POCA, the Stroke Belt, and a Little Bird

Earlier this summer, a patient was looking at our Locate-A-Clinic map when she commented: “You have almost no clinics in the stroke belt.”    “The what?”  I asked.   The following week we met for coffee, where she pulled out a laptop and spent the next few hours walking me through her PowerPoint slides with CDC maps about disease and geography.  She is a PhD fellow at UMBC, studying health disparities among lower socioeconomic groups.  The stroke belt–Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia– has age-adjusted stroke mortality rates more than 10% above the national average, and features higher rates of diabetes, obesity, and physical inactivity than the rest of the country.  This area is also one of the poorest in the nation, and one of the most underserved by community acupuncturists. 

Where the need is greatest, our services are most inaccessible.

CAN has done as much as possible within the confines of a professional acupuncturist organization (501c6) to meet this need.  The forums, books, and workshops have all been created with the intention of propagating community acupuncture seeds from coast-to-coast.  And yet, entire states in the stroke belt go unserved by CAP’s.  Alexa Hulsey at East Nashville Community Acupuncture (ENCA) reports that her patients will cross state lines and travel several hours to receive care at ENCA.  Sadly, the stroke belt is not alone in the category of underserved regions.  Regularly, I field emails in the CAN box from all over North America, asking when we will put-up a community acupuncture clinic in Cheyenne, Quebec, or Bismark.  I have a patient who had planned on retiring to Florida to live near her brother, but since discovering community acupuncture in Frederick she has postponed her move because there is not a community acupuncture clinic in Miami.  “When will there be an affordable clinic?”  she asks.  The answer to this question has thus far been: “It’s kind of like the lottery; you have to wait for a community acupuncturist to pick your city.”

Until now.

POCA is a multi-stakeholder cooperative which will govern itself via sociocracy.  Sociocracy will include the voices of all participating members of the co-op and more thoroughly respond to the local, regional, and national needs of its stakeholders.  To learn more about participating in a sociocratic organization, read “We the People: Consenting to a Deeper Democracy” by John Buck and Sharon Villines. 

The People’s Organization of Community Acupuncture accepts investments from four membership categories: acupuncturists/students, patients/community members, clinics, and organizations.  That is FOUR times the membership categories which CAN is able to offer.  And with an average ratio of 1000 patients to every 1 community punk, POCA will grow exponentially larger CAN ever could.  While POCA expects and is preparing for a large operating budget derived from memberships, POCA will not offer financial returns to its investors. POCA is a social business, which means that all profits will be reinvested in the Community Acupuncture Movement.

With POCA, someone in Birmingham, AL might decide that they want a Community Acupuncture Practice (CAP) in their very own city.  They can join the Patient/Community membership category of POCA through our soon-to-be-released website, and encourage their friends, family, neighbors to do the same.  And once enough people in Birmingham have joined POCA, we can use their membership fees to offer a very low interest microloan to an acupuncturist who is willing to start a CAP in that community. 

Last month I met an acupuncturist from Des Moines, IA who wants to start a CAP there.  Yay!  IOWA!!  But she has no credit after borrowing money for acu-school.  No lender will help her start a business.  With POCA, she could begin promoting POCA patient memberships in Des Moines.  Once she gets three-hundred or so people in her community to join POCA as patient/community members, *shazam!*, she can apply for a POCA microloan to build the CAP in her own community.   Plus, having done all that POCA marketing, she’ll hit the ground running with a solid patient-base ready to fill the chairs when she opens the doors.

What else is in it for patients, besides bringing CAP’s to new communities?


  • Each patient receives 3 FREE treatment cards to give to their friends or family, to be redeemed at POCA-member-clinics!
  • New patient paperwork fees are waived (FREE) for POCA-members at all POCA-member-clinics!!
  • Every POCA-patient-member receives FREE acupuncture on his/her birthday!!!  
  • Patient members will receive the FREE newly-launched POCA newsletter Sticking Together, which will soon have more articles written for patients!!!!
  • POCA-patients will have the opportunity to vote in POCA elections. 
  • Patients can offer hands-on-support for POCA-the-organization and/or their local-POCA-clinic.

How much is a patient or community membership?  $25 – $100 annually 

Why would acupuncturists or students join?*


POCA-punks will receive FREE access to the CAN forums: a rowdy display of wisdom, support, humor, experience, and friendships, along with workshops, virtual groups,  regional meetings, and semi-annual national conferences .  Also included are all the perks that patient members receive: 1 free birthday treatment, 3 free treatment cards to send to friends/family near POCA clinics, NO new patient fees at any POCA clinic, free e-newsletter Sticking Together, the opportunity to vote in POCA elections, and offer hands-on-support for POCA-the-organization and/or their local POCA-clinic.

