Wanted: Your Comments
Posted November 29th, 2007 by shichangpu
I know this may be redundant for some of you that have already registered your comments with the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) about the proposed standards for First-Professional Doctoral Programs in Acupuncture and Oriental Medicine (read--doctoral as entry-level education) BUT I think it is important that they hear a lot of noise coming from those of us who think this isn't such a great idea.
THREE things you can do BEFORE the DECEMBER 15th DEADLINE:
1-go to: http://www.acaom.info/ and scroll to the bottom of the page where you can create a user id and log in to comment.
You can give editing remarks on the actual wording of the document, or if you scroll to the end of the document there is room for more general comments.
2- Using the following script
[attachment 160 ACAOMFPDcomments.doc]
as a sample- EMAIL the three ACAOM staff members whose email addresses are listed at the bottom of the document and ask them to share you opinion with the commissioners and standards review board.
2-Print the patient petition
[attachment 157 ACAOMandpatientpetition.doc]
and have your patients register their opposition to the doctorate as entry-level. MAIL THIS TO ACAOM before the deadline if possible.
Lets create an impact by having them hear from some key stake holders, like our patients, and from you, CAN friends and members who are diligently working to make our medicine a source of power and healing in the hands of the people, not the intellectual property of an elite few.
Re: Wanted: Your Comments
(Oops, the last paragraph of my previous post was left out.)
Our colleagues, who support the idea of an entry-level doctorate, need to connect-the-dots here. An entry-level doctorate has nothing to do with ensuring quality of education for students, but, has everything to do with ensuring a new source of revenue for the ACAOM.
Re: Wanted: Your Comments
What a ride it's been for me! Sometimes, when I have a moment to reflect, I can hardly believe how lucky I am. I'm an acupuncturist, achieving success and fulfillment doing something that I absolutely love.
But it's not just luck that got me here. The Jung Tao School of Classical Chinese Medicine's Acupuncture Program played a large role in making me the professional I am today, and for that I'll always be grateful.
I learned so much in my four years at the Jung Tao School of Classical Chinese Medicine about acupuncture, and developed extensive knowledge and skills that continue to serve me well today.
My friends, who graduated from TCM schools, frequently complain to me about their low level of training/education. It's really sad.
Apparently, the ACAOM, CCAOM, NCCAOM, and AAAOM are more interested in making money than in ensuring quality of education.
Re: Wanted: Your Comments
Wonder if the tuition recovery fund applies to this?
Each alum could sue the school in small claims court (no lawyers allowed) for 7,500$ (california maximum) for breach of contract (it would probably not work but would get their attention. If it did work, 7,500$ could pay some rent and buy a few chairs!).
Re: Wanted: Your Comments
Wow, I didn't know all the schools were that bad. All I had experience with were the one I attended and quit because it was so lame, and a second that I did some required coursework which was even worse. Just as you discribed above, to a t... Sorry to hear my experience with was a universal one. I guess I was hopeful that after school some formalized system of mentorship could help, but yikes, how to fix this thing?!? I've really only been thinking about point 2 above. How to start this reform before our work gets driven into the ground?
Clearly (to me after hearing from you all), no amount of time (in these schools) or money will fix this.
You guys are amazing at taking two problems and turning them into elegant solutions for each other, so keep us posted if you have any "ah ha" moments on this one.
ACCHS?
Re: Wanted: Your Comments
cris, thanks for your last comment. i suppose that's where i stand too - i am not much drawn to an integrated practice - it seems like way too much energy expanded. a couple of years ago i was invited to join one and turned them down. they wanted me to do all this footwork to promote the whole clinic and at the same time charge higher fees to the patients to cover large overhead and insurance billing while i collected less fees as my compensation. they were presenting it as a great opportunity for me. i saw through it and chose to keep my own small practice, market just for that, in the way i felt comfortable, charge less and make more because i only had to cover my small overhead. needless to say there is a bit of a trust issue here for me. however, i have friends who got jobs in a big integrative clinic with huge insurance billing department and are very happy working there, mainly because it provides a steady paycheck.
i am pretty comfortable with going over lab work when patients need it. but in general my current interest is to grow as an acupuncturist practicing Chinese Medicine, to make up for the lousy education i received in school. one of the ways i am doing it is by working on creating the kind of practice that allows more people to access my car, so that i get more clinical experience. i have been told repeatedly by long-time clients and friends i have treated since i graduated that i have recently gotten much better at needling. i find my treatments, although not complex are becoming more effective. this is the growth i want and care about. i am happy to let someone else read the xrays and tell me what they saw. i think that going back to school to sit in a classroom will not give this growth and i cannot afford to have more debt.
as i mentioned in an earlier comment above, i currently teach at a school, and skip is pretty accurate that one of the reasons i started doing this is to get more income. i also think i am a pretty good teacher, as i have taught yoga for 5 years in my youth and generally have an educator mindset. being at the school reminds me of my own mostly crappy education, so i strive to deliver good instruction, as best i can. students say they appreciate what i do.
skip, i agree with your 2 requirements above, and i would add to that that the schools need to be held more accountable for HOW they spend all the money they milk off the students. they need to have more transparent finances than your average private entity, because they have an ethical responsibility to use the tuition money to train quality health care providers who are skilled to succeed practicing their medicine in the real world and pay down their debt. until they can actually prove that they need more time and money to produce such a result (and they don't), they should not get another cent. so, put me down for the pool, i have some good candidates to put on that list!
