A note on synchronicity: this post apparently written simultaneously with Jordan’s preceeding one.

It’s wintertime in the cold, rainy mid-Atlantic; and, a boy’s fancy
turns to vacation, or travel. But, just as quickly, it turns to doubting that that
can really happen while running and growing a business.

For years and years, I’ve fantasized about  a
network of far flung clinics whose practitioners could rotate among
locations. It so happens that the Community Acupuncture Revolution, the
CAR, is the perfect vehicle to make it happen. So, all right, all you CAPs. Are we there yet? Have we been
doing this long enough to start figuring out work trades? We know what
we’re doing. It’s totally possible. And, I’m serious, I wanna plan a

I find that when I’m in other people’s clinics
I notice all kinds of important things that either I forgot or I never
thought of. We need each others’ experiences. Our patients need us to
get out now and then. And, how attached have we gotten to being THE
acupuncturist for particular patients? It’s the acupuncture itself,

Oh, and all you people thinking about starting a community clinic by
yourself, imagine how much easier it will be for you to get away if you have a partner to orient
the acupuncturist-in-residence with whom you’re swapping clinics.

my mind
really enjoys these fantasies. In one, I’m living in the Mission in SF for
two weeks, eating lots of yummy Mission food, taking walks and playing
soccer in Golden Gate Park. Meeting all the wonderful people in the
Circle Community Acupuncture community. In another, I’m having book and music conversations with Nora after treating some people in Detroit. In another one, I’m working in Manchester, getting to treat my mother-in-law a few times. (Wow, that’s an embarrassing fantasy.) In another, I’m feeling the dry Tuscon air and smelling the desert on my day off from Tuscon Community Acupuncture.

Unfortunately, the fantasy is
rudely interrupted by the prohibitive expense and insane
particularities of state licensure. 

let’s think Big and Fun….. as in….. our lives. This is the kind of future for CA that I want. More connected to each other. Less bureaucracy. More
acupuncture for more people done by healthier acupuncturists.

And, I want to go to San Francisco, man.

And Austin, Denver, Minneapolis, Santa Cruz, Chicago, Seattle, Asheville, Bozeman, Brooklyn, Boise, Olympia, etc.

Korben Perry
Philadelphia Community Acupuncture

Author: korben

I'm an acupunk and owner at Kindred Community Acupuncture in Pawtucket, RI. I co-founded Philadelphia Community Acupuncture in 2007, and moved to Providence in 2011 to be close to family after the birth of my son, and to work with the inimitable Cris Monteiro at PCA.

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  1. clinic swapping!

    i love this idea korben. i’d love to have you as a “guest practitioner” in our clinic sometime, altough you might find it a bit slow, compared to yours at this point.

    hey, does that mean we get to stay at the house of the person we are “swapping” with? Laughing

    i wonder what the various state regulations are around having someone come in to work as a “temp” with a license from another state. i tried to look this up for california, but could not find the answer. anybody know? perhaps acupuncturists without borders would know because i am sure they have had to deal with this.

    it’s a great vision, though: a global trotter community acupuncturist, a modern barefoot doc… i want to go to: philly, asheville, austin, victoria(bc), providence (rhode island), minneapolis / st paul area, chicago… to start with.


  2. Temporary License

    When teachers such as Dr. Tan travel from state to state, they get a temporary acupuncture license from the state in question.  I know because one time they failed to apply in time, and I was one of a handful of ‘punks who got to put in needles for the good Dr.

    Thanks for thinking “outside the clinic” Korben, I love your idea.

     Here on Cape Cod, I had despaired of ever taking time off in the summer….



  3. Just tonight

    while fighting with mr woodstove as he threatened to go cold on me after I tired of feeding him hard woods, I thought:

    Too bad a punk who’d find a winter blackout in the woods charming isn’t up here working with me tomorrow!

  4. Hi Diana. Unfortunately,

    Hi Diana. Unfortunately, there are many states that don’t offer a temporary license, e.g., Virginia, Tennessee, North Carolina, Georgia, Florida, etc.

