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

Comment

Comment by Tatyana Ryevzina on December 3, 2009 at 1:16pm

So I have been away for almost 2 weeks and boy, has this thread been hopping! I appreciate everyone’s input and am particularly thankful to my CAN colleagues and comrades for keeping the conversation going in my absence. Currently, I feel (as many CAN members and leaders do) that ultimately my time is best spent doing my part working to defeat the FPD rather than keeping arguments going here, but I suppose as the person who started this blog, I would like to say a few words in response to several folks here:
To Amy – FYI, I LOVE Zang Fool and yes, I think his posts are very appropriate for CAN. If that makes you see me as a terrible teacher, feel free to skip being my student. I would certainly not want you to be in a learning situation that you find offending, nor is it likely that I would have time to process a lot of personal feelings during my clinic shift. I expect that the students who register for my clinic shift are interested in practicing in a community acupuncture clinic and want the training experience on how to do that. I do my best to offer that to them, as someone who is running such a clinic and has figured out a way to teach this. One of my former students recently got a part time job at a community acupuncture clinic after graduation and she was reportedly very grateful for the training and my positive recommendation to her current employer. The way we work on my clinic shift is really different from other shifts and I set up very specific boundaries and expectations for my students. They are there for the sake of training and for the sake of providing good care to our patients. You do not get to do what you might call “integrative medicine” (I think that phrase is a buzz word, personally). You might talk some more to the students that have already taken my shift and then decide if it is a fit for you.

To those that are accusing CAN of being rigid and not willing to converse or bargain on the tiered licensing option: (as Matt mentioned here): There is NO tiered option on the table at this time, so any discussion of this while the FPD is being pushed forward is a fantasy-land scenario. Plus, the FPD proposal is in direct conflict with the tired licensing vision, since it is being put forward as an entry-level degree. The FPD has to be off the table for any real discussion to begin around tiered acupuncture education. I think this is what Jessica was trying to convey. This is not a CAN temper-tantrum or ultimatum or whatever you wish to call it, it is just plain logic. I agree that overall tiered licensing idea is one that CAN would be on board with, but we have to see a real possibility of it, and some details of what that would mean, and that is not possible while the FPD is being considered. So I would not expect CAN to do any kind of bargaining at this time. In the meantime, if you are curious about some of the ideas that have been thrown around on CAN about what acupuncture education could look like check out these posts:
http://www.communityacupuncturenetwork.org/blog/fluffn-stuff
http://www.communityacupuncturenetwork.org/blog/wishing-and-hoping
http://www.communityacupuncturenetwork.org/blog/if-i-was-going-start-my-own-acupunk-school

To the folks that have fixed it in their mind that CAN is an enemy because they are hate-filled, venomous, rude, offensive, etc. I see this as a way for you to shrug CAN off, and a way to look down on CAN leadership as inferior, unprofessional, riff-raff. I urge you to dig deeper, beyond tone and think about the meaning of what we are saying and perhaps think about WHY we are saying these things. CAN is not a hate club, but it is a focused organization with a very specific mission and clear goals. We have set forth these goals and we have lots of work to do to achieve them. That is the reason CAN has strict posting policies – we want to stay on track. We learned the hard way how much time and energy some of the arguments we wound up getting into with acupuncturists suck up. We learned the hard way that we cannot take care of hurt feelings of every CAN member, nor is it a productive thing to do. If you join CAN and check out the forums, you will mostly find that members support each other more than any other acupuncture professional group. In fact that was what drew me to CAN in the first place, the openness, honesty and support of the community. I found resonance, people who were discussing real issues openly and sincerely. Sometimes there are disagreements, but they also are very educational because they touch on real issues and thus help us all learn something useful.

There is anger on CAN, and it is also a very useful thing. If you want to understand better why CAN seems so angry, read these:

http://www.communityacupuncturenetwork.org/blog/guide-understanding-cans-anger-any-member-acu-establishment
http://www.communityacupuncturenetwork.org/blog/understanding-cans-anger-redux

So why do we care about acupuncture education and FPD? Well, we really really want more people to be able to afford regular acupuncture. We really really want to increase the class and ethnic diversity of the acupuncture world – both practitioner and patients aspects. We really really want acupuncturists to be able to make a living giving acupuncture to their communities. Many of us have grown busy community clinics and have started creating actual jobs for acupuncturists (such the hateful monsters we are). We are finding that the practitioners that the current schools trained are mostly not well-suited to work in a community acupuncture clinic and that good help is extremely hard to find, even with all those unemployed acupuncturists running around working 4 other jobs to make their loan payments. We are finding many acupuncturists after graduation are really burned out and tired from the rigors of their boated training programs, very heavily in debt from the expensive bloated degree they just finally attained, freaked out about their future, have no idea how to start and run their own practice. Somehow adding on more educational requirements to this already very sick situation does not make any sense. It’s like “tonifying a stagnation / evil” instead of breaking it up.

There are many more things I could say to a bunch of you here, that’s enough for now.
Dig deeper folks, examine your intentions.