Re: Wanted: Your Comments
Michael- I'm not sure what you are saying with suggesting that new acupuncturists could benefit from a post grad internship year at places like nursing homes and WCA, but speaking as a co-owner of WCA I know that grads of acu schools, both the current master's type and the "new & improved" doctoral type are pretty unqualified to practice at my place as their training is at way too low of a level to be successful unless they are much better than the run of the mill graduate. perhaps they could spend some time with you first?
So obviously I find that the quality of education in our field is not good enough and I tend to see the reason is because most of the teachers are failures in their own field. They don't have what it takes to support themsleves in a private practice and so they "teach" for some scratch. The class and homework activities at most schools are cutting edge 19th century and the intern year teaches the students how to overthink and waste time. Maybe that's because the fine profession of teaching is also neglected. Just because someone has some understanding of a subject (and not a great understanding in this case) doesn't mean they make good teachers.
The idea that the schools are(through the ACAOM, which they fund) floating the idea that they can try to get at least another year's tuition/loans from students to do more of the same wretched education seems like a bad joke to me. I could imagine supporting the idea of an entry-level doctorate if:
1) A serious reform of teaching methods is undertaken and,
2) The schools connect better with the real world so that the majority of their grads become successful (make a living) in the field.
As it is, what I see what the schools are proposing is a money grab. They expect students to trust them when they haven't earned that trust.
The sad thing with all of this mess is that like a failing acupuncturist who raises their rates because they are not seeing enough people only to see even fewer people coming to them, the schools, with their declining applications, are now proposing to, in essence, raise their rates! Maybe we should start a pool: which schools will go under first.
Re: Wanted: Your Comments
I love comments that are not large excerpts of other comments followed by critique of some points (while neglecting others). This splice and snipe method is not one I find especially helpful for learning from each other...and I have learned lots of great stuff from the many eloquent and thoughtful people who frequent this site.
My point about potentially vast income disparities between practitioner and patient were not to say that we are bad people for wanting to pay back our debts. The point I was hoping to get folks to consider is that any response we acupuncturists could make to this reality of income disparity (which is one of the economic legs that classism needs in order to stand) could also be made by a DO or MD. The years of our lives and huge amount of debt that we take on to learn this art lead us to feel, reasonably, that we should at some point be able to pay off this debt, and the hourly wage that we seek reflects this reality. An orthpedic surgeon also has these same realities, multiplied by at least 3 times, usually much more (med school is what, 40K a year now?). This surgeon has very little freedom to create a practice in line with their ideals, and the care they provide can be directed by an MBA (who put far less of their own lifetime into getting their particlar initials/degree, and make more than the surgeon. They are also not on call!). It becomes possible to feel a sort of moral superiority to an orthopod who doesn't take medicare and medicaid, especially when one is treating without regard to one's ability to pay, but we can never fully know the reality of a person's life that led them to a particular moment in time. Maybe that highpriced plastic surgeon up the street, who would seem to contribute little to the world aside from actualizing the vanities of the wealthy, spends his weekend building homes with habitat for humanity, or reconstructing the faces of Iraqi children. Maybe he has a relative in an institution that costs 6K per month. The point is, we don't know. I feel the power of CAN is in doing work that we are proud of, but not waste qi in some sort of "us and them" dichotomy. Try, if you wish, for a day to subtitute the phrase "we humans" for "they" and you may understand the place that I strive (with varying degress of sucess) to be.
It is legal for me to order xrays, and I do from time to time. This reqires no "amazing" acu skills, but rather familiarity with the system. If you take your kid to the pediatrician with a possible distal radius fracture, they order an xray, read the radiologist report, and decide on appropriate care based on that report. We can do the same thing. If a patient comes to me with a bad ankle injury that may be a fracture, the xray and report become inportant tools to figure out if I need to refer this person to a greater level of care. It saves them money and time in not having to pay another practitioner to write an xray order. I also like to see xrays (if they have been done) when treating some spinal disorders. I tell the patient that there is no chance that I will see something in the xray that the radiologist or ortho missed, but I do like to sometimes see just where the bone spurs are, for example.
The reason I am comfortable doing this stuff is through familiarity of working in the system, no special magick or intelligence.
