Summary: Responses of readers from the acupuncture and Oriental medicine (AOM) profession challenged a statement in the most recent Integrator round-up. They argue that there is no “emerging consensus” on the proposal of the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) to establish a “first professional doctorate” (FPD) for the profession. Here are responses and links to the heated debate. Included are statements from the Community Acupuncture Network (opposed) and the American Association of Acupuncture and Oriental Medicine (in favor). CAN will formally take their protest to the US Department of Education should ACAOM go forward. I follow with some altogether non-conclusive comments.
The January 2010 Integrator Round-up contained a short article on the proposal of the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) to promulgate standards for a “first professional doctorate” (FPD). I wrote that “consensus for the direction has grown in recent years.” My reference point was a supportive 2008 resolution from the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM), reported here. Some AOM readers quickly challenged me. I was reminded that the Community Acupuncture Network (CAN) which promotes a community room acupuncture model, has long opposed the move. Here are the responses, and discussion. I personally find myself torn by this challenging issue.
First, 2 reference points. First, a widely circulated pro-FPD document, referenced in the Round-up, is available here. This provides some of the pro-FPD content against which these statements react. Second, a recent survey found that 57%-64% of acupuncture and Oriental medicine (AOM) practitioners favor the FPD’s higher and more expensive educational standard of entry into the profession. This marked a gain, for advocates, from the 45% who supported this direction in a 2003 poll. Yet this is, on the face of it, far short of “consensus.”
Preface: ACAOM will have a formal response after its February 11-14, meeting
The ACAOM’s winter meeting will be February 11 – 14, 2010 in San Diego. Carla Wilson, MA, DiplAc & CH, LAc, ACAOM chair shared that “the commission will evaluate community response at that time.” Wilson described ACAOM’s present position as:
“The idea of a first professionald doctoral degree (FPD) has been in debate within the profession for some time now. ACAOM had initiated the process of developing accreditation standards for the degree, but subsequently adopted a resolution placing further development on hold pending stronger evidence of consensus within the profession for moving forward. When the Commission receives sufficient evidence of consensus within the profession and develops and pilots standards for FPD programs, we will seek USDE recognition for the FPD program reviews as well.”
The Integrator will follow-up on this story.
1. Jordan Van Voast, LAc: “FPD will relegate AOM to obscure status …”
Jordan Van Voast, LAc runs a Communi-Chi, a community room acupuncture program in Seattle, Washington. His clinic is a CAN member. By way of disclosure, his clinic and services have been used by me and members of my family. (I personally like the experience of the community room setting.) He begins by clarifying that he doesn’t want to harm our client relationship. Then:
“I read your summary piece in the Integrator that gave ACAOM’s versions of the impending decision on the proposed FPD (First Professional Doctorate). I’m guessing you are aware that there is a different version of the story found on numerous public CAN blogs in the past month. Some of it is a bit rowdy and decidedly satirical, but nonetheless, I believe the points raised are valid: If the FPD goes forward, it will continue to relegate the acupuncture profession to a relatively obscure status.
“Yes, from some perspectives, it will look more mainstream, gaining more credibility in official circles. But fewer practitioners will enter the profession if the cost continues to rise (and it will despite vague promises to the contrary). Fewer will survive in practice. And fewer patients will be able to afford it. Which is really a shame. Acupuncture could make such a difference to ordinary people (without insurance), helping people deal with pain and stress in this difficult time. HR646 [the bill promoted by the acupuncture profession to gain inclusion in Medicare and federal employee benefits] is not any panacea either, but I won’t go there now.
“I believe CAN is correct when it places its focus on the patient by increasing patient access to acupuncture. ACAOM, in placing focus on the profession – promoting the status of acupuncturists, simply confirms to me how far they have drifted from the Taoist roots of humility and creating value through altruistic service (i.e. work).
“Lastly, it feels like a distortion to say there is consensus on this issue in the profession. If ACAOM pushes forward with this in the face of (I’m guessing here) – a few thousand patient signatures on petitions opposing the FPD, and many (hundreds of?) practitioners sending faxes, it will be interesting to see what the spin on this supposed ‘growing consensus’ that I keep hearing about will be.”
Jordan Van Voast, L.Ac. CommuniChi Acupuncture Clinic
Comment: The CAN thrust on creating a business model that offers affordable, cash-based services for the general public is quite appealing. Who would not blanched at $80 a session for a series, even if one’s family income is significantly better than the average. I agree with Van Voast that the higher standard will entail more costs, more debt, and will accelerate the spiraling away from a cash-based, service model.
