Acupuncture for the New Economy

Or: Barbara Ehrenreich Explains It All, or: Why I Couldn't Finish My NCCAOM Survey

 Ever since we started teaching Community Acupuncture 101 workshops, Skip and I would argue periodically about the section where we talked about class. It's not exactly right, he would say. I know, I'd say, but it's better than nothing. We both agreed that class in the US didn't fit neatly into the definitions we were trying to use, and the more the economy changed, the more it didn't fit. Well, fortunately for us, Barbara Ehrenreich and John Ehrenreich thought so too. They wrote a new class analysis for the 21st century; Nora linked to it on Facebook; and I read it and said hallelujah! Not only is it much more accurate, but it explains an awful lot about the state of the acupuncture profession.

Here is a condensed version of that analysis on the Ehrenreichs' blog. Go read it, OK? It's not very long, I promise.

Many people think that by going to acupuncture school, they are getting themselves a ticket into the Professional/Managerial Class. Since the 1990s, when acupuncture schools became able to offer federal student loans and to provide Masters' degrees, the acupuncture profession has aspired both to join the PMC and to treat the PMC. A lot of conventional acupuncturists, unless they have unusual class backgrounds and have done a lot of thinking about it, probably reflexively identify with the PMC, so it's not surprising that this is also whom they want to treat.

For the last seven years, the community acupuncture movement has had a lot to say about the acupuncture profession's aspirations and why they're problematic.  But one thing we haven't brought up — the biggest problem of all — is that the PMC itself is falling apart. The acupuncture profession thinks that it's playing it safe by trying to get into the PMC clubhouse — but according to the Ehrenreichs,  behind its respectable facade, that clubhouse has basically been bulldozed. It might also be on fire. And the smoking ruins are owned by big corporations. There's no safety to be had in there.

I read the Ehrenreichs' analysis and had a whole new appreciation of the arguments I've been getting into for the last decade, especially with boutique acupuncturists who mean well, who want to like us, and who can't understand what we're so upset about. I needed somebody to explain to me that PMC folks dream of a society “ruled by reason and led by public-spirited professionals”. PMC acupuncturists in particular, I think, dream of a society where acupuncture can exert a gentle, Taoist influence on Western medicine and Western lifestyles; where acupuncturists can proudly speak the words “Liver Qi Stagnation” to respectful MDs; where all those chubby Spleen deficient Americans push away their ice cream and reach for their congee (with a side of enlightenment). Meanwhile the acupuncturists all have designated parking spaces at the gleaming hospital towers and nice upper-middle-class paychecks. I didn't get the emotional resonance of that dream, because, well, that's how class works: I just can't feel the same warm fuzzies about reason and professionalism, even when I try (and I did try).

Anyway, on my side of the argument, what I couldn't convey was the visceral feeling of the classes pulling apart, the chasm widening between the haves and the have nots, with all of my people on one side. As I've written elsewhere, I am the way I am in part because my father grew up stealing bread in order to eat. He walks with a limp because he got hit by a car and couldn't go to a hospital. That kind of life will become reality for many more people as the safety net continues to be shredded and the ranks of the working poor keep growing. Some acupuncturists, of course, aren't concerned about the disappearing middle class; the chasm doesn't bother them as long as they're on the “have” side, treating the wealthy. But a lot of PMC acupuncturists don't want to look at the chasm at all, and I can barely speak to them sometimes.

 I was also grateful for the Ehrenreichs for helping me identify what class I'm in now: the “old middle class” of small business owners. Many of us who support ourselves by doing community acupuncture belong to that class. It's not nearly so comfortable, or so secure, as the PMC seemed to be for a time. And of course, it requires accepting the reality that nobody is going to just give you a job. (Successful community acupuncturists who happen to be employees also know this; if you have a job, you made it yourself.) You constantly have to watch the bottom line. Your attention can't wander, ever, from the humble details of running a clinic. It's not glamorous and a lot of it has nothing to do with acupuncture at all.

Which gets me to the 2013 NCCAOM survey. I wanted to fill it out because you know, it's a put up or shut up kind of thing. I firmly believe you can't complain about something if you don't even try to participate. So I tried. Speaking of trying, Cris also tried to warn me when we talked about it on the phone. She said, there's a lot of questions about Western medicine, stuff we don't deal with at all, it's pretty frustrating. I thought, OK, I'm prepared. But I wasn't; I got halfway through and just stopped. My wrist was starting to hurt from clicking “not important at all” down a line of possible tasks, but it wasn't my wrist that stopped me. I was getting a headache from the  migraine-like sparkles of the Professional/Managerial fantasy of being an acupuncturist — otherwise known as the fading aura of MD Lite. I just couldn't stand to look at the mirage up close anymore. It's bad enough from a distance.

How important is it for the first year acupuncturist to be able to read X-rays for all the patients she doesn't have? I give up.

