Tag Archives: ACAOM

Third Night – Lowering Standards!?

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In recent conversations with colleagues I’ve heard a few exclaim “we won’t agree to lower our standards!” and “we aren’t going to go backwards on our education!”

I haven’t heard anyone suggesting that we lower our standards or go backwards, so I was baffled.

Only momentarily, though, because then I remembered -The Acupuncture Revisions Proposal from the POCA Tech BOD to “revise acupuncture education and testing standards so as to benefit current and future (1) acupuncture students, (2) acupuncture schools, (3) acupuncturists, and (4) the general public.”

They make clear that their proposed standards are based around students meeting all of the competencies required for ACAOM accreditation and preparing graduates to be safe and effective practitioners. (The proposal is concise, well-written, and worth reading. Please do.)

Unfortunately, “high standards” in this profession has come to mean number of hours spent in school. So any change in the number of hours is interpreted as a lowering of standards.

I understand how it happened. When we’ve fought for acceptance, we’ve stressed our hours of training to establish our worth. When clients mention that they got acupuncture from their Chiropractor, we talk about how much time we spent in acupuncture school compared to the D.C.’s short courses. Hours of education has been a battle cry in the dry needling fight. (Which has been mostly unpersuasive since the PT’s 1) deal in competencies, and 2) we use different rules when we count our hours and we count theirs.)

Actually, a standard is “a conspicuous object (such as a banner) formerly carried at the top of a pole and used to mark a rallying point especially in battle.” (Merriam-Webster).

So, hours has become our standard. But it’s such a meaningless standard. I’m sure I’m not the only person who’s been to three-day CEU classes that have been a complete waste of time while a one-hour class contains a transformative nugget. I’ve spoken to people who have taught at some acupuncture schools and the picture they paint is not of hour after hour of quality programming.

We’ve got a workforce that needs to grow. And levels of educational debt that are an impediment to professional success. Affording graduate school and repaying loans isn’t going to get easier.

Read the Acupuncture Revisions Proposal with an open mind.

Our banner should be more meaningful than a number.

 

 

Proposal regarding Acupuncture Education

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The POCA Tech Board of Directors has been studying what it takes to become an LAc and wondering whether there isn’t a better way. POCA Tech has been approved by ACAOM as a candidate for accreditation, and has graduates who are NCCAOM-credentialed, state-licensed and working in the field. The POCA Tech BOD is in a good position to know what works. Here’s what they propose –

Acupuncture Revisions Proposal

I’ve been around long enough to expect the proposal will be met with some outrage. We’ve been insisting that it is the hours of education we have that set us apart. And that almost 2000 hours of training only scratches the surface of what there is to know about Acupuncture and Asian Medicine.

I’ve also been around long enough to know that 1305 hours of training is enough to produce competent providers. That there are countless CEU programs and additional degree programs to help us deepen our knowledge. And that there is no clear evidence that our more extensive training leads to better outcomes.

People want acupuncture. We need more practitioners to meet the demand. And 100K in debt helps no one. I think the POCA Tech proposal makes a lot of sense. What do you think?

 

 

Continuous Improvement and Feedback

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It’s difficult to make things better when you don’t know what’s wrong.

I’m glad when a client lets me know that something isn’t working. It gives me a chance to change things, or help them find something that better meets their needs. Things are better for both of us when we’re honest.

That’s why I’m having trouble moving on from a column that equates discussion about our problems with treason (“giving the other professions … the ammunition they need to diminish acupuncture”) and so many of the responses to the Gainful Employment regulations. (Here’s a selection — ACAOM gainful employment word, Acupuncture school response, and the ASA’s response.)

The cost of an acupuncture education, how that cost compares to future income, and the likelihood of that income being sufficient to pay off loans in a timely fashion while also sustaining oneself, are critical issues for the profession. Welcoming feedback from those who have “been there and done that” is necessary to guide improvement.

The Gainful Employment rules require transparency and accountability from for-profit career colleges. The regulations don’t close schools. They may, in time, keep students from receiving federal Title IV student aid to attend programs that don’t meet the accountability standards.

Although the impacted schools insist that the education they provide is a good value, they are correct to fear that, absent federal guarantees, students will have trouble coming up with enough money to attend.

