Fluff’n Stuff

I haven’t spent a night in my own home since June 27th.

With 2008 (Brown Rat) serving as the second year of the Chinese water cycle, it should really come as no surprise that my family’s life has been turned upside down by this element’s damaging effects. After our dishwasher broke, our car was recalled for a water pump failure, and my husband’s clinic flooded. Then we discovered that the condo unit above ours had water leaking from the clogged drain tile of their heat-pump, trickling down through our walls, saturating our flooring for a long time. Undetected. For a very long time. Furthermore, we learned that the condo’s unmaintained exterior has also been permitting water seepage into our home…for a very…long…time.  Did I mention the water main that broke under our building?

As the extent of the water and mold damage became apparent this summer, we were evacuated to live first with friends and later in a long-term hotel. Our pets have been boarded for months. Our belongings were all packed-up and shipped-out for cleaning—save for the growing incinerator pile in our garage. I have been wearing the same five outfits for fifteen weeks. (I had only two to choose from the day that NBC arrived to film at my clinic, because the other 3 were being cleaned by a textile-restoration company in Baltimore.) The boys have been without their toys for so long, they don’t even remember what they possess. We have no jackets or sweatshirts for the dropping autumn temperatures, and we have been water-logged during rainstorms because we haven’t had the appropriate gear. As our lives have been disrupted by long commutes to the children’s care providers, their schools, and our clinics, we have grown increasingly isolated from our community.

Events like these force a radical evaluation of bare-bones necessities.

Lisa summarizes the basic requirements of acupuncture succinctly in The Remedy: “Needles, Cotton Balls and Stillness.” Within the forums, we challenge one another to find the simplest solution for our daily questions. Are individually-operated heating blankets necessary for every chair, or will clearance-sale fleece suffice? Do we need to carry a stack of charts throughout the shift, or will seeing each patient in the present moment and without physical barrier serve best? Do acu-protocols require elaborate theories with posterior points, or would you use just one needle if possible? We streamline procedures, treatments, and reimbursement structures. We joke about needling patients in the smoldering ashes of our former buildings, all in the name of radical simplicity.

But we haven’t tried to pare-down the biggest, most expensive, clunkiest, needing-to-be-deprogrammed commodity in our businesses: the licensed acupuncturist.

Acupuncturists are not the only medical professionals qualified to provide needling services. NADA has trained more than 10,000 professionals, including counselors, social workers, outreach workers, drug court judges, corrections officers, psychologists, nurses, medical doctors, and others to use the protocol. The AAMA trains its MD’s in a 200-hour course. Many Chiropractors and Naturopaths take short acupuncture classes as a part of their standard curriculum. Teaching someone how to stick a needle doesn’t have to take 3 years. Or $100,000.

We have collectively acknowledged that the best teacher of acupuncture is not found in the classroom, but rather in playing “connect the dots” amidst a busy community clinic. If we concede that effective acupuncture treatments can be quite simple— Jingei, Miriam Lee, Extraordinary Vessels, Dr. Tan, the famous One-Point-Wonder—is it possible for us to simply disseminate these basic protocols to others, thereby increasing the collective number of community “acupunks”? Wouldn’t this effectively expand our communities’ access to needling services?

Take, for instance, the Licensed Practical Nurse (LPN). Most LPN training programs last about 1 year, during which time students are taught to safely prick and prod their own patients (among various other nursey-activities). In 2006, there were more than 1,500 State-approved training programs in practical nursing through technical and vocational schools or community and junior colleges. Other programs are available through high schools, hospitals, and colleges and universities. The cost of an LPN degree: $5,000. The expected starting salary for an LPN: $30,000 for a 40-hour work-week.

Turnover in traditional medical settings for LPN’s is atrocious because of the terrible working conditions and excessive documentation expectations. When I worked them, nursing homes were the second most heavily regulated industry in the nation…second only to nuclear power plants. LPNs’ patients need round-the-clock care, and so the nurses work overnights, weekends, and holidays. They often stand for long periods of time and help patients move in bed, stand, walk, go to the bathroom, or bathe. LPNs may face hazards from caustic chemicals and radiation. They are subject to back injuries when moving patients. They often must deal with the stress of heavy workloads. In addition, the patients they care for may be confused, agitated or uncooperative.

