Things Change

These days, one of the websites I spend a lot of time on is ACAOM’s, because I’m fascinated by the nuts and bolts of acupuncture education in a way I never would’ve thought I’d be. If you’re not as geeky as I am about this stuff, you might not have seen this announcement:

The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) is pleased to announce a two-part project to engage the Acupuncture and Oriental Medicine (AOM) field on the pressing issue of Degree Titles and Designations.

You can read more details here, and also — POCA members, will you please indulge me and take a look at this forum thread? Anyway, I think it would be good to consider this project in the context of some broader reflections  — as in, what is acupuncture’s place in our society?  Degree titles are the tip of the iceberg;  just under the surface, there’s a massive frozen bulk of unresolved issues for the acupuncture profession. Such as, what is an acupuncturist’s role? What does acupuncture do, and for whom? What should it do? What does it owe society, what is it owed, and who, if anyone, owns it?

In the course of doing some other POCA Tech work I ran across a weird personal symmetry.  The first practice acts for acupuncturists went into effect in 1973 (around the time the Young Lords and the Black Panthers were adapting acupuncture to their work at Lincoln Detox). 21 years later, I graduated from acupuncture school (1994). 21 years after that, I’m on sabbatical from actively practicing (another thing I never thought would happen) so that I can focus on getting POCA Tech ready for its spring site visit from ACAOM. The development of the acupuncture profession as we know it took place over an arc of 42 years; that really isn’t that long, when you think about it.

Here’s some more data (imperfect data, but I think still interesting) for the context of the degree titles discussion. Like I said, I spend time on ACAOM’s website…anyway, I was geeking out on this page, trying to count how many acupuncture schools opened in each of the last four decades, and I noticed an interesting pattern. My numbers are probably not perfectly accurate; I was trying to focus on schools that are still around, and sometimes the date that the school actually opened, as opposed to when it got accredited, is not easy to find.  But here’s what I got:

in the 1970s, 7 acupuncture schools opened;
in the 1980s, 12 acupuncture schools opened;
in the 1990s, 22 acupuncture schools opened;
in the aughts, 17 acupuncture schools opened;
and since 2010, 2 acupuncture schools have opened, POCA Tech being one of them.

The thing about the aughts, though, is that almost all of the schools opened in the early part of the decade. If you count the Recession as starting in 2008, only 2 acupuncture schools have opened since then, the same 2 that opened since 2010.

On the other hand, I counted 5 schools that have closed since the Recession: HCOM (Hawaii) in 2014, Samra in 2010, Touro in 2010, the Swedish Institute in 2012, and in 2015, SWAC closed their Albuquerque campus (I guess we could debate whether that counts as a whole school closing). There have also been 2 high profile mergers of very established free-standing acupuncture schools with larger non-acupuncture institutions: NESA (the oldest acupuncture school founded in  1975) and ACTCM (not that far behind it, founded in 1980). I think most people would agree that we have yet to see the true impact of the new Gainful Employment Regulations on for-profit schools in general, and about 50% of acupuncture schools are for-profit.

But looking at the list, obviously something happened in the 1990s, right? Before that, what it looks like is white people, not all that many of them, gradually getting more interested in acupuncture. But then there’s this boom that starts in 1990 and continues through the early aughts. Those of us who were there remember what happened: access to federal student loans.

What didn’t happen was a way to pay them off; which gets back to the problem of acupuncture’s role in society. (And also to degree titles; I know people who are getting their DAOMs mostly in order to postpone having to pay back the loans they accrued getting their Masters’.)

If you went to the last POCAfest, you got a spectacularly helpful history lesson: the people who set much of the course for the acupuncture profession and its institutions were not practicing acupuncturists. It makes sense, given the time and the place and the people involved, that their dominant image for the role of acupuncturists in our society would be doctors in white coats. It unfortunately reflects biomedical hegemony, but it makes sense.

What’s interesting to me, though, is to think about all that’s changed in the intervening 40 years about the healthcare system, and the role of doctors within it, and above all the economy — as it affects healthcare and as it affects everything else. In the 1970s, doctors had a lot more power and freedom and job satisfaction than they do now. Recently I had a conversation with a prominent local MD about the sky-high burnout rate of primary care doctors; that’s probably a topic for another post, but the point is that sometimes things change pretty fast.