I think that if schools are really serious about improving acu educatition, they don't need more of the students time, and especially not more money. Education, and the reception we get from conventional western medicine, could be improved through a post graduate year of internships (with a stipend, not more tuition) in hospitals, nursing homes, WCA, etc. I really do think that to know us is to love us, and the more we collaborate with people with other types of training, the faster we break down the barriers. If this country should happen to one day stumble into sanity and go with a single payer system, it is vitally important that we are already well integrated into our prevailing sickcare (it's hard to call it healthcare, I admit) system.
CAN is a beautiful flower (with a heady aroma) on the tree of chinese medicine, one that resonates with me personally. There are many other flowers too, all just as beautiful.
purr, michael v
Re: Wanted: Your Comments
Don't you think we could all be more successful with more respect? We are practicing Traditional Oriental Medicine, we are not technicians. We should have the degree that goes along with the profession. I get asked daily in my practice how long my schooling was. It is a huge concern for my potential patients and I know that if there was a doctoral requirement that there would be no question or concern. Lets keep the LAc success percentages up and help countless people who may otherwise be too scared to come in to a a less educated individual with their health concern. There is no shortage of people who need us, it is not hard to make it as an LAc if you have faith and conviction in your medicine and use it well. Money seems like a lot when you don't have it but once you are making enough to pay your loans back quickly because people respect your knowledge and skill it will seem much more than worth it.
Re: Wanted: Your Comments
Part of my attraction to CA and my interpretation of how to set up my practice according to the basic principles of: simplifying treatment, low-cost, and community, is that I see myself as a practitioner in a context that resonates for me. I am not drawn to be part of an integrative medicine practice, as Michael is (has been) doing. I do not object to this type of practice and I am excited to think that CA and some of the ideas behind it (like accessibility, affordability,etc.) are seeping in all over the acupuncture/medicine world.
Largely, I think that the group of practitioners that has settled around CAN (early converters, et al.) are looking for a way to practice OM independently of the bio-medicine establishment, whether that be hospitals, doctors' offices, or insurance reimbursement. An interesting demographic in the CA community that I have noticed, is that there are a lot of ex-nurses. In no way do I think that those of us I am describing here are opposed to the other system's existence, but would rather work outside its confines. We need to be able to recognize "red-flags" for our patients and to be able refer appropriately. That was part of our basic training, and might require some occasional refreshing, which could easily be a part of continuing education.
We have the opportunity to remain small, decentralized, self-governing, localized, and to be a part of the communities we serve, while sustaining ourselves and our practices. If your community is largely made up of doctors then it seems logical that you would have more of a bio-medical focus. But it would be absurd to require this of the entire profession, just like it would be to require all of us to be fluent in Spanish in order to get a license, even though it is the second most spoken language on the planet. But if you are serving a Spanish speaking community, it does make sense to take additional training in Spanish, no?
Personally I find bio-medicine (physiologically, pathologically, clinically) interesting and often use my Merck manual to understand what I can about a patient's western diagnosis. But I do not attempt to treat them from this understanding. In fact, for those of us raised with a western cultural viewpoint, I would argue that it is this bias that keeps us from being completely comfortable with the language and ideas of eastern medicine, particularly the idea that we have to completely understand and describe what is happening in the body for any modality to work.
Chinese medicine was introduced in the US through the chiropractic profession primarily, and has thus far retained that air of "medicalized professionalism". The comparisons between midwifery and acupuncture are great. Both of these ancient practices empower people much more than biomedicine, though all three serve people in some way. I feel fortunate to have access to high-tech diagnostic tools, drugs and interventions, but also need tools that I can use in my daily life to keep me healthy. Acupuncture is one of those tools (as a patient).
I wold like to hear more about what is legally permitted for acupuncturist in California. If it were legal for me to order x-rays with my license, I wouldn't do it. Nor do I think it is important to the practice of acupuncture as a whole, to have this privilege. I know there are amazing acupuncturists who have orthopaedic knowledge and an x-ray would be helpful. This is where an integrative approach, or perhaps a second tier of training which would permit a cross-over into biomed. would be great. I just don't think this should be a requirement to be able to begin the practice of acupuncture.
Re: Wanted: Your Comments
Hi Michael,
I won't respond to all that you've said because I'm not familiar with many of the topics you raise. Probably the central issue in terms of CAN, as it relates to this thread, is broadening access to acupuncture.
There is obviously a need for a reform in acupuncture education. The proposed doctoral standards by ACAOM, rather than representing a step in that direction are a giant leap in the wrong direction (as others have explained more eloquently than I.)
I don't smell the air of moral superiority you seem to infer. There may always be people who can afford to pay more, and practitioners who chose to serve them. I think most people in CAN recognize and accept that without needing to put anyone down. I have many friends who have traditional style practices. I was one of those folks a mere six months ago myself.