Makes working in a serene CA clinic sound pretty attractive, doesn’t it?

With a little extra training—not deprogramming, mind you—the LPN would make a fantastic community acupuncturist. They don’t need to stop thinking about complex herbal formulas, detailed ten-question intakes, or lifestyle coaching because they’ve never learned any of this to begin with. Their roots are in the blue-collar community colleges…not elitist graduate programs. Their salary expectations fall within the parameters of a community acupuncture clinic’s structure. There is no requisite for compensation commiserate with repayment of obscene TCM-school loans. They might not even graduate with a student loan in the first place. If they spend their nights and weekends during junior college by waiting tables, they could graduate sans loans and possessing the very qualities we seek in our punks.

LPNs are trained in clean needle procedures. They’ve been taught to keep their intakes short and to the point (no pun intended). They know how to move fast and document efficiently. Do they really need training in feng-shui, 5-element nutrition-therapy, or tui na to operate effectively in a CA clinic? I’ve never used my orthopedics exams or consulted my pharmacology notes to create an effective acupuncture plan; I venture to guess that they won’t miss these courses either. By simply adding to an LPN’s education with community acupuncture basics, we have an opportunity to breed a whole new generation of acupuncturists: a group without the fluff.

LPN’s currently operate under the direction of a Registered Nurse or Physician. I am willing to wager that their unions and lobbyists would love to work with our organization to change the State’s laws for the right to poke patients under the direction of an L.Ac. It may even be possible to piggy-back on NADA’s regulatory loophole, which enables NADA to train non-healthcare providers in basic auricular acupuncture protocols. In fact, that is exactly what NADA sees as the trend for the future: “In the USA and Canada, many localities encourage the (full NADA) program through regulations allowing the training and utilization of non-acupuncturist providers… always under the supervision of a licensed acupuncturist or medical doctor…The general trend in regulation is to move into the NADA-favorable category.”

CA clinics could pay for the LPN’s continuing education to attend seminars like Dr. Tan’s and WCA’s, bringing them quickly up to speed in basic treatment protocols. We might even find that starting an LPN with the efficient One-Point-Wonder is all that’s really needed, thereby enabling up to twelve patients per hour to receive acupuncture. This efficiency in needling speed could be used to either lower the sliding scale yet further ($5 – $15 anyone?) or to provide additional clinic revenue.

Perhaps we don’t need another new acupuncture school with its specialized programming, financial aid requisites, credentialing and surveys…even if it is steeped in good intentions and CA principles. Maybe we already have schools churning out potential community acupunks by the hundreds in our own backyards. What if we simply redefine who it is that can set these harmless little needles?

100+ days is a long time to be without the fluff of my life. Makes me wonder what else could be simplified…

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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Responses

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  1. wow!

    I guess we already knew this, Jessica, but you must have some strong Fire energy to balance all that water!  And I bet you have some real inkling of what all the folks that have been displaced by hurricanes have been going through.

    Practicing CA, I’ve really come around to the idea that we need to LOWER the requirements for entry into the field – in terms of cost and number of hours – instead of increasingly raising them.  The LPN-recruiting idea is a really interesting one.

    Michigan still hasn’t figured out how they want to license acupunks, and I’m looking at the possibility of having to take more NCCAOM modules, which they added since I originally took and passed the test but didn’t follow up and pay for the certification, if my Caflifornia license is deemed insufficient.  Without being able to work at what I know how to do (i.e. acupuncture), I won’t be able to afford taking these new modules (which would of course include the cost of going somewhere where they’re doing the testing).  What a racket. 

     

  2. Whoa Jessica

     

    I don’t know what to say except I admire your kidneys, you are a real inspiration.  

    Wishing you and your family continued courage, strength, perseverance. 

