Now is the time to have your voice heard about the First Professional Doctorate

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Comment by Benjamin Dierauf on November 27, 2009 at 11:30am

From the TCM Yahoo Group:

Societal cost of the FPD

Posted by: "Benjamin Dierauf" bdierauf@aimc.edu bdierauf
Wed Nov 25, 2009 1:48 pm (PST)

If the FPD were adopted, my sense is that most of the schools in CA would
drop their masters and go with the FPD because they already have a bloated
3,000+ hour program and it wouldn¹t take that much more to ramp it up to a
FPD. In other states, especially those that don¹t have herbs as part of
their scope and primary care as part of their standards of care, my sense is
that the majority of schools that aren¹t CA approved will stay with their
lean and mean acupuncture masters. An example of an exception would be
Tri-State in NY, which is already ramping up for the FPD.

Why is Tri State doing this? They are training their students to be able to
function in an integrative medical setting and get jobs in hospitals. While
its unfortunate that the title ³doctor² carries an inordinate amount of
weight in hospital settings, the crucial aspect of the proposed FPD training
is that AOM practitioners would be learning competencies to speak the
language and function in mainstream bio-med culture. From what I¹ve heard in
terms of actual placement of grads in hospitals, Tri-State has been the most
successful of all the schools so far. In contrast, the other programs in NY
that don¹t ramp up and continue with the masters would continue to produce
grads with the competencies to provide acupuncture care as an independent
practitioner and spend a year less in school.

I don¹t think that many schools would continue with both a masters and FPD,
it would be one or the other, and the competition would be between schools
lean and mean masters and other schools reaching for higher doctoral
standards. Some of the really large schools might try to keep both.

As far as how much this would cost, I¹ll speak from my experience as a Dean
at AIMC Berkeley and use our tuition/faculty/admin costs to extrapolate what
the additional costs for the proposed FPD would be:

As it stands with the current proposed FPD, a CAB approved AOM program needs
the same number of academic years (4), and requires 50 hours less clinic
(950 vs. 1,000). The increase of 50 clinic hours would cost about $790.

A non-CAB approved ACAOM accredited Masters OM program needs the same number
of academic years (4) as the proposed FPD and requires 150 hours less of
clinic (850 vs. 1000). The increase of 150 hours would cost $2,370.

There could well be additional costs for other programs, depending where
they are and what personnel they already have; this would include upgrading
an Admin to doctoral level (+$40K/year) and paying some faculty that teach
biomedicine more (+$25K/year). In terms of student tuition, my estimate is
that these additional admin/faculty costs increase student tuition by
$1,650, assuming 100 full time students attending for 3 calendar years. [=
(40K(3) + 25K)/100]

Given that a majority of students receive financial aid, I¹ll assume that
debt amortization would double these costs. Given the criteria above, we end
up with the estimated additional costs of the FPD coming out to:

For CAB approved programs the minimum student overall increase for proposed
FPD compliance:
$5080

For non-CAB but ACAOM approved programs the minimum student overall increase
for proposed FPD compliance:
$8000

As far as the societal cost goes as measured by the additional fees patients
would end up paying, we can look at a prototypical AOM practitioner that has
a 30 year career and sees 30 patients/week for 50 weeks per year and
calculate the additional cost per treatment. For those doing CAB approved
FPDs, this additional cost comes to a little more than 11 cents per patient
treatment. For those doing the non-CAB approved FPDs, the additional cost is
a little less than 18 cents per patient treatment. Given that the average
cost of treatment these days is about $70, we¹re looking at an increase of
0.16% to 0.26%.

For a prototypical CAN-style practitioner that has a 30 year career and
treats 100 patients/week, the additional cost per patient treatment is 3.4
cents for the CAB approved FPDs and 5.3 cents for the non-CAB FPDs. If we
estimate that the typical CAN-style patient pays significantly less, say
$20/treatment, we¹re looking at an increase of 0.17 to 0.27% for patients.

