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 The AAAOM website currently has no news of the recent elections, the board information is outdated, and there is still no whistleblower protection policy.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.

 

 

17 Foundational Beliefs of The Acupuncture Observer

Embracing the season of gratitude and thanks, it’s time for The Acupuncture Observer to take a step back and share some of her foundational beliefs about the medicine, the profession, and life.

  1. Acupuncture/OM works. The unique situation of the patient and the unique skills of the provider influence effectiveness. No single tradition provides all of the answers or benefits.
  2. Acupuncture/OM has fewer negative side effects and risks than conventional treatment for many conditions.
  3. Access is a necessary precursor to effective treatment.
  4. Effective treatment will increase wellbeing and could decrease health care costs.
  5. Every means to increase access carries trade-offs. Those trade-offs must be understood as we determine our path forward. We should learn from the experiences of other professions.
  6. Understanding and explaining the mechanism of acupuncture from the knowledge base of modern biology and physiology is useful and interesting, but is not necessary for acceptance by the medical establishment.
  7. The current “science-based” understanding of health is known to be limited. Insisting that Acupuncture/OM be taught, thought of, or explored only in the language of modern medicine/science is unscientific and risks centuries of experience and wisdom.
  8. Consumers should have significant freedom of choice in health care. Understandable and clear information about potential benefits and risks, as well as an exploration of the costs (financial and otherwise) is necessary for good decision-making.
  9. Self-serving thinking leads to hypocrisy. Special attention is needed when an argument for patient protection creates an economic benefit for particular providers.
  10. Simple, easily learned treatments can be effective and safe.
  11. There is the potential for growth and success within the acupuncture/OM profession.
  12. Many acupuncture programs do not provide sufficient or accurate information about post-graduation life and do a poor job of teaching business skills. This can be changed easily and inexpensively.
  13. The financial and karmic ROI (Return on Investment) of positively promoting our profession is superior to that of engaging in political/regulatory battles with others.
  14. The future of the medicine and of the profession are interconnected but not identical.
  15. Thoughtful and respectful analysis can identify areas of common ground.
  16. Focusing on areas of common ground decreases factionalism, and builds unity, understanding, and participation.
  17. The profession lacks venues for respectful dialogue on these issues. As a result, many scholars and potential leaders within the profession avoid involvement.

Do we agree on some of these? Can respectful dialogue increase the areas of agreement? What if we read the Tao Te Ching, the I Ching, and The Art of War first? What if we go deeper than our Wei level response to some of these issues? I believe it is possible that we’ll be able to find a new path forward, one we can walk together, with our hair flowing free. After all, I’m an acupuncturist.

Positive Developments for the U.S. Acupuncture Profession

Volume 1, No. 1 of Meridians: The Journal of Acupuncture and Oriental Medicine hit my mailbox last week.  It’s difficult to keep up with my “reading pile,” but knowing that Jennifer Stone and Lynn Eder were involved was a great incentive.

Though my time at the AAAOM was “nasty, brutish, and short” I did meet some great people there. Jennifer, who was editor-in-chief of The American Acupuncturist, and associate editor Lynn were among them.  Their work was top-notch and when I saw that they were part of the exodus from the AAAOM I feared their skills would be lost to the profession. Luckily, the new endeavor is off to a great start.

My favorite section was “Clinical Pearls”, focusing on Frozen Shoulder this issue. (Submissions on How to Treat Blocked Menses (Secondary Amenorrhea) will be accepted until November 15.)  I was so glad to see a focus on acupuncture treatments rather than herbal remedies. The growing (damaging and disturbing) trend in the profession to restrict practice to those with full herbal credentials demands frequent reminders that needling points is an incredibly effective stand-alone treatment. Thanks, Dylan Jawahir, Clinical Pearls Editor.

I also appreciated Jennifer Stone’s piece on postherpetic neuralgia. I’ll give the protocol a try the next time I’m confronted with a case that does not respond to my usual treatment choices. Again, simple needling can have great results.

My state association membership includes online access to MeridiansJAOM, which is a great perk. Still, ongoing survival of the journal will depend on subscribers and I hope that many of us will step up, subscribe, and support its advertisers. Subscription rates are very reasonable.

I have just one gentle request for Jennifer — can we have a more eye-friendly font? The footnotes were almost impossible for me, and even the main text required good lighting and rested eyes.

Another bit of good news last week — the launch of the Acupuncture Now Foundation. I’m often frustrated that so much of our profession’s energy and money goes to fighting with other professions, increasing our own licensure and educational requirements, and fighting to participate in a broken medical system. Meanwhile, helping the public understand the benefits of our medicine doesn’t seem to be a priority for many of our professional organizations.

