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Don’t go to Acupuncture School

Posted 7:02pm May 18th, 2011 by Shauna 

I’ve become stubbornly passionate about sharing my acupuncture school experience and early practitioner journey with prospective acupuncture students.  In the spirit of full disclosure, you should know that I’m not making a dime off any of this nor do I ever expect to.  I’m speaking out because few people in the acupuncture profession will actually pony up the information and certainly not the AOM schools.  Straight up, the numbers thrown around by the schools and the profession just didn’t match up the longer I spent in school.  Why were so many graduates TAing, in no hurry to finish their board exams, ‘slowly’ building their practice, maintaining part-time jobs outside the profession, leaving the profession for other jobs, or never practicing at all?  Really, at all?  Yep…..not at all.  Each year that I was in school, I was afforded the time to get to know fellow acupuncture students who were entering the acupuncture profession.  I’ve somehow kept up with a vast number of people who graduated from OCOM and other AOM schools.  The reality of AOM student loan debt in relation to actual AOM income is completely out of balance.  It was even presented by the NCCAOM at the American Public Health Association conference as early as the fall of 2008. 

When I started to write this blog, I couldn’t get the 3 D’s out of my head: Divorce, Default & Death.  I know it sounds dramatic, but unfortunately they are some of the less appealing student loan repayment options that are on the table.  I’ll get to divorce below.  Death needs no explanation.  Default, while financially irresponsible, might not be so bad.  Well except for the fact that you could be stripped of your professional licensure.  The reason for the student loan debt in the first place.  If you are considering attending acupuncture school and need to take out student loans to finance your education, these options could be yours one day too.  Think I’m joking when I say ‘don’t go to acupuncture school’?  Unfortunately, I’m not.  Not following me?  For some background see this CAN guest blog post from last year.  If you haven’t read it, you really should….you’ll enjoy part deux so much more! 

In the time since I wrote that blog, I’ve been working almost solely as an acupuncturist (seasonally I work a few hours per week as a ski & snowboard instructor).  In order to keep first year business expenses down, I made the conscious decision to not open a brick and mortar clinic.  Instead, I’ve built a growing mobile acupuncture practice and worked part-time at WCA. The key here is no additional debt burden.  This scenario has also allowed me to really focus on the clinical side of patient care instead of being distracted by trying to run a full time acupuncture business, take out a small business loan with an upside down income to debt ratio or worry if I’d have enough money in the bank for office and related business expenses.  Don’t forget, actually having enough real money (after taxes) to pay myself a monthly salary to pay my monthly student loan payment. 

Now let’s visit tax time 2011.  It marked the first full year of being an acupuncturist.  Since 2002 or 2003, this is what I wanted to be.  It was a milestone.  Historically, I wrap up my taxes by Valentine’s Day.  I’ve never had a tax balance due.  I’ve always received an annual refund of some sort.  This has been happening since I could file a tax return when I was in high school.  This year was different.  I really dragged my feet.  I’d been crunching some numbers and staying up on the options of managing my staggering AOM student loan debt otherwise known as my acupuncture mortgage.  I had a plan and a backup plan.  If you know me, you know I even had a backup backup plan.  None of it panned out.  Not the plan (A), the backup plan (B) or the backup backup plan (C).

Plan A – File ‘married’, break even or get around a $1,000 in a return.  This plan granted us the smallest return ever, just over $1,000, but no complaints.  Future consequences of this choice are significant and pretty financially crippling as my husband’s income would be included in the pool of available money to calculate my monthly student loan payments.  The reality is that his income bears the most weight to keep the roof over heads, keep us fed with health insurance, etc.  With this choice, I estimate that I’ll likely owe around $400 per month in a student loan payment or just under $5,000 annually.  OK, doable with both of us working while slowly chipping away at the acupuncture mortgage.

Plan B – File ‘married separate’, break even or owe between $500-$1,000 in additional taxes.  I worked to keep my first business expenses under control and put away a couple thousand dollars in anticipation of this possibility.  As touted by the IBR options, filing taxes under this status would afford me a more realistic repayment plan and take into account the income actually obtained by working as an acupuncturist.  With this choice, I estimate that I’ll likely owe under $200 per month for 25 years.  While not desirable, very appropriate in relation to the income derived from my acupuncture practices (i.e. actually treating patients, not TAing, selling acupuncture needles, waiting tables, etc.) and achievable while not putting my family in a financial hard place.  What actually happened was that filing ‘married separate’ would have cost my family $3,500 on top of the taxes that were already due and accounted for with the normal filing process.  This scenario would continue annually.  Not very appealing and not working to reduce the balance of my acupuncture mortgage.

Plan C – Divorce.  Really?  Has it honestly come down to putting this card on the table?  Actually, yes.  When you crunch the numbers, this option makes the most financial sense on paper.  Crazy thing is, before I even started classes at OCOM, I specifically asked the Financial Aid administrator for historical information regarding the FAFSA results for other married students in the program.  I was told quote “getting married is not a negative. It usually helps with many other aspects of being a student”.  When I visited with the Financial Aid administrator in person and asked for possible breaking points in income levels that I needed to consider, the message was an almost sound bite similar.  What I’m trying to let other potential AOM students know is that much like them, I did my homework, asked very pointed questions, weighed pros & cons before matriculating and looking back it was more like being in a used car lot (sorry car dealers).  I didn’t need to get married to validate my relationship.  What I did need was some solid advice from the people who are supposed to have a handle on this information for prospective students.  If there were consequences that I should take under consideration, I was prepared to make the best decision possible for the sake of our finances and cost of my AOM education.

Now what?  I’m on to Plan D by now.  Ironic isn’t it, Plan D and the 3 D’s.  I’m in the process of moving my loans out of ‘deferment’ status and completing the formal transition into the Income Based Repayment (IBR) plan.  This is the best option available to me before divorce, default or death to remain in the acupuncture profession.  OK, no worries, the IBR payments will be reasonable, right?  Guess again.  How does approximately $700 per month in a student loan payment sound to you?  The $700 per month is not on the standard 10 year repayment plan either.  It is for at least 17 years if I can keep up with these monthly payments.  Are you kidding me?   This is half of our monthly mortgage payment and more than twice as much as our monthly food budget.  Around $8,500 per year in student loan payments for 17 years or about $144,000 total!  The impact of this is huge.  All of this for an AOM education at a school that holds no career fair for their interns.  For a profession that has no officially recognized BLS workforce data let alone jobs for their graduates to move into.  So prospective students, does this idea still sound appealing to you?  Please see the writing on the wall and don’t go to acupuncture school if you need to finance your AOM education on student loans!  There is sufficient evidence out there now to support the fact that an AOM education is a bad return on your investment.

