Are AOM Students Being Misled About Their Career Opportunities?

Are AOM Students Being Misled About Their Career Opportunities?

Since publishing my practice-building book a year and a half ago, I have had the chance to give several courses on practice building, speak to hundreds of students and recent grads, and brainstorm with many of the most experienced practice building teachers in the U.S.  These activities followed 2 years of close communication with the founders of the Community Acupuncture movement – the paradigm-breaking juggernaut that is now the most widely used practice model in the U.S. The one common thread I found from my interaction with all of these sources is the realization that the vast majority of students coming out of our AOM schools don’t have a grasp on what is needed to turn their training into a financially sustainable career.  

As Al Gore noted, some truths are inconvenient. They can also be uncomfortable and awkward, especially when being pointed-out by respectful colleagues. I personally know some of the heads of our leading AOM schools and consider many others I don’t know to be colleagues so saying this is awkward: Many of our schools are misleading AOM students about their career opportunities. I am not saying school officials are consciously lying but that the information being offered-up about careers in AOM is misleading – obscuring the known negatives while building-up false positives with flawed statistics.  This leaves many AOM graduates completely unprepared for the career realities that await them, hinders their chances for success, and is wounding the AOM profession as a whole.

Before citing specifics, let me first state that I am not saying our schools have a responsibility to make sure all prospective students have a clear picture of AOM career opportunities. It would be good of them if they did but it really is the student’s responsibility to do their own due diligence.  However, schools do have a responsibility and moral obligation to not knowingly give misleading information about career prospects when a student or prospective student attempts to do their due diligence and that does not appear to be happening. Case in point: Look at the information given on the Council of Colleges of Acupuncture and Oriental Medicine’s (CCAOM) website under their Career Opportunities section of both their Student and Career Councilors tabs:

“AOM practitioners can create financially supportive careers with flexible work schedules that are rewarding on many levels….. The settings in which AOM practitioners work vary from a multi-disciplinary clinic with other health care professionals, to a hospital, to a private practice. Other career options include teaching, translating, publishing, research, or working with an herb or acupuncture supply company.”

This list of at least eight different settings makes it sound as if there are lots of options for anyone entering this field. The problem is that the best information we have tells us that 88% of AOM practitioners are in solo private practice or otherwise self-employed (from NCCAOM’s 2008 Job Task Analysis). So while the information given on CCAOM’s website might not be an outright lie, it is certainly misleading. If 9 out of 10 people entering this field end-up self-employed, don’t you think schools have a responsibility to tell prospective students up-front that actual jobs in places like hospitals and research facilities are extremely rare and their best chance to create a “financially supportive career” is being self-employed and especially, solo private practice?  CCAOM is made of representatives from more than 50 AOM schools and their website is a logical place for anyone thinking of entering the AOM field to research their career options. Having misleading information on their website is a dark mark on the integrity of all our schools. This organization claims to be “Committed to Excellence in Acupuncture and Oriental Medicine Education” but apparently this commitment has little to do with teaching how to earn a living in AOM.

The fact that self-employed private practice is the only viable career option for the vast majority of our AOM graduates may be an awkward, inconvenient truth for our schools and their students, but it is the truth. This is the “negative” that is being obscured I mentioned above. Entering into private practice requires an investment of many thousands of dollars in start-up money and usually requires many more thousands of dollars to live off of before a practice is established enough to actually earn a living-wage profit. Start-up businesses also require long hours, a smart game plan, and hard work. I can tell you from all the conversations I have had over the last years with students, recent grads and others involved with practice-building that few of our AOM students are being told that they will need to invest many thousands of dollars on top of the money they already invested in their tuition not to mention the crushing burden of student loan debt interest. Even if an individual school has a decent, reality-based practice management course, by the time students get to that course it is often too late to set them straight.  

The thing that is so frustrating to me is that I am one who actually believes many of our AOM graduates CAN build successful, rewarding careers in private practice if they were given the right information from the start. I am working at trying to share what I learned from my 27 years of full-time practice and to support others trying to build their practices. The problem I have found is that because students have not been told first off that they need to be prepared for the realities of practice building, they balk (to say the least) when someone like me tries to give them real-world advice. It is a hard truth they are unwilling to accept because they were never prepared for it as they should have been.  

In addition to glossing over the evidence that private practice is the only viable career for most entering the AOM field, the possible income figures offered-up for AOM practitioners are all flawed and inflated. There are two major mistakes that keep being made in the few attempts there have been to measure income levels for AOM practitioners. One is that these income surveys ask for the “gross” income or terms to that effect. Asking gross income is OK when asking those who work as employees and get a paycheck that states their gross (before tax) and net (after tax) incomes but not when 9 out of 10 people being surveyed are self-employed and have overhead expenses. Without going through the trouble to make sure that you are not mixing-up the “gross” income of a business from the gross taxable income of the business owner after overhead expenses are subtracted, any figures for “gross” income are useless. Overhead expenses can run as much as 40%-50% in a practice. Statistically, that creates a huge margin of error. Confusion about those figures is a common problem as seen when the Obama administration was proposing raising the tax rates on individuals making over $250,000 and many complained that it would hurt “small” businesses because they were thinking of the total income of the business, not the taxable income after expenses.