Just as Matt Bauer’s Making Acupuncture Pay book and website have helped new practitioners by filling the gaps left by many of our acupuncture schools, the Acupuncture Now Foundation promises to do the public outreach work often given short shrift by our organizations. I hope that Matt gets the support he needs to finally do the work that has been his vision for years. He’ll need our help if this project is going to reach its potential. Sign up to receive updates on the ANF home page.

What’s your Acupuncture Degree Worth?

Answer: Less than it used to be.

(Please, sign the petition.)

If you earned an MAc and Dipl. Ac (NCCAOM) twenty years ago, you thought you had it made. You could get a license in almost all states with licensure. The schools and the NCCAOM touted the caliber of the education and credentials. You knew you had plenty to learn about this medicine, but you could practice safely.

In the gainful employment letter ACAOM points to the (supposed) earnings of those long-ago grads to minimize the financial struggles of recent grads.

But in 1995 the NCCAOM added the Herbal exam, and later the OM. Some states now require those additional credentials of all practitioners. ACAOM has increased hourly requirements for school accreditation several times. And the NCCAOM has put additional limits on who can take their exams.

Some of our most esteemed teachers do not meet the current requirements for sitting the exams. Many practitioners are trapped, unable to relocate.

By increasing the range of degrees and credentials available before our “brand” was established and our profession was strong, the alphabets increased division and confusion. No wonder the public can’t figure out how an LAc’s education compares to that of other providers.

And here comes the First Professional Doctorate. With this new degree, my alma mater announces,

“[graduates] will be recognized as doctors, both professionally and publicly, and will have increased credibility and standing.”

If graduates with an FPD have increased credibility and standing, what has happened to the credibility and standing of graduates of Masters programs?

According to ACAOM’s gainful employment letter, licensure requirements just happen, and practice success is a simple matter of practitioner choice.

Really, though, the “alphabets” have played a significant role in the expansion of requirements and credential creep, and most of the schools do little to teach students how to make wise business choices.

If, as ACAOM wrote, the graduates of twenty years ago do so well, why have entry level requirements been increased so much? Why are grads struggling to pay off existing loans encouraged to return to school to maintain their credibility? Will the NCCAOM require an FPD to sit their exams? Will the alphabets encourage states to require it for licensure?

ACAOM/NCCAOM/CCAOM/AAAOM — if you represent us, defend the value of our degrees and credentials. Your “options” too often become a requirements.

Colleagues, did the gainful employment letter represent your views? If not, sign the petition. 129 people have, which means ACAOM etc. can still claim to represent 32,871 of us.

For additional information and analysis about educational costs and value, check out this from The New York Times and two posts from Dr. Phil Garrison

 

 

Loans for Acupuncture School

It’s been too long. September brought a rush of obligations. And my post of X things (X to be replaced with a number when the list was completed) wrong with ACAOM’s gainful employment letter made it to 25 things by the time I got to the bottom of page 2 (of 7).

The gist of ACAOM’s letter — It’s not our fault. The cost of the education and the inability of many of our graduates to pay off their loans in a timely fashion has nothing to do with ACAOM, the schools, or CCAOM. It’s the fault of the system and the poor choices of our grads.

If you believe the schools and professional organizations should spend less time denying responsibility and more time taking responsibility, let them know by signing this petition.

My top 7 issues with the letter:

  • The authors absolve the schools of responsibility for the success or failure of their graduates. Where is their evidence that “the primary determinant for success in earnings is dependent upon the students who make their own personal choices….”  And doesn’t an effective education include helping students make choices that lead to success?
  • The organizations claim to represent the entire profession without justification.
  • With the exception of CCAOM, the participating organizations are operating far outside their missions. For example, NCCAOM’s job is to provide a means of credentialing practitioners to protect the public. Why are they weighing in on student loans?
  • The authors conflate the impact of the proposed gainful employment rules with the impact of student debt on establishing a practice. It is student debt that limits practice choices, not plans that would prevent excessive debt for ineffectual schools.
  • While the authors blithely refer to the “realistic” time frame to establish a health care practice, materials provided to prospective acupuncture students are silent on such matters.
  • Putting schools in charge of the metrics (like graduation rates) that determine loan availability is a classic fox guarding the hen-house scenario.
  • The salary figures reported in the letter are questionable at best and mostly irrelevant. Even if it were true that the median salary of practitioners with 20+ years of experience is $122,500, which is doubtful, an acupuncture education 20+ years ago was far less expensive and shorter. (Perhaps the lack of federally guaranteed student loans had something to do with that?) Graduates who could not establish a successful practice are not around twenty years later. What are grads supposed to do about their loans for the first twenty years of their professional life?

It’s requiring a good deal of self-restraint not to continue with my list, but enumerating the failings of ACAOM’s letter doesn’t create momentum for positive change. A petition signed by some of those 30,000 people the organizations claim to represent might create momentum. It isn’t easy to determine how best to lower costs and increase practitioner support. It will require careful analysis and consultation with experts. But if the powers don’t care enough to ask the questions, we’ll never approach the answers. Sign the petition.