How much is an acupuncturist or student membership?  $45 – $200 annually 

* Current CAN memberships will roll-into POCA-acupuncturist memberships, so that punks will retain access to the forums until their existing individual membership expires.

Who will the organizational members be, and why would they join? 

CAN was the first organizational member to join POCA this summer.  Other members could include biohazard disposal companies, recliner chair manufacturers, computer programmers (think EMR and scheduling systems, specially designed to meet the needs of POCA-clinics), insurance companies, credit card processors, printers, authors, workshoppers…hell, the AAAOM could even join!  Any organization which supports the provision of affordable acupuncture to lots of people is welcome.  There might be a website developer  in Missouri who joins POCA as both a patient and an organizational member, advertises his business in Sticking Together, and connects through the co-op newsletter with a California patient who runs her own daycare business…California woman might inquire about the Missouri webmaster’s ability to help with her daycare’s website.  The nature of the multistakeholder cooperative is to connect ALL members together and meet their collective needs. Organizational members will receive the opportunity to advertise in POCA’s newsletter, market their goods or services to POCA members, or simply participate in our elections.

How much is an organizational membership?  $100 – $1000 annually 

What do POCA clinics get, besides the microloans?

POCA clinics will receive a listing on POCA’s Locate-A-Clinic page.  (Note that CAN’s current Locate-A-Clinic page will be eliminated.  Clinics will need to be signed-up with POCA by mid-October, if they wish to be listed on POCA’s Locate-A-Clinic page.)  POCA clinics will receive hands-on-support from POCA-members: answering phones, hanging flyers, painting walls, building bike racks or baking cookies for a grand opening party.  POCA clinics will benefit from employer materials, access to a national hiring network for community acupuncturists, materials and support to help clinic members create jobs and be good employers, collective marketing (like a patient in New York sends a free treatment card to a friend in Austin, who then becomes a regular patient and brings his/her friends along to the Austin clinic too), bulk purchasing, transitional support, and the benefit of strategic organizational relationships.

How much is a clinic membership?  $50 – 1% of annual gross receipts (annually)


Each POCA clinic agrees to: 

  • waive new patient paperwork fees for all POCA-members.
  • honor all POCA-free treatment cards.
  • give one free birthday treatment to each POCA member.
  • offer acupuncture within the newly revised LOC guidelines.

POCA LOC Guidelines

All clinics must have at least three days and twelve hours per week where they use a group or community treatments space. When having group or community treatments, the following criteria must be met:

  1. Adopt a sliding scale between $15-50 with the low end no higher than $25.
  2. Herbal consults are charged at the same rate as the community clinic.   
  3. If a flat fee is charged, that fee can be no higher than $30.
  4. For first time visits, a surcharge of no more than $15 can be assessed.
  5. For clinics that have private treatments for some patients, there is no private treatment requirement in order to gain access to group treatment.
  6. Prices must be listed on the clinic’s website. 
  7. No proof of income is required or requested by the clinics. A notice to this effect must be placed near the listed prices. The notice can be flexible. Examples: No Income Verification required, or Pay what you can afford, or The choice is yours, or You choose what to Pay. Clinics work with the POCA members charged with maintaining Locate-A-Clinic to come up with appropriate wording.

Back to our earlier POCA story…what happens after a community signs-up enough patients –> secures a microloan –> builds a CAP –> gets a punk –> punk is supported by the forums’ well-tapped-potential –> clinic takes advantage of purchasing discounts through organizational members?  The community grows itself a Busy Little Clinic (BLC).

And then…the BLC starts to feel some growing pains.

I received an email this week from a social worker in Washington DC who is looking for affordable acupuncture services for her low-income clients.  “Is $15 low enough?” I wrote back, with a link to CAN’s LOC page.  She quickly responded: “Yes!  We have so many people who would do that, and the price is right!!  Little Bird is right up the street from us–but why does their website say they’re not accepting new patients?”

A short while later–on a conference call that Nick Kurtz, Suzzanne Lohr, and I were having about our upcoming workshop in Washington DC (*ahem*) I asked her about the hold on new patients.  Suzzanne explained that she is so freaking busy, she had to close the schedule to new clients.  Little Bird in DC sees over 130 patients per week in a tiny little space and currently has a waiting list of 30 newbies who are clamoring for the next available opening.  LB has the growing pains of a Busy Little Clinic.  She needs to open more hours, but can’t without another community punk.  Suzzanne has a job available, but no one to fill it.  

