Position Paper Responses Part 1

We’re delighted that our position paper has sparked discussion. We’ll be responding to emails we’ve received. Here’s part 1.

1. How can you justify lowering the educational standards this profession worked so hard for? This proposal would weaken the acupuncture profession.

One of the functions of ACAOM (the Accreditation Commission for Acupuncture and OM) is to establish standards for education. From ACAOM’s Accreditation Manual: “To participate in an accreditation process, an educational program or institution voluntarily undertakes a comprehensive self-assessment of its purpose and of the structures that support that purpose, according to the criteria developed by the accrediting agency.” This comprehensive self-assessment is also called a self-study. Our proposal to reduce educational hours emerged from a long, thoughtful, self-critical process focused on educational improvement for POCA Tech.

It’s important to recognize that POCA Tech is in an unusual position for an acupuncture school –as one of our ACAOM site visitors noted — in that we’re not just preparing students to go out into the world with the hope that they succeed as acupuncturists, we’re preparing students to participate in the co-op. We expect to have ongoing relationships with our graduates as our colleagues, coworkers, and comrades.  Thanks to POCA’s multi-year effort to collect detailed data through our annual member clinic survey, we have a pretty good idea of what they’ll be doing in their practices and what challenges they’ll face. However, even though this is more data than most acupuncture organizations have with respect to acupuncturists’ practices, we weren’t satisfied, so we contracted with a psychometrics firm to conduct our own Job Task Analysis. ACAOM encourages schools to undertake institutional research, and we did.

POCA Tech took our self-study very seriously. We’re not only accountable to ACAOM like other schools; we’re also accountable to the employers and patients of the POCA Cooperative who have been funding our program. And our institutional research yielded unambiguous results: the majority of POCA respondents told us that, in relationship to their current jobs, their schooling was too long and too expensive.

POCA Tech’s faculty and administration agreed. The single most important way that we could improve our program for the benefit of our students would be to make it shorter, less expensive, and more focused. (As some graduate schools are doing with their MBA programs.)

As a Master’s-level program, we’re committed to practicing and teaching critical thinking. So we have to question the assumption that more hours equals a stronger educational program.

If improving a program were as simple as adding hours, what’s the point of having any other educational standards? And why would ACAOM mandate a self-study process at all, or especially, institutional research?  If more is always better, why not just keep increasing hours and who cares about the effects? The demand for regulations around gainful employment arose in response to this kind of problem: predatory for-profit schools offering hours of education that led to student debt, but not to commensurate employment for graduates. Unfortunately, educational hours by themselves are no guarantee of quality.

Higher education is changing rapidly. There is more focus on competencies, responsiveness to the needs of future employers, and the ability to locate and organize information as needed, rather than simply memorizing and regurgitating it — in part because everyone has access to infinitely more information. If there are ways we could be more educationally efficient, why wouldn’t we embrace them?

What’s the source of the assumption that reducing educational hours and student debt is the equivalent of lowering educational standards?  Where’s the research that shows that acupuncturists who were educated in the 1980s and early 1990s in shorter programs are of lower quality, less effective and less safe as practitioners? We would very much like to see the data to back up the assumption that more equals better, and less equals worse, when it comes to acupuncture education. Because we have survey data from practicing L.Acs, both employers and employees, that says the opposite.

2. This devalues the worth of a Master's degree. And it's not fair to everybody who got Masters' degrees over the last 10 years, those of us who had to spend $100K+ to enter the acupuncture profession.

This is a troubling set of objections. First, the cost of acupuncture education has far outpaced inflation, and the worth of a Master’s degree isn’t a function of the cost of tuition, it’s a function of postgraduate earning potential — or should be, particularly for schools participating in national rather than regional accreditation (most acupuncture schools). The way to lower the worth of a Master’s degree is to establish a track record of graduates not being able to make a living and/or repay their student loans, which is what our field has in fact accomplished as the cost and length of education has ballooned.

