Guest Blog by Jennifer Woolf: Response to a recent AT article

Response to “Progress Report on Our Profession” By Mark McKenzie, LAc,, Acupuncture Today, December 2010
“Trust the instinct to the end, though you can render no reason.”
Ralph Waldo Emerson
Imagine my surprise when, glancing through the latest Acupuncture Today issue, I found yet another “Progress Report On Our Profession”. With the intense national debates within the profession over the past 18 months, I surely thought we had covered this. Perhaps something new had surfaced that American acupuncturists need to know about – some sign of unity, some change that would repeal the infighting and fear between members of our personal society. I read the article with curiosity and hope.
Alas, Mr. McKenzie did not surprise or thrill me.
The writing turned out to be nothing more than the usual cheerleading based on misleading statistics, philosophies of business that deny access to millions of citizens, and reliance upon an ever-increasing student debt load to shore up the general acupuncture ego in this country.
We’ve all had our share up to *here* of the debating, arguing and foul play on these topics. I don’t want to beat a dead horse. However, in case there are still one or two acupuncturists left that haven’t heard both sides of the story, I thought I’d respond.
As to the now-annual meeting of organizations, some of which are regulatory in nature and some of which are membership organizations, I wonder why the Community Acupuncture Network (CAN) has not been invited year after year. CAN is a rapidly growing membership organization representing 1000+ acupuncturists worldwide. Surely inclusivity would be helpful in addressing the difficulties acupuncturists face today.
I agree with Mr. McKenzie’s statement that many acupuncturists struggle to create or maintain financially viable practices. Given that, I believe it would serve the educational arm of Asian Medicine to educate students in a style and business practice that routinely offers jobs both hourly and salaried: Community Acupuncture. If educational costs were kept down rather than continuing to skyrocket via such avenues as the first professional doctorate, students would not feel such pressure to achieve that mythological magic paycheck in the sky. Community Acupuncture offers interesting, steady work, regular pay at a sustainable rate, the opportunity to work closely with peers, and a sound, repeatable business model that allows nearly every member of society to take part in the wonderful world of Asian medicine.
In reading Mr. McKenzie’s thoughts on the current state of our profession, I appreciated most the paragraph stating, “Our second challenge is…when and how to move to the optional First Professional Doctorate, and to identify the ramifications of that decision with due consideration of the financial viability of our profession.” Thank goodness I don’t have to add more thousands of dollars to my already exhorbitant student loans, which I struggled to repay until I achieved a regular paycheck by working for a Community Acupuncture clinic.
When should we move to the FPD? When there is evidence that it will clearly benefit the lives and livelihoods of acupuncturists across the country. So far, in examining other professions such as physical therapy that have added such a requirement, the drawbacks are many and quite apparent.
As I see it, one of the main issues for our profession at this time is that we have been taught that we should all make a fabulous living off of our profession. The concern that few are actually achieving that goal apparently is unimportant. The fact that, in most countries, acupuncture is not an upper-middle class profession is completely overlooked. Unfortunately, steady work for a good wage, such as found in job listings on CAN, is considered not good enough for the average acupuncturist, who apparently would rather starve than work. Or work a side job waiting tables or painting houses, still unable to pay back student loans. This is how we are taught. It is not inherent to acupuncture that we think our $60,000 student loans will be easy to repay based on our amazingly productive clinics. It’s what we hear over and over again in school – acupuncture is so effective! (True.) So mysteriously healing! (True.) Once you convince people how great you are, they will flock to your door and pay you tons of money! (Not so much.)
Lastly, I would like to address the notion that acupuncturists need to achieve “federal recognition” and insurance parity. As someone who ran a successful – by acupuncture standards, very successful – private-room acupuncture practice that jumped right out of the box into more than $100,000 a year, I can honestly say that I want nothing to do with insurance coverage for acupuncture. Good bye, profits and hello headache. I figure that by the time I am done with a year in Community Acupuncture, I am left with only slightly less than I made in a year in private-room practice – because I don’t spend money and time learning codes, filling out forms, arguing on the phone about coverage, tracking down patients for money or information, hiring billing specialists or billing companies, or sitting in continuing education classes on how to get money from insurance companies. I mention this because I read plainly the implied statement in the article by Mr. McKenzie: gaining insurance coverage or coverage under a federal health care plan will FINALLY result in good jobs and great pay for acupuncturists. 
I’m here to tell you that a lot of evidence points to the contrary. There is growing sentiment among members of our profession that insurance coverage will not prove to be the magic bullet, as it is touted by some. At any rate, in my Community Acupuncture clinic a treatment costs less than the average co-pay for an office visit to a medical doctor, and I keep more of it than I did in my private-room clinic, where I lost about half of every dollar earned to overhead and taxes.
As Mr. Emerson so eloquently states, “Trust the instinct to the end.” Of course I believe – hopefully we all believe – in the joy of an ancient and effective toolbox that can aid patients in the restoration of comfort and health. That is never in question. I also believe that most patients would pay top dollar for that gift if they could. Since most of America can’t, isn’t it time we addressed the needs of the majority and stop pandering to the minority? Stop hitching our wagons to a dying breed? Believe in the truth of acupuncture. Let go of the lie of “If only we… our riches will be made.” Let’s regroup right here, where we are. Accept our differences in treatments, business styles and salaries. Some will make a lot of money. Some will make very little. I’d like to see a shift towards most acupuncturists making somewhere in the middle: a living wage. The way things are right now? That would be a huge step up.
Jennifer Woolf, L.Ac.
Concord Community Acupuncture
Concord, NH

