Continuous Improvement and Feedback

It’s difficult to make things better when you don’t know what’s wrong.

I’m glad when a client lets me know that something isn’t working. It gives me a chance to change things, or help them find something that better meets their needs. Things are better for both of us when we’re honest.

That’s why I’m having trouble moving on from a column that equates discussion about our problems with treason (“giving the other professions … the ammunition they need to diminish acupuncture”) and so many of the responses to the Gainful Employment regulations. (Here’s a selection — ACAOM gainful employment word, Acupuncture school response, and the ASA’s response.)

The cost of an acupuncture education, how that cost compares to future income, and the likelihood of that income being sufficient to pay off loans in a timely fashion while also sustaining oneself, are critical issues for the profession. Welcoming feedback from those who have “been there and done that” is necessary to guide improvement.

The Gainful Employment rules require transparency and accountability from for-profit career colleges. The regulations don’t close schools. They may, in time, keep students from receiving federal Title IV student aid to attend programs that don’t meet the accountability standards.

Although the impacted schools insist that the education they provide is a good value, they are correct to fear that, absent federal guarantees, students will have trouble coming up with enough money to attend.

Ideally, their concern would translate into concerted efforts to gather data about their graduates’ experiences and provide it to prospective students. They’d focus on what could be done to reduce expenses for students, and develop programs to ease those first few years post-graduation when they acknowledge income may be low. They’d make sure that all prospective students had an understanding of the economic realities of life as an LAc before collecting that first tuition payment.

Instead, when I read the responses from our schools and organizations, I hear, mainly, this isn’t fair, it’s not our fault, and it shouldn’t apply to us.

They argue that the responsibility is on prospective practitioners to educate themselves about the field and educational options, but also say that the data available doesn’t reflect the true picture. (And they fail to mention that before the Gainful Employment rules required it, they paid little to no attention to what happened to their students post-graduation.)

Try comparing the earnings of graduates from various programs, or finding out the percentage of graduates still in the field 5 years later. That data doesn’t exist. How will prospective students get a fair picture if practitioners who are share their struggles are told to keep quiet and say only nice things? If the concern is that some of the things being said are inaccurate or overly negative, take the opportunity to provide correct information and the other side of the story.

Working part-time, having employment structures that don’t accurately reflect all money earned as taxable income, and a lag in the time it takes to reach full earning potential are not unique to acupuncture school graduates.

Low student loan default rates aren’t evidence that all is well. Default carries significant and long-term harms and, luckily, acupuncturists are responsible enough to make payments and take advantage of options to defer or reduce payments when necessary. Of greater significance – do we earn enough to pay off our loans in a timely fashion while also supporting ourselves? Can we save for retirement and purchase disability and health insurance? Will we ever be able to buy a home, or build up a cushion in case of hard times? The overall financial health of the average graduate should be the focus of attention. The highly successful grads are the exception, not the rule.

I’m not surprised that the schools are fighting to avoid consequences for the struggles of their graduates. I am surprised that other organizations and voices are supporting their evasions.

There are more than sixty Acupuncture and Oriental Medicine Programs in the US. What’s a bigger threat to our future – that a few might close or that a significant number of graduates, burdened by debt, leave the profession before they can get established? How about the impact of student loan debt on the affordability of our services? Is that important?

Understanding and acknowledging our problems is the first step in making things better. We need more data and discussion, not less. More transparency and accountability, not less. A greater emphasis on making things better, not making excuses for why they aren’t. It’s time for us to own our challenges, not blame and deflect. Let’s get honest.

 

 

Ethical Questions

Our future requires a willingness to explore beyond our quick conclusions of what is “right” and what is “wrong.” How do we proceed when two “rights” are in conflict with each other, or when a good end might depend upon a questionable means (or vice versa)?

Providing safe, effective, and accessible treatment to everyone who wants/needs treatment while also supporting ourselves and our families requires us to face various ethical quandaries. Many ethics classes are short on teaching principles to guide ethical decision-making and are long on lists of rules like “don’t have sex with your patients.”

