The Object Is Help

“…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.”

OCOM webpage


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.

LarryG
Author: LarryG

CA punk for 12 years. AZ License #600

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.

Responses

  1. Beautifully said, Larry.

    And a nice introduction to our developing professional activism.  Every issue you brought up can be, will be addressed.

  2. I say amen!

    Larry, this post rocked my morning routine!  Thanks for articulating these super important points so well – and thanks for the great quote from SSM.

     

  3. tone

    Wonderful, wonderful. And, as we do the work of promoting community acupuncture (I love the idea of a “Community Acupuncture Today”, and I would excitedly get behind that project), we can all learn a lot from not only the great points you make here, but I think especially your tone, and that of SSM.

  4. Wow!

    Am I glad we signed you up as a blogger! Did you send this to Acupuncture Today as a letter to the editor? I doubt they’d print it, but as it’s an awesome piece of writing, I think you should give it a shot.

  5. Thanks, all, I am glad you

    Thanks, all, I am glad you enjoyed this piece. This is an issue that means a lot to me. I do believe that acupuncture in this country will be mortally wounded if the doctorate goes through and we really need to organize now to prevent being marginalized later as a loud, yet “small” minority of disgruntled and angry practitioners by the powers that be. History shows that this is usually the next step by Power when it unsuspectedly makes a misstep; renew resources, tweak the disinformation campaign and marginalize dissenters.

    I suppose a lot of this organizing can move to the Forum. The question is, how do we proceed?

    I sent it to Acupunture Today.Cool

  6. next step

    Excellent piece Larry. Perhaps there is a way to give this article and the issue of the entry level doctorate – more prominence on the CAN website…some sort of link (e.g. “Featured Article”) on the home page so that when successive blogs are posted, this doesn’t get buried. It does seem to be a critical issue in relation to the CAN vision of acupuncture in America and we need to speak up for the millions of Americans who could benefit from acupuncture without getting marginalized by the “acu-industrial complex”. 

     After that, we need to keep doing what we are doing…striving to be skillful practitioners at high volume affordable acupuncture…..and….stay very vigilant regarding where this issue goes in the acupuncture hierarchy.

    The fact that my interview in American Acupuncturist was recently published gives a glimmer of hope, but we mustn’t assume this is more than just strategic patronage.

     

    Cynicism is a smokescreen for laziness and fear. Clear light mind awaken! Pierce through all layers of doubt and delusion! Inspire me onwards in ceaseless waves of selfless activity.

  7. Excellent points!

    Your blog really got me going on all these things I could expand and reiterate on. It just really struck me.

    I wonder how many of us would even have bothered to become acupuncturists if a doctoral degree were required for entry into the profession? (to be honest – I wouldn’t have) Wouldn’t acupuncture then become even more obscure? Then for those of us who did go through the whole educational doctoral rigamarole, would all the time, energy and money to just become an acupuncturist not be enough to deter many from then proceeding to start a practice? (many of us know what it takes to start a practice – a tremendous load of time, energy and money! Just what we did at school!).

    Not only that, but let’s be serious- how many members of the general public / potential patients have any clue at all of what kind of training it takes for us to become acupuncturists? And do they really even care? I’ve been asked by all kinds of people if it’s just like going to hair school or if you even need a degree. Of course it is important for us to know what we are doing and have a solid education – but let’s be real – acupuncture is not rocket science.

    And to be a good acupuncturist, how important is all that schooling, anyway? The old saying “practice to learn” (rather than “learn to practice”) is really key. Being a community acupuncturist, in my (humble… perhaps biased!) opinion makes us better acupuncturists because we can treat so many people – gaining experience. All this “practice” in our practices is indeed extremely more educational then many of the hours spent slowly plodding through the (many excessive) requirements of school, or getting just barely a handful or two of patients to treat each week in a (painfully slow) boutique clinic.
    And last but of course not least, the biggest and saddest reality that we ALL know – that most people simply cannot afford acupuncture as is typically practiced. It is just plain exclusionary. Stuck up. Yuck.

    Good thing we (CAN’ers) all know that we can service people from all walks of life and still make a living. Good thing we can make acupuncture more well-known as it is experienced by more people. Good thing we can change lives and potentially cause more and more people to see how amazing acupuncture is! And of course the best part is – it feels SO good doing it.

    You are right – we should have CA brought to schools. In the meantime, it seems to be catching on amongst students – albeit slowly. Perhaps it will catch on kind of like a new CA clinic does – first slowly, then faster and faster! And even with little discussion about CA in schools – CAN exists as an incredible resource to anyone who wants it – teaching us pretty much anything we need to know to set-up and run a CAP. It’s amazing.

  8. Halelujah and Amen

    Larry,Great piece…  This stuff really gets me blood boiling and I agree with youthat we need to keep vocalizing our dissent to our profession at large and to the presumption that what our profession needs is more credentialing, more legitimacy, etc. Especially when the obvious problems, i.e. many people have no access to health care at all, are largely ignored.   I would also like to also question the presumptions that underly the health care system in this country, as our profession’s “leaders” try to get us on board this sinking ship of managed care. One of the basic, deeply entrenched beliefs of our health care system is that longevity is the goal at any cost.  Another assumption is that science is medicine.  When these are the models thru which to understand our bodies and health, there is a tremendous loss of vital awareness of ourselves. The economics of having a body that can be preserved indefinitely (for those who have access to those resources) are the same as those that allow such a small minority to control such a large part of the world’s resources. If CAN is nothing short of a revolution in the acupuncture world, and it is, then this momentum and refocus can also be directed towards a healthcare that is not only fair, and just, but that gives us a way to have a real relationship with our bodies and our health.   Cris