Guest guest Posted March 17, 2005 Report Share Posted March 17, 2005 , " sperb1 " <greg@s...> wrote: > > AB-1113: Diagnostic Authority > > This bill would specifically authorize acupuncturists to diagnose > ...While this is very > positive for the profession, the bill itself is quite vague (but > will probably become less so). This is a big fight, but with a good > prize at the end. We will support this bill. According to Tom Haines at PCOM, the LHC report made it clear that diagnosis is implied by authorization of independent treatment. Adding the wording will change nothing. That is also my reading. If the intent of CSOMA or AIMS is to attempt to gain some level of WESTERN diagnostic authority, that will never happen, so why waste resources on this one? > AB-1116: Postgraduate residency > > This bill would establish a postgraduate residency. There is no known justification for > this residency. Unless one considers western medicine, which requires some degree of residency inall specialties. CSOMA has spent a lot of time and money in recent years trying to achieve some degree of parity with MDs in scope, title, etc. Yet when it comes to actually having similar educational requirements prior to licensing, all of a sudden, we see no reason for parity. The amount of exposure students get in clinical training during internship is nothing short of a joke. I have done the math on the list before. The typical acupuncture intern in CA gets to manage only a handful of internal medicine cases over a sufficient period of time to gain any insight. The 5-7 such cases one gets to manage of this sort are usually dissimilar, thus no signficant " experience " in anything is really gained. Nothing even close to the thousands of patients chinese doctors get to follow during their internships and residencies. I have had to restrain my amusement at recent requests that students let the clinic staff know what their specialties are for more efficient patient scheduling. Aside from orthopedics, no student even has enough experience in anything to call themselves a novice, much less a specialist, even upon graduation. Lets get real here. I learned Chinese herbology in my self imposed low paid residency at OCOM after graduation. In 2 years working there, I was involved in the prescription of over 4000 herbal formulas, either as a primary or assistant to a senior herbalist from China (mostly Wei Li and Guohui Liu). During my internship, I only prescribed about 100-150 formulas. Do the math. People ask me how I learned this stuff. that's how. I completely disagree that a single exposure to a given case is a sufficient basis for practice. That you can learn it all on the job. While you can't see everything in your internship that will come your way during a career, you need far more than the current level of internship to hone the skills necessary to be completely on one's own in the handling of complex cases. Anyone who has hosted continuing education knows exactly what I mean. Practice developed without sufficient foundations laid is the main source of confusion and clinical failure in our field. This list hovers at about 1000 members, while there are 20,000 in the field. The reason I most oft hear for leaving the list: people are just looking for clinical tips. They have no interest in the complexities of it all. Insufficiently trained, intellectually uncurious. I can't think of a better remedy than a mandatory residency. And we should not be so quick to look a gift horse in the mouth. Residencies are paid. That means there will be guaranteed employment for all graduates. In addition, an infrastructure similar to the teaching facilities of western medicine will have to be developed in response. This will lend great legitimacy to the field and even become a vehicle for doing research. While some will complete their residency and open private practices, the new infrastructure will also allow many many others to remain in the teaching clinics as attendings, researchers, administrators, etc. This could be the beginning of the mainstreaming of acupuncture, something that will never happen without such conventional infrastructures. I would say not only is there a great precedent for required residencies, but great gains to be had in the process. I have no idea why the CCAOM would oppose this idea. It would seem to be far more of a potential cash cow for them in the long run than the ill fated DAOM programs (since there will never be a mandatory entry level DAOM in CA). I must say I find it ironic for CSOMA to support an entry level DAOM, which will serve no social purpose, but oppose a master's level residency, which could be of great benefit to all. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2005 Report Share Posted March 17, 2005 > According to Tom Haines at PCOM, the LHC report made it clear that diagnosis is implied > by authorization of independent treatment. Adding the wording will change nothing. > That is also my reading. If the intent of CSOMA or AIMS is to attempt to gain some level of > WESTERN diagnostic authority, that will never happen, so why waste resources on this one? It is not Westrn diagnosis, but simply clarifies that we are allowed to diagnose within our scope of practice for the express purpose of performing Oriental medicine. let me make this perfectly clear: CSOMA does not support doctoral entry level. We actually have no position on it as far as I know. As I understand it, the former president of CSOMA, gone for years, was a proponent of entry level doctorates. Apparently that is a thrust of CAOMA, a group of local OM associations that we do not belong to. While I don't disagree with the need to have more patient exposure, our profession is utterly incapable of sustaining a residency program at this point. Paid residencies? How about paid licensees? Less than 50% of graduates are actually pursuing OM as a career. Those that are run the gamut from barely able to pay the bills to big bucks. How are we going to place thousands of graduates in a position AND PAY THEM. If this is going to be at all viable, we need to upgrade the businesses of our entire profession. And if you look at medical residencies, they get huge subsidies from the government, pay them less than janitors, and work them death, just to make it viable. Learn anything? Yea, quite a bit, but it is more a rite of passage. Residencies would probably destroy the profession if implemented currently. They certainly would destroy the schools and the only consistent source of employment for a good number of OM practitioners. And for perspective, DC's don't have residencies. > > AB-1116: Postgraduate residency > > > > This bill would establish a postgraduate residency. There is no known justification for > > this residency. > > > Unless one considers western medicine, which requires some degree of residency inall > specialties. CSOMA has spent a lot of time and money in recent years trying to achieve > some degree of parity with MDs in scope, title, etc. Yet when it comes to actually having > similar educational requirements prior to licensing, all of a sudden, we see no reason for > parity. The amount of exposure students get in clinical training during internship is > nothing short of a joke. I have done the math on the list before. The typical acupuncture > intern in CA gets to manage only a handful of internal medicine cases over a sufficient > period of time to gain any insight. The 5-7 such cases one gets to manage of this sort are > usually dissimilar, thus no signficant " experience " in anything is really gained. Nothing > even close to the thousands of patients chinese doctors get to follow during their > internships and residencies. I have had to restrain my amusement at recent requests that > students let the clinic staff know what their specialties are for more efficient patient > scheduling. Aside from orthopedics, no student even has enough experience in anything > to call themselves a novice, much less a specialist, even upon graduation. Lets get real > here. I learned Chinese herbology in my self imposed low paid residency at OCOM after > graduation. In 2 years working there, I was involved in the prescription of over 4000 > herbal formulas, either as a primary or assistant to a senior herbalist from China (mostly > Wei Li and Guohui Liu). During my internship, I only prescribed about 100-150 formulas. > Do the math. People ask me how I learned this stuff. that's how. > > I completely disagree that a single exposure to a given case is a sufficient basis for > practice. That you can learn it all on the job. While you can't see everything in your > internship that will come your way during a career, you need far more than the current > level of internship to hone the skills necessary to be completely on one's own in the > handling of complex cases. Anyone who has hosted continuing education knows exactly > what I mean. Practice developed without