Toaster Tour Interview #4: Steven Stumpf, Ed.D.

strong>1)  Looking at the recent NCCAOM Job Task Analysis, why do you think there are so few jobs for acupuncturists? What do you think that says about the acupuncture profession?

The NCCAOM JTA is a curious document because it attempts to say as little as possible about a very sad situation yet careful reading says it all. The only job for an LAc is solo practice. When reaching out to prospective students the schools make this sound like a business opportunity. The data say it is a business dead end. Lisa has summarized the facts here. Is it any wonder the leadership orgs have never put together a workforce survey? We see the unavoidable impulse to twist the data in the NCCAOM report where it is reported that 70% earn $60,000 or less per year. Huh? This is like those real estate investment ads on late night TV. Some people are making millions every month flipping homes. You could too! The NCCAOM JTA should have a photo of Kory Ward-Cook on a racing boat with a cigar and tanned LAcs in the background dancing to the groovy beat. "Seventy percent of LAcs make $60,000 or less!" Become a TCM doctor. Charge physician fees as a Chinese medicine physician. Complete your degree in 3 years. When people cannot earn a living, when as many as 40% of LAcs are making less than $20,000 a year the message should be clear. If it's too good to be true...it ain't true.

strong>2) What jobs for acupuncturists do you know of that fit the criteria of The Toaster Tour -- real, relevant, and replicable? (See this blog post for an explanation of the criteria.) Please list the jobs, including the nature of the funding stream that supports them if you know it. We will try to independently verify them, of course; any contact information you have is greatly appreciated.

Best I can do is 2 out of 3. I met a CANner at the May 2011 conference who was working a Federally Qualified Health Center. He was being paid a salary. Without knowing much about him I know this. The job is real because FQHCs are supported by federal $$ to provide healthcare to indigent people. An FQHC can bill under an E&M code which means the clinic will get paid for practically any service delivered. It is relevant because he is treating every day poor people with primary care problems. This is not addiction medicine or auricular acupuncture or one of the other "branches." This is medicine in a mainstream clinical setting. Unfortunately, it is not replicable. Could be but it would take some kind of coordinated work to make it happen nationwide. I hope he realizes how lucky and rare he is. A working LAc making a fair living in a fiscally stable setting.

strong>3) Who do you think is the largest employer of L.Acs in the U.S.? How many jobs does the largest employer provide?

Buzzzz. Loaded question. Not fair to the solo practitioners and their advocates. Everyone who doesn't have their head in the sand should know the only org that is "hiring" is CAN. Every now and then my former student Simon Shapiro sends me a notice he gets from OCOM advertising for a p/t clinical supervisor at $10/hr. No wonder he went to med school at 36 y.o.

4) In your opinion, what groundwork needs to be done in order for more acupuncturists to have real jobs? Who is responsible for doing that groundwork?

I used to think that training needed to be grounded in primary care medicine. This means completing 6 to 9 months as a student working alongside physicians, RNs, NPs and PAs in a community clinic. I used to think that reforming acupuncture from within was the way to go. I am not so sure anymore. The problem is nobody cares about what happens to acupuncture; not mainstream medicine and certainly not the acupuncture schools or leadership orgs. There are certainly exceptions to my perception. Michael Jabbour is working very hard to reform AAAOM and ACAOM. NGAOM under the direction of Steve Paine and Hugh Morison are working hard to win contracts for Guild certified LAcs. The problem is the NCCAOM and the CCAOM want things to stay just like they are and have been. LAcs as a group are unable to organize. The best motivator is the ability to earn a living. The only avenue open is solo practice or independent practitioner. Even though going solo is sold as a great opportunity it is actually the only option available. Many "pros" talk a big game to promote their book or special skill set. The only measures that matter are hours worked and revenue generated. The only group I see that is sharing their data is CAN. Who is responsible for the groundwork? Are you part of the solution or part of the problem? The folks with the "TCM solution" got us to this point. It turns out they are the problem.

strong>5) The availability of jobs for acupuncturists is a pressing concern because students are now graduating with so much Title IV debt that it is impossible for many of them to start their own businesses, which means more and more graduates are never able to practice acupuncture at all. What do you think is the solution to this problem? And who is responsible for addressing it?

Student debt loads are disgusting, shameful, criminal. If you are not up to speed on this subject a simple google search under Harkin Hearings will catch you up. The new LAc curve has been flat or in decline for almost a decade. Money talks and bullshit walks. Would-be students are voting with their feet and going into other fields. What we can do as "leaders" with voices is pull together on behalf of the students and the profession and go after the openly fraudulent schools like California Union University that was shut down by the INS. A position statement by AAAOM, ACAOM, CAN and NGAOM that denounced visa scam practices would be a simple and bold beginning. If I may take the podium a moment...every school with a 50% failure of students who take the California Acu Licensing Exam or the NCCAPOM certification exam should be censured by the proposed coalition. Every school that sends less than half its graduate to sit for a licensing/certification exam should also be censured. These schools should be publicly identified and asked to defend their record. I often ask where is the outrage?