Suzzanne is not alone.  Last month, Jade Fang, Nora Madden, and I travelled to Madison, WI to organize a job-fair and CA training workshop, in part because Jade and Nora have struggled to fill positions in their CAP’s.  We had dozens of punks in attendance from all over the Midwest and Canada, but only two of them wanted to be employees.  Community Acupuncture clinics have a labor shortage.  In a country with 9.2% of the current workforce unemployed, we represent a consortium of employers which cannot fill its job openings.  Of course, it doesn’t help that ACAOM doesn’t consider feedback from employers (like ourselves) before the adoption of revised educational standards, much less provide resolution of filed complaints (like ours).    It doesn’t help that schools are selling dreams, failing to give students the skills necessary to work in busy community settings.  It doesn’t help that the current TCM program is so ridiculously overpriced that most of its graduates can’t pay back their loans with living wage jobs, and therefore seek employment outside of the acupuncture industry.

POCA has the potential to grow big enough that we can finance our own educational opportunities to meet the needs of community acupuncture employers all over the country, by training more punks at a lower cost, so they can work in clinics that offer jobs at working class wages.  POCA will help establish and support more clinics to handle patient overflow, create more job opportunities for part-time employee-punks to split positions between clinics, build more educational opportunities for training and re-training community punks, develop more resources to support and train employers (because really, how many of us went to acu-school with the intention of managing staff?), and collectively express ourselves so that our voices will be heard.


POCA Mission Statement

The purpose of the People’s Organization of Community Acupuncture is to create a stable and sustainable economic foundation for the delivery of affordable acupuncture, and to establish and maintain structures to that end.

POCA is a Cooperative owned by patients, acupuncturists, students, community acupuncture clinics, and their supporters, that organizes collective investments of time, energy, participation and money, to further its vision.

POCA serves a variety of member interests, including access to affordable, quality acupuncture and the creation of living-wage jobs in the acupuncture profession. POCA contributes to vital, healthy communities by providing hands-on members support for the success of Community Acupuncture clinics from schooling to start-up to success.

POCA’s Vision

  • To provide affordable acupuncture care for at least 50 million Americans by 2020.
  • To foster the growth of community-based professional training programs for community acupuncturists
  • To create living-wage jobs for acupuncturists and clinic support staff
  • To create a micro-lending program: for clinic start up or for clinic expansion that involves job creation
  • To fund scholarships for acupuncture students
  • To create collective marketing campaigns for community acupuncture clinics
  • To build social capital via creating jobs and providing needed services in an affordable manner

POCA Goals & Objectives

Goal #1-Facilitate the opening of new clinics, expansion of existing clinics, and stabilize clinics in transition to create and maintain jobs.

  • Objective #1-Create a microlending program for new or expanding clinics.
  • Objective #2-Create a program that patients and non-acupuncturists can use to set up a Community Acupuncture clinic, including hiring an Acupuncturist.
  • Objective #3-Create a program to help clinics in transition including providing mediation services and, eventually, POCA itself buying viable clinics.
  • Objective #4-Provide resources to clinics to be good employers. 

Goal #2-Expand, support, and sustain the workforce of Community Acupuncturists.

  • Objective #1-Create an affordable path to licensure for prospective Community Acupuncturists.
  • Objective #2-Create a retraining program for existing Acupuncturists.
  • Objective #3-Provide resources and information around Best Practices.

Goal #3  Cultivate Collaboration between Patients and Community Acupuncture Clinics through the Coop.

  • Objective #1- Establish legal structure for direct patient participation in clinic operations.
  • Objective #2 -Establish a Patient Advisory Committee
  • Objective #3- Encourage the expression of patient voices in coop, marketing, and educational media.

Goal #4-Maximize our resources for the economic benefit of POCA members

  • Objective #1-Establish a malpractice coop for POCA Acupuncturists.
  • Objective #2-Establish a Buyer’s coop for clinic supplies.

Goal #5-Educating members and the public about Community Acupuncture

  • Objective #1-Establish a newsletter for members.
  • Objective #2-Provide for an annual POCA conference.
  • Objective #3-Launch a collective marketing campaign.
  • Objective #5-Use social media to educate the public about Community Acupuncture.
  • Objective #6-Establish a Locate A Clinic page for public use. 

POCA Membership Annual Fees

  • Patient/Community Member ($25.00 – $100.00) annually
  • Acupuncturist or Acupuncture Student ($45.00 – $200.00) annually
  • POCA Clinic ( $50.00 – 1% annual gross receipts)  annually
  • Organization ($100.00 – $1000.00) annually

Anyone wanting to just pay more for their membership is welcome to do so.

