Reflections from NADA conference
I attended (part of) the annual NADA conference in KC, MO this past
weekend (didnt want to miss Friday at the clinic) and was impressed by a
few different things. Dr Michael Smith in his closing remarks had some
choice words for LAcs. He said that licensing for acupuncturists exist
they way they do now because of class privilege. He also challenged
LAcs to get serious about using acupuncture and that too many of us are
willing to trust western medicine to hold the front line in health
care. That acupuncture often works better and is cheaper than
pharmaceuticals and surgery especially in the case of mental illness but
right now acupuncturists believe in western med more than the drug
companies do. Acus are all too happy to stay away from the front
lines. He urged us to step up to the plate and leave our boutique
practices behind. He said right now acupuncturist behave like a
protective gild and work to keep anyone else from using acupuncture
needles even though they are completely safe and can make a huge
difference in both the physical and financial health of this country.
He pointed to the growing percentage of people who are becoming disabled
in this country and placed the blame squarely on our current medical
system and said acu can stop this trend.
His charge that the current LAc is a product of class privilege
makes a ton of sense. That is why we have the structure that we have in
the profession right now. The expensive graduate degrees, the
boutique/ spa prices, the orientalism, the esoteric teachings, the goal
of making six figures, the interest in treating patient who can pay
$60-120+ per treament, and the resurrected FPD. Licensing is supposed
to be there to protect the public by making sure they are getting safe
care and not to protect the guild from perceived interlopers.
Western
medicine has a class structure (not to say that it is perfect). CEOs,
MDs, NPs, PAs, PTs, RNs, LPN’s, CNA’s. There is nothing wrong with
having different classes. There is something wrong with people with
power and privilege taking advantage of those who don’t have it.
Working class and successful don’t have to be opposites. What would
happen if the MDs insisted that everyone who works in a hospital be an
MD? Costs would explode. People would have huge student loan debt.
The hospital would cease to function and tons of people would not
receive any care except for the 2-3% that could pay the big bucks (hello
current acu world). Imagine what the acu world would look like if an
LAc was more like an RN or LPN. Acupuncture is safe enough and simple
enough that there should be no problem to do this.
He also
talked about acupuncture theory and research. And how the acupuncture
books ignore current research in favor of thousand year old texts and
that that is completely unacceptable for health care providers. If we
accepted the research then the books would get real thin real fast and
training would be simpler and cheaper (hello LAc that is more like an
RN) and more people would be helped. He talked about how the research
shows that point location does not matter and that different styles of
acupuncture and sham acupuncture are all effective and if all that is
true then most acupuncturist don’t understand how acupuncture works. He
said acupuncture right now is more like a religion then medicine and
acupuncture books are more like the bible than a medical textbook.
Many
CANers are already doing this to the extent that we break the
superstitious rules we learned in school in favor of what works. The
goal to look for simple treatments that help many people is a central
tenant of “Noodles”. It has also got me thinking about Jessica’s May
Day, Miriam Lee, and what would it take for me to treat a lot more
patients in an hour.
Many of you have heard me complain about
my 5E acu training. Maybe 5E is onto something though. It, like 5NP
(even 3NP), and ML10, advocates simple treatments over and over and then
things come into place. There is no need to get hung up on special
treatments to go after specific ailments because in the end all the
treatment strategies get us to the same place. Now am I going to give
up Tan/Tung?- not likely- I have become comfortable with it and have a
basic treatment that is easily modified to fit just about everything- my
own style of noodle if you will. It does bring me back to that other
CAN truism that frequency trumps cleverness. It makes me wonder if
maybe I can simplify my treatments so I can get faster.
One other
thing that became self-evident. Acu puncs cannot rely on being brought
into the mainstream system. NADA attempted to do that with the
addictions world and the non-profit world. The funding has dried up in
recent years and despite the clear benefits of NADA (backed up by
research) the number of programs have been dwindling. Even Dr. Smiths
own Lincoln center is not immune to this trend. The dollars are already
stretched too thin.
Here I think CAN has an opportunity to teach
something to NADA. How to be self sustaining. Imagine community
supported NADA clinics. A clinic could pay its own rent and give a
working wage to its employees. WCA started with the equation 4X15=60.
Well how many NADA treatments can one punc do in an hour? 15 or 20
seems reasonable. The equation can just flip. 15 patients x $4= $60.
