10 MYTHS ABOUT THE First-Professional Doctorate for Acupuncture and Oriental Medicine (FPD)
1. A FPD WILL RAISE THE STANDARD OF EDUCATION
The main assumption layered into this myth is that the current level of education
is deficient in some way. Those who support an increase in educational hours for
entry-level, and a new degree title claim that because the new programs will
involve more integrative medical training, acupuncture will become more
accepted by western medical practitioners, facilities, and reimbursers. This
simply is not true.
What is true is that a new-entry level doctorate (FPD) will raise the cost and time
involved to earn this degree. The educational effects, if any, are yet to be
measured or evaluated, and the conclusion that more education means more
jobs or earnings or even a better education for graduates is unfounded.
Questions this myth raises:
Do current AOM graduates lack knowledge, skills, competence, or are they in
some way dangerous? Who has perceived these deficiencies? practitioners,
educators, governments, other healthcare professions, insurance companies,
hospitals or patients? What exactly will be achieved by “raising the standard” (ie
increasing hours) of education when the existing education already produces
safe and effective practitioners? Who would benefit financially?
2. FPD WILL MAKE MORE JOBS FOR ACUPUNCTURISTS
Currently there are very few jobs for licensed acupuncturists, outside of teaching
in acupuncture programs. Data on the actual incomes of acupuncturists is
scarce and misleading, and a large percentage of licensed acupuncturists stop
practicing in the first 5 years. Although bio-medicine is starting to become
interested in AOM there will be no sudden increase in the demand for
acupuncturists, even with a new degree title or a year more of education focused
on bio-medicine. No one outside of the profession will take much notice or have
much invested in what degree title and acupuncturist has. Even research jobs
will not become available to entry-level doctorate graduates, as these programs
are not academic doctorates intended to make a significant academic
contribution to the field (like a PhD.) Entry-level doctorates like entry-level
masters degrees, provide the basic training necessary to begin practicing.
Questions this myth raises:
What are the AOM organizations doing to create more jobs for licensed
acupuncturists? How are the schools helping students to succeed/ stay in
business? Why are there so few statistics about AOM employment? How many
hours does the “typical” acupuncturist work? How much do they actually gross?
net? or earn per hour? Why do so many acupuncturists tell the same story of
starting with the assumption that AOM would be an easier and more lucrative
profession?
3. STAKEHOLDERS OF THE PROFESSION HAVE REACHED
CONSENSUS REGARDING THE DEVELOPMENT OF STANDARDS
FOR AND SUBSEQUENT PILOTING OF A FIRST PROFESSIONAL
DOCTORATE IN ACUPUNCTURE AND IN ORIENTAL MEDICINE ,
IN ANTICIPATION OF MAKING IT THE NEW ENTRY-LEVEL DEGREE
The following groups of stakeholders have not been adequately
addressed:
1.Current AOM patients
2.Employers of acupuncturists
3.Stakeholders in communities having limited access to acupuncture
because of affordability, lack of AOM care-facilities in these places, and
lack of practitioners from and serving these communities
All of the surveys conducted by the large organization of the profession have
shown disagreement about changing the entry-level degree for the profession.
Terms like “widely accepted” and consensus are not clear.
Questions this myth raises:
What level of agreement is acceptable to the acupuncture organizations? A
simple majority of those polled? An overwhelming majority? Who are the most
important stakeholders? The patients, the students, the practitioners, the
schools, the organizations? Who stands to profit most directly from these
programs?
4. AS A PROFESSION, AOM HAS A CLEAR VISION FOR IT’S FUTURE
ROLES IN THE HEALTHCARE
A vision for our profession, or any other healthcare field, needs to be tied to core
values such as access, affordability, patient care, and the creation of stable,
sustainable delivery system. The profession is, and has long been, divided about
the means to uphold these most basic core values. Like bio-medicine,
professional values for AOM have the potential to become weakened by the
costly, bureaucratic, and sometimes greed driven elements of current delivery
systems.
As a nation we are struggling to envision and re-structure our healthcare system.
AOM, like it or not, still remains on the edges of that system, with less than 5% of
the population even seeking AOM services. From this vantage point, however,
we can better see and navigate our way to a more equitable and sustainable
means of providing our medicine to the people. We can also choose to structure
training and education in AOM to reflect and promote social justice, and to
realistically account for economic realities for all the people we can potentially
serve with our care and services.