     

  3. Interesting idea

    I agree our education is bloated, and far too expensive but I do use a lot of what I learned in school.  I had many fantastic teachers who truly believed in educating people to be good acupuncturists.  I believe there is more to what we do than just knowing how to needle.  I think sometimes we take our knowledge for granted.  I quit practicing acupuncture for two years, I never even looked at a book.  I found it has taken a lot of study to get back into giving quality treatments, the more I relearn the better my results are.    I still make detailed diagnosis and use a a lot of different techniques that I learned in school, I just don’t spend an hour talking about it.  I feel the quality of my education is part of what allows me to make quick treatment decisions.  I do think my education could have lost some fluff and saved me some money, but I did learn a lot. 

    The educational requirement of the LPN acupuncturist would have to be carefully thought out if they are to do the treatment from diagnosis to end for me to get behind this idea.  

  4. provoke you did

    jessica,

    great post. i haven’t been blogging as regualrly because i haven’t felt that what was running through my head recently could stand up to the level of provocation that has been appearing here lately.

    as an immigrant to this country i have some idea about living a transient life, but i still cannot imagine doing it with kids and a business to run. you girl are a powerhouse.

    i think that you nailed it – the way acupuncture is taught, practiced and used has got to change fundamentally, radically in this country in order for it to be used as a mainstream medicine and a mainstream way of making a living. we need radical heart surgery, not a band-aid, so the fluff’s gotta go. i like your idea about l.p.n.’s but ultimately don’t think the solution is to have an alternative way for folks to get credentialed to practice acupuncture or one special school that embraces CA, because that will still leave the other acu schools in the stagnant state they find themselves in – churning out graduates with hge debts that have trouble making a practice happen in the real world. the net has to be wider than that. i believe that many chinese medicine concepts we spend months and years chewing on in acu school can be presented and understood and applied in much more streamlined manner. we have seen dr. tan and others do just that. i think this is a tough idea for many of us l.ac.’s to swallow, as it is such a direct hit to our ego, to our “alternative” bubble we have firmly placed ourselves into. i admit, i felt it when i read your post – my ego twinging, saying: “wait a moment here, i studied hard for 3 f*ing years and have accumulated lots of debt to get to do this acupuncture stuff!”

    good dose of realism, good medicine for us to taste, thanks.

    -tatyana

  5. It’s not just ego, there is

    It’s not just ego, there is a lot to learn and I do think we forget that.  I had to go back and relearn the basics while studying Dr. Tan.  In my entire lifetime I will never be able to learn all there is to know.  I don’t think we need to disregard our education as just a useless waste of money.  I can’t speak for all schools, but I learned a lot and was exposed to many different style and techniques.  The question seems to be what is really required knowledge for entry level practitioners.  That is a big question that would take a lot of thought.

    To really change the way acupuncture is taught would mean taking on our cultural assumptions on education and professions.  We are taught and licensed using the western professional model.   

  6. disregarding the value of education

    I have listened to the general opinion that since we do not know how acupuncture works, we should just stick needles in people and not think a whole lot about what it is we are doing. This seems to be in line with that thinking. Since acupuncture is very rarely harmful (except in the event of a lung puncture) you might be able to get away with this line of thinking in our profession.

    However, to discount thousands of years of accumulated knowledge and say that we do not need it-that it is just fluff -seems very arrogant to me. The treatments that I give based on what I have learned in school (diagnosing heat, phlegm, yin xu, etc) have been very effective.  I do not need to talk for a long time to make those diagnoses-just look quickly over their intake and ask a few short questions.  One of the reasons I can do this quickly, is the education I received.

    I have worked for a long time in the field of laboratory medicine. At one point, there was a push to get rid of medical technologists (there is a requirement of a 4 year degree to become a med tech these days). I was trained in one year (with the requirement that people coming into the training already had a BS degree in biology or chemistry)-5 year total schooling. That one year was intense but got the job done. 

    After trying to have medical technicians do the job instead, (they have much less training in what the lab tests mean as far as disease process than medical technologists)- the industry decided that having that extra training was important. I could go into the reasons for that-but just suffice to say that having another pair of trained eyes evaluating if the lab results seem correct (looiing for lab errors) or helping to decide what tests to run, is very important.

    Yes, we can probably run an acupuncture clinic with ‘techs’ being overseen by trained acupuncturists- but will the quality of the treatments be the same? Are we becoming like the medical industry – sacrificing quality for quantity in an attempt to make a living?

