Road to 10,000

I have a confession to make, recently I had a chance to do something, something I haven’t done in seven years, something dear to my heart, and so utterly addicting (to me), I just have to come clean and fess up:I… went…. snowboarding.Weee-hoooo!

You wouldn’t think it to be possible in the land of saguaro cactus, but high above the Sonoran desert floor of Tucson at 8000-9000 feet, exists a teeny gem of a winter wonderland called Mt. Lemmon – that is, when we get a lot of snow up there, for a few weeks some years.And we did 2 weeks ago, about 5 feet in one storm, enough to make me and a whole lot of other smiling faces feel like we were in heaven.I missed the big powder by about 3 days, but who cares.It was phenomenal.What a way to press the reset button.In some ways reminded me of getting a really, really good acupuncture treatment.And today while I listen tobeautiful rains fall on our doorstep, it’s snowing up on the mountain again.

So also recently I picked up some leisure reading.I have been meaning to read this book for about a year, and finally got around to it.I was so lost in FPD land there for awhile that I was  forgetting about the sheer joy of reading something not related to acupuncture, politics, acupuncture politics, or some depressing slant on corrupt national politicians trying to spin a good yarn about the bucketful of er, shit, they are trying to pass off as national health care reform.(Go Grijalva !Don’t back down.)

So I picked up Outliers, finally, as I am a big fan of Malcolm Gladwell.I have truly found many of his observations in his previous books (The Tipping Point and Blink) to be especially helpful in this journey so far as a community acupuncturist.I’ve written about this a little bit in the forums, and I recommend them for every community acupuncturist’s reading list.

Jessica recently wrote about the Roseto effect here mentioned in Outliers.)

So as I swam further and further along with the currents in Outliers, pages speeding by me like a fresh breeze on a (packed) powder day high in the clouds on a mountain sky island above the desert, my mind would always drift back to “Chapter Two: The 10,000 Hour Rule”. 

The idea that excellence at performing a complex task requires a critical minimum level of practice surfaces again and again in studies of expertise.  In fact, researchers have settled on what they believe is the magic number for true expertise: ten thousand hours.” (Outliers, chapter 2 p. 31)

Neurologist Daniel Levitin is quoted by Gladwell : “The emerging picture from such studies is that ten thousand hours of practice is required to achieve the level of mastery associated with being a world class expert – in anything.  In study after study, of composers, basketball players, fiction writers, ice skaters, concert pianists, chess players, master criminals, and what have you, this number comes up again and again.”(Outliers, chapter 2 p. 31)

So how long does it take to do ten thousand acupuncture treatments?

I’d ask Mr. Turtle or Mr. Owl , but I think Owl might just do 3 acupuncture treatments and write a book, or bite the needle.  So let’s count.In acupuncture school I was required to log 850 hours in the clinic, 150 observation and 700 treatment hours.With one patient per hour, the most treatments I could have done was 700.  So about 300-350 treatments per year in the school clinic over 2+ years.So let’s just say about 700 treatments for the average acupuncture graduate.

Doing some more math, (courtesy of Skip), the average acupuncturist in 2007 saw a whopping grand total of 638 visits.  How long until 10,000 at that rate?15.7 years.Well, 14.7 years if you count the treatments given in school.

Let that sink in for a minute…

So the average acupuncturist approaches “mastery” or world class expertise in 15 years.Yikes.That’s a long road.

How quickly can one’s skills progress as a community acupuncturist?Well, if you double the annual visits from 638 ( 2007 average noted above) to 1276, then you effectively cut the time to 10,000 in half.  About 7.5 years.At 2500 visits per year, it’s 4 years.And so on.

I’ve heard things like this said,  “Community acupuncture is all low quality anyways so all you are doing is becoming a ‘low-quality’ recipe technician”, or“Who cares if you see more people but give substandard treatments…”, etc.

That is a whole ‘nuther blog, but basically to which I say, “(coughing) ba-low-nee”.

Here are some footsteps to follow and shoulders to stand on:

Miriam Lee: 80 patients a day, reportedly crammed into all the nooks and crannies of her house.