As you are reading this, you may be thinking, how could this be?  Let’s see the data, the numbers (props to acupunkgirl) based on our real life family of two who own a small home, have chosen to be child free, have a single car payment, commute by bike and/or take public transportation (unless time or safety dictate otherwise), are pretty handy and don’t pay full retail for the majority of discretionary purchases.  All in all, we do pretty well with what we have, plan and save for what we want, or do without things we really don’t need.  Our numbers look like this:

$70,000 = AGI.  This is our combined adjusted gross income.  If you don’t know what this is you might want to get a handle on it before if you think you want to go to acupuncture school.  It’s what the IBR payments are based from.  It’s not exactly real money that you get to fully touch and hold.

$50,000 = Actual take home pay.  This is real money that goes in our bank accounts after state & federal taxes, health insurance, retirement, etc are subtracted from the $70,000.   

The $50,000 of real money needs to pay for the following annual expenses: 

$25,000 = Mortgage, properties taxes, home owners insurance, mortgage insurance and all utilities.  If we were renting we could reduce this to around $18,000 per year at best unless we lived in a box.  Let’s be realistic here. 

$15,000 = Food, auto insurance, car payment, gas, health insurance co-pays, anticipated misc expenses, etc. 

$5,000 = Savings.  This is way less than we should be saving, but probably on par or better than most people today. 

From the $50,000 of real money, the above normal and expected annual expenses leave us approximately a $5,000 cushion fund.  As most people know, especially home owners, this isn’t just free money lying around.  Things come up over the year that we like to try not to tap into our savings for.  Normal but not always expected house fixes, vet bills, short cheap sanity weekends away all eat away at this buffer pretty quickly.  So the fact that my acupuncture mortgage monthly payment is becoming $700 per month in the near future is quiet daunting.  That’s about $3,500 more than what we have left in our remaining $5,000 cushion each year.  Essentially draining our buffer finances, our responsible safety net, and putting us in a poor position should any quantifiable expenses come up.  Not just for a few months or even a couple years until we work through it and quickly clear the debt, but for at least 17 years.  But who I am to assume prospective acupuncture students ever want to own homes or any financial security.  No, that would be crazy….about as crazy an idea as plunking down $100,000 in student loans to go to acupuncture school. 

I have to wonder when the last time an AOM school administrator sat down and looked at the IBR chart, let alone any student loan repayment options, and calculated what their expected payment would be if they had $100,000 in student loan debt?  How would this impact their own family and for how many decades?  Would they advise their own child to go to acupuncture school?  Could they honestly tell prospective acupuncture students that financing an AOM education on student loans is even worth considering?  Hopefully not and especially not if they need to resort to the spiel that they are investing in their future by investing in themselves!  I can think of an endless list of ways to invest in yourself that don’t ever involve going to acupuncture school and graduating with an acupuncture mortgage of their very own with little chance of finding a real paying job in the profession.  Let’s start with #1) invest in yourself by NOT going to acupuncture school unless you have $100,000 in the bank right now. 

So now what?  Well, obviously the current cost of the AOM education can’t continue along its historical path.  It is completely unsustainable for everyone but the acupuncture schools.  It’s unsustainable for the students, for the patients, and even for the tax payers down the road.  Think housing bubble here.  I really don’t mean to break prospective acupuncture student hearts with actual numbers, information and experiences but these details need to be shared openly and honestly if we are ever going to grow as a profession.  We have to work to change this.  We need to work to make sure the education is accessible and affordable to a wide range of prospective students from a wide range of backgrounds who can become licensed acupuncturists and serve their communities by providing accessible and affordable acupuncture.  We’ve got some elemental work to do.  OK, who’s in?

Art And Healing And Sustainable Business 

Posted March 16th, 2008 by korbenp 

This is inspired by Andy’s post below. He refers to an article by Kevin Kelly. Look it over if you haven’t. As I was reading it, my wife walked by the computer and said “oh yeah, that’s an awesome article.” What I’d like to write about here is why she, an artist, and I, and acupunk, had both come across it, and why it’s meaningful to both of us. 

My wife, Amy Walsh, has totally changed her relationship to earning a living as an artist over the last year or so. These very conscious shifts have in no small way been informed by Lisa Rohleder’s book about changing the business of acupuncture, and by helping me start Philadelphia Community Acupuncture. In her own work, Amy is going this very direct route of cultivating an audience, or the “true fans” of which Kelly writes.

Two years ago, Amy was showing at an amazing amount of venues in Philadelphia and other places, collaborating with other artists, and earning great critical reviews. She was earning zero net money from this work. She watched her colleagues either quit art-making, or fit it into the wee hours of time between income earning jobs. She, herself, was piecing together adjunct teaching positions, hoping to maybe secure an elusive full-time position within a few years. An occasional lucky compatriot of hers was able to make art full time while not being a New York art star; but, this was by virtue of inheritance.

At the same time, I was treating patients privately at 45 – 65 dollars per treatment. Even though I was having mostly great success with my patients, and even though they were telling other people, and even though I had virtually no overhead, I was far from earning a living as an acupuncturist. I worked a separate 30 hour a week job in addition to treating people.

So, there we were, for years, doing what we do quite well, and feeling like we’d always be broke, always struggle to even pay rent. I think we were both a little hopeless that it could ever be different, felt like that’s just the way it has to be in the advanced capitalist world that places very little value on the non-technological contributions of fine artists and healing artists. 

What this community acupuncture revolution has helped us realize is that artists and acupunks (other healers?) have a lot in common in terms of their relationship to the economy and to community. They both contribute something that is vitally important, non-negotiably central to a healthy society. The work of both has been historically undervalued and exploited. For both artists and acupuncturists of our generation, the rules by which we were trained to engage our clients were created largely by peripheral industries which manipulate profits by turning our work into territories of the privileged.

But, Amy and I are also realizing that we can both use the same recipe for taking power back, and for making a living by putting our work in the center of our communities and our communities in the center of our work.

To make big change, you usually have to give up on something to which you’ve been, whether conscious of it or not, committed. One of the things I had to give up on was being some kind of superhero healer, summoning unique therapeutic skills from my own solitary mind and body. On the other hand, I also had to give up on the idea that what I was doing would always exist on the margins, and that, therefore I shouldn’t waste my time reaching out to everyone as potential patients.

It was a similar process for Amy. She had to give up on an unconscious dream that some abstract art establishment was going to recognize her brilliance and crown her a famous star. And, on the other hand, she had to give up on the idea that what she was doing would always exist on the margins, and that, therefore she shouldn’t waste her time reaching out to everyone as potential audience.

What’s most interesting to me here is that in both of our cases, there was a big chunk of unexamined classism in terms of who we were (and were not) allowing ourselves to imagine as our patrons, who we thought the acupuncture and the art were for. Of course we both had a belief that art and healing are human rights, but we couldn’t find our way out of the behaviors that the overall classist economic system helps keep in place. 

One interesting story is when Amy had some of her teachers and classmates and other colleagues from Pennsylvania Academy of the Fine Arts over for dinner. She was telling some of them about doing “a painting a day” and selling them on line. Several people in the room were visibly disappointed, and warned her not to use her real name if she wanted to maintain her place in the art world. 