Marilyn Allen’s recent column on ethics demands our attention. She’s had a significant role in shaping the acupuncture profession, and she teaches ethics. She has power.

The column focused on a discussion about “gainful employment” that has since been removed from the AAAOM practitioner forum.

The forum included colleagues sharing concerns about their debt, and upset at schools that exaggerated the future acupuncture job market while glossing over the skills and financial backing needed for success.

Ms. Allen (who has given considerable funding to the AAAOM over the years) is angry that this discussion was permitted. She insists that it is in the best interest of the profession, and our future colleagues, to keep concerns to ourselves. Even a shared conversation in a practitioner forum is too risky. We “should have shown support for the schools,” she writes.

Ms. Allen proposes the Rotary’s Four-Way test in her column. It’s not my preferred guideline for ethical decision-making, but since she refers to it I’ll use it —

 

1) Is it true? Many graduates of acupuncture schools do struggle to pay off debt. Schools did use misleading data in promotional materials, leading to unrealistic career expectations. The proposed Gainful Employment regulations did raise concerns about acupuncture programs. The forum topic is no longer present to allow for a complete fact check, but my assessment is that much of the content was true.

2) Is it fair to all concerned? What do we mean by “fair.” Who is “all concerned?” And what is “it?” I could write a post on each question. When a topic is being explored by many people, in many settings, does each contribution need to reflect the views and feelings of each stakeholder? Is it unfair to share our personal experiences and opinions about a system in which we have little power and bear the consequences? Is it fair for a membership association to solicit the opinions of its members? My assessment – it was fair for the AAAOM to provide a forum and for practitioners to use it.

3) Will it build goodwill and better friendships? Humans do better when we know we are not alone. Sharing our concerns and our experiences is a way to build community and friendships, which support us in our sometimes isolated professional life. Knowing that other regulated fields share these concerns can also help build goodwill and understanding. If we feel that a friend (or, in this case, a system) is taking advantage of us, does it strengthen the friendship and build goodwill if we speak up, or stay quiet and suffer? Yes, the discussion had the potential to build friendships and goodwill. Ms. Allen’s column, by advocating denial and repression, does not.

4) Will it be beneficial to all concerned? My list of people who would benefit from the conversation, even if it escaped the private forum: current debt holders who feel alone and unheard, schools who care whether graduates are satisfied, potential students who may not have fully explored the economics of entering their dream career, and taxpayers who may not want to subsidize ineffective programs. The discussion isn’t beneficial for the schools that want to keep raking in loan money while avoiding responsibility. Should we be censored for their benefit?

Ms. Allen writes “It is sad when you read an article about the profession that contains negativity coming from inside the profession. Essentially, this is giving the other professions (those looking to treat acupuncture patients) the ammunition they need to diminish acupuncture and attain their own goals.

I say, it’s sad when those with the power to change things for the better instead advocate for a flawed status quo. It’s a danger sign when secrecy is demanded for the good of the group. The Catholic Church and the Penn State Football program are examples of the moral failure that comes with that argument.

Thank goodness we’re dealing with finances and not child abuse. Nonetheless, shutting down conversation and preaching secrecy is neither ethical nor effective. If Ms. Allen wants to uphold acupuncture as the place “where hope and healing meet” then we need to delve into our challenges, not hide them.

 

 

Professional Harmony, Professional Growth

Acupuncturists know that good health isn’t acquired by attacking invaders. Instead, we advocate living in balance with our environment to develop a strong, self-reliant, vessel. We are healthy when our system excludes threats without our even being aware of them.

As individuals, most of us practice (most of the time) what we preach. We strive for balance.

As a profession, though, we’ve chased the equivalents of miracle cures, mega-antibiotics, and the promises of “experts.” Like our clients who seek well-being that way, we are tired and struggle to maintain our tenuous health.

What if practitioners, schools, organizations, regulators, and credentialing agencies saved the energy and money that went to filing lawsuits against PT’s, (and having to defend ourselves when we are sued in return), establishing new degrees, and changing state regulations to require more training and exams? What if, instead, they identified the minimal standard necessary to practice safely and effectively and committed to work, state by state, to establish that standard as sufficient for licensure? What if we took as a guiding principle and goal that an acupuncture license in one state, and a history of safe practice, should be sufficient for licensure in any state?

