Acupuncture Degrees Are Mostly Meaningless
on (not) transforming healthcare, part two
Our school has an unconventional perspective on acupuncture degrees,1 which can be hard for prospective students to understand. Big thanks to subscriber Amelia Zahm, DAOM for a deep dive into this topic.
This is Part Two of a three part account of how an acupuncturist who did everything — and I mean everything —right according to the standards of the acupuncture profession, ended up disillusioned with the system. Part One, about the process of creating an integrative medicine position in a Federally Qualified Health Clinic (FQHC) is here.
This is Amy’