There’s a lot to say about Amy’s shift from making only installations for galleries and museums to also making art that she can sell and that people other than the very rich can buy. Lots of interesting stuff about the different people she’s connected to as crafter, the kind of money she’s actually able to earn, her rediscovery of creating beautiful useful objects from the most simple of materials, etc. I’d actually like her to do a guest blog entry because I think it shines a different kind of light on what we’re doing well and not doing well.

Conference Keynote: Breaking the Ceiling

Posted 11:14am April 9th, 2011 by Lisafer 

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.

That, I have to say, is one of the things I really love about community acupuncturists. We talk openly about numbers. Because numbers are an important way to be connected to reality. This seems like a good time to thank all of the people who worked on the 2010CAN Survey, especially Justine Deutsch. Thank you all.

One of the things that we at WCA have observed over time, watching other clinics, is that 100 treatments a week is a kind of ceiling.100 treatments a week sounds like a LOT of treatments to most acupuncturists at first, something that it’s hard to imagine doing.But almost all clinics really need to break through that ceiling in order to be successful and sustainable. Ideally, each acupuncturist in a clinic is able to provide 100 treatments a week as a matter of course, consistently, no big deal. One of the main things we wantedto do with this conference was to provide some help and some resources for acupuncturists in breaking that ceiling, breaking through the 100 treatments a week barrier. I want to use this talk to frame WHY breaking that ceiling is so important, what it means for individual clinics and also what it means for community acupuncturein general.

But first I want to back up a little and talk about sizing, or right-sizing, of businesses.

There’s a famous business and marketing blogger, Seth Godin, and his blog is where I heard about right-sizing. Actually, another acupuncturist, Elaine Wolf-Komarow, sent me a link to his blog,because she’s much better on keeping up with Internet stuff than Iam. And I was really grateful, because the idea of right-sizing fits so well with this conference. So let me summarize Seth Godin’s blog post of  February 24, which he titled “an atomic theory of business size”.

In chemistry, the point of the periodic table of the elements is to define elements by the size of their atoms: the number of protons, neutrons and electrons that they each have. An oxygen atom always has 8 protons, and a titanium atom always has 22, and so on, and that’s their atomic number. You don’t have an element that is part oxygen and part titanium, you just can’t. The elements are what they are. And the electrons that orbit the nucleus are where they are,depending on their quantum numbers. According to Seth Godin,businesses have an elemental size: a size where they are supposed to be, a size where they really work, where they are stable and successful and sustainable. He says: businesses that exist, exist because the marketplace allows them to function at the right size.

He says a mom and pop business is just the right size for mom and for pop. The rent and the overhead are probably relatively low, so it works out, it’s stable.  A mom and pop business doesn’t need,say, its own advertising department that costs hundreds of thousands of dollars a year – if you added one of those to a mom and pop,it’s out of scale, and the business isn’t stable anymore. 

He says the next level of business up from mom and pop feels different – different furnishings, different payroll, different everything. It’s not an incremental step, it’s a quantum leap. 

So what does all that have to do with us? Well, there are individual implications, and there are professional implications.Let’s start with the individual implications.

One of the big things that keeps community acupuncturists from breaking that 100 treatments per week barrier is a problem with right-sizing.  We have an image of an acupuncture practice in our minds, but that image isn’t the right size. It’s way out of scale. It’s like our mental setting for an acupuncture practice is at hydrogen, which has an atomic number of 1; but really the elemental size for an acupuncture practice is closer to, say, tungsten, which has an atomic number of 74. It doesn’t work at hydrogen, it works at tungsten. But we keep picturing hydrogen. We’ve got our attention inthe wrong place.

One of the funny things for me about giving this talk is that it’s almost 9 years to the day – today – that I gave my first “community acupuncture” treatments. It’s almost exactly 9 years ago that we started the clinic that would end up being Working Class Acupuncture. I remember that we got the keys to the space sometime inmid-March of 2002 and we started seeing patients there in early April. So it’s almost exactly 9 years ago that we started using the community acupuncture business model, though of course we weren’t calling it that at the time. We didn’t actually have a name for what we were trying to do. We were flailing around, trying to figure out how to make a living doing acupuncture.

In 2002, my mental picture of an acupuncture practice was, like everybody else’s that I knew, pretty much stuck on hydrogen. Stuck on 1. I didn’t know tungsten was an option, because I didn’t know it existed, or I didn’t know it could exist for me – I’d heard the stories of course of great acupuncturists in Asia seeing  a hundred people a day, but nobody I knew did that in America. I knew I needed to see more patients than I was seeing if I wanted to support myself as an acupuncturist, but I didn’t really know how many. You all weren’t around back then, so we didn’t have anyone to talk toabout numbers; we didn’t have any real support for doing the math. So my attention was on doing one treatment at a time, which is where most American acupuncturists’ attention is, which is, of course, the wrong place. I thought if I did one treatment at a time, it would eventually add up to enough treatments, but that isn’t actually what happened. Adding up one treatment at a time is taking incremental steps.  I don’t think anybody can get to 100 treatments a week by adding up one treatment at a time. You don’t break through the ceiling incrementally, you break through the ceiling with a quantum leap.

My patients are the ones who catalyzed my quantum leap. They did it by not cooperating with my idea of one treatment at a time. They didn’t show up one at a time. They showed up two or three or four at a time; they showed up late or early, they showed up with friends and family members and coworkers. Eventually I got it, that the space I thought was mine, the acupuncture practice I thought was mine, wasn’t really mine, it was theirs. Like most acupuncturists, I thought acupuncture was mine and I was doing a good thing by wanting to share it. I learned that acupuncture wasn’t mine at all, it wasn’t mine to share and it wasn’t about me being good. It’s about acupuncture being big. Really big. I caught a glimpse of how huge acupuncture really is, and I got it that I was supposed to participate in it rather than control it or own it. That was how I discovered tungsten, or my version of it anyway.

When I say that breaking the 100 treatment per week barrier is a quantum leap, I don’t mean that it happens all at once, because it doesn’t. It’s not like you’re seeing 30 people one week and then yougo through a wormhole and you’re seeing 100 the next week, it generally happens over time, more time for some people, less time for others.  The important thing to understand is that consistently doing 100 or more treatments a week is qualitatively different –not just quantitatively different – from doing 30 or even 50.There’s a threshold that you cross where it’s not about providing one treatment after another treatment anymore, it’s about taking care of a space where a LOT of people come to use acupuncture in the way they want to use it, which might not be the way you think they should use it. There’s a point where the space starts to belong to the patients.That’s when your practice is elementally different from a conventional acupuncture practice, when it’s stable at a level that conventional acupuncture practices can’t possibly be stable.Getting there is hard for a lot of acupuncturists because of the way we were trained to think about acupuncture.

In that first week of April 2002, I think about 12 community acupuncture treatments happened. If you look at the numbers from the 2010 CAN survey, these days, 6783 treatments are happening each week in a hundred or so clinics. We know that not everybody answered the survey, and we know that we don’t even know about all of the community clinics, so we know the actual number of treatments is probably a lot higher. Maybe it’s 10,000, we don’t know, but we can say pretty confidently it’s not less than 7,000 treatments a week. So 12 treatments a week to 7,000 treatments a week; that’s a 58,000 percent increase at least. Pretty good for 9 years. I’d call that evidence that the community acupuncture model likes quantum leaps.