The second major flaw in these income figures has to do with not knowing how many people who do not respond to these surveys are actually out of business and have quit the AOM field altogether. Those practitioners would likely have been at the bottom-end of AOM incomes before they abandoned their “financially supportive careers” and their lost figures would have lowered the income averages significantly.

A striking example of overestimating average AOM income figures is seen in a study titled “Changing Demographics of Acupuncturists”. It was conducted by four employees of the Oregon College of Oriental Medicine (OCOM) and published in the Fall 2012 edition of the American Acupuncturist, the (peer reviewed) Journal of the AAAOM. This paper reported on a survey conducted in 2010 and compared to a similar survey done in 2007 that was sent to OCOM graduates at years 3,5,7,9, and 13 post-graduation. The response rates were around 55% and included 82 graduates in the 2010 survey and 86 in the 2007 survey. The estimated average income for those working full-time was at nearly $106,000 per year in the 2010 survey and just over $72,000 in the 2007 while part-time income was at nearly $31,000 per year in the 2010 survey and just over $33,000 in the 2007. Again, neither survey attempted  to understand if these “gross” income figures were after overhead expenses were subtracted or not nor was the possibility of some graduates being out of practice and earning no income even mentioned as an unknown data point that would skew the estimates. While not accounting for these two critical factors is the unfortunate norm in AOM income studies, what is striking to me is that this study was reviewed by the AAAOM peer review process and apparently neither the study’s four authors nor the peer reviewers caught these fatal flaws.

I don’t want to be all negative here. I applaud OCOM for at least attempting to survey their graduates -something all schools should be doing but, I suspect, very few are. Even if the $106k figure in the 2010 survey was including rather than subtracting overhead expenses, that seems like good news although the devil is in the type of details their surveys did not tease-out. I also understand OCOM has been working with the Oregon Association of Acupuncture and Oriental Medicine on compiling research on acupuncture to educate state officials and expand the list of covered conditions for acupuncture treatment within Oregon’s public health insurance coverage. That is fantastic as most AOM professional associations struggle with resource problems and desperately need the type of help some AOM schools could provide. This seems like a great model of collaboration I wish other schools and professional associations would emulate.

To my mind, the most telling information within the Changing Demographics study was the authors admission that  “little research about the AOM profession has been undertaken, and little is known about AOM professionals. “ …. “high quality research into the incidence and specific causes for practice underperformance has not been undertaken.”…. “ the acupuncturist community has not engaged in any kind of large-scale standardized research that would settle this question profession-wide.” These statements are absolutely correct and raise two questions: Why not be upfront and tell all prospective AOM students that little is known about AOM professionals’ income but we do know that most all have only private practice/self-employment as a career option? And also – why has the research that needs to be done not been done?  

No doubt, people will say that there is no money to carry-out the type of research that could tell us what is happening to our AOM graduates. Really? Is the problem no money or no desire to make it happen? Again, CCAOM has over 50 member schools who collectively take in millions of dollars a year. True – that is gross income before overhead expenses (see, that wasn’t so hard to remember) but still, even if those schools chipped-in just 1% of their annual budgets, that would go a long way to funding the type of study that would finally allow them to be able to tell AOM students what is realistic to expect. You will never get all the schools to contribute, you say? Well, how about this? For some reason, the CCAOM has for years been in charge of administering the Clean Needle Technique process required by many states for licensing/certification. Maybe portions of those fees would be better spent on funding the type of research that would then allow the CCAOM to post fact instead of fantasy about AOM careers on their website.   

 Look, I am not being critical just to be critical. I have no doubt that schools want to see their graduates have successful careers.  I can appreciate that running an AOM school is very complicated and many constantly struggle to stay afloat. But the fact that our AOM graduates are so unprepared for the career realities that await them actually hurts the schools too. This issue has been swept aside for too long. I have no doubt that great strides could be made in career preparations if this were to be made more of a priority.  I am dedicating this stage of my career to this and would love to work with schools or AOM organizations to find creative solutions – that is, if any of them will have anything to do with me after reading this. 

Author: POCAGuestBlog

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  1. “I don’t want to be all negative here. I applaud OCOM for at least attempting to survey their graduates -something all schools should be doing but, I suspect, very few are.”
    I suspect other schools would be doing this if this revolution started in their backyard. WCA is hard for OCOM to ignore and that is awesome.

  2. Wow, such blatant self-promotion disguised as an article is…odd to see here. Kudos to you for ‘dedicating this stage of your career’ to helping people grow their practices but when I read this it just sounded like one big pitch for your business/website/course (I’m assuming you have a course you sell).