This story was posted on July 11 2011 by Jessica Feltz.

Comments

  • July 18 2011 at 1:27 PM
    Roppy writes:

    “every school with a 50%

    “every school with a 50% failure of students who take the California Acu Licensing Exam or the NCCAPOM certification exam should be censured by the proposed coalition.”

     

    yeah, I meant to ask some of the California CANers at the Canference what is up with California licensing exam failing so many practioners.  

    Anyone?

     

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  • July 18 2011 at 4:23 PM
    david villanueva writes:

    Calif. always has to be different.

    The CA Board Exam is intentionally tougher than the National Boards. Maybe it has something to do with this state having the most number of acupuncturists of all the states (I think that’s right) and  it was decided (by those who decide these issues) that CA needs its own, more rigorous exam to discourage some people from practicing here. That last part is my personal opinion.

     

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  • July 18 2011 at 9:01 PM
    Guest writes:

    Toaster Tour…

    Hi,

    Just sharing.  I graduated from AOMA in Austin with 125K debt (took the max in order to be able to pay rent & eat some ramen, ha!  Also worked PT $9/hr AND had/have an earning partner…).

    I am currently working in a clinic in the Kansas City area that operates on the private biz model ($120 initial/$65 follow up) & I pay the clinic 50%.  I spend 1.5 hours per person during the initial visit and 1 to 1.25 hours per person for follow-ups.  Most of my patients receive a combination of acupuncture, tui-na, cupping, infrared heat, etc. as needed/indicated.  I also prescribe herbal formulas. Very few, if any, of my patients are from the “elite” or “noble” classes.

    This is my first year, and my patient load fluctuates quite a bit.  If I did not have a partner, I might be able to survive completely on what I make, but would most likely have to work part time somewhere else, at least for awhile.

    When considering all the years and expense it took to get through school, to keep up with continuing education and the very real and high level of responsibility I carry in regards to my patients, $65 for a visit does not seem unreasonable.  Most of my patients do not view it as unreasonable, either.  How much is it for an hour of massage, on average, and how much time does it take to become a massage therapist?  How much responsibility does a massage therapist have for his/her clients compared to an acupuncturist?  I am using this comparison as in this area, MT charges are about $45-$90 per hour.

    How much does an OD charge for an initial visit on average?  $200, $300, $400?  An MD?  Or a Nurse Practitioner?

    I know money is all relative, and that many providers accept insurance, but the point I am trying to make is that for the education, training, expertise and caring that we all offer our patients, charging $50 - $90 is not unreasonable.

    On the other hand, I also am very, very aware that there are MANY people who could benefit from our medicine who cannot afford even those reasonable prices.

    And as the population increases, and as the economy continues to change, wages/pay will probably continue to decrease, so it is also not unreasonable for me to expect a decline in dollars earned per visit, as a reflection of what patients are able and/or willing to pay.

    I also agree that the TCM education industry is, well, I don’t even know really WHAT to say.  I feel like my education was pretty good, but very overpriced.  However, all higher education in this country is overpriced, so I am not sure how that is any kind of an exception.  I feel like the school administrators and “leaders” painted a false picture of what to expect on the other end of the 4-6 years of study (3.5 years if you have previous credits, photographic memory, have no dependents, house or previous debts and are under age 25, ha!) and 100K plus debt.

    Am I glad I did it?  Yes, especially when someone who has been in pain for 30 years starts to feel better for the first time, and she smiles & her eyes light up when she tells me how her week went, and that she is no longer vomiting every morning…  You all know…

    Would I do it again if I thought it through very carefully from a money standpoint?  If I only considered the raw numbers, probably not.  But then again, money has never mattered that much to me (and I am from poor/working class - most years our family income was below poverty, lived in a trailer, etc.).  It is out there, like air or water, and it comes and it goes.  It is not static, and it is not finite, contrary to what many believe.  And therein lies the conflict for most of us: our beliefs about money.  That’s a whole ‘nother conversation, though!

    TCM does not have the infrastructure that regular medicine does (duh, as we all know).  There are no residency programs for graduates, no hospitals or clinics to jump into.  Would we really want such a system?  I guess there are pros and cons about that, too.

    Despite the apparent grim reality, it is at the same time kind of exciting - you are free to make your own rules and create your own business - as CAN folks have done and continue to do.

    Sorry this is a bit of a ramble - I have enjoyed reading the postings here and I think about all of these things a lot.  I would like to offer cheaper prices for visits, and maybe in the next year or two when I feel comfortable leaving my current clinic, I will.