I wouldn’t say that we knew or guessed that a 58,000 percent increase in what we were doing was going to happen, because we didn’t. But we did know that the hydrogen scale was wrong, and we were flailing around, reaching in the dark for what the right scale was, what the right size was. My point is that we had an inkling that the mindset we inherited in acupuncture school had to be questioned,had to be discarded even. I want to return to the issue of individual acupuncturists making the quantum leap to 100 treatments a week, and how that happens. It has to start with a feeling that the scale you’ve got is wrong. I don’t mean a feeling of panic as in “OMG I’m not going to make enough money!” Lots of conventional acupuncturists have that feeling too, it doesn’t have anything really to do with shifting your scale. The feeling I’m talking about isn’t about you, it’s not personal, it has nothing to do with your success or your failure – it has to do with the nature of acupuncture itself. It’s sort of like feeling that maybe the world doesn’t work the way you thought it worked, and acupuncture doesn’t work like you were taught to think it worked – it’s bigger and stranger and more magical than you expected. It can actually shift you out of worrying about yourself and your success, because you’re no longer just focused on yourself. You’re seeing the big picture with you as a part of it, but not at the center anymore. It’s not necessarily a comfortable feeling, there is a kind of uneasiness for sure, but there’s also a kind of wonder and curiosity. I remember thinking,wow, I guess I was really wrong about everything, and that’s probably good.

So first you need to get into a kind of creative discomfort, a kind of suspicion that maybe everything you think you know is wrong,and the truth is actually going to be a relief when you finally find it. The ceiling is first and foremost a ceiling in your mind. If you know you’re blocked, if you can’t break that ceiling, instead of fighting the block, it’s generally more productive to be curious about it, to work off the theory that you’re confused about something and you don’t even know what it is that you’re confused about, but once you figure it out, you’ll be much happier. If you’re on the wrong side of that quantum leap, you have to start by just being open to a qualitative solution instead of a quantitative one. A quantum solution instead of an incremental one.

The next step, I’d say, is to really think about how people work,and how acupuncture works, and how they work together in the real world, which is extremely different from how they work in textbooks.In textbooks, if you do the right treatment, the patient gets results; if you’re smart enough, you should be able to make a living as an acupuncturist. It’s all about your knowledge and your skill. If you start from that premise, you are looking at your practice as a hydrogen atom, atomic number one. It’s all about one treatment at a time, because you can only do one treatment at a time, and this is all about you, right? So if you just do enough single treatments they should eventually add up to the point where you can pay your bills,and it’s OK to have relatively low numbers of patients, as long as you are smart enough to help  ALL of them.

The problem with having a low atomic number for your practice is that low numbers are not a good fit with how people actually behave,and so your practice is not ever going to be stable if the numbers are low.  Different people can stick with a treatment plan to different degrees; there are a lot of people who, even if you’re helping them, are going to stop coming in, because they can’t be consistent about anything in their lives, including acupuncture.Other people can be consistent in short bursts, and then they get inconsistent again. People drop in and drop out of getting acupuncture. They get busy, they get better, they move away, they come back. These are trends that are very obvious to anyone who’s had a community acupuncture clinic for five years or so – you get to see the way people flow in and out. This means that you have to set your sights on seeing lots and lots and LOTS of people, if yourclinic itself is going to be steady. Sometimes I suggest to acupuncturists with new clinics that they should just focus on tryingto accumulate a thousand files. Once you accumulate a thousand files,you’re in the ballpark for having introduced enough people to acupuncture that some of them are going to be consistent. The mos tbrilliant acupuncture treatment in the world is not going to make an inconsistent person into a consistent person, it can’t be done. Partof the quantum leap is understanding that and letting go of all your patients as individuals. You can and should care about them asindividuals, of course, but you shouldn’t hang on to them as individuals, ever, because you never know what they are going to do.

It’s a similar thing for treatments – you have to let go of individual treatments. In the textbooks, individual treatments matter a lot; in real life, not so much. You can’t measure the effect of acupuncture in discrete increments; it’s more like a big, messy continuum. Acupuncture works unbelievably well for some people – if you went to the documentary screening last night, you’ll have some examples immediately coming to mind – and not so well for others.Acupuncture works very slowly over time for chronic conditions and chronic pain; sometimes people can only track the effects by noticing that this month was a lot better than last month. Most of all,acupuncture doesn’t work precisely.  After 17 years of doing it,I’m pretty convinced that acupuncture is not like a laser, it’s like a shotgun. You can try to aim it all you want, but its effects still go everywhere. So acupuncture is not really meaningful in small quantities, with small atomic numbers. As an element, it’s only stable when the numbers get larger, and then it’s a beautiful,amazing thing. You know what tungsten is used for? Making lightbulb filaments. It shines in the darkness.

OK, so it doesn’t make sense to think about acupuncture in terms of individual patients, or in terms of individual treatments. Once you get that, you need to take a look at all of the ways you put yourattention on individuals, and ask yourself if your attention really belongs there. Sometimes it does, and sometimes it doesn’t. For example, an acupuncturist who has broken through the 100 treatment ceiling is never scared by a room full of patients; she doesn’t get overwhelmed, and she doesn’t lose track of people. A full room feels good to her, and it feels good to her patients; everybody is having their own individual experiences, but there’s this other thing going on that is much bigger, and she’s holding the space for that thing as she’s moving from person to person. She’s connected to the tungsten element of her practice. But an acupuncturist who hasn’t broken through that ceiling has trouble holding that space for tungsten,because she’s still trying to hold it for hydrogen, she’s still thinking one plus one plus one. She might do something like spending too much time with one patient so that she gets way behind with the next  few patients. She can get caught up in what she’s doing with a patient, what she’s learning, what she wants to think about,and not be able to tune into the room as a whole, what the patients are doing with each other whether they know it or not. She is overwhelmed by a lot of people because she’s no longer able to be in total control, and then she can’t keep track of everyone. If that’s what’s going on for her internally, of course she’s not going to be able to attract or retain high numbers of patients. If she’s made the shift to a sliding scale, she’s dependent on high numbers to make a living, but she hasn’t really embraced the limits, and the possibilities, of community acupuncture. She’s essentially trying to have her practice be partly one element and partly another, and that’s about as unstable as you can get.