  3. Really, Stillpoint, I promise you that Matt is sincere. Unlike all sorts of other people who are teaching practice management stuff, he is for real a successful clinician who doesn’t need the extra income, he just feels for new graduates. I think it’s valuable to have his perspective out in public, because he’s not a community acupuncturist, he’s a veteran of the profession, and finally, he’s a genuinely nice person who STILL thinks something is rotten in Denmark/the CCAOM. This piece is cross-posted here because our blog has a lot more visibility than Matt’s website, and also because I think it’s useful for people to see that it’s not only screaming radicals like us who have a problem with all those “data granularities” out there.

  4. I was writing this between patients and just saw Lisa’s post:

    I thought at one time I might try to charge something for the time and money I put into what I am trying to do to help others but I was afraid that would seen as just trying to profit so I offer my time and advice for no charge. I did write a book that is for sale but I don’t require anybody to buy that to ask my advice. In a nutshell –here is the deal:

    After speaking at length with Lisa a few years ago, she encouraged me to tell others about my own experiences and career telling me I did not realize how rare my situation had been – that I had supported my family from my practice right out of school and continued to do so for more than 20 years. Once I saw the NCCAOM’s JTA stats showing 9 out of 10 end-up in private practice and most earned very little income, I decided to try to do something so I wrote a book and then started a website. I am essentially trying to do with the model I promote what the CA leaders did for the CA model by giving ongoing support to those trying to practice that model. My book was meant to serve the same purpose as the database of Forum posts the original CAN site built-up. I enthusiastically support the CA model but I know following that model is not for everyone so I try to offer another model in the hopes some can make it work for them.

    I wrote this post for one reason – to try to get the schools and professional associations to look seriously at how they promote careers in AOM and to start to offer honest information something POCA would like to see happen also. The POCA people were kind enough to corss-post from my site.

    I am fortunate that I have been able to earn a living off of my full time practice. I am not trying to earn a living off of teaching people how to earn a living – there is too much of that going on so I understand the suspicion.

  5. I came to this page directly from a share on Andy W’s facebook page, so I missed the “this is a crosspost from another website” disclaimer on the blog front page. In that context the article and why it’s on POCA’s site makes more sense.

  6. Just to make clear – when I said I would love to work with schools or AOM organizations I meant at no kind of charge. If there is a group of students within a school that would like to communicate with me the same applies. I heard from someone I know today who is on the Board of Directors for an AOM school. He told me her agrees with my points and is going to discuss my post with the administration of his school. I hope for similar reactions with other schools and organizations. We can discuss this like adults. While I have a lot to share because of the range of experiences I have had in addition to my own practice, I am not saying I have all the answers. I want to get others involved to seek solutions but it must begin with being honest with the reality AOM students face. Call it growing pains – call it a conspiracy. Whatever. Changes need to be made.

    Oh – and one thing to set the record straight: My motivation here is not out of my compassion for AOM students although I do feel for their plight. I care foremost about getting this safe therapy to the public and every failed practice and practitioner is a lost opportunity to do that. POCA is doing that better than anybody with the CA model and I hope to contribute in a similar vein. Matt Bauer

  7. So, Matt published this piece shortly after the bulk of this discussion was initiated on POCA, including the WCA-produced videos discussing the OCOM survey and the realities of working as an acupuncturist. But he published it without linking at all to the original discussion or videos.

    Here would have been a nice place for a video link:

    “when someone like me tries to give them real-world advice”

    Of course, we here at POCA are “someone like Matt,” offering real-world advice.

    No links at all to our very rich discussion.

    I see what you’re trying to do, Matt. You’re following the themes provided by the leadership and senior punks of POCA, and you’re re-writing the material in what appears to be a more palatable, friendly way:

    “I don’t want to be all negative here.”
    “Look, I am not being critical just to be critical.”

    Although you do manage to slip in just a shade of the snarky captioning tone adopted in the Gross/Net video:

    “True – that is gross income before overhead expenses (see, that wasn’t so hard to remember)”

    You’ve distanced yourself from us in time, while acknowledging a minor relationship:

    “2 years of close communication with the founders of the Community Acupuncture”

    And you’re hoping that your kinder, gentler, submissive tone will get you a conversation with “schools or AOM organizations… to find creative solutions – that is, if any of them will have anything to do with me after reading this.”

    It’s kind of odd to read your piece and watch your strategy. It’s like Lisa’s got a very sweet, well-intentioned doppelganger.

    I have this to say about working change from within the current schools and Orgs:

    I think it’s a lot like asking a BA practitioner to make incremental changes towards CA practice. It’s not going to work without a whole lot of tearing down internal pre-existing structures, and that de-programming is *inherently* painful and violent.

    “We can discuss this like adults.”

    We can, and we are. We are discussing this like angry adults who see the good intentions and hopes of the students flushed down the student debt toilet by profit-motivated schools.

