FPD: Who Might Benefit if it Passes?

December 7, 2009

David

There appears to be more than one Pink Elephant in the room.

Why is it that when that some people and organizations with vested

interests in FPD just don't wish to hear ANY opposition?

That is of course a rhetorical question.

Suppression of.......or objection to....... free speech (especially

commercial free speech) is at risk in the US these days and it appears to be

coming from other arenas than the government.

You may not like my opinion and I may not like yours BUT they are both

valid and should be respected.

Richard

In a message dated 12/07/09 7:42:50 P.M. Eastern Standard Time,

acuman1 writes:

Lets also look at who might benefit if it doesn't pass:

Community acupuncture folks who need people who will work for cheaper than

anyone else and love it for the chance (we used to call it " barefoot and

pregnant " , but now it is " barefoot doctor " ). Jeez. I went to school for 3

years and don't know what to do with my patients, or for that matter how to

gain physician trust, or even how to get and retain patients! Maybe if I

putz around with lots of patients for long enough, I'll get good enough to

open a private practice.

Folks with a lot of patients who have been in practice for years, and who

have taught themselves all the stuff they didnt' learn because the

schooling was so abyssmally short. They dont' want someone to show them off, if

they are from the " keep the competition out " school of thought.

Since it seems we are going negative, I wanted to attract negative

attention by pointing out the Emperors clothes.

David Molony

December 7, 2009

Skip wishes he could post this himself, but he's having technical difficulties.

From Skip VanMeter, in response to Will Morris & Benj Dierauf:

Ultimately we need to decide on the FPD based on whether it will help our

profession by creating more jobs. Might it make life easier for graduates, who

by various estimates get out of our profession within five years of graduating

at a 50-80% rate? In other words most graduates fail in their practices-at least

half and possibly three-quarters or more:can the FPD change this awful

statistic? Or could the FPD make it even worse? This is a complicated question,

but if we look at the three types of jobs that are available to graduating

Acupuncturists, we can get a good handle on answering it. First though, the

three types of Acupuncture jobs:

1) Independent private practice, which the great majority of us are in today.

This means the Acupuncturist is responsible for creating every aspect of his or

her own job, not only the cash flow but all of the supporting systems -- a whole

lot harder than just getting a paycheck.

2) Integrated in Western medical institutions, HMO's, hospitals, etc., all of

which stands to undergo major reform today as we all know.

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

acupuncture world.

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

help.

Independent Private Practice

How it works: There are several types of private practice out there. There's the

Community model, as preached here on CAN, there's the high-end Private Practice,

there's the insurance-driven model, and various Hybrids of all three. The

details of each are different but in the end they all depend on the same thing:

referrals. If you get enough referrals then you survive; if not you go out of

business.

How does one get referrals? Through word of mouth; through personal contact.

This is not a business where normal advertising works. One has to develop a

reputation that makes people (either patients and/or other medical providers)

tell their friends or patients to see you. It's that simple. Whatever you do

with the patients once you have them depends on the style of treatment you use,

but whatever you do you need them to refer other patients to you in order to

survive.

So would having an FPD in place help the Independent Private Practitioners? In

the short run, not really, and in the long run it could well hurt. Let me

explain.

Remember, reputation is key with this type of job. But that reputation does not

come from a title; it comes from results. From your track record in the real

world. Patients and other medical providers refer to you because they know, or

have heard, that you get good results with either a certain type of condition

(if it's a medical provider) or with a particular patient who then refers a

friend or loved one to you. This is all informal and personal. It's not based on

scientific evidence even when an MD refers someone; it's based on practical

experience.

But would having the word " Doctor " in front of your name open new doors and new

referrals? Maybe a few prospective patients on the margins might come thinking

that the Western medical establishment has now granted legitimacy to

Acupuncture, but there aren't many people like that, people who are currently

not coming through our doors because they don't like our current titles. Medical

providers will certainly not refer more people because they will still view us

as Acupuncturists; even with the FPD we will not have had nearly enough Western

training to practice like MD's. In the balance it will still be your reputation

in your community that will determine if you sink or swim.