Most of what it takes to break through that 100 treatment a week ceiling is not external, it’s internal. It’s not about marketing o rsignage or what conditions you feel confident about treating. It has to do with your ability to be present for people, and how much space you have inside you for other people’s suffering. You can attract and retain people in direct proportion to how much internal space you have for them. Call it the atomic number of your heart. So of course it’s harder if, say, you’re a new parent, or if you’re the parent ofa child who’s having any kind of difficulty; lots of your heart space naturally will be taken up by parenting. Similarly, if you have any kind of troubles or worries you can’t put aside, you won’t be able to attract or retain people in large numbers. And if you have any interests outside of your practice that are seriously competing for your attention, you’ll have trouble attracting and retaining patients in large numbers. You have to be fairly one-pointed in your focus on making space for people. And this, of course, is not what they teach in acupuncture school; they don’t teach you how to make space for people in your heart, especially lots of people simultaneously. Community acupuncturists all have to learn how to do that for themselves, by trial and error. Lots and lots of error. It can be done, you can raise the atomic number of your heart, it jus trequires effort and desire and practice. Maybe desire more than anything. You have to want to help a lot of people.

So in the end I think it comes down to looking at yourself, yourpersonal relationship to the numbers. Where do you put you rattention, what’s the atomic number of your practice, really? How much space do you have inside you, what is the atomic number ofyour heart, honestly? A few months back we put on a class for Oregon acupuncturists, and a really interesting combination of people showed up: a lot of very new acupuncturists who weren’t doing community acupuncture, and a bunch of hardcore community acupuncture comrades.I remember looking out at everyone and thinking you could tell who’s who by their faces. Most of the conventional acupuncturists looked kind of shiny. You could tell that they hadn’t seen a lot of people,and also that they weren’t oriented toward seeing a lot of people.They were oriented towards expressing themselves as acupuncturists,concerned with the individual nature of their practices.  The community punks, on the other hand, looked, well, used. Well-used.You could see that they had been seeing a lot of people, and they were kind of worn around the edges, sand-papered down by other people’s pain, but also lit up inside. Tungsten filaments.

OK, that’s the personal part of the atomic numbers, let’s talkabout the profession as a whole. Seth Godin says that rightsizing your business is one of the most important decisions you can make. What if an entire profession hasn’t found its elemental number, its correct atomic size? Businesses that exist, exist because themarketplace allows them to function at the right size. What if each of our businesses is also impacted because the profession that they are a part of is not functioning at the right size? Because the profession never actually made a decision about rightsizing,never thought about what size it should be because it was too busy putting all its energy into glorifying individuals being individuals?The acupuncture profession is really good at that: making gurus,making specialists, encouraging people to express their uniqueness asa marketing strategy. Does it work?

Let’s look at what it means when only a few people are gettingacupuncture, say 3.1 million in 2007. We’ll restrain ourselves andnot start ranting about the fact that most of the professionapparently thought 3.1 million was a great number, even though it’sabout 1% of the population as a whole, which means that 99% of thepopulation in America didn’t get acupuncture. That’s the size we’reat right now as a profession. What does it mean for our businesses?

Well, it means that a lot of people may have heard aboutacupuncture, but the odds are overwhelming that they don’t knowanybody who’s actually using it regularly. Furthermore, thatsituation seems normal not just to them but to us as a profession. Ifwe think 3.1 million is a great number, that’s what we’re saying,right? That we’re OK with 99% of the population not gettingacupuncture. It means acupuncture is supposed to be sort of a secret.Acupuncture is supposed to be reserved for special occasions, ormaybe special people? How are we supposed to market something that isalso meant to be a secret? Now, I’m not saying that acupuncturists ingeneral are OK with the fact that the majority of them are unable tomake a living. But I’m going to stick with what I said earlier, thatthe discomfort of “OMG I’m not making any money” is not the kindof useful, creative discomfort of really feeling that we’re at thewrong scale for our businesses. I think a lot of acupuncturists wouldbe fine with acupuncture being a secret if they were also able tomake a lot of money at the same time, but of course business doesn’twork like that. People can’t rave about something they don’t knowabout. If a secret goes viral it’s not a secret anymore. But I’mafraid a lot of acupuncturists actually got into the professionbecause not a lot of peopleknew about acupuncture.  Not in spite of it, because of it. Thesecrecy and the specialness are part of the romance of being ahealer, right? If you’ve got a lot of ordinary people gettingacupuncture anytime they feel like it, it loses that specialness. Andthe healers lose their specialness. The whole thing becomescommonplace.

That leaves out, of course, the reality that for each of thoseordinary patients getting acupuncture, the experience itself is oftenmagical, amazing, anything but commonplace. People say things like,acupuncture has given me back my life. They say, I had forgotten whatit was like to feel really good. They say, I feel like myself again.There’s the difference between the patients’ reality and theacupuncturists’.

Patients are quite capable of picking up on the fact that, nomatter what the profession is saying, acupuncturists don’t reallywant them to get acupuncture in large numbers. It’s pretty clearthat, as a profession, we’re just not that into them; we’re notthat interested in them getting their lives back or feeling likethemselves again, unfortunately. So they respond in kind. When wehave no enthusiasm, they have no enthusiasm. You can’t fakeenthusiasm. And where there’s no enthusiasm, there’s no momentum. Intheory, there are more than 20,000 licensed acupuncturists in theU.S., and there have been for a while. And yet only 3.1 millionpeople got acupuncture in 2007. If every licensed acupuncturist weretreating 1,000 individual patients a year – some of those peopleconsistently, some more of them inconsistently, because that’s howpeople are – there should be more than 20 million individualsgetting acupuncture each year. And of course that’s in addition toall of the people who might be getting acupuncture from someone otherthan a licensed acupuncturist, someone like a medical doctor or achiropractor or a physical therapist or whoever. If you had more than20 million people getting acupuncture a year, we would start to seesome real momentum. The more people get acupuncture, the morepeople get acupuncture.  Youcan say those words with a few different meanings, and all of themare true. That is what we should be seeing. Instead we’re seeing isthe opposite –  numbers of licensed acupuncturists arestagnating, and in some places they’re actually declining. So theless people get acupuncture, the less people get acupuncture.

Maybe the profession hasn’t made the sizing decision consciously,but it’s made it nonetheless: we have chosen the atomic size thatmakes us feel special.  And it’s a very small size indeed.Unfortunately, due to the realities of how acupuncture works, and howhuman beings work, you don’t get to be special as an acupuncturistand also be able to make a living.

So I’m going to advocate that we revisit that decision aboutsizing the profession, and this time we do it consciously andrationally. What does it mean if lots and lots and LOTS of people getacupuncture?

If every one of those 20,000 licensed acupuncturists managed tobreak the 100 treatment per week ceiling – and let’s say we giveeverybody 2 weeks of vacation a year – that would be 100 milliontreatments a year. And it’s hard to say how many patients exactlythat would be, because some of them would be consistent and somewould be inconsistent, but it’s probably more than our previous 20million calculation – because a lot more people would be tryingacupuncture for the first time, because they would finally have heardabout it from someone they knew.  Acupuncture would start to bean ordinary thing for lots of ordinary people. We would start to getthe momentum we needed. 