     How about a movement to reduce the cost of education rather than eliminating it?

    I imagine if you asked Tan whether he thought that someone just coming for his seminars without the acupuncture education background was qualified to be an acupuncturist- he would answer no. That is pure speculation. Would anyone like to find out by asking him?

  7. LPN’s don’t diagnose or design treatment plans

    Those duties fall outside their scope of practice.  LPN’s work under the direction of either a Registered Nurse or Medical Doctor.  They don’t have to go to a 4-year nursing program or to medical school to dispense pharmaceuticals, implement wound care, or start/push an IV…someone with those degrees determines what medical procedure the LPN should do, and the LPN follows the directions they are given. 
    What if an LPN-acupunk worked under an L.Ac’s direction, too?  It might look like: one L.Ac. per shift in the clinic, with many LPN’s poking patients.  L.Ac. could do the intakes, adjust the treatment plans as needed with major changes, and be on staff for consultations.  LPN’s follow the L.Ac’s guidance.

    Or the scenario with an LPN might look entirely different…

    “Let the beauty we love be what we do.  There are hundreds of ways to kneel and kiss the ground.” –Rumi

    http://www.TheTurningPointAcupuncture.com

  8. Wow Jessica

    Wow, lovely post with so many things to ponder. I think that there are so many levels that people with a lesser training than the 3-4 yr masters training that is the industry standard could possibly plug into.

    I am reminded of the” founding fathers” of the school that I did my first 2 yrs of acup training in.They had their own clinic and several of my friends were able to get the plum positions of being moxa slaves in their clinics during their schooling and they would front up to be amazed at all the wonderful treatment protocols that they would be witness to and so often I was told that the prescriptions amounted to some local points and empiricals for back pain and a combo of Sp 6, St 36, the 4 gates and various empiricals for most everything else. Not rocket science!!

    Modified classic formulas readily available in Giovanni comprised a lot of their herbal prescriptions and we all know how very well their patients did…..IF they were able to get enough of the herbs in their systems or enough acup treatments for a good therapeutic outcome….!

    It is the points that are doing the job if we are able to get them in frequently and to explore the issue of how it might look to have less trained practitioners working in CA clinics is a provocative one and an exciting one. 

     

     

  9.  I think there could be a

     I think there could be a place for an “acupuncture assistant” type practitioner in a thriving clinic, but I think the majority of those in our profession are far too fearful to even consider something like that.  Some people even fight the NADA practitioners.  There is so much fear in those turf wars.  Hopefully in the future an idea like yours could be fully explored.

  10. now that is the REVOLUTION talking

    Just thinking about a bunch of needle-wielding LPNs will make me happy for MONTHS. I have a patient who is an inhome caregiver (late 50s, no education beyond high school, I think she earns $10 an hour) who can feel qi as well as any acupuncture student I’ve ever met, plus she has a better work ethic. I would love to arm her with a box of needles and a sharps container —  some serious good would get done.

    Doing acupuncture is a lot like using a computer — you can accomplish some amazing things while having absolutely no idea how it works. Acupuncture theory is lovely but not particularly a prerequisite for acupuncture practice. And didn’t somebody tell me that Master Tung couldn’t read or write? I’m sure he forgot more about acupuncture than any of us will ever know.

    Hurray for you, Jessica. 

     

  11. Lisa…

    Lisa, George W. Bush would certainly agree with your line of reasoning.

  12. Ludicrous

    How crazy that meeting the requirements for California licensing–the most stringent in the country–would be insufficient for a newly regulated state.  Is anyone over there (in MI) creating an association to oversee the new licensing regulations?…   

  13. Thank you, Lisa,

    for providing a forum in which we’re encouraged to express out-of-the-box ideas.  I would’ve been shot on site for suggesting this in other acu-circles…

  14. Provoking (Tatyana)

    I can only pick so many fights within my own brood before I get sent to the time-out corner.  My liver was revving-up for a good argument somewhere…  😉

  15. Lesser Training

    I agree.  At MCOM we started sticking needles during clinic only a few months into the program.  At that point, we hadn’t even had treatment strategy classes.  And our patients all got better without our understanding why.  We used simple pt combinations, like you described above.  We had all the info that we needed to run with a treatment, in a very short time…far less than 3-4 years of a masters program.

