FPD: Who Might Benefit If It Passes?

Ultimately we need to decide on the FPD based on whether it will help our profession by creating more jobs. Might it make life easier for graduates, who by various estimates get out of our profession within five years of graduating at a 50-80% rate? In other words most graduates fail in their practices-at least half and possibly three-quarters or more:can the FPD change this awful statistic? Or could the FPD make it even worse? This is a complicated question, but if we look at the three types of jobs that are available to graduating Acupuncturists, we can get a good handle on answering it. First though, the three types of Acupuncture jobs:

1) Independent private practice, which the great majority of us are in today. This means the Acupuncturist is responsible for creating every aspect of his or her own job, not only the cash flow but all of the supporting systems -- a whole lot harder than just getting a paycheck.

2) Integrated in Western medical institutions, HMO's, hospitals, etc., all of which stands to undergo major reform today as we all know. 

3) Acupuncture schools, currently the healthiest sector of the non-MD acupuncture world. 

Let's look at each one in turn, see how they work, and determine if an FPD would help.

Independent Private Practice

How it works: There are several types of private practice out there. There's the Community model, as preached here on CAN, there's the high-end Private Practice, there's the insurance-driven model, and various Hybrids of all three. The details of each are different but in the end they all depend on the same thing: referrals. If you get enough referrals then you survive; if not you go out of business.

How does one get referrals? Through word of mouth; through personal contact. This is not a business where normal advertising works. One has to develop a reputation that makes people (either patients and/or other medical providers) tell their friends or patients to see you. It's that simple. Whatever you do with the patients once you have them depends on the style of treatment you use, but whatever you do you need them to refer other patients to you in order to survive.

So would having an FPD in place help the Independent Private Practitioners?  In the short run, not really, and in the long run it could well hurt. Let me explain.

Remember, reputation is key with this type of job. But that reputation does not come from a title; it comes from results. From your track record in the real world. Patients and other medical providers refer to you because they know, or have heard, that you get good results with either a certain type of condition (if it's a medical provider) or with a particular patient who then refers a friend or loved one to you. This is all informal and personal. It's not based on scientific evidence even when an MD refers someone; it's based on practical experience. 

But would having the word "Doctor" in front of your name open new doors and new referrals? Maybe a few prospective patients on the margins might come thinking that the Western medical establishment has now granted legitimacy to Acupuncture, but there aren't many people like that, people who are currently not coming through our doors because they don't like our current titles. Medical providers will certainly not refer more people because they will still view us as Acupuncturists; even with the FPD we will not have had nearly enough Western training to practice like MD's. In the balance it will still be your reputation in your community that will determine if you sink or swim.

In the long run, the FPD might hurt Private Practitioners. Part of developing a reputation is people knowing you exist.  But with only 1% of the US having experienced Acupuncture to date, most people actually have no clue about us. What Private Practitioners need most is help in getting the word out that we are in fact here and can help with all sorts of conditions. But with the FPD as the entry level degree, with its longer time in school and proportionally greater costs, fewer students will enroll, so there will be fewer Practitioners in the long run.  This might be okay for currently successful practitioners but not for the rest of us who are struggling. Ultimately Private Practitioners, as a group, need the general population to think of Acupuncture as a normal, if alternative, therapy for what ails them, and that only comes from word of mouth.

Integrated in Western medical institutions 

How about this group? Will the FPD help here? Let's look closer. 

What we are talking about here is working as a medical tech in a hospital or HMO. Whoa! Why do I write, "Medical tech" and not Doctor?  Because even with a Doctorate you will not be allowed to determine a course of treatment in such institutions. If you step back a bit you know this to be true. Just look at our messed up health care system in the US. The one Obama is doing a poor job in reforming. No one is even talking about letting MDs regain control of how to treat patients; that's the turf of the insurance industry and that isn't gonna change anytime soon. Just a little Googling will bring up scads of articles on how unhappy Doctors are, how much they have no say in what they do for patients. But we, as patients in that system, know this already. Why would it be any better for Acupuncturists working in that system? In fact it would be worse because until the Western medical establishment determines exactly how Acupuncture works and how it helps certain conditions, the idea that we might have the same status as MD's is misleading at best: only the most gullible among us would believe that.