Everything keeps changing. To try to hold onto (and defend) a fixed identity is like trying to capture a great river in your hands. How many more centuries or millenia will these healing ways still be practiced before they are relegated to the dust and memories of the past? I suspect the ACAOM will be long gone before that time.
As for your last comment about visions of increased income - certainly most acu-punks I know want to make a sustainable living. However, to state that CAN inspired acu-punks want to make "potentially many times more than a working class client"....is curious, and the possibility for misinterpreting that statement seems large. I certainly don't think that way. Perhaps you could you clarify your meaning a bit more here so nobody jumps to conclusions?
jordan (fwooooosh!)....sound of a whale surfacing from a very deep dive.
Re: Wanted: Your Comments
Thanks all. I too enjoy spirited debate--I see the exchange as mostly respectful (although I don't see calling ideas/beliefs different then your on as "weird" to be especially helpful--feels more like a put down, rather
than striving to understand another human being...).
I am so excited about changing and opening my practice to more people!
I also won't be surprised to find other types of practitioners using the CAN model to better serve their own communties, and can also evsion a day of community healthcare clinics using the CAN model to offer many types of healthcare, without getting strung out on government money and grants(which always seem to fade away and require ever increasing amounts of qi to find new sources of funds).
I feel like M.D.s are caught up in the same inhumane system that we are, where the financing of both education and healthcare lead to the triumph of economics over humanity.. I personally feel that other measures, for example the fight for elimination of corporate personhood, could change this more than veiwing other types of practioners as some sort of foe.
One area whereI think the schools could improve is in clinical education. The schools train us as if we will be part of this greater medical community, but do nothing to support that in becoming a reality. Other practitioners tend to have some period of their training where they work with practitioners who have completely different training
than their own, e.g. a person in the process of becoming a nurse practitioner will work in a cardiology unit not just with other nurse practitioners and trainees, but also with all of the other folks who deliver care, from md's to respiratory therapists. Of course, the trainee gets to know the ins and outs of various cardiac conditions through experience, not a book. I am not advocating an exact replica of this system, but certainly it would be one way for us to be a part of this system, where we could fluently speak their language and they could have some idea of the benefits we could offer to people with heart disease (these benefits are huge by the way, check out the studies). In china, there are many different levels of acupunture training, but to get the equivilant of a B.S., takes five years of work, including the last year of clinical work often spent in a hospital. A masters takes an addtional three years, and a phd three more. Of course the financing of education works differently there...
I feel that by working shoulder to shoulder we may be able to overcome some of the feelings of superiority that each side brings.
My experience tells me that not only are people missing out on care due to finances, but also that there are many people also who could afford a reasonable fee that are also not getting care, due to prejudices on all sides. CAN may or may not address this, but I find it is generally better to reach out to people where they are, rather than where I think they should be.
"Primary Care" is not just a work comp term here, but a reality of how many of us are able to legally practice here in California. More on that later.
In closing (for now) I don't think an air of moral superiority over people who have other treatment models that work for them is helpful, or even accurate. After all, many are drawn to CAN by visions of increased income, an income that is potentially many times more than a working class client--hey wait, I thought only allopaths did that?!?
Michael V (woof!)
Re: Wanted: Your Comments
Michael wrote:
"They (those who can afford treatment but don't know how much it could help them) might be deprived of this care because we personaly don't want to spend the time to have an in depth working knowledge of the dominant healthcare paradigm (western medicine) here in the states. If you can't speak to the docs in their own language, it is doubtful that they will feel good about refering folks to you."
I am not sure who "they" in the above quote are, but it if we are talking about being able to afford treatment at $75 per session, "they" is a limited segment of the population and those served (present or future) by CA clinics represents a much larger potential patient base. Not having an in depth knowledge of the health care system (I call it the health insurance care system) doesn't seem to be a petulant act of neglect by alternative care givers such as ourselves, but a matter of priority and what we see our roles to be in providing care.
"This is where more education could help (and no I don't mean more medical terminolgy classes!). In california, L.Ac.s are primary care providers, putting us on a level with MD's, DO's DC's etc in terms of what our license allows us to do (diagnose and treat illness), but the level of education is far below nurse practitioner etc."
Those in favor of a first-professional doctorate for AOM argue this same point. Many of us are contending that our educations in AOM were lacking in some way. What are the specific deficiencies in our educations? Is the high attrition rate (for licensed grads) because we didn't have enough TCM theory?,pharmacology?, medical terminology? Is it our inability to communicate with MD's that causes us to be marginalized in the media (this is getting better)?
Our "primary care" status in California has been used as an arguement for mandating the doctorate and other increases in hours required for licensure (like the recent increase passed in California). Here in Rhode Island where the licensing title is "Doctor of Acupuncture", some acupuncturists argue that we should require everyone who gets an Acup. license in RI to have a Doctorate because afterall we are called doctors. I would glady get surrender my licensing title than to submit to this kind of ridiculousness.