    Thanks again,

    Kris

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  • July 19 2011 at 4:10 PM
    acupunkgirl writes:

    NCCAOM exam pass rate

    “Every school that sends less than half its graduate to sit for a
    licensing/certification exam should also be censured. These schools
    should be publicly identified and asked to defend their record.”

    I chose to attend Tai Sophia despite their clear statement that they weren’t going to teach to the NCCAOM exams.  Now that I’m preparing for these exams, I get angry at them over this (but mea culpa, it’s not like I didn’t know).    In particular, I was required to take bioscience classes (as ‘prerequisites’, not included in my tuition!) that were on the whole very poorly conceived of and poorly taught.  Upon reflection, I believe that some of the reasons they have crappy bioscience instruction include the following reasons:

    grads who choose to stay in Maryland do not have to take the NCCAOM exams to practice in Maryland
    most instructors at Tai Sophia are acupuncturists (and 99% of these instructors graduated from Tai Sophia).  To pay a qualified bioscience teacher would require salary levels to attract these people, and the economics of this are not a priority right now (speculation on my part but even now the folks who are teaching bioscience have in general poor science qualifications and even poorer qualifications as teachers).

    I think Tai Sophia hides behind this disclaimer about the national exams, knowing that students who come to their school are not yet well-informed enough to know to require a curriculum that really prepares them for it.  In my exit interview, I told the assistant registrar that I thought that my bioscience classes at Tai Sophia were so poorly done as to be criminal.   I gave several examples, from physics to the medical examination  to an airy-fairy class called “New Science, New Thinking”.   This statement got the pat response that they don’t teach to the test.  I was like, “Why the hell not?  I can understand that this is a five-element school, but for the bioscience exam, you REQUIRE bioscience credits! why not teach the same bioscience as might be tested on the national exam??!”  Yes, I’m outraged.  And preparing on my own, now.

    I don’t know how many people sit for the NCCAOM exams from Tai Sophia, since a large percentage of the graduates stay in Maryland and this is muddled as some  of those who stay in Maryland initially eventually take the exam before moving to another state that requires the certification.   During the ACAOM certification process I had the chance to ask about the school’s over all pass rate, and the person in charge of that said it was hard to track total pass rate, since some students never take the exam and the school doesn’t track who doesn’t take it.  They get a statistical aggregated number of pass/fail from candidates who said on the NCCAOM test that they graduated from Tai Sophia, but the school doesn’t know by name which students have taken the test based on aggregated NCCAOM reporting (if my memory serves).  I wish that ACAOM or DOE would require this kind of reporting as part of a quality assessment outcome measure for any given schooll.  I think it is lame that the school says they can’t track this and that they don’t bother preparing the students for these exams.  

    Geographically and financially,  it would have been difficult for me to attend NESA instead of Tai Sophia, but it is a school I wish I had considered more closely. 

    So I agree:  “Every school that sends less than half its graduate to sit for a
    licensing/certification exam should also be censured. These schools
    should be publicly identified and asked to defend their record.”

     

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  • July 26 2011 at 4:02 PM
    Guest writes:

    The Calif Acu Licensing Exam - CALE

    The CALE is a fine exam in terms of psychometric properties which is to say when you run all the accepted analyses it shows well. The problem is more like what acupunkgirl writes. Is it testing useful knowledge? There is a strong thread of folks who wear their commitment to TCM as a merit badge. This position encourages the training programs to follow suit and teach TCM. Whether TCM is a “medicine” or not is an interesting philosophical and historical debate for which I am not qualifed. However, I am certain that TCM contributes ZERO to finding work in mainstream medicine. And I am fairly confident that earning a living in acu is unlikely if you are relying on TCM principles, lessons on how to run a successful private practice, and without referrals from the system that feeds all other CAM professions. CAN is the LONE exception. Does this mean CAN is for all? Of course not. However, at least CAN is working in the right direction and relies on fundamental principles. Faith is a beautiful thing but business is about being practical and having clear vision. Back to CALE. Why do so many fail? Because the training programs are lousy, irregular, non-standard, etc. Keep a couple things in mind. The main criterion for gaining admission to an acu training program is the ability to write a check. Many schools are simply less concerned about the quality of the education than keeping students enrolled. What about the NCCAOM exam? How is it that pass rate is in the 80th percentile? The 2003 Little Hoover Commission report included a decent analysis of the two exams. I do not have the reference with me but you can find it easily by searching Little Hoover Commission Acupuncture Report. One final comment. There is no central org that guides the acu profession. Therefore, nobody is guiding anything, much less how tough an exam is. The CALE has been compromised several times with bribes and release of answer keys. The training system is and has been corrupted by a group of schools that are owned by single shareholders, have p/t faculty, teach their own bioscience as a revenue opportunity, and have no real commitment to health professions education. Calif has the majority of acu students and schools. The majority of phony schools are probably also here although I have no data to back that up. This is the reason why the pass rate is so low. Now why is it the ACAOM or CCAOM do not go after the phony schools?

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