So at best we might see more technician-type jobs in HMO's and, yes, technicians don't make much money.  We will also be told how many times we get to treat a patient, as determined by the insurers. But will the FPD make those jobs happen when they otherwise wouldn't? That's hard to say. The problem is no one has studied how Acupuncture is integrating within the HMO's.(If someone has ever seen a good study to that effect, please link it, we'd all like to see it. Anecdotal evidence suggests acupuncture integration is marginal, haphazard, and often the first to get the axe when funds are short.) We are still very early in this integration process with Western medicine and so one should expect to see new jobs opening up naturally as Acupuncture becomes more available. But the big problem here has little to do with the FPD or lack of it: it's the problem of the Western Medical Model and its HMO's and insurance driven ridiculous costs. We know that the System is in seriously bad shape and it's not getting better. One result of this is that the Gatekeepers of this System are NOT into seeing their way to embrace new techniques like Acupuncture. In fact private insurers are dropping the option of Acupuncture from their plans. (WCA regularly sees patients who come in saying: yes, I've gotten acupuncture before, I love it and I loved my acupuncturist, but my insurance dropped it so I can't afford her/him anymore.) Yeah, I know, Acupuncture would save the insurerers money, theoretically, but they are so strapped for cash that they don't have the time to look at Acupuncture and how good it is. We are just not on the table, FPD or no, so maybe some tech jobs will open up but only on the margins and all low-paying. 

Yes, I understand what I am saying is quite at odds with what Acupuncture Today and some school presidents and deans are saying but step back and look at medicine in this country and see how much of a mess it is in. Now tell me that the HMO's and hospitals will look at the tiny Acupuncture profession and prioritize how to employ us. Yeah: ain't gonna happen. They are too busy screwing themselves.

Acupuncture Schools

The healthiest part of the Acupuncture profession these days are the schools, due to their ability to get federal student loan money. Currently there are 50+ schools in the country. However even though they take in millions of dollars few of them are making much of a profit as they spend almost everything they make. (I say this from looking at the non-profit schools' publicly available financial records and from some informal conversations wit various school officials. I have no idea about for-profit schools like PCOM as they don't have to disclose financial info.) 

So these schools need to be careful with their money and naturally they are looking for added revenue streams. Here are a couple:

a) Following on the heels of getting student loans, came the Master's level programs. It would be interesting to see the 20 year history of the master's programs and how they've grown, but grown they have. My class at OCOM (93) was the first class at that school that was granted a master's degree. I went to school for three normal academic calendar years and had my summers off. At present, OCOM students have a three and a half year program and they take classes all summer. Clearly OCOM has added classes beyond what are required. My guess is that most schools have followed suit. In addition the price per credit has gone up beyond the rate of inflation. Will Morris, president of AOMA in Austin, wrote just the other day that the Master's programs are bloated. I agree, plus I'll add that he and his peers have taken an already too long master's program and bloated it for their own profit. It seems like whenever the schools have had a choice, they have opted for MORE: more classes, more time, more money from students. Given an inch, they've taken miles. If anybody can cite an example of acupuncture schools opting to look at efficiency, and actually cut something from their programs or streamline something to save students money, I would love to hear about it. You have to look at the FPD as part of a pattern of bloating and ask if this passes, what do you think they'll want to add next?

b) The DAOM programs. These started oh five-six years ago. After a quick start they have almost all fizzled financially. (I say" almost" because I don't know how each one is doing. I just know that all the programs I know are seriously struggling.) They only have a handful of students enrolled at a time. They have turned out not to be popular because they aren't needed to have a successful practice. 

c) Regional accreditation.  Almost every acu-school is accredited by the ACAOM, the national body that was set up to do this sort of thing. This is an unusual situation actually as most mainstream schools (colleges, private high schools, etc.) are accredited through one of several regional accrediting bodies. Basically only very marginal educational institutions, like Acupuncture schools, set up their own national accrediting bodies because classes taken at a non-regionally accredited school are not transferable to other schools-except those using the same national accreditation institution. For example, that Pathology class you took in acu-school wouldn't be recognized at a Med school. 

But now some of the larger Acu-schools are trying to get regional accreditation. Tai Sophia is one and from that regional accreditation they can branch out beyond just Acupuncture degrees. This is a good move on their part, I say, broadening one's revenue stream.

I list these programs by the schools to note that survival for them is not a given; they have to work at it just like us. But with that we must realize that they have a stake in the FPD as another revenue stream and because of that any advocacy for the FPD by them must be seen by us as colored largely by self-serving financial reasons more than altruistic helping of the Acupuncture community in this country. It's like they are taking a variant of the old Eisenhower saying, "What's good for GM is good for the US," to "What's good for the Acupuncture schools is good for the Acupuncture profession."