Remember: Current CAN memberships will roll into individual acupuncturist memberships. Acupuncturists will continue to receive access to the forums.  Clinics will need to join as POCA clinics to be listed on POCA’s LOC (by mid-October) and receive additional clinic benefits.

POCA memberships opened this week! 

To sign-up, call 971-400-8739…

send an email to pocacoop@gmail.com …

or write to POCA, 3526 NE 57th Street, Portland, OR  97213… 

Jessica Feltz
Author: Jessica Feltz

<p> I learned about Community Acupuncture while studying at the Midwest College of Oriental Medicine (MCOM) in the Spring of 2006 when Lisa Rohleder's first article about her clinic appeared in Acupuncture Today. Coming from a middle-class background myself, I was the only student in my acupuncture class to have not experienced the healing benefits of this medicine prior to beginning studies at MCOM. I couldn't afford it. And my family couldn't understand what I was doing by investing in an education that they didn't perceive to be financially sustainable. </p> <p> The Community Acupuncture model is a perfect fit for me, balancing social justice and taoist simplicity with the patient's innate ability to heal him/herself (with a few gentle nudges from strategically placed needles). I am grateful every day to have found CAN and the love it brings into my life. I want to share that joy by spreading the message about how we can create a new health care experience in our communities through each of our very small efforts...and how those very small efforts can in turn change the world. </p> I enjoy my two sons, my 4 cats, and big stacks of books.  I own and operate...

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  1. Thank you, Jessica!

    How amazing to have all this information in one incredibly informative post.  And: 13 hyperlinks?  Not bad, comrade, not bad.

  2. Go Jessica!
    Will this be

    Go Jessica!

    Will this be posted to the AAAAAAAAAAAAACAOM website?

    (with a note at the bottom saying “how do ya like us now?”) 

  3. Wow.

    This is an awesome post, thanks for putting it together!!!  When I was a student at Tai Sophia there was a membership drive every spring for the AAAAAAAAOM student org, and I never signed up because there were never any tangible benefits.  I see the same thing in the org as a new practitioner.  But POCA has benefits like whoa!  What an awesome, awesome thing it will be for the CA movement to start reaching even more of all those people out there who don’t have access to affordable treatment yet. 

  4. Thank You !

    First off I just want to say thank you for putting all the POCA info. together and making it easier for us to understand.  We are going to have our first regional meeting down here in TX soon and this helps my job of gathering the info. to answer all the other acupunks questions.

     I just wanted to comment about lack of service in some of those areas.  I just moved back to TX after having spent the past 2.5yrs. in Louisiana and the real problem there are the licensing laws. You have to be under an MD’s license to practice and I spent over a year meeting docs and negoitating possible jobs only to have them back out after reading the licensing laws. If you ask the state to clarify certain laws they are no help either. Louisiana is prime ground for a CAP but the laws need to change first and because of the “good ole boy” network that is still in place I felt like the job of changing the law was bigger than I could tackle alone. Maybe the grassroots movement of CA and POCA will become so massive they will be forced to change. 

    Thanks again for all the work you guys are doing!

  5. I suggest

    That all you clinics out there print this out and put it in your front window, waiting room, bathroom – wherever patients are likely to read it!  I’m printing it out now.


  6. Yes!

    This is so well laid-out- thank you Jessica!!


    Add me to the list of people printing this for their clinics- I’m making a few copies for reception reading and on the bulletin board, in the window, I’ll link to it in my next newsletter, maybe even front page of my website… 


    Feeling really lucky to be a part of all this! 

  7. Re: law structuring

    I think licensing is a major issue in many states and really hope that POCA is able to point out the problems and stick the lawmakers to the task of making acupuncture available.

  8. Thank you!


    Thanks for this post and for clarifying POCA. This is exciting to me – I’ve never been so proud, happy and humbled by a group of people as I am now. Most days I wander around wondering how and why I became an acupunk. This really, really helps me understand how these choices can make a difference on so many levels. Cheers! 

  9. MD’s backing out

    Could you shed any light on what the M.D.’s saw in the licensing laws that made them want to back-out of working with L.Ac.s? Was it just that they felt the laws were unclear and they not want to risk any liability under unclear statute or was they something in the statue they felt left them too much liability? Thanks (and thanks for your efforts)

  10. px incentives…

    Just got a newsletter from the Maryland acu board, in which they state this: “It is also unethical for acupuncturists to fofer financial incentives or other valuable considerations to patients in exchange for recruitment of other patients.  Such incentives can distort the information that patients provide to potential patients, thus distorting the expectations of potential patients and compromising the trust that is the foundation of the patient-physician relationship.”  I suppose POCA incentives aren’t able to be included in this, but something like a Free Treatment Friday for new patients, with current patients getting a free tx if they bring a friend, is considered unethical under this?  Does it seem to anyone like the POCA incentives could be called into question under this rule?  It doesn’t make sense to me that a current px would bring a friend to get a free tx if they thought the punk was lousy – why keep going at all, how does anything get distorted that way?  Thoughts?