Questions this myth raises:
Will AOM ever be able to reconcile the different visions for the profession,
especially when the approaches diverge so much? Do we need to reconcile or
create a tiered profession? How much do professional politics and personal
agendas play into the professional organizations’ priorities?
5. ACUPUNCTURE IS LIKE PHYSICAL THERAPY, OCCUPATIONAL
THERAPY, PHARMACY, OR NURSING
PT, OT, Pharm. and nursing all have their foundations in the principles of bio-
medicine, which are at the core of the medical system that supports these
professions. Acupuncture is fundamentally different, and though it’s modalities
and theories can be practiced along side those of bio-medicine, the differences at
the core of the two medicines cannot be merged.
There are literally thousands and thousands of clinical jobs in PT, OT, Pharm.
and nursing that graduates need only apply for. There are very few jobs like this
in acupuncture—maybe a few dozen. Most acupuncturists must also be
entrepreneurs. If acupuncture were truly like these professions, and was poised
on the brink of becoming wildly accepted by the mainstream, there would need to
be shorter degree programs to address the shortage of acupuncturists.
Questions this myth raises:
Are there other professions that acupuncture is more similar to? What have the
outcomes been in those professions where there are multiple entry-level
degrees? Do the people with the newer degrees earn more? have greater skills,
job-satisfaction, confidence, debt?
6. FPD PROGRAMS AREN’T GOING TO COST MORE THAN THE
CURRENT MASTER’S LEVEL PROGRAMS
Yes they will and here’s why: having faculty with higher academic degrees
requires higher salaries; FPD programs will require larger libraries, more labs
and clinic sites, more administrative oversight, more evaluation, etc. All of these
things will cost the student more. The existing master’s degree is already fairly
expensive and burdens graduates with debt for years after graduation. An FPD
would further increase debt burden for students.
Questions this myth raises:
Post-graduate clinical doctorate degrees in acupuncture recently came into
existence as a means for those desiring further institutional learning. These
programs have just begun to be evaluated. Why is there so much pressure to
make yet another degree for the profession that would require increases in costs
to students, schools, and ultimately patient/consumers?
7. HAVING AN FPD AS THE ENTRY LEVEL REQUIREMENT WILL
ATTRACT MORE PEOPLE TO THE PROFESSION
What will attract new people to the profession is affordable, quality, education
and sustainable, stable jobs. One supporter of a new entry-level degree
speculated that black and Hispanic people are not generally entrepreneurial, and
therefore a new degree title in acupuncture would attract students from these
greatly under-represented groups to the profession, because the new degree will
create jobs. This thinking is fantasy at best and racist at worse.
Questions this myth raises:
What is the demographic of most acupuncture students? Why are there so few
black or Hispanic acupuncturists? What is the economic status of most
acupuncture students? Who are we trying to attract to the profession? Are there
any scholarships or student-loan forgiveness for acupuncturist? Would acu-
technician training be useful to patients or students? in what settings? How
much would this type of training cost? How long would it take?
8. EVERYONE WHO IS CURRENTLY LICENSED WILL BE
GRANDFATHERED IN AND WILL AUTOMATICALLY RECEIVE THE
NEW “DOCTOR” DEGREE TITLE
Those currently in practice with master’s degree or pre-master’s degree
certificates will be give the option to complete a “transitional” or “post-
professional” degree. These programs will be virtually un-supervised and un-
evaluated simply due to a lack of resources (since a new entry-level degree
would be the priority for these resources.)
It is highly unlikely that the professional organizations would accredit post-
professional or transitional degree programs, due to cost and low demand.
Those seeking to “update” to an entry-level doctorate would bear the expense of
another year of school (approximately $18,000 in tuition), travel to and from such
programs, and loss of work while completing such a program.
State lawmakers look to professional organizations and certifying agencies to set
the standards of education. If the FPD became the entry-level degree, some
states would change their laws to reflect this. Without strong advocacy and
representation practitioners with master’s level or non-degree certificate
educations (like all of our old teachers) could be legislated out of practice.
Questions this myth raises:
Isn’t it ironic that so many of the supporters of new, longer programs, are people
who graduated from much shorter programs than those in existence today? Do
they consider themselves safe and effective practitioners? Can your teachers
get a license in your state? Are the laws in your state exclusionary? Have you
ever been involved in the legislative process for your profession?
