A Level Playing Field

This was a comment to It’s Not Fair.  You can see the beginning of the exchange there.  Frank raises some great issues, so I’ve cut and pasted his comment below, along with my responses in italicsI’ll split it into a few posts to keep the length under control.

Frank writes:  Here is why I think we are not on a level playing field:

(I’m not a sports fan,so my analogy is probably off, but there is a difference between a non-level field and not knowing how to put together a team or play the game to your advantage.  My position is that while there are things that put us at a disadvantage we could still develop a winning strategy and a winning team. Underdogs can and do win.)

Exogenous factors  (All have endogenous aspects.)

1) Licensing. Not every state even licenses acupuncture, and of those not all include the scope of practice (herbs,nutrition, tuina) that people are taught in school. As far as I know, every state licenses PT.

If you haven’t seen my post about Scope, please read it. Most of our “leaders” don’t seem to understand the term, and, subsequently, we spend a lot of time and energy fighting unnecessary battles. A technique does not need to be specified in your legislation to be within your scope. Herbs, for example, are unregulated by the FDA and so anyone, including the check-out guy at the 7-11 can sell them.  (Check out the ingredients of Airborne, for example.)

Sometimes I wonder whether licensure has done more harm than good (a discussion alive in the ND community) but, accepting, for the moment, the conventional  wisdom that it is a good thing, shouldn’t we focus on licensure in all 50 states before pushing for Medicare coverage?  Shouldn’t we pay attention to reciprocity, agreeing on a mutually agreeable minimal set of requirements for licensure so that qualified and experienced LAcs in one state are likely to be able to practice in all states? (I’ll be posting more on this, but I find it tragic that within the profession we are setting rules that exclude so many of our colleagues!)

2) Money. PT is a $30 billion industry. A lot of the big clinics are funded with private equity money. They use aggressive Starbucks style positioning and can run clinics at a loss in hopes of pushing other big clinics out of business. Plus, they can fund advertising campaigns that make PT seem like a normative activity, and of course they can generously donate to candidates.

Yes, there are more PT’s and it is an industry. I don’t know enough about the specific business practices to comment, but I do know that many investors in PT practices are MD’s, powerful allies to have.  They also seem to have a strong national association.  Meanwhile we’ve got associations which have been promising they’ve turned the corner for years.  And we’ve spent so much energy fighting with other providers over our fear that they will “steal” our medicine that we’ve made enemies rather than friends (check out Love the Bomb). From what I can tell, there are enough people open to acupuncture that it is normative.  WebMD talks about it on a regular basis. Folks often report the great results they’ve seen when their pets receive treatment, for example. Our problem is that we have been unable to make good use of the positive buzz that is out there.

As for advertising, again, we have the money to do this, we just do it poorly. The AAAOM spent two years coming up with information cards that were intended to carry a positive message about our profession.  Instead, the first line reads — “Many healthcare providers are performing unlicensed therapies similar to acupuncture, but each state licensed acupuncturist has extensive training in an accredited college that ensures their dedication to providing excellent healthcare.”   We can’t even start on a positive note without casting aspersions on professionals who could be allies. This one sentence contains several inaccuracies/inconsistencies:  a) professions are licensed, not therapies, b) hasn’t the profession been arguing (foolishly imo) that these therapies are not similar to acupuncture but are acupuncture,and c)not all licensed acupuncturists graduated from accredited schools — it depends on the state and on whether they attended a US school. I’m no advertising executive, but that isn’t a helpful introductory line.  How many MD’s or PT’s (who could refer to us) would agree to display a card like that in their office?

It doesn’t take necessarily take big bucks to influence legislation — it does take a winning strategy, choosing issues wisely and building alliances whenever possible. We have not done that.


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© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2033. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

8 thoughts on “A Level Playing Field

  1. Wow, thanks for making my comments into a post! But maybe I should elucidate on the whole playing field thing I started with. It is predicated on the fact that so many people in our profession are framing this as a conflict or competition, and asking how “we” can stop “them” from stealing “our” medicine. My point is that if someone wants to look at this through the lens of conflict (which I don’t), it is a highly asymmetrical one, and we are not going to be able to use the same tactics as the other side. Yes, we can use advertising, but we cannot deploy multi-million dollar campaigns on a regular basis. Even participating in a community event,which I used to do frequently, is starting to become cost prohibitive. I don’t like relying on smear tactics either. Insinuating that other practitioners are somehow less than ethical or may put people in danger, in my opinion just makes us look petty. I think the real solution is to reflect on why acupuncture even exists in this country, and identify the need it serves, and work towards fulfilling that need.