Comment by Matthew D Bauer on December 3, 2009 at 8:34am

Hi Jessica and thanks for your support of my public outreach ideas. You asked why this has not been discussed before in the “acupuncture establishment?” I actually first proposed this type of campaign to the original AAAOM Board of Directors in 1991 and they approved the idea! Unfortunately I was unaware that they were undergoing a crisis in leadership at that time and was really only an organization in name and when I tried to follow-up and move the campaign forward – no one was home. Since that time, I have proposed this campaign to several different leaders of the professional organizations and while all of them said it would be a good idea, they also said they were too busy with other projects. I finally found a strong supporter for this in Michael McCoy when he was the top administrator of the Acupuncture Alliance (although it took Michael one year to come to the conclusion this was needed.) He and I were working on laying the groundwork for this and a strategy for approaching the other acu-organizations, but then the merger happened and Michael was out.

Long story short: I have tried on many occasions to get the leaders of these organizations to seriously consider this but got nowhere. I thought many times about “taking this public” – appealing to the rank and file acupuncturists as I have now done on my last post, but I held back because I did not want to criticize the leadership of these organizations because I really do respect their very hard efforts. I hoped they would see the value of this and then they could take credit for doing something really important for their membership – putting patients in their member’s waiting rooms.

I did send word of my posting here yesterday to Rebekah Christensen of the AAAOM, someone I consider to be one of the most able administrators ever in an acupuncture membership organization. I also plan to send my article to some others I know in leadership roles, but I have no idea how it will be received because I am essentially stating that there needs to be a significant shift in priorities and such criticism – no matter how respectful and constructive I try to make it - may not be well received.

I have let the cat out of the bag now and we will see where the chips fall. I really do ask that anyone out there hearing of this who thinks our organizations should at least give this very serious consideration, please speak-up and let yourself be heard. Pass this along to others you know. Contact your school’s administrators and the leadership of your professional association. If you don’t belong to a professional association, let them know you would join if they got behind this sort of campaign. I have been ready to lay-out this strategy with our leadership for 20 years and hope I may finally get the chance to do so

Comment by Jessica Feltz-Wolfson on December 3, 2009 at 7:25am

Matthew, I love the idea of an educational/marketing campaign!

My God, look at what that’s done for pharmaceutical companies: Remember the “little purple pill” campaign? More than 7 million Americans now take Nexium, and IMS Health reports that it earned more than $5 billion in US sales in 2006. All from an educational/marketing campaign that told patients to ask their doctors to ask about the “little purple pill.”

Nexium’s advertising campaign didn’t describe what the pill did or who would benefit from it. The campaign didn’t discuss the side effects or risks of the pill. The campaign didn’t tell the public how long the pill had been in trials, or what kind of testing it had undergone, or what the results of various studies were.

The public doesn’t care about any of that.

In the same way, our patients (i.e. consumers) do not care how long we have been in school, or what classes we have taken, what our degree is, or even what the results of various studies are. They do not care if we operate in hospitals or in community clinics. They do not care what we are called. None of the things that this FPD campaign are focused on will have any bearing on the general public’s awareness or usage of acupuncture.

But imagine what an educational/marketing campaign could do!

Think about the “Milk. It does a body good” commercials. In the 1980’s, the Dairy Board's advertising agency designed a campaign around this message, because consumption of milk had been steadily declining at a startling rate. Within 36 months it had reversed the trend, and milk's share in total beverage consumption rose for the first time in five years.

Why on earth hasn’t this been discussed before in the acupuncture establishment??? Many community acupuncture clinics have already implemented brilliant local campaigns in their towns with minimal budgets…this should be a no-brainer for the national orgs.

“Now is the time to shift the focus of our efforts to direct outreach to the public. You remember the public. They are the ones our efforts were supposed to be about in the first place.” Here, here! Thank you for the contribution, Matthew.

Comment by Matthew D Bauer on December 2, 2009 at 10:05am

Hi Benjamin,

Thanks for your apology I of course accept it and this matter is behind us now. The funny things about this was I was just getting ready to contact you and ask that we communicate some between ourselves because I have always felt you and I actually share many of the same sensibilities about how to try to resolve issues. The reason I stress the inability of our organizations to engage the profession is that I actually think there has been a major mistake made over the years in the way our professional associations especially have prioritized their limited resources. By way of explaining what I mean by that statement, I am including below a draft of an article I wrote that relates my passion for this missing piece of the puzzle to the FPD issue. This is just a draft and I doubt I could get it published anywhere as it brings-up criticisms I have toward those organizations. I thought of sending this to ACAOM as my feedback about the FPD but have not decided this yet. Sorry it is a bit long but the subject matter warrants it. I would appreciate your feedback and well as that of others on this blog.

Matthew

Balancing Top-Down with Bottom-Up

I want to offer my opinion on the First Professional Doctorate (FPD) and why I am opposed to moving forward with this plan at this time. As you will see, my opposition to the FPD is directly tied to my belief that there is a much more pressing issue the Acupuncture and Oriental Medicine (A/OM) profession should be undertaking right now.