Could someone run a high volume NADA clinic (or ML10 clinic) on a
sliding scale of $0-15 or $1-15 and see double or triple the patients of
a CANer? As we all know, $15 is still too expensive for many people
who could benefit from treatment. Are simpler treatments and higher
volume an answer to that?
Once again
Once again you’ve shown that you’re not scared to ask the hard questions, Nick. Thanks for the overview of Dr. Smith’s talk, and your own ideas of how to move forward in medicine as an acupuncturist.
I’ve been pushing for larger numbers per hour since seeing Jessica’s May Day numbers, and now this gives me another framework to build on. Good blog.
MM
.
“but right now acupuncturists believe in western med more than the drug
companies do.”
i love this, so true.
thanks for the report nick
CaNada
Dear Nick:
This is Mary, responding from Baltimore, MD. Thanks for posting this blog, and especially for the equations of the last paragraph.
I am one of three CAN clinics in Baltimore, and I am located in a neighborhood where the NADA clinic idea has been percolating in my thoughts since before I opened. (I also work part-time in a city clinic for the uninsured that offers $0-5 NADA sessions as part of its “primary care for uninsured folks” package. The sessions are growing and seem to be deeply appreciated by patients and doctors alike.)
I recently asked my fellow local CAN clinic owners if they thought offering some NADA-only-hours at my clinic was still in keeping with the CAN philosophy. I haven’t started yet. I would LOVE to launch something like the $1-15 scale idea you propose very soon. I am just not sure if I should keep my clinic under the CAN umbrella, or if I need to be “a different thing.” I know that these forums and this organization are dedicated to the CAN model, part of which relies on the $15-40 sliding scale range. Is this the important part? Or is it the accessible treatment with sufficient volume that I can make a living wage part? Because, for me and my clientele, $1-15 x 15-20 would be a sweet, sweet solution.
Is CaNada a possibility here?
.
Hi Mary, I went to Tai and spent a lot of time at the Penn N clinic in W Baltimore. Its great that Bmore is getting some CAPs! Not sure if there are NADA clinics already doing this or not. There is a NADA FB group that could prob help
https://www.facebook.com/home.php#!/home.php?sk=group_207177675973381&ap=1
also advocacyfornada@gmail.com
There is also this thread: https://www.communityacupuncturenetwork.org/node/5689
and this one: https://www.communityacupuncturenetwork.org/node/6267
Im not a board member but i dont think CAN has any beef with sliding scales that go lower than $15.
clarification
I dont speak for NADA or CAN in any offical capacity. These are just my thoughts after attending a conference.
Nick
here is another NADA link https://www.acudetox.com/nada-protocol/nada-advocacy/117-learning-m.html
Made for each other
Although it’s been said before that CAN is more for the middle (health care) and NADA the bottom (public health) of society, these two groups share so much in common.
The numbers game works well too. Doing an ear acupuncture demo for a large group, I saw 108 people over a 4 hour period including a couple of 15/20 minute gaps where people were a bit freaked out to do it. At the detox centre I usually see 6-8 people and it really only takes 15 minutes to get the needles in the ears and some in the hands for specific problems, and that includes the talking.
My best results in terms of treatment and patient response have been in the detox setting. People who haven’t felt their fingers for years can, backs feel better and oral abscesses get better. Why? They are there every day; simple treatments, repeated.
It’s hard to ask for more work between CAN/POCA and NADA because there are differences, but I think the support we can offer each other is great. Hopefully NADA will become some of POCAs first official friends & members and we can reciprocate with support for their work as well.
Yay!
Thanks for sharing this. I
Thanks for sharing this. I wanted to attend that conference but ended up at acu without borders in chicago instead. What I found interesting was that many people attending the class were happy to volunteer for causes with AWB and no one seemed to get up in arms when they showed the video of training sometimes kids high school age or a little older how to insert needles in Haiti so people could continue to do NADA after they left. It seems like a big disconnect.. Maybe my math and some of my peers math is just different. more people better, means more people getting acupuncture, getting acupuncture, means opportunity for a sustainable income regardless of the fee structure. I have always felt that in the light of service it is our duty to serve. Not just after a natural disaster or on a healing exchange in Nepal but to our communities that we live in. We don’t need to travel across the country or the world to make a difference, we really need to do it literally in our backyards for our neighbors and teachers and bar tenders and small business owners and students and librarians and regular people living regular lives. That’s how acupuncture becomes common place, that’s how the world gets changed. Doesn’t everyone have a baggie of needles and a travel sharps container in their purse and back seat of their car just in case! 🙂
I agree, Clayton.