sufficient foundations laid is the main source of > confusion and clinical failure in our field. This list hovers at about 1000 members, while > there are 20,000 in the field. The reason I most oft hear for leaving the list: people are > just looking for clinical tips. They have no interest in the complexities of it all. > Insufficiently trained, intellectually uncurious. I can't think of a better remedy than a > mandatory residency. > > And we should not be so quick to look a gift horse in the mouth. Residencies are paid. > That means there will be guaranteed employment for all graduates. In addition, an > infrastructure similar to the teaching facilities of western medicine will have to be > developed in response. This will lend great legitimacy to the field and even become a > vehicle for doing research. While some will complete their residency and open private > practices, the new infrastructure will also allow many many others to remain in the > teaching clinics as attendings, researchers, administrators, etc. This could be the > beginning of the mainstreaming of acupuncture, something that will never happen without > such conventional infrastructures. I would say not only is there a great precedent for > required residencies, but great gains to be had in the process. I have no idea why the > CCAOM would oppose this idea. It would seem to be far more of a potential cash cow for > them in the long run than the ill fated DAOM programs (since there will never be a > mandatory entry level DAOM in CA). I must say I find it ironic for CSOMA to support an > entry level DAOM, which will serve no social purpose, but oppose a master's level > residency, which could be of great benefit to all. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2005 Report Share Posted March 17, 2005 Oh my goodness, I would MUCH rather have a residency program than to pay for " more of the same " (or similar) from one of the TCM colleges just to enable me to say I had a doctorate. I'd rather NOT have the title and have the hands-on learning, thank you very much (especially if the residency was a paid position! - what a double blessing that would be!) Nora wrote: > , " sperb1 " <greg@s...> wrote: > > > >>AB-1113: Diagnostic Authority >> >>This bill would specifically authorize acupuncturists to diagnose >>...While this is very >>positive for the profession, the bill itself is quite vague (but >>will probably become less so). This is a big fight, but with a good >>prize at the end. We will support this bill. >> >> > > >According to Tom Haines at PCOM, the LHC report made it clear that diagnosis is implied >by authorization of independent treatment. Adding the wording will change nothing. >That is also my reading. If the intent of CSOMA or AIMS is to attempt to gain some level of >WESTERN diagnostic authority, that will never happen, so why waste resources on this one? > > > > >>AB-1116: Postgraduate residency >> >>This bill would establish a postgraduate residency. There is no known justification for >>this residency. >> >> > > >Unless one considers western medicine, which requires some degree of residency inall >specialties. CSOMA has spent a lot of time and money in recent years trying to achieve >some degree of parity with MDs in scope, title, etc. Yet when it comes to actually having >similar educational requirements prior to licensing, all of a sudden, we see no reason for >parity. The amount of exposure students get in clinical training during internship is >nothing short of a joke. I have done the math on the list before. The typical acupuncture >intern in CA gets to manage only a handful of internal medicine cases over a sufficient >period of time to gain any insight. The 5-7 such cases one gets to manage of this sort are >usually dissimilar, thus no signficant " experience " in anything is really gained. Nothing >even close to the thousands of patients chinese doctors get to follow during their >internships and residencies. I have had to restrain my amusement at recent requests that >students let the clinic staff know what their specialties are for more efficient patient >scheduling. Aside from orthopedics, no student even has enough experience in anything >to call themselves a novice, much less a specialist, even upon graduation. Lets get real >here. I learned Chinese herbology in my self imposed low paid residency at OCOM after >graduation. In 2 years working there, I was involved in the prescription of over 4000 >herbal formulas, either as a primary or assistant to a senior herbalist from China (mostly >Wei Li and Guohui Liu). During my internship, I only prescribed about 100-150 formulas. >Do the math. People ask me how I learned this stuff. that's how. > >I completely disagree that a single exposure to a given case is a sufficient basis for >practice. That you can learn it all on the job. While you can't see everything in your >internship that will come your way during a career, you need far more than the current >level of internship to hone the skills necessary to be completely on one's own in the >handling of complex cases. Anyone who has hosted continuing education knows exactly >what I mean. Practice developed without sufficient foundations laid is the main source of >confusion and clinical failure in our field. This list hovers at about 1000 members, while >there are 20,000 in the field. The reason I most oft hear for leaving the list: people are >just looking for clinical tips. They have no interest in the complexities of it all. >Insufficiently trained, intellectually uncurious. I can't think of a better remedy than a >mandatory residency. > >And we should not be so quick to look a gift horse in the mouth. Residencies are paid. >That means there will be guaranteed employment for all graduates. In addition, an >infrastructure similar to the teaching facilities of western medicine will have to be >developed in response. This will lend great legitimacy to the field and even become a >vehicle for doing research. While some will complete their residency and open private >practices, the new infrastructure will also allow many many others to remain in the >teaching clinics as attendings, researchers, administrators, etc. This could be the >beginning of the mainstreaming of acupuncture, something that will never happen without >such conventional infrastructures. I would say not only is there a great precedent for >required residencies, but great gains to be had in the process. I have no idea why the >CCAOM would oppose this idea. It would seem to be far more of a potential cash cow for >them in the long run than the ill fated DAOM programs (since there will never be a >mandatory entry level DAOM in CA). I must say I find it ironic for CSOMA to support an >entry level DAOM, which will serve no social purpose, but oppose a master's level >residency, which could be of great benefit to all. > >Todd > > > > > > > > >Chinese Herbal Medicine offers various professional services, including board approved continuing education classes, an annual conference and a free discussion forum in Chinese Herbal Medicine. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2005 Report Share Posted March 17, 2005 I'm with you on the residency thing. Basically I agree with everything you've said. Once again, the schools seem to be the root of the problem. Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2005 Report Share Posted March 17, 2005 I agree with Todd on this one. I've mentored a small number of graduate students for several years now. I think it is essential that new graduates work with established practitioners in order to get a sense of what they'd need to do to treat difficult cases and write prescriptions. There are a number of ways this could be done. One, the schools set up special clinics for graduates with senior practitioners. Two, mentoring programs with senior practitioners in private practice. Three, special programs that can be set up by the likes of Blue Poppy Institute for specialty training. My own experience is that while new graduates have a decent grasp on acupuncture technique and biomedical disease differentiation, pattern differentiation and herbal prescribing is still weak. This is why seminars on clinical tips, points selections and formulas fill conference rooms, while deeper discussions on complex illnesses and theory do not. Having thought about this a lot, I think that the educational system, which began in a very amateurish manner with a lot of naivete, has grown a lot, but in fits and starts. In other words, one area, such as herb classes improves, but then another area begs for improvement. The growth of education and the profession in general has not been very smooth, to say the least. As Bob Flaws mentioned a few weeks ago, we are trying to deal with branches, when the roots have to be treated. However, economically this is very difficult. We cannot just trash the educational system and start over