    Sorry for the potty-mouth, Matt. I hope “nice” is also effective, but I doubt its power to effect significant change in a system that’s been thoroughly corrupted by easy Title IV money.

  8. HI Michelle – You have pretty well captured the basic dynamic between my approach/tone and POCA’s and by the way -you never have to apologize to me for a potty mouth. My wife cusses like a sailor and she got that from me in my youth. So you know – I actually did post a link to the first video on my Facebook page on January 18th when I wrote a Forum post: “What Did Your AOM School Tell You About Your Career Opportunities?” I had also written a Forum post on December 10th “What Every AOM Student Should Be Taught About Earning a Living”, in which I made the case that every AOM student should be taught that solo-private practice affords the most control over one’s financial destiny and that students should also then be taught the real-world fundamentals of how to establish such a practice. That is the main niche I am trying to address. So happy you guys raised this issue now and graciously allowed me to piggy-back my own thoughts even though – as I was once told by some in the acu-establishment -“You are a nice guy but your politics are weak.”

  9. ” It’s like Lisa’s got a very sweet, well-intentioned doppelganger.” Hahaha — oh wait. What are you trying to say here, Michelle? 😉

    Seriously, though, I know that’s not where this post started, but I welcome the discussion about tactics, and change from within vs. change from without, and how the liberals and the radicals can interact.

  10. Hi Matt,

    Thanks for your answer. You and I have talked a fair amount about what Lisa has nicely (sweetly) framed as the “change from within vs. change from without” strategy question, and I agree this seems like a good time to have a round of that in a public forum where more folks can chime is.

    So, if you don’t mind, I’ll start with questions:

    Mostly, I’m wondering what in the world the schools can even do at this point to set things right? In my limited imagination, I’ve got three ideas:

    1. A pre-enrollment come-to-Jesus talk about the fact that folks are going to need to have saved up not only $5-$15K to start a practice, but a good 6-12 months of living expenses (right??) on top of it when they leave school. And they’re going to need serious entrepreneurial and social skills and a huge dose of intestinal fortitude (no, students, you don’t get these when you pay your clinic supplies fee).

    But, this pre-enrollment warning seems like the Surgeon General’s label on cigarettes: hey, hey, the product hasn’t changed.

    2. Maybe they change the product. Tweak their Practice Management curriculum. Maybe that’s what you’ve got in mind – to teach them how graduates *can* in fact earn the $80-$120K per year net that they’re going to need to pay off those loans. Big blank in my mind here. Yes, *some* people will be able to do that. But, hey, *some* people play ball for Major League teams, too.

    3. The only thing I can see that would *actually* give students a fighting chance is for schools to slash their tuition by 60-70%.

    But then all the Koi would die of starvation.

    I went to Southwest Acupuncture College, and the Santa Fe campus is infamous for its grand entrance, complete with huge, multi-story Koi pond. Despite the posh abode, all through my tenure there, those poor fish kept dying off. The pond was constantly drained for repair, the fish were being looked at under microscopes in the hallway to see what killed them, and my school day always started with a waft of dead fish smell when I entered the grand, shiny, gold-and-red, origami-crane appointed foyer. If SWAC cut tuition, who would pay for all that fish food and health care?

    I’m not terribly enthusiastic about the schools coming to the table with real solutions.

    But if there really is something we want them to do that they *can* do, I am all ears. Thanks, Matt.


  11. Hi Michelle – Awesome. Thanks for your questions. I love to dig into pointed questions looking for practical solutions. I am going to give some detailed thoughts here that might make it seem like I think I have all the answers but I don’t. I would want to participate with others who have their views and work toward consensus. But here goes – First and foremost – every school should be held to an ethical standard to only give factual information regarding career realities in AOM to prospective students. I don’t know if CCAOM has a Code of Ethics for their member schools (they should) but giving honest information regarding AOM careers should be part of that code. Of course, the CCAOM would have to start by changing the information they have on their site. People will disagree over just what is “factual”. OK, if no consensus can be reached then just Goddamn say that: “There is no consensus regarding job opportunities, salaries, or other aspects of AOM career opportunities.” I would argue that the NCCAOM’s 2007 JTA stats showing 88% of respondents in solo private practice or otherwise self-employed is one statistic that is reliable (unlike the flawed income stats) so schools should be up-front about that.

    Now – as for what individual schools could do with their practice management programs. If all prospective students start to enroll knowing that private practice is their main option and with a realistic assessment of other, very limited career options, that would change the focus of most all of these programs. They could then start to focus on teaching the fundamentals of opening one’s own practice – realistic start-up capitol, budgeting overhead, cost effective marketing, and my special area of interest – how to make one’s AOM services work (clinically and financially) for both the patient and practitioner. Students should be taught about the limited resources out there to support them in their career struggles with POCA being by far the most comprehensive support system albeit for just the CA model. I am trying to build something similar for a moderate patient volume/moderate fee model (the Middle Way model) but I am just one person and if I can’t attract others interested in helping on this I may not achieve that goal. That is why I keep saying I am interested in working with AOM associations or schools.