The results I got over and over and over in my NADA gig with exactly the same kind of approach are what got me seriously questioning the conventional wisdom we learned in school about what constitutes “proper” acupuncture. The more we say it over and over and over again, the more people will start looking at their preconceptions and realize that we’ve been sold a bill of goods.
here, here!
“We don’t need to travel across the country or the world to make a
difference, we really need to do it literally in our backyards for our
neighbors and teachers and bar tenders and small business owners and
students and librarians and regular people living regular lives. That’s
how acupuncture becomes common place, that’s how the world gets changed.”
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.
Hi Mary
This is an official Board answer: Offering NADA treatments inside of a CAN/POCA clinic won’t get you kicked-off the LOC page, not at the rates you’re suggesting.
The rest of this is a Jessica response…
I can see some confusion arising for you and your patients from this arrangement.
Would NADA treatments be offered at a separate time from regular community treatments? If so, this creates a stigma for patients who want to use the NADA sliding scale (only addicts come at those times).
Let’s say someone wants to pay you $15 for a treatment…is that top of the NADA scale for a 5-needle treatment, or bottom of the scale for a community acu-treatment? How do you or your patients distinguish what they’re paying for?
My sliding scale is $15 – $35. BUT I routinely drop the bottom end for patients who are struggling with addictions, severe pain, or anything else requiring daily acupuncture. Most community clinics do this. The punk tells patient how often to come in for acupuncture, and in exchange for their committment to the treatment schedule, the patient pays what they can. Sometimes, that’s as little as $5.
I think you can offer NADA treatments, for as little as $5, in the same setting and same time as your community treatments, and probably even throw-in Miriam Lee’s 10 needles as a bonus…without dividing your community into addicts vs. non-addicts. That is, I don’t think you need separate sliding scales or separate treatment times; I think you can treat your community collectively. M2C.
sustaining the flip
i think anything is possible Nick. I’m glad to hear Clayton’s experience of so many people in a 4 hour period for ear clinic. LG was pondering similar ideas here early on. i’m happy with the practice as it is so i don’t really have the personal motivation to open a $5 ear clinic and see it through. i wonder is there enough people yet using acupuncture where the 12-15 per hour could sustain the flip at $5/Tx ( kind of a rhetorical question)? i imagine this scenario to be most doable in higher, denser population areas. just some thoughts.
so true
Although the acu-travel I’ve done to help disaster relief organizations has been a big part of my learning as a human being, increasingly, I’m seeing the critical importance of taking care of ensuring intact communities where we live instead of running all over the globe chasing disasters. Perhaps that last statement seems a little harsh and it’s not that disaster relief work isn’t important…just that unless we create affordable and sustainable health care in our communities- then they will increasingly become disasters in need of an outside rescue. We need to get to the source of the problem.
Also, I really liked your comments above Jessica about how to skillfully integrate addiction treatment into a CA clinic without creating stigma and segregation.
A lot of food for thought in this thread.
Communichi Acupuncture Clinic, Seattle
https://www.communichi.org
Thanks, Jessica
Thanks for the prompt official response as well as the additional comments. I understand what you are saying about separating the NADA treatments from other open clinic hours. My concern about offering treatments below $15 as you describe is that my patients will feel that inconsistency as some kind of pressure–as now, even when a patient elects to pay $15, they comment that they are not paying me “enough.” Saying, “You can pay less than the scale…as long as you’re committed to the treatment plan” may seem like a favor, not a policy. I’m still thinking about all this. (And thanks for forwarding those threads, Nick! I had not read them before!)
Thanks for sharing
Thanks for sharing your recap of the conference, complete with thought provoking questions. Gotta love a healthy debate about health!
yeah
i have the same thoughts keith and am not rushing to change anything right now. the clinic is working great on the 15-35. I just really want to break 100! prob what it needs is more time to continue to grow.
NADA/CAN/AWB
I was at the NADA conference, after going through the week-long training. I’m an LAc, but I wanted to receive the training, especially from Mike Smith. His comments at the closing of the conference were, as described earlier, both inspiring and challenging.
Tornados occurred in Missouri, the day after the end of the conference. Joplin MO was about one-third destroyed. Some acupunks in MO requested AWB to come in and do a one-day training so we could respond to the disaster.