A licensing titile or designation from the California Worker's Comp system (under which LAc. are considered Primary Care) does not change a bit of our scope of practice as defined in the law, and doesn't justify to me diagnosing or treating outside of our scope of practice.
Is the debate in our profession in regards to the Doctorate about what it is we do as acupuncturists or an attempt to gain status with insurance companies and MDs? If it is the former, we all need to be more active to have our scope of practice defined, first by ourselves and peers, and then in the law. This will create some of the parity that some folks are seeking with MDs, since defining the practice of AOM in the law could prevent MDs, DCs, etc from practicing our medicine without training, which is how things are now in many states.
Patients are not going to flock to acupuncture simply becasuse we have more credentials. They will come if we can help them and if they can afford our services. Doctors are not going to start accepting us simply because we have more schooling. Nor are insurance companies gong to drop their self-interest. Building relationships with docs, etc. is a two way street, and the open minded docs will be able to "feel good" about referring to us if they see good results.
Good results are going to come from us when we align our ideals with our actions. Everyone who comes to the CA model is encouraged by the possibilty of practicing the medicine we love, making a "decent living", and helping others. We can debate practice style, treatment protocols, etc. to no end. We all will find our most effective methods if we get out there and try different things. CAN promotes methods that work well for this business model.
I have enjoyed the lively debate betwen Michael and Tatyana and see their comments as a respectful exchange of empassioned ideas. I feel so conditioned to be "nice" all the time when being real would be so much more effective.....
Wruffff....grrrrr.....
Re: Wanted: Your Comments
Thank you for sharing your thoughts Michael Volk. Unfortunately, there are a few CAN members who behave like "attack dogs."
Re: Wanted: Your Comments
"I do not think that being perceived (hopefully correctly) as being committed to the highest standards of one's profession and being a caring human being who expresses their altruism through how they work and live are mutually exclusive."
i never said these were mutually exclusive. we are talking about prioritizing in favor of access to care first and foremost. adding thousands of dollars worth of debt is not going to encourage affordable fee structure upon graduation, nor will it encourage many non-upper middle class folks to study Chinese medicine. highest standards of our profession according to whom?
"I definitely like to use both distal and local points. While this approach may be "weird" , certainly I am always working on improving my practice style; I like whole body acupuncture, and find it to be a most effective approach for quite a few conditions. Yes, most people will get some benefit from the four gates, Tai Xi and San Yin Jiao, but in addition to money, they are also invest their precious time, so I like to give the most appropriately potent treatment that I can. I don't want economics (the ability to treat as fast as possible) to guide my treatments."
i never said the approach of using local and distal points together was weird. i did say that implying that a distal treatment is of a lesser quality is pretty weird. and just simply not true. economics play a role when a person cannot afford to see you as often as they need to or if you cannot afford not to charge them an affordable fee because you are only seeing one person per hour. most people do not care where the needle goes as long as it works. btw, i work at quan yin currently and have been there for over a year (i guess we never met, or maybe briefly?). the funny thing is, i rarely do or feel the need to do back treatments there when i work. no complaints so far, i am usually fully booked every week.
"An acupuncturist seeing six folks at a time for 15 dollars will certainly make more per hour than I do seeing one elder at my office (it takes them longer to do most anything) or at the local retirement home, and I am ok with making a bit less while doing the best I can."
are you seriously implying that community acupuncturists only treat people who are young and can move quickly? i recommend you watch the patient panel video from WCA that is posted on this forum - it will speak for itself about quality of care people are getting while their practitioner is treating 6 people per hour.
"I still believe that much of the underemployment of acupuncturists is, in part, our own failure to consistently and effectively reach out to our brothers and sisters who happen to be MD's or DO's, and let them know how we can be partners in the mission of helping to relieve suffering-that we can all work together. "
i am not sure that many m.d.'s and d.o.'s feel the brotherly and sisterly love you are advocating. i have tried this strategy when i started practicing and it was futile. there are exceptions, of course, but i would rather put my efforts into making acupuncture affordable to as many people as possible.
-tatyana
Re: Wanted: Your Comments
Thanks for your response. I do not think that being percieved (hopefully correctly) as being committed to the highest standards of one's profession and being a caring human being who expresses their altruism through how they work and live are mutually exclusive. Alienating others in the medical community who have similiar goals and philosophies will not help our world in any way that is obvious to me. Yes, a person can have a medical doctorate and be just as committed to helping others as an acupuncturist is.
I guess what I am getting at for myself is making a less decent living so that I can offer what I do to more people. You may not "need" m.d.'s to send you people, but why would you want to shut out people that would benefit from your work, especially the seriously ill, the elderly and others who may not be part of your community yet? One thing I like about the being in the country is that everyone who lives here is part of our community, even when we don't look, think, eat or vote the same way.