again. Remember, even for the best of us, teaching and supervising is basically a part-time activity alongside private clinical practice, so we haven't even developed a professional teaching core yet. On Mar 17, 2005, at 10:44 AM, wrote: >> AB-1116: Postgraduate residency >> >> This bill would establish a postgraduate residency. There is no >> known justification for >> this residency. > > > Unless one considers western medicine, which requires some degree of > residency inall > specialties. CSOMA has spent a lot of time and money in recent years > trying to achieve > some degree of parity with MDs in scope, title, etc. Yet when it > comes to actually having > similar educational requirements prior to licensing, all of a sudden, > we see no reason for > parity. The amount of exposure students get in clinical training > during internship is > nothing short of a joke. I have done the math on the list before. > The typical acupuncture > intern in CA gets to manage only a handful of internal medicine cases > over a sufficient > period of time to gain any insight. The 5-7 such cases one gets to > manage of this sort are > usually dissimilar, thus no signficant " experience " in anything is > really gained. Nothing > even close to the thousands of patients chinese doctors get to follow > during their > internships and residencies. I have had to restrain my amusement at > recent requests that > students let the clinic staff know what their specialties are for more > efficient patient > scheduling. Aside from orthopedics, no student even has enough > experience in anything > to call themselves a novice, much less a specialist, even upon > graduation. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2005 Report Share Posted March 17, 2005 It is a good thing to get clarity whether it be in our laws or in practice. I think that clearly spelling out what we do in the legislation is a positive, less likely to be challenged in a court. Even this does not mean that we won't be. I would have to say that I disagree with your perception as to the number one reason for graduate failure. Based upon what I have seen in this and other alternative professions, it is economics. Grads have problems securing start up money and lack the ability/knowledge to successfully run a business. I can say this as I have experienced this myself. Even though there is a lot of hype about CAM therapies, I am not seeing a lot of practitioners that are doing well financially. Something just does not add up. In the midwest, many local graduates seem to be working in other jobs and acu is a hobby. I do happen to support the idea of a paid residency and like Zev's suggestion about schools setting up a graduate clinic. The question that remains is what will the qualifications be for the supervisors. After our debates at length about how poor the US education one wonders if any of us trained here would qualify. Lastly, the concept of a laboratory diagnosis is not limited to MD as we seem to think. The DC, ND and PT all use various western medical terminology/testing in the course of care. The first two groups rely heavily on western tests in order to come up with a, you guessed it, a DIAGNOSIS. Let us not forget that even in SE Asia there is a mixing of the two as part of the practitioner training. We should be working toward this goal lest we be ecclipsed. Later, Mike W. Bowser, L Ac Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2005 Report Share Posted March 17, 2005 I've also thought about the issue of herbal training and acupuncture training being separated, that was being discussed on CHA a few weeks ago. Granted, the modern PRC separates the training, forcing concentration on one modality over the other, with a clear favoritism to herbal medicine. However, as Bob Flaws pointed out, a combined profession is a fait accompli in the West. I don't think this is necessarily a bad thing, but we don't have ideal models in the schools for doing this. So I've been examining a few possible models for teaching a combined approach. Mind you, I am just thinking out loud, and would appreciate others' imput. One is the old NESA model of training in acupuncture first followed by two years concentrated in herbal medicine studies (I'd say we need three or four years now). This would be best if biomedical studies were handled at a college or university program. Another is to teach integrative models of acupuncture and herbal medicine. One is already taught, the 'zang-fu' acupuncture model that uses the diagnostic methods of herbal medicine. While taught widely here, it doesn't seem to be as popular in China.. . correct? The best example I've seen of this is Bob Flaw's " Sticking to the Point " volume 2, with its comprehensive diagnosis and treatment plans, but I've seen few people use this as a source text, relying basically on what are the usually over-simplified point prescriptions and formulas in the 'standard' state board texts. In my opinion, the standard textbook zang-fu acupuncture and herbal medicine are not the best or most imaginative. The Li Dong-yuan integrative acupuncture/herbal model is another one. " Golden Needle Wang Le-ting " is a great text for applying spleen-stomach theory to acupuncture, I've gotten a lot out of it. Several of the great physicians had an integrative herbal medicine/acupuncture model, such as Zhu Dan-xi, Li Dong-yuan (see the acupuncture sections of Treatise on Spleen and Stomach). The Shang Han Lun discusses acupuncture as well, admittedly brief, but it does indicate its utility in Han Dynasty medicine. . The latest issue of the Journal of has several articles on an integrative SHL acupuncture/herbal medicine model. It expands on the original sources in the SHL, proposing point prescriptions that could be used alongside the herbal prescriptions in the original text. A model that has been of great interest to me recently is Sensei Ikeda's integrated model of acupuncture and herbal medicine, which he claims is based on the Nei Jing, Nan Jing, Shang Han Lun, and Shen Nong Ben Cao. In practice it appears to be a combination of channel-based acupuncture with a SHL-based Kanpo model, which, of course, is more simplified than the mainstream Chinese herbal medicine model. But perhaps this is one that can be taught more easily to practitioners than in-depth Chinese herbal medicine plus zang-fu acupuncture. Just some ideas to consider. I'd be glad to elaborate or discuss them some more. On Mar 17, 2005, at 10:44 AM, wrote: > I learned Chinese herbology in my self imposed low paid residency at > OCOM after > graduation. In 2 years working there, I was involved in the > prescription of over 4000 > herbal formulas, either as a primary or assistant to a senior > herbalist from China (mostly > Wei Li and Guohui Liu). During my internship, I only prescribed about > 100-150 formulas. > Do the math. People ask me how I learned this stuff. that's how. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2005 Report Share Posted March 17, 2005 Zev, Are you posing one model that a student would have throughout their education or an op to learn others as well? I would like to hear more about the integrated Japanese model you mention. Later Mike W. Bowser, L Ac > " " <zrosenbe > > >Re: Re: California Doings >Thu, 17 Mar 2005 15:04:41 -0800 > >I've also thought about the issue of herbal training and acupuncture >training being separated, that was being discussed on CHA a few weeks >ago. Granted, the modern PRC separates the training, forcing >concentration on one modality over the other, with a clear favoritism >to herbal medicine. However, as Bob Flaws pointed out, a combined >profession is a fait accompli in the West. I don't think this is >necessarily a bad thing, but we don't have ideal models in the schools >for doing this. So I've been examining a few possible models for >teaching a combined approach. Mind you, I am just thinking out loud, >and would appreciate others' imput. > >One is the old NESA model of training in acupuncture first followed by >two years concentrated in herbal medicine studies (I'd say we need >three or four years now). This would be best if biomedical studies >were handled at a college or university program. > >Another is to teach integrative models of acupuncture and herbal >medicine. One is already taught, the 'zang-fu' acupuncture model that >uses the diagnostic methods of herbal medicine. While taught widely >here, it doesn't seem to be as popular in China.. . correct? The best >example I've seen of this is Bob Flaw's " Sticking to the Point " volume >2, with its comprehensive diagnosis and treatment plans, but I've seen >few people use this as a source text, relying basically on what are the >usually over-simplified point prescriptions and formulas in the >'standard' state board texts. In my opinion, the standard textbook >zang-fu acupuncture and herbal medicine are not the best or most >imaginative. > >The Li Dong-yuan