Long story made short(er). . . treatements were started a week after the storm, primarily in the Salvation Army Relief Tent (kudos to that organization) and are continuing at that venue now and for an additional period of time. And at least half of the folks who volunteered to work in Joplin are Acu Detox Specialists, NOT LAc’s. This is exactly the purpose of the NADA protocol. It’s simple and does not require a Masters degree to do.
As I needled folks in Joplin, I was repeatedly impressed with the effects of the 5NP and 3NP. Pain, anxiety, insomnia and so much more were relieved with 10 tiny needles. Missouri is a bit “slow on the uptake” with acupuncture sometimes, but I think we have made some lifetime fans with this effort.
As to combining the CAN and NADA work, I am offering “stress” clinics a couple of evenings a week at my CA clinic, with pricing up to $10. It’s a drop-in event and I only do ear needles. It has been well-received so far.
Dr Smith challenged us to step up and treat. To push ourselves to treat more people, more conditions. I truly feel that the CAN model is the answer and the future of much of health care in this country. For sure, the lack of care for many people and the pharmaceutical care for most others is not the way to a healthy population.
Thanks for this forum.
M. Sage Norbury, LAc
Summit Acupuncture
.
it was good to meet you Sage. Its great you were able to get down and help out in Joplin. Thanks for that. I have some family there and luckily they are ok. Sounds like the town got hit pretty hard.
nick
overcoming the fear of ‘doing it wrong’
I remember in my CAN workshop (the one in Frederick Maryland) that Skip advised beginners at CA to simply do the Miriam Lee protocol over and over, and not worry otherwise about point selection, because the patients *will* get better with frequent treatment.
This was an empowering moment for me, because while I might have some theoretical and conceptual reason for using this point or that point or point combination, to not have fear about ‘doing it wrong’ is critical to my being able to move quickly in treatment planning and implementation and on to the next person.
I keep coming back and reading this again
I was profoundly affected when I got to hear Dr. Smith several years ago, and that was at the end of my first year of school, when I hadn’t found CAN and wasn’t yet at the practical end things.
I keep coming back and re-reading this message and resonating with it.
Deep gratitude to Dr. Smith for this speaking, and thanks especially to Nick for taking the time to write all this out for us.
Joplin experience
I too, keep reading this blog and realizing the truth in “all acupuncturists stepping up to the plate”. I wasn’t at the NADA conferance but my husband Ron Vickery was attending the training and the conferance. He came back inspired and transformed by his experience. The very next day, Joplin took the “hit” and Ron felt the calling to serve. I would talk with him daily and he would share the highlights of the day. I loved hearing all the heart felt stories of desperate people that would leave from the treatments more centered and relaxed. Just from a simple 5 needle protocol.
“Keep it simple” was a foundational teaching from my Chinese teachers in school. I remember that and try to abide by it in my practice. It’s challenging at times because I want to practice the “art” of the medicine and study the patient in depth and use my education in the practice of Oriental Medicine to the highest so called power, hoping for miraculous results; all that effort and time.
Ron came back from one of his trips to Joplin suggesting I come along for a couple days to experience what he had seen and felt. I have to say that my experience was what many acupuncturists might benefit from. The “simple” NADA protocol is easy, effortless and oh so profound. Skeptics and exhausted victums left more alive, awake and centered; each and every one was the miraculous result I was seeking. The community feeling of all these people sitting together by themselves in peace, in the middle of a disaster, was….hard to describe but inspiring to me.
The future of our profession rests in simplicity and availability of our service. Yes, these services were free but the best type of advertising for our professtion is experience. This simple treatment is so effective that in my experience of 15 years in practice, I had never felt so fulfilled nor had I ever had the opportunity to treat 60 people in two days. I am now inspired to create a CAN styled practice using NADA.
I have a slow quiet practice giving my patients an hour of my time in a comfortable cozy treatment room with all the bells and whistles of a “boutique”. Meanwhile, out there in the real world many people need what can be given in a quick, simple treatment that is “proven” in its effectiveness. I’m confident through this experience, witnessing the results that many people felt, that they would happily pay for this work, were it made available to them. I could make a modest living while doing more to help humanity,
I hear the calling, I really do and believe that others like myself might benefit by implementing a program like the NADA/CAN protocol; we are the change we have been waiting for.
nashville
Daphne, can you come to Nashville next weekend? There is a Working Class Acupuncture training going on the 16th and 17th.
Or
the Madison, WI workshop?