Category Archives: education

Eight mini-Posts for Eight Nights! First Night – Acupuncturists, Weigh In!

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The NCCAOM is looking for feedback on a possible Safe Compounding and Dispensing certificate program. I don’t work with herbs so I’m not considered a stakeholder, but please reply if you are eligible. My questions/concerns —

  1. Will the certificate be available to anyone or just those with an NCCAOM herbal credential? Practitioners often delegate herbal preparation to office staff, so staff might benefit the most from the training. Additionally, some excellent and well-trained practitioners aren’t able to sit the NCCAOM herbal exam due to the nature of their herbal education. Could they still obtain this certificate?
  2. Will this certificate result in restrictions on the practices of those without it? The NCCAOM has previously developed credentials promoted as optional, which have, in short order, become requirements.

There are many areas of practice in where some of us could use more knowledge and training. It’s nice to have a way to show that you’ve got some special training or skills. At the same time, we’ve got enough battles with other professions and within the profession, and too often new credentials lead to new fault lines and new tensions.

Share your thoughts with the NCCAOM if you’re a stakeholder. Let’s help them serve our needs and understand our concerns.

 

 

 

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?

 

 

Happy AOM Day??

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“Acupuncture is a safe and cost-effective treatment that could benefit so many. If only the medical establishment could see the benefits of what we do.”

That was our mantra decades ago.

So one might think, now that Acupuncture has become accepted and of increasing interest to the establishment, we’d be happy, thriving, and confident.

But that isn’t the prevailing feeling. We love our work and most of us couldn’t imagine doing anything else. And yet AOM Day 2017 finds us fearful and disheartened.

Many of us carry significant debt and are not earning enough to pay it down in a timely fashion. Many of us are limited in where and how we practice due to varying state rules. The hoped for benefits from insurance reimbursement came with significant administrative burden and limits on what will be covered. Increasingly acupuncture is being provided by non-acupuncturists. Meanwhile, the profession isn’t growing. Based on figures from Acupuncture Today, there are fewer LAcs now (24,612) than there were in November 2013 (24,707).

So it is not surprising that we aren’t hopeful. The public and the medical establishment see the value of acupuncture, but we aren’t thriving.

There are things we control that could change our trajectory.

Those of us who completed acupuncture training prior to 1990 (some of our most admired mentors and colleagues) probably got about 1000 hours of formal schooling. If you graduated in 2000 you likely had about 1725 hours of schooling, and if you completed your training after 2011 your program was at least 1905 hours.

You can see, here, how the Virginia regulations have changed over the years. The hourly requirements did not change in response to concerns about practitioner safety or skill, but to keep the regulations compatible with the ACAOM and NCCAOM requirements.

In 1988 tuition at The Traditional Acupuncture Institute (now MUIH) was $11,000 (about $23,000 in today’s dollars). When I started in 1992 it was about $18,540, ($32,616 in today’s dollars). By 2003 tuition had increased to $32,865 ($43,722 in 2017 dollars). And, if I wanted to begin at MUIH today, the program would take almost four years to complete with tuition of $75,924. For a Masters in Oriental Medicine, necessary to practice in Florida, California, and Nevada, I’d pay $99,604.

A student loan of $40,000 at 6.8% interest can be paid off in 10 years at $460/month – considered manageable with an annual salary of about 50K. A $100,000 loan will take over $1150/month and you’d need to make almost 140K/year to manage that.

So it’s not surprising that the profession isn’t growing and that acupuncturists are worried.

Sure, the NCCAOM can embark on a major public education campaign touting our training and credentials.(Well, touting their credential, actually). That’s fine. But with the downward pressure on health care spending in this country, and the impact of debt considerations on professional training, it’s going to take some damn fine PR to make a difference. (Big Pharma & Health Products spent about 245 million on lobbying in 2016.)

A far more direct way to help the profession grow, help future graduates make a living, and make Acupuncturists available to those who want acupuncture would be to address our training. If those who graduated in 1989 were safe with a 1000 hour $18,000 education, why do current students need at least 1905 hours and $75,000? Can we simplify the path and reduce the cost of becoming an Acupuncturist? (Yes, we can!)

If people want acupuncture they will find a way to get it. If we’re not there to provide it, someone else will be. We do have the power to change this, and it won’t take 245 million. In honor of AOM Day 2017, let’s agree that more Acupuncturists and less debt would be a very good thing.

 

 

We WANT to hear from Acupuncturists!

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And, now, for something completely different — a group that wants “to get as accurate a picture of the acupuncture profession as possible!”

That shouldn’t be noteworthy, but it is. While some have been telling us the good of the profession depends on keeping our experiences to ourselves, POCA Tech wants “to gather data about what acupuncturists are doing in their day to day practices and how this compares to acupuncture school curriculums” and is “interested in learning about how acupuncturists feel about the cost and value of their education.”