And then the marketplace would change. Businesses that exist,exist because the marketplace allows them to function at the rightsize. Currently we have a lot ofacupuncture “businesses” that don’t really exist; they don’tfunction as businesses, they function as hobbies. Because they don’thave enough patients, there’s no incentive for them to keep regularhours. So their patient flow is unstable, and then their hours areunstable, and then their revenues are unstable, which ultimatelymakes the job itself unstable; and that all culminates in making thepatient flow even more unstable. That’s the elemental nature of asmall acupuncture practice in a wrong-sized profession: unstable. Butall that changes if we collectively decide to right-size theprofession. We commit to a stable flow of patients at a high volume;we commit to stable hours; we start to reap the benefits of stablerevenues and stable jobs, and every year we see the patient flow getmore and more stable. That’s what we’ve seen at WCA, these last 9years. If we collectively decide to rightsize our own businesses andto rightsize the profession as a whole, what the marketplace allowsus to do will change. 

Sometimes I think that acupuncture in America is trying toright-size itself through us. It’s huge, it knows it’s huge; it’s theacupuncturists who haven’t realized that it should be huge. For lotsof the last 9 years, I’ve had this feeling that I’m just takingdirections from something that knows what it wants, somethingenormous that already exists somewhere that I can’t quite see. I’mtrying to run errands for it, get things set up the way it wants themto be set up so that it can do what it already knows how to do.

So I want to read something that Brent Ottley wrote recently aboutthe progress of community acupuncture over the last few years. 

CAN has grown beyond being simply a counter-movement to theacupuncture status quo in America.

(The organization) has moved into a period where questionsabout philosophy and the basic viability of the model are beingovertaken by questions about sustainability and organizationalidentity. Translating the raw energy of first principles intopractice without becoming entangled in bureaucracy and rules isalways tricky. Implementing necessary structure without inducingstasis is probably the biggest challenge that any young organizationfaces. It’s heady and exciting territory, rich with potential, butit’s also thickly strewn with landmines. Great care anddeliberation are warranted. 

A short few years ago, CAN barreled out of the Northwest likesome scruffy, brilliant lovechild of Dorothy Day and The Dude,pricking, prodding, provoking, kicking, scratching, screaming,stamping its feet, holding its breath, taking it on the chin, jumpinggleefully on alphabet-festooned grenades, playing the skunk atacademic garden parties and relentlessly broadcasting theinconvenient truth that despite all the preening andself-congratulation, the American incarnation of the Emperor remainsin many ways as naked as a jaybird. All along the way, CAN hasgathered kindred spirits, a fast growing cadre of committedpractitioners and support staffers, and an army of patients. For awhile, CAN could be dismissed by the rest of the profession as abunch of frothing radicals too extreme to be taken seriously. Butthen something tipped, and all of a sudden it was impossible for therest of the acuworld, like it or not, to deny that CAN had builtsomething; a simple, stable and philosophically consistent whole thatactually does what it claims to do. Something that works on theground, again and again, everywhere, right where the rubber and theroad collide, something that proves that putting patients first whilesupporting acupuncturists really is possible,and that the limit is nowhere in sight. And most importantly, it’ssomething that acupuncturists and patients are flocking to. Someonewrote once that the first purposes of any revolutionary movement areto comfort the afflicted and to afflict the comfortable, and if theresponses CAN is getting now are any indication, by that measurewe’re doing pretty well. 

Larry, in his excellent blog of last month called it “the endof the beginning”, and I agree with him. We are participants in andwitnesses to the emergence of a new species of acupuncturist, ahybrid that’s never quite existed in modern memory; birthed,inspired and nourished by the immense cultural riches of Asia,mentored by the legacies of  Bangladeshi economists, Catholicradicals and contemporary social theorists, and yet still raised andindelibly marked in the context of modern American commercialculture. Community acupuncturists are by now nearly as different fromthe conventionally established definition of what a U.S.acupuncturist is as they are from acupuncturists in Asia. With someused furniture and a fundamental healthcare technique created halfwayacross the world millennia ago, community acupuncture is crafting anew synthesis of healthcare, social entrepreneurship and basic humanjustice. In the process it’s accomplishing what the establishedacupuncture profession, in Larry’s words, has “utterly failed”to do, and that’s building the foundation from which acupuncturegenuinely enters the whole society to become the fundamental,affordable and accessible primary care resource it has the capacityto be.

We’ve made a quantum leap. And because of that, we have become,elementally, a different kind of acupuncturist.

There are lots of implications for that, but I want to spend therest of my time here talking about just one of them, which is theimplication for how we organize ourselves.

The Community Acupuncture Network is a 501c6 nonprofit, a businessleague, which means, basically, an organization for people with acommon business interest, that promotes a particular industry. A501c6 is an organization for professionals, in our case, licensedacupuncturists. Just like when I opened my clinic 9 years ago, I wasstuck on a hydrogen atomic model, because that’s all I knew, whenwe created CAN in 2006, we used the only organizational model that weknew about. We basically created the community acupuncture equivalentof the AAAOM.

But as Brent wrote, CAN has grown beyond being simply acounter-movement to the acupuncture status quo in America. Some ofwhat we do is still to prick, prod and provoke, certainly, but whenyou look at the totality of what we are at this point, we’re notthe equivalent of the AAAOM.  We do different things, we needdifferent things. So that means, if we want to continue to bestable,  we need an organizational quantum leap. We need anelemental structure that is bigger, because a 501c6 nonprofit can’treally support us for what we have become. And just like the space in our clinics belongs to the patients and not just to us, we need an organization that belongs to the patients and not just to us. 

Let me say a few things about that before I get more specificabout the quantum leap. There were two figures that blew me away in the 2010 CAN survey: first, that 102 clinics gave 353,000 treatments last year, and second, that those 102 clinics had collective revenues of between 6 and 7 million dollars.

Let’s start with the treatments. Again, not every clinicanswered the survey, and we know that there are clinics out thereoffering community acupuncture who aren’t part of CAN. So what is the actual figure for community acupuncture treatments last year? 500,000? Probably not less than that, if we can actually document 353,000 of them. And how many individual patients is that? I think it’s safe to estimate that, at this point, the community acupuncture movement involves at least a hundred thousand people every year. Probably if you look at the last few years, severalhundred thousand people coming and going in community acupunctureclinics all over the country, patients and practitioners.

And just as we are a different species of acupuncturist, with a different elemental structure, in many cases, our patients area different species as well, with a different atomic number. There are a lot of community acupuncture patients out there who bear absolutely no resemblance to the passive consumers of healthcare that our culture expects.  A great many community acupunctureclinics, including mine, are thriving primarily because some of ourpatients took enormous initiative in getting the word out about us. They made sure that everyone they knew came in and got acupuncture atleast once. They got us in the paper, on the radio, on TV. Theypainted our walls and built our bike racks and organized our offices.We wouldn’t exist without them. And yet we have no formal role for them in the structure that we’ve got, because technically they don’t “share a common business interest” with us. That doesn’tmake any sense. 

The community acupuncture business model has never fit neatly intothe for-profit category, because we make so many decisions that arenot about profit. And yet we don’t fit into the non-profit categoryeither, because we make our own money and we don’t depend on grantsor donations. For-profit businesses have consumers; non-profitcharities have clients and volunteers; we have our amazing patients,and neither the non-profit structure nor the for-profit structure hasany category that explains them. It would be a really good thing ifwe had a way to organize them, to track and to recognize all theircontributions in a consistent, structured way. At least once a monthI get a phone call or an email from a patient asking how they canhelp start a community acupuncture clinic in their hometown – Iwish I had something to tell them.