Ideally, their concern would translate into concerted efforts to gather data about their graduates’ experiences and provide it to prospective students. They’d focus on what could be done to reduce expenses for students, and develop programs to ease those first few years post-graduation when they acknowledge income may be low. They’d make sure that all prospective students had an understanding of the economic realities of life as an LAc before collecting that first tuition payment.

Instead, when I read the responses from our schools and organizations, I hear, mainly, this isn’t fair, it’s not our fault, and it shouldn’t apply to us.

They argue that the responsibility is on prospective practitioners to educate themselves about the field and educational options, but also say that the data available doesn’t reflect the true picture. (And they fail to mention that before the Gainful Employment rules required it, they paid little to no attention to what happened to their students post-graduation.)

Try comparing the earnings of graduates from various programs, or finding out the percentage of graduates still in the field 5 years later. That data doesn’t exist. How will prospective students get a fair picture if practitioners who are share their struggles are told to keep quiet and say only nice things? If the concern is that some of the things being said are inaccurate or overly negative, take the opportunity to provide correct information and the other side of the story.

Working part-time, having employment structures that don’t accurately reflect all money earned as taxable income, and a lag in the time it takes to reach full earning potential are not unique to acupuncture school graduates.

Low student loan default rates aren’t evidence that all is well. Default carries significant and long-term harms and, luckily, acupuncturists are responsible enough to make payments and take advantage of options to defer or reduce payments when necessary. Of greater significance – do we earn enough to pay off our loans in a timely fashion while also supporting ourselves? Can we save for retirement and purchase disability and health insurance? Will we ever be able to buy a home, or build up a cushion in case of hard times? The overall financial health of the average graduate should be the focus of attention. The highly successful grads are the exception, not the rule.

I’m not surprised that the schools are fighting to avoid consequences for the struggles of their graduates. I am surprised that other organizations and voices are supporting their evasions.

There are more than sixty Acupuncture and Oriental Medicine Programs in the US. What’s a bigger threat to our future – that a few might close or that a significant number of graduates, burdened by debt, leave the profession before they can get established? How about the impact of student loan debt on the affordability of our services? Is that important?

Understanding and acknowledging our problems is the first step in making things better. We need more data and discussion, not less. More transparency and accountability, not less. A greater emphasis on making things better, not making excuses for why they aren’t. It’s time for us to own our challenges, not blame and deflect. Let’s get honest.

 

 

Professional Harmony, Professional Growth

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Acupuncturists know that good health isn’t acquired by attacking invaders. Instead, we advocate living in balance with our environment to develop a strong, self-reliant, vessel. We are healthy when our system excludes threats without our even being aware of them.

As individuals, most of us practice (most of the time) what we preach. We strive for balance.

As a profession, though, we’ve chased the equivalents of miracle cures, mega-antibiotics, and the promises of “experts.” Like our clients who seek well-being that way, we are tired and struggle to maintain our tenuous health.

What if practitioners, schools, organizations, regulators, and credentialing agencies saved the energy and money that went to filing lawsuits against PT’s, (and having to defend ourselves when we are sued in return), establishing new degrees, and changing state regulations to require more training and exams? What if, instead, they identified the minimal standard necessary to practice safely and effectively and committed to work, state by state, to establish that standard as sufficient for licensure? What if we took as a guiding principle and goal that an acupuncture license in one state, and a history of safe practice, should be sufficient for licensure in any state?

Other professions are doing this. PT’s, Nurses, and MD’s are all working to make it easier for practitioners to relocate. Even lawyers can be “waived” into a state based on prior experience. These professionals don’t have to start school wondering whether their degree will be sufficient. A family move doesn’t mean giving up a career.

Acupuncture school is a risky investment, especially when requirements for licensure vary widely and change regularly.

Unlike our other battles, moving toward standardization (of licensure NOT lineage), doesn’t require convincing any judge or insurance company of our position or value. We hold the power to create a system that supports acupuncture professionals and serves the public.

It shouldn’t be difficult. It will be. We are better at vehemently disagreeing and walking away than we are at overcoming differences and finding compromise.

Both herbal credentialing and the FPD degrees were enacted despite concerns we now know were prescient.The ACAOM-sponsored DELPHI process (to establish degree titles), an after-the fact attempt to address some of those concerns, is moving forward, but not without challenges.