integrative acupuncture/herbal model is another one. > " Golden Needle Wang Le-ting " is a great text for applying >spleen-stomach theory to acupuncture, I've gotten a lot out of it. > >Several of the great physicians had an integrative herbal >medicine/acupuncture model, such as Zhu Dan-xi, Li Dong-yuan (see the >acupuncture sections of Treatise on Spleen and Stomach). The Shang Han >Lun discusses acupuncture as well, admittedly brief, but it does >indicate its utility in Han Dynasty medicine. . The latest issue of the >Journal of has several articles on an integrative SHL >acupuncture/herbal medicine model. It expands on the original sources >in the SHL, proposing point prescriptions that could be used alongside >the herbal prescriptions in the original text. > >A model that has been of great interest to me recently is Sensei >Ikeda's integrated model of acupuncture and herbal medicine, which he >claims is based on the Nei Jing, Nan Jing, Shang Han Lun, and Shen Nong >Ben Cao. In practice it appears to be a combination of channel-based >acupuncture with a SHL-based Kanpo model, which, of course, is more >simplified than the mainstream Chinese herbal medicine model. But >perhaps this is one that can be taught more easily to practitioners >than in-depth Chinese herbal medicine plus zang-fu acupuncture. > >Just some ideas to consider. I'd be glad to elaborate or discuss them >some more. > > > > >On Mar 17, 2005, at 10:44 AM, wrote: > > > I learned Chinese herbology in my self imposed low paid residency at > > OCOM after > > graduation. In 2 years working there, I was involved in the > > prescription of over 4000 > > herbal formulas, either as a primary or assistant to a senior > > herbalist from China (mostly > > Wei Li and Guohui Liu). During my internship, I only prescribed about > > 100-150 formulas. > > Do the math. People ask me how I learned this stuff. that's how. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 17, 2005 Report Share Posted March 17, 2005 Hi I wanted to inform our profession of some developments that are occurring in California. There are large amount of bills that have been introduced in California that affect our profession. As a newly elected board member of the California State Oriental Medical Association (and an even more recently elected as treasurer), we just had a board meeting where the following bills were discussed with Bill Mosca from AIMS. After discussing the bills, I will give a brief overview of what went on at the CSOMA board meeting on 3/6/05. AB-681: Work Comp medical fee schedule (Vargas) This bill will freeze workers comp rates at 5% below the 12/31/2003 rates until 2010. While this may sound bad on the surface – reduction in reimbursements without any raises for the next 5 years – the reality is that the likeliest thing to happen between now and then is further reduction in fees. This rate is the current rate and while it precludes raises until 2010, it prevents the far more likely further reduction in fees. This is generally positive for the profession in California and we will support it. The following five bills were put forward by Leland Yee, speaker pro tem of the assembly. Connie Taylor, the president of CSOMA, Yolanda Marin-Sandoval, the executive director, and I met with Assemblyman Yee on 3/7/05 to discuss them. AB-1113: Diagnostic Authority This bill would specifically authorize acupuncturists to diagnose for the use of performing or prescribing the use of acupuncture, herbs, massage, and most of our scope of practice. This bill would be great. The problem is that the California Medical Association will vigorously oppose it because they believe the word " diagnosis " should only be the purview of medical doctors. While this is very positive for the profession, the bill itself is quite vague (but will probably become less so). This is a big fight, but with a good prize at the end. We will support this bill. AB-1114: Continuing Education This bill would increase the number of CEU's required from 30 to 50 hours every two years with 5 of them to be dedicated to public health and safety issues. This is a direct response to the Little Hoover Commission's report. It is a little less than their recommendation but certainly in the ball park. Generally, we are for this bill, simply because it is a quite benign version of the LHC's recommendations and it would be political suicide to oppose it. It is likely that in negotiations the 5 hour requirement will be raised and we are hoping for 10 hours of directed CEU's. AB-1115: Acupuncture Assistants This bill would authorize the California Acupuncture Board to establish requirements for a certification program for acupuncture assistants in California. Even though we would probably be for such a program, this bill is incredibly vague. Our discussions with Lee did not yield much in the way of specificities. One of the things that did come up was that this would probably not include needle removal in the duties that an acupuncture assistant could perform. I don't know about anyone else, but I would think that would have to be a basic task they could perform in order to be truly useful to the profession. There weren't any specifics on what kind of training they would require or what duties would be allowed. We are opposed unless amended. AB-1116: Postgraduate residency This bill would establish a postgraduate residency. This probably comes from the LHC which stated it as more of a possibility than a recommendation. The bill basically gives the CAB the reins to establish the program and the bill is incredibly vague with no direction for number of hours. There is no known justification for this residency. As such we will be opposing it. Word on the street is the council of colleges is very opposed to this as well. AB-1117: " Asian " Medicine This bill changes the word " Oriental " to " Asian " in all state laws. This is probably to help shore up some of Yee's constituency. We are tending to say this is an immaterial bill and therefore we won't oppose it or actively support it. Word has it that the council of colleges will be opposing it. The next two bills were sponsored by AIMS. AB-1549: Work Comp QME's (Koretz) This bill will allow acupuncturists to be Qualified Medical Examiners under the Workers Comp system. This would have no effect on our ability to bill within the workers comp system. It does allow members of our profession who wish to become QME's (with 300 hours of training) to be able to perform compensation evaluations. This bill puts us on equal footing with psychologists, optometrists, dentists, podiatrists, and DC's. Again, it will not be necessary to be a QME in order to bill workers comp. This is generally a helpful bill for our profession and allows us to be more integrated within the workers comp system. We will support it. SB-536: Scope of Practice (Alarcon) This bill will specifically state that we are allowed to perform manual therapy and myofascial release as used in western terms and treatment procedures. This bill has come about due to rejection of treatment codes involving manual therapy and myofascial release from insurance companies. They state that these modalities are not within our scope of practice, and no other codes can be use for these modalities. This bill will overcome this rejection from insurance companies. It is generally positive for our profession and we will support it. So those are the major bills we are looking at today. There are a number of other bills that may evolve into bills that affect us; if that happens we will keep you informed. The CSOMA board met on 3/6/05. This was the first meeting after election of several new board members, including myself. We established a strategic planning committee to develop a 2 year detailed strategy with a less detailed 5 year plan. This process will take the greater part of this year. We maintained the same executive committee with Connie Taylor as President, Jeannie Kang as Vice-president, Marc Sklar as Secretary, and myself as the new treasurer. My goal is to streamline financial operations and institute new ways of looking at the data in order to facilitate appropriate decision making. I will be researching financial planning and specific ratios for membership organizations. We also discussed the next issue of California Journal of Oriental Medicine and the status of Expo North. Both sound very exciting, so be sure to join CSOMA for your issue of CJOM and join us at Expo North in San Francisco April 28-May 1, 2005. For further information about CSOMA check our website at www.csomaonline.org. If you have any further questions on any of these topics feel free to contact me or CSOMA. Greg Sperber ********************************************************************* Dr. Greg Sperber, BMBS (MD), MTOM, MBA, L.Ac. Treasurer, California State Oriental Medicine Association Diplomate in Chinese Herbology (NCCAOM) Diplomate in Acupuncture (NCCAOM) Diplomate