Dr.Richard Tan:“Practice to learn…”

Dr. Tung: various reports have him seeing thousands upon thousands of patients, treating the Chinese army for crying out loud.

Dr. Wang Ju-Yi : “Twenty of us would see patients at a time.The old wooden temple buildings had been sub-divided into six large treatment rooms with two to four doctors in each room.I remember once that twenty of us saw six hundred patients in one morning alone.We had a lot of beds.”Dr. Wang reports that he worked in this setup for ten years. (Applied Channel Theory in Chinese Medicine, p.434)

I am sure there are plenty of more examples out there. ( and please feel free to add these in the comments)

So, how do you get to see so many more people so quickly?

It’s simple really.

Make your services affordable.

( Here’s a nod to Rebecca who recently mentioned the difference $5 makes.I have to agree with her on this. ) 

Sounds like a win-win situation for everyone.More people get affordable care, and the community acupuncturist’s skills grow stronger and stronger more quickly to serve more people effectively.  And personally, I feel very, very happy with my “job”.  I LOVE it.  ButI didn’t truly get it until DOING it.

Who else gets this?

In the chiropractic world, some chiropractic places locally get it, they charge $20 or less for a treatment and take people on a walk-in basis.Recently I stopped by one of these local affordable chiros to accompany my sweetie for treatment towards the end of the day, and this chiro had already seen 80 people.  He’s been at it for years.  I’ve seen him, and I consider him very knowledgeable, skillful, and I am glad he is there for the community.  The care is affordable, skillful and there when I need it.

In the material world, places like thrift stores understand affordability.  It makes so much more sense to me on many levels to pay $5 for a pair of gently worn pants.  Small amounts, bigger volume, it all works.

Some of my friends run a yoga studio here and have recently discovered the power of affordability in the form of $4 per class, the sustainability of lots of small amounts.  In a flat economy, they just opened another location.

So if you are considering being a community acupuncturist or getting community acupuncture, be careful not to underestimate the power of lots of small amounts, and happy trails on your road to 10,000 treatments. 

keithananda
Author: keithananda

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  1. nice blog keith

    another way of looking at the 10,000 hours to mastery in relation to acupuncture practice could be like this:

    10,000 hours is equivalent to 10,000 treatments if you are a BA practitioner that sees one per hour.  However, an acupuncture practice hour can be considered the sum total of all tasks performed during each hour, whether it is actual needling, interpersonal communication skills, charting, etc.  So, any practitioner that works 30 hours a week is mastering their practice at the same rate regardless of their actual practice model, whether seeing 6 per hour, 20 per hour or 1 per hour.  Mastering CA at 30 hours a week gets you to 10,000 hours at the same rate, 6.41 years, as mastering a BA practice that sees one or two people per hour. (10,000hours/30hours per week=333.33 weeks, 333.33weeks/52weeks in a year=6.41 years) However, the big issue for all graduates is merely surviving that 6.41 years and not going bust. 

    If a practitioner is successful in their model they will master the specific skill set inherent to their practice in 10,000 hours.  An hour is an hour.  I feel good in clinic after 1.5 years and probably 5000+ treatments.  But me, master level CA dude?  Um, no.  That’s why I still get flipped pretty hard from time to time by the thoughts of some folks on this blog and in the forums, usually Skip and Lisa.  They may be the only CA folk practicing CA for 6.41+ years.  Please correct me if I am wrong or there are others.  Some of the other senior CANners also blow my mind from time to time…Nora, Moses, Andy, etc….  We all have insights to offer, though, and it is helpful for all of us to offer up advice and insight if it is helpful to others on the path.  That’s what CAN is for.

    It has been written by Matt from WCA that he thinks 3 years is the amount of time necessary to ‘get’ CA.  Is getting it, mastering it?  Semantics?  Maybe.  I know I get it.  I’m just no master.

     

     

     

  2. switcharoo

    I know, I know, I pulled the ‘ol switcharooni, implying that 10,000 treatments = 10,000 hours.  It’s probably a combination of these when you see more people.  I would say that the time it takes to become a more knowledgeable and skillful practitioner is reduced by increased numbers of treatments given.  As far as mastery goes, you’re right, that’s definitely subjective and relative.  There’s always more to learn, and deeper understanding that can happen.