9. ACUPUNCTURISTS ARE PRIMARY CARE PRACTITIONERS
In a few states, like New Mexico and California, acupuncturists are in the letter of
the law called primary care. New Mexico suffers from an overall lack of medical
professionals and so acupuncturists have been asked to help out. In California
there has been a lot of confusion regarding the role of AOM practitioners. In the legal intent section of the California licensing law LAc. are “primary care professionals” in the field of AOM. This is much better explained in all of it’s complexity inLitle Hoover Commission report on the subject found at https://www.lhc.ca.gov/studies/175/report175.pdf . Nowhere in the regulations of the legislation are LAc. defined as “primary care practitioners. In NM acupuncturists, due to an aggressive AOM lobby, can order diagnostic tests like x-rays and blood work, and can prescribe a limited number of drugs, and do injection therapies.
These two examples of acupuncturists as primary care are repeatedly paraded
as a call to the entire profession to assume roles and responsibilities that a
majority of practitioners do not want, nor are qualified to have. For those
practitioners desiring a place in the integrated care setting, the post-graduate
DAOM degree is an opportunity to gain the proficiencies necessary to make this
leap. To require this leap as a next step for all present and future AOM
practitioners would be a great detriment to AOM’s potential to reach hundreds of
millions more patients.
Acupuncture and OM needs to be promoted for what it is: a simple, inexpensive,
treatment for almost anything, that reduces stress, and prevents illness. As our
medicine has changed in time and with cultural contact with the west, we bear
different responsibilities. Our greatest benefit to others is currently in the simple
and in expensive way that acupuncture provides relief for almost any condition,
and in particular conditions worsened by stress. If we prioritize the need to be
seen as “equals” with bio-medical professionals, we cannot prioritize the needs of
our patients.
10. A DOCTOR TITLE FOR AOM PRACTITIONERS IS NEEDED TO HELP
THE PUBLIC UNDERSTAND WHAT IT IS WE DO
At present there are at least 5 degree titles for acupuncturists (MTCM, MAc.,
MAOM, DAOM, DOM—technically those with DOM certificates do not actually
have a degree called DOM) and almost as many license titles (LAc., CAc.-WI,
DAc.-RI, AP-FL, DOM-NM). If you find this confusing, imagine how the general
public would feel, or a prospective employer or non-acupuncturist colleague.
We can best help the public to understand what it is we do by delivering
treatments directly to them.
Author: crismonteiro
I've always thought that I would live to be 100 years old and now that I have an actual idea of what it might be like to inhabit this body for a century I want to be damn sure that Community Acupuncture is around to help me through my days and in the end, on my way. In the meantime, I am passionate about getting shit done, and also having fun.
Well written, well reasoned blog.
I fully agree with every point you make.
Thank you for organizing this Cris!
When somebody asks me a question or raises an argument, it is so helpful to have this information available…
Thank you Cris, I have this
Thank you Cris, I have this printed out at the clinic for people to better understand this issue and its implications!
Keith
#8
I wonder if the AAAOM has considered that a doctoral degree does not necessarily mean that graduates of the FPD would be able to market themselves as doctors. Here in Massachusetts, acupuncturists are expressly prohibited from calling ourselves doctors unless we are an MD, even if we hold a PhD or other advanced degree. An FPD could not change this, only a change in state laws would. I’m sure there are many other states in which an FPD would not provide this benefit, either because of laws prohibiting it or because the LicAcs are already able to use the doctor title.
Thanks Chris
This is really well thought out. I appreciate the time you took and agree with your points.
Blythe
Thank you so much
I have been gathering signatures at school and because I had several printed copies of this given to me, almost everyone I asked today signed! I didn’t get to talk to very many people, but because of this myth buster, I am hopeful that I will get many signatures in the coming days.
Thank you!
I am so thankful to have found CAN!!!!! Especially when things like this come up! I know we can count on community acupuncture to stand for justice!
re myths
Great explanations and questions, thanks for your writing.
LOL, I would never be
LOL, I would never be against a Physician’s assistant going on to an MD degree, or an LPN from getting an RN. Why stop an MSOM from becoming an OMD? CAN seems to be thinking too small in this situation.
We aren’t opposing the DAOM.
The optional doctorate degree is fine with us.
