Reposted: AT Says NCCAOM Numbers Even Worse. Wait, What?

 

Thanks to the alert readers who forwarded me this article in Acupuncture Today, and particularly to the alert reader who said: Hey, where did those graphs at the end come from?

Yeah, I know, it's kind of surprising that AT would devote an article to the NCCAOM's 2008 Job Task Analysis, seeing how that report gives the unfortunate impression that our profession sucks. But here's something a lot more surprising: in this article, Kory Ward Cook releases data to AT that was not in the original report. For instance, those graphs.

Leaving aside the big question of why would she do that????? for just a moment, let's look at the data.  In an earlier post, I discussed the implications of a statement in the original report that “70.1% of respondents have an annual gross income from 'their AOM activities' of less than $60K.” I complained about how big that range was — so big as to be meaningless — especially considering that the JTA Survey asked the question about annual income using increments of $20K, not $60K.  I complained even more about the skewed picture that the JTA Analysis creates by asking for gross income without asking for net, when it turns out that 91% of the respondents are self-employed. What I didn't complain about, and it turns out I should have, is that the original report combines the data for part time and full time practitioners when it says, “70.1% of respondents have an annual gross income from 'their AOM activities' of less than $60K.” 

Hold on to your hats, comrades, because the AT article not only separates the data for part time and full time practitioners, it shows that the researchers did in fact compare it. They didn't put their comparison in the original report, because the results are worse than terrible, horrible, no good and very bad.

The majority of L.Acs, 60%, work part time, or less than 30 hours per week. Of that 60%, about 45% earn less than $20K annually from their AOM activities. And remember that's gross, not net. (If only the survey had asked for net income, in increments of $5K. Hey, maybe I'll get lucky, and a future article in AT will reveal that it did!)

When you add in the proportion of part time L.Acs earning between $20K and $40K along with those part-timers earning $41K to $60K we get a total of more than 80% of part timers working less than 30 hours earning less than $60,000.  More than 80%. Gross.

For a little perspective, let's just say that I work part time — more on why I don't work part time in a minute, and it's important — but let's just say that I do. Let's use my real numbers, or an average of them. I work 4 shifts a week in my clinic. These shifts are 4 hours long, but I really hate to chart, so due to procrastination I often end up spending 5 hours in the clinic, even when I'm not closing. I see 75 patients a week and they pay $18 per treatment. So, in somewhere between 16 and 20 clinical hours a week, 50 weeks a year, I generate $67,500. Gross. Not that hard to do.

But — getting back to the newly revealed data — even if I say I'm working full time, I'm doing pretty well in comparison to other full time L.Acs. Approximately 42% of LAcs working full time (30+ hours per week) earn $60,000 or less. Another 25% earn between $60K and $100K.

Can you imagine what the picture would look like if the report defined full time as 40 hours? Even my own organization, composed as we all know of slacker hippy communists and located in laid-back, economically prostrate Portland Oregon — even WCA defines full time as 35 hours a week. 

Ah, the mystery of part time and full time work for acupuncturists. Looking at the original JTA report, 60% of respondents work less than 30 hours a week. That includes 19% who work less than 10 hours a week in their practices; 20% who work between 11 and 20 hours; and 20% who work between 21 and 30 hours a week. 47% say they prefer to work part time, while 53% would prefer to work full time. The report states, “this practice characteristic warrants further study to better understand and interpret these findings.” The Acupuncture Today writer suggests “More research is needed in this area as it is not known whether these practitioners choose to work part-time or are forced to work part-time because of availability of work in their region.”

Further research? You can read, I know you can, and it IS known. The answer is in the original report.  53% overall reported that they would prefer to work full time.  40% of all the respondents would like to work between 31 and 40 hours per week. Double the number that actually do. This does not seem to be a matter of choice unless the choice is to work  30 hours or more than 30 hours. Most L.Acs are not making a choice; they want to work more, and they can't.

And you know what, comrades? These numbers, abysmal as they look in the abstract, are even worse when you put them in the context of 91% of L.Acs being self-employed. If you kidnapped me, tore me away from my shabby but beloved neighborhood and my shabby but thriving practice, and dropped me into an unfamiliar city with nothing but a few boxes of needles and a valid license, I can promise you that as soon as I got over the shock, I'd be working at least 50 hours a week. I might only be treating a handful of patients at first, because I wouldn't know anybody, but I would be WORKING 50 hours a week from the minute I hit the ground. Working on my “AOM activities”, as they say. Because starting up your own business is a lot of work; running your own business, even after it's started, is a lot of work, apart from actually treating patients. In fact, it's pretty much endless work. You could always do more. When you have your own business, there are only two ways to limit the hours you work: set some boundaries for yourself, or drop from exhaustion. Do I hear an amen? I think I hear a lot of amens, from weary, happy, fulfilled community acupunks. 

That's assuming, of course, that you have some clue what to do. 

Oh look, here's another interesting quote from the AT article:

“The perceived preparedness to practice AOM after entering the profession was rated “very well prepared,” “well prepared” or “prepared” by 90 percent of the diplomates for acupuncture; 87 percent for electro-acupuncture, moxabustion and cupping; 79 percent for Chinese herbology; 70 percent for Asian bodywork therapy.

Other skills such as collaboration with other health professionals, practice management, marketing and public relations, risk management, and legal/ethical issues fell significantly below the other preparedness ratings.”

In other words, they are well-prepared to practice acupuncture anywhere except in the real world. Where there's a distinction between gross income and net. Where it matters whether your patients can afford to complete a course of treatment. Where you have to be able to envision what your business might look like, which includes knowing who your patients are, before you can do the work to create a setting in which you can actually practice.

Just above the graphs in the AT article is this sentence: “Although more detailed results are available in the full JTA report, below are a few figures that support the summary of findings summarized above.”.These detailed results were purposefully left out of the released report.

OK, in summary, I am out of negative superlatives to describe both this data and the process of reporting it. I'm at a loss. Seriously, Dr. Ward Cook, and seriously, AT editorial writers, aren't you ashamed of yourselves? This is looking like some deliberate and prolonged obfuscation; this is looking like you jerking around the profession you claim to represent. Please release the whole data set; some of us would like to know what the truth is.

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