Toaster Tour Interview #5: Elaine Wolf Komarow, L.Ac.

span style=”font-size:10pt;”>First off, thanks for exploring these questions.I’m honored to have been included in your list of questionees.Let me say that my involvement in the leadership arena of the profession (involved for many years on the board of the state acupuncture association (Virginia) and on the state Advisory Board), has been a result of seeing that there are things that need to be done and seeing that no one else is stepping up to do them.I certainly never set out to be involved in this way.I say this because I often hear colleagues expressing frustration with what the leadership has or has not done as though we are anything more than fellow practitioners doing the best we can with our knowledge and experience and energy.

1)Looking at the recent NCCAOM Job Task Analysis, why do you think there are so few jobs for acupuncturists? What do you think that says about the acupuncture profession?




span style=”font-family:’Arial Unicode MS’;”>The first thing I notice when I look at the JTA is that a very small number of practitioners responded.A total of 732 completed all or part of the questionnaire (out of 18,000 diplomates).I found the JTA to be incredibly time consuming to complete and if I hadn’t been part of an acupuncture tradition that is in the minority I doubtI would have taken the time to complete it.Also, 301 of the respondents had been in practice less than five years.Last, but not least, the timing of the survey was such that it arrived during an economic recession.I say this only to point out that I remain unconvinced that the survey gives an accurate picture of the profession.I do remain concerned about the information it contained and agree that far too many of us are having trouble finding professional success. 

span style=”font-family:’Arial Unicode MS’;”>I agree that very few practitioners work as employees of others.I think there are so few jobs, as in applying for a position as an LAc and being hired by another to do acupuncture, because this has never been a focus of the profession.From the time I knew of acupuncture as something that existed and was actually done here in the US, in the late 80’s early 90’s and on the East Coast, I knew it only as something that looked, as far as practice went, like seeing a therapist or a dentist.It wasn’t anything I thought of outside of a private practice setting.Also, at that time, it was not legal for anyone other than an M.D. to do acupuncture here in Virginia.All of my early efforts in the profession were focused on making it possible for LAcs to do acupuncture in Virginia and for Virginians to receive acupuncture from anyone other than the few Asian M.D.’s who sometimes would treat a few individuals. 

span style=”font-family:’Arial Unicode MS’;”>Many of the folks I knew who were going into the field were escapees, if you will, from jobs in the healthcare arena.Quite a few of my classmates were nurses, who were thrilled at the prospect of being able to help others without some administrator telling them that they had to do more in less time, or work overtime because their replacement hadn’t shown up.Many of us in the profession were attracted to it for the control we thought it would give us over our future.Throughout my time in the profession, even when my practice was struggling, I’ve never wanted to go back to life as an employee. 

span style=”font-family:’Arial Unicode MS’;”>After I’d been in practice about 5 years I was approached by an MD associated with one of the local Kaiser Permanente offices.They were interested in having “alternative medicine” practices available to their members and she wanted to know if I’d be interested in coming on board.Before we even got to a conversation about salary I knew I wasn’t interested.Work week would be 40 hours plus, they’d be in control of who could see me and for how many visits, and there was no guarantee the program would continue – if they found it didn’t increase their bottom line, they’d end it.For me, there was no question that my freedom and control was worth more than anything they could pay me.(And, they weren’t interested in hiring the newbie just out of school.)I understand (from my cousin who works for Kaiser) that this has been an issue in other places. 

span style=”font-family:’Arial Unicode MS’;”>For all intents and purposes, the only source of income for LAcs, is individuals willing to pay for it.In the case of an LAC as an employee, the individual has to pay not only enough to pay the practitioner’s fee or salary, but also enough to cover all the things the employer provides, like health insurance, disability, etc., and also, in almost all cases, enough for the employer to make a profit.WCA may feel that 1% profit is enough to make a new location worthwhile, but for the average profit-motivated employer I don’t think that this is the case. 