2. Opponent who favors anonymity: “Profession is weak (financially) …”
This e-response arrived immediately from a long-time member of the AOM profession. The practitioner asked not to be named as the respondent said that prior comments had cause pain and the practitioner thought being open would stimulate another round. The comments are insightful and balanced.
“I know you have been covering the FPD for Acupuncture and Oriental Medicine. In your last blog you mentioned that the consensus seemed to be building. There actually has still been strong opposition to the FPD within the community. It is not so much about the FPD as it is the tendency for those at the top of acupuncture to continually use education as the way to build strength in our industry.
“The acupuncture profession is weak professionally. The income has not risen in the population. Other professions are vying for a share of our business and we pale in comparison business skills-wise compared to chiropractors or PT’s. The FPD is not the best solution for all members of the profession. It is in the best interest of the educators who control the debate, and it is in the best interest of the administrators of acupuncture, but not in the best interest of the practitioners who are the foundation on which the administrators and the educators rely upon for their incomes.
Those who think the FPD is not a good idea for this particular time want those at the helm of acupuncture to concentrate on making those who already practice stronger and they want higher visibility for our profession. Of course most of those at the top are not practitioners, but educators and administrators so I can see their reticence at tackling an issue at which they are not familiar with. There are those who have practiced, but they were more than happy to leave that behind. There is a google group discussion where this item has been hotly debated to the point where all parties have decided to take a break for a few days. Discussion has been heated at times. I just wanted you to know that consensus if far from being achieved. I am saying this having been on the FPD task force in 2005.”
Comment: The response is an insightful look into the stakeholders inside the stakeholder that is AOM. The dialogue over income breaks this way. Some focus on the kinds of income that some entrepreneurial practitioners can earn and a view of what they believe they ought to make, based on their education and services. The aspirational income level is in family medicine’s $85,000 – $125,000 range. Others, led by CAN, point out that many graduates drop out of the profession and other who make a go of it often are under-employed and take home $30,000-$40,000 or less. CAN stresses the service-orientation of many practitioners, the fact that this level of income is not bad relative to averages in the U.S., and sets this level of income as a ballpark for CAN members.
3. Community Acupuncture Network (Board Member) Jessica Wolfson, LAc: “Surprised at the slanted perspective …”
Jessica Wolfson, LAc is a member of the board of the Community Acupuncture Network and owner of The Turning Point: A Community Acupuncture Center. She wrote:
“I noticed your article about the FPD in yesterday’s email from The Integrator Blog. I have always appreciated your neutral reporting of issues which affect our industry, so I was surprised to read the slanted perspective you wrote about the ACAOM’s comment period. Perhaps you haven’t had an opportunity to learn more about this issue.”
Wolfson then shared an article on her opposition which appeared in the Beltway publication, the Frederick News-Post in which she was quoted as arguing that “[CAN] places a high value on our patients’ access to care, which would stand to suffer given higher debt loads and smaller graduating classes.” Wolfson shared additional links, including the recent survey, a Facebook page of over 1000 opponents, a forum at one of the accredited schools and evidence of other opposition from non-CAN leaders. Wolfson also linked to this official position statement, signed by (the President of) CAN’s (Board of Directors):
“To the Commissioners of the Accreditation Commission for Acupuncture and Oriental Medicine,
“I write to you as a representative of the Community Acupuncture Network (CAN) Board of Directors. CAN represents over 1,000 OM practitioner members who are actively engaged in utilizing acupuncture and Oriental medicine to make a positive impact on communities that have been, more often than not, under-served by the profession. These communities include the vast working class along with racial and ethnically diverse peoples in the United States. We estimate that our member clinics have given approximately 200,000 acupuncture treatments in 2009 alone, a testament to a commitment to service and the effectiveness of the model of care. We also consider CAN to speak for this under-represented patient population in the gathering of feedback for a First Professional Doctorate.
“CAN is strongly opposed to the development of standards for and subsequent piloting of a first professional doctorate in acupuncture and in Oriental medicine. We firmly believe that the first professional doctorate is not in the best interest of the public at large, including both potential patients and potential students. As such, it is a misuse of the profession’s time and resources to continue the development of the doctoral standards and resume a process that may well lead to a change in the entry level degree designation for the profession.
“Thank you for the opportunity to express our opposition to the first professional doctorate.”
Sincerely, Andrew Wegman, L.Ac. President – CAN Board of Directors
4. CAN to oppose ACAOM before US Department of Education
On January 13, 2010, Wolfson arrived at the ACAOM offices with an armload of opposition to the FPD. She described the contents this way: “1856 pages of non-consensus documentation, 2039 signatures of objection (363 letters and 1676 petition signatures), and 1400 pages of blogs, online forums, public comments, etc.”