Both the current OM masters and proposed FPD would require 4 academic years
(= 12 quarters = 8 semesters = 9 trimesters = 36 months) to complete. As
outlined above the additional costs of the proposed FPD would be much less
than doing the 1,200 hour DAOM add-on, which, if the FPD were to be
established, would likely evolve into a post-graduate degree for those that
want to go really deep into the medicine.

The FPD is a complex issue and I¹ve been working on it for over 15 years
from both the professional and academic sides, and I¹m still learning new
things about it. While I personally think the proposed FPD should have more
rigor, ACAOM has set the bar low enough so that the transition would be
relatively simple and inexpensive. Its very much a worthwhile investment
that I think will eventually play a key role in the transformation of health
care in this country, as will community acupuncture (we¹ve got 2 clinic
shifts at our school doing CA) and they don¹t have to be mutually
exclusive!

Benjamin

Comment by Benjamin Dierauf on November 27, 2009 at 11:22am

Hi Jessica,

Ha! I was just looking; i didn't realize i had joined that Facebook group. Is that the reason you friended me ;-)?

Instead of the blanket term "dubious", could you be more specific? I do appreciate constructive criticism, and i'll publish the post above as the Yahoo group its on is for practitioners only.

I personally got a chuckle out of Zang Fool, and the humor is helpful in understanding the CAN mindset. However, I do have concern with the less than respectful tone of the CAN leadership. The reality is that we do have much more in common and the negative tone of is destructive to our profession as a whole.

Does CAN have an official position on a tiered profession? What do you believe are objectives that we have in common that we could work on together?

Benjamin

Comment by Valerie on November 27, 2009 at 9:51am

Jessica, you really find that blog to “prick, prod, and provoke both the imagination and the conscience of the acupuncture profession.” ? That isn't satire. Satire is supposed to be witty and funny. That blog is neither. It is insulting and demeaning and frankly it does nothing to open dialogue on an uncomfortable subject nor does it expose any weakness or flaw in the FPD plan.

I find it so disappointing to see such hate-filled diatribe on a site that's supposed to promote our profession. It's embarrassing to be even remotely associated with such people. The community style acupuncture treatment model is a great model but the community acupuncture network is hardly a community.

What's ironic abut that blog is that it very much mirrors the posting policies of the CAN site. To quote from your posting policy:

2. The CAN Forums are moderated more heavily than the CAN Blog, because the purpose of the CAN Forums is to help people understand and implement the community acupuncture business model; the purpose of the Forums is to be useful. If any thread, comment, or post is deemed by the CAN Board to be not useful, it will be deleted. If any CAN member consistently posts in a way that the Board deems not useful, that member will be banned and his or her membership revoked.

What is not useful, includes, but is not limited to: deliberately posting controversial statements to gain attention for the sake of attention, deliberately posting controversial statements to incite argument for the sake of argument, encouraging any member of CAN to behave more like Gandhi and/or Mother Theresa, disagreeing with fundamental premises of community acupuncture as stated by Board Members or founders of CAN, and defending or promoting any aspect of conventional/private room/boutique acupuncture practices and/ or “hybrid” practices. If you wish to do any of these things, you may do so on your own blog or forum, not here.

3. The CAN forums are not democratic. The Board is in charge of the discussion. The Board decides what is useful and not useful and is under no obligation to explain any of their decisions to anyone.

4. Challenging the authority of the CAN Board in any way, including challenging any moderating action, is grounds for immediate banning from the forums.

5. Constitutional rights to “free speech” do not apply to private forums. If the Board decides that you and/or your posts are not useful, you are out.

6. The standards for the CAN Blog are somewhat looser, because the CAN Blog is meant for public consumption. However, the same principles apply: the Board is in charge of the conversation. Challenging any Board decision is grounds for banning.