    I would like to see some sort of forum for a meeting of the minds of those involved with practice building. I have spoken to one of the better known people out there about the possibility of putting a program together that all the schools could use (or as many as would want to). If a few of us could reach some sort of agreement on what would be a sound, comprehensive program and then produce that together, then the schools could offer that. This would make for more consistency in what students are being taught and save the schools effort and money in putting together these programs.

    Like many things in life, all of the above hinges on the will to make it happen – a desire on the part of the schools or the “profession” to take career opportunities in AOM seriously. If the schools could be pressured to give honest information about AOM careers to all prospective students, that would likely result in fewer people enrolling but far better success rates of their graduates. Better success rates of graduates will be better for the future of the AOM profession even if that means more schools go out of business during this transition to reality. Having so many students go through our schools and then drop-out of the profession because they were unprepared for career realities threatens the viability of the AOM profession moving forward.

    I agree that schools have gotten too expensive and that the rise in tuition is not at all proportional to an increase in either clinical skill or especially career preparedness. But even if the cost of AOM schooling was drastically reduced, it would not help graduates’ chances of success much at all if they are not going into their schooling knowing what they are getting into and then coming out of that schooling armed with the information needed to build a career. That is what POCA Tech is aiming to do and I applaud you guys for that. It is too bad the maze of requirements POCA Tech has to go through to develop a program leading to licensure has gotten so bloated and expensive but that is a whole other topic.

    Sorry to hear about the Koi. I guess that’s the Liberal in me. Matt Bauer

  12. Well, it’s been a while since I visited my alma-mater’s home page. When I took a look today, their landing page *is* their disclosure page, complete with median student loan debt ($104,858) and the Occupational Code, and a link to the uber-legit Bureau of Labor Statistics website for our “occupation”:

    This makes it *look* like they’re being transparent about the career prospects, and nothing more needs to be discussed. It sure looks like you can make $70k+.

    And yet, of course, there’s:
    no distinction between gross/net,
    no mention of self-employment as the predominant career option,
    not a word about the BLS fine print that says *no self-employment salary information is included*,
    no heads’ up that the data on the website is *not* for acupuncture, but for a whole bucket of “Health Diagnosing and Treating Practitioners – other”.

    It’s terribly misleading,and yet SWAC leads with it. Landing page. This puts them in compliance with the 2011 “gainful employment” legislation for private career school recipients of Title IV student loans (which then got totally gutted last year when the for-profit schools challenged it in court). Boo.

    So, the Surgeon General’s Warning we’d want the schools to issue would need to include all of the above, ahem, granularity. And the true picture of career prospects would then be so abundantly clear, why would anyone apply?

    Question for you, Matt: what’s in it for the schools to suddenly start providing this type of clarity? Why would they ever do that? They fought the gainful employment legislation and won. Their priorities seem abundantly clear, and I’m not at all hopeful that they are reformable.

    I myself don’t want to work with them at all or ask them for anything. I just want us to continue to dominate the airwaves with the truth.

    Part II –

    About a better Practice Management curriculum: Re-arranging deck chairs on the Titanic.

    POCA *is* the after-market practice management course for community acupuncturists. And it hasn’t been built by “a few of us… reach(ing) some sort of agreement on what would be a sound, comprehensive program and then produc(ing) that together”. Once Skip and Lisa hatched the key, core model, the nitty-gritty of how to make it work for each of us has been ground out through endless forum discussions, bit by bit, in a disorganized and yet shockingly fractal pattern of development by people whose hearts are all in the same place, and whose heads and hands work differently.

    So, for you, along with your ultimate dream team, to develop, polish, and package a lovely, viable “Middle Way” practice management curriculum and then deliver it like a foundling to the doorsteps of the schools… Well, I guess I’d rather see you raise the kid yourself.

    Unearned money corrupts, and it sure looks like unearned Title IV money corrupts absolutely.

  13. Hi Michelle – On the these two parts: You asked what would be in it for the schools to start showing clarity regarding careers in AOM. I think it has been easy for schools to avoid the issue of factual disclosure because there has not been much pressure put on them to look at this critically and then respond. Lisa and CAN had raised this in the past and now POCA has done so again and I wanted to follow-up on this to try to build more exposure of this issue including outside of POCA and especially to flush-out some of the details of why the current data being used is flawed.