  5. Hell Yeah!

    You are very welcome to come poke at the Circle CA.  We’d be happy to let you “teach” at our clinic in order to get that temporary-vacation-license. Although, we’re not quite in the Mission — about 15 minutes walk away.  We are in the more transient SOMA neighborhood with all of the nightclubs and bear-bars.


    By the way, I’ve always wanted to visit Philadelphia.  For some reason, I’m really attracted to the place even though I’ve never been.  I think it has something to do with a bunch of collge friends from there, an old girlfriend from there, and a love for Siltbreeze Records during the ’90s. 

    If I ever do a Philadelphia CA vacation stint, can I wear my “I’m Not Angry, I’m From Philly” t-shirt?



    Circle Community Acupuncture

    San Francisco

  6. love it!

    I think all CANers should have that shirt (angry? us?) 

    I also love this idea, Korben.  First of all, I love that you love your job so much that your idea of a vacation includes doing some needling!  And I love the “new pair of eyes” thought; and I can only imagine the great conversations about community. 

    We have a small fold-out bed here for anyone who’s not allergic to cats (you could probably sleep at the clinic if you were!)…and anyone who isn’t allergic to gray weather is welcome to come to Detroit this winter!

    Regarding licensing: isn’t there a way to let someone practice “under” your license (as students do in the school clnics)?  I think I can trust any one of you not to damage the patients and lose me my license (that is, when there is a MI license).

  7. The things cold weather make you want to do…

     It’s cold here, like -8 right now, and suposed to be -25 tonight.  So naturally the thought of being somewhere else has crossed my mind lately.  And I was actually contemplating this very thing yesterday afternoon.  I think it would be wonderful to get to check out a new city/ CAP/ comunity of people.  It would be totally cool to be able to travel to another CAP for a vacation or perhaps 3- 6 monthsand really get a feeling for a new palce.  Yet still be working and making a living.  

    It would be nice if all the states had temporary licenses, or if there was a national license.  However, if you planned far enough in advance (say 6 months) you could just get a license in the state you were going to visit.  Obviously this wouldn’t work in California, and it could be expensive. But I think that if someone wanted to get a license in MT it costs less than $150.

    Seems like a national license would be an easier way though….


  8. That is because the north

    That is because the north carolina board has no ethics. 

    if you go to the NCALB website and click on ethics, you get a blank page.  Oh, state board of mine…………………

    Korben, I love your idea also.  I think it’s funny how we all sound like McCain.  We are calling for acupuncture “deregulation.”


  9. less than $150?????  That

    less than $150?????  That is  amazing.  It costs $600 to get a NC license and $300 to maintain every 2 years.

    One license, under CAN, with acupuncture and social justice for all

  10. a patient perspective

    korbenp wrote:

    >Our patients need us to
    >get out now and then. And, how attached have we gotten to being THE
    >acupuncturist for particular patients? It’s the acupuncture itself,

    Good questions, to which I feel the need to respond as a CA patient.

    No, it’s not just the acupuncture itself. That undervalues the human relational aspect of what you all do. Continuity and context are important. Frequency of contact builds a kind of context that is not all in the chart. It’s not just the needles. It’s in your fingers, in your sense memory, in your ongoing familiarity with your patients’ physical/emotional affect and changes over time.

    Maybe that’s more important for some of us, who need to be treated long term. Maybe it’s more true for some of us who have been badly treated in an increasingly over-stressed Western medical system, where some people don’t even bother to learn your name, let alone build a relationship with you as an individual. The trusting relationship is part of the healing. At least, that’s what I believe.

    Sure, acupuncturists need to get out, take vacations, go to seminars. Patients know you’ll be unavailable from time to time. But handing me off to a “visiting acupuncturist”, someone I don’t know at all, from a different part of the country, would strike me as treating me like a timeshare. When my practitioner needs to hand me off to a partner, that’s different. A partner is someone who has at least seen me in the clinic a few times. I know them, at least a little. They know me, at least a little. That’s part of what makes it a community, yes? A real, face-to-face, non-virtual community? That’s part of what makes community acupuncture unique, yes?