7. Summing up this policy, do not bite the hand that feeds you.

You can pretty easily take that blog and change FPD to CAN; change interns to posters and you've got an actual, realistic review of your "community" where it is very much "our way or the highway." I find that so unfortunate. I also find your comment about looking forward to our involvement in the discussions on your site rather odd, as you posting policies make it clear that if posters don't tow your line, they aren't welcome.

Comment by Jessica Feltz-Wolfson on November 27, 2009 at 8:52am

Hi Amy,
I am on the CAN Board of Directors and am also the Blogger Boss, and I approve of the Zang Fool’s message. Our bloggers are encouraged to “prick, prod, and provoke both the imagination and the conscience of the acupuncture profession.” The Zang Fool chooses to use satire to raise issues that most in our profession feel uncomfortable discussing.

On the other hand, our writers are not permitted to mislead their readers with dubious statistics, as in Benjamin Dierauf’s recent post to the Traditional Chinese Medicine yahoo group. (Thank you though for your support of our Facebook group, Ben.)

Our blogs and FPD discussions are all open to public comment. We look forward to your participation.

Comment by Amy Shouse on November 26, 2009 at 9:56pm

I deleted my initial post regarding this link b/c I was so floored by its content that my comment was probably a bit heated. So here I am to post it again after reigning in my initial reaction.

I wasn't going to come back and comment, I felt that I had gathered enough info from everyone and my two cents was pretty well spelled out as the thread progressed. But I am truly surprised at what you allow to be posted on CAN Tatyana. This is beyond the pale:

http://www.communityacupuncturenetwork.org/blog/4th-doctoral-year-curriculum-leaked

Does the Board of Directors not moderate the site? I guess I am just truly shocked at the depths that this poster has gone to insult not only MD's in general but to assume so many things about students who support the FPD, too many things to go in here. Tatyana, clearly you are not the person that wrote this post, but you represent the CAN community here at AIMC. Seriously, what is the deal? Why the mean-spirited-ness?

I wanted to leave this as a private message for you. Perhaps we can discuss this further that way?
amycshouse@gmail.com.

I was planning to sign up for your Community Clinic shift next trimester but I'm not so sure now. I want to learn about CA but this experience has turned me off.

Thanks.

Comment by Matthew D Bauer on November 24, 2009 at 4:26pm

Hi Sara - I have long felt that the acu-students were our profession's best hope as too many of us old farts are too stuck in past debates. I would be happy to communicate with anyone serious about these issues. I can be reached at acu.guy@gte.net

Comment by Sara Szmodis on November 24, 2009 at 2:13pm

If the both of you are interested in seriously having dialogue and reaching a cross-section of ears, I would suggest that you approach the AAAOM-SO. The student organization is full of bright, motivated, smart individuals who are interested in promoting our profession as a whole. Not only are they just beginning their professional lives in the medicine, but they're also going to be forging the road ahead.

Comment by Matthew D Bauer on November 24, 2009 at 2:01pm

Hi Benjamin,

I am posting here an article I wrote for Acupuncture Today that appeared 7 ½ years ago (April 2002 issue) that might help to show people how long this issue of schooling hours has been around. You will see that I tried my best to call for a series of summit style meetings with the involved parties to hammer-out an understanding. There was no response to that call because the involved parties were more interested in going to battle because they thought they could prevail over the other side. This was long before the Community Acupuncture people were part of this debate and they are by no means the only ones against raising hours.

You may recall that during the Little Hoover Commission process, I tried to warn those attempting to raise the hours here in California that the only chance they had of making that happen is to develop a tiered system. They would have none of it because they were determined to have only one license. They failed and got nothing. I am trying to warn you all again; there is not enough support for the FPD and too much opposition. The only chance of making this happen is a tiered system. Some people are just too involved with making their idea prevail and don’t see the reality clearly enough. The reality is a tiered system is the only way that sort of increased hours program has a chance to happen. I know this because I have never taken sides on these debates other than to try to point-out what I see as the realities before us. I am not against an FPD if I thought there was unified support for it but because I am happy to dialog with both sides in our profession’s debates, I know something about the depths of the divisions between the sides and I am trying to tell you once again that you can’t win this battle if you insist on one and only one license.

