Dream Traffic and Ice Floes
After the recent blogs and posts, some personal experience, and with some pondering, I’ve been asking myself, do graduating acupuncturists really want to work and be in practice? After 3 or more years in school, does completing school mean you’ve accomplished your dream of being an acupuncturist?
I’ve been thinking of some of Lisa’s words (and other CANners) in her last post that I haven’t quite been able to shake off the last few days – one particular phrase, referring to the schools, “you traffic in dreams”.
I’ll admit it – I love, love, love this phrase. It’s powerful. It’s been eating away at me – kind of like carpet beetle larvae. You see the problem and don’t want to deal with it until you find holes in your clothes or you start finding the little buggers everywhere. Being a google hound, I have been searching high and low for book snippets, movie lines, song lyrics, but have come up empty. My guess is that this line, “you traffic in dreams”, will appear somewhere soon in a movie or a song. Maybe the next Joe Hill will use it.
The dream of an advanced education and the subsequent pros of a degree, one that leads to a job in which a person can make a living , just aren’t what they were cracked up to be just 20 or 30 years ago (and much has been written about this elsewhere). An acupuncture education didn’t even exist anywhere near to its current form 20-25 years ago, nor did licensing or the whole AOM alphabet soup kit’n’caboodle. We all know this, and we’ve had this narrative that the AOM alphabet soup was a necessary creation to protect our craft, thus allowing the cottage industry acupuncture educational product to legally unfold in its own time, through self regulation and self oversight, producing 2000+ licensed grads per year since the mid 90’s.
So, on the one hand, we have acupuncture education as an educational product.
But is this the acupuncture dream? Is the acupuncture dream equal to the completion of the educational product?
Acu-schools seem to be fulfilling their purpose and mission of education, by providing an educational product to the students (which provides the bulk of school revenues) and providing healthcare to their student clinic patients at a reasonable cost (student clinic patients are a minor revenue streams for schools and most schools charge in the neighborhood of $30/visit). This culminates with a certificate of accomplishment/degree with some letters that allows a newly minted grad to access another alphabet soup product/process – national or state boards , which leads to licensing, necessary in 44 states and Canada for legal practice. All part of the road to (hopefully) gainful employment (self or otherwise), otherwise known as making a living. All the while another part of the AOM alphabet soup deals with school oversight. But even this part indirectly relies on student enrollment.
And this whole shhh-bang creates other startups, notably the CEU/PDA/workshop industry, the textbook/video industry, the needle, herb, and product suppliers.
So, back to the idea of “the dream” – Is the dream of “becoming an acupuncturist (AOM practitioner) ” simply mean just finishing school? And once again I am asking myself the question, do acu-grads out there want to work? Do newly minted grads have any idea what it means to be in practice?
In one sense, surviving school is definitely an accomplishment in and of itself, the culmination of 3-4 years of study, long hours, immersion, and indoctrination into what for many was previously completely unknown territory. As Demetra mentions, some grads see this finish line as the opportunity to rest, rejuvenate and gear up for the big push into the much coveted Holy Grail, the hundred thousand dollar practice. For a time in school, I was enamored with the $100K practice idea, and also the free clinic idea (aka giving back, working for free). At least that is what I think many students convince themselves of in the beginning. When some flashes of the truth due to school’s end being a little bit closer, things begin to shift to either “holy effen crap my student loans just ran out what am I going to do now?” or “ I have no idea how to get a practice going other than what I learned in 2 practice management classes and what I did in student clinic”.
Welcome to the ice floe, er, uh, I mean profession.
I honestly believe for many graduates that reality of school is a lot closer to Stockholm syndrome mentioned in Lisa’s last post. In psychology, Stockholm syndrome is a term used to describe a paradoxical psychological phenomenon wherein hostages express adulation and have positive feelings towards their captors that appear irrational in light of the danger or risk endured by the victims, essentially mistaking a lack of abuse from their captors as an act of kindness. (from wikipedia)
After you spend 3-4 years in a school situation doing things a certain way, you get into a groove. Everything is paid for, all you have to do is basically show up, study, pass your tests, complete your in-seat hours and student clinic hours, and voila! – thank you very much, next class please – you have a shiny new diploma and a couple of letters to put after your name. I watched some of my classmates and myself struggle with certain aspects of schooling, but for the most part if you stick to the script, pass the exams, and don’t decide to drop out in the first or second year, getting the degree is doable as long as you pay up.
