Wednesday, February 18, 2009

Community Style Acupuncture

Community acupuncture is springing up all over the place. This practice model uses a sliding scale, usually $15-$45 a treatment, which allows patients to come more often. Acupuncture works best when more treatments are done in less time - 12 treatments over two weeks are usually much more effective than 12 treatments over 12 weeks.

Here's a link to a story from upstate New York.

There is no standard practice model for acupuncture and Chinese medicine. It's a young field and prices are all over the map. Some insurance covers acupuncture, some doesn't. Some acupuncturists accept insurance, some don't. Chinese medicine is not fully integrated into the mainstream health care system, and might never be. But as someone about to graduate from a 4-year TCM school, I've noticed that most acupuncturists in private practice charge between $65 and $150 per treatment.

Community style acupuncture uses a group treatment room and mostly chair acupuncture to reduce overhead. With a group treatment room, more people can be treated at one time. Having to maintain a private room for each patient reduces the number of patients one can see in any given time period.

The people who popularized community-style acupuncture, Working Class Acupuncture in Portland, bring a very stridently socialist outlook to their practice. For more, take a look at this blog entry by Lisa Rohleder, entitled "A Guide to Understanding CAN's Anger, for Any Member of the Acu-Establishment."

There are some valid points in the article, for instance:
  • No one is going to hire you to be an acupuncturist. There are very few salaried jobs available to people fresh out of acupuncture school. It's an entrepreneurial profession, and will likely remain so for quite a while. (President Obama might bring substantial change to American health care - if so, I hope Chinese medicine is integrated on a wide scale so that more people can benefit.) But I knew that when I started school, as did nearly all of my classmates. I can't imagine that anyone was seduced into Chinese medicine school and then was shocked (shocked!) to discover upon graduation that they had to start their own practice.

  • Chinese medicine school is expensive. Typical costs are about $65,000 over four years, not including living expenses.

  • Acupuncture works best when people get more frequent treatments. True! Bob Flaws wrote a great article on this called Acupuncture and the 50-Minute Hour.

  • Acupuncture should be available to people of all income levels. This is, obviously, impossible to disagree with without looking like some sort of monster. No one will say that only rich people deserve acupuncture.

I dislike the whiny tone of this article and the setting up of acupuncture schools, the NCCAOM, ACAOM and others as "the acu-establishment" that needs to be struggled against (e.g. "The heads of the larger schools and of the NCCAOM make six-figure salaries." Horrors! No one should make that much!). I grew up in Berkeley and have seen these tactics used by people with left-leaning political views nearly all of my life. Perhaps they don't realize that by indulging in this kind of "otherization," they are fostering further division and creating more problems than they solve.

I give the Community Acupuncture Network kudos for all the work they have done. Most people just whine and let it be. The people of Working Class Acupuncture have done a wonderful job of setting up a practice model that new acupuncturists can use to make a reliable income and at the same time, help so many people with their health problems. A friend graduated from acupuncture school last year and started out with the standard model, renting a room once a week from another acupuncturist, seeing three or four patients a week, trying hard to get the word out. Our online chats filled me with dread: "I'm so bored," she would say. "I'm so lonely." Is this what would happen to me when I graduated?

Then she joined a community-style acupuncture group. All of a sudden she was seeing twenty patients a day and making almost enough money to quit her "day job" that she'd had all throughout school. In addition to financial benefits, seeing so many patients gives you an incredible amount of experience. In the clinical portion of our school education, we see one patient an hour (the exception being externships, where students often work at low-cost or free clinics and see many more patients). Seeing four patients an hour forces you to make good, fast diagnoses, and the low cost means you get to see the patient the next day and the next day and adjust their treatment as the condition progresses. This is priceless.

I do take issue with one particular point: Acupuncture is easy and we should have less training. Wha-a-a?? In Lisa Rohleder's own words:

the disconnection between how simple acupuncture actually is, and how much we paid to learn it. Acupuncture and herbs are not the same thing. You can get excellent clinical results with acupuncture with a minimum of training in Chinese medical theory. After a little time working with real patients in the real world, most of us come to the conclusion that we could have learned what we needed to know about acupuncture, in order to help most people, in eighteen months of schooling, tops. Most of what we spent armloads of money to learn has no direct (or even indirect) usefulness to our patients. That curricula are designed and accredited in this way suggest to us that what patients need does not interest you.

Now, I haven't treated any "real patients in the real world" yet so maybe I'll be changing my tune after the licensing exam later this year, but really... eighteen months? Yes, sticking a needle in someone and getting the qi is a skill that can be learnt relatively quickly. But that's not all there is to acupuncture. Like tai ji, acupuncture is easy to learn but difficult to master. Any argument for less training seem counter-intuitive.

Acupuncture is also not all there is to Chinese medicine. The process of Chinese medicine starts with diagnosis. If you get the diagnosis wrong, your treatment will be wrong. I don't think you can make the case that TCM diagnosis can be learned in eighteen months with a straight face.

Rohleder does bring up an important point: the disconnect between acupuncture and herbal education. In China, acupuncture and moxibustion are a separate department of medicine. Many TCM doctors who were trained in China, including many of our professors and clinic supervisors, think that acupuncture is inferior to herbal therapy. Our education in TCM school reflects these ideas. I don't necessarily think one type of therapy is better than the other (in fact, I think exercise and a healthy emotional life is the best medicine of all), but this is how it is. Your effectiveness as an acupuncturist certainly isn't stunted by learning about herbal medicine.

There is already a short training course available which certifies one to do acupuncture after only 300 hours of training. You just have to be an M.D. first.


Jason Moskovitz said...

preach it brother! i'm with you on all points.

Jonah Ewell said...

Thanks! When do you treat your first patient?? Do you have that piece of paper?

sarah said...

Regarding the 300 hours of training for a MD to practice acupuncture -

Jonah, have you already written on this one or shall this be your next project? :)

Jason Moskovitz said...

it takes another month to get that magic paper in hand :)

Jonah Ewell said...

I don't think I've written on it - perhaps you would care to pen a guest piece?

Kirsten Cowan, L.Ac said...

Thanks for sending me over here - I missed it when you first posted.

You hit the nail on the head with many of my concerns with CAN (the 'official CAN Party' that is). It's great that there are more options for giving, and getting acupuncture, but the ideological purity thing is a bit over the top.

I think the community model is changing, as it becomes more popular, and less ideologically motivated people get involved.