Author: andy-wegman

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  1. Amen sister

    BTW Andy, I never really thanked you for your service to CAN as our first president.  You are a special person and it takes a special person to try to keep up with this herd of cats.  CAN Cats…very retro.  Sorry to loose the thread a minute but I wanted my thanks to be public. 

    Tess Bois (formerly McGinn)

    One World Community Acupuncture

    Fitchburg, MA

  2. Why does it have to be so one-sided?

    There are plenty of insurance based acupuncture clinics that serve thousands of people and create a very good living for the practitioners. We should be looking toward every option to find ways to create a sustainable living for acupuncturists. For the record, the average co-pay in my practice is under $15, it’s cheaper than any community acupuncture clinic I have ever seen.

    The CAN model is great and works well for many people, but there is a place for many types of clinics and instead of the never ending in-fighting in the profession, why not start working together? Acupuncturists are often their own worst enemies, this is why most are struggling to make a living. If we stopped arguing about which business model, style, etc. is best and put that energy toward growing the profession as whole, everyone would be better off.

  3. Dear Guest (not verified),

    “…growing the profession as a whole…”

    My point exactly.  That means making affordability – both for the student and the patient – a reality.

    Jennifer Woolf, L. Ac.

    Concord Community Acupuncture, Concord, NH


  4. Guest, please be specific

    “If we stopped arguing about which business model, style, etc. is best
    and put that energy toward growing the profession as whole, everyone
    would be better off.”  What exactly do you mean by that? How do you propose that we “grow the profession as a whole”? Seriously, people are always intoning these kinds of platitudes, and I have no idea what you are talking about. It doesn’t mean anything unless there is some practical action that we could take. What would “growing the profession as a whole” even look like? 

    Pragmatism: bring it if you’ve got it. We value it highly around here, which is one big reason we are so much at odds with the rest of the profession.

    Jennifer, great post!

  5. Actually Guest (not verified),

    Jennifer’s last paragraph is a call to action in support of working together:  “Let’s regroup right here, where we are. Accept our differences in treatments, business styles and salaries. Some will make a lot of money. Some will make very little. I’d like to see a shift towards most acupuncturists making somewhere in the middle: a living wage.” (Emphasis mine).