in Oriental Medicine (NCCAOM) ********************************************************************* Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2005 Report Share Posted March 18, 2005 " Remember, even for the best of us, teaching and supervising is basically a part-time activity alongside private clinical practice, so we haven't even developed a professional teaching core yet. " This is, of course, part of the problem. When Western medicine fixed its image and income problems in the early 20th century, one of the things they did was to require full-time med school faculty. Previously, mom-and-pop med schools used part-timers, with all the problems of qaulity control associated with that. It wasn't until the med schools bit the bullet and employed full-time professional teachers that they were able to upgrade and standardize their teaching. Agreed, the med schools received funding from the Rockefeller and Carnegie foundations in order to switch over to full-time faculty, and I don't see anyone out there willing and able to endow our schools in the same way. However, teachers were willing to move from part-time status to full-time status even though their total income actually went down. They did this for the security, the freedom from the hassle of running their own clinics, and, in some cases, the freedom to devote themselves to research. In other words, even though their total annual income went down, they made this switch because of other perceived benefits. I do not see any real way to change the quality of our educational process until or unless we also have full-time professional faculty. For me, this has already been " proven " by the MDs' previous experience. And, until we have better quality education, we will not achieve parity with MDs in terms of status in society or income no matter titles we confer upon ourselves. As part of the upgrading of the Western medical schools in the first decades of the 20th century, the profession consciously and deliberately raised academic entrance requirements, the academic standards of matriculated students, and the cost of tuition. They did this KNOWING that it would decrease the number of med students and the number of med schools. Not only did they know this would happen, they WANTED it to happen as a necessary pre-requisite for improving the image and earnings of physicians. " Those who are ignorant of history are doomed to repeat it. " Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2005 Report Share Posted March 18, 2005 Just an addition - The school that led the way in raising standards/tuition/training etc., was Harvard, and, even with funding from Rockefeller/Carnegie, they barely made it through the transition. It was not until other schools began following suit (several years later) that Harvard was able to breath again and that their gamble paid off. But, we are in a different economic world now, and unfortunately those schools that might have the desire to make the shift are usually the ones without the resources to survive the change. The schools with the resources don't want to lessen those resources by not admitting most comers. So, who is going to take the risk? We shall see! Marnae Marnae At 12:48 PM 3/18/2005, you wrote: > " Remember, even for the best of us, teaching and supervising is >basically a part-time activity alongside private clinical practice, so >we haven't even developed a professional teaching core yet. " > >This is, of course, part of the problem. When Western medicine fixed >its image and income problems in the early 20th century, one of the >things they did was to require full-time med school faculty. >Previously, mom-and-pop med schools used part-timers, with all the >problems of qaulity control associated with that. It wasn't until the >med schools bit the bullet and employed full-time professional >teachers that they were able to upgrade and standardize their teaching. > >Agreed, the med schools received funding from the Rockefeller and >Carnegie foundations in order to switch over to full-time faculty, and >I don't see anyone out there willing and able to endow our schools in >the same way. However, teachers were willing to move from part-time >status to full-time status even though their total income actually >went down. They did this for the security, the freedom from the hassle >of running their own clinics, and, in some cases, the freedom to >devote themselves to research. In other words, even though their total >annual income went down, they made this switch because of other >perceived benefits. > >I do not see any real way to change the quality of our educational >process until or unless we also have full-time professional faculty. >For me, this has already been " proven " by the MDs' previous >experience. And, until we have better quality education, we will not >achieve parity with MDs in terms of status in society or income no >matter titles we confer upon ourselves. > >As part of the upgrading of the Western medical schools in the first >decades of the 20th century, the profession consciously and >deliberately raised academic entrance requirements, the academic >standards of matriculated students, and the cost of tuition. They did >this KNOWING that it would decrease the number of med students and the >number of med schools. Not only did they know this would happen, they >WANTED it to happen as a necessary pre-requisite for improving the >image and earnings of physicians. > > " Those who are ignorant of history are doomed to repeat it. " > >Bob > > > > > > >Chinese Herbal Medicine offers various professional services, including >board approved continuing education classes, an annual conference and a >free discussion forum in Chinese Herbal Medicine. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2005 Report Share Posted March 18, 2005 And I agree with what you wrote, as well. Either we show some integrity or we are doomed. I am one who has reduced my income to teach for the various reasons you said and yet still find myself without much benefit in stability, etc. I have recently enrolled as a matriculated student in a Masters in Education program, specializing in Instructional Design and Technology. I could walk out of this program and choose any number of 75K a year jobs with benefits. I hope by the time that day comes that I will not be forced to make such a choice. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2005 Report Share Posted March 18, 2005 I should point out, however, despite the shortcomings of this scenario, that many of us teach as a 'labor of love'. For me, it is a sacrifice of income to teach, even part time, rather than see more patients. I see teaching as a calling, and also as a reality check that takes me out of the confines of seeing only private patients in a small one-man clinic. On Mar 18, 2005, at 9:48 AM, Bob Flaws wrote: > This is, of course, part of the problem. When Western medicine fixed > its image and income problems in the early 20th century, one of the > things they did was to require full-time med school faculty. > Previously, mom-and-pop med schools used part-timers, with all the > problems of qaulity control associated with that. It wasn't until the > med schools bit the bullet and employed full-time professional > teachers that they were able to upgrade and standardize their teaching. > > Agreed, the med schools received funding from the Rockefeller and > Carnegie foundations in order to switch over to full-time faculty, and > I don't see anyone out there willing and able to endow our schools in > the same way. However, teachers were willing to move from part-time > status to full-time status even though their total income actually > went down. They did this for the security, the freedom from the hassle > of running their own clinics, and, in some cases, the freedom to > devote themselves to research. In other words, even though their total > annual income went down, they made this switch because of other > perceived benefits. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2005 Report Share Posted March 18, 2005 I think there are possibilities of different models being introduced at CM schools, although I think a school needs to provide a strong foundation in a single approach, such as mainstream TCM . For Ikeda's integrated Japanese model, check out the new Eastland Press book, " The Practice of Japanese Acupuncture and Moxabustion " . On Mar 17, 2005, at 3:36 PM, mike Bowser wrote: > Zev, > Are you posing one model that a student would have throughout their > education or an op to learn others as well? > > I would like to hear more about the integrated Japanese model you > mention. > Later > > Mike W. Bowser, L Ac Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2005 Report Share Posted March 18, 2005 Bob, Also keep in mind that the western medical profession paid a few other stiff prices for their status and economic security - the Rockefeller and Carnegie Foundations (and the pharmaceutical companies and the petroleum industry that were the powers behind these) gained the power to dictate what was taught in accredited medical schools. The Flexner Commission of 1908-09 that was part of this " upgrade " process stipulated that botanical medicine should no longer be taught in the curriculum and punished those medical colleges that did by not renewing their accreditation. I gave up status and money when I left the medical research profession, because I was literally becoming ill from having to play the hypocritical medical game, when I knew there were better alternatives out there. During my college years, when I mentioned to my mother I was considering medical school, she suggested that I reconsider before I did something I might regret - she was a long-term advocate of natural health methods and had suffered her share of abuse by medical doctors. My exposure to the medical research industry perhaps gave me better overall insight into how the system is rigged than if I had gone into clinical medicine. Herbs have long been the nemesis of the pharmaceutical industry, which schemed for many decades to make doctors dependent on synthetic drugs, dependent on the bureaucracy for their status and security, and ignorant of herbs. I've long suspected that the powers behind the medical profession are quite happy with the acupuncture profession's general lack of competence in clinical herbology, for the same reason that the Flexner Commission booted herbs out of the medical schools in 1909. I still notice medical websites that pretend to be open-minded by listed all sorts of New-Age therapies, like positive thinking, guided imagery, massage, acupuncture, etc. - and in quite a few of these lists herbology is often missing, or lumped into some obscure category like " Misc. " or " Other " . Now it receives a bit more attention, especially of the negative sort, like " drug-herb interactions " . The key to understanding all this is that the medical profession is not threatened by a bunch of fluffy New Age techniques that are probably mostly placebo effect. They have always been threatened by herbs and by herbalists - a major motivation of the Inquisition was to put independent midwives and herbalists out of business by presecuting them as " witches " , thereby shifting power over health care to medical professionals who were approved and licensed by agencies of the Catholic Church. Ask yourself to what extent you are willing to become a slave to a toxic system just to gain professional status. This is one of the reasons that there will always be a demand for alternative services by the public - at least by those people who see through the media facade and hypocrisy of the medical industry. What I find perplexing is, on one hand, the devotion of most practitioners on this list to faithful translation of Chinese ideas, yet, on the other, a willingness to throw out the very methods that allowed Chinese medicine to steadily advance for thousands of years - independent, relatively unregulated practice, with private study and internships with individual practitioners as the main mode of transmitting knowledge and experience to the next generation. Some of the most capable practitioners I have met have been trained in apprenticeships and internships with practioners of their choice. Why are schools necessary at all in this process? Both in China and in the U.S. modern educational methods are the product of schemes to create the ideal factory worker, and have only been around for a 150 years or less. Students and practitioners should be able to hook up with each without any third parties (like schools) imposing stiff fees, bureaucratic contraints, and other forms of meddling. RMHI students who graduate from our curriculum are encouraged to seek out clinical internships with practitioners who match their interests. Students who choose this route are often far more satisfied with their experiences than those who choose to enroll in accredited TCM colleges to gain clinic experience. No one needs to decree that internships are a good thing. Many already recognize this and arrange these on their own motivation. Perhaps we should be considering simple ways to formally recognize those who have already chosen to complete private internships, rather than attempting to impose change on an educational system whose failings are entrenched. Attempting the latter is a historical lesson that I personally do not wish to repeat. ---Roger Wicke, PhD, TCM Clinical Herbalist contact: www.rmhiherbal.org/contact/ Rocky Mountain Herbal Institute, Hot Springs, Montana USA Clinical herbology training programs - www.rmhiherbal.org > " Bob Flaws " <pemachophel2001 >Re: California Doings > > > " Remember, even for the best of us, teaching and supervising is >basically a part-time activity alongside private clinical practice, so >we haven't even developed a professional teaching core yet. " > >This is, of course, part of the problem. When Western medicine fixed >its image and income problems in the early 20th century, one of the >things they did was to require full-time med school faculty. >Previously, mom-and-pop med schools used part-timers, with all the >problems of qaulity control associated with that. It wasn't until the >med schools bit the bullet and employed full-time professional >teachers that they were able to upgrade and standardize their teaching. > >Agreed, the med schools received funding from the Rockefeller and >Carnegie foundations in order to switch over to full-time faculty, and >I don't see anyone out there willing and able to endow our schools in >the same way. .... >As part of the upgrading of the Western medical schools in the first >decades of the 20th century, the profession consciously and >deliberately raised academic entrance requirements, the academic >standards of matriculated students, and the cost of tuition. They did >this KNOWING that it would decrease the number of med students and the >number of med schools. Not only did they know this would happen, they >WANTED it to happen as a necessary pre-requisite for improving the >image and earnings of physicians. > > " Those who are ignorant of history are doomed to repeat it. " > >Bob > ---Roger Wicke, PhD, TCM Clinical Herbalist contact: www.rmhiherbal.org/contact/ Rocky Mountain Herbal Institute, Hot Springs, Montana USA Clinical herbology training programs - www.rmhiherbal.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 18, 2005 Report Share Posted March 18, 2005 Roger, " Perhaps we should be considering simple ways to formally recognize those who have already chosen to complete private internships, rather than attempting to impose change on an educational system whose failings are entrenched. " I agree the failings are entrenched, and I have no real expectation of any meaningful reform. That's at least one reason why I work outside the system (meaning the schools, NCCAOM, accreditation commission, etc.). Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 19, 2005 Report Share Posted March 19, 2005 Zev, I like the idea of presenting an overall view with historical discussions of ideas and how these ideas changed over time. I am currently reading Unschuld's Nan-Jing and find the commentaries to be quite entertaining. I think we need better development of practitioners in both acupuncture and herbology. I do not think we need to increase hours in some of these areas as much as we need to cover more rellevant topics. Mike W. Bowser, L Ac > " " <zrosenbe > > >Re: Re: California Doings >Fri, 18 Mar 2005 11:57:47 -0800 > >I think there are possibilities of different models being introduced at >CM schools, although I think a school needs to provide a strong >foundation in a single approach, such as mainstream TCM . For Ikeda's >integrated Japanese model, check out the new Eastland Press book, " The >Practice of Japanese Acupuncture and Moxabustion " . > > >On Mar 17, 2005, at 3:36 PM, mike Bowser wrote: > > > Zev, > > Are you posing one model that a student would have throughout their > > education or an op to learn others as well? > > > > I would like to hear more about the integrated Japanese model you > > mention. > > Later > > > > Mike W. Bowser, L Ac > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 19, 2005 Report Share Posted March 19, 2005 When you fill out a hcfa 1500 form and put a number in the ICD-9 code lines you are either creating a diagnosis or using the one provided by another practitioner such as MD/DO/DC. Back pain is a diagnosis. Please correct me if I am wrong. In this, we need to have the right to perform and get paid. Mike W. Bowser, L Ac > " sperb1 " <greg > > > Re: California Doings >Thu, 17 Mar 2005 19:33:04 -0000 > > > > > > According to Tom Haines at PCOM, the LHC report made it clear that >diagnosis is implied > > by authorization of independent treatment. Adding the wording >will change