Finally, the most important aspect of the Ehrenreichs' analysis is how it can help us plan for the future. Like our meeting with the co-op folks last week, I'm taking this article as a sign that we've already done a bunch of things right with POCA. One of the most practical, productive responses to corporate domination of society is to invest in cooperatives. Self-help is our best (and maybe only) hope. Nobody is going to build a more egalitarian world for us; we've got to do it together. There are not going to be a lot of PMC jobs for acupuncturists to close the have/have-not chasm; the only place you can really expect to find PMC jobs in acupuncture anyway is in acupuncture schools, and we'll see how long they can keep selling the PMC fantasy in the new economy.

So it will become clearer and clearer that you have to choose who you want to serve. As the tectonic plates of our class system keep separating, you'll be able to look at any given element of the acupuncture profession and see which way it's heading. I'm not going to be able to laugh off WCA's red fist as a joke much longer, and POCA's ancient recliner won't pass for irony either. Those symbols will function more like flares in the fog: hey, we're over here! Acupuncture in the new economy will mean that even if you don't want to talk about class, you're going to have to figure out which side you're on, and who's there with you.

Author: lisafer

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


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  1. “That kind of life will become reality for many more people as the safety net continues to be shredded and the ranks of the working poor keep growing.”

    …HAS already become the reality. SO many of the people I meet either as patients or “socially” not only have no safety net – they’re still trying to plug the holes from a few years ago when they had one. No health insurance, can’t afford new glasses, medications, clothes, food, gas, car insurance, car maintenance. Where the HELL would these people get money for conventional acupuncture?

    And this was always my personal pet peeve with the (newly christened) PMC-LAC’s – “proudly speak the words “Liver Qi Stagnation” to respectful MDs”…made me howl with laughter.

    As always, Lisa, you’ve found the resonance in the Ehrenreich piece, grokked it, and made it grok-able for the rest of us. Thank you, always, just thank you.

  2. ” the fading aura of MD Lite.”

    Snorted my tea right out my nose on this one. Once again, Lisa, you’ve hit the nail squarely on the thumb. I can’t figure out what hurts more, the truth you’re illuminating or my spasms of laughter at the absurdity of the whole situation we’ve found ourselves in. Thanks for pointing out the Ehrenreichs’ work. Barbara has been a hero of mine for long and long, and more from her camp is always welcome. Wouldn’t it be lovely to have them at a POCAfest?

    PS. I couldn’t make myself finish the survey either.

  3. Lisa, thanks for writing this article. I’ll probably never lay eyes on the NCCAOM survey (and I’m ok with that!) but I have had difficulty with explaining why I struggled to relate to BA practitioners. This bit hit home for me the most: “you have to choose who you want to serve.” Thank you.

  4. I admit, I also started, but could not complete the NCCAOM survey. Too bad they won’t have enough of a response rate for their survey to be representative of the profession… but which profession? The one of their imaginations, the one that rank and file boutique acupuncturists mostly fail or bail from?

    Partly I couldn’t complete the survey b/c there were just too many pages of questions about the importance of practicing western bio-medicine for the new AOM practitioner. I was getting madder and madder as I went through the questions wondering when were they going to ask about the importance of communication skills, building rapport, or addressing expectations through a treatment plan. Then in the midst of starting the survey late one night, and waking up yesterday morning realizing the deadline had passed and despite NCCAOM’s appeal email (one of 3 emails I’ve ever received from them even though I was NCCAOM certified for 12 years), I received a very swanky “Annual Report” from my alma mater, ACTCM.

    I don’t recall ever receiving something so nice from them. I found the article on endangered species ironic since acupuncturists themselves could be counted on this list. There was an article on community medicine that I found philanthropically patronizing (to those being helped.) There was news of more certification programs, and then some mysterious maths-graphs. One of these showed the $4.8 million of revenue, and how the school spends this money. The expenses graph shows that administrator salaries are $752K annually. If there were one administrator to every 12 students enrolled, that would mean that those 7 administrators gross $100K+ per year. Interesting! Then there was the bubble graph that shows 82% of acupuncturists in private practice, 10% in hospitals, 11% teaching, 5% in spas, 8% in community acupuncture, 8% in multi-disciplinary practice, 4% other…. huh 140%?

    Speaking of surveys and response rates, POCA will be conducting it’s annual LOC clinic survey in April. Tax time is when we all have to get our financial info together and it’s a time when many clinic owners take the time to look at the progression of things: number of treatments, budgets, adding shifts, etc. The results of this survey conducted first by CAN and now by POCA has helped many clinics decide how to steer their course. I know that back a few years ago, seeing for example, that the busiest clinics also had sliding scales between $15 and $35, helped me make the decision to change our scale from $20-$40 to $15-$35.

    We actually have a community acupuncture profession, one that appears to me to be thriving and thrashing and alive. So I hope that ALL LOC clinics will respond this year. The data is really valuable for all of us.