Survey, Part Three

The ASVA membership meeting was April 7th and I’ve been meaning to write about it ever since. I heard good things about the associated weekend seminar, the setting was lovely, and ASVA received support from a number of vendors. Two folks stepped up to fill open positions on the board, and it looks as though good things are happening for the group.  I remember well the hard work it takes to run an organization and big events like this one – kudos to the board for their efforts.

The survey results, though, diminished my good spirits (and please read 6 even if you skip the rest!)  —

1) 75% of respondents replied yes to supporting efforts to add Acupuncturists to the list of covered providers in the Social Security Act. I only wish the profession had more information about what a successful effort would entail, the odds of success, and the potential impacts of success. I have seen nothing that comes close to a well-done analysis of these issues.

2) 82% support the national effort to include acupuncture as a federally mandated EHB. The current HHS policy is that if a state does not establish their own EHB, the federal government will rely on existing plans within that state to establish an EHB. Any efforts to include acupuncture in a federally mandated EHB would first require a complete change in how HHS is establishing EHB for states. I don’t know of any active national effort to bring about this change and unless the acupuncture community believes that we can win an argument with all of the states and the US Congress about greater federal control of healthcare, an arena more typically left to the states, this is a non-starter. (And if we were successful it would have some huge impacts for us that I have not seen discussed anywhere — I’ll be posting about it one of these days.)

3) 75% support fundraising for the purpose of updating the Virginia scope. There wasn’t any conversation about what changes anyone had in mind, so I’m not sure what people are supporting. See my March 26 post about scope for more on this issue, but, based on what was said at this meeting, there is still a lack of understanding of what “scope” means.

4) Only 60% supported a grassroots campaign to support the election of legislators supportive of acupuncture. Perhaps ASVA members are reading this blog? I hope my look at the question and the relative lack of support for the strategy as stated does not translate to a lack of involvement with our legislators.  It is super-important that we, as individuals, get involved in local campaigns and stay involved with our state politicians. Done right, this is one of the most important things we can do, and a great place for help from our state organizations. The tricky part is doing it so that we develop allies, not create enemies.

5) 68% supported fundraising for legislative efforts to restrict other professions from practicing acupuncture. I can’t begin to imagine a way that such legislation could be successful in Virginia — where low regulation and the free market seem to rule (except in matters of the uterus). I can imagine many ways the mere introduction of such legislation could create division and hard feelings with fellow health professionals.

6) About 10% indicated they’d be willing to serve on a committee. Which leads me to two thoughts —

a) (and most obviously) – success in any of these areas would require far more than 10% of the profession to step up and serve. Of course, being on a committee isn’t the only way, but we’d all need to be involved and contributing time and money.

b) (and most importantly) – it is easy to say we support an idea or an action in the abstract. But when we are in touch with the real time and effort a yes entails, it’s not so easy. Questions 1-5 would have a far greater impact on our day-to-day workload and life than serving on a committee. So, colleagues, before you say you support inclusion in Medicare or legislative action or acupuncture as an EHB, give it just as much thought as you would the decision to serve on a committee.


Copyright —

© 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 “Survey, Part Three

  1. Elaine,
    Thoughtful and articulate as always. One of the reasons I have avoided membership in the national acupuncture society is that they consistently support measures that I strongly disagree with. And now ASVA is being swept up in the same rush. There seem to be two desires behind the push for Medicare reimbursement: the Rodney-Dangerfield-I-just-can’t-get-no-respect motive (discussed in your blog post on dismissive docs), and the we need to get more money motive. Ask chiropractors how much respect pours their way from members of the medical profession. As to the second desire, the need to have staffs to take on the complexity of billing and the low level of reimbursement seems to wipe out any gains from increased patient volume. Also, if it is so profitable why do so many docs and dentists convert their practices to do cosmetic work specifically to avoid the hassle of any form of insurance? There is an old saying that those God wishes to punish, he first grants their wishes. It would be wise if the acupuncture profession took the time and thought you articulated before putting big changes on their/our wish list. Thanks for your posts.

  2. I did lower my prices in the last place I was in but it did not make a difference. I am actually afraid to open up another practice and get disappointed again. Honestly, I don’t have it in me to devote that much time to a new practice as I need to do. I will not give up my license or my national certification but I need to have a profession I can actually make money at and feel good about. People do not honor us. Look at the jobs offer to us cruise ships? From the posts I read it sounds abusive. It is unfortunate that our group of people did not get done what they said they would when I went to school 13 years ago. I feel tired and worn out fighting everyone. I wish we had more options that’s all. I have worked with Chiropractor and Physical therapist all they want to do is make money off of you and rip you off. I do feel sick and tired and I feel we got the short end of the stick. I know other’s feel as I do but I am not sure what to do about it. At this point I have come to terms with the possibility of letting it go for now. Maybe things will change in the future.

    I guess my heart and spirit feel broken and I need something easier because I spend so much of my time making sure my son’s needs are met. I don’t know if you know how much time is takin out of my day dealing with kids. My whole weekend was baseball. I don’t mind I love my son but there is only one of me. I just wish I knew what my life would have look like and knew the state acupuncture would stay in because I probably would have chosen another career. I went to school before kids.

    I appreciate you listening as I make up my mind. I don’t think I am the only one going through this. Maybe someone has ideas or our conversation can help someone else. I do think what you are doing is important. I encourage you to continue. Someday something will change and it will be partly because of what you are doing. Keep it up!!!