We lack an organization for regulators. This increases the tendency for states go their own way, and will make coming together even more difficult. Too often regulators have focused on their personal visions for the profession rather than serving the public. Many of them also sit on the boards of, or work for, acupuncture schools, raising the potential for conflicts of interest.

We could overcome these challenges. We could focus on the benefits and commit to sticking together. We could ensure the public can access Acupuncturists when they want acupuncture. We’ve spent enough on the antibiotics of legal action and the miracle cures of being Doctors and pursuing third-party payment. Now we need to focus on establishing common ground and common requirements, building our strength and our stamina. That would be a huge step toward good health for the profession.

 

 

Acupuncture Organizations 2015 – State of the Profession

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The 40ish days between January 1st and the Lunar New Year are perfect for reviewing the past year and preparing for the next year. What worked, what didn’t? What direction will we go in when the days warm, the yang rises, and we spring forward?

There is much to consider when evaluating our practices and our profession. To understand how it all fits together we need to dive into the weeds. It’s going to take a few posts, but it will be shorter than the tax code!

Associations/Organizations/Guilds —

AAAOM (The American Association of Acupuncture and Oriental Medicine): Historically, our national professional association. And, historically may be all. The website shows no action items since 3/13/14, and no President’s blog post since 10/9/14. Is there anybody there? Is the AAAOM still alive?

ACAOM (The Accreditation Commission for Acupuncture and Oriental Medicine: Graduation from ACAOM-accredited schools is a requirement in many states. 2015 ended with an announcement of a Degree Titles and Designation Project. This should be interesting – there are already graduates of and students in the existing range of programs and there are widely varying state rules. Better late than never? (Wouldn’t it be easier for the public if we were all Acupuncturists?)

ANF(Acupuncture Now Foundation): Finally, there is an international charitable organization dedicated to educating the public, other health care providers, and those who work in health care policy. For too long we’ve relied on piecemeal efforts to educate others.The ANF is just getting started and needs our support to provide a visible, accessible and positive message about who we are and what we do.

ASA(American Society of Acupuncturists): This non-profit collaboration of state associations launched in 2015. The ASA has potential, and challenges. One challenge – “six degrees of separation” between individual practitioners and the group. A planned website should help bridge the gap. Of greater concern – at the state level, the ASA defers to the preferences of the state association. If an ASA-member state association supports a law or regulation that serves its current members to the detriment of all other LAcs, too bad, so sad for the profession as a whole. There are good people involved with this group so I remain cautiously optimistic. I hope that, before too long, the member groups will see that a victory that disadvantages other Acupuncturists isn’t a win.

CCAOM (Council of College of Acupuncture and Oriental Medicine): The membership association for schools and colleges of AOM with ACAOM accredition or candidate status. They administer the NCCAOM required CNT course, and released an updated (available free!) CNT manual this month.

IHPC (Integrative Health Policy Consortium): The IHPC “advocates for an integrative healthcare system with equal access to the full range of health-oriented, person-centered, regulated healthcare professionals” and has been working to build enforcement of Section 2706 of the ACA to end insurer discrimination against classes of licensed health professionals working within their scope. I don’t know of any LAc that doesn’t support this group’s mission, so it is odd that many LAcs support legislation that would create this sort of discrimination.

NCASI (National Center for Acupuncture Safety and Integrity): One individual? Silent for many months now.

NCCAOM (National Commission for the Certification of Acupuncture and Oriental Medicine): The NCCAOM “validates entry-level competency in the practice of AOM through professional certification.” Their vision is that AOM “provided by NCCAOM credentialed practitioners will be integral to healthcare and accessible to all members of the public.” They are powerful, organized, effective, and better funded than any other acupuncture group. They have had a major role in the path to licensure in many states. However, if you are not an NCCAOM diplomate, feel that the credentialing process is out of hand, and/or if you value traditions other than TCM, the NCCAOM is probably working against your interests.