But honestly I don't know if the FPD will be good for the schools.  Yeah, if the same numbers of students that now enroll in the Master's programs enroll in the FPD, then yes it would be good. But asking for another year (at least; remember how the Master's programs have grown) of school when many students are already crossing over the $100,000 debt line: I don't think it's realistic to expect. 

It's not like the Acu-schools know best either. Will Morris has publicly written that wrong decision were made about the Master's programs. Since he and the other people pushing for the FPD were in charge of setting up those Master's programs, who's to say that they aren't wrong again? Look at the prospects of working in the HMO's or Private Practitioners above: do you see a need for more schooling in either instance? The acu-schools that are pushing for the FPD do. I think they are deluding themselves. 

So in conclusion, I don't see a need for the  FPD. It might actually hurt the profession. The reasons given for the FPD on Acupuncture Today and various internet forums -- more jobs -- basically can't be backed up with any study. I hope you see this and give your voice to slow down the FPD express and start looking into the reasons why the profession isn't doing better.

This story was posted on December 7 2009 by Skip.
Tags: fpd

Comments

  • December 7 2009 at 3:19 PM
    JuliaC writes:

    A+

    Very well written, Skip.  I encourage you to post this on some of the TCM forums.  The even tone of the piece and your clearly articulated arguments will surely persuade some of the fence sitters who aren’t sure how to penetrate the debate as it stands now.

     

    Julia (your fan) in Berkeley 

     

     

      0 likes
  • December 7 2009 at 3:21 PM
    Jessica Feltz writes:

    Skip ~

    Would you like this reposted on a forum that Will Morris, Benj D, and Dort Biggs participate on?

      0 likes
  • December 7 2009 at 5:32 PM
    andy wegman writes:

    The answer to your question, Skip:

    Is likely, very few schools and the folks who loan students money.

    —-

    I was blessed to be offered a job as a staff punk right out of acu-school (thanks Amy Jiao!).

    The position was part of an ‘integrated’ medical practice.  I was a fresh-faced L.Ac. who had just spent 3 full years at NESA - amassed $24k in loans (paltry by today’s standards) , and *still* had to earn my clinical legs over the following several years, seeing ~ 20 pts/week.

    After 6 years or so, I left the practice, and opened a community acu-clinic that better reflected my values as a person and practitioner.  It also has provided me the opportunity to give, along with my colleagues, > 20,000 treatments since June of 2007. 

    The MD who employed me and I still work together (tech stuff) and refer back and forth.

    As Skip noted, the progress made in securing a living for myself and my staff, and making acupuncture available to lots of folks can be credited to word of mouth referrals. 

    I realize my story is a singular one, but also one absent an entry-level doctorate degree.  

    To take on ~ 4 years of post-grad education and ~ $100,000 in debt, in hopes to make for a better candidate in an integrative medical practice or inpatient palliative care position should be a matter of choice.  

    In my opinion, it would make for an outrageous and expensive requirement, in order to become a competent and employable acupuncturist or potentially productive clinic owner.

      0 likes
  • December 7 2009 at 8:00 PM
    Jessica Feltz writes:

    Medical Technicians!

    $10,000 education from a regionally-accredited community college.

    -OR-

    $100,000 education from an acupuncture college.

    Which employee will be more cost-effective for the hospitals to hire?

    *thinking music*

      0 likes
  • December 7 2009 at 9:22 PM
    tessmcginn writes:

    It’s a good idea Jessica…

    but that idea is going to be year’s away.  I think just trying to save us from FPD is enough for now.  I get a little nervous that acupuncturists who don’t think FPD is a good idea, will think even less of Medical Techs and so cast themselves with the higher degree fearing the lower one. 

    The dentists continue to do that to the idea of a Dental Tech because they fear loss of credibility and probably just greed.

      0 likes
  • December 7 2009 at 10:15 PM
    Guest writes:

    Like this?  There will be more to come.

    http://www.chicagotribune.com/health/chi-tc-nw-alternative-meds-1205-dec06,0,4957841.story
    (sorry for not pasting the link properly)

    WASHINGTON -—Acupuncturists, dietary supplement makers and other alternative health practitioners, some of whose treatments are considered unproven and risky by the medical establishment, would be brought more squarely into the mainstream of American medicine under the health legislation now before the Senate….