CAN’s issue lies with changing the entry-level standards of our profession via the First Professional Doctorate. An LPN doesn’t have to receive a doctorate degree in order to stick needles in patients…neither does a PA.
Why should an acupuncturist need a doctorate degree for entry into the profession?
Thanks for the thoughtful blog
I know it sounds kind of competitive to say it, but I am one of the few people who actually went back to school for the DAOM degree. It cost a lot and it was a ton of work. Beyond the actual tuition cost, I had to cut down my practice to keep up with school work. I don’t mean to sound competitive, but after all that time, sweat, and money, I feel like I EARNED this degree. There was very little incentive to do it (no change in my scope of practice) other than an insatiable passion to learn more about medicine. One of my concerns with the FPD is that it will essentially make the DAOM meaningless! How unfair to everyone who has invested so much in it.
Beyond the specifics of the FPD, I think the field really needs to pressure states to standardize what we’re called. It’s absurd, really, that we have so many possible titles. Any state you go to, a chiropractor is a DC, a naturopath (in the few states they’re licensed in) is an ND, a medical doctor is an MD, an osteopath is a DO, etc.
Especially confusing is that a couple states (NM, RI) allow acupuncturists to call themselves doctors. This has led to a sneaky practice by some acupuncturists in other states of obtaining licensure in one of the “doctor states” and then writing “Joe Smith, Doctor of Oriental Medicine (NM)” Everyone knows the average patient has no idea what the “(NM)” means there, so, clearly it’s an attempt to deceive people into believing you have a higher degree. If there were nationwide standardization of titles, this wouldn’t be an issue.
Thanks again for the thoughtful essay.
A wake up call to the profession
FPD Food for Thought
Have you thought about what community acupuncture is doing to the acupuncture profession? It is causing acupuncture to depreciate in value. The more it depreciates, the more it dies off. Why don’t you address this topic in your quest to substantiate your argument regarding FPD. Let me explain.
Let me first start with the Workers Compensation Fee Schedule. This is the gold standard that determines insurance reimbursement rates according to geographic area. It determines our value as a profession. It determines the value of our services. There are acupuncturists who are treating and getting paid well over $100 per treatment. The more the market is saturated with low fees, the greater the depreciation. There are several ways to drive down reimbursement rates. Number One: Submit claims for reimbursement to insurance companies that are less than what is listed as appropriate on the Workers Compensation Fee Schedule. Some community acupuncture clinics do this. Private practitioners do this. School student clinics do this. They do this by providing receipts for care that reflect extremely discounted treatment fees and then have patients submit these receipts to their insurance companies. These receipts must not be submitted to insurance for reimbursement. It is inappropriate to provide patients a discount that is greater than 20% of the actual rate if you are billing insurance. The Working Class model and those like it are bastardizing the profession, kicking acupuncturists when they’re already down. To simplify, providing treatments that are less than the cost of a manicure or a hair cut depreciates the value of our profession. Period.
These are a few examples of the reimbursement rates currently used in our NW region: (unless you are part of some discounted network provider)
New Patient Exam: 99202-25 ($65)
Intermediate Exam: 99212 ($50)
Acu w/Electro 1st Unit: 97813 ($78)
Acu w/Electro 2nd Unit:97814 ($63)
One unit of acupuncture is 15 minutes. A follow up treatment with 2 units of acupuncture is completed in 25 minutes and is reimbursed $141.
Who is the most powerful figure leading to the demise of our profession?
Acupuncture schools and their diploma-mill tendencies.
These schools are not regionally accredited. Therefore, credit earned at these institutions cannot be transferred to other regionally accredited institutions i.e. colleges offering an education worthy of the degree. The teaching staff is underpaid and therefore undervalued. You get what you pay for. Their business model is not to prepare acupuncturists for business as a professional. Their business model is to make as much money as they can, obviously, but not to pump out acupuncturists who will be financially successful. If they did care about the quality of education their students receive, they would have experienced instructors who are successful themselves and they would pay them what they’re worth.
Increasing education standards and the new-entry level doctorate (FPD) is an excellent way to weed out those students who do not have the scholarly prowess to represent themselves as a competent medical professional. Reflecting on those days when I was in acupuncture school, I remember the whining and complaining about how difficult the program was. I remember the students who would come to class smelling of pot and those who were hung over. I remember students who were not professionally dressed and/or had poor hygiene, looking and smelling as if they were homeless or a streetwalker. Schools have dumbed down their program to accommodate these complaints in order to keep their students from falling out of the program. In order to keep profiting, schools need as many students as they can get. Why not let the pot-head slacker slip on into the graduation line up as long as they pay their tuition and fees? A school needs to survive, right?