  3. loved it!

     

    absolutely loved this book! there are many other salient points regarding circumstance, timing, perception, how advantages play into success, etc. i agree–must reading for CANers. i read blink a few years back and just finished tipping point also.

    tipping point has good theories in terms of how ideas spread–echoing many of the CA marketing strategies/realities of word of mouth; “stickiness” of ideas, “mavens”–the people who spread them, etc, etc.

    love to keep this discussion going–an all gladwell thread!

     so glad you got some heaven time, keith!

    Melissa

    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  4. Another way to look at it:

    Let’s assume 10,000 hours is the benchmark for mastery.  Would you rather receive care from a “10,000-Hour-Master” who has given 10,000 treatments, or from one who has given 60,000 treatments.  I know which I’d choose…

    (Nice blog, Keith.  I love Gladwell’s writings, too.  Did you see he has a new book out?  I haven’t picked it up yet; race you to finish it…)

  5. multiple mastery

    After the initial 10,000 hour mastery their comes further layers of mastery.  Just think, over time you will have probably spent 10,000 hours on just low back pain, another 10,000 on neck pain, and another 10,000 on gynecological issues.  

    David “10,000 hours of childhood TV watching” Lesseps

     

    Circle Community Acupuncture

    San Francisco

    http://www.circleca.com

  6. I’m certainly no master

    I’ve never read Malcolm Gladwell, but definitely by the time I had logged 10,000 hours if needling I was feeling more confident. By the time 20,000 hours slipped by I was wondering what exactly I was confident about. After 30,000 hours, I seriously didn’t know. 40,000 hours hasn’t helped me answer anything. I’ve passed 50,000 hours now-nothing.  I’m not being flip.

    I guess I don’t know what the word, “Mastery” means.  On one level, sure, I am a Master: I know how to run a clinic and I feel confident that I can treat most conditions.

    But just in terms of needling, I have to be aware of both recent studies that show random needling being better than a placebo effect, coupled with Matt’s paper and between the two I don’t know what exactly I am doing. I do suspect that I am doing much less than what my ego tells me I am doing; that I have Mastered nothing much of consequence. 

    I see Larry’s point that it’s hours rather than patients that should be counted. I tend to agree though with Keith though: patients are more important than hours. Acupuncture is an applied medical technique and so the more you do it the more you know it. To put that another way, the book knowledge doesn’t get you very far in the field. 

     I think I see in this country that there are a fair number of Scholars, who have done a lot of hard work trying to understand the ancient texts. Orientalists, they are all too often. Trying to understand Master Tung or TCM or 5 Elements. I guess their efforts are kinda worthwhile, but I don’t think that constitutes Mastery because even if you knew everything in those texts you would still not be able to explain why tossing needles in randomly is such a good thing or why possibly some of the gerry-rigged systems that are known to us Westerners might work a little better than such random needling. Such texts as the Nei Jing don’t get down to that level of understanding. Nor does the Nan Jing speak to Matt’s Paradox. Basically I am saying that the field of acupuncture has been stagnant for a couple of millennia now and just learning a lineage, while useful to an extent that helps us needle people, is ultimately decadent if not ultimately examined and critiqued.

    I am not saying what the ancients wrote was wrong. But they are incomplete for our day and age and civilization. I dearly hope that we can use them to build a better health system because I think they shed a light on healing that we don’t know much about. But translating them, memorizing them, meditating upon them is not enough to Master them because Civilization, a living breathing thing, is much more than language.

    Here-this is what I am saying: We can’t graft the ancient knowledge of a different civilization onto to our civilization. It won’t thrive. It will die as this curious little play toy of the rich. We have to absorb it into us and release it into how we look at the world and each other. If acupuncture is to survive another 100 years it will have to look a hell of a lot different from what it does now. Until that happens there is no Mastery.