Best - Matthew

The California Debate: A Crossroad for the Ages
By Matthew Bauer, LAc
Legislation was recently introduced in California that, if passed, would increase the education hours required for acupuncture licensure in that state. Assembly Bill 1943 mandates California approved schools teach a minimum of 3200 hours by the year 2003 and then 4000 hours by 2007.
Currently, a minimum of 2348 hours is required. Sponsored by the Council of Acupuncture and Oriental Medicine Associations (CAOMA), a coalition of seven California acupuncture associations, AB 1943 represents the latest in a series of attempts by parties in that state to increase entry-level education requirements. Its introduction also represents the latest volley in a long standing feud between forces within our profession that are sharply divided over the issue of appropriate education hours.
The Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) together with the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) and the Acupuncture and Oriental Medicine Alliance, have opposed the movement to raise California's education hours. Representatives from all of these organizations - state and national -- have clashed in the past, and there is every indication AB 1943 will up the stakes in this struggle.
I have friends and professional acquaintances in leadership roles on both sides of this debate. Over the years, despite their differences of opinion, the organizations these people represent have accomplished great things in helping advance acupuncture and Oriental medicine in this country. But as their sphere of influence grew over time, these groups increasingly found themselves crossing paths, culminating in the showdown now taking place in California. Frustrated over the current state of affairs and regretting the inevitable drain of resources, both sides nevertheless feel they have little choice but to continue to fight for what they believe.
Watching this debate evolve over the years, I have maintained a neutral position as I truly felt both sides made valid points. As each side defended their position in various venues, several difficult questions emerged: what is the role of a licensing board; by what criteria should entry-level standards be established; what is the significance of primary care in licensing standards; and how important is the development of a single, national educational and licensing/certification system?
I have spent many hours discussing these questions with those at opposite ends of the political spectrum. I have come to believe that, like the spokes of a wheel, most of theses questions are connected to one central hub that we, as a profession, must focus on if we are ever to resolve the current impasse: How much Western medical training should acupuncturists have, and should they be expected to make a Western medical diagnosis in addition to an Oriental medical diagnosis?
Those in favor of increasing California's education hours feel the question of making a Western medical diagnosis is a done deal: California law, they state, already requires this of its licensed acupuncturists by virtue of their primary care status. Education hours need to be increased to allow, among other things, more training in Western medicine so acupuncturists can render the Western diagnosis they are obligated to perform. Those opposing an increase in education hours disagree, believing the "primary care" language contained in California statutes does not compel acupuncturists to render a Western medical diagnosis. Even if it did, some would argue, that is a mistake that should be corrected.
As stated above, both sides make valid points in defense of their position. Those opposed to acupuncturists being responsible for performing a Western medical diagnosis warn that publicly making this a requirement will leave acupuncturists vulnerable to the legal liabilities such a responsibility entails. Some also worry that even 4000 hours of training is not adequate to competently train acupuncturists to perform both Western and Oriental medical diagnosis. It is better, they state, to acknowledge our limits in Western diagnosis and train acupuncturists to learn when to refer to those who have thorough training. Those in favor of increased hours, in addition to their interpretation of California law, state that Western medicine is the prevalent medical system not only in this country but throughout the world. Insurance companies require Western medical diagnosis on their claim forms, and U.S. courts do not recognize Oriental medical concepts. Without better training in Western medicine, we leave ourselves more legally vulnerable. Besides, they argue, our colleagues in countries such as China or Korea train their acupuncturists more fully in Western medicine and few find fault with their training.
Interpreting California law is too complex and technical an issue to consider in this article. It also does not address the broader debate. Other states have likewise attempted to establish regulations requiring 4000 hour entry-level licensing, and there is every indication this trend will continue. The recently approved, nationally accredited, 4000 hour post entry-level doctorate program, so many years in the making, is another important consideration in this debate -- but its development seems to have hardened the resolve of those at odds with each other.
Acupuncture and Oriental medicine is the product of a science inspired by a worldview spawned in another time and culture. The amazing resiliency of this medical system and its current explosion of worldwide popularity is testimony to its enduring value. We live today in a time and culture dominated by a medical system produced from a science inspired by a different worldview. It is only natural that questions would arise about how to combine the two. These are questions of importance not only in California or nationally, but internationally. The history of acupuncture and Oriental medicine shows that, while the essential principals remained intact, shifting cultural trends have time and again influenced the way this healing system was practiced. Never before, however, has acupuncture and Oriental medicine faced a more challenging crossroad.
We need to appreciate the magnitude of the philosophic questions before us and not get bogged down with secondary issues. As we attempt to do in our practice, we need to address the root problem as the primary concern and not focus too much on various branches. I believe the only way we can work through this impasse is to hold a series of summit-style meetings with the root issue of Western medicine/diagnosis as the focus. Such a historic meeting would require an unprecedented expenditure of time and resources, but without such a commitment, I fear we are destined to expend even more resources fighting each other and getting nowhere. The founding fathers of our nation held such a meeting when they hammered out our Constitution. Many predicted that meeting would end in failure, but recognition of the importance of the issues inspired a resolve to work out differences at all cost. Where there's a will, there's a way.
________________________________________
The following past issues of Acupuncture Today (available online at AcupunctureToday.com in the Archives section) provide an interesting backdrop of information for the current situation in California:
• January, 2000 - Point-Counterpoint: Should the California Acupuncture Board Raise the Number of Hours Required for Licensure?
• May, 2000 - Are Acupuncture Schools and Colleges Providing Primary Care Education for California and Other Independent and Primary Care States?
• July, 2000 - We Get Letters
• November, 2000 - We Get Letters
• January, 2001 - Defining a Primary Care Provider
• February, 2001 - Educational Standards in Acupuncture: A Student's Perspective & Defining a Primary Care Provider, Part II
• May, 2001 - Scope of Practice
• August, 2001 - Spotlight on ACAOM's New Chair: An Interview with Terry Courtney, LAc, MPH & Update from the Council of Colleges of Acupuncture and Oriental Medicine
• October, 2001 - Demystifying Accreditation: An Inside Look at the Accreditation Commission for Acupuncture and Oriental Medicine
• November, 2001 - We Get Letters