Honestly, acupuncture programs are not challenging. They do not meet the standards met by regionally accredited institutions. They are simply not up to par. And with the survival mentality mentioned in the above paragraph, they never will be up to par. I simply do not understand why acupuncture schools do not align themselves with regionally accredited state colleges and/or regionally accredited chiropractic colleges in order to provide their students with an education worthy of the degree they pursue.
How are we going to save acupuncture as a profession? If you ask me we are too late. However, why not consult with the icons of those who are exemplary of scholarship and professionalism in our field regarding the survival of our profession and the new-entry level doctorate (FPD). Why not talk to Harvard graduate and OCOM doctoral fellow, Edward Chu, DAOM, LAc; Fulbright scholar and OCOM doctoral graduate Henry McCann or even Bob Flaws. Bob Flaws has been very vocal regarding low professional standards in our field and lack of adequate pay for teachers and clinic supervisors, especially that there are no significant entry-level requirements. Anyone can go to acupuncture school even without a bachelor’s degree or entry-level exam similar or akin to the LSAT or MCAT as required in other professional education programs.
I do appreciate the heart of what community acupuncture is trying to do but it’s coming at the cost of the profession and the needless suffering of acupuncturists who cannot afford to pay their bills much less repay those student loans. However, community acupuncture and others that follow in their footsteps have a delusional perspective on what it takes to save acupuncture as a profession. If nothing changes, and I do not foresee it changing fast enough, acupuncture as a stand-alone profession will fade into nothing. Then again, maybe not. There are many of those who have been successfully practicing acupuncture as chiropractors, medical doctors, physical assistants, physical therapists, podiatrists, nurses and dentists. I’m sure they don’t give their treatments away for $35 or less. And, I bet they don’t smell of patchouli.
Agreed on standards of scholarship
I believe cheap community clinics can coexist with more expensive private ones (like me). I even have a few patients who go to a community acupuncture clinic between visits with me. I cost 3 times as much, but it’s a totally different level of care, and I mean this with no disrespect to community acupuncture clinics. I spend a lot of time with my patients, the atmosphere is more upscale and more private, there’s more continuity, they get herbal formulas, etc. Between treatments with me, if they want to get inexpensive maintenance treatments at a community acupuncture clinic, that’s fine.
Anyway, I agree wholeheartedly on the issue of scholarship. First, schools have no business awarding master’s degrees to people who don’t have bachelor’s degrees. A master’s degree, after all, is a “post-graduate” degree. A 4-year bachelor’s degree should be a VERY BASIC prerequisite for acupuncture schools. It’s a pretty minimal demonstration of one’s commitment to learning and determination to follow through. So, the prospect of giving doctorates to people with a fraction of the education of those with ND, MD, or PhD degrees is absurd.
Those were some funny comments regarding the character of the average student body of acupuncture schools, but let’s not disrespect patchouli. We both know it’s highly effective at aromatically transforming dampness, which is a plague in the NW.
I, too, had many fellow classmates who would complain about having more than one exam in a week. Having done my undergrad work at a huge university where my professors had no contact with each other, they couldn’t have cared less what my other academic requirements were. So, I was astonished at how much hand holding some people needed in acupuncture school. A good handful of my classmates essentially opted not to learn herbal medicine (that is, they just barely passed their herbs classes and rationalized this by asserting that they were only interested in acupuncture). Some had a tenuous grasp, even by graduation, on basic anatomy, physiology, biomedical pathology, and even TCM theory. If there isn’t a major shift toward more rigorous standards, should we really be awarding DOCTORATES to the graduates of these programs? I doubt half the students in AOM programs could make it through NCNM – much less a medical school.
I think academic standards of schools of AOM should be exponentially higher, AND I still think the entry level degree should be a master’s. Realistically, there are plenty of folks out there who don’t have great intellectual prowess, but who are talented, insightful, and intuitive healers, and perhaps there should be a (non-doctorate) entry level degree available to them. As it was presented to me, the DAOM is a degree program for practitioners wishing to go beyond the basic education provided in the entry level program. The FPD would preclude any advanced achievement.