OK, on to the money. 102 clinics with combined revenues of 6.5million dollars. To return to Seth Godin’s blog, the vast majorityof those clinics would qualify as mom and pop businesses. Unlike arandom collection of mom and pops, however, we are all doing almostexactly the same thing, and we’re trying to do it together. So manyof our systems are the same. And collectively, we have revenues thatdefinitely are out of the mom and pop range. It would be a reallygood thing if we could find a way to coordinate our interestseconomically, to access the economies of scale that are available toa business with millions of dollars in revenue. 

CAN acupuncturists are not just a collection of individuals,anymore than the patients who come to our clinics to get treatedtogether are just a collection of individuals, and what connects usis so much more than “a common business interest”. Just like aclinic that has broken the 100 treatment a week barrier has thatelement of tungsten in its operations – there’s an awful lotgoing on between patients that you can’t necessarily see – we’vegotten to the tungsten element as an organization. There’s so muchgoing on between all of us that is at an entirely different level.And yet we’ve still got an organizational structure, a 501c6, thatis only meant to work for a collection of individual acupuncturists,a bunch of hydrogen atoms, who maybe can work together,incrementally,  to get things done, incrementally – but weneed a structure that recognizes that we’ve gotten past theincremental stage, we are already taking quantum leaps together, andwe need to take more of them.

Let me give some concrete examples. One of the things that peoplekeep asking us to do is micro-lending. Clinics can start up with abudget of  $5,000 or $6,000. And yet it’s harder and harderfor new businesses to qualify for any kind of credit. Doesn’t thatseem like something CAN should do, make small loans to help start newclinics? Absolutely, but a 501c6 is not set up to do microlending.Another thing that keeps coming up is resources for employers. Somany of us have become employers, and yet we don’t know really whatwe are doing. CAN is helpful as a kind of online support group, butwe need more than that. Is that something 501c6s do? Not generally.We need to organize our patients – wouldn’t it be amazing ifpatients who wanted to see a community acupuncture clinic in theirhometown didn’t have to just sit tight and wait for anacupuncturist to find them? Wouldn’t it make a lot of sense if wecould organize a patient base for a clinic BEFORE the clinic opened,instead of after? 501c6s absolutely don’t do that. We don’t needto “promote our industry”, that’s too vague; we need tocoordinate our interests economically, find ways to pool ourresources and access economies of scale.

For those of you who follow the CAN blog, and especially some of the arguments we’ve gotten into with the acu-establishment, you’ll note that our opposition has some consistent complaints: not only are we rude, not only are we scruffy,  but we’re not a very good 501c6. They want to see our bylaws. They take exception to how ourmembership is set up. The thing is, they’re right. We’re NOT avery good 501c6. We really ought to be something else, something thatlets us organize our patients, and provide resources for employers,and access economies of scale, and create a microlending program.

Lucky for us, there is an organizational structure that allows usto do all of those things. It’s called a multi-stakeholdercooperative. Cooperatives have been around a long time – in factthey have a whole movement of their own, which we are looking forwardto joining – but multi-stakeholder cooperatives are a relativelynew phenomenon. They are more common in Europe and in Canada thanthey are here – in some places they are beginning to replace traditional social-service nonprofits – but they are starting to appear in the U.S as well, where they are being used to do things like reconstruct local food systems in the Midwest. A cooperative is a kind of organizational and business recognition that producers and consumers — or practitioners and patients — depend on each other.

So I’ve already been talking at you for way too long to get intothe technicalities of how multi-stakeholder cooperatives work. I’mgoing to be doing a breakout presentation on that very topic latertoday and again tomorrow, and if you can’t come to thepresentation, you can certainly get the handouts. Mostly what I wantto do is just to make the official announcement that we have foundour new atomic number, and we know where we will land after our nextquantum leap. We’ve spent the last 6 months or so hammering out ournext organizational structure, which is actually a new organization– one that CAN itself will join as a member. That’s how a multi-stakeholder cooperative is set up – you can have individuals as members, and they can be practitioners and also they can be patients; you can have community clinics as members, and you can also have institutions or organizations as members — like CAN, like CLIMB, like a needle company. All linked together as a new economicfoundation for community acupuncture.

Our multi-stakeholder cooperative is called the People’s Organization of Community Acupuncture, or POCA. Get it?  Theactual transition — into really being able to use POCA foreverything we need it to do — will probably take us about a year orso. But you can expect that after this weekend, the conversation onCAN is going to be all about POCA. In a month or so, CAN and POCA will have one website; and in the meantime, POCA has a Facebook page where you can get more information.  You should also expect to get emails and phone calls about POCA as we’re getting it established. There’s a lot to do.

We’re really thrilled about this. It is a lot of work to move anorganization onto an entirely new foundation – an awful lot oftechnical details – but we feel strongly that it’s a necessaryinvestment in our future. The structure of a cooperative seems to be a really perfect fit with our sensibilities, especially our desire for self-empowerment and economic self-determination; and there’s a lot of exciting potential for connecting with other cooperatives. We feel that POCA will really let us all take responsibility for ourselves in our communities at a whole new level, and let us create the future for community acupuncture that we want to see. We think that POCA is ultimately the vehicle that will allow us to collectively right-size the profession — which means that the marketplace will allow more and more of our individual clinics to function at the right size, to prosper and thrive. 

I want to close with a last quote from Seth Godin’s blog post onhis atomic theory of business size:

When in pain, consider your scale. When you’re too big or toosmall for the revenue or the impact you seek, you’ll feel it inyour bones. Leap.

Thank you.

FPD and ACAOM for the gold!

Posted 8:01pm February 22nd, 2010 by Lisafer 

In the new Olympic sport of Moving the Goalposts. Or is it Gaslighting? Hard to define, but it’s clear we have a winner! In this blog post, a recap of a groundbreaking performance, along with some commentary from this thoroughly embittered viewer.

Let’s go back to 2003, with a quote from the CCAOM Entry Level Standards Committee, History and Findings: “The Council of Colleges of Acupuncture and Oriental Medicine’s Entry-Level Standards Committee was formed in May 2003 and charged with the task of gathering information on potential changes in entry-level educational standards. The intent in creating the committee was to create an open process to gather feedback on possible changes to entry-level standards and to fulfill our vision by taking actions that would be open, transparent, welcoming, and without a preconceived agenda.” This seems to be where the public process officially started. That document also contains gems like this: “While concurrent Master’s and doctoral programs may co-exist in some states, most states pointed out that once a higher level of entry education is defined, the lower level is phased out.” 