Comment by Benjamin Dierauf on November 24, 2009 at 1:15pm

Hi Mathew,

I'd welcome a national dialogue on what a tiered profession might look like; it's an issue that's been on the back burner for quite a while. But we're a profession with limited resources and limited numbers of people that get involved, much less join and support their professional associations. Currently the focus is about hiring a national lobbyist and increasing our patient pool through inclusion in federal employees insurance and Medicare - and we're making amazing unprecedented progress.

As a young struggling profession it’s important to be unified. This doesn't mean that we have to agree on everything, but at the least it means that we need to listen to others opinions, present our own in a collegial and respectful manner, and continue a dialogue that can lead to the necessary compromises on both sides. Its not easy do this when you're being called a selfish/elitist/greedy. I'm not going to speculate on where this is coming from, but it does damage potential dialogue and is destructive to the profession as a whole.

This is especially critical if its going to be a dialogue about a tiered profession, where we're discussing how to divide up the proverbial pie and honestly figure out what is going to be in the best long-term interests of all the different types patients there are.

While I haven't served on any professional boards for a while, i do have relationships that i could use to advance the progress of a tiered profession. And in the bigger picture, the FPD and the development of a tiered profession are inextricably linked, with the FPD being the tier that requires the most education, followed by the masters, followed by the ear detox technicians - (the current DAOM would become post-graduate specialty study). From what I'm hearing from the CAN folks, it sounds like there might also be a place for a lean and mean acupuncture-only tier.