How many students before school actually have any real clue what it takes to run a business? Not many have seen a busy clinic in action, let alone run a lemonade stand. I think this is where some of the economic disconnect mentioned by Larry and Lisa comes into play. This kind of disconnnect has always been in place between the halls of academia and the workplace. It was there when I got my BS degree 20 years ago, I was woefully unprepared to make a living or land a job in my field, and I was supposed to be in a good field for jobs. School is a fun bubble to hide in where you don’t have to think about these things until you’re not in school anymore, but all the while the larvae are eating holes in your labcoat or scrubs. When I went to acu-school seven years ago, I was a little bit more prepared on the ins and outs of running a business from some experiences in-between college and acu-school, but after awhile in school I was once again lured towards the rocks by the sirens.
To be a bit fair and balanced, the schools are a business like any other, but students are never let in on the running of the school’s business (not even the student clinic's finances) – the necessary daily drudgery, the paying of bills like rent and utilities, fees to the alphabet orgs and AAC, local permits, personnel salaries, marketing, upkeep, employee personnel management, herding cats (i.e., students), the B.S. dance that surrounds occasional site visits from ACAOM and other state regulatory agencies, and various other things like board meetings and the such. It takes a lot of personnel hours to run a school, and a minimum revenue stream to pay the bills. I saw this from the inside after I graduated as I worked for my school for a time. Most of the schools are not financial mega-powerhouses, they are small to medium mom-and-pop shops that squeak by, while a few do much better than the rest, supporting the owners/founders. I believe most of these halls of academia have been created with good intentions, but in the light of the continued high failure rate of graduates, painful self-examination needs to take place at the school level if there is ever going to be any responsibility taken to set up the newly minted grads for success, instead of driving the train down the same tracks.
Well, hello, Department of Education’s proposed rules on gainful employment. Living within an AOM school bubble ( not talking about the greater education bubble here ) lends itself to self preservation, a preponderance of the me-first $100K+ generation of grads, and a continuation of the status quo because the education revenue stream – student loans – hasn’t changed in years. Now that there is some worry about the gainful employment rules, which could be a total game changer or a total dud, there is the pushback on the gainful employment rule from the school sector. Should schools bear any responsibility for an educational product that is not necessarily defective, per se, but perhaps better characterized as incomplete, at least from the perspective of the ins and outs of running a successful practice and business, or giving someone the ability to gain employment.
Circling back around to the first question – do grads want to be in practice – my overall sense is yes, new grads want to work, but I believe most grads want this on their own terms, with most of these terms and notions being modeled after the one patient per hour private room setup in a school clinic. It’s really no surprise – this is the way it’s done in school for 3 – 4 years, so it’s probably going to be the way you try to practice when you graduate, 3-4 shifts per week in student clinic in the final school year = 12-16 pts per week in private practice. Is this what it means to be in practice? The predominant one-on-one model taught in schools hasn’t changed in 20 years, and still prevails today in student clinic. Recently a few schools have bent a little bit and offer some version of group acupuncture in their clinics, but none that I know of let students handle the money, except maybe TSI.
If we lived in a fantastic bizarre parallel universe where there were a demand for acupuncturists to fill lots of open paying positions at hospitals and in other settings, I still have some doubts whether or not new grads would want to work. But we all know hospitals will never employ acupuncturists in the U.S. on any large scale. At best, hospital access and insurance overage will always be token, or an ongoing pilot project where acugrads pay a fee for access. So new grads are faced with some tough choices, especially in harder economic times with larger debt loads looming. I agree with what Michelle has said, in that I feel truly lucky to have fallen into the arms of a couple thousand new local acupuncture lovers, and hundreds of CAN comrades. Best of all, after just a relatively short period of time, I feel happy about co-founding a local business that provides affordable health care to the community and jobs for six people.
I think what you say below is true…
but I believe most grads want this on their own terms, with most of these terms and notions being modeled after the one patient per hour private room setup in a school clinic. It’s really no surprise – this is the way it’s done in school for 3 – 4 years, so it’s probably going to be the way you try to practice when you graduate, 3-4 shifts per week in student clinic in the final school year = 12-16 pts per week in private practice. Is this what it means to be in practice?
But I think that CA is a timely alternative to that mindset…just keep blogging about it Keith.
Avoidance, Denial and Fear
I think avoidance, denial and fear are definitely huge reasons why people finish school and never even begin to practice.