You think you know what’s going on here, don’t you. Therein lies the subtle beauty of this performance! Let’s move on to 2005, when the ACAOM Doctoral Task Force issues their final report, and announces the first public comment period. “ACAOM has established a Doctoral Committee, consisting of the Executive Director and several
commissioners, to consider the public comment on the Task Force report as it works to develop
proposed accreditation standards for first-professional doctoral programs in AOM.
” And here is a quote from that Doctoral Task Force:

ACAOM Doctoral Task Force Guiding Principles
We undertake to help facilitate this process should it occur according to the following six principles:
1. Above all else, we will endeavor to do no harm.
2. We will endeavor to bring all communities of interest and voices in the AOM community into
this process and through it together without eliminating or excluding anyone.
3. We will respect all voices in the field and all traditions in the field.
4. We will provide clear communication about our discussions and the processes we propose to the
entire community throughout our discussions.
5. We recognize that our current curriculum leading to the professional degree in AOM and the
competencies that they represent support a valid First Professional Degree at both the current
masters and the proposed doctoral degree level.
6. We recognize that content of curricula will continue to evolve, as it always has, based upon the
need to support new professional roles which emerge for practitioners of AOM

Sounds pretty good, doesn’t it? Do no harm, bring everyone into the process, respect all voices, provide clear communication about our discussions and the processes we propose. A flawless set-up.

And now, the comment period. Other than the public meetings, the only way comments could be submitted during this period was through the ACAOM’s website. An extraordinarily bureaucratic, user-unfriendly website. My first clue that this process was not going to be “open, transparent, and welcoming” was when one of my patients, who was 77 at the time, got frustrated with the website and called the ACAOM to try to register her opinion. She said that she had trouble with computers, being 77 years old, and she wanted to give her comment; the Executive Director hung up on her. Loudly. Not accidentally. Nonetheless,  apparently enough comments got through, from enough young, computer-literate, nondisabled and otherwise privileged people, that in February 2008 the ACAOM adopted a “Resolution on First Professional Doctoral Standards”.

This part is very, very important. This is how defines “resolution”:


1. a formal expression of opinion or intention made, usually after voting,by a formal organization, a legislature, a club, orother group.Compare concurrent resolutionjoint resolution.

2. a resolve or determination: to make a firm resolution to do something. 

3. the act of resolving or determining upon an action or course of action, method, procedure, etc.

4. the mental state or quality of being resolved or resolute; firmness of purpose.

Sounds firm, formal, authoritative and clear, doesn’t it? It sounds like something you might actually believe if you read it. Your belief is key to the spectacular athletic feat that is coming up. And here is the resolution:

In the collective and unanimous judgment of the Commission, there is currently insufficient evi‐ dence of consensus within the acupuncture and Oriental medicine communities of interest, which in‐ cludes state regulators and legislators, educators, and the practitioner community, to warrant imple‐ menting a first‐professional doctorate as entry‐level into the profession. Absent such consensus, the Commission lacks authority to make decisions on whether or when first‐professional doctoral standards, policies and procedures are adopted for purposes of entry into the profession.
Be it resolved that the Commission urges the acupuncture and Oriental medicine communities of inter‐ est, as the primary conveners, to continue to seek consensus by whatever means deemed appropriate regarding the issue of a first‐professional doctorate as entry‐level into the profession.
Be it resolved that once consensus is reached within the profession, the Commission will renew its ef‐ forts to develop and subsequently pilot standards, policies and procedures for first‐professional doctoral programs in AOM as entry‐level into the profession.

My next clue that this process was not “open, transparent and welcoming” came with an anonymous phone call, the gist of which was that there were not going to be any efforts at consensus-building; instead the “public comment period” had been mysteriously re-opened, with no effort to notify those who had made comments before — at least those of us who opposed the FPD. “They’re hoping to get a different answer than they got before,” said my source, who happens to be inside the CCAOM, the ones who got this Olympic snowball rolling in the first place. 

And yet, I couldn’t really believe it. That’s what makes this performance world-class. I’ve been in the profession fifteen years, and even I didn’t really think this was possible. In fact, my partner called the Executive Director of the ACAOM to confirm that we were going to be submitting our comments correctly. He was adamant that there should be no phone calls, no emails, only letters and faxes. OK, we said; the rules sound clear, we can play by them.  

And then, suddenly, emails were allowed. A few weeks later, the ACAOM explained that the “FPD” was NOT ACTUALLY AN FPD, merely a “PD”, a “professional doctorate”. All this concern about a potential change in entry level standards? So silly, when “the question of a ‘Professional Doctorate’ vs. ‘a First Professional Doctorate” is not a distinction that is important from the perspective of accrediting agencies” (Dort Bigg, email, Jan 4, 2010). What is everyone so hysterical about? This has nothing to do with changing entry-level standards!

Quick, look back up at the top of this post, so that you can experience the vertigo as the goal posts are moved! Do you doubt your own sanity, just a little? That’s good, you are experiencing the Olympic-level mastery of confusion to which many bureaucrats aspire, but which so very few achieve! Before you get your bearings, listen to this: “the Commission has purposely not designated or adopted a specific “definition” for determining consensus for purposes of its review of the professional doctorate.   The Commission has many communities of interest including educators/educational institutions, practitioners and practitioner orgs, state regulators and members of the public, among others and need to take the views of all communities of interest” (Dort Bigg, email Jan 4). 

The true beauty of this is that the word “consensus” DOES have a definition. A very simple, specific definition, actually. Here it is, according to Merriam Webster online: 

1 a : general agreement : unanimity <the consensus of their opinion, based on reports…from the border — John Hersey> b : the judgment arrived at by most of those concerned <the consensus was to go ahead>
2 : group solidarity in sentiment and belief

Let’s translate that email out of bureaucratese into English: if you purposely don’t adopt a specific definition of consensus, it means you are not using the definition of consensus that everyone else is using, the one that’s in the dictionary. It means that you don’t mean consensus at all. It means you have moved the goalposts. Be it resolved…oh, never mind. Resolutions are so inconvenient.

And now for the finale! Let’s look at the February 2010 ACAOM Decision on First Professional Doctoral Standards:

“The Commission received approximately 3000 letters and petition signatures on the subject…”

2039 of those represented opposition to the FPD. We know, because we counted them. We photographed their delivery (there’s another story there).

“Based on this review the Commission, in its exercise of professional judgment, is satisfied that there is
sufficient support to justify the further development of first-professional doctoral standards.” 

Let that sink in for a minute. Sufficient support. So much for consensus, so much for do-no-harm, so much for transparency. So much for resolutions and respect and clear communication.

You win, ACAOM. You win, AAAOM. You write the rules however you want, and you win. You’ve moved me deeply; I didn’t know I could feel appalled anymore, but I can. Your victory brings tears to my eyes. Really. John Weeks nailed it when he wrote that this is essentially all about the conflict between service to patients and status for the profession. The people who want to be called “Doctor” just want it. They’ll never stop wanting it. They don’t care what happens to anyone else. Because you know, a good way to do harm to a profession is to lie to the people in it. Set them up. Gaslight them.  

You know, the one thing I wonder? Why you ever asked for input in the first place. No, don’t tell me; I’ll never believe a word you say.

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