    The flawed data part of this is a technical issue that has the potential for recognition and consensus if there is a concerted effort to highlight it: Is it not the case that without separating gross practice/self employment income from gross taxable income these income figures are badly flawed and statistically unreliable? Yes or no? The answer is clearly yes and I think if put on the spot, school reps would have to admit this. Once this is recognized and admitted, then they would have to correct this or risk being exposed as clearly and consciously lying to students/prospective students. Believe it or not – I think many schools, if confronted with a consensus that these stats are fatally flawed, would do the right thing and correct this. The problem is how to put them on the spot – to expose this issue to a wide enough segment of the AOM profession that schools will be compelled to “officially” respond. Normally, this could be done through a profession’s professional associations but I don’t know if any of them would care to do so. POCA could try but I understand why there may be no interest in expending limited resources on this as you guys are way past trying to reform the acu-establishment.

    The second part – developing better practice management curriculum – is much less straightforward. As Lisa has pointed out, the only way to prove a practice model works is to test it in the real world seeing if it can be reproduced by real practitioners at a reasonable rate of success. That is what I am trying to do with my Middle Way model but I don’t know if I will get enough people to participate in this experiment to prove its validity. I too want to get people out there trying to apply it and grind out the nitty-gritty details through (hopefully not “endless”) forum discussions. I have invited people to do so and am making myself available to facilitate this discussion but do not know if this will happen at the level needed to really “test” this model. I am personally convinced that what I am trying to teach can help a good percentage of those who apply it faithfully build financially successful and sustainable practices but we can only confirm this if enough apply it and communicate their successes and failures. You may be right though – that I won’t be able to pull together any kind of dream team of practice management types and will need to deliver this baby by myself. I told myself I would give this two more years and will see what happens.

    Thanks again, Michelle for taking the time to engage in this discussion. I hope this may be seen by those in a position to make some things happen. Matt Bauer

  14. I kinda have to agree with Michelle that the schools are beyond hope and I would throw in that working to get them to change is a waste of time. Many of them are struggling to keep their doors open and being honest with their students might just break them financially.

    Not only is tuition too high, but the years of higher education required to practice are ridiculous. LAc debt is not only from acupuncture school but also from at least a few years of undergraduate studies if not a bachelors degree.

    Does a practitioner really need a masters degree to be able to safely and effectively practice acupuncture? Do they really need 6, 7, or 8 years of higher education? The schools only seem interested in tacking on more time and not looking at acupuncture education in an honest and pragmatic fashion.

    Why do we not have the data that we need? Because it is more profitable— no, it is essential to the survival of how things are— to keep us all in the dark. If the lights actually came on the whole of the acu-establishment would look like a joke. The structures of our “profession” have it all wrong. It only works for a select few who are in the business of acupuncture education.

    Thats whats keeping acupuncture from helping patients, setting new grads up for failure and wounding the reputation of acupuncture in general.

  15. Ztrukn – I agree and disagree with pretty much all of your points.

    You said working with schools would be a waste of time because schools “are struggling to keep their doors open and being honest with their students might just break them financially”

    Exactly, that is why pressure should be put on the schools to only give factual information to prospective students. Having so many schools on the verge of bankruptcy is unhealthy and we need to get rid of some.

    You state that tuition and undergrad requirements are too high. I agree both are too high for training entry-level practitioners but I also know that Chinese medicine is such a vast subject that Masters and Doctorate levels would be completely justifiable. That is why I have argued for years to have tiered licensing with a 2000 or so hour entry level (and that could even include basic herbs).

    You also said if the lights came on the acu-establishment would look like a joke. Listen, I have been a vocal critic of many of the policies that have evolved over the years. It has killed me to see things come to where they are now but the core of what was established is not only not a joke, it was a remarkable accomplishment – more impressive than any other “alternative” medical field. Would you rather our establishment be like the Chiropractors, Naturopaths, Ayurverdics? Do you have any idea what we went through to fight for licensing in state after state and to establish the institutions that gave us credibility so states would pass this licensing legislation? No other alternative field did as much in as little time. This was such a Herculean effort against the “medical-establishment” that it burnt-out the original fighters who did care about the patient and then the money and prestige interests emerged from those ashes.

    People are being helped by acupuncture. Not nearly as many as could and should be that’s true but we did build the infrastructure of a legitimate profession. It is sad that things went off the rails but that is why we need fresh blood to step-in and not only point-out what is wrong with the status-quo but what can be done to fix it. CAN and now POCA has been the one bright light to emerge in this profession after 20 years of a sad slide. Being a good acupuncturist means being a good problem solver. The challenge we face now is finding ways to solve these problems. POCA is already doing this and that gives me the most hope I have had in a long time. Matt Bauer

  16. I think you hit the nail on the head when you said being a good acupuncturist means being a good problem solver. But in order to solve a problem you’ve got to have one to solve. Some folks created the acupuncture establishment, got it legal, and the rest isn’t really their problem. I mean, isn’t that their basic reaction when the many, many people who have spoken up about the current state of affairs points out how sad it is? Don’t they basically just say “well you need to do your own due diligence” (translation: that’s your problem not ours). You don’t need fresh blood to keep tilting at the same windmills. The reason you won’t get the established schools on board is that it’s not their problem – this is the same reaction most of the “haves” always have, it’s I’ve Got Mine Best of Luck Getting Yours. The folks who actually want to fix it are fixing it (right here), and POCATech is the next phase of that.