What if I told you that there was a project the A/OM profession could carry-out that would do more to unite our profession than anything else we could do rather than dividing us as the FPD is doing? What if I also told you this project was the best possible way to directly benefit A/OM practitioners and the public by generating hundreds of thousands of new patients seeking-out A/OM services? What if I told you that in the process of carrying-out this project, it would build our professional associations by putting new patients in their members’ waiting rooms, generating gratitude and support toward those associations? What if I told you this project would help our schools by allowing them to tell prospective students something they cannot honestly tell them now: “Come, join our profession and enjoy a stable income while helping others.” And what if I told you this project was completely within our means and would start paying dividends within months? Don’t you think such a project should take priority over those like the FPD that take years to accomplish their goals and drain much of our profession’s resources? The project I am referring to is a comprehensive public outreach campaign

Many Americans are interested in acupuncture but know very little about it or other aspects of Oriental Medicine. They know even less about those who would be poking needles in them. Most Americans don’t even know that acupuncturists need a license to practice! This lack of understanding has greatly damaged the growth of the A/OM field especially individual practices. When I would point this out to different leaders of A/OM organizations over the years, they all told me they thought public education was important but most their efforts to address this problem ended-up targeted in the wrong direction. There have been several efforts made to educate political, insurance industry, and medical leaders about A/OM but absolutely no coordinated campaign to directly educate the public. In other words, we have been following a top-down approach; lobbying leaders in the hope they will change policies that will eventually trickle-down to benefit the public and practitioners. Evidence shows these efforts have failed to generate an adequate patient-base for A/OM practitioners leading to many failed practices.

In the National Certification Commission for Acupuncture and Oriental Medicine’s 2008 Job Training Analysis (JTA) of NCCAOM Diplomats, they found nearly 90% of respondents to their survey (88%) were in solo private practice and that the average annual gross income for all respondents was between $41,000 to $60,000. 70.1% grossed under $61,000, 21.1% grossed between $61,000 to $120,000, and just 8.8% grossed over $121,000. When you are in private practice, a pretty good chunk of your gross income – at least 25% to 40% - is eaten-up by expenses such as rent, utilities, advertising, supplies, insurance, etc. When you subtract those expenses from the gross income, this brings the average before tax income of nearly three out of four Licensed Acupuncturists to somewhere in the $30,000 to $40,000 a year range at best. It is hard to imagine enjoying a comfortable living on those wages especially considering that 50% of those surveyed were carrying an average of $40,000 in student loans from their schooling.


These dismal statistics show relying on the top-down approach alone is not working. We spend most of our resources lobbying politicians and fighting amongst ourselves over things like education standards and then spend almost nothing on reaching-out directly to the public. The dental profession has an outreach program with their 1-800-DENTIST campaign. Why do the dentists do this? Because they know people are afraid to go to just any dentist so they work at making the public feel more secure in making first contact. If the public is worried about selecting a dentist they don’t know, imagine how they feel about seeking an acupuncturist, especially considering they know nothing about our training. Yet despite this glaring need to reach-out to the public, we dedicate no resources to directly easing that fear. There is no reason why the A/OM profession couldn’t have its own outreach campaign.

It’s said: “Where there is a will, there is a way” but up to this point there has been a lack of will within our leadership to make this type of public campaign a priority. Think about what happens when there is a positive story about acupuncture on T.V. or in some magazine. Many acupuncturists start getting phone calls from people wanting to know more. Virtually all of these media reports about acupuncture take place spontaneously because some media person thinks such reports would be of interest to their viewers or readers. Now imagine how much more publicity could be generated within the media if our A/OM organizations were devoting themselves to developing a comprehensive media campaign. It is foolish to just wait for these things to happen by themselves, we should be making this happen. Acupuncture is newsworthy. People are fascinated by it. We need to cultivate this interest and get our message out there in a coordinated way.

Taking Responsibility

When you understand the organizational infrastructure of the A/OM profession, it is clear just what organizations should be responsible for a public outreach campaign: the professional associations and schools. As our lone national professional membership organization, the AAAOM should be taking the lead in this campaign together with state professional organizations and with the help and financial backing of the schools. These groups have consistently put most of their resources in the top-down approach so making public-outreach a priority will require a change in their traditional mindset. The emphasis on the FPD issue is a good example of why this mindset needs to change.

The most compelling rational given for undertaking the huge effort of establishing the FPD is that it will better prepare those with that training to work within the mainstream medical system, especially within integrative medical establishments. While this goal is certainly laudable, it shows a complete lack of awareness of the realities facing the A/OM profession today. The NCCAOM’S JTA found 88% of acupuncturists are working in private practice and only 12% are employed in hospitals, multi-disciplinary centers, schools, and the like. What the leaders of the FPD movement are saying is that they want to expand this 12% to make it possible for more A/OM professionals to have those types of jobs. The problem with this approach is that it does nothing to help the 88% out there today in private practices who struggle to keep their heads above water. The FPD is a complex, multi-year undertaking that holds the hope of creating more opportunities some day in the future. Pinning our hopes for growth by focusing our limited resources on future hospital and integrative center jobs is essentially giving-up on supporting private practice. We end-up putting everything into growing the 12% instead of helping the 88%.