But if I go to the AAAOM board and say "let's start a discussion about a tiered profession to help the CAN folks", I risk getting thrown out of the meeting because, aside from all the potential conflicts inherent with a tiered system, I'll be asked "how can I be willing to help a group whose members can be so rude, demeaning, and destructive to the profession as a whole?” And I’ll have to say something like “there are important needs that need to be discussed, and that it’s important for leadership to put aside emotional attacks and start a dialogue that has the potential to promote healing within the profession”.

Since we seem to have the attention of some of the CAN board of directors: Would you all be willing to consider withdrawing your opposition to the FPD in return for:
1. A national discussion focused on developing the structure of a tiered profession? This could include committee meetings, blog discussions, panel discussions at their national conference, meetings between the 2 boards… If some sort of agreement were reached, it could be taken to state boards as the basis for starting a discussion about changing licensing acts.
2. ACAOM implementing a discussion and possible task force on developing standards for a lean and mean acupuncture only technical program? If a state were to change its licensing act, schools could then start teaching it for that state.

While these possibilities will happen eventually on their own, the pace of the process will most likely be defined by the quality of the dialogue and compromise that goes along with it. Can CAN dance the cancan together, and work on defining mutually beneficial solutions that aren’t mutually exclusive?

Benj

Comment by Sara Szmodis on November 24, 2009 at 8:30am

Right there? Right there where you say never the twain shall meet--maybe that's something of what's at the core of this entire discussion. While it's true that MDs and acupuncturists occupy partly different spheres, we're also, at least in California, all primary care providers which means that we interact on a pretty regular basis. It sounds like from your post and from the kinds of things that have been posted here that there is a sense of continuing some sort of insulation or isolation from MDs and Western medicine via avoidance of a doctoral degree. If that's what you want for yourself, then I say good for you--may the road rise to meet you. However, for my own mileage, I think we're in this together with Western medicine--through our patients, through the perceptions of the people who come to us from a Western medicine background, through our contact with MDs, RNs, NPs, and the many many others. Again, for my own mileage, I think that the most productive way forward for our profession is by continuing to provide outstanding care which integrates with the Western medicine that our patients may, have, or will be receiving. While I could hold onto all sorts of idealized visions of how I would like my interaction with Western medical professionals to be, the fact is that in that arena, degrees matter. Knowledge and academic rigor matter. And if I or anyone else would like to pursue this level of learning, I don't see what the problem is and I've not heard anything yet to make me think otherwise.

Since it's already pretty personal around here, I'm happy to address your parenthetical comments. Like many people at AIMC, it took me a while to come to the medicine. I did other things first and had other ideas in mind for my professional life. You could choose to view this education as wasted or unnecessary but if you knew me outside of this board, you would know that I don't see any education as wasted, unnecessary, or even without use. From the first MA I got all of the doctor-patient work I was talking about as well as the public speaking skills that I teach and use today. From the second, I got, possibly, the best humanities education I have ever had. I learned what academic rigor and work are. I got to know Agnes, who was the sole surviving member of her family to be released from Auschwitz, who survived political turmoil in Hungary, and emigrated to the US, who teaches every one of her students to enjoy and revel in the learning process. (As an aside, if you ever have the chance to do graduate work at the New School for Social Research in NYC, take it--it's worth every penny). I tend to be a cashout sort of a person, interested in the cashout value of what it is that I'm up to and the cashout from all of my education has been that even though I'm no longer on an academic life track, I couldn't have gotten here without all of it. It all makes me a better, more prepared practitioner in terms of dealing with people. So now here I am, working toward the thing I want to be doing and as one of those wise faculty once told me, "If you want something, you want everything that goes with it." I want to be here, so I want the education that goes with it.

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