(Before you say it isn’t possible, here is a school that has designed an affordable acupuncture program with a focus on creating successful practitioners.)

Who Speaks for You?

ACAOM’s letter to the Department of Education regarding the proposed gainful employment rules begins —

On behalf of the Commissioners of the Accreditation Commission for Acupuncture & Oriental Medicine (ACAOM), and in partnership with the Council of Colleges of Acupuncture & Oriental Medicine (CCAOM), the National Certification Commission for Acupuncture & Oriental Medicine (NCCAOM) and the American Association of Acupuncture & Oriental Medicine (AAAOM), we write to offer comments…. Collectively, we represent over 33,000 students and graduate acupuncturists in the United States, and 56 colleges of Acupuncture & Oriental Medicine.

Are there 33,000 students and graduate acupuncturists? Where did they get that number? Do they represent me? Reading the rest of the ACAOM gainful employment letter confirmed it – their letter doesn’t reflect my position on the proposed rules, or on the state of the profession.

ACAOM‘s existence depends on the schools and a steady flow of students, CCAOM represents the schools, and the NCCAOM‘s income depends primarily upon new graduates taking credentialing exams.  Once these groups get their money the future of acupuncture school grads is of little consequence to them.

Of course they would make the case for maintaining the status quo, but they should not be telling the DOE that they represent me.

I’ve just sent this email to the ED of ACAOM (mark.mckenzie@acaom.org) with CC’s to the leaders of NCCAOM, CCAOM, and AAAOM (kwardcook@thenccaom.org; executivedirector@ccaom.comcastbiz.net; DonLeelac@gmail.com), and to ashley.higgins@ed.gov (of the DOE) and bduran@mpamedia.com (of Acupuncture Today) —

 

ACAOM’s May 23rd letter to the DOE regarding the proposed gainful employment rules includes this phrase —

“Collectively, we represent over 33,000 students and graduate acupuncturists in the United States.”

Neither ACAOM nor any of the other organizations mentioned represents me.

The only organization listed that even pretends to serve graduate acupuncturists is the AAAOM. Their professional and student membership is a thousand or so, optimistically, and they were not in partnership with you for this letter.

I am not surprised that organizations that profit off students and new graduates would write a self-serving letter avoiding responsibility for the number of acupuncturists struggling to pay off huge educational debt.

I am not even surprised that you would claim to represent me. But I am angry that you did so.

Unless you can provide documentation that you do represent 33,000 students and graduate acupuncturists please retract your statement to the Department of Education and make clear that you are speaking on behalf of your organization, which depends on schools and a steady flow of students to survive.

Speaking for myself,

Elaine Wolf Komarow, LAc

In coming weeks I’ll explore more of the distortions and spin in the ACAOM letter. But for now I hope you agree that standing by while these organizations claim to speak for us is a mistake.

Borrow my text or use your own, but, let ACAOM and the other alphabets know they don’t represent you — and make sure the Department of Education knows that too.

Acupuncture Careers

ACAOM gainful employment — This deserves its own post.  I don’t have the head-space to write such a post at the moment.  I don’t even have the time to fully read and digest this document.  The little bit I can digest is making me sick to my stomach. I’m betting some of my readers would like to dig into this. I’d love to hear what you think.

Acupuncture in Louisiana

If a resolution is passed and no one is listening, does it still impact the profession?  Sadly, in this case, yes.

I wasn’t planning to write today, but then I came across Louisiana SCR 22 which has been moving through the legislature. It may have passed already (I’m trying to find out), though according to the information here it is still in a House Committee. (5/21, verified, this is not YET a done deal, there are still two opportunities for the resolution to be amended!) You may know that in Louisiana only MDs and DOs can be Acupuncturists.  An individual who has gone to acupuncture school or passed the NCCAOM exam can apply to be an “Acupuncture Assistant” and work under the supervision of an MD. This resolution would establish The Practice and Regulation of Acupuncture and Oriental Medicine Review Committee, and could have been a terrific opportunity to make the practice environment in LA more amenable to LAcs.  It gets off to a great start –.

WHEREAS, the practice of acupuncture and oriental medicine provides important health benefits to the residents of this state; and

WHEREAS, the practice of acupuncture and oriental medicine has become a well established, widely-used, viable modality across the United States; and

WHEREAS, when practiced as a whole medicine, by a fully trained practitioner, the practice of acupuncture and oriental medicine satisfies a missing niche that includes a prophylactic approach that allows the patient or a referring medical director a proactive avenue towards health when neither symptoms nor severity of disease warrants other forms of treatment; and

WHEREAS, oriental medicine often becomes a valuable way to identify those in need of a referral to a western medical provider.