If our profession was seeing most of our A/OM schools’ graduates transitioning into successful private practice, then it would make sense to try to build the job base currently enjoyed by that 12%. I am all for integrative center and hospital jobs for A/OM professionals but our resources are limited and this is not the most pressing issue our profession faces. We are ignoring the issue of putting patients in A/OM practitioner’s waiting rooms today in favor of those future jobs. We need to shift a healthy share of our resources to direct public outreach. Getting patients into waiting rooms is something we could see start to happen with a few months of a public outreach campaign and this would help the three out of four practitioners who are struggling right now.

Our organizations’ leaders will undoubtedly say that we don’t have the money to do any education/marketing but this shows a lack of vision. We have some 60 acupuncture schools today and if each were contributing just $500 and month over the next few years, this would give us a $30,000 a month budget. I guarantee you we could put hundreds of thousands of patients in practitioners’ waiting rooms over the next few years with that budget. Even if we had less money available to us, it won’t take a lot of money to make great strides in promoting A/OM directly to the public. Getting articles published in the print and electronic media is more about planning than money. We could accomplish a great deal with innovative marketing campaigns on very modest budgets that will translate as more patients for more practitioners today.

Students and alumni of schools and members of professional associations need to ask the leaders of these institutions why they have seen fit to leave public outreach for another day while so many A/OM professionals are hurting. Start demanding more be done on this issue. Consider the A/OM profession like you would a patient. When treating patients, one needs to learn when to shift the focus of the treatment to address the changing levels of imbalances. The A/OM profession needed the top down approach in our early years to make us a legal profession in most states and establish our infrastructure with regulators. We should all be very appreciative of the work that was done to establish this infrastructure, but it is now time to shift the focus of our efforts to direct outreach to the public. You remember the public. They are the ones our efforts were supposed to be about in the first place.

Comment by Benjamin Dierauf on December 2, 2009 at 9:12am

Hi Mathew,

I apologize; I didn’t state that well. Matthew was very articulate in his communication with Little Hoover, and I’m sure that’s why he was selected. It’s just unfortunate that they didn’t also pick at least one association rep from CAOMA (the umbrella organization representing all the various language based associations in CA) to help with the process, too. It’s funny we're finally talking about this now. (For my part, i was younger, idealistic, and more single-minded, and now wish I’d reached out to talk to you more at the time.)

Because of the lack of representation from professional associations, I disagree with the assertion that Little Hoover was fair and inclusive. I remember the first meeting as having about half association reps and the other half various acupuncturists. It was a diverse group, including some characters who took up a lot of bandwidth. The process was frustrating for me because I felt the professional associations’ positions were not getting communciated well. The public hearings after that were good, as everyone got their say, but Little Hoover then went behind closed doors with their panel of experts to hammer out their report. There should have been a rep from CAOMA representing the diverse cultures and ethnicities of our profession. Not including all of the major stakeholders in that final step doesn't strike me as fair and inclusive, and this damages the report’s credibility.

As far as the work of CSOMA goes, I feel confident that in my role as a leader at the time of the largest CA professional association we did our best to reach out and communicate with the CA profession through journals, newsletters, panel discussions, email alerts, etc. Sure, there were some things we could have done better, but on a volunteer basis we put a lot of time, money, and jing into protecting and advancing the profession at the expense of our families and practices. Yes, our overall percentage membership was lower than we would have liked in relation to the profession as a whole, but most of the non-member LAc's i spoke with were still supportive of what we were trying to do - or just didn't care (sigh). Aside from Little Hoover, our successes included:
- Removing the sunset clause from participation in Workers Comp
- Becoming Primary Treating Physicians within the Workers' Comp system
- Protecting acupuncture coverage under MediCal (supported by our primary healthcare status)
- Clarifying our scope of practice to prescribe herbs and nutritional substances, and expanding it by adding magnets
- Protecting our scope of practice by preventing chiros, nurses, PT's, etc (except MD's - who can do anything) from practicing acupuncture
- Increasing educational standards and training

I have no doubt that if you did a survey of CA acupuncturists from that time they would be highly supportive of these accomplishments.

Benjamin

Comment by Matthew D Bauer on December 1, 2009 at 1:18pm

I hate to muddle the discussion here but a line has been crossed and I am going to demand that Ben issue an apology to me for publicly stating a lie that harms my reputation. Ben, you stated that in the Little Hoover Commission process “the group that ultimately made the decisions was composed of insurance company execs, MDs, and an acupuncturist that didn't represent any association in CA (Mathew!)” This is completely untrue and Ben has not one shred of evidence otherwise. I was not part of any group who “made decisions” for the LHC. In fact, I never even had communication with the LHC’s Chairman, Michael Alpert, as did some of the leaders of the California acupuncture groups. The reason I respect the LHC is exactly because their process was so fair and inclusive. Everyone who wanted to be heard had an equal opportunity to do so. They are real professionals who take on far more complex and important issues than the childish infighting that plagues the A/OM profession and they played no favorites in that process.