NGAOM (The National Guild of Acupuncture and Oriental Medicine): A professional medical society organized as a guild under the OPEIU, affiliated with the AFL-CIO. The NGAOM list of 13 VP’s includes the VP, Immediate Past President,Treasurer and one additional board member of the AAAOM and following in that tradition there is significant mystery around their membership and their decision-making process. They want the profession of acupuncture to be more like other health professions. Many LAcs affected by their work aren’t pleased with the consequences. You’ll learn more in upcoming posts.

POCA (The People’s Organization of Community Acupuncture): Mission — “to work cooperatively to increase accessibility to and availability of affordable group acupuncture treatments.” 708 Punk (Acupuncturist) members, 138 clinic memberships, and 1348 patient members. Minutes of meetings posted in their forums, 8 free CEU’s for practitioner members, loads of member support, and a school (POCA Tech) working towards ACAOM accreditation and currently accepting applications for the third cohort of students. This is a successful acupuncture organization.

State regulatory boards are not professional organizations or associations. Their mission is to protect the public, not promote licensees.

An exploration of acupuncture education, events in the states, legislation and regulation, and other items of interest, including more about these organizations, will be coming soon.

 

Acupuncture and Oriental Medicine in Nevada, What’s the Deal?

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A regulatory board working against the best interests of the public and the profession  — it’s tragic, and it happens too often.

It has never been easy to become an acupuncturist in Nevada. Despite having the country’s first licensing law, passed in 1973, there are only about 50 individuals now practicing in Nevada, the 7th largest state.

It’s not only the $1,000.00 application fee, or the $1,000.00 practical exam fee. In the 2001 the press explored how Nevada’s unique rules caused problems for the profession.  The regulations may have changed, but similar issues remain.

Given the excellent safety record of practitioners licensed in states with less stringent educational requirements and via the widely accepted NCCAOM credential, it’s long overdue for the Nevada Board of Oriental Medicine to change their regulations, making it possible for the citizens of Nevada to get access to the safe and effective acupuncture and Oriental Medicine services that are available in so many other states.

The board is moving to update the regulations. To make it harder, not easier, to get a Nevada license. Not in response to harm to the public, not to bring the process in line with other states, but, because “the degree of MSAOM is odd and absurd.” Look for the “Justifications to amend,” on page 18 in this set of Nevada workshopdocs. You’ll shake your head.

The workshop docs show two sets of proposed revisions. The set dated June 16, 2014, was proposed by a previous Board, has made its way through the regulatory process, and could quickly be officially adopted after two more public meetings. However, the newly appointed Board members have decided not to act on those regulations, and have proposed new revisions. The lawyer in the Attorney General’s office isn’t quite sure what will happen now — it seems that “our” Board is unique in introducing a new set of revisions at this point in the process. (See ** below for more info on the Nevada Regulatory Process.)

The Nevada 2014 proposed regulations would have been somewhat problematic. The Nevada 2015 proposed regs would be a disaster. The reasonable aspects of the 2014 proposed regs are discarded and more restrictive provisions are introduced. The “grandfathering” provision, specifically excluding CEU’s from the 3000 hour requirement, takes away the one avenue for licensure available to most experienced practitioners. The insistence on a DOM or DAOM for all graduates after November 2017 is a significant financial burden for practitioners.

The proposed changes would slow access to and increase the expense of acupuncture in Nevada. They won’t help the schools meet those new gainful employment figures. The proposal dismisses the attempt (for better or worse) to defer to ACAOM for school accreditation, instead establishing an expensive and closely held accreditation process. A change which would allow applicants to sit the practical exam (offered only twice yearly) while their training and background is being vetted is discarded. The regs allow for an increase to $1,000.00 to the license renewal fee, rather than $500.00, and deletes a section on professional ethics from the current regulations. It’s hard to imagine that such awful regulations were written by our colleagues, not acupuncture-hating skeptics. Amazingly, the President of the Board certifies that, “having made a concerted effort” to determine the impact of these regulations on small businesses, there is none.  (See the workshop docs.)

My suggestions on what the profession could and should do in response to these regulations will come soon in a separate post. In the meantime, review the documents and consider how the changes would impact the profession Even those of us who don’t know a soul in Nevada and expect that we’d never practice there will see problems. At the moment, the LCB has not put these proposed revisions on the agenda.  Stay tuned.