The consensus issue is significant not only internally for the AOM profession, but formally. When the US Department of Education recognizes a standard for accreditation, the agbency typically looks for evidence that the accrediting entity making application is reflecting the profession it serves.
In a follow-up note, Wolfson said ACAOM will face a formal challenge should it move ahead in promoting the FPD. She wrote: “There are many more blogs and internet conversations around the issue of non-consensus that I did not print and copy to ACAOM as well as hundreds (thousands?) more letters of opposition from stakeholders. I can easily gather them all together. I advised Dort Bigg [executive director of ACAOM] that we are prepared to go to the US Department of Education with our records, should there be even an inkling that the FPD is moving forward.”
5. AAAOM published position in support of FPD in December 2009 letter
In the midst of the internet and blog-based fury, and less than a month before the end of the ACAOM comment period, the American Association for Acupuncture and Oriental Medicine sent a formal notice to ACAOM in support of the FPD. Here is the December 20, 2009 letter provided to the Integrator:
December 21, 2009
Accreditation Commission for Acupuncture and Oriental Medicine
Maryland Trade Center #3
7501 Greenway Center Drive, Suite 760
Greenbelt, MD 20770
Attention: Dort S. Bigg, JD, Executive Director
Dear ACAOM Commissioners:
It is with pleasure that I write to you following our December 14, 2009 AAAOM Board meeting. With a great deal of thought and consideration for all the issues involved with the First Professional Doctorate, we have voted to support ACAOM’s ongoing process as detailed in the motion included below.
“MOTION by Shane Burras, seconded by Jeannie Kang that the AAAOM endorse and support the ongoing process of the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) to establish educational standards for the First Professional Doctorate (FPD) based upon AAAOM membership input, namely the FPD Survey (June 30, 2009), as well as previous task force representation and participation of both lineages of the unified AAAOM–the AAOM [American Association for Oriental Medicine] and the AOM [Acupuncture and Oriental Medicine] Alliance. There were no abstentions or objections. The motion carried by general consent.” [bold added]
“I look forward to the future and the next steps ahead for our profession. If you have questions or are in need of our assistance in any other way, please don’t hesitate to contact me.”
Deborah Lincoln RN DiplAcp NCCAOM
President AAAOM Board of Directors
Comment: The reference to the two “lineages” is significant. For 15 years from the early 1990s through 2007, the AOM profession was debilitated by a split into the AAOM and the AOM Alliance. The former tended to house those who presently are the strongest FPD supporters while the latter showed more interest in directly getting needling to the public. An example was the Alliance’s support for the National Acupuncture Detoxification Association, which modeled a community room delivery setting. The mention of the 2 lineages in the letter suggests that old issues remain near the surface, even though a “general consent” was reached.
6. General Comment: Urging the “two lineages” to strength in finding resolution
The issues in this intra-professional AOM conflict reflect the tension between service to patients and guild interests and stature which pull at all professions.
An additional complexity here is that each party is arguing benefits to both service and guild. An entry-level doctorate is clearly muscle flexing for the AOM as a guild, and an argument for higher income. At the same time, if successful in setting this standard, in time greater patient access (service) to AOM practitioners would be expected to follow as AOM doctors participate more thoroughly in research, in public policy and in reception of 3rd party payments.
On the other hand, the CAN members have, from the beginning, argued that their community room model is both a way to serve more patients and one which can also strengthen the AOM guild. CAN supports the guild by providing an income model with which additional practitioners can make and sustain a living. The more the model is successful in reaching lower-income clients, the broader the public use and potential support of the profession as part of the healthcare matrix.
My own conflicts in this area are profound, and personal. I am a user, beneficiary, and advocate of the low-cost community-room services. It is not just the cost I like (even at at $35 maximum fee): I prefer the community room to an individual cave when I am being needled. With higher standards and more student loan debt, this kind of practice will be less attractive if not impossible.
Meantime, I am professionally involved with a project which is examining the role of AOM and other licensed complementary and alternative healthcare practitioners in meeting the nation’s primary care needs. The general practice of AOM, with appropriate clarity and up-training, can be part of this solution. The standards for such a practice would be on the higher and more extensive end of the scale, not far from the FPD.
I am torn on this one and glad that others are charged to find a solution. I hope the two lineages will be strengthened and more tightly woven together in finding solutions.
Full blog with hyperlinks available at The Integrator Blog, by John Weeks.