It is true that toward the end of the public part of the LHC process, I was invited to partake in a group that was to consider issues related to scope of practice and it is also true that none of the “leaders” of the California organizations were invited to that group and it is certainly true that they were (and apparently still are) “pissed” over that. They were so pissed they threatened to crash the meeting and it had to be canceled over security concerns and a golden opportunity to explore scope issues for the A/OM profession was missed. One of those invited to that meeting was a professor from Harvard who is an expert on these matters and would have no doubt been a great help.

I don’t know why I was invited to that meeting and others were not. I always suspected that someone involved with that decision thought I would be a constructive addition to the process and others would not but that is just a hunch. I never had any secret deliberations with the LHC honchos to learn why they did what they did. There were no back room meetings to plot against the California organizations. I can only assume Ben may have thought this to be the case because that is the way many of the California groups were operating back then and perhaps still do.

When I addressed the LHC at their first public meeting I was asked if I supported increasing training hours and I replied that as far as I was concerned you could just “toss a coin” as I cared far less about what path we took as long as we took it together. I then offered my observation that this issue was not one most acupuncturists cared or even knew about but was being fought between a small number of leaders of organizations. A commissioner then asked if I was saying this was an “Inside the Beltway” type of issue and I said yes, that if you looked at the audience attending this important first public hearing, it was only the heads of the organizations present – virtually no rank and file acupuncturists were there.

This has been my problem with how these groups operate. Ben talks about the “profession’s perspective” and how I did not “represent any association in CA.” None of these groups truly “represent the profession.” If they did I would go along with their policies. None of these groups have memberships large enough or in any way INVOLVED enough to claim representation. That is the problem. They have failed to engage the profession and even their own memberships but then want to take action anyway and claim that “they” represent the profession and people like me don’t count.

The reason I have not aligned myself with ANY organization was because I refused to be drawn into turf wars – I still do. Up until the last LHC work group meeting, I was able to perform a delicate balancing act of communicating with both sides because I did not choose sides. But when I did not stand-up to be counted with the California groups I was told to my face “You’re Out!” and they have been pissed at me ever since. Childish. As far as they were concerned, if you weren’t with them, you were against them and my neutrality wasn’t good enough.

The LHC recommendations played no favorites and even found the CALE (California licensing exam process) to be superior to the NCCAOM’s dispelling any myth about the national groups undue influence over the process. The process was open and fair and they heard what Ben and the others had to say - they just did not agree. But the groups here in California, so used to getting their way, simply could not accept that and resorted to unfounded conspiracy theories and protests of not being heard and now – slanderous charges naming me by name.

So Ben, we can agree to disagree but you have made a false charge against me and I want you to retract it and apologize.


Matthew Bauer

Comment by Sara Szmodis on December 1, 2009 at 12:34pm

Hi Larry:

I couldn't help but stop to read your lengthy post. You wrote:

Exactly how are we trying to stop the FPD conversation? As I think you know, the CAN website has been conversing about the FPD non-stop for nearly 2 weeks. We are hardly trying to prevent conversation. In fact, it is my opinion that there would not be an FPD conversation happening at all, if not for CAN. Contrary to stopping the conversation, we are inciting it. It is a clear opportunity to delve into a broader discussion regarding AOM study, practice and care, set within the context of race and class.

If you really think that the behavior exhibited here under the guise of discussion is simply inciting said discussion, then I worry for you and the entire CAN contingent. So far in this thread alone we have had multiple members of CAN leadership post in ways that are clearly and unapologetically venomous, hateful, and with no regard for the opinions of others. As I said below, the modus operandi for what's been demonstrated here appears to be "my way or the highway." That isn't inciting discussion, it's bludgeoning about the head and shoulders those who do not fall into line with your way of thinking.

So far in this thread alone CAN representatives have implied and outright stated that those who support FPD are selfish, racist, classist, and and a detriment to patient health. If this is the way that CAN would like to do business, then I can't see how anyone will get what they want, including CAN.

What is so difficult about putting down the offensive languaging and sitting down at the table like adults to discuss this issue rationally?

Comment by Jessica Feltz-Wolfson on December 1, 2009 at 12:17pm

Dear Zhang Zhong Jing ~

I have to say that I was very surprised to discover that you had risen from the dead in order to wade into the FPD debate. Obviously I have great respect for your work. So please forgive me for saying that the following letter, which you posted on the Internet, does not quite measure up to your previous achievements as a writer. Your arguments in support of the FPD are about what I would expect from someone who has been dead for a couple of millennia:

Dear ACAOM Commissioners,

I’m writing to express my support for continuing the discussion on developing a First Professional Doctorate. I believe that the FPD is critical to the future growth and strategic positioning of the AOM profession for the following reasons:

1. The additional biomedical learning competencies would better position graduates to get jobs in integrative clinics and hospitals, providing more access to AOM care for patients who really need it.
2. In our culture the doctorate title provides a higher level of respectability to the AOM profession from both patients and other health care providers.
3. The FPD would help protect and better support our scope of practice in state legislative and regulatory bodies.
4. Besides opening the possibility for more jobs in the health care sector, a FPD opens access to seats at the table of policy-making bodies that make decisions on how our medicine fits into the health care system.
5. Future students would have a choice in whether to pursue the current three academic year acupuncture Masters, four academic year OM Masters or a four academic year FPD.
6. Future students that would otherwise be attracted to pursue a DC/ND/MD might choose an AOM career instead.