 

** Nevada regulatory process —  the Legislature meets only every other year, for 120 days. Nevada law establishes a Legislative Commission, made up of 6 legislators from each house, that can approve regulations when the legislature is not in session. See more here, (generalize since this was written for a particular commission). Regulatory changes do not need to be approved by either the governor or the full legislature.

 

FPD/DAOM required, Schools, ANF, Dry Needling — and more Acupuncture News….

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New news:

Word is that the Nevada acupuncture board is poised to require an FPD (or is it a DAOM?) for licensure, even though citizens there are already under-served. I’m trying to get more information. Stay tuned for updates. State actions that limit our profession tend to stay under the radar until it is too late.

The acupuncture school landscape is changing. Last week brought news that Bob Duggan and Dianne Connelly will no longer be part of MUIH faculty or staff. For those who have been paying attention as The Traditional Acupuncture Institute morphed into MUIH, it shouldn’t have been a surprise. But it is sad. While TAI had its good and its bad, many who attended did so because of Bob and Dianne’s contributions. The announcement was quickly followed by a letter, in perfect TAI-speak, that, for the sake of the students, we shouldn’t get caught up in stories about this. As in, don’t even ponder what it is we aren’t telling you.

This week also included the news that NESA is merging with MCPHS, and ACTCM is merging with CIIS.  (Thanks, Integrator Blog.) Is the age of the stand-alone acupuncture school coming to an end?

Have you heard of The Acupuncture Now Foundation? They aren’t a membership organization, and they don’t want to get involved in acupuncture-politics. They just want to educate the public about our training, our skills, and the great results from our medicine. Please, support ANF! Marketing the medicine shouldn’t have to be an individual effort.

Older News:

Developments in dry needling, with the hope that we might learn from history:

  • Louisiana joined other states with an AG opinion that dry needling is within scope for PT’s and DC’s. Other AG opinions can be seen here.
  • Tennessee’s Governor signed Legislation formally adding dry needling to scope for PT’s, joining Utah and Arizona which saw similar legislation in 2014.
  • The Maryland Acupuncture Society came out in strength behind HB 979 and SB 0580 that would have set limits for dry needling by PT’s and DC’s. The bills went nowhere, perhaps a blessing in disguise as “success” would have opened a can of worms.  (The bills did not define dry needling, MAS support put the acupuncture community’s stamp of approval on a 200 hour standard for acupuncture training that had been previously unacceptable, and the wording opened the door for PT’s with 200 hours of training to argue that they were now, indeed, doing acupuncture.)

The AAAOM website has been updated with board bios and a revamped committee list, but still no answers for any of my sixteen questions for the AAAOM.

ACAOM responded to the petition in response to their Gainful Employment letter in the ACAOM Fall Newsletter.  The good news — they heard us. The bad news, they continue to believe that significant student debt is helpful for those who want to serve low-income communities.

There you have it, at least some of the news you aren’t seeing in Acupuncture Today.

 

AOM Leaders?

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Who decides the future of the profession?

Did you know about the meeting of the Acupuncture and Oriental Medicine “leaders” last weekend?

Who represents working acupuncturists at these meetings?

These meetings started in 2005. You can read about previous meetings here, here, and in CCAOM newsletters. Attendees typically include reps from ACAOM, CCAOM , NCCAOM, SAR, NFCTCMO, CSA, AAAOM, AOBTA, and sometimes COMRE. It’s good (I think) that these groups are communicating. It’s not good that most acupuncturists in the US are several degrees of separation away from representation there.

There’s not yet a publicly available report of the 2015 meeting. I do know —

The AAAOM continues to be invited and to attend, despite being out of compliance with their bylaws for years. The AAAOM website currently has no news of the recent elections, the board information is outdated, and there is still no whistleblower protection policy. Word is that the current board overlaps significantly with the board of the NGAOM. Michael Jabbour continues to fill the board position of Immediate Past President (what happened to the real immediate past President Don Lee?) and was present at the AOM Leaders meeting. Membership numbers of the organization are a mystery and I hear the AAC continues to provide much of their funding.

The others present at these meetings know that the AAAOM is a deeply troubled organization that represents only the smallest handful of practitioners. Why, oh why, does the AAAOM rate a seat at the table?

