distinction that says much about the absence of standards in acu training. License is higher order than certification, determined by statute as in law of the land (state, fed). Nearly every state that licenses acupuncture requires proof that “appropriate” training occurred and that an examination which tests what was taught in the progam was passed by the licensee. Nearly every state (excepting California with which I am most knowledgable, couple others noted here) defers to ACAOM to accredit the trainig programs. ACAOM is a monopoly. NCCAOM is the next handoff for states that do not have their own licensing exams. NCCAOM is a monopoly. California does not defer to NCCAOM for testing proof of knowledge/skills/competencies. Calif has its own exam – the CALE which is demonstrated by the Department of Consumer Affairs to be a valid test of such knowledge and skills.

    NCCAOM certifies because it CANNOT license because there are no national standards for training much less scope of practice. If there were – as there is in physician assistant practice – then NCCAOM would surely move to become the national licensing board.

    What does this have to do with CAN’s desire to propose minimum standards for training? Plenty. Leet AAAOM and CAN share their ideas. I think I have made my preferences for minimum training standards clear. Every LAc has to be abel to make a medical diagnosis to guide treatment.

  90. personal repsonsibility in researching a profession

    The high school debate analogy is helpful. I think you are talking about proclamations in the absence of data. Chopping is CAN style. Lurking is the AOM board style. I prefer chopping but woujld like to see briefer point-counterpoint style. To my point…it has not been possible for any prospective AOM student to research this profession regarding potential income or job prospects because the data have not existed. My co-authors and I recently summarized what does exist in a published article. In addition to the bleak work prospects and more recently the enormous student debt loads (publication coming soon!) it is my belief that the profession – the former acustablishment (I do believe MJ is working hard to change things) – purposefully avoided collecting such data. This was practiced by schools that made false (DOE required) reports regarding employment outcomes, ACAOM that religiously looked the other way in their on-site inspections, and AAAOM that failed to investigate charges of degree mills and unemployment. So it is difficult for me to blame the victim – the graduate. By the way, the charade continues. Look at how the NCCAOM Director amended her Feb 2010 JTA report to release more detail in September (as Lisa noted in her end-of-year column). Exactly how is that explained? She was sitting on the data for two years. We still do not know what is the average or median income – net or gross – for the 700+ LAcs who responded to the 2008 national NCCAOM JTA. She has it. Maybe she will release it another 6 months.


  91. I think it’s really important

    to look at what people’s jobs actually are, in terms of tasks and skills, and what specific training is required. I want to be clear in this case: the acupuncturist who does not have a BA is doing exactly the same work that I am doing with my BA. He’s not an assistant. He doesn’t need to be supervised by someone with a higher degree. Not one acupuncturist in my clinic — or any other community acupuncture clinic– needs a Master’s degree to perform the essential functions of the clinic. They need some basic foundations and then some very specific training. I don’t need people with graduate degrees to supervise “extenders”. Michael, I would like to ask you to please visit at least 3 or 4 truly busy, successful community acupuncture clinics. Mine can be one of them if you are able to attend the conference in April in Portland. I don’t think you have a good picture of what we are doing, who we are treating, or what we need.

  92. CAN Clinics

    Hi Lisa, I hope to attend the conference in Portland and if I am able to get out there would like to see your clinic. I have seen some CA clinics in NY and about a decade ago visited Chiro clinics doing the exact same thing.

    Regarding the educational standards for someone that practices a medicine versus someone that is essentially a technician, those ideas and options will need to be thoroughly fleshed out and submitted to the profession at large for comments (practitioners, employers, organizations, etc.).

    I personally believe in survival of the fittest ideas. Right now there is a lot of confusion in our profession and it is very disheartening. Let’s try to collaboratively get arguments on all sides as strong as we can and allow the community and ground swell to guide us.

    ps. I have watched the democracy and republic be equally destructive in governance. Hopefully we will have some combination of facts and luck to guide us.
    pss. This is my 6th attempt to figure out this hellish CAPTCHA.

  93. Community Acupuncture IS the fittest

    model for acupuncture survival in this environment and the forseeable future.  Don’t be disheartened.  The ground swell is guiding you.  As for being a technician, the employers ARE giving you comments.  They are telling you the dreams of being a “real” doctor, being employed by a hospital, working in ER, are just that, dreams.  You can talk consensus and collaboration all you want, but that’s the difference between business and academia.  Focus on the return on investment; if you want the most amount of people to recieve acupuncture treatment, where will investing your time and money and energy have the greatest pay off?  Lobbying Congress to be included in Medicare?  Do you think there’s a congressperson alive who wants to do that?  Spending years to develop “integrative” clinics in hospitals which will be the first on the chopping block when budgets get cut?  To get Medicaid?  Every state is broke!  There will be no government or insurance savior for us, people are going to have to pay out of pocket for this service, and they are going to pay  what they can afford or not at all.  If some people can get away with charging $80, good for them, but if I undercut their business that’s too bad.  I’m not going to subsidize them directly or indirectly.  All businesses in the free market face competition, unless they are subsidized, and when that subsidy goes away, they crash even harder.  Thank you for working to reorganize things in the organization, but if there is some way to deliver more care to more people more efficiently and cost effectively that we have overlooked, please tell us.