I also support the development of a transitional FPD for currently licensed AOM professionals and students that takes into account such factors as the program from which they graduated, their professional experience, and post-graduate learning endeavors. A transitional FPD should be affordable, accessible (with distance learning options), and include challenge exams as part of the process.

According to the recent AAAOM profession on the FPD, 65-70% of those who expressed an opinion were supportive of the FPD in Acupuncture-Oriental Medicine (http://acupuncturetoday.com/mpacms/at/article.php?id=32093). This clearly demonstrates enough support to continue the discussion about developing the FPD, and I strongly encourage ACAOM to do so.

Sincerely,

Zhang Zhong Jing

I think the problem here is that, quite understandably, you don't get what's going on with the FPD debate. Having been incorporeal for so long, your perspective will naturally be a little different from those of us who are involved in this issue on the ground, us flesh and blood mortals who need to make a living and pay our bills. You're beyond all that and have been for a long time. So I hope you won't mind if I try to catch you up a little.

The medicine which you love has been having a hard time here in twenty-first century America, particularly around the issue of professionalization. This article provides an excellent summary of our struggles in the recent (to you, at least) past. But things have been changing even since that article was written. That's one of the challenges of our time: things change fast. We're arguably in the midst of several social and economic upheavals that profoundly affect the prospects for acupuncture in America.

We don't know much about your life. I hear you may have held "an official position", which I'm guessing means that you had a job. I don't know hard it was for you to get that job or keep it, or whether you had any anxiety about supporting yourself or your family, if you had a family. So I don't know how this will sound to you, but I need to speak to you very bluntly about jobs, money, and acupuncture in the present time, because that's the area where your FPD arguments really fall apart.

Everything in our society is shaped by the way it is paid for. This might have been true in your day as well, I don't know. To understand how something works, you have to look at its funding stream. A very eminent acupuncturist of our time, Dr. Michael Smith of NADA, commented that it has been hard for America to understand acupuncture, but it's easy for America to understand schools. And so, as people (and by this I mostly mean white people in this context) became interested in establishing acupuncture among other (mostly white) people, they concentrated on making schools. They concentrated on making schools to teach acupuncture more than they concentrated on the actual mechanics of how practitioners could PROVIDE acupuncture.

Because it is easy for America to understand schools, soon after the acupuncture schools began to be established, an easy funding stream was found for them in the form of federal student loans. Now, I'm sure you didn't have those back in your time. Basically what it means is that people who want to become acupuncturists can borrow money in order to go to acupuncture school, with the expectation that once they become acupuncturists and are working, it will be no problem for them to pay it back. But there is a problem, of course, and it's that the mechanics of how practitioners were to provide acupuncture in American society remained shaky and unformed, particularly the economic aspects -- even as the schools became more and more organized. I know this because I was there for much of this organizing process. When I went to acupuncture school, my class was only the second class to receive a Master's degree or to be able to take out federal loans. Everyone was excited about this development, but in hindsight it is obvious that no one had the faintest idea about how those of us who got those degrees were going to make a living.

Among certain social classes in America, money is kind of an unseemly, awkward topic. It's not polite to bring it up. I come from a social class in which talking about money is natural and expected, because we have so little of it, relatively speaking. We have to talk about it; we don't have a choice. When I first started bringing up the details about the economics of acupuncture in America -- were practitioners really making a living? who could afford to pay for acupuncture at the going rate? -- many of my fellow practitioners treated me as if I had violated a taboo, as if I had taken all my clothes off in public. There was a definite if unspoken message that I was doing something sort of disgusting by trying to provide acupuncture cheaply to my friends and neighbors. (Even that word, "cheap", is loaded in our culture). Anyway, I got the message that I was both dirty and out of line, and I learned that there was no possibility of having these conversations politely. Which turned out to be all right in the end, because some of the economic structures of the acupuncture profession, as it has evolved in America, are so ugly that being polite about them is no longer appropriate.

So let's talk about your arguments.