Representatives of the Council of State Associations are also in attendance at these meetings. I am glad that the CSA exists, working to mitigate the damage done by the lack of a functional national organization. I’m concerned, though, that few practitioners have any direct knowledge of this group and what they have to say at the AOML meetings. If you are involved with a state organization, and if the state organization participates in the CSA and communicates back to the membership, then you’ll find out about the CSA. Otherwise, you’re in the dark.

Why isn’t POCA invited? I don’t suppose they’d enjoy being there, but if the AAAOM with their mystery membership is invited, and the NFTCTCMO is invited, why isn’t POCA?

It’s difficult to find the right tone for this post.  I know the groups representing acupuncturists depend on volunteers who are doing their best. I also know that working practitioners too often find themselves at the mercy of the “good ideas” of credentialing agencies, accreditors, schools, and a few powerful colleagues. To make it worse, most practitioners have been misled about what actions are likely to be effective and create positive change.

When I look at who is invited to the AOM Leaders meetings, and how far most of us are from what happens there, it’s no surprise that so many of the developments within the profession seem to work against the best interests of acupuncturists. It reminds me of Congress, and that’s not a good thing.

 

 

A Little Humor

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Here in the DC area a few bulbs are sending leaves up through the cold ground. As their energy rises so does mine. Soon, I’ll share my response to ACAOM’s latest communication and news that yet another jurisdiction seems poised to put licensure off-limits for those without full NCCAOM herb credentials. (DC. Once again, this is happening out of sight of most US practitioners. Shouldn’t we be care more about this than what the PT’s are doing?)

But, for today, I decided to share a humorous bit that I posted to Acupuncturists on Facebook the other day. For those who, understandably, avoid that group, enjoy. For those whole already saw it, apologies.

The Six Stages of Cold Induced Illness in LAcs —

1) Dignity — I’ve been so healthy this year! I do lots of Qi Gong and eat right and get good sleep and take Jade Screen. Don’t worry about me, I’m great.

2) Denial — Hmm, the air in the house must be dry. Or maybe I’m allergic to something. I’m fine.

3) Dosing — Echinacea, Ginger Tea, Chicken Soup/Bone Broth, Jing Fang Bai Du San. More tea. I’ll throw in some Airborne. And some Yin Chiao.

4) Delusion — Really, I’m fine. Let me step out for another box of needles (copious nose blowing and repeated handwashing). Oh, yes, just a little sniffle, it’s nothing.

5) Decompensation — My nose is dripping, can I get the needle in before it’s too late. How many clients do I still have today — can someone please be a no-show. Why is everyone on time? Oh, can I put my head on my desk for a minute. Do I have any Sudafed around here?

6) Despair — This is ridiculous, I surrender. Begin the phone calls to clear the day tomorrow. Of course I’ve had two good weeks in a row for a change — where can I put these folks. 🙁

I hope that all of you are well and healthy. Enjoy these last weeks of hibernation.

An Acupuncturist Looks for Balance

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How do I help the greatest number of people?

The wisdom of Acupuncture/East Asian Medicine has improved my health and the health of my clients for more than two decades. Throughout that time I’ve worked with professional regulation, legislation, and our organizations, with the goal of increasing public access to the full benefits of this medicine.

My involvement in the political sphere of our profession has taken significant qi that I could have used to study the medicine, improve my technical skills, and increase my own well being.  Most days at my clinic include at least one moment when I know that with deeper study I could have provided better care.

This fall I felt that I should choose, Practitioner or Advocate? My clients weren’t getting my best. Could I find a way to support myself through advocacy and leave my practice? Would I be happier if I focused on the intellectual challenge of working toward a widely shared vision of success for the profession, and developing a path to that success? Or should I leave the advocacy work and focus on my patients? In the clinic the appreciation doesn’t carry a side order of harassment and ill will. When I treat I see the positive impact of acupuncture and Asian medicine every day.

It’s winter. I’ve been taking a break. I can’t quite follow the Nei Ching and sleep until the sun rises, but I’ve stepped back. I’ve read the communications from ACAOM and the AAAOM (and this, and this (apologies for it being post-deadline, it was hidden), followed the complaints about health insurance (what it costs, what it covers, what it pays, the work involved in getting those payments), wondered about our dry needling strategy, and pondered whether blogging about these things is “worth” the qi.

It’s still winter….