  2. You make great points as always. I’ve never been comfortable with PT’s doing acupuncture especially when so few acupuncturists are paying the rent. But…maybe the battle is not with other practitioners doing acupuncture. Maybe, just maybe, the little turf wars we’re involved in, (and losing), are keeping the focus away from the key here. That is, getting state reciprocity, insurance reciprocity, a national PR campaign/strategy that actually informs the public, and a consensus of acupuncturists in what we want our profession to be. Not what we don’t want other professions to be! Maybe if I focus on being the premier expert in the field of acupuncture and Chinese medicine, I’ll actually have some ground to stand on rather than screaming again and again, “They just pissed in my pool! That’s the reason I can’t make it as an acupuncturist.” I have never once been at a party or event or and gathering where I introduce myself as an acupuncturist and there isn’t a lot of interest. Can’t say the same for bankers, realtors, lawyers, doctors, nurses, or PT’s. People are genuinely interested/excited by what we do. They also are very discerning when they hear whining and falsehoods about “safety issues” and other arguments against those evil professions trying to “take over.” (They can tell what helps them.) Why are we not so well known, so expert and so effective that no one can come close to what we do? I don’t think that’s because chiropractors or PT’s or MD’s use our art. I think that’s because we fight too much. Completely wedded to the anti-establishment attitudes that so often drive our energies. I’m staying open and want to be respectful of clinicians like Frank that also feel uncomfortable and have legitimate concerns about training and public safety. I’m open to dialogue as well. That’s the way I learn, by actually listening to others that have information and opinions that I don’t. Alliances anyone….?

    • Thanks, Pete. We absolutely need to be looking at why so many practitioners aren’t making it, and, I don’t think unfair competition or even uneven insurance practices are going to be the main issues. Things we should be considering — lack of rigor in admissions and education, educational debt, lack of support for start-ups, lack of business training, lack of imagination, lack of reciprocity, etc. Look at what is going on over at POCA for some evidence that success is possible. As you say, people are interested and excited by what we do, and if we keep the focus on doing what we do well and building supports we should do fine.

      My only concern about the “being the premier experts in the field” is that it tends to end in conversations about how we need more education, we need FPDs and DAOM’s and must have the herbal requirement. The result is that it further limits the number of LAcs, raises educational expenses, and actually contributes, imo, to driving patients to other professionals also using “the needle.” If we could just agree to get behind the MAc and got some transparency from the schools about the success of their graduates, we’d be off to a good start.

      I’m not comfortable with PT’s doing acupuncture either — but for me acupuncture is a complete system of diagnosis and treatment. I don’t see using a hypodermic to release a trigger point as acupuncture. And if the type of needle is the issue then we can’t claim concern for the patient as our driving force.

  3. About those AAAOM cards: in my office is that no one will read or even “get” the opening statement. And not only are they wordy; they are bleh in graphic design. They’re not in the least eye-catching. Those cards do not draw attention. They are totally uninteresting. I’d rather make up and print my own cards to deliver the message. (btw, I am not commenting on whether or not I agree with the message – just on the quality of the cards.) Did they hire a graphic designer and then accept that work?

    • I’m not sure of the specifics of the design, I think the work was done pro bono. I know that one problem was that because the requirements for licensure vary so much it was difficult to come up with text that would work on a national level. As for having them in your office, my thought is that once people are in your office, they don’t need the cards. They are coming to you, you can educate them. I thought the idea of the cards was that we could put them in other places and attract people. I fear the languaging makes that unlikely.

  4. I agree with all that has been said. The one thing missing are the schools. Acupuncture school are not teaching the same material uniformly through out all schools. In California, colorado, and Florida herbs are required as other states might require herbs as well. In New York which contains 3,000 acupuncturist herbs are not required. California has it’s own brutal test not that it means anything. Acupuncture as a whole is not a respected profession.

    Our acupuncture schools are not in accredited Universities like PT or OT occupations are. It makes a big difference!!! Our credits are not transferable. We need to take western science classes from accredited colleges or universities. All this also factors in as to why we are not respected. I am sorry to say all this but it’s true. More than other reasons all stated above I think it starts with the school issues and inconsistencies. Thanks,

    • I agree that schools are part of the problem, though I am not sure we are in full agreement on the specifics. Personally, I think we come from a rich and full tradition, and I fear that if all the schools were to teach the same thing a lot of the fullness of Chinese Medicine would be lost. Also, I am not sure we aren’t respected (except by each other) — a lot of that is our own story.

      That being said, I’d be in full support of more of the western sciences being taught at “real” colleges or universities — which is how it was when I was a student. The caliber of our education does vary widely. There is no real way for potential students to determine the quality of education they will get — training people to pass the NCCAOM does not equal training good practitioners. The differing requirements from state to state put us at a huge disadvantage. Again, this topic could use several complete posts. Bottom line, the schools (and ACAOM) make $ for enrolling and graduating students, regardless of long term professional success (or lack thereof).

      I think the problem really starts with the lack of a group that is a strong and sensible voice for LAcs — a voice that provides a counterweight to the power of the schools, ACAOM, NCCAOM, that could help the folks at the state level understand the value of adhering to a level of licensure that would encourage reciprocity, a group that could provide services of use to practitioners today, a group that didn’t just talk of reconciliation but really worked to find unity among the disparate subgroups of the profession.

      I will be very interested to see what happens when POCAtech gets up and running — POCA is super-transparent and dedicated to providing an affordable education that prepares students for clinical success. A little stiff competition among the schools could be just what the LAc ordered.

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