    So while the fantasy is a pleasant one, and many of the ensuing comments have been very sweet demonstrations of your camaraderie, I have to ask, what would patients get out of it?

  11. I can’t thank you enough

    for your comments.  We knew intellectually that we were missing the voices of the rest of the community beyond the acupuncturists, but now I FEEL it.

    Please, prick and provoke us more and invite your friends, too 🙂

    And indeed, aren’t we here for the patiets?  Thanks for the reality check!

  12. Wisconsin’s license cost $35

    Wisconsin’s license cost $35 when I first applied.  I see that it’s up to $53 now, what with the recession and all…

    MD is closer to $400.  But there are no temp licenses available here.

    This temporary licensing issue has come-up before, in a blog about doing ACWB emergency-type of work.  Is this something that we could enact on a federal level–one national law for temporary licensing–or do you think it would have to be done on a state-by-state basis? 

  13. continuity and context

    Pricked and Provoked,
    One of the very special features of the
    Community Acupuncture Network, thanks to this virtual discourse, is
    openness and transparency. One result of this is that thoughts and
    ideas, like the one in my blog entry, sometimes emerge in public print
    before they’ve either cohered into an actual plan or disappeared. One
    can tune in and witness a collective imagination at work. Ideas develop
    or dissolve.
    But what always remains and usually shines is a
    core of people trying to figure stuff out about two things, really:
    1)making acupuncture affordable, accessible and effective in a
    community setting while 2) being able to create sustainable jobs for
    acupuncturists who need to be paid and who, like most everyone else
    want out of isolation and into community.
    Thank you for your
    feedback. I sure agree with you about continuity and context. It’s one of the
    main reasons I’m doing community acupuncture. In our case, here in Philly, patients get to have long term relationships (continuity) with we three practitioners and the clinic itself (context).
    This means a much greater likelihood that the treatments make a big
    difference in patients’ lives, and it means that we get to have much
    deeper relationships with the people who we care deeply about and with
    the medicine itself (further learning).
    I’m quite confident
    that you, as a patient, have found it true that your
    CA practitioner(s) are not exactly jet setters, recklessly shuffling
    patients around in order to take their next trip. That’s laughable, and
    I know that’s not what you’re saying.
    you no doubt know the following, but let me paint a little picture, for
    those who’ve never experienced CA, of what the relationship is like
    between patients and practitioners at Philadelphia Community
    Acupuncture. Most CA centers/clinics share these details, but I’d love
    to hear from others.
    I’d say three fifths of our 750 – 800
    appointments a month are made up of people who only see one
    acupuncturist. Another fifth is people who are usually treated by one
    practitioner, but who are happy to see someone else when it means
    scheduling an appointment at the right time. Then, the last fifth is
    made of people who see two or all three of us, as they need to come
    three or more times a week.
    I just got a really sweet email from
    a patient who is seen by all three of us. He hadn’t been here for a
    couple weeks (very unusual), and just felt like checking in, telling us
    how the improvement in his health was “holding” (he had taste, and
    smell, and clear nasal passages for the first time in many many years).
    He made sure to tell me to pass on his very personal note to Ellen and
    Rebecca, and that he was looking forward to coming back in to see us
    another story about continuity and context. I just came home from my
    shift at the center. One of the people I treated had had a horrible
    experience with a boutique style acupuncture clinic in the past which
    left him wary about needles and the whole experience. Among the things
    that were hard about his experience was him being left alone in a dark
    room with no explanation of what he would feel, this while being a
    person who was seeking treatment for anxiety and depression. While
    treating this person, I let him know that while i wouldn’t be able to
    stay beside him while he rested with needles, he would be in a room
    with many others including myself and another acupunk nearby. That we
    were a glance away from being able to check in with him. Once the
    needles went in, my patient had a huge cry of relief about the safety
    of the room.  I came by a couple times to say it was totally okay to
    cry, plenty of room for it. I know my partner made eye contact with him
    a couple times, too. He was able to really relax after a while, and
    walked away feeling really good. Anyway, there’s another example of
    patient is only going to be in Philly for 2 weeks, and yet he’s started
    a sort of intense process with the acupuncure he received tonight. He
    happens, however, to live in another city with a fabulous CA clinic,
    started by a wonderful practitioner with whom I’ve worked before. It
    was very nice for both me an the patient that I could confidently
    recommend that he continue getting treatments with this acupunk and his
    partner. And, that’s continuity.
    Not only do acupuncturists need to leave town now
    and then, but so do patients. We’re trying to figure out how this whole
    network can be truly supportive of both patients and practitioners, as
    well as other employees.
    So, to answer your question about
    what do patients get out of this. They get the same thing the
    practitioners get: a sustainable, nation-wide, or better yet,
    world-wide network of clinics and practitioners who are supporting each
    other and are connected and close to one another and know how each
    other works.