span style=”font-family:’Arial Unicode MS’;”>I’m sure I could go on and on, but I hope that will suffice for now.In summary, I think the profession, for better or worse, developed with a particular vision of how acupuncture would be provided to clients and that much of our energy thus far has been directed to finding a way for even that type of practice to be available to patients.I think that thus far, the students attracted to the profession (at least within the area of the country I have any familiarity with) have been attracted to the freedom and control of being self-employed (though they may have no understanding of the economics of that choice), and, as we’ve seen the development of managed care and group practices in other fields, many of us have been satisfied with how things have developed. 

span style=”font-family:’Arial Unicode MS’;”>To paraphrase my Dad, what I believe this says about the acupuncture profession is that we have been doing the best we can with what we have in the time we’ve had.It is now time to reconsider where we are and where we want to go and how we can get there, and I think many of us are doing that.

span>2)What jobs for acupuncturists do you know of that fit the criteria of The Toaster Tour — real, relevant, and replicable? (See this blog post for an explanation of the criteria:strong> ) Please list the jobs, including the nature of the funding stream that supports them if you know it. We will try to independently verify them, of course; any contact information you have is greatly appreciated.






span style=”font-family:’Arial Unicode MS’;”>I’m not entirely sure it makes sense to see work as an acupuncturist in private practice as significantly different from work as an employee doing real, relevant, and replicable work.However, accepting the distinction, the only thing I know about (with absolutely no supporting information) that hasn’t been mentioned by other respondents, is that I believe there are some LAcs paid for working at Walter Reed here in the DC area.My knowledge is that a program was begun by a local LAc and that it is successful in its mission and has been funded by grants and charitable donations.

span>3)Who do you think is the largest employer of L.Acs in the U.S.? How many jobs does the largest employer provide?






span style=”font-family:’Arial Unicode MS’;”>I have no idea.My guess would be CAN clinics, but it is just a guess and I have no idea how many jobs.

span>4)In your opinion, what groundwork needs to be done in order for more acupuncturists to have real jobs? Who is responsible for doing that groundwork?






span style=”font-family:’Arial Unicode MS’;”>In my experience, many ideas that folks have had for businesses or practices that employ LAcs have been well received.CAN is doing great, Eric has developed something wonderful, I think the only thing holding us back thus far has been good ideas and people willing to do the work to bring those ideas to fruition.Who else is there other than our fellow professionals to create jobs?We’re the ones who know the profession, what it can do, what we need to succeed, etc.The schools could and should do a better job of preparing students for life after graduation, with better business skills, ideally with skills that could translate into running a private practice and/or developing different business models.

span>5)The availability of jobs for acupuncturists is a pressing concern because students are now graduating with so much Title IV debt that it is impossible for many of them to start their own businesses, which means more and more graduates are never able to practice acupuncture at all. What do you think is the solution to this problem? And who is responsible for addressing it?






span style=”font-size:10pt;”>The problem of student debt and how disproportionate it is for income levels is far bigger than the acupuncture profession and is something that is gaining the attention of politicians and social scientists.The easiest and most direct root for making a change would be making sure prospective students understood the professional implications of debt and had realistic expectations of what they would be likely to earn as acupuncture professionals.If that resulted in schools having trouble attracting students I suspect there would be some downward pressure on tuition.Then again, that has not yet worked in other fields./span>

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  1. re: debt-to-potential income ratios

    Elaine, thanks for your repsonses; the following criticism is not directed at you particularly, or exclusively.  I totally take your point about student debt issues being bigger than our field.  Many of us have regretfully discouraged folks – who might well have proven to be excellent acupuncturists – from attending the current programs and entering the field, because of the dire debt-to-income outlook.  At the same time, many of us CA clinic owners urgently need employees, and most communities we know are still without Community Acupuncture clinics…and even if all of the currently-trained punks took to CA (as employees or owners), we’d still need more.  So, telling people to NOT become acupuncturists and then waiting for the schools to notice the “downward pressure” is not a very good option.  

    What’s really starting to get to me is that there’s all this talk (even finger-wagging) about prospective students not doing their due diligence, while at the same time there’s a disingenuous silence about how the training programs got so unnecessarily long and expensive in the first place.  As if it’s just sort of happened, naturally.*  If anyone has anything helpful to say about that I’d like to hear it. 