  17. @Kim, that’s exactly what’s always been so striking to me about the acu-establishment. They’re up in arms about the idea of PTs doing dry needling because of the impact on our “profession”, but it doesn’t seem to trouble them at all that we’ve been pushing new graduates out onto ice floes for years and then blaming them when they can’t survive. WTF.

    I’m glad that Matt brought up the point about what happened after the initial push to legalize acupuncture was accomplished: the people who cared about patient access backed off and the people who cared about prestige got really loud. There was a period of time (2007-2009, maybe?) where all kinds of people in the acupuncture profession started calling me up on the phone. Some of them were disaffected, some of them were the establishment, but all of them wanted to talk about the state of the profession. As I’ve written other places, I got especially annoyed with the male baby boomers who wanted to tell me how much I reminded them of them in their youth when they used to be idealistic. (I’m not idealistic, I’m lower class, there’s a difference.) Anyway, out of all those people, Matt is the ONLY person who ever apologized — not as an individual, but as the representative of one generation of practitioners to another. I remember standing in my kitchen listening to him say on the phone, “I am sorry that we left you this mess. After the fight for licensing, we were just tired. When the people who only cared about prestige started taking over, we should have stood up then and stopped them, but we didn’t.” And I thought, wow, that’s different. I wish everybody else in the establishment was like that.

    So I’m happy to see this conversation here where other people can see it. I have to say, Matt, I still think the same thing — I wish more of the people in the establishment were like you. But it doesn’t look like they are. There’s very little evidence that they care –at least in the way that we define “care”, which is, “care enough to fucking do something about it.”

  18. Wow – Lisa, thank you for that but I’ve got to say – when I told you how sorry I was we left you in that mess, I was talking about Portland. Kidding, of course! It was Lisa who opened my eyes to the unfortunate state of so many coming into this profession. I was only a bit player in the early days but knew and worked with some of the pioneers. Aside from being on the Board of one association early on, I did not serve in any leadership roles in the establishment (because it was so ridiculously polarized back then) although I did keep-up my connections with many leaders and thought I was staying current with the evolution of the AOM field. I did not, however, work for any of the schools (my office was too far away) so I did not have much contact with students or grads.

    The few times I did give talks at schools I would always ask what the students planned to do once licensed. Not one ever told me they planned to rent an office, put out a shingle, and start their own practice like I had done. They all told me they were planning on working for someone else or with someone else. I was a little jealous because when I went to school, there were no such opportunities so you knew that private practice was your only chance to earn any income. It wasn’t until I began talking to Lisa and looking back and putting 2 and 2 together that I came to figure-out there wasn’t any of those opportunities for those students either (except maybe working at their school) and many of those misguided grads struggled and failed.

    I think back now to all of my “colleagues” I rubbed elbows with in the different organizations and at all those conferences and realize that the vast majority of them worked for schools and had part-time practices. Most of those I butted heads with are now no longer involved with AOM or at least sure as hell not practicing. No wonder so many students were encouraged to charge higher rates and see fewer patients. When your main gig is a paying job in a school, you can afford to run a part-time practice that way. There’s a difference between the profession of being a caregiver and that of teaching wannabe caregivers. I realize now that I actually had known very few caregiver colleagues – those whose “work” was caring for the suffering of others. That is why I felt a kinship to the CA people. When you are out there trying to make a living taking all comers and fighting your best to help them function and thrive, only someone else doing the same really understands.

    And that is the part of the AOM profession infrastructure that we really blew big time – our professional associations; the place where professionals are supposed to associate. We ended-up with too many teachers or teacher/practitioners and not enough professional caregivers that could bring a caregivers’ sensibilities into the relationship with the rest of the establishment. That is who should have been putting pressure on the AOM schools about factual disclosure of career options and soaring tuition costs. Without caregiver representation in this part of the profession, a critical check and balance mechanism is missing and schools and other parts of the infrastructure go unchecked.

    One of the first conversations I had with Lisa (maybe the one where I apologized), I asked her if she wanted to take over the AAAOM. I told her that if enough CAN members joined the AAAOM, they could then vote her in as President. She laughed at that idea and told me that she needed to stay focused on developing CAN and not get distracted with the nightmare that would be. She was right, of course, and I am so happy to see an even better idea emerge with POCA. The AOM “profession” such as it is still needs a professional association that is actually made-up of professional caregiver acupuncturists but I don’t see that happening anytime soon. It would be great, however, if AOM students could get together in their own forum. – Matt Bauer

  19. I should probably clarify a point or two about my previous post as that was written after a long week and with my brain running on fumes. When I used the term “caregiver” and said I did not know many caregiver colleagues, I didn’t mean to imply that those teaching in our schools and with part-time practices didn’t “care” for their patients or were not caregivers themselves. I was trying to find a way to underscore the point that if the AOM field is to ever begin to meet its potential as a healthcare resource we need to develop a profession of full-time practitioners. I was not saying one group cares more for people but that those whose livelihoods depend solely on delivering medical care have a unique perspective and responsibility as stewards of that medical system. Most of our current professional associations are not dominated by those working full-time as CAN was and POCA is now. I know someone who was in a leadership role in the AAAOM who made the suggestion that they should make it a requirement that their Board of Directors be full-time practitioners. That did not go over well at all and that person is no longer with that organization.