    “But insurers and some scientific watchdogs say they could lead to support for unproven and even dangerous therapies. And they say the Senate measures would undermine one of the central principles of the health reform: That the health system cut costs by eliminating medical treatments that aren’t proved effective…”

    “It provides grants to create teams of health professionals who would collaborate on patient care. The teams could include alternative health care providers and might even be led by those providers—a feature that some physicians say could be dangerous…”

    The ever popular “some people say” tactic.  It’s rare that a newspaper ever writes about acupuncture in anything less than glowing terms.  But notice how this article conflates acupuncture with terms like, risky, unproven, dangerous, patient confusion and more.  I’m not one to be cynical, but this seems like the first step of an insurance industry eager to not make the mistake they made with chiropractors.  Expect a pushback and a smear campaign.  See you on quackwatch.com!

      0 likes
  • December 7 2009 at 11:27 PM
    Guest writes:

    “If anybody can cite an

    “If anybody can cite an example of acupuncture schools opting to look at efficiency….”

    One of the things that I didn’t state in a previous tread, The Educational Dilemma: A Minority View, was that Jung Tao School of Classical Chinese Medicine’s acupuncture program is streamlined to save students money.

    Here’s the course outline:

    year 1 - the healthy state • 450 clock hours
    E-100 Energetic Anatomy and Physiology 150*
    B-100 Biomedical Anatomy and Physiology 180
    B-101 Biomedical Sciences     90
    E-101 Taijiquan                               30

    year 2 - diagnosis and pathology • 540 clock hours
    E-200 Energetic Diagnosis                   150
    B-200 Biomedical Pathophysiology           180
    B-202 Point Location                             90
    E-201 Taijiquan                               30
    C-200 Clinical Observation                     90

    year 3 - clinical skills • 540 clock hours
    E-300 Energetic Treatment                   150
    E-302 Treatment Techniques                   90
    E-303 Integrative Medicine                     90
    P-300 Professional Skills                       90
    E-301 Taijiquan                               30
    C-300 Clinical Observation                     90

    year 4 - Internship • 600 clock hours
    C-400 Clinical Internship                       600

    total program                                     2130 clock hours

    The school doesn’t offer federal financial aid; the program is spread out so that students can work in between classes (classes are held five-consecutive days per month). This allowed me to graduate without any debt from school.

    Does anyone know of any other schools that are doing a good job? This type of information would be very beneficial to potential students.

      0 likes
  • December 8 2009 at 10:56 AM
    Skip writes:

    Jung Tao

    If more schools were like Jung Tao in its efficiency and respect for their student’s wallets we would be in a very different place. As it stands they are the exception that proves the rule.

      0 likes
  • December 8 2009 at 9:46 PM
    Guest writes:

    I would encourage CAN to

    I would encourage CAN to create a resource page for potential students that lists schools that are doing a good job. Just as Matthew Bauer advocates for a comprehensive public outreach campaign, I’m advocating for a comprehensive potential student outreach campaign. This could result in a significant bottom-up effect on schools.

    Potential students wield consumer power!

    What do CAN members think about a comprehensive potential student outreach campaign?

      0 likes
  • December 8 2009 at 10:01 PM
    LarryG writes:

    it is on our agenda

    the board is in talks about doing just this, GNV.  We’ll keep y’all posted.

     

      0 likes
  • December 9 2009 at 5:17 PM
    bonnyrhoads writes:

    thanks so much Skip

     

    for laying out the issues so beautifully.

     

    And to guest not verified, the student campaign is genius! Keep those ideas coming folks!

      0 likes
  • December 9 2009 at 8:35 PM
    peoples writes:

    going back to NADA

    I just gave my 2 cents to ACAOM and cc’ed it to info@workingclassacupuncuture.  I asked why our profession has not been seeking to create more NADA clinics as a way of creating more jobs.  It would be a more practical goal than the FPD since it puts more practioners to work at living wage jobs and it would benefit communities right away. 

    I doubt they care for my two cents but I thought I would add what I am in favor of in addition to what I am not in favor of. 

    Again to Skip, Jessica, Andy and Everyone, thank you for making such strong and valid points.  You are more well written than I am.  I am hoping these points are on the table when debating the doctorate.  do we have to drive to Maryland and pound down the door of ACAOM for a little transparency?

      0 likes
  • December 14 2009 at 2:07 PM
    wmorris writes:

    Benefit?