THEREFORE, BE IT RESOLVED that the Legislature of Louisiana does hereby direct the Department of Health and Hospitals to create the Practice and Regulation of Acupuncture and Oriental Medicine Review Committee

But, look at the language for the committee membership  —

(1) The secretary of the Department of Health and Hospitals or his designee.
(2) The Senate president or his designee.
(3) The speaker of the House of Representatives or his designee.
(4) The executive director of the National Certification Commission for
Acupuncture and Oriental Medicine or his designee.
(5) The executive director of the American Association of Acupuncture and Oriental Medicine or his designee.
(6) The executive director of the Louisiana State Board of Medical Examiners or his designee.
(7) The executive director of the Louisiana State Medical Society or his designee.
(8)A chiropractor designated by the Chiropractic Association of Louisiana who is certified as a diplomat of the American Board of Chiropractic Acupuncturists or has completed equivalent training in acupuncture.
(9) A physical therapist designated by the Louisiana Physical Therapy Association.

 

So, eight members, including a DC and a PT, but no fully-trained acupuncturist. The AAAOM doesn’t even have an Executive Director at this point, and probably doesn’t have the funds to hire one, and in any case represents only a tiny portion of the profession.  The NCCAOM should be on our side, but their input in Delaware, for example, wasn’t positive for the majority of LAcs.  Once upon a time we might have looked to the PTs as allies, but our speech and actions regarding dry needling destroyed that.

I did send this Letter to Senator Mills today (which you can borrow from), but if the resolution is engrossed it is too late. The best we can do then is advocate for acupuncture friendly designees, make sure to stay in touch with the eventual appointees, and hope we can show them that the public would be served by allowing those trained as acupuncturists to be acupuncturists.  I’m sorry that this one got by me (I’ve got a practice to maintain), and sad that we don’t have a national organization to track and act on such things. AAAOM, where were you? I have high hopes for the CSA, but, without a state organization, Louisiana probably wasn’t on their radar. This was a missed opportunity.

“Join your Acupuncture Organization!”

We’ve all heard it, along with “we are doing the best we can with the resources we have” and, “if you participate you can help set our direction.” Heck, I’ve said those things.

Yet membership in most organizations is steady or declining. News of trouble in the AAAOM was met with a yawn. Many acupuncturists are active, involved, motivated people in general, so why do so many of our voluntary organizations struggle?

In a Facebook conversation regarding the AAAOM a current board member wrote “…if we were to have had one failure as an organization … it has been our challenges in staying in touch … to keep everyone up to date about what we’re doing, what we’re facing and how we’re being successful. I can see how not hearing from us creates space for concern and allows the possibility to misinterpret truth from reality.” If there has been one failure??

Another board member dismissed the recent resignations as a necessary step in getting “like-minded” folks on the board. Then, as the day follows the night, the conversation pivoted to a plea for unity, so we could get the big things done, like the FPD. (There’s a unifying topic.)

Having served on the board of my state association for years I remember the difficulty of trying to do much with little. Yet my recent offer [early 2014] to teach members about strategic policy planning was quickly dismissed with “no one would come, but if you write something we’ll distribute it.”  And my recent attempts to communicate with board members (whom I consider to be my friends and respected colleagues) about some of the association’s positions were dismissed with “the membership elects the board and the board sets the agenda” and “I know there are differences but I don’t care about the details.”

Is it any surprise that struggling practitioners aren’t convinced that joining and participating in these organizations will produce results?

One membership organization is doing well. As of February 15th POCA had 1569 members, including 242 clinic memberships (which each include one practitioner membership) and an additional 653 practitioner memberships. It isn’t easy to get membership figures for other acupuncture organizations, but I’ll go out on a limb and say that POCA currently has the largest practitioner membership of the national voluntary acupuncture organizations. (POCA’s 895 patient membership isn’t too shabby either.) POCA doesn’t claim or try to be the organization for everyone, but it has one heck of a mission and is clearly doing a few things right.

Here’s a real kick in the gut — did you know that a group of AOM Leaders has been meeting since 2005 to “promote the general interest of the acupuncture profession”? The next meeting will be held in just a few weeks. Look at the list of past attendees. Who is representing your needs and interests to this group?  Who decides on the participants? Has POCA been invited? Have any of the participants investigated why so few practitioners (who invested in the expensive education, sat for the expensive exams, maintain the expensive credentials) join their acupuncture organizations?  It is not because we are a young profession and it is not because we are cats, difficult to herd.

Is the message that the interest of “the profession” doesn’t include the interests of practitioners?

Last week’s poll was a tie, so this post is a mash-up.  There is plenty to explore regarding our acupuncture organizations. For now, it’s time come up with a plan.  How do we get the “leaders” to consider the needs of those they claim to lead? Don’t say by joining groups that don’t seem to care.