I definitely like to use both distal and local points. While this approach may be "weird" , certainly I am always working on improving my practice style; I like whole body acupuncture, and find it to be a most effective approach for quite a few conditions. Yes, most people will get some benefit from the four gates, Tai Xi and San Yin Jiao, but in addition to money, they are also invest their precious time, so I like to give the most appropriately potent treatment that I can. I don't want economics (the ability to treat as fast as possible) to guide my treatments. I think this is about what the practitioner chooses to charge too, but I feel some trepidation at having anything guide "how to practice" except what will be of most benefit to my client.
An acupuncturist seeing six folks at a time for 15 dollars will certainly make more per hour than I do seeing one elder at my office (it takes them longer to do most anything) or at the local retirement home, and I am ok with making a bit less while doing the best I can. There definite benefits to common space acupuncture, but some of these benefits are economic ones for the acupuncturist. Quan Yin Healing Arts center in SF, where I have worked, treats in a common room, but one where sheets hanging on wire do give some sense of privacy, and allow clothing to be removed etc. I have just rented a space with large and small rooms, and I am still giving a lot of thought to how I will set up my clinic.
While altruism is one on the propelling forces of community acupuncture, so, it seems, is making a living for acupuncturists. I still believe that much of the underemployment of acupunturists is, in part, our own failure to consistantly and effectively reach out to our brothers and sisters who happen to be MD's or DO's, and let them know how we can be partners in the mission of helping to relieve suffering-that we can all work together.
I am glad to hear about all the options happening in CAN clinics-thanks for all the great info!
Re: Wanted: Your Comments
"I feel that M.D.s all over the country would love to send more folks to us, but they have to perceive us as "Medical Professionals" in order to feel good about it."
isn't it more important to be perceived (and to be) a caring acupuncturist who expresses their altruism and makes a decent living by offering effective and affordable care? if that's not professionalism, i don't wan to be perceived as one anyway. if you have a clinic that is sustained by its community because it is affordable and provides good acupuncture, you don't need md's all over the country to send you folks, your community will send you folks. that community will likely include some md's - just ask skip and lisa.
"I have a concern about some sort of two-tier acupuncture system, where only those with the economic means can get, for example, their backs needled."
that sentence seems to imply that back treatment is somehow superior to distal treatment. that's weird.... besides, people in many community acupuncture clinics can get their backs needled for the same fee as the recliner treatment. there are plenty of clinics that choose to have tables and upright massage chairs in addition to recliners in their common space. in fact, i am planning a clinic just like that as we speak. it's more about how the practitioner chooses to practice and what to charge, not where you are going to needle.
Re: Wanted: Your Comments
lakshmita posted while i was typing my overly-verbose (and underspelled) response, but certainly the clinical component I am talking about could happen in the 3-4 years it takes to get through acupuncture school.
Wasn't there a school in southern california that had students rotate through a hospital?
Yes, many schools are not doing a good job, and certainly don't deserve more mandated tuition.
Thanks for educating me on this issue, and I will respond against the proposed increase.
Re: Wanted: Your Comments
Thanks for your response Jordan--so much to learn from each other here.
"Tutorial Student" is an eductional pathway that we have (at least for the time being) in California is along the nature of an apprenticeship. Like School, these also have mixed results in terms of how much one can learn. I was lucky to find a great situation in a community owned health care center in rural Humboldt county. Our clinic was (is) a large operation. When I worked there in the 90's we had 2 m.d.'s (one of whom is a great homeopath), Physicians Ass't, Nurse practitioners, Midwives, Family counselors and a complete dental facility. This was the first place that I worked at that featured a self-reporting sliding scale. We saw many folks on medi-cal, medicare, you name it. What I was most proud of in our work there is that everyone recieved the same care and respect, regardless of whether they lived in a mansion or under a bridge. What happen to this wonderfull place? Actually it is still thriving as far as I know, but without getting into all of the gory details I will say that larger powers in the county wanted our building and our referrals (how did these hippies get all this stuff anyway..?), and sent professionals to sow discord in the community.
One thing that I really appreciate about my education was all of the different medical predicaments that I was exposed to. I personally don't strive to be a "walking encyclopedia" and I think in a way that choice of words supports some of what I was saying above. Once we live an experience it leaves that realm of bookish encyclopedia type learning and that experience becomes integrated (hopefully) into our being. I do think having a familiarity with what western medicine has to say about a given condition can help to provide better care.