nothing. > > That is also my reading. If the intent of CSOMA or AIMS is to >attempt to gain some level of > > WESTERN diagnostic authority, that will never happen, so why waste >resources on this one? > >It is not Westrn diagnosis, but simply clarifies that we are allowed >to diagnose within our scope of practice for the express purpose of >performing Oriental medicine. > > let me make this perfectly clear: CSOMA does not support >doctoral entry level. We actually have no position on it as far as I >know. As I understand it, the former president of CSOMA, gone for >years, was a proponent of entry level doctorates. Apparently that is >a thrust of CAOMA, a group of local OM associations that we do not >belong to. > >While I don't disagree with the need to have more patient exposure, >our profession is utterly incapable of sustaining a residency >program at this point. Paid residencies? How about paid licensees? >Less than 50% of graduates are actually pursuing OM as a career. >Those that are run the gamut from barely able to pay the bills to >big bucks. How are we going to place thousands of graduates in a >position AND PAY THEM. If this is going to be at all viable, we need >to upgrade the businesses of our entire profession. And if you look >at medical residencies, they get huge subsidies from the government, >pay them less than janitors, and work them death, just to make it >viable. Learn anything? Yea, quite a bit, but it is more a rite of >passage. Residencies would probably destroy the profession if >implemented currently. They certainly would destroy the schools and >the only consistent source of employment for a good number of OM >practitioners. And for perspective, DC's don't have residencies. > > > > AB-1116: Postgraduate residency > > > > > > This bill would establish a postgraduate residency. There is no >known justification for > > > this residency. > > > > > > Unless one considers western medicine, which requires some degree >of residency inall > > specialties. CSOMA has spent a lot of time and money in recent >years trying to achieve > > some degree of parity with MDs in scope, title, etc. Yet when it >comes to actually having > > similar educational requirements prior to licensing, all of a >sudden, we see no reason for > > parity. The amount of exposure students get in clinical training >during internship is > > nothing short of a joke. I have done the math on the list >before. The typical acupuncture > > intern in CA gets to manage only a handful of internal medicine >cases over a sufficient > > period of time to gain any insight. The 5-7 such cases one gets >to manage of this sort are > > usually dissimilar, thus no signficant " experience " in anything is >really gained. Nothing > > even close to the thousands of patients chinese doctors get to >follow during their > > internships and residencies. I have had to restrain my amusement >at recent requests that > > students let the clinic staff know what their specialties are for >more efficient patient > > scheduling. Aside from orthopedics, no student even has enough >experience in anything > > to call themselves a novice, much less a specialist, even upon >graduation. Lets get real > > here. I learned Chinese herbology in my self imposed low paid >residency at OCOM after > > graduation. In 2 years working there, I was involved in the >prescription of over 4000 > > herbal formulas, either as a primary or assistant to a senior >herbalist from China (mostly > > Wei Li and Guohui Liu). During my internship, I only prescribed >about 100-150 formulas. > > Do the math. People ask me how I learned this stuff. that's how. > > > > I completely disagree that a single exposure to a given case is a >sufficient basis for > > practice. That you can learn it all on the job. While you can't >see everything in your > > internship that will come your way during a career, you need far >more than the current > > level of internship to hone the skills necessary to be completely >on one's own in the > > handling of complex cases. Anyone who has hosted continuing >education knows exactly > > what I mean. Practice developed without sufficient foundations >laid is the main source of > > confusion and clinical failure in our field. This list hovers at >about 1000 members, while > > there are 20,000 in the field. The reason I most oft hear for >leaving the list: people are > > just looking for clinical tips. They have no interest in the >complexities of it all. > > Insufficiently trained, intellectually uncurious. I can't think >of a better remedy than a > > mandatory residency. > > > > And we should not be so quick to look a gift horse in the mouth. >Residencies are paid. > > That means there will be guaranteed employment for all graduates. >In addition, an > > infrastructure similar to the teaching facilities of western >medicine will have to be > > developed in response. This will lend great legitimacy to the >field and even become a > > vehicle for doing research. While some will complete their >residency and open private > > practices, the new infrastructure will also allow many many others >to remain in the > > teaching clinics as attendings, researchers, administrators, etc. >This could be the > > beginning of the mainstreaming of acupuncture, something that will >never happen without > > such conventional infrastructures. I would say not only is there >a great precedent for > > required residencies, but great gains to be had in the process. I >have no idea why the > > CCAOM would oppose this idea. It would seem to be far more of a >potential cash cow for > > them in the long run than the ill fated DAOM programs (since there >will never be a > > mandatory entry level DAOM in CA). I must say I find it ironic >for CSOMA to support an > > entry level DAOM, which will serve no social purpose, but oppose a >master's level > > residency, which could be of great benefit to all. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2005 Report Share Posted March 20, 2005 Bob, We're working on a private, voluntary certification system almost full time now, may have something to announce within a year. Will be open to anyone in the world who can pass a standardized computerized exam. Would allow them to post a webpage listing of their training and internships, if submitted to us in the form of a notarized affidavit, especially with emphasis on the individuals they studied with rather than merely the names of faceless institutions. Roger > Fri, 18 Mar 2005 21:35:13 -0000 > " Bob Flaws " <pemachophel2001 >Re: California Doings > >Roger, > > " Perhaps we should be considering simple ways to formally recognize >those who have already chosen to complete private internships, rather >than attempting to impose change on an educational system whose >failings are entrenched. " > >I agree the failings are entrenched, and I have no real expectation of >any meaningful reform. That's at least one reason why I work outside >the system (meaning the schools, NCCAOM, accreditation commission, etc.). > >Bob > ---Roger Wicke, PhD, TCM Clinical Herbalist contact: www.rmhiherbal.org/contact/ Rocky Mountain Herbal Institute, Hot Springs, Montana USA Clinical herbology training programs - www.rmhiherbal.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2005 Report Share Posted March 20, 2005 , rw2@r... wrote: > Bob, > > We're working on a private, voluntary certification system almost full time now, may have something to announce within a year. Will be open to anyone in the world who can pass a standardized computerized exam. Would allow them to post a webpage listing of their training and internships, if submitted to us in the form of a notarized affidavit, especially with emphasis on the individuals they studied with rather than merely the >>names of faceless institutions. this is an example of one way modern computer and information technology can supercede the paternalistic state and allow for a libertarian society that works. In the past, libertarianism's ugly brother laissez faire corporate capitalism failed to win the hearts of the citizens for two reasons. The public was ignorant and easily kept that way plus no rules bound the corporations who ruled them. Now it is not so easy to hides one's misdoings. And while the public responds like a sloth, it does respond. so the same libertarianism is considerably restrained inthemodern age by the free flow of information. Companies that sell things are very sensitive to public disapproval and thus even untrue rumors must be paid heed. Information and education are all that is necessary to protect public safety in most cases. The computerized testing model Roger has developed is a quantum leap in academic assessment, IMO. The nature of the exam is a series of randomly generated case oriented exercises. Beginning with simple clinical choices, such as choosing herbs according to their categories, tastes, temperatures, channels, the progress tests advance