But also, this suggests a kind of vindictive, anti-social logic which is unworthy of any helping profession. By this reasoning, the Fair Labor Standards Act of 1938 should never have been passed because prohibiting child labor in manufacturing and mining would be unfair to all the children who had previously been exploited. Children who lost their fingers in factory machinery would be outraged that no more fingers would be lost — so in the name of fairness, let’s keep feeding children’s hands to heavy machinery? (Credit to Chris Rogers for this disturbing and apt analogy.) It gets back to the question of educational improvement — aren’t those of us who are running schools responsible for continually creating better conditions for our students than we have now? If not, why have self-studies ever? And why have accreditation, if we’re not open to research, self-reflection and self-improvement?

And shouldn’t we, as a profession, be invested in the success of the next generation of acupuncturists instead of being preoccupied with making sure they suffer as much as we did?  If we have research that shows that the cost of an education is no longer proportionate to what many graduates are earning — and POCA Tech’s JTA data on acupuncturist incomes was in general consistent with NCCAOM JTA data on acupuncturist incomes — don’t we have a collective obligation to correct our course?

Finally, we aren’t demanding that all educational programs reduce their hours. Many acupuncture schools are committed to increasing educational hours and converting to a first professional doctorate. For institutions whose own self-reflective process has led them in this direction, obviously they have their reasons. We are simply asking for the same freedom, to change our program in response to needs identified through the accreditation process itself.

To be continued…

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  1. I have spoken with some acupuncturists who say that they are in favor, or at least not opposed to tiered licensure. This is a good thing.

    The same acupuncturists are not in favor of reducing hours. Okay, that’s fine. Let’s start with the tiered licensure. I will work with anyone who wants to work on that.

    I do want to add, though, that by defending the hours of current acu programs just because we and other people who know had to suffer through that is not a very good reason, in my opinion. That argument does not take public interest into account. The public needs acupuncturists. period. whether we have had 1900 hours of training or 1300 hours of training. We have proven that the hours spent on our master’s degrees have not proven to make our practices more profitable.

    But, again. I am willing to work with anyone who wants to work towards tiered licensure and separating herbal requirements from acupuncture across the board.

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  3. I’m so confused by the “lowering standards” comments. Is hours of education a “standard?”

    I’ve been hesitant to wade into this next bit, because I’m aware it raises a bunch of complicated issues – but – I often hear colleagues talking about the length and excellence of the programs in China — if you really want to learn Chinese Medicine, go there. If we really want respect, we need to get that type of education, people say. And yet, in my experience (and we can’t have a clear picture because so many disciplinary decisions are confidential) – practitioners who trained in China are not more effective, safer, or more competent. It’s clear that hours and caliber of education are remotely related, if at all.

  4. I keep thinking back to the times I hear “we’ll let the market decide” when talking about adding the FPD or adding the herbal NCCAOM exam. “We’ll just create the option, and it doesn’t have to change anything for existing practitioners.” Of course, we don’t have a free market system, and so once the herb exam was out there we had people (including some working for NCCAOM) who decided it needed to become a requirement. Likewise, once FPD’s and Doctorates were out there we had some powerful people making moves in Nevada to make it a requirement.

    It seems to me, that when it comes to the current length of our programs, the market of potential students has decided it’s just not worth it. The cost is too high and the job market is just too uncertain.

    And the market of customers has decided they really don’t care how many hours of education their practitioner has. They may ask about how long someone has been in practice (which actually selects for those with fewer hours of formal training), but if it’s a PT who is convenient and able to help with their pain, they’ll be happy to receive treatment from a PT. Or an MD with a few hundred hours of training. (It’s my understanding that there isn’t even any clear evidence that outcomes are better if you receive treatment from an LAc.)

    I’d hope that, after all these years of upping the required hours of education with no clear evidence that it helps anything except the student loan industry, the powers that be would jump at the chance of going back to the more accessible education that created so many fine practitioners. We’ll let the market determine the success of the “Traditional Acupuncture” programs.