  11. Not an issue, Kim.

    POCA isn’t offering anyone anything in exchange for a referral.  EVERY patient, punk, and student who joins POCA gets 1 FREE treatment card for themselves (Birthday) and 3 FREE treatment cards to share with friends and family.  Whether they choose to share the free cards or not is entirely up to them, and they do not receive anything special for having referred patients.  (Well, I actually send my patients a hand-written thank you note for every referral, and also more business cards…but I don’t think my 49 cent greeting cards count as a “valuable consideration.”) 

    I (personally) don’t give my current patients free treatments when they bring referrals along.  With 2-for-1 Tuesdays, the free treatment goes to the new patient; there’s nothing in it for the existing patient.

  12. This is also the policy in California

    It’s designed to prevent substantial kickbacks, so for instance you can’t have a contest where you offer $1500 worth of treatments for your biggest referrer in a period of time.  I think you need an interpretation of “valuable considerations”.

    I also don’t give free treatments for current patients who refer new patients.  When I have a free day, or days, it’s free for everyone, and all new patients are free the first time at our clinic.  It’s just easier for me to keep track of, and makes it easy for people to make the decision to come in out of curiosity.


  13. The ethics of inticements for medical services

    The underlying philosophy behind these sorts of regulations is that it is unethical to use pressure-type of inticements (such as “limitied time offers”, etc.) for medical services. The idea being that, if people need or wish to puirsue medical services, they should not be inticed into doing so by marketing stratagies. Medical professionals can inform the public about their services and charges but should not use the same gimmicks used to “sell” products or non-medical services.

    Of course, the bar has been lowered over the years and different regulators will have different specific standards and enforcement policies. I think you would have to go clearly over the line for any regulators to spend their limited resources going after something like that.


  14. laws

    Some MDs were uneasy having someone else technically working under their license even if I carried my own malpractice, etc. Other MDs were open to it until they read the fine print which said things like the acupuncturist could only work as long as the MD was no more than 30 minutes away.  Which drew up questions of does that mean the acup. couldn’t practice if the MD was out of town or sick that day? The state was no help clarifying questions. The MD had to always sign the acupuncturist’s charts and one punk told me he was temporarily closed for not having all his charts signed. There were four acupuncturists in my town and I think to some extent they were afraid to rock the boat because they knew they got in and that is not an easy thing to do in LA. I also met other acupunks who did what I tried to do because they had family in the area and wanted to move back but eventually left because of politics.

    Laws are a whole other issue I wish received more attention from national organizations. Now I’m just focusing on starting again with the people I’ve met in TX that believe in CA and POCA and that’s exciting.

    Thanks again CAN!

  15. Great article and…

    I’m writing an article to my community and was planning to include a link to this article as possibly the best explanation I can find so far that explains POCA and its benefits to patient members…however, it seems odd that a link within this post “POCA is a Social Business” results in this message:

    Access denied

    You are not authorized to access this page.

    Not exactly the message we are trying to send to our potential new member owners….




    Communichi Acupuncture Clinic, Seattle


  16. CAN membership access for the link you noted.

    It’s because the post is in the practitioner forums and not the public forums. It’s easily resolved if a practitioner joins CAN. As noted above:

    Remember: Current CAN memberships will roll into individual acupuncturist memberships. Acupuncturists will continue to receive access to the forums. Clinics will need to join as POCA clinics to be listed on POCA’s LOC (by mid-October) and receive additional clinic benefits.

    ….but I get what you are saying Jordan. I guess it’s just one more reason to join CAN and get even more info.

  17. membership expiration

    Don’t know if this is the best place to post this but my CAN membership just expired. Would it be best to re-new my CAN membership and allow it to roll over to an individual acupuncturist POCA membership or sign up directly with POCA for both my individual acupuncturist membership and clinic membership?



  18. Good question, Ninah.

    You should still renew your individual membership thru the CAN website.  Call into the POCA line for signing-up your clinics under the clinic membership category.

  19. new punk in the stroke belt!

    As of the first week of October, IDCA (Indy Downtown Community Acupuncture) will open it’s doors. The first CA clinic in indianapolis, the first in indiana!

    so happy to be joining the community.

    Erica Siegel