“…physicians should not rely on their own excellence, neither should they strive with their whole heart for material goods. On the contrary, they should develop an attitude of good will. If they move on the right path, concealed from the eyes of their contemporaries, they will receive great happiness as a reward without asking for it. The wealth of others should not be the reason to prescribe expensive and precious drugs, and thus make the access to help more difficult and underscore one’s own merits and abilities. Such conduct has to be regarded as contrary to the teaching of magnanimity. The object is help.”
-Sun Si Miao
“The Doctor of Acupuncture and Oriental Medicine (DAOM) degree represents the highest formal education credential available in the field of acupuncture and Oriental medicine in the United States. A doctoral degree can open numerous doors for a licensed acupuncturist; it can provide increased stature within the health care community, the potential for hospital credentialing, teaching and research opportunities and increased income.”
From January to December of 2006, WCA in Portland, Oregon reported a gross income of $201,475 solely from acupuncture treatments. From January to December of 2007, they reported a gross income of $294,509, again, solely in acupuncture treatments. This represents a growth rate of 72% in one year. These are impressive numbers that should give all acupuncturists hope and inspiration. However, as exampled in Marilyn Allen’s latest editorial in Acupuncture Today (Whether or Not to Survive and Flourish: That is the Question, May 2008), there is a general state of anxiety within the acupuncture community at large as to the survival of our profession in the United States. A closer look, though, reveals that the gravest threat to our profession comes from within the acupuncture professional community and not from outside organizations.
Essential to realizing our fullest potential as practitioners, as well as a profession, is bringing our medicine to as wide a population as possible. The community acupuncture business model fulfills this goal. Combining elements of social justice, healthcare reform and sustainable business, the community acupuncture movement is arguably the most exciting development in the practice of Chinese medicine in the West since 1972 when Mr. Nixon went to China. At no other time in the history of this country has acupuncture been made so accessible to the public at large. The sliding scale can be seen as a powerful equalizing tool that bridges the chasm between the standard practice model and the working and middle classes. Based on the stunning success of the model in Portland, as well as other major American cities, there can be little doubt to the fact that there is a viable alternative to the standard model of acupuncture practice in America today. With enough momentum and organization, community acupuncture practitioners can change the very face of practice in this country and consequently force acupuncture schools to include the CA business model into their curriculum. By tapping into the values of community, sharing and inclusion that most practitioners already identify with, we can assure that this medicine survives and flourishes without overhauling the acupuncture education system into the first professional entry-level doctorate, as some insist is pertinent to our survival. This curriculum has already been drawn up by the CCAOM and approved by the ACAOM. All that is needed is for it to be “widely accepted” by the professional community.
Outside of the success of CA clinics nationwide, the profession as a whole is stagnant. The solution being offered by the editor of Acupuncture Today calls for practitioners to continue our discussion of the entry-level doctorate, lest “we lose the market share” we have worked so hard to achieve to chiropractors and medical doctors. By implying that it is our education, or lack thereof, that is responsible for the overall state of stagnation of the acupuncture profession, as well as inciting a sense of fear that L.Ac.’s will ultimately not be the ones practicing acupuncture in three to five years, Allen completely ignores the fact that more people, a lot more, would try acupuncture if they could afford it. Rather, the issue for Allen is that practitioners in the U.S. have less training than other practitioners around the world. She writes, “The profession has a responsibility to be as well-educated as possible in order to serve the needs of its patients.” Nowhere in the article is the issue of treatment cost mentioned, nor insurance reimbursement either. She does not seem to consider that acupuncture, as practiced in the U.S. is just too expensive for most folks to consider, especially during troubling economic times, such as we are in now. It seems preposterous that money strapped Americans will suddenly start to fork over cash they don’t have, because a practitioner has a doctorate. However, this probably does not even factor in for Allen, as she is blind to the market that CA seeks to include with it’s sliding scale.
What should also be considered, is that if the entry-level doctorate is given the green light, our ranks as acupuncturists will suffer, as the cost of education skyrockets and the extra time spent in school forces people into compromising financial positions that they are unable to sustain for six to seven years, the minimum program length discussed in the proposed standards. The doctorate seems to primarily benefit the institutions that would deliver it, the schools.
On February 9th, 2008 ACAOM declared in it’s Resolution on First Professional Doctorate, “…the acupuncture and Oriental medicine communities of interest…continue to seek consensus by whatever means deemed appropriate regarding the issue of a first professional doctorate as entry level into the profession.” It also decreed, “…once consensus is reached within the profession, the commission will renew its efforts to develop and subsequently pilot standards, policies and procedures for first professional doctoral programs in AOM as entry-level into the profession.” This issue is not going to just disappear, as evidenced by Allen’s latest editorial. And while Allen seems to fluster as to why “this profession cannot unite to create strength of purpose” and fall into line behind the doctorate, she clearly can’t recognize that a good number of practitioners create purpose not by increasing titles and status, but through providing access and inclusion for patients.
It is true that we mustn’t allow our profession to wither due to lack of pubic interest. But the success of the CA business model from cities as diverse as Portland to Philadelphia, prove that the problem is not insufficient time spent in school, but a monotonous business model that is not relevant to the majority of potential patients due to economics. People with limited resources will not stretch their dollar on something unfamiliar, regardless of a practitioner’s title. And while it is doubtful that a doctorate would help acupuncture services be covered under insurance plans, even if it did, this does nothing for the 47 million Americans with no health insurance, or the untold millions who are underinsured. Waiting around for and assuming single-payer healthcare will come and fix the problem in the future does nothing for those suffering today.
The bottom line is that while we must make a living performing a service we love, our top priority must be promoting a business model that allows a practitioner to include as many people as possible in their practice. Rather than wait for the next move by those who would implement the entry-level doctorate, we can mobilize effort through letter writing and e-mail campaigns to the ACAOM, the CCAOM and other organizations within the Acupuncture-Industrial Complex. We can all work hard at promoting CAN however possible in the professional community. We can even start our own trade magazine. How does Community Acupuncture Today sound? We can promote our agenda, which should be implementing a curriculum that includes and emphasizes the CA business model into all aspects of student training, from clinical to practice management. It must be remembered that as per federal law, agreement on the entry-level doctorate within the acupuncture professional community must be “widely accepted.” In the interest of our communities, it is our continuing role to ensure that it is not.
Fortunately, it is not too late to create an education system that serves more people, adheres to our values, and promises a quality income for practitioners in the field. Marilyn Allen would have us “discuss how this medicine will look in the next three to five years.” Indeed, we should do just that. Central to that discussion should be the idea that CA is taught in our schools and brought to the streets.
That’s a conversation worth having.