Other professions are doing this. PT’s, Nurses, and MD’s are all working to make it easier for practitioners to relocate. Even lawyers can be “waived” into a state based on prior experience. These professionals don’t have to start school wondering whether their degree will be sufficient. A family move doesn’t mean giving up a career.

Acupuncture school is a risky investment, especially when requirements for licensure vary widely and change regularly.

Unlike our other battles, moving toward standardization (of licensure NOT lineage), doesn’t require convincing any judge or insurance company of our position or value. We hold the power to create a system that supports acupuncture professionals and serves the public.

It shouldn’t be difficult. It will be. We are better at vehemently disagreeing and walking away than we are at overcoming differences and finding compromise.

Both herbal credentialing and the FPD degrees were enacted despite concerns we now know were prescient.The ACAOM-sponsored DELPHI process (to establish degree titles), an after-the fact attempt to address some of those concerns, is moving forward, but not without challenges.

We lack an organization for regulators. This increases the tendency for states go their own way, and will make coming together even more difficult. Too often regulators have focused on their personal visions for the profession rather than serving the public. Many of them also sit on the boards of, or work for, acupuncture schools, raising the potential for conflicts of interest.

We could overcome these challenges. We could focus on the benefits and commit to sticking together. We could ensure the public can access Acupuncturists when they want acupuncture. We’ve spent enough on the antibiotics of legal action and the miracle cures of being Doctors and pursuing third-party payment. Now we need to focus on establishing common ground and common requirements, building our strength and our stamina. That would be a huge step toward good health for the profession.

 

 

Acupuncture Organizations New and Old

We have a lot of organizations and associations for a small profession. Here’s some of what they’ve been up to.

AAAOM

Finally, communication from the AAAOM. According to their April mailing they’ve revamped their membership structure and are planning their first annual conference in over five years.

The new membership structure includes a free “Basic Membership” category. Does the basic membership give access to the annual report or permit the member to vote in BOD elections? If not, it isn’t a membership, it’s a mailing list. Calling it a membership gives the AAAOM cover to inflate their numbers (they’ve been throwing 7000 around) and mislead policy-makers about their strength.

ASA

The first Annual Meeting of the American Society of Acupuncturists was held March 4-5. You can read the full summary here. It includes updates on the activities of many other professional groups. Check it out, including the links.

CCAOM

I’ve only recently been alerted to significant problems in the 7th Edition of the CNT Manual released in July 2015.

One example – is wiping a point with alcohol prior to needling still required? In the position paper on their website and the July 2015 AT article CCAOM indicates that the skin does not necessarily need to be swabbed prior to insertion. Page 97 (or 73 in internal pagination) of the CNT manual puts swabbing with alcohol on the Critical (required) list, with the text “swabbing continues to be recommended.” Which is it, critical, or recommended?

The manual also contradicts itself regarding the cleaning of chairs and tables between patients. Must each table and chair be disinfected or cleaned? Between each patient, or only daily?

With our many traditions and practice styles it is difficult to define or describe a “standard of care” for many aspects of our medicine. This gives documents such as the CNT manual extra weight in the legal system.

This area of practice is outside my bailiwick. Is there an expert out there willing to do a thorough review and write a guest post? It is critical (not recommended) that we get this document right.

NCCAOM Academy of Diplomates

Yes, another new national organization. My feelings about it are as conflicted as my feelings about the NCCAOM.

On the one hand, NCCAOM Diplomates are a significant portion of the profession, and the NCCAOM has the money, power, and support staff to get things done. Earning a seat on the CPT committee (see the ASA report), for example.

On the other hand, an organization that promotes Diplomates only (and how can they vouch for anyone else) runs the risk of deepening a fault line in the profession. The NCCAOM’s history in the regulatory arena shows 1) they are persuasive and 2) their positions often benefit the NCCAOM and some subset of practitioners at the expense of the profession as a whole.