I think the acupuncture profession is largely operating out of a vision constructed in the 70s and 80s, a vision that stuck around and found a funding base through the 90s and up until the Recession. The vision was for acupuncturists to be doctors; but the funding for the vision never came from acupuncturists actually occupying the role of doctors in society. That was the dream, not the reality. And it’s a dream that got us to where we are now: where the cost of becoming an acupuncturist, for most people, is completely out of alignment with what a practicing acupuncturist can expect to earn.

Which gets us back to all the questions beneath the degree titles: what is an acupuncturist’s place in society? Who does an acupuncturist work for? How does an acupuncturist get paid? Who does acupuncture belong to? I don’t think it’s too late to go back to these questions in a serious way. The status quo in the acupuncture profession hasn’t actually been around all that long, and it might not be around that much longer. Where do you want us to be, 21 years from now?

lisafer
Author: lisafer

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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. Such good questions…tough ones too.
    I’ll try to answer a few…

    what is an acupuncturist’s place in society?
    To provide services in a safe, clean space among other folks receiving and giving in this same spirit. Not acting as a physician, but rather a good neighbor with specific skills to offer that can ease Suffering.

    Who does an acupuncturist work for?
    Ultimately for the Creator(s), but Practically for the folks who seek us to lend a hand.

    How does an acupuncturist get paid?
    Hopefully without the interference of third parties.

    Who does acupuncture belong to?
    Acupuncture is like the wind…to whomever works to harness it.

    Where do you want us to be, 21 years from now?

  2. really great history article in the link, i enjoyed and learned new things.
    so,
    What is an acupuncturist’s place in society?
    depends on the place. can be in more than one place (in society) at a time. varies by the person, depends on the people they see. could be harm reduction, health promotion (assuming health is a quality people already have), a fellow human. health care and recovery. a co-creator.

    Who does an acupuncturist work for?
    hard to tell. again, varies, and multiple setups exist within the same society. some are here, some are there. some work for themselves and their patients, some work within communities for something bigger than themselves. some work for schools. is an acupuncturist not an acupuncturist when they’re working in another way?

    How does an acupuncturist get paid?
    second job. jk. some speak of results-based payment, i wonder if that could become a big thing (eg: part of a single payer health care plan) and by and by impact us too.
    otherwise, probably similar to how things are now: paid per treatment, on a sliding scale in a classist world, by people being treated, with varying degrees of money. or medicare.

    Who does acupuncture belong to?
    same as the earth. things change, everyone dies. no one owns nothing. tho, on a temporary basis, it’s been said the earth belongs to those who work it. maybe same goes for acupunctura.

    Where do you want us to be, 21 years from now?
    acupunkturing. on earth.

  3. What is an acupuncturist’s place in society? I tend to think the right starting point for anyone’s place in society is “good neighbor”. We’re getting off on the right foot if we have some decent boundaries, not a ton of unnecessary hierarchy, we pay attention to the impact we have on those around us, we’re there to pitch in and contribute what we have to make our corner of the world, one another’s lives, as good as it or they can be. Or even a little better. That’s what I think we should be doing as acupuncturists too.

    Who does an acupuncturist work for? How does an acupuncturist get paid? You work for your patient community. You get paid fairly.

    Who does acupuncture belong to? To whoever is getting it. And I like to think of POCA as making acupuncture belong, in general.

    Where do you want us to be, 21 years from now?
    As ubiquitous as Starbucks and Dunkin Donuts. It should be as easy to get acupuncture as it is to roll up and get a cup of coffee. That well known. That plain.

  4. For perspective, this is a good article about doctors’ perspective on their work: https://www.theatlantic.com/magazine/archive/2014/11/doctors-tell-all-and-its-bad/380785/

    “Today’s physicians… see themselves not as the “pillars of any community” but as “technicians on an assembly line,” or “pawn[s] in a money-making game for hospital administrators.” According to a 2012 survey, nearly eight out of 10 physicians are “somewhat pessimistic or very pessimistic about the future of the medical profession.” In 1973, 85 percent of physicians said they had no doubts about their career choice. In 2008, only 6 percent “described their morale as positive,” Jauhar reports. Doctors today are more likely to kill themselves than are members of any other professional group.”