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.




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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.

9 thoughts on “Continuous Improvement and Feedback

  1. After 10 years of practicing acupuncture in a private practice and also for a drug rehabilitation company, I shifted careers to teaching High School. I just couldn’t make enough money. It was contract work and there were never benefits or retirement. I always worried that if something happened to my husband, I wouldn’t be able to support our children. There just aren’t that many jobs available for acupuncturists. If you look at most hospital websites they’ll have 14 to 16 pages of openings for nurses, respiratory therapists, physical therapists, physicians assistants and so forth, but there might be one or two openings at an Integrative Medical Clinic at a hospital. I personally love the field of Chinese medicine, but looking back I wish I would have studied at a regionally accredited University. My current teaching position can’t pay me for a Master’s degree from my Oriental medical school. I blame myself, and not my college, though if asked, I always encourage students to stick to careers in demand.

    • Lots of folks share responsibility. I certainly don’t think the colleges deserve all the blame. I know plenty of people who are bitter about their student loan burden who also used $$ for one last hurrah of travel before they got down to work, for example. A thousand here and a thousand there and it adds up. And, the students, mostly, don’t know what they don’t know and do know what the schools have been telling them, which, in many cases, is misleading at best.

      I agree, too, that the lack of regional accreditation is an important issue that many students don’t understand. When I was starting out I took my prereqs at the local community college, which at least meant they’d be useful for something else if acupuncture didn’t work out. A&P from an acupuncture school – not so much.

  2. Well, I suppose the schools can breathe a sigh of relief. Is anyone surprised that this administration is backing off?

    Hey schools, now that you don’t have to worry about losing out on all that $$, perhaps you can start paying attention to what is happening to your graduates?

  3. Agreed and very well put. I actually wrote my school a letter last year, 5 years after graduating and not being able to support myself or work much in acupuncture. I got a response but it wasn’t an open dialogue. It was basically that they said they didn’t guarantee success and that most of their graduates seem to be doing okay. My question was, what does okay mean? Exactly as you said. Are they seeing 20-40 patients, making decent money but not enough for student loan debt or are the ones doing okay not the ones that needed full loans to begin with? It was hard for me to write my school because there is this quiet, hush hush, we don’t talk about the bad stuff side to acupuncture but I did it anyway. I wish they felt more accountable but they don’t seem to. We should be talking about how to make this better for us now and those in the future or there wont’ be a future to the acupuncture profession.

    • I’m not surprised that the schools and organizations are responding to the GE rules with concern and action to get exceptions or overturn the rules. I AM, well, not surprised, having been around for a while now, but very disappointed that the responses have not ALSO included acknowledgement of the issues and outreach to the people already out in the field. If you have the resources to file suit against the DOE, don’t you also have the resources to contact your grads, gather information about how they are doing, offer support and business and career counseling as part of your program? The focus from the schools and orgs has been to fight back, with no attempt to fight for the students who will be paying off their educations for the next decade(s).

    • Also, someone wrote to me that if 50% of the schools close there will be no future for the profession. But isn’t the same true if 50% of graduates leave the profession in a short period of time (or never even work in it). How is that better?

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