  16. There is an association…

    …I’m not a member yet due to being broke :^)  Also I’m not sure if I agree with the association’s position on education/standards.  But apparently they are considering parity with California – I just don’t know yet.  The board is supposed to decide any minute now (this has been the case for months).  It feels like a picking-your-battles situation.

  17. Labor issues vs. education/training issues

    The issue of MDs doing poor acupuncture due to too little training
    is partly an educational issue, as well as an economic issue.  Medical
    techs doing more and more work in hospitals (for example) is also an
    economic issue, a labor issue, a workplace speedup issue. 

    I doubt anyone would argue that some training and education is important.  And most of us, I believe, love Chinese Medicine theory.  Some of us got into acupuncture through an interest in herbs.  But I have come around to thinking that the US needs more acupuncturists than herbalists, and that my education gave me too much that I have since needed to unlearn, and not enough acupuncture training and experience.  I think really competent acupuncturists could be educated in a year or two, including excellent clinical training. People that are already caregivers are likely to be quicker on the uptake.  This is probably also true of people who wait tables for a living.

  18. I am a member and I know

    I am a member and I know some of the members of the MI acu board.  They have always stated they do want practitioners to be able to use California OR NCCAOM, but they are up against a lot of bureaucracy with  another organization in the state, and just may not be able to make that happen.  There are people who have basically given their lives over to making acupuncture legislation happen in MI, and they are doing the best they can to be fair.

  19. Hey Nora, you don’t have to

    Hey Nora, you don’t have to take NCCAOM modules unless and until MI gets it together and agrees on licensing standards, which it hasn’t done yet. One of the reasons we don’t have standards is that a local massage school is fighting the current proposal–that’s because that school has been teaching and granting “certificates” in acupuncture. I have to admit, I have mixed feelings about this, but the social-justice-in-medicine part of me wants these people to be able to practice in some capacity. I think they could certainly be helpful to a CAP.

    Darlene Berger

    Community Health Acupuncture Center

    801 Livernois, Ferndale, MI 48220

    248.246.7289

  20. What does that mean??

    Can they needle?  Or just do bodywork like cupping & guasha?  You BET that could be useful!  That totally ties-into this blog about expanding the definition of who can needle.  Very interesting indeed…

  21. Hey Jessica,
    Sorry to hear

    Hey Jessica,

    Sorry to hear about all the dampness in your life right now. It must be stressful. I’m glad you turned it around into a great conversation here, tho. Thank you for taking the time to write this.

    Darlene Berger

    Community Health Acupuncture Center

    801 Livernois, Ferndale, MI 48220

    248.246.7289

  22. qi and stuff

    I have shown some of my patients how to feel the qi say at LI 10 more than once and they ‘got it’ right away. However, those same people could very easily needle LI4 or GB21 and belly points on a pregnant woman.

     Do you not believe that certain points have functions like moving qi in a direction (downward in the former case)? I get the feeling that you believe you can stick needles anywhere you feel the qi and acupuncture will work. How do you explain the many postings right on this site of acupuncturists asking for needle prescriptions for certain syndromes they are unable to help with the points they have used so far?

    I use a computer to do many wonderful things, but I also get stuck(yuck yuck) from time to time and make mistakes that I would not make if I had more training.

     

  23. From what I understand they

    From what I understand they needle, but must work under the supervision of an MD, they won’t be able to work with us.  This situation is a nightmare that happened because MI didn’t have any regulation.  I don’t have a problem with the idea of acupuncturist assistants as some sort of profession, but not the way it’s happened here.  We should not look to MI for the future of our profession unless we want to totally screw it up.

  24. am i missing something

    am i missing something here?

    what about the hundreds of acu-schol grads who can’t make a living?  why wouldn’t you want to employ them before starting to open up the field?

  25. you would…

    employ them if they were good employees for a community clinic, which many acupuncturists aren’t. the idea here (in a nutshell) is that the more folks practice and receive acupuncture, the more mainstream  and accepted it is, the more work everybody will have.

    -tatyana