M.D.'s are my largest source of referral, and through them I am blessed to have an opportunity to help folks that never would have considered acupuncture, particlarly my geriatric patients. Thes doctors are grateful to have something besides more pills to offer. I feel that M.D.s all over the country would love to send more folks to us, but they have to percieve us as "Medical Professionals" in order to feel good about it. I can understand wanting to opt out of that whole system, but there are so many that would benefit from acupuncture, and can afford it who are instead being given more ambien (5 bucks a pill!). This is a seperate issue from being deprived healthcare due to economics. They (those who can afford treatment but don't know how much it could help them) might be deprived of this care because we personaly don't want to spend the time to have an in depth working knowledge of the dominant healthcare paradigm (western medicine) here in the states. If you can't speak to the docs in their own language, it is doubtful that they will feel good about refering folks to you. This is where more education could help (and no I don't mean more medical terminolgy classes!). In california, L.Ac.s are primary care providers, putting us on a level with MD's, DO's DC's etc in terms of what our license allows us to do (diagnose and treat illness), but the level of education is far below nurse practitioner etc. A college degree is not (or wasn't last I checked) required, except from an acupuncture school.
The whole student loan system is modern indenture servitude.
I would like to here more about the business model "forced" onto you acu school graduates??
I assure that the phrase "I don't know" is one that I constantly use in my practice, but I also take my responsabilty for folks in my care very seriously, and I do feel that for me part of my job discription is to spend time on pubmed etc, and to be up on the latest trends of overdiagnosis and overtreatment, as well as the latest drug company hussles. BTW, I don't doubt your competence, but I would ask how your competence/confidence level has evolved over this past decade. I think that most of us find that over the years we do improve in some ways, and lots of clinical experience does fast forward this process.
Getting back to education, the acupuncture school is a very recent developement in the history of Chinese medicine. It has been a medicine of learning by doing, with the supervision (and molding, and chastisment, and prodding) of an expert. Each school has it's own history around it's birth, but the clinical component is far less than in a traditional apprenticeship, or a medical school internship for that matter. While there is very little to copy from that system, I do think that having significant clinical experience between graduation and school is something to consider, and not just dismiss without reflection. Of course, this should be a situation where people are paid (rather than pay) to work.
I am in the process of shifting my practice, definitely inspired by CAN. I look forward to learning more here, and will go into more detail on a different forum. I will say that I am struggling with having to treat everyone in a community space, especially here in rural america, where everybody knows everybody. I have lived in China for extended periods, and I do love the energy that treatment in a group can offer, but also I feel that, at times, the best way for people to mantain thier dignity is with some privacy (i could give many examples). I have a concern about some sort of two-tier acupuncture system, where only those with the economic means can get, for example, their backs needled. Of course, the are many great points to needle with a patient in a chair or recliner, but I guess I am a bit over protective/attached to the way I treat. I can't be the first one who has struggled with this.
Re: Wanted: Your Comments
oh please. underemloyment of acupuncturists is definitely related to the quality of their education, but not to the quantity. we don't need to spend more time and money on our education, we need to spend our time in school learning truly practical skills for running a practice in the real world. CAN is basically picking up the slack these days and that's why practitioners who find it are so grateful and actually start succeeding in their practices.
the problem is that the schools are milking us and don't care about helping us learn options for practice models and business skills for the real world. they only care that we pass the damn licensing exam and pay them lots of money to have more letters after our name. they create a very rosy picture in their practice management classes - saying we can charge a lot after licensing and make a living. but they are not out there, trying to build practices, they are running a school.
i think i could consider myself one of those "star students" in a teaching role at my former acu school. i was a capable student and a good test taker. i wound up teaching there because i am good at teaching and enjoy it, but mostly because i needed work and could not get my practice off the ground. i won't be there much longer because i plan to expand my community acupuncture practice to full time in the next year.
we don't need more debt and someone else to tell us what to study to expand our knowledge of this medicine. there are plenty of good teachers around that we can study with without getting forced to shell out for another credential. we need more class and race diversity in our profession and raising the cost of education is only going to make matters worse. let acupuncture be the peasant medicine it was always meant to be.
Re: Wanted: Your Comments
Michael,
Thanks for sharing your thoughts. First, I'm not sure what you mean by "a tutorial student."
Regardless, there are a few different issues raised by your post that I'd like to invite you to reflect on further, if you are open to that:
1. The (already) high price of an acupuncture education and how that forces graduates into a certain business model which is currently failing most new acupuncturists today. Your anecdotal theory that the reason for failure of most new acupuncturists is not enough education is a personal theory which I and many others do not find compelling.
While I like your suggestion that the acupuncture profession would benefit if its practitioners gave more thought to communicating with western medical professionals (and not bashing them - see previous thread from a few weeks ago), I disagree with your implication that we need to be walking encyclopedias, able to spit out information at will from the Merck Manual. I suffer no loss of ego from telling a patient "I don't know," when asked a question on allopathic theory. If it truly seems important, I can open the Merck Manual, or suggest that they talk with their doctor about it.
Often, I will ask them what they found out so I can learn. Does that make me incompetent to practice acupuncture? Neither I, nor the vast majority of my patients over the last ten years think so.