    Our AOM schools have their own organization, the CCAOM, where they can work on issues involving schools and their employees. I am not saying teacher/practitioners should not belong to our professional associations but that we need more full-timers involved and in leadership roles. The whole idea of the trouble we went through to build a new healthcare “profession” was to get this healthcare to the people in need. While schools play an important role in meeting that goal, this care needs to be primarily delivered by those who make delivering this care their careers. And those full-time “caregivers” need to organize themselves to bring their perspective to how we develop this profession moving forward. Matt Bauer

  20. Well, here’s the thing. The whole idea of part-times and full-times was never even mentioned as an issue back in the day. When my friend told me he had tried to get the AAAOM to make full-time practice a requirement for their BOD, it was the first time I ever heard of anyone in one of those associations even bringing it up. He obviously felt it was a problem for that organization but he was made to feel unwelcomed and dropped-out and now volunteers his time in another organization dealing with integrative medicine issues. In other words, here was a very capable guy willing to devote his time to helping move this medicine forward and he is no longer associated with our lone national professional membership organization.

    I think what happened was a gradual thing that no one was paying attention to. You know how difficult it is to run a full-time practice demanding at least full-time hours and constant attention. When you then try to add more hours volunteering in an organization, it is a huge stress as POCA is learning and you, Lisa, have been doing now for years. Looking back, I can see it was only natural that those with paying jobs were in a better position to devote the extra time it takes for these volunteer efforts. Most of those working full-time in their practices were OK with letting those with more availability step-up and do the work. As these organizations became lopsided with teacher/part-timers, the few of us full-timers who were willing to put-in the time and do the work I think tended to have concerns that were not shared by the others. We tended to get marginalized when we pushed for things that were more directly patient centered (like public education) and not AOM education centered (like the FPD). Eventually, you get tired of beating your head against the wall and not getting anywhere and you back away. A lot of good people who were much more patient-centered in their goals within these organizations no longer bother trying to volunteer.

    As a Taoist, I am uncomfortable with fixed labels and don’t want to come-off as saying that full-timers are more compassionate or ethical than part-timers but there is a difference in sensibilities and we need much more leadership coming from full-timers. I have been going to acupuncture conferences for nearly 30 years. In the first few years there was this buzz and feeling of togetherness between those working to get acupuncturists legal in more states but that faded as the goal of “professionalism” took over. When I went to the POCA-Fest last year, it was the first time I was surrounded by acupuncturists that wanted to talk and teach first and foremost about HELPING PATIENTS. I could tell that even those who had been only working 2-3 years were already grizzled veterans of the trenches of full-time AOM private practice. I honestly don’t know how to foster that with those who don’t work in the CA style. I know they are out there but I am not sure the rally cry that might pull them together. The CA movement brought-out the anger and resentment many felt about being abandoned by the establishment together with the excitement of actually getting to treat and help higher numbers of patients via low-cost fees. I don’t do anger very well but I am trying to build a place where those who really care about providing care while making a full-time living and don’t practice CA can get together and share. Where that may lead is anyone’s guess.

  21. Great discussion, i’m only catching up on it now.

    I was a teacher/practitioner for many years, in many ways it was my goal in school. Why? Partly because i’m basically a geek, but also partly because that’s who’s gotten status in the profession – the people who wrote books were the names we were all familiar with in school, Dan Bensky, Bob Flaws, Stephen Birch, Mark Seem, Diane Connelly, etc etc. Nobody knew the names of people who had booming practices. Writing Manual of Acupuncture was a monumental achievement and advancing the medicine; seeing 100 patients a week, meh.

    Things have definitely shifted since CAN/POCA, but i think for a lot of people the desired trajectory of success is still to hang out in Asia or figure out some new angle on some aspect of OM, then write a book and become a CEU provider.

    I remember being told in Japan that practitioners there really only listened those with the big patient numbers, and it is considered premature to write a book until you’ve had twenty years or so of fulltime practice under your belt (and even that’s pushing it).

    Anyway, lotta lightbulbs over my head currently.

  22. When I was in OM school, I was asked about 6 different times by other students and some considering going to OM school, whether I planned to teach. I said no. I went to OM school to be able to practice acupuncture and help people feel better. Teaching was/is the farthest thing from my mind.
    I am glad I have since found the company of many other like-minded acupuncturists in POCA and the former CAN.