We don’t have a balance of power in the profession. The NCCAOM is in a weight class by itself and the Academy further tilts the scales in their direction.That concerns me. On the other hand, we’ve got no other group heavy enough to get in the ring with non-Acupuncture groups right now.

Let’s keep a close watch on the Academy.

NGAOM

The sparsely attended (30 practitioners?) February Town Hall covered why the NGAOM-affiliated malpractice insurance is such a bargain, how the OPEIU can help the NGAOM, and what’s happening in various states regarding dry needling and insurance reimbursements.

What I didn’t hear was further discussion of NGAOM’s baffling goal of mandating malpractice insurance for licensees in all states. Despite their claims, there is no evidence that lack of mandated coverage has had any impact on scope of practice issues or on how we are seen by other professions. Any insurance plan, landlord, wellness center, or employer can choose to require malpractice coverage. But if a self-employed or unemployed (by choice or circumstance) practitioner decides to bear the risk of working without malpractice insurance, they should be allowed to do so.

If this is the NGAOM’s idea of helping practitioners, we’re in trouble.

 

A few months ago I mentioned that change might be coming to The Acupuncture Observer. I haven’t yet resolved the tension between sharing breaking news and saving my limited time to explore the broader philosophical and strategic issues facing the profession. Would any of you like to be a breaking news blogger? (ASA, would you like a state update column every now and then?) For now, I’ve added a Facebook feed to the home page of the blog. Checking there (or liking The Acupuncture Observer on Facebook) should help you stay informed between posts.

 

 

Acupuncture Organizations 2015 – State of the Profession

The 40ish days between January 1st and the Lunar New Year are perfect for reviewing the past year and preparing for the next year. What worked, what didn’t? What direction will we go in when the days warm, the yang rises, and we spring forward?

There is much to consider when evaluating our practices and our profession. To understand how it all fits together we need to dive into the weeds. It’s going to take a few posts, but it will be shorter than the tax code!

Associations/Organizations/Guilds —

AAAOM (The American Association of Acupuncture and Oriental Medicine): Historically, our national professional association. And, historically may be all. The website shows no action items since 3/13/14, and no President’s blog post since 10/9/14. Is there anybody there? Is the AAAOM still alive?

ACAOM (The Accreditation Commission for Acupuncture and Oriental Medicine: Graduation from ACAOM-accredited schools is a requirement in many states. 2015 ended with an announcement of a Degree Titles and Designation Project. This should be interesting – there are already graduates of and students in the existing range of programs and there are widely varying state rules. Better late than never? (Wouldn’t it be easier for the public if we were all Acupuncturists?)

ANF(Acupuncture Now Foundation): Finally, there is an international charitable organization dedicated to educating the public, other health care providers, and those who work in health care policy. For too long we’ve relied on piecemeal efforts to educate others.The ANF is just getting started and needs our support to provide a visible, accessible and positive message about who we are and what we do.

ASA(American Society of Acupuncturists): This non-profit collaboration of state associations launched in 2015. The ASA has potential, and challenges. One challenge – “six degrees of separation” between individual practitioners and the group. A planned website should help bridge the gap. Of greater concern – at the state level, the ASA defers to the preferences of the state association. If an ASA-member state association supports a law or regulation that serves its current members to the detriment of all other LAcs, too bad, so sad for the profession as a whole. There are good people involved with this group so I remain cautiously optimistic. I hope that, before too long, the member groups will see that a victory that disadvantages other Acupuncturists isn’t a win.

CCAOM (Council of College of Acupuncture and Oriental Medicine): The membership association for schools and colleges of AOM with ACAOM accredition or candidate status. They administer the NCCAOM required CNT course, and released an updated (available free!) CNT manual this month.

IHPC (Integrative Health Policy Consortium): The IHPC “advocates for an integrative healthcare system with equal access to the full range of health-oriented, person-centered, regulated healthcare professionals” and has been working to build enforcement of Section 2706 of the ACA to end insurer discrimination against classes of licensed health professionals working within their scope. I don’t know of any LAc that doesn’t support this group’s mission, so it is odd that many LAcs support legislation that would create this sort of discrimination.