  7. “I see Larry’s point that

    “I see Larry’s point that it’s hours rather than patients that should be
    counted. I tend to agree though with Keith though: patients are more
    important than hours”

    10,000 hours at 4 patients per hour is 40,000 pokes…no jokes.  Lots o’ stickin’.  We see more patients per hour than your BA person and master our craft by seeing a lot of people.  I am not pointing to hours being more important than people.  But by extension of how we structure our practice I agree that we have a different craft to master or practice than the sole act of inserting needles.  Mastering the 4.6 per hour busy clinic flow, entails a lot more than the pokes, as we all know.  I didn’t just mean to rhyme, it just happens sometimes.  What we do at the chair, when and why, our communication skills, cultural competency, empathy and compassion, appropriate boundaries-  these elements are the essence of my learning curve as a punk, an employer and a social justice activist using needles for social change.  That’s what I was trying to get at in my previous post.  I agree that ‘mastery’ is a difficult and entangled concept.  I do think I need many more people to fail with in regards to cultural competency and communication before I can consider myself anywhere near a comfortable description of that term.  As roshi used to say, 8 times fall down, 9 times get up.  I am not discounting needling, while also experiencing the effect of Matt’s Paradox(i like this term).  A poetic butcher probably won’t have the busiest roster, unless they tap into that SM demographic.  😉

  8. Sustainable Practice of Acupuncture for the Long Run

    I Love the point Skip made. 

    It’s looking at the individuals and the system at the same time. 

    As individuals we are developing as acupuncturists, but the system isn’t sustainable. We aspire as individuals to become like Master Tung or Miriam Lee. But long term survival of acupuncture as an art requires more systematic integration of acupuncture into common everyday life. 

    Jade Community Acupuncture, Winona, MN

    acupuncturewinona.com

  9. Reminded of a couple things

    I’ve always thought of myself as a journeyman acupuncturist; I’ve done my apprenticeship and passed my exams, so why not? In the olden days, trades had these fun distinctions between the different levels of practitioners.

    I don’t want to open the whole barrel of fuck that even mentioning hierarchy does around here, but all of us begin as students then go into practice, and from the few that are able to sustain their practices a few become teachers. Apprentice, Journeyman, Master. Whether anyone has the right to call themselves master is another question, but I’ve worked with master tradesmen before of all different skill levels. Some caused other problems which I’ve had to go and repair and others have proved themselves exceptional workers and they were all masters. I remember a course I took with Matsumoto Kiiko where she felt that a master was someone who had enough understanding of acupuncture theory and practice to find something new. I’m not 100% behind that, but I can get behind her point of view.

    In the world of martial arts, any teacher is your master, it’s a respect thing. The culture of North America (and much of Europe) has a very different view of what it means to be taught something. I know that’s a gross oversimplification, but many of us get defensive when someone tries to teach us. Sometimes it’s the student and other times the teacher who causes friction, but our lessons often come at a higher cost.

    There is no supreme martial art, but rather people in different levels within what they know. Unlike martial artists we don’t go around challenging each other to fights in the streets because our duty is to our patients, not our masters/schools/egos. But like modern martial artists we certainly need to learn more than we have been taught at the beginning.

    10,000 might be an arbitrary number, but I would hope that with the effort I put into that many hours I might have something to teach someone eventually. That’s actually one of the things I enjoy about CAN (certainly more than the many hostile replies to my comments) is that it’s a great place to share with each other as we’re learning in our different places. I feel accelerated faster towards better understanding the more I read the occasional nugget of gold on this site.

  10. I’ll bite

    Perhaps you would like to go into detail about how merely mentioning hierarchy opens a “barrel of fuck” around here, as you put it.

    Does this mean the barrel just opened?  

  11. YES!!!

    Clayton, you’ve also been to “The Barrel Of Fuck” brothel outside of Niagra Falls?  That place is soooooo great.  Hierarchies are so negotioable there- who is on top and who is on bottom, that is.  Too bad it isn’t like that in the real world. Seems like you can pick how you get fucked in a brothel where as you can’t in life- that’s largely chosen for us.

    What was your experience like there?  Please share!