In the long run, the FPD might hurt Private Practitioners. Part of developing a

reputation is people knowing you exist. But with only 1% of the US having

experienced Acupuncture to date, most people actually have no clue about us.

What Private Practitioners need most is help in getting the word out that we are

in fact here and can help with all sorts of conditions. But with the FPD as the

entry level degree, with its longer time in school and proportionally greater

costs, fewer students will enroll, so there will be fewer Practitioners in the

long run. This might be okay for currently successful practitioners but not for

the rest of us who are struggling. Ultimately Private Practitioners, as a group,

need the general population to think of Acupuncture as a normal, if alternative,

therapy for what ails them, and that only comes from word of mouth.

Integrated in Western medical institutions

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

What we are talking about here is working as a medical tech in a hospital or

HMO. Whoa! Why do I write, " Medical tech " and not Doctor? Because even with a

Doctorate you will not be allowed to determine a course of treatment in such

institutions. If you step back a bit you know this to be true. Just look at our

messed up health care system in the US. The one Obama is doing a poor job in

reforming. No one is even talking about letting MDs regain control of how to

treat patients; that's the turf of the insurance industry and that isn't gonna

change anytime soon. Just a little Googling will bring up scads of articles on

how unhappy Doctors are, how much they have no say in what they do for patients.

But we, as patients in that system, know this already. Why would it be any

better for Acupuncturists working in that system? In fact it would be worse

because until the Western medical establishment determines exactly how

Acupuncture works and how it helps certain conditions, the idea that we might

have the same status as MD's is misleading at best: only the most gullible among

us would believe that.

So at best we might see more technician-type jobs in HMO's and, yes, technicians

don't make much money. We will also be told how many times we get to treat a

patient, as determined by the insurers. But will the FPD make those jobs happen

when they otherwise wouldn't? That's hard to say. The problem is no one has

studied how Acupuncture is integrating within the HMO's.(If someone has ever

seen a good study to that effect, please link it, we'd all like to see it.

Anecdotal evidence suggests acupuncture integration is marginal, haphazard, and

often the first to get the axe when funds are short.) We are still very early in

this integration process with Western medicine and so one should expect to see

new jobs opening up naturally as Acupuncture becomes more available. But the big

problem here has little to do with the FPD or lack of it: it's the problem of

the Western Medical Model and its HMO's and insurance driven ridiculous costs.

We know that the System is in seriously bad shape and it's not getting better.

One result of this is that the Gatekeepers of this System are NOT into seeing

their way to embrace new techniques like Acupuncture. In fact private insurers

are dropping the option of Acupuncture from their plans. (WCA regularly sees

patients who come in saying: yes, I've gotten acupuncture before, I love it and

I loved my acupuncturist, but my insurance dropped it so I can't afford her/him

anymore.) Yeah, I know, Acupuncture would save the insurerers money,

theoretically, but they are so strapped for cash that they don't have the time

to look at Acupuncture and how good it is. We are just not on the table, FPD or

no, so maybe some tech jobs will open up but only on the margins and all

low-paying.

Yes, I understand what I am saying is quite at odds with what Acupuncture Today

and some school presidents and deans are saying but step back and look at

medicine in this country and see how much of a mess it is in. Now tell me that

the HMO's and hospitals will look at the tiny Acupuncture profession and

prioritize how to employ us. Yeah: ain't gonna happen. They are too busy

screwing themselves.

Acupuncture Schools

The healthiest part of the Acupuncture profession these days are the schools,

due to their ability to get federal student loan money. Currently there are 50+

schools in the country. However even though they take in millions of dollars few

of them are making much of a profit as they spend almost everything they make.

(I say this from looking at the non-profit schools' publicly available financial

records and from some informal conversations wit various school officials. I

have no idea about for-profit schools like PCOM as they don't have to disclose

financial info.)

