(This is an excerpt from another writing project, in progress.)
I have a story about jobs in the acupuncture profession.
Last Saturday, I was working in the clinic, and my schedule was very full — almost over-full. We tend to get busy in the late winter/early springtime anyway, and lately it seems like everybody’s got the same bad cold. Midway through my shift, our receptionist Carolyn asked me if she could squeeze another person in. I looked at the name and realized that she was someone I knew, someone I went to acupuncture school with, lo these many years ago. “Sure,” I said to Carolyn, “put her in, she’s an acupuncturist, it’s not like I’ll have to explain anything to her.” And yet, I ended up talking too long with her and getting behind on my schedule anyway; but I think it was a very instructive conversation, and all of it happened for a reason. This is why.
The acupuncturist, whom I’ll call Jane, told me she had recently lost her job. The weird thing is that I had something to do with creating her job, a long time ago, and I actually never expected it to last as long as it did.
I graduated from acupuncture school in 1994, and unlike most people, I had a job right away. A part-time job and not well-paid, but it was a real job. I wasn’t an independent contractor and the job wasn’t a business opportunity. My employer took taxes out of my paycheck, I accumulated vacation and sick time, I didn’t have to buy my own supplies. Or find my own patients. I worked in an alcohol and drug treatment center for pregnant women, mostly doing the NADA protocol. That program was one of several that used acupuncture, all of them part of the big Portland non-profit Central City Concern that helps people who are often chronically homeless and addicted. I did acupuncture in a number of different Central City Concern treatment programs for about 7 years, off and on.
During one of the off times, I was the first acupuncturist who worked for another big nonprofit, a huge HMO actually, doing housecalls for their hospice program. They had gotten a sizable bequest from someone who thought hospice patients would benefit from acupuncture, and they used that money to create a pilot project. I ran it: provided the treatments, tracked the results, wrote the final report that led them to decide to keep funding acupuncture for hospice patients. By then, though, I was tired of the bureaucracy of a huge HMO, and I went back to working for Central City Concern and trying to treat patients in my tiny private practice.
When I worked for the huge HMO, I was an independent contractor. I hated being an independent contractor (I never could manage to calculate my self-employment taxes correctly) and I kept trying to persuade them to make me an employee. They said it would never happen, and I believed them — part of why I left. I also knew that funding for their acupuncture program was tenuous, and I was fairly surprised when they actually expanded the program after I left and took on two other acupuncturists as independent contractors.
Jane was one of those two. She told me on Saturday that over time, she actually managed to talk the HMO into hiring her and the other acupuncturist as real employees — no more self-employment tax, no more buying her own supplies and trying to keep track of the cost. But they were just barely real employees; they were always categorized as part-time, on-call employees, even when they had worked there for 10 years. Jane tried to get the union to help them, and for a time seemed to be having some success — until, she told me ruefully, the union entered contract negotiations with the HMO and “threw the acupuncturists under the bus” in return for some other, more important concessions.
Throughout all of this, the hospice acupuncture program kept going. Patients loved it — of course they did, people love acupuncture, and a lot of people got a lot of relief from pain and anxiety — and as a result, Jane said, the HMO kept getting bequests to fund it, some in the hundreds of thousands of dollars. And then, one day, some new top executives were hired at the HMO and they made a top executive decision –that no programs should be funded with bequests or donations. It didn’t have anything to do with acupuncture at all, but that didn’t matter; the hospice program, and Jane’s job, ended overnight.
While Jane was working 20-30 hours a week for the HMO, for 10 years, in theory she also had a private practice on the side. But, she told me sadly, she neglected it of course, because the paychecks from the HMO were easier, and now it couldn’t support her. She thought about trying to build it back up and just felt tired.
I thought about the last 10 years for myself, working as an acupuncturist. In 2000, I was working some 20 hours a week for Central City Concern, and Skip was working more than that; Central City’s acupuncture program was how we fed our kids and paid our mortgage. By 2001 we were both having the same bad feeling that this arrangement might not last, that the funding for acupuncture wasn’t really stable. At that time Central City Concern employed something like 10 full time acupuncturists and another 10 to 15 part-timers. When I left in 2001 to get serious about being self-employed, and Skip followed a year or so later, everyone we worked with thought we were crazy.
In late 2004 or 2005, I can’t remember exactly, the bottom fell out of Central City’s acupuncture funding, and the program contracted down to 3 acupuncturists. Almost everyone we had worked with got laid off. By then, Skip and I had basically replaced our salaries. In 2005, we made WCA a corporation and made ourselves employees — no more sole proprietor tax returns, no more self-employment taxes! (I really do hate those.)
By last Saturday, when I was having this conversation with Jane, WCA had 7 salaried acupuncturists and 2 part-timers. Also, we have more than 10,000 patient files. We have the only funding for acupuncture that I trust anymore: a large patient base that is happy to pay fees they can afford for treatments that work. WCA made just shy of $600K last year (that’s gross, and of course we spent almost as much, most of it on payroll). Every year we treat more people. If Skip and I had tried to hold on to acupuncture jobs that looked secure at the time, the odds are high that right now we would have nothing. An awful lot can happen in 10 years.
This made me think about investment. The big HMO had no real investment in Jane’s job or in the acupuncture program. Central City Concern has been one of the major supporters of public health acupuncture forever, but because of their funding, there is no way they will ever be as invested in their jobs for acupuncturists as WCA is in ours. Jobs in big corporations, nonprofit or for-profit, potentially come with the benefits that only a big corporation is able to leverage, so naturally acupuncturists would like to have jobs in big corporations. The problem is, though, if you are an acupuncturist working for a big corporation, one of the benefits you can’t count on is stability. Because there is currently no real mechanism and no real incentive for big corporations to invest in jobs for acupuncturists. Skip and I invested everything we had, not really knowing what we were doing, and it paid off beyond all expectation. At the time we looked like we were crazy; now we look like we’re really lucky. We scraped and scrounged and made countless mistakes — we’re probably making a bunch more right now. And yet somehow we ended up creating jobs.
Acupuncturists want stable jobs, providing acupuncture. Patients want acupuncture, and they want it without a lot of conditions or restrictions or interruptions. There should be a direct economic link there, but there isn’t unless we make it ourselves. We have to figure out how acupuncturists who want jobs and patients who want acupuncture can invest in making those jobs a reality; nobody is going to do it for us. Investment is all about taking risks, staking your time and your energy on something that may not be easy or certain — that’s why people aren’t often eager to do it. But where could we be in 10 years, where could our movement be, if we figure out together how to really invest in it?