to the selection of syndromes and formulas based upon numerous interwoven variables. One is able to slowly and deliberately reveal the the elements of each randomly generated case. By beginning with a random clue, one can then choose specific data to reveal to check one's working hypothesis. For example, if the random clue is epigastric pain (a chief complaint), one might next ask request systemic clues about acuity of onset, energy level, etc. This is exactly the hypotheticao-deductive process Bob Flaws teaches in his master's level diagnosis lecture. As one gains skill, one should be able to be more efficient at identifying the data one needs to confirm one's working hypothesis and be able to make a correct determination with the least possible clues. The laws of probability would prevent anyone from guessing successfully any more than would be predicted by chance, so ther eis no concern about success in this endeavor by pure luck (which of course, does not really exist). The exam rewards one for this increased aptitude over time. It pretty much mimics the process whereby one gains such skills over a career through rpeated problem solving. The exam is taken over a 40 hour period in a month or so. Some will finish all the modules faster than others and one can go back until one gets it right. I do have some concerns about cheating, but no moreso than with current exams. While unsupervised, such exams are recorded in unalterable progress files. It would be very expensive to pay someone to cheat in a 40 hour exam and while it may be possible to use one's text and other resources to access information, it will slow one down and thus lower one's score. Some will try this and along the way, they will learn the data and eventually succesfully complete the exam. If one can reliably find correct complex solutions in a timely manner, yet access one's books in the process, the outcome is my only concern. It is not a race. It is about teaching a person to be able to make the right clinical decisions, whatever tools they may use in the process. We rarely treat emergencies or do surgeries, the only situtations where it is imperative that one have all the data on the top of one's head. This exam also does not prove one's clinical skills, but then neither does graduation from a typical acupuncture internship. We have already discussed on a private list that many of us who support voluntary international herbalist certification and legal unlicensed practice of chinese herbology, would not personally ever recommend the services of a person who had merely passed an exam, no matter how well conceived. Roger was in vocal agreement. But that is for each person to decide for themselves. As long as full disclosure is mandated and everyone knows what they are getting themselves into. And anyone who is found to violate even the spirit of the dislcosure rule should be seriously prosecuted to demonstrate the effectiveness of the law in protecting public safety. So one aspect of disclosure would be demonstration of competency through various means, including education, independent examination, internship and residency or apprenticeship (where, for how long, with whom). BTW, it would not be necessary to develop and independent exam if the NCCAOM had not reneged on their pledge to always adminster a separate Diplomate in Chinese Herbology, in recognition that this is an independent profession (don't believe me, dig up their minutes and publications from around 1995 for a real pageturner). CHA has considered addressing some of the other aspects of disclosure by creating a registry of fellows in Chinese Herbology. This registry would be based upon several criteria, including education and clinical training as well as passage of some standardized exam (whether CA or NCCAOM or something yet to come or something already in use in a foreign country). We might also require letters of reference, as well, in some or all cases. While it would be sufficient in many cases to provide this information directly to the patient in one's office, some will be reassured by having an independent auditor review credentials on a purely voluntary basis, especially when visiting younger, newer or less well known herbalists. There are varying levels of voluntary and mandatory certification, registration and licensing, to suit every taste, without infringing any one's freedom. All made possible by modern technology. I see no reason we should have to seek government approval for personal health choices if we do not want to. As long as the government sanctioned services are there for those who want them, everyone will be happy. And those regulatory agencies will not disappear any time soon. for every government rule, there is a private sector company profiting on it and thus a powerful lobby to insure their continued existence. If there were no income taxes, there would be no tax preparers. If there were no patent laws...., well, you get the idea. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2005 Report Share Posted March 20, 2005 The 5-7 such cases one gets to manage of this sort are usually dissimilar, thus no signficant " experience " in anything is really gained. >>>>You want to tell me that the average number of internal med cases one menages throughout TCM education at this time is 5-7 cases? If that is true we should close the schools. That can only be described as complete failure of this system. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2005 Report Share Posted March 21, 2005 Roger, I agree that the MDs paid a stiff price. Since no one is offering us this kind of money, I don't think we need to worry much about the consequences. I was only underscoring the need for dedicated, full-time professional faculty, however that may be achieved. As for standards stifling innovation, I also do not support the creation of legally mandated monopolies. That does not mean, however, that an individual school or even an entire professional could not/should not have agreed upon standards. Further, although there are national, provincial, and municipal standards of care for CM in the PRC, this has not stifled research and innovation. Just read the Chinese medical journals and you can see all sorts of opinions, theories, and divergent practices. Difference of opinion and practice is alive and well in the PRC despite these published standards. Further, I agree with Z'ev that practitioners should not be experimenting on paying clients in their private practices. There is a time and place for research, i.e., RCTs, with disclosure, IRBs, etc. In other words, while research, innovation, and a certain amount of diversity are vital to a profession's continued growth and health, that does not mean there cannot/should not be standards of care which govern/guide the majority in their daily practices. In my experience, any doctrine, even libertarianism, when taken to its logical extreme proves inadequate in real life application. Life is always a compromise, and doctines are always only approximations. Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2005 Report Share Posted March 21, 2005 Bob, Responsible libertarianism, in contrast to the current corporate rape-and-pillage libertarianism that threatens to degenerate into fascism, has always emphasized full disclosure. There are many ways to do this. Many of my own clients are educated people who like to know a bit about the background of the things I recommend, and I'm always more than willing to share this info. However, in alternative health, there is a large gray zone between accepted standards and experimental. Especially in an area like cancer, where the mainstream medical view may have been actually based on fraudulent research and standards, leaving everyone in a state of confusion. In such cases, I try to give my clients some feel for the politics and background of the controversy so that they can do some reading on their own. Roger >Further, I agree with Z'ev that practitioners should not be >experimenting on paying clients in their private practices. There is a >time and place for research, i.e., RCTs, with disclosure, IRBs, etc. >In other words, while research, innovation, and a certain amount of >diversity are vital to a profession's continued growth and health, >that does not mean there cannot/should not be standards of care which >govern/guide the majority in their daily practices. > >In my experience, any doctrine, even libertarianism, when taken to its >logical extreme proves inadequate in real life application. Life is >always a compromise, and doctines are always only approximations. > >Bob > ---Roger Wicke, PhD, TCM Clinical Herbalist contact: www.rmhiherbal.org/contact/ Rocky Mountain Herbal Institute, Hot Springs, Montana USA Clinical herbology training programs - www.rmhiherbal.org Quote Link to comment Share on other sites More sharing options...
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