  14. Maybe we need to start a thread of getting out of state license.

    Sometime this year my husband and I will need to spend some time in Hawaii again, to finish up details of my mom’s estate.  If you and Amy come, you can work in my stead 3 days of the week, sleep in our apartment in our bed, use my car (at your own risk, of course) and spend the rest of the time exploring beautiful west Marin and the City, visiting Circle A. and the like.  That way you’ll get your trip, earn money, my patients won’t miss their treatments.  All we have to do is get the licensing thing down.

    Since my patients know that I’m leaving next year, they have been introduced to the idea that someone else (hopefully) will be taking care of them in the future.

  15. more from me


    I thank you for your lengthy, thoughtful and thorough reply. It was, dare I say it, considerably more circumspect than the original post. I’m actually quite familiar with Internet-enabled radical transparency within other contexts. It was also my impression that I, as a patient, was already somehow a part of this network (that’s what the CAN homepage says anyway). My comments were offered in the hope that patients can do more than “tune in and witness”, but can actually contribute to the “collective imagination” of which you write. With that in mind, I’ll prolong the discussion, with some rhetorical questions thrown in as food for thought.

    Korben, your practice details are revelatory. Look at what you are saying: 60-80% of patients in your practice start from a preference for a relationship with single acupuncturist (which tells me that I may be in the majority, and not an outlier in this). I, too, would be very interested to learn if this is a pattern elsewhere. If so, why is that, do you think? Have you asked your patients about it? And have you (and any of the rest of you still reading this who so readily jumped on board with this idea) asked your patients how they would feel about being treated by an out-of-town guest? Perhaps not, because the idea was presented as more of a what-if than a serious proposal, and it appears that the licensing obstacles may the major hindrance. But if patients do have that basic preference, what would be a patient-centered way of bringing in a guest acupuncturist? Could creative use of technology overcome some of the initial unfamiliarity and resulting resistance patients might feel? I’m sure you know that patients will have a say, whether they get the opportunity to express it overtly or not. What are the models for these kinds of guest or substitute or reciprocal arrangements among other health care professions?

    As far as your last paragraph, in which you attempted to answer my original question, I have to say that, for now, I am unconvinced that cross-country work trades are essential for this network to function and flourish as envisioned. Thanks to the brilliant, dedicated work of its founders (including creation of this website) and the participation and visibility of its passionate, skilled and committed practitioners (including you, Korben!), as a patient I feel like I can already self-refer if I am moving around. Were I in Philly and needing acupuncture, I would not hesitate to visit PCA. Likewise, this network already enables you to refer patients to other CA practices. If you are uncomfortable doing that without in-person familiarity, I’m sure you can see that it comes down to the same factors of human nature that make it difficult for me to feel comfortable with the idea of my treatment being handed off to someone I’ve never met. It’s all a matter of who’s in control, who’s making the choice.

  16. You’re right; I remember Jordan saying something about this.

    There could be an oversight agency (even NCCAOM could do it; they have the structure, and they’d love the extra dollars) that would put out an application for state-to-state temporary licensing, receive and review the CEU and licensing docs we’d submit, collect a small fee for the ID card that could be downloaded and printed out from their website.  That is, if they agree to do this at affordable rates.

    To get the persnickety states like California to agree, that would take some kind of lobbying, maybe another grassroots movement with nudges from the federal government?

     Wonder how Jordan feels about this?