    • Susan,

      I am sorry you are struggling. I know that you are not the only one going through this and that you are not the only one who had the impression that life would be different at this point in the profession. I think that many of the issues you bring up are worth a whole post, so I won’t address them all here, but there is certainly no magic answer — we can work outside the system, for ourselves, and make more more per hour but also be responsible for building and maintaining a business, we can work for others and perhaps feel that we are underpaid and overworked, we can find ways to work within the system and potentially end up fighting for $ as you see among some DC’s and some PT’s. Our situation isn’t all that different from the vast majority of people — fighting for jobs we like while taking care of our families and wondering how long we can keep it together. Our biggest problem, I think, is that our organizations and institutions have promised that more education, or fighting with other professions, or becoming part of the system will magically save us, while neglecting types of support that could have actually helped. And I am hoping this blog begins to change that.

      Good Luck!

  3. Hi,
    Just read your new blog. As I have said before I do agree with you on most things but, the big but, I have recently been counseling people with traumatic brain injury. I told you before I also have a masters in psychology. This program is run by New York State and there are other programs run in other states. I was thinking, wouldn’t it be great for these people and us to be able to work with them. We can not because this is done through medicaid. It is truly a shame all the programs we are shut out from. It is bad for us and them. We could be doing so much more. The people running our political standing have done a poor job. We could be involved in so many programs and be counted as valuable. What makes OT or PT so valuable? They are everywhere and we are no where but with people who can afford to pay out of pocket. We are very limited. We have limited ourselves. Thanks guys.

    • Thanks for your comments, Susan. Let me clarify – participating in the system might be a good choice for us. We just have not been given enough information to know. There might be other ways to provide services for people who can’t pay out of pocket — pro bono work, for instance. I’m not sure what you mean by “valuable” regarding OT and PT — I don’t think what they make on a per patient basis is comparable to what most LAcs make, but I don’t know. I know that PT practices tend to rely on Physical Therapy Assistants, partially because the reimbursement rates aren’t sufficient to have PT’s provide all of the services.

      I completely agree that we have loads of work to do to make our services available to more people. Let’s just consider all the possible solutions rather than blindly follow the same path that has caused so much trouble for so many other health care professions.

      • Hi,
        It is unfortunate that no one seems to know what programs are out there and how would they effect us or not. I heel like I have been in a closet for years and suddenly I see all these programs opened to all of these other fields but not open to us. It is truly eye opening. OT can work any where. All these agencies are out there and they hire OT, PT, nurses, ect… You get jobs or work in the school system and do your thing, write your reports and get paid and go home. Sounds go to me. I personally am sick of building businesses and learning about insurance and all that garbage. I just think we are not doing the right things for ourselves. I don’t think we know all the information either. I am currently looking to return to school for possibly Occupational therapy. I have a child and I am single parent. There is only do much I can do in a day. I want a job I can do my thing and go home. I don’t want to be doing my job 24 hours a day and plus. I need to split my time with my child. That is my personal decision.

        • There are increasing numbers of jobs out there for LAcs too. I know of community acupuncture clinics looking to hire people, and VA hospitals and the military are also hiring, as is an HMO in the DC area. Check out the AAAOM homepage for a variety of opportunities. I encourage you to talk to lots of OT’s and before investing in an OT degree — there is lots of griping in that field too, with many feeling they are overworked and underpaid and buried under paperwork. I know lots of nurses, and though they have no trouble finding jobs, they often find their working conditions very difficult. I’m not meaning to be negative, but there are lots of careers that look a lot better from the outside than from the inside 😉

          • You are probably right. I am in Rochester, NY and I kind of have to stay here until my son graduates High School. He is Dyslexic and found this amazing situation here where the city school district does pay for him to attend a private school. This situation is not replaceable but I guess my career aspirations are secondary. Which is why I do need something main stream I think? I am looking into many options. I am pretty confused as to what to do right now. I did not have the heart to open a third practice to just barely making it again. My stamina for all that is just not there which is why I got a job counseling. I would just stay with the counseling but I just can’t make enough money with it over the long haul. I am still looking into things and checking it all out. I look into the nursing but decided I hated it. It is difficult. I love Acupuncture but this financial environment is not good for it. I hate being a salesperson. That is definitely not me. I like doing my craft and going home. I have too many obligations at home to deal with. I appreciate you letting me talk. If you have any other suggestions I would love to hear it. I personally hate the idea of community acupuncture. To me that is a cheap way to sell acupuncture. It is not even worth doing it. I don’t even use any of my skills. Have a nice weekend!!!

          • I’m not sure what you mean by not using your skills if you were doing community acupuncture. Do you have any first-hand familiarity with it? I know practitioners who have worked in private room and community settings who report using far more acupuncture skills in the community setting. Practitioners diagnose, design treatments, use appropriate needle technique, cupping, bleeding, etc. The main difference imo is a lot less time chatting. It’s actually pretty similar to how acupuncture is practiced by most of the Asian practitioners in my area, only without curtains separating patients. If you’ve read Miriam Lee’s Insights of a Senior Acupuncturist she’s describing something very much like community acupuncture.

            It is interesting that the impact of third party payers and Medicare often moves western medicine into something that looks a lot like a community clinic, more patients per hour to make up for the lower reimbursements, so that is something to keep in mind as you explore fields that are already part of the system. I am sorry that you are struggling with finding something that works for you. There isn’t any magic wand — but if the financial environment you are in means that not enough people can afford acupuncture then lowering your rates is the most sensible way to address that. Have you spoken to other practitioners in your area asking about opportunities? On two occasions I’ve had practitioners let me know that they have left the profession when I knew of opportunities that might have helped them had they let me know sooner.

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