    And you mention putting our energy toward growing the profession as a whole; well, CAN is doing just that. The way we see it, the best way to grow is to treat LOTS of patients.  Patients are how our profession will thrive – we have to bring the medicine to them; we have to make it accessible.  That’s the only way to grow.  No patients, no growth.

  6. plus…

    Going the way of insurance is one old tired song.  Many acupuncturists have spent many years in states like Massachusetts to put acupuncture on the insurance map and have largely failed.

    Say the miracle of all miracles happens and acupuncturists get to 3rd party payer away.  I used to work for a chiropractor and bill insurance and I assure you it is no walk in the park.  Mostly you have to pay someone else to bill for you or spend your free time on the phone tracking down the claims and asking “what is your name for future reference?” alot.  You may have to write letters and send faxes and still not get paid.  IT is admittedly nice to get a big fat one from BC/BS for all your well covered insurance.

    And yes you are right, all acupuncturists should have the right to be able to bill like all the big boys chez chiro and chez physical therapists.  You guest should start working for your state membership on issues like reimbursement.

    But I don’t want to.  I would rather treat my 90 plus patients per week, earn my living wage, and go home at the end of the week having worked towards helping lots of people.

    People who would not go see an acupuncturist charging $65 per treatment, because I am sure most of these folks do not have the kind of insurance that would pay those claims.  My mother, a long time CTA member has that kind of insurance, (25 txs per year bless her) but you can bet even that will change with teachers in California who are not yet retired.  

    But I am a CAN member because I am proud of what our organization is doing for acupuncture.  We are not waiting for something to happen.  We want increased access to acupuncture services through streamlined acupuncture education programs and being more affordable while still making a living wage.  

    If this organization were organized around what our esteemed guest wants which is access limited by insurance I would drop my membership tomorrow.  Start your own “change the world” website.  Or provide our organization with an insurance model we can take to our clinics tomorrow and use.  But make it simple, include the working class and we don’t want to send bills to anyone to pay us.

    I can’t figure out what compromises CAN is supposed to make for the good of the entire profession.  I for one do not want to change one thing about my adopted business model.  It suits me and it suits loads of people who walk in my office everyday.  If your business model suits you that’s great.  According to the statistics of our profession, very few feel as lucky and reimbursable as you. 

    Tess Bois (formerly McGinn)

    One World Community Acupuncture

    Fitchburg, MA

  7. My First Treatment

    I went to a western doctor covered under my work’s health insurance for chronic repeated strain injury related to the type of work I do. After a brief interview about the pain, where, when, how much, the doctor recommended surgery, the sooner the better. In fact, I should make an appointment for surgery before I leave the clinic. This seemed insane to me. No other therapies, change of work practices, medication to try first? Straight to the cutting table? I asked if he could refer me to an acupuncturist. He said “I could, but it wouldn’t do you any good.”
    This was my first attempt at acupuncture treatment. I never went back to that doctor. A few months later, I found a woman offering sliding scale acupuncture near where I was living. I went there because I could afford it. It wasn’t covered under my insurance, it didn’t need to be. I was able to circumvent the red tape and negative attitudes of the Western medicine and get help I needed. And it was incredibly helpful. I recovered and never had that surgery. The Community Acupuncture model has the potential to greatly improve the lives of a huge segment of the population in this country, people who would otherwise not even consider it an option. Think of millions of low income people, faced with daily stress, being treated for depression, anger, insomnia, stress. What a different world this would be…

  8. One insurance tale

    Here in BC, for low income (<$30,000 per year) families like my own are given something called premium assistance. Up to ten visits per year which the government will pay $23 for acupuncture, chiropractic, naturopathic or massage. Not much when one can spend $70-$80 for acu, $80 for chiro, a few hundred for naturopathy and even $90 for massage. 

    But is certainly is enough for a CAN clinic, 10 visits fully covered is a great opportunity for health care that people might otherwise not take. For the most part this is what funds my NADA/acudetox clinics since no funding is available anywhere in the system for it. The local First Nation also benefits from this because nearly half are unemployed and health services are woeful on the rez. In the clinic it's great because people at the very low end of the scale don't have to choose between food or living with less pain.