1. Adding more biomedicine into the curriculum will make it easier for graduates to get jobs in hospitals. Oh Zhang Zhong Jing, you're centuries and centuries old, how can you be so naive? Do you not understand that the healthcare system in America, especially as represented by hospitals, is a for-profit system? Remember what I said about the shape of anything here is determined by its funding? There is no profit in acupuncture. Even though it works at least as well as many drugs, it can't be patented. Funding for hospital jobs is inextricably tied up with the funding streams of the pharmaceutical companies, the insurance companies, and all the other for-profit companes that make up American healthcare. Acupuncture doesn't make anybody's shareholders any money. Sure, there may be a handful of jobs for acupuncturists in hospitals who want an integrative "flavor", but we're not talking about more than a handful. And if you really want to bring up this discussion, you need to stay current with John Weeks' blog. You might be especially interested in all the posts that talk about how many integrative medicine initiatives fail because their funding streams collapse.

2. In our culture the doctor title provides a higher level of respectability from patients and other health care providers. OK, I can see how even if you were floating incorporeally around the Internet, and you found Linda Barnes' article, you might believe, as many acupuncturists believe, that doctors are the gatekeepers, and if doctors respect us, we will be able to participate in taking care of patients within the health system. That isn't true anymore. Doctors aren't the gatekeepers of healthcare in America, insurance companies are the gatekeepers. And what happens in healthcare is no longer about who gets respect, but about what makes a profit. Having a title does not help us to create a funding stream for our work; titles and funding are no longer inherently connected. Ask all of the folks with doctoral degrees who are vainly trying to get their "evidence based medicine" into actual practice.

Also, while you might be hoping to magically conjure power and authority by means of using a name, names don't work that way in our current economic reality. Not even yours. Ahem.

3. Scope of practice, regulatory bodies, etc. You're showing your age here again, Zhang Zhong Jing. The acupuncture profession fought the battle of independent licensing a long time ago (mostly, though not everywhere) and won -- but stands to lose the war over, well, our long-term existence. In this day and age, it's not about legislation, it's about economics. For the majority of licensed acupuncturists in America, their scope of practice, however well defended and supported by titles, is like a beautiful fantasy, because they have no actual patients to practice ON. Our own lack of an economic foundation for our profession is our problem, not what other people will let us do.

4. FPD opens policy doors, how our medicine will fit into the healthcare system, etc. Maybe you can't believe this, because it's pretty hard even for us to believe, but America is rapidly going broke trying to pay for health care. In this climate, nobody is going to be adding new modalities. I know, I know, we could save them money -- but the ones who are in true control of the system, who are making money, don't care. And the ones who aren't in control see acupuncture as a luxury, as fluff, as something exotic for rich people to pamper themselves with -- maybe because, I don't know, American acupuncturists themselves have been busy marketing it that way? And even if we got a seat at that table, as one of my colleagues pointed out recently, it's a filthy table. It's actually killing people.

5. Future students would have a choice. They have a choice now. If they want a doctorate, they can get a DAOM. Making the doctorate entry-level is what makes those of us opposed to it so very suspicious.

6. Future students that otherwise might pursue a DC/ND/MD would go into our field instead. I'm going to combine my response to this with your paragraph about supporting a transitional FPD, because they reflect the same issue.

Like I said, I don't know how to say this politely, Zhang Zhong Jing, but your perspective on our field is that of someone who clearly doesn't have to make a living in practice. I recently heard a quote from a practitioner that goes like this: "I have been practicing for four years now, and much of the feedback I get from fellow graduates is that they cannot make a living in this field...and some it seems go back to teaching or working at our school when it appears they cannot make their own practice fly." This was in the context of a survey that showed the average income of practitioners in that area coming in at $20,000 dollars a year, and no one identified whether that was gross or net. If you were ever in business for yourself, Zhang Zhong Jing, you would know why that difference really, really mattered.

DCs and NDs have much the same problem as we do; competing with their fields doesn't solve our problem. The problem is that all alternative medicine education, whether chiropractic, naturopathic, or acupuncture, bears a painful -- though I'm sure unintentional -- resemblance to a Ponzi scheme. I hope they didn't have those in ancient China. By which I mean alternative medicine education requires a steady stream of people who don't understand what is really going on to keep giving it their money. When they discover that their diploma, whether it be an ND, DC, or M.Ac.OM, plus $4, will buy them a cup of coffee at Starbucks -- and that's it -- one of their only viable options, besides leaving the field altogether, is to try to get back in the business of educating other people. Alternative medical education is mostly financially viable because it perpetuates itself, not because it helps people create a livelihood. I know this is a terrible thing to say. Actually, I would like to be proven wrong. However, since statistics on practitioner success seem difficult or impossible for anyone to gather, no one even wants to have this discussion with me. As usual. I don't think you are intentionally trying to hurt anyone, ZZJ, as you advocate for more education. I just think, because you do not have to support yourself the way we do, you have absolutely no idea how hard it is, or how the process of acupuncture education sets people up to fail. So you would have no way of knowing how badly we as a field need to deal with the underlying issues of creating viable economic structures for acupuncture delivery. And how jumping towards an FPD will only make an already bad situation so much worse.