    *The latest AT poll, for example, asks “Do you think incorporating more business management classes in AOM schools is [sic] useful for the profession?” and not, for example, “Do you think the current business management classes in AOM schools could be better designed to be more relevant and useful?”  The way they frame the question naturalizes the assumption that more is better (and 87% of the people who bothered to respond say “yes”– but it shouldn’t be a yes/no question; if they *really cared* about what their audience thinks it should be multiple-choice-with-fill-in-option.)

  2. I agree

    I think some of the reason for the lengthy programs came from pressure from within the profession.  There is a subset of practitioners who wants the respect that MD’s have, and/or focuses on exclusivity, and so they’ve wanted to add to the amount of training.  All it takes is for that to happen in one big state and all the schools scurry to add to their program so that their graduates can practice in that state.  Also, the schools are businesses, even the non-profit ones, so, at least some of them have no qualms about putting their interests first.

    I know that ACAOM is currently looking for practitioner members.  The deadline to put your name in the running is July 29 — just around the corner.  The CAN folks have a lot of good ideas about our education, so I really hope that some of you are applying for one of those positions.  ACAOM has a ton of power.

  3. as if it all just happened, naturally

    “What’s really starting to get to me is that there’s all this talk (even finger-wagging) about prospective students not doing their due diligence, while at the same time there’s a disingenuous silence about how the training programs got so unnecessarily long and expensive in the first place. As if it’s just sort of happened, naturally.* “


    As a recent grad, and even while enrolled, I began to conclude that our training was unnecessarily expensive, and that there were wasted educational opportunities.  I was aghast to hear, in regards to some bodywork classes (‘ZB’ or other options) that my program would ‘love to include more’ but ‘there isn’t time in the curriculum” and that they were in fact thinking of dropping the ones already included in the curriculum.  There were plenty of classes that we, as students, universally regarded as ‘fluff’.  One egregious example is a class called, “Partnership with Nature”.  On the whole, when I took this class, it was poorly taught, even if you accepted that the learning in that class is sufficiently important to be included for 12 hours worth of ‘classroom’ time (or so).   This is one example from Tai Sophia, and there are undoubtably more, depending on your philosophy.

    One question that arose for my classmates and I was:  we pay so much, but our teachers’ salaries are so low.  Where does the money go?  No one from the administration was willing to be transparent about budget with us, even when they jacked up our tuition significantly mid-session (and lost a good many students from the classes behind us).  However, thanks to someone on CAN, I was able to find the Tai Sophia 990 forms that all non-profits must submit, and I must say these were somewhat enlightening (although not at all easy to interpret).  My conclusion was that the purchase of the property and the construction of the building were huge and disastrous factors in the climbing tuition at Tai Sophia. 

    This capital investment, along with the increasing lending amounts from student loans available, seem to contribute to the high tuition.  It is almost as if when looking to set tuition, a school says, “Well, how much can they borrow?  Let’s charge that!”.  In fact, when I started, my tuition was just a hair under the highest borrowing limit for a Stafford loan, and perhaps because of the bond coming due on the land, the tuition hikes of 2009/2010 raised tuition about $500-800 per semester over that upper limit.  

    Now,my conclusions are all speculation but it is not like we, as students, didn’t ask for the information… but the administration were unwilling to share it with us.  So if I am speculating based on the 990s, what other choice do I have?  

    Fed up with all the obfuscation, on the brink of considering enrolling in the 2-yr herb program offered by Tai Sophia, I straight out asked the director of that program if the school would be around in 2 years.  He is fairly smooth and unflappable, and I admire him personally, so I was surprised to hear him stammer in response to my answer.  He answered that he was sure the school would be around, but I got the impression that the question itself was unthinkable as he put words to his response.  In the end, I didn’t enroll, not because of my doubts about Tai Sophia’s solvency, but because I was just tired and unsure that taking an herbal program for 2 more yrs and an additional $15K would be helpful in my future work.  


    Elaine, thanks for your work in VA; as someone who is about to apply for licensure in the Old Dominion, I appreciate how much you have done to make my path smooth, including your current service on the board.