NCASI (National Center for Acupuncture Safety and Integrity): One individual? Silent for many months now.

NCCAOM (National Commission for the Certification of Acupuncture and Oriental Medicine): The NCCAOM “validates entry-level competency in the practice of AOM through professional certification.” Their vision is that AOM “provided by NCCAOM credentialed practitioners will be integral to healthcare and accessible to all members of the public.” They are powerful, organized, effective, and better funded than any other acupuncture group. They have had a major role in the path to licensure in many states. However, if you are not an NCCAOM diplomate, feel that the credentialing process is out of hand, and/or if you value traditions other than TCM, the NCCAOM is probably working against your interests.

NGAOM (The National Guild of Acupuncture and Oriental Medicine): A professional medical society organized as a guild under the OPEIU, affiliated with the AFL-CIO. The NGAOM list of 13 VP’s includes the VP, Immediate Past President,Treasurer and one additional board member of the AAAOM and following in that tradition there is significant mystery around their membership and their decision-making process. They want the profession of acupuncture to be more like other health professions. Many LAcs affected by their work aren’t pleased with the consequences. You’ll learn more in upcoming posts.

POCA (The People’s Organization of Community Acupuncture): Mission — “to work cooperatively to increase accessibility to and availability of affordable group acupuncture treatments.” 708 Punk (Acupuncturist) members, 138 clinic memberships, and 1348 patient members. Minutes of meetings posted in their forums, 8 free CEU’s for practitioner members, loads of member support, and a school (POCA Tech) working towards ACAOM accreditation and currently accepting applications for the third cohort of students. This is a successful acupuncture organization.

State regulatory boards are not professional organizations or associations. Their mission is to protect the public, not promote licensees.

An exploration of acupuncture education, events in the states, legislation and regulation, and other items of interest, including more about these organizations, will be coming soon.

 

FPD/DAOM required, Schools, ANF, Dry Needling — and more Acupuncture News….

New news:

Word is that the Nevada acupuncture board is poised to require an FPD (or is it a DAOM?) for licensure, even though citizens there are already under-served. I’m trying to get more information. Stay tuned for updates. State actions that limit our profession tend to stay under the radar until it is too late.

The acupuncture school landscape is changing. Last week brought news that Bob Duggan and Dianne Connelly will no longer be part of MUIH faculty or staff. For those who have been paying attention as The Traditional Acupuncture Institute morphed into MUIH, it shouldn’t have been a surprise. But it is sad. While TAI had its good and its bad, many who attended did so because of Bob and Dianne’s contributions. The announcement was quickly followed by a letter, in perfect TAI-speak, that, for the sake of the students, we shouldn’t get caught up in stories about this. As in, don’t even ponder what it is we aren’t telling you.

This week also included the news that NESA is merging with MCPHS, and ACTCM is merging with CIIS.  (Thanks, Integrator Blog.) Is the age of the stand-alone acupuncture school coming to an end?

Have you heard of The Acupuncture Now Foundation? They aren’t a membership organization, and they don’t want to get involved in acupuncture-politics. They just want to educate the public about our training, our skills, and the great results from our medicine. Please, support ANF! Marketing the medicine shouldn’t have to be an individual effort.

Older News:

Developments in dry needling, with the hope that we might learn from history:

  • Louisiana joined other states with an AG opinion that dry needling is within scope for PT’s and DC’s. Other AG opinions can be seen here.
  • Tennessee’s Governor signed Legislation formally adding dry needling to scope for PT’s, joining Utah and Arizona which saw similar legislation in 2014.
  • The Maryland Acupuncture Society came out in strength behind HB 979 and SB 0580 that would have set limits for dry needling by PT’s and DC’s. The bills went nowhere, perhaps a blessing in disguise as “success” would have opened a can of worms.  (The bills did not define dry needling, MAS support put the acupuncture community’s stamp of approval on a 200 hour standard for acupuncture training that had been previously unacceptable, and the wording opened the door for PT’s with 200 hours of training to argue that they were now, indeed, doing acupuncture.)