2. The other part of this issue as I see it, which you seem not to really address, is access to health care. There is a difference between "doing plenty of low/no-cost good karma medicine for folks in need", and setting up your practice so that you make it possible for 99% of the population to take avail themselves of your healing skills. There is a difference between empowering people to make changes and relegating them to charity cases which surely is less transformative, and does nothing to heal the larger class divides in our world.
For the acupuncture profession to succeed, we need to stop trying to turn this simple but effective healing tradition into another exclusive, rarified speciality that very few people will be able to afford or even want.
We need to figure out ways to broaden access, and for that to happen, we need to figure out how to trim the fat of gross self-interested behavior from within.
Re: Wanted: Your Comments
I have already said more than enough, but would like to add that I also find this generation of acupuncturists to be dynamic and inspiring, and to really be bringing the soul of our profession to new heights It is my hope that some good things can happen to help students get more experience, and hopefully get paid some and not have to run up such huge debts.
mv
Re: Wanted: Your Comments
I absolutely understand the pyramid scheme feelings, but as a tutorial graduate I do feel that one element of all of those unemployed/underemployed acupuncturists is exactly because of the weak clinical education that I find in recent acupuncture school graduates. The majority of graduates that I meet are not ready to "hang out their shingle" and often have little or no experience treating a variety of complex conditions. Often they are unfamiliar with basic medical terminology and common conditions. I would not want a seriously ill menber of my family to be a test case for them. If you were just diagnosed with ALS and wanted the many benitfits that Chinese mendicine can offer, would you want to be that acupuncturist's first case? Of course, we treat the patient (and pattern) and not the disease, and likely the acupuncturist would have experience treating that pattern, but having a real grasp on the persons western diagnosis, course of the disease and likely clinical outcome (without running to a back room and pulling out the Merck Manual) can not only put a patient more at ease in their choice to seek complementary/alternative care, but also serves to greatly facilitate communication with the client's other practitioners, and I believe ultimately improve the clinical outcome. None of this can happen without experience, and I believe leaving recent grads to "learn on the job" does not best serve our patients and our profession. BTW, my practice is busy, sucessful, and anything but lonely, and I do plenty of low/no-cost good karma medicine for folks in need.
How many acu schools are true non-profits (with no administators' friends on some self perpetuating board)? Can quality faculty be attracted and retained when they often have no benefits and are paid an hourly wage far less than a successful and experienced acupuncturist could make (the administrators generally run the show for their own benefit)? Often the faculty are "fresh off the boat" and while they may have vast clinical experience, they may or may not have the tools to communcate this experience effectively; indeed they may or may not have the tools to communicate with patients or other medical professionals effectively. Often these teachers are down the road once they get their own practice up and running. Also often encountered in teaching roles are star students of years past--these are typically bright and articulate folks who are excellent test takers, but by definition they lack the years of clinical experience that I feel are crucial to teach from real life.
I am not in favor of giving schools more access to student money, but also feel that the problems of under employment and insufficient education are intrinsically related. I find that those best prepared to offer high level healthcare and to succeed financially (but hopefully not to a sickening degree) are those who also have some other course of study with a large clincal component, like graduates from Bastyr who also have an N.D.
Food for thought.
Re: Wanted: Your Comments
Tatyana, I'm not Cris, but when I clicked on (2) above (ACAOM FPD comments.doc) and went to the bottom of the sample letter, I found three e-ml addresses of ACAOM staff members (_____@acaom.org).
Re: Wanted: Your Comments
Are there any "official rules" of petitions? I was just wondering if there are any standards we should be following in order that the signatures we gather from our patients are taken seriously by ACAOM and not dismissed because they lack verifiability. E.g. Should we also collect people's phone numbers and addresses?
Re: Wanted: Your Comments
cris - i could not find the emails of the three staff members you are referring to in the blog.can you post a link to where they are located?
thanks!
Re: Wanted: Your Comments
Thanks to Lisa for nudging me (and all of you) to make sure our voices are heard, and for saying it like it is. I loved your comments.
Cris
Re: Wanted: Your Comments
Thanks Cris, I printed out my petitions and put them at the front desk. I'll be asking patients to sign.
Lisa, as usual your succinct comments to the ACAOM are exactly what I would like to say if I could put words together like you do. Very nice.
Kerri
Re: Wanted: Your Comments
Thank you Cris! And loved your perspective, Lisa. Ha! (Pyramid scheme) I have 10 signatures already.
Re: Wanted: Your Comments
Thanks for making it easy, Cris. Now I really have no excuse.
Re: Wanted: Your Comments
Thank you Cris for putting this together. I printed out a bunch of the patient petitions and we will be educating patients about the issue for the next two weeks, asking them to sign.
Lisa, Thank you as always for your forceful commentary putting this issue into clear perspective.
Jordan