POCA writes —

“If you practice a style of acupuncture that you feel is unrecognized by the profession as a whole, we particularly want to document it.

If you feel successful in your practice, we want to hear from you; if you feel frustrated in your practice, we want to hear from you.

If you are no longer practicing, your information is equally valuable!”

Complete the survey, which takes about twenty minutes, and you’ll get a coupon for a free 3 CEU online class.

The more we know, the more we can improve. Please, twenty minutes of your time, and in return, help us plan for a better future, and get some CEU’s.

Here’s the survey!

 

 

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.

 

 

Ethical Questions

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Our future requires a willingness to explore beyond our quick conclusions of what is “right” and what is “wrong.” How do we proceed when two “rights” are in conflict with each other, or when a good end might depend upon a questionable means (or vice versa)?

Providing safe, effective, and accessible treatment to everyone who wants/needs treatment while also supporting ourselves and our families requires us to face various ethical quandaries. Many ethics classes are short on teaching principles to guide ethical decision-making and are long on lists of rules like “don’t have sex with your patients.”

Marilyn Allen’s recent column on ethics demands our attention. She’s had a significant role in shaping the acupuncture profession, and she teaches ethics. She has power.

The column focused on a discussion about “gainful employment” that has since been removed from the AAAOM practitioner forum.

The forum included colleagues sharing concerns about their debt, and upset at schools that exaggerated the future acupuncture job market while glossing over the skills and financial backing needed for success.

Ms. Allen (who has given considerable funding to the AAAOM over the years) is angry that this discussion was permitted. She insists that it is in the best interest of the profession, and our future colleagues, to keep concerns to ourselves. Even a shared conversation in a practitioner forum is too risky. We “should have shown support for the schools,” she writes.

Ms. Allen proposes the Rotary’s Four-Way test in her column. It’s not my preferred guideline for ethical decision-making, but since she refers to it I’ll use it —

 

1) Is it true? Many graduates of acupuncture schools do struggle to pay off debt. Schools did use misleading data in promotional materials, leading to unrealistic career expectations. The proposed Gainful Employment regulations did raise concerns about acupuncture programs. The forum topic is no longer present to allow for a complete fact check, but my assessment is that much of the content was true.

2) Is it fair to all concerned? What do we mean by “fair.” Who is “all concerned?” And what is “it?” I could write a post on each question. When a topic is being explored by many people, in many settings, does each contribution need to reflect the views and feelings of each stakeholder? Is it unfair to share our personal experiences and opinions about a system in which we have little power and bear the consequences? Is it fair for a membership association to solicit the opinions of its members? My assessment – it was fair for the AAAOM to provide a forum and for practitioners to use it.

3) Will it build goodwill and better friendships? Humans do better when we know we are not alone. Sharing our concerns and our experiences is a way to build community and friendships, which support us in our sometimes isolated professional life. Knowing that other regulated fields share these concerns can also help build goodwill and understanding. If we feel that a friend (or, in this case, a system) is taking advantage of us, does it strengthen the friendship and build goodwill if we speak up, or stay quiet and suffer? Yes, the discussion had the potential to build friendships and goodwill. Ms. Allen’s column, by advocating denial and repression, does not.

4) Will it be beneficial to all concerned? My list of people who would benefit from the conversation, even if it escaped the private forum: current debt holders who feel alone and unheard, schools who care whether graduates are satisfied, potential students who may not have fully explored the economics of entering their dream career, and taxpayers who may not want to subsidize ineffective programs. The discussion isn’t beneficial for the schools that want to keep raking in loan money while avoiding responsibility. Should we be censored for their benefit?

Ms. Allen writes “It is sad when you read an article about the profession that contains negativity coming from inside the profession. Essentially, this is giving the other professions (those looking to treat acupuncture patients) the ammunition they need to diminish acupuncture and attain their own goals.”

I say, it’s sad when those with the power to change things for the better instead advocate for a flawed status quo. It’s a danger sign when secrecy is demanded for the good of the group. The Catholic Church and the Penn State Football program are examples of the moral failure that comes with that argument.

Thank goodness we’re dealing with finances and not child abuse. Nonetheless, shutting down conversation and preaching secrecy is neither ethical nor effective. If Ms. Allen wants to uphold acupuncture as the place “where hope and healing meet” then we need to delve into our challenges, not hide them.

 

 

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.

 

 

A Day in the Life…..of an Acupuncturist

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What do you do at work?

How much of your day is spent in conversation with your clients, and how much is spent needling?

How do you decide where to put the needles? Do you rely on pulses, or tongue diagnosis, the patient’s report of the pain, what your acu-graph tells you?

Do you spend a lot of time prepping herbs? Or no time at all?

Do you have staff that helps with scheduling and treating, or do you do it all yourself?