The AAAOM website has been updated with board bios and a revamped committee list, but still no answers for any of my sixteen questions for the AAAOM.

ACAOM responded to the petition in response to their Gainful Employment letter in the ACAOM Fall Newsletter.  The good news — they heard us. The bad news, they continue to believe that significant student debt is helpful for those who want to serve low-income communities.

There you have it, at least some of the news you aren’t seeing in Acupuncture Today.

 

Sixteen (or so) Questions for the AAAOM

AAAOM representatives advocate transparency and Board members have offered assistance. I’ve got some questions, and I look forward to getting some answers!

  1. What is the current dues paying individual voting membership of the AAAOM and how many individual members voted in the March 2015 elections?
  2. How many organizational voting members does the AAAOM have, who are they, and how many voted in the March 2015 elections?
  3. Who was on the Election Committee supervising that election?
  4. Why do the new bylaws close Board meetings to members unless invited by the Board?
  5. Why is there such a large range (9-15) allowed in the size of the Board of Directors?
  6. How will the size of each Board be determined?
  7. A 15 person Board requires a vote of 8 for a position to prevail. A 9 person Board only needs a vote of 5.  Isn’t there risk that dissenting members could be driven from (or removed from) a larger Board in order for what would otherwise be losing positions to prevail?
  8. Does the new provision that elections be held only for contested positions open the door for a board to manipulate elections by setting the board size?
  9. What or who determines whether a director’s meeting absence is excused?
  10. What is the hold-up in the whistleblower policy? Why has it been impossible to develop a policy acceptable to the Board over the past two years?
  11. In the past 5 years, how many past employees or board members have been threatened with legal action by the AAAOM after departing their positions?
  12. Who was on the Governance Committee in 2014, and who is currently serving on that committee?
  13. Are substantive changes being made in the draft legislation from the 2013 language? How is the AAAOM planning for a different outcome than in 2013?
  14. Who is on the expert panel reviewing the “unified competency model“?
  15. AAAOM 2013 990 states that annual reports are available to the public via the website.  However, currently access is limited to members. Where can the public access the AAAOM annual reports?
  16.  The AAAOM refers to itself as the “profession’s national flagship organization.”  Is this similar to this Flag Ship Service Organization?     Okay, just kidding on that one.

AAAOM, how about some answers?

 

 

AOM Leaders?

Who decides the future of the profession?

Did you know about the meeting of the Acupuncture and Oriental Medicine “leaders” last weekend?

Who represents working acupuncturists at these meetings?

These meetings started in 2005. You can read about previous meetings herehere, and in CCAOM newsletters. Attendees typically include reps from ACAOM, CCAOM , NCCAOM, SAR, NFCTCMO, CSA, AAAOM, AOBTA, and sometimes COMRE. It’s good (I think) that these groups are communicating. It’s not good that most acupuncturists in the US are several degrees of separation away from representation there.

There’s not yet a publicly available report of the 2015 meeting. I do know —

The AAAOM continues to be invited and to attend, despite being out of compliance with their bylaws for years. The AAAOM website currently has no news of the recent elections, the board information is outdated, and there is still no whistleblower protection policy. Word is that the current board overlaps significantly with the board of the NGAOM. Michael Jabbour continues to fill the board position of Immediate Past President (what happened to the real immediate past President Don Lee?) and was present at the AOM Leaders meeting. Membership numbers of the organization are a mystery and I hear the AAC continues to provide much of their funding.

The others present at these meetings know that the AAAOM is a deeply troubled organization that represents only the smallest handful of practitioners. Why, oh why, does the AAAOM rate a seat at the table?

Representatives of the Council of State Associations are also in attendance at these meetings. I am glad that the CSA exists, working to mitigate the damage done by the lack of a functional national organization. I’m concerned, though, that few practitioners have any direct knowledge of this group and what they have to say at the AOML meetings. If you are involved with a state organization, and if the state organization participates in the CSA and communicates back to the membership, then you’ll find out about the CSA. Otherwise, you’re in the dark.

