First wave, New wave, Permanent wave

First wave, New wave, Permanent wave

First I want to say how completely smitten I am with all of you, my colleagues, here at the Community Acupuncture Network. I read the blog entries and WHAM I am just amazed at this dynamic, intelligent, engaged, passionate group of people all working together towards common goals.

This is also a long post (not a really loooooong post) but I do finger yoga so I’m okay. (Skip, I’m sending you a finger sized yoga mat)

“It’s not hard to imagine the collapse of the organizations as they are constructed these days if these organizations don’t change their orientation from looking for maximum profits for themselves. To do that though they have to stop using the weapons of the first war, that of faux intellectualism, and honestly assess what they are doing.” Skip

From www.aborm.org
“Specialization in Oriental Medicine is not a new concept.”
True, but specialty boards are a new concept for OM. The AOBRM website goes on to say this:
“Our medicine is holistic in nature, and that holism must be retained as we choose to gain advanced knowledge in the treatment of fertility with Acupuncture and Oriental Medicine….”
What are they saying here in regard to holism? Are they are defending themselves from the conclusion one might draw that by focusing mainly on imbalance, disease, and illness in one part of the body that there cannot be a focus on the whole. A specialty board is by nature one that focuses on a narrower scope of medicine. Surely we all are drawn to treat different conditions and there is no reason a person seeking help with getting pregnant from an acupuncturist couldn’t also be treated by them for migraines. As acupuncturists, we all know that we can treat a part to treat the whole. Most likely we all do this to some extent when we practice. We may treat the meridian or organ system that is most symptomatic because the patient will feel better and even without a clear definitive diagnosis, I would argue, we are affecting the root imbalance. I think it is with herbal treatment that lack of a clear diagnosis is more problematic (eg using cold clear heat toxin herbs when nourishing the yin is called for.) Just the basic function of putting needles into a body has benefit.

Let’s read on: “…In the interest of the health of all our patients, and the advancement of the AOM profession, ABORM asserts the right of any practitioner to gain advanced knowledge in any area he or she chooses to study.” If we break this down we are talking about the interests of our patients, the interests of “the profession” and the rights of practitioners to gain advanced knowledge. I don’t think anyone would argue with the notion that it is a good idea for us to gain advanced knowledge. Pairing this “right” with the interests of the patients…well that seems logical. We want to know how to help our patients. But why does the desire to gain more knowledge in an area of specialty, lets say gynecology or reproductive health need to be asserted as a right?

A right in this sense implies something that is morally upstanding, approved, or true. So if it seems logical to you dear reader that we all should continue to grow our knowledge as practitioners, then perhaps what the authors of the above statement are getting at is the idea that it would be in our patients’ best interest for there to be a specialty board in reproductive medicine. There is a huge demand for these services and people are spending tens and hundreds of thousands of dollars out of pocket to try to conceive. Another way to interpret the word right would be as a moral or legal entitlement to have or obtain something. That would be the right of practitioners of Oriental medicine to have our share of this cash cow.

Let’s return to the idea of treating part to treat the whole. Let’s assume that acupuncture as a profession is ailing. Graduates are not staying with their chosen profession, those that are struggle to make it a viable full time profession. Would it make sense to try to pump up one area of practice, let’s say fertility medicine? Now let’s say that we apply the principles of OM to this scenario…we are lacking a successful, sustainable mode of operation for many of the practitioners of our profession. Now mind you, while it is necessary for us to have schools, and an examination board, and of course CEU and gatherings where we can all get together and learn, network, and generally yuck it up, I am looking at the patients and practitioners of OM as the qi of the profession. Without us there would be no profession. If specialty boards are formed within our profession, in order for them to really serve the profession and its members, the practitioners, they need to provide a sense that there is some security in obtaining a board certification. From an economic standpoint we are looking at a very small segment of potential patients who can afford out-of-pocket fertility treatments (or standard acupuncture rates). A specialty board in work related injury would make more sense if we wanted to do the maximum good.

Skip wrote about one of the challenges to the profession being the rising costs of obtaining an education. Dave’s recent post mentions the overwhelming feeling of facing 100k of student loans. At a recent continuing ed class I attended the teacher voiced great concern that specialty boards would create limitations to the patients of those practitioners without the board certification, ie without a board certification in gynecology for example, there would be limitations to liability coverage. For some practitioners, this is a stopping point. For some patients it would be more important to see some extra letters after their practitioners name, rather than to call various practitioners to see how much actual clinical experience they have. I live in a state where the licensing title is “Doctor of Acupuncture” and though many of us have Masters degrees (not doctorates), the first wave acupuncturists here don’t, because Masters level education in acupuncture didn’t even exist when they were in school.
I have seen acupuncturists as far away as Hawaii and California who have a RI license so that they can call themselves a “Doctor of Acupuncture.” Is this in the best interest of our patients?

Part of my issue with this issue comes from my experiences here as part of the very small RI professional group, RISAOM. I served on the board for almost 4 years first as the secretary and then the president. At that time there was a battle being waged here in lil’ Rhody between the two acupuncture groups. Mind you AT lists circulation of its paper as 55 here now, but we have two professional groups. So, the fight here was mirroring the one then happening in California, where an increase in the number of hours of education required for a license was proposed, and eventually passed. The proposed law in RI had it so that by next year (2008) 4,000 hours would be required to get a license, with no grandfathering in for practitioners who have been practicing for 20+yrs (in fighting of the first wave?) Basically this state with 55 practitioners was going to set the precedent for a doctoral level education by 2008. At the time this bill was first introduced there were no doctoral level, or 4,000 hour programs in existence anywhere but in Asia, where you also did a medical degree concurrently. What I think is behind this kind of rhetoric, or even more dangerous, the proposed legislation that comes from it, is greed and exclusionary tactics. I actually saw a patient of one of the acupuncturist in favor of the increase in hours get up and testify to a bunch of legislators that she didn’t feel safe having someone with only 2,500 hours of education stick an acupuncture needle in her. This same practitioner suggested that deficiencies in the hours of education could be completed at his office.

I digress.

So why is there so much opposition to the idea of specialty boards in Oriental Medicine? Wouldn’t these boards infuse the profession with some much needed qi? Wouldn’t this provide a way for practitioners to distinguish themselves to patients who would be attracted by a board certificate in an area of specialty? Perhaps this would cause some initial movement, but like moving qi strongly in a patient who is qi deficient, the result is ultimately collapse. Specialty boards are the new wave of style wars. Focus in one area isn’t a problem any more than deciding to practice 5-element, or Toyo Hari style. The problem lies in the intent. These specialty boards serve those who form them first and foremost. In medicine the patient must come first. As diverse as a profession as we are, we all represent a part of the whole. CA is a holistic image of healthcare. The basic principles of simplicity, community and low cost help to cut away the excesses that end up stagnating and depleating so many practices. Does acupuncture really need a transfusion or just the chance to allow the aspirations and dreams of its practitioners to help other to be realized through more realistic practice models. Are we waiting to board the luxury liner of managed care with our specialty designations, the wait may be long, and remember the Titanic.