  4. I think you are right

    that the cost of the building has become a millstone around the neck of the school.  It is a beautiful facility, but perhaps not money well spent.  I wish the ACAOM regs made it easier for schools to exist in conjunction with existing educational facilities — community colleges and the like.  Seems like it would be a win-win.  Less expense, better quality and recognition.  It is my understanding that ACAOM requires separate facilities.  Changing that could make a huge difference in expense.  I hope that some of the readers are stepping up to serve on the ACAOM Board.

    And I also agree that there is a lot of wasted time in the program and classes that leave something to be desired.

    My suspicion regarding the lack of answer from the Director of the Herb program is that he remains unflappable by not paying attention to such details….  He IS a great teacher.

  5. misplaced


    “What’s really starting to get to me is that there’s all this talk (even finger-wagging) about prospective students not doing their due diligence, while at the same time there’s a disingenuous silence about how the training programs got so unnecessarily long and expensive in the first place. As if it’s just sort of happened, naturally.* ” 

    The quoted bit above was from Nora’s response, to which I meant to reply, but when I looked again, this is not evident.  Apologies for any confusion.


  6. chiropractors

    There aren’t too many replicable jobs for chiropractors yet their profession doesn’t seem to be imploding. There are some associate positions but most go into private practice themselves.

  7. chiros

    I don’t have the citations here, but there is plenty of evidence out there that the chiro profession is imploding.  They do have an extremely high default rate on student loans, which is not a good sign.

     And, they have a huge amount of business training in their degree programs.

  8. Agree #2 re: ACAOM

    Yes, it would be good for CAN members to apply to serve on the ACAOM Board. But the power that ACAOM has could end. Apparently ACAOM’s inability to comply with the Dept of Ed’s requirements for accreditors means they could loose USDE approval if they dont fix the many cited problems — including the lack of input by constituencies — within 1 year.

    To point this out, here is a comment that was posted elsewhere on your dicussion page.

    “…It is pretty clear that ACAOM is in trouble with USDE. According to the USDE staff report, ACAOM was found in violation of over 20 of the Department of Ed’s requirements for accrediting agencies. And they are giving ACAOM 12 months to come into compliance. The applicable regulations can be found at the following link under Sections 603.36(e)(3)(i) & (ii): I also cut and pasted the relevant regulations below followed by a brief explanation: (3)(i) Except as provided in paragraph (e)(3)(ii) of this section, if a recognized agency fails to demonstrate compliance with or effective application of a criterion or criteria, but the senior Department official concludes that the agency will demonstrate or achieve compliance with the criteria for recognition and effective application of those criteria within 12 months or less, the senior Department official may continue the agency’s recognition, pending submission by the agency of a compliance report, review of the report under §§602.32 and 602.34, and review of the report by the senior Department official under this section. In such a case, the senior Department official specifies the criteria the compliance report must address, and a time period, not longer than 12 months, during which the agency must achieve compliance and effectively apply the criteria. The compliance report documenting compliance and effective application of criteria is due not later than 30 days after the end of the period specified in the senior Department official’s decision. (ii) If the record includes a compliance report, and the senior Department official determines that an agency has not complied with the criteria for recognition, or has not effectively applied those criteria, during the time period specified by the senior Department official in accordance with paragraph (e)(3)(i) of this section, the senior Department official denies, limits, suspends, or terminates recognition, except, in extraordinary circumstances, upon a showing of good cause for an extension of time as determined by the senior Department official and detailed in the senior Department official’s decision. If the senior Department official determines good cause for an extension has been shown, the senior Department official specifies the length of the extension and what the agency must do during it to merit a renewal of recognition. My read of these sections is that ACAOM’s recognition did NOT get renewed based on violations of the requirements for accreditors. What the Department did do was “Continue the agency’s current recognition and require the agency to come into compliance within 12 months, and submit a compliance report that demonstrates the agency’s compliance…” Thus under subsection ii of the rules, if ACAOM doesn’t correct all the 20+ violations of Dept of Ed requirements within 12 months, ACAOM will loose US Dept of Ed recognition and the schools (as well as their students) would loose federal financial aid eligibility unless ACAOM can show the “extraordinary circumstances” for seeking an extension for coming into compliance. This looks to be very serious for ACAOM.”