Why isn’t POCA invited? I don’t suppose they’d enjoy being there, but if the AAAOM with their mystery membership is invited, and the NFTCTCMO is invited, why isn’t POCA?

It’s difficult to find the right tone for this post.  I know the groups representing acupuncturists depend on volunteers who are doing their best. I also know that working practitioners too often find themselves at the mercy of the “good ideas” of credentialing agencies, accreditors, schools, and a few powerful colleagues. To make it worse, most practitioners have been misled about what actions are likely to be effective and create positive change.

When I look at who is invited to the AOM Leaders meetings, and how far most of us are from what happens there, it’s no surprise that so many of the developments within the profession seem to work against the best interests of acupuncturists. It reminds me of Congress, and that’s not a good thing.

 

 

An Acupuncturist Looks for Balance

How do I help the greatest number of people?

The wisdom of Acupuncture/East Asian Medicine has improved my health and the health of my clients for more than two decades. Throughout that time I’ve worked with professional regulation, legislation, and our organizations, with the goal of increasing public access to the full benefits of this medicine.

My involvement in the political sphere of our profession has taken significant qi that I could have used to study the medicine, improve my technical skills, and increase my own well being.  Most days at my clinic include at least one moment when I know that with deeper study I could have provided better care.

This fall I felt that I should choose, Practitioner or Advocate? My clients weren’t getting my best. Could I find a way to support myself through advocacy and leave my practice? Would I be happier if I focused on the intellectual challenge of working toward a widely shared vision of success for the profession, and developing a path to that success? Or should I leave the advocacy work and focus on my patients? In the clinic the appreciation doesn’t carry a side order of harassment and ill will. When I treat I see the positive impact of acupuncture and Asian medicine every day.

It’s winter. I’ve been taking a break. I can’t quite follow the Nei Ching and sleep until the sun rises, but I’ve stepped back. I’ve read the communications from ACAOM and the AAAOM (and this, and this (apologies for it being post-deadline, it was hidden), followed the complaints about health insurance (what it costs, what it covers, what it pays, the work involved in getting those payments), wondered about our dry needling strategy, and pondered whether blogging about these things is “worth” the qi.

It’s still winter….

 

 

 

 

Gainful Employment and Strategic Errors

The Gainful Employment final regulations have been announced. Forgive my commenting prior to a complete and thorough analysis of the 941 page document. (You can see some analysis here.) The gist is that for-profit schools (which includes half of US acupuncture programs) will soon have to show that graduates’ student loan payments are manageable with the profession’s available employment (not taking IBR into account). If they can’t, federally guaranteed student loans will no longer be available.

Why should taxpayers continue to provide loans for educations that history shows aren’t worth the investment? Imagine tuition rates and post-graduate employment assistance if the schools provided and guaranteed loans, and took the hit if they weren’t paid back in a timely fashion.

It is no surprise that for-profit schools are displeased about the impending end of the gravy train. Many for-profit schools, and their related organizations, did everything they could to block the regulations. And, just under the wire, the acu-educational establishment contributed comments (see ACAOM gainful employment word).

(The more expensive FPD, and pressure away from “acupuncture-only” degrees now carry a significant downside for the schools.)

Did ACAOM think their letter might exempt them from the rules or impact the final regulations? It seems unlikely that this little community would shift the tide. It was an unforced error for ACAOM to write a letter that reveals such little concern for graduates and such a strong desire to dodge responsibility. (Some of the more significant issues in ACAOM’s letter are discussed here.)

But our own strategic errors have allowed ACAOM and other other alphabets to disregard our well-being.

The petition that asked the alphabets to stop denying their role in our circumstances received 227 signatures. Petitions to stop dry needling often receive thousands of signatures. Which is more likely to limit professional success — a school that leaves students with extensive debt, poor business skills, and no job placement or alumni support, or a little competition? If we can’t survive the competition from those “untrained” professionals our education is surely lacking.

The Feds and the taxpayers pay a price when schools sell an education for far more than it is worth. We graduates pay a far more personal price. It’s too late for us, but at least the Feds are willing to look out for the interests of those who will follow in our footsteps.