    I know that this is a unique situation, even in Canada, but it is a story of success working with public insurance that doesn't affect care or add a lot to my workload. I didn't spend any of my energy on this at all, the college did as well as other health professions who have come to accept that acupuncture might actually be doing something good. But really, we as practitioners can certainly be most effective working on providing the best care we can and let the politicians do their political thing. I love working with the CAN philosophy, and even if there was no insurance to speak of, I'd still be doing it because it's the only thing that makes sense where I am. If I work in response to what the public around me wants and needs, then I need to provide that care in the way the people need it.

    Insurance isn't a bad thing, but fighting for it at the expense of providing quality care to the public is. As my mom says, STFU and GBTW.

    All the best, Clayton 

  9. Sub $15 copays

    …generally assumes that health insurance is available for the general population. We are being told that will be the case in just a few years. But that remains to become reality and definitely is not the case for most Americans currently.

  10. That’s wonderful Reverend

    That’s wonderful Reverend JB, I’m happy you were able to get great results at an affordable price.  Unfortunately, I see many people in my clinic who had surgery, but didn’t get better, some even got worse.  I hope with the growth of CA, acupuncture becomes something people will try before such radical options as surgery.  Right now most of my patients are seeing me as a last resort, it’s too bad that something that works so well and has virtually no side effects is chosen last. People have told me that the high cost is part of the reason they haven’t tried it before.  

  11. CAN as a single payer model

    There was much infighting during the year of debating healthcare reform. One of the hottest topics was single payer which was about the government (Center for Medicare and Medicaid – CMS) paying for citizens’ healthcare. The Affordable Care Act excluded any such provision and insurance companies with their shareholder mandated 20% margins were given another lease on life. Undocumented immigrants were also excluded from the ACA. They get healthcare in community clinics where they often pay out of pocket on a sliding scale. In 2007-08 I evaluated a Chronic Pain Clinic run by LAcs and DCs that was hugely successful in treating high patient volumes. Who knew so many immigrants would be open to acupuncture and chiropractic just because they were in pain? And who knew they would pay out of their pockets on a sliding scale for treatments? Sound familiar? Unfortunately, healthcare will remain expensive long as insurance companies are in the middle. However this must and will change whether via single payer or out-of-pocket payer. CAN is ahead of the curve.

  12. yes, however

    Doctors still have an iron grip on many if not most patients’ healthcare. Practically every week I have a patient discontinue care because their doctor discovered they were getting acupuncture and told them to stop. I plead with the patients to trust their own experience rather than what someone is telling them, to no avail. It’s great that this patient went against his doctor’s advice but in my experience most will not. This is the reason we must pursue insurance and other paths as well as CAN. In Germany, the insurance companies finally got together and paid for a study of acupuncture and low back pain. THE INSURANCE COMPANIES PAID FOR THE STUDY! And they discovered what they had suspected, not only does acupuncture work, it’s cheaper than standard care. So they began to cover acupuncture treatment. It’s this kind of waking up to reality on the part of larger mainstream medicine that will really change the system. And perhaps our country will avoid bankruptcy from our broken medical model and the grip of Big Pharma will be broken. It looks like we’re stuck with a profit-driven medical system. Eventually they (scientific establishment, insurance, doctors) will disover that Chinese medicine is cheaper and more effective. I think we need efforts on all fronts. Many docs (at least here on the East Coast) still hate Chinese medicine, especially herbs. And they give out bad advice about acupuncture as they don’t understand the myriad of health conditions that it treats. I had a serious health crisis this year and would have ended up applying for disability. The only thing that saved me was Chinese herbs (acupuncture did nothing). CAN can’t do everything and must focus on its mission. But surely CAN members can discontinue casting aspersions on others who are doing their part to create this medicine as mainstream in this country through a different route.