Do you change your linens and do your own laundry?

Do you bill insurance?

How many patients do you see in a day or week? Do you have multiple locations? Do you treat differently depending on the location?

Describe your practice location(s) or setting(s).

Do you work with other Acupuncturists? Other health care providers?

Do you do lots of moxa, cupping, gua sha, e-stim, hand acupuncture, scalp acupuncture, tui na?

Do you talk to your patients about how they can support their health when they’re not in the treatment room?

Is there something that’s been incredibly important to your practice that you didn’t learn in acupuncture school? Are there things you spent tons of time on in school that you never use now?

Do you do your own bookkeeping?

Do you read journal articles or historical works about the profession on a regular basis?

How long have you been in practice and how much has your style of practice changed between now and when you started out?

Do you have a good understanding of the rules and regulations that govern your practice? How did you find out about those rules and regulations?

I’m doing some research about the profession and I’d like to hear from as many practitioners as possible. The questions above are just to give you some ideas of things to think about. You could keep track of what you do all day long – how many times do you review pharmaceuticals? How often do you consult with colleagues on a tricky case? How many times do you wash your hands?

Please, share your list of everything you do in a day at your practice, and how often you do it, in the comment section. Or, you can use the contact form.

Spread the word on Facebook. The more the merrier. However, please ask people NOT to reply via Facebook comment. They are hard to collect, and I don’t have access to all groups.

Thanks for your help. We’re a diverse profession and I’d like to learn more about just how much we share, and how much we differ.

Acupuncture Education 2015 – The State of the Profession

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If we want people who want acupuncture to receive it from an Acupuncturist, acupuncture education deserves our attention.

There aren’t good statistics on how many Acupuncturists or acupuncture students there are in the US. But those handy maps printed in Acupuncture Today can give us some idea. The December 2013 issue (with an article on AT’s unprecedented growth) showed 24,342 Acupuncturist and 3,124 student issues mailed. In December 2015 – 24,231 Acupuncturist and 2,624 student issues mailed. That’s not growth. The 2014 NCCAOM Annual Report (the most recent available) also reveals – we are not a growing profession.

There is a lot of churn in Acupuncture education — schools close, schools open, programs merge, new degree programs are established. New Gainful employment rules adopted in late 2014 may well contribute to that churn. They require for-profit schools (about 50% of acupuncture programs) to provide at least some debt and jobs data to prospective students.

Small class sizes can skew the data. Still, check out these reports (selected because they came up first in Google): Emperors, ACAOM (the school not the agency), Arizona School of AOM, Midwest, AIAM, and Colorado School of TCM.

Only two schools reported job placement, at 50% and 67%. Median loan amount (omitting a 1.5 million figure given by Midwest that must be a mistake) ranged from 17K to 72K. A real eye opener was the percentage of students completing the program in the expected time frame. The average across all 6 programs was 55%. Omit the 100% reported by Arizona, currently on probation with ACAOM (the agency), and it’s 46%.

It’s not encouraging. Add student uncertainty that the degree they obtain will enable them to practice and it is no surprise our profession isn’t growing.

Imagine if we could tell prospective practitioners –  “A Master’s Degree in Acupuncture from any ACAOM accredited program will fulfill the educational requirements to practice in any state.”

I may not love the ACAOM standards but I’ll accept them to help the profession. Is there a downside to offset the upside?

NGAOM you have a stated goal of establishing uniform standards, yet are fighting to keep California schools out of the ACAOM system. Please explain.

We had some significant losses in Acupuncture education in 2015.

Spring brought news that Dianne Connolly and Bob and Susan Duggan would no longer teach or be part of the program at MUIH (which Bob and Dianne founded in 1974 as The Maryland College of Chinese Acupuncture). Bob and Dianne are part of the foundation of this medicine in the US. They profoundly influenced my acupuncture journey and it is a significant loss that they won’t be part of every MUIH student’s education. I am glad they are continuing to teach and share their wisdom in other settings.

Bob Duggan played an integral role in establishing acupuncture standards, credentials, agencies, and commissions. His goal in so doing was to enable this safe and effective medicine to be legally available to more people. He shared in a personal communication his ambivalence at how things turned out – that though his work enabled so many people to be healers and to be healed, “If I had real courage I’d have gone to jail and insisted this was the people’s medicine and we shouldn’t allow it to be professionalized.”

2015 closed with another loss, the death of Dr. Richard Teh-Fu Tan. Dr. Tan was an excellent teacher, deeply committed to teaching. Directly, and through his students, he eased the suffering of countless patients. Dr. Tan made no secret of his doubts about the caliber of acupuncture education most of his students received in their degree programs. Many seminar attendees reported learning more about effective acupuncture in four days with Dr. Tan than in four years of acupuncture school.

Attention must be paid.