I find it really sad that many of the people who I know who I went to school with aren’t practicing – 3+ years later – or did only for a very short while – yet on some level I get it. I will admit that about 6 months into practice I was having such a hard time I wished I could quit, and thought that maybe this wasn’t the profession for me – of course it was all just a tough growth period that I thankfully pushed myself through and now I am truly enjoying my work – but I could see how this may have happened to some people who gave up earlier. The financial fear is enormous. Also, before practicing while we are students, we’re sheltered and enjoying the avoidance/denial/fear tactic. I used it myself when I went straight from undergrad to acupuncture school without a break, mostly because I was afraid I wouldn’t get work right out of college and didn’t even know what I wanted to do, but that I wanted to have a career and make a living and just finish whatever further school I would need ASAP – and I also lacked all the solid data that we still lack with regards to how I would make a living when I finished acupuncture training (I also thought i could make $100k+/year). What I never understood, though, were the people who just kept going to school year after year, accumulating degree after degree and more student loans – and there were several of these in my class. Also, some of the students in my class who were far more enthusiastic than myself about practicing (I was sort of in my own self-absorbed world while in acu-school – not exactly the healthiest state of mind and body, and not exactly the most enthusiastic about being in school at all because I was completely burnt out from undergrad) never ended up practicing. These were some of the people who loved helping people most, who had twinkles in their eyes talking about treating their patients in student clinic. And sadly, I think many were never ever inclined to the idea of doing business or ever having to run a business on their own so they gave up before they even started – while others maybe had fantasies of working for others or in hospitals – or decided that when they finally finished the grueling program they’d start their family, etc. and that “later” they would practice.
Anyway, I don’t know exactly where I’m going with this and it’s not even really explained ilnearly except to say that I agree with you, Keith, about many of the points you make – and I too feel SO lucky to have found out about CAN and to now have a thriving practice, happy and healthier patients, a feeling that I am doing good in my community and gratitude for my humble financial gains.
Going thru school, I had no
Going thru school, I had no other busy practice model to emulate, only stories in the classroom and student clinic of how busy practitioners said they were doing. As a third year student, the one per hour was easy breezy, with lots of down time. Initially before I went CA, I thought running 2-3 rooms in practice would be a busy practice model for me. The big paradigm shift for me took place on our first day in practice, like Larry previously mentioned, seeing 70 new people in 3.5 hours. Blew me away. But, honestly, different strokes for different folks, if the one,two per hour works well for some practitioners, that’s great. In thinking about it more, one of the things that I wish to accomplish in practice is to show as many people the wonderful changes acupuncture can help them do for themselves, helping as many as possible, and CA is a great vehicle for that end.
It’s easy in school to focus
It’s easy in school to focus on the next exam and put the future practice on the back burner. first things first? Perhaps as time goes on, CA practices can continue to provide a concrete example to future practitioners of at least one plausible way to practice, all the while increasing the numbers of acupuncturees on a large scale at the grassroots level, an under the radar pillar of sustainable community based health reform.
This post also explains why
it can suck SO MUCH to try to employ acupuncturists. A lot of graduates take it for granted that they can have their practice on their own terms — and yet they are totally unprepared to be self-employed (which is a strange combination of having everything on your own terms and simultaneously surrendering your entire life to your business). And getting a job means not having anything on your own terms. And actually taking care of people means thinking about their terms, not yours.
It is an interesting
It is an interesting question. Who holds the responsibility for acus to be working after graduating? This is a big problem throughout higher education in general. There are certainly people who are able to succeed in school but are unable for whatever reason to succeed at work.
The fraudulent claim that acu schools support is the idea of living the acu lifestyle. Easy living, no boss, and 100k. Some people have achieved that dream. Most of them have been around for a long time and are attached to schools. Its clear to me that it is unrealistic to believe that we can all do it. There are just not enough rich patients to go around.
Unfortunately people get out of school and realize that it is not easy to run a business and that there are not a lot of people looking to hire them and then drift to the next thing.
Is that their fault or was there something wrong with their education? People often blame the culture of today and a sense of entitlement. There is also the business culture of selling a product and not worrying about its real value just its marketability.
I’ve been thinking about this a lot
as I hear crickets chirp in response to my help wanted posting. My office is less than 50 miles from a major acupuncture school. While it is a common joke that people in Boston think the state stops at I495 (or sometimes I95), I can’t imagine another profession where new graduates would hesitate to drive 40 minutes for a job opportunity. Certainly, if they *really* wanted to help people for a living it shouldn’t be an issue!