So these schools need to be careful with their money and naturally they are

looking for added revenue streams. Here are a couple:

a) Following on the heels of getting student loans, came the Master's level

programs. It would be interesting to see the 20 year history of the master's

programs and how they've grown, but grown they have. My class at OCOM (93) was

the first class at that school that was granted a master's degree. I went to

school for three normal academic calendar years and had my summers off. At

present, OCOM students have a three and a half year program and they take

classes all summer. Clearly OCOM has added classes beyond what are required. My

guess is that most schools have followed suit. In addition the price per credit

has gone up beyond the rate of inflation. Will Morris, president of AOMA in

Austin, wrote just the other day that the Master's programs are bloated. I

agree, plus I'll add that he and his peers have taken an already too long

master's program and bloated it for their own profit. It seems like whenever the

schools have had a choice, they have opted for MORE: more classes, more time,

more money from students. Given an inch, they've taken miles. If anybody can

cite an example of acupuncture schools opting to look at efficiency, and

actually cut something from their programs or streamline something to save

students money, I would love to hear about it. You have to look at the FPD as

part of a pattern of bloating and ask if this passes, what do you think they'll

want to add next?

b) The DAOM programs. These started oh five-six years ago. After a quick start

they have almost all fizzled financially. (I say " almost " because I don't know

how each one is doing. I just know that all the programs I know are seriously

struggling.) They only have a handful of students enrolled at a time. They have

turned out not to be popular because they aren't needed to have a successful

practice.

c) Regional accreditation. Almost every acu-school is accredited by the ACAOM,

the national body that was set up to do this sort of thing. This is an unusual

situation actually as most mainstream schools (colleges, private high schools,

etc.) are accredited through one of several regional accrediting bodies.

Basically only very marginal educational institutions, like Acupuncture schools,

set up their own national accrediting bodies because classes taken at a

non-regionally accredited school are not transferable to other schools-except

those using the same national accreditation institution. For example, that

Pathology class you took in acu-school wouldn't be recognized at a Med school.

But now some of the larger Acu-schools are trying to get regional accreditation.

Tai Sophia is one and from that regional accreditation they can branch out

beyond just Acupuncture degrees. This is a good move on their part, I say,

broadening one's revenue stream.

I list these programs by the schools to note that survival for them is not a

given; they have to work at it just like us. But with that we must realize that

they have a stake in the FPD as another revenue stream and because of that any

advocacy for the FPD by them must be seen by us as colored largely by

self-serving financial reasons more than altruistic helping of the Acupuncture

community in this country. It's like they are taking a variant of the old

Eisenhower saying, " What's good for GM is good for the US, " to " What's good for

the Acupuncture schools is good for the Acupuncture profession. "

But honestly I don't know if the FPD will be good for the schools. Yeah, if the

same numbers of students that now enroll in the Master's programs enroll in the

FPD, then yes it would be good. But asking for another year (at least; remember

how the Master's programs have grown) of school when many students are already

crossing over the $100,000 debt line: I don't think it's realistic to expect.

It's not like the Acu-schools know best either. Will Morris has publicly written

that wrong decision were made about the Master's programs. Since he and the

other people pushing for the FPD were in charge of setting up those Master's

programs, who's to say that they aren't wrong again? Look at the prospects of

working in the HMO's or Private Practitioners above: do you see a need for more

schooling in either instance? The acu-schools that are pushing for the FPD do. I

think they are deluding themselves.

So in conclusion, I don't see a need for the FPD. It might actually hurt the

profession. The reasons given for the FPD on Acupuncture Today and various

internet forums -- more jobs -- basically can't be backed up with any study. I

hope you see this and give your voice to slow down the FPD express and start

looking into the reasons why the profession isn't doing better.

Your comments are welcome here:

http://www.communityacupuncturenetwork.org/blog/fpd-who-might-benefit-if-it-pass\

es

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December 7, 2009

Thank You Skip.

.....and I respectfully invite Benjamin Dierauf and Will Morris to reply to Skip

Van Meter's post.

Turiya Hill, L.Ac.