One last thing. Developing the FPD standards requires consensus in the acupuncture profession. Being from a hierarchical society, you might not understand the definition of consensus. It doesn't mean a majority, and it doesn't mean that you can spin your presentation to make it look like people who don't agree with you don't exist. Now, I know you're new to this scene, but you really might want to think twice before trying to personally represent the disembodied essence (though you ARE disembodied, I realize that) of the acupuncture profession. Because if that's who you are, you and I have a lot of talking to do. And while you might not be accustomed to having women and peasants talk back to authority, you're going to have to get used to it. Because, like I said, things are different now.

Lisa

Comment by Larry Gatti on December 1, 2009 at 11:09am

http://www.communityacupuncturenetwork.org/blog/dear-zhang-zhong-jing" target="_blank">

a link directed to the author of your letter, Ben.

Comment by Larry Gatti on December 1, 2009 at 9:08am

Ben,

You wrote:

ACAOM needs to hear your opinion as part of its discussion on developing the FPD, and to counter the extremist position of the CAN leadership that wants the discussion to stop. Please feel free to use the draft letter below and modify as you see fit.

Exactly how are we trying to stop the FPD conversation? As I think you know, the CAN website has been conversing about the FPD non-stop for nearly 2 weeks. We are hardly trying to prevent conversation. In fact, it is my opinion that there would not be an FPD conversation happening at all, if not for CAN. Contrary to stopping the conversation, we are inciting it. It is a clear opportunity to delve into a broader discussion regarding AOM study, practice and care, set within the context of race and class.

And you shouldn't try to frame the issue as if it is primarily "the CAN leadership" that is steering the overall opposition to the FPD amongst our members. You really misunderstand CAN if that is what you think. We are approaching 600 strong; practitioners, educators, students, administrators and staff and, of course, PATIENTS. We are a large body and people from all these groups that aren't on the board are taking leadership positions across the country. We may have a board, but rather than looking at ourselves as leaders, we view ourselves as organizers. And something critical for you to understand is that leaders want power. Organizers want to create. Create jobs, access to education and practice, access to care and health. And our membership is composed of impassioned, committed and dedicated organizers. So when you see that our blogs and forums are exploding with activity, you are witnessing organizers doing what they do best. Creating change in their community. CAN is not some cabal of ten or so power tripping ego maniacs. It is a consortium of organizers from around the country that work together to create positive change. And those folks DO NOT want this conversation to stop.

So characterizing our position on tiered licensing as wanting the overall conversation to magically disappear is, what? Misinformation? Disinformation?

Previously, you wrote this:

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?

We heard that as this:

Stop all your organizing against the FPD, let it go through, and we promise to talk to you about what you want.


Um, no. And that is all Jessica stated in her response to you. Broken down, she said:

You stop your organizing. And then we can open up a more broad conversation that could include talk of tiered licensing in the manner you suggest.

Is that not common sense on our part? If the "CAN leadership" went back to the membership and said "Hey, we're dropping our opposition. Ben says that they promise to talk about our concerns after consensus is declared. What do y'all think?" our members would either revolt or start another website. In any case, there is no stopping our organizing against the FPD, because that would give you and yours absolutely no incentive to actually meet us at "the table" to discuss anything. You would have what you want, why chat? Good faith? Please...

What is worse, is that you would post that letter here, not only misrepresenting our position about the FPD, but misrepresenting the task of ACAOM come February. The letter states:

Dear ACAOM Commissioners,

I’m writing to express my support for continuing the discussion on developing a First Professional Doctorate. I believe that the FPD is critical to the future growth and strategic positioning of the AOM profession for the following reasons:

The ACAOM is not ruling on consensus over whether to continue a discussion. They are meeting to determine if consensus exists within the profession to develop standards for and pilot doctoral programs in order to petition the USDE for a change in scope for accreditation purposes. Supporting the FPD, which you are doing, is the extremist position here that wants to end the discussion and if consensus were to be declared, that would end the discussion phase over developing standards and piloting the programs.

The letter opens and closes deceptively.

...continue the discussion about developing the FPD, and I strongly encourage ACAOM to do so.

Consensus ends discussion, no consensus continues discussion, more than likely with the tiered licensing subject as part and parcel to it. That is what Jessica stated, which you apparently either misread or didn't want to hear. Any discussion held if the ACAOM were to declare consensus would be radically different than what it would be if consensus is not declared.

Matt Bauer wrote that he would go along with go along "with any policy as long as the process for reaching that policy is fair, open, transparent, and inclusive." So would we, so would everyone. Because that kind of process would result the satisfaction of not only all practitioner communities, but also the patients they serve. Is that not what we should be striving to achieve, the best interests of the different patient communities? The letter you posted subverts the policy criteria that Matt so eloquently defined. And since the FPD is clearly NOT in our communities interest, and you think that it is in the interest of your community, a commitment to continuing a mutually beneficial conversation requires that FPD process be halted. Now. Today. Until then, it is our duty to oppose the FPD in order to demonstrate the real: lack of consensus. But this does not indicate that we want this conversation to stop. Don't misrepresent us that way. Pursuing the FPD prevents the conversation that would address all parties interests. Dismissing the FPD would be a clear indication of a commitment to compromise; tiered licensing.

Larry Gatti
Organizer amongst Organizers
CAN board

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