    It hurt to read your comments and I wonder if we might talk together? My cell is 310-963-6819. I am responding here to your comments directed towards me. I believe the AAAOM FPD Factbook will do an excellent job of clarifying matters.  It surprised me to see your email with my name in it claiming that, “<i >Will Morris has publicly written that wrong decision were made about the Master’s programs. Since he and the other people pushing for the FPD were in charge of setting up those Master’s programs, who’s to say that they aren’t wrong again?</i>” I admit publishing that. While getting older, I am not so old that I was in charge of setting those programs up! wink The first accreditations took place in 1999 just after I finished my OMD program at SAMRA in 1998, the very last OMD offered. I didn’t get involved in academic medicine and program design until 10 years after that in 1998.  You also quote me saying, “<i >The Master’s programs are bloated.</i>” But, you also slander, “<i >He and his peers have taken an already too long master’s program and bloated it for their own profit.</i>” Not as powerful as you would have it! I have never been in a position to increase hours. I just completed four years in the role as a college president, a time frame that does not comport with your assertions! Further, as recent as 2003, the professional acupuncturists in California attempted to push 4,000 hours for entry and then backed down to 3,800 – this was shot down by the council of colleges.  I left a $120,000 a year practice in Chinese medicine to earn half of that in academic medicine. This was because of a belief in the medicine, a desire for it to be taught better, and an interest in bringing a family lineage into mainstream education. That lineage project failed, but I discovered an interest academic medicine and teaching. To this day I don’t make as much as I used to in private practice. So, when I hear profit motive, well, no one asked me what my motives are!  I believe that everyone entering the field now should have a doctorate, not a master degree.  I also believe in and support lower cost models of entry for programs such as NADA and CAN. The underprivileged people who cannot afford CAN models of practice should also have access. My motive is pure and simple. Chinese medicine is part of a solution for the American Healthcare system. We should be in the game and not on the sidelines.  Warmly, Will 

      0 likes
  • December 14 2009 at 3:33 PM
    Lisafer writes:

    hi Will

    Skip sent you an email—please let us know if you didn’t get it.

    I don’t want to get into the middle of your exchange with him, but since you left this as a public comment, could you clarify a couple of things about the FPD?

    First, very specifically, you wrote, ” the underprivileged people who cannot afford CAN models of practice should also have access”. I have seen access for underclass patients referenced elsewhere as an argument in favor of the FPD. Is that what you’re saying? If so, can you explain exactly what economic structure would fund acupuncture treatments for underclass patients? 

    Second—actually, that’s probably going to get this thread too bogged down. I’ll wait for the second part.

      0 likes
  • December 14 2009 at 11:00 PM
    wmorris writes:

    Hi Lisa

    I got Skip’s email and sent him a request for a phone call. 

    My responses to Skip are indefense of my name - not the first professional doctorate,which I left to the AAAOM Q&A.

    My mission is for all Americans togain access to acupuncture and Chinese medicine,no matter their class. 

    Right now,it is schools that subsidize services to underclass patients. Sometimes itcomes from private funds or municipal funds because it lowers the cost load. I don’thave a good systems-based answer. It is like putting our finger in the damn! Wedo need to hold a vision since that guides dialog and subsequently policydevelopment. 

      0 likes
  • December 17 2009 at 5:13 PM
    Guest writes:

    Search engine optimization

    If CAN does comprise a list of TCM programs that are successful to the needs of the students, I would recommend using some sort of search engine optimization so that it is listed in the top 3 searches.

      0 likes
  • December 17 2009 at 7:58 PM
    Nora writes:

    good idea, duly noted

    We can certainly do things like link to it from all of the CAN member clinic websites…maybe get the Integrator to talk about it?, etc.

      0 likes
  • December 18 2009 at 1:35 PM
    chaitime writes:

    To Will

    Is there a link to the Q & A so that it can be read? Would you be willing to answer specific questions about the FPD as well? I think it would be very helpful. thanks.

      0 likes
  • December 19 2009 at 12:59 PM
    Guest writes:

    Acupuncture school ratings

    Insights for acupuncturists.com has a self-reported rating of various schools of TCM.  Potential students can read reviews posted by alumni/current students

    http://www.insights-for-acupuncturists.com/best-acupuncture-school.html#VisitorPages

      0 likes
  • January 2 2010 at 3:09 AM
    wmorris writes:

    To Chai Time

    Hi Chaitime -

    Here is the link to the control document for the FPD Fact Book http://asny.org/FPD-12-18-09.pdf. It is really tough for me to keep up with the stream of commentary. I recommend that you go to the forum that is designed for the discussion at http://groups.google.com/group/aomcommunity since the issues are complex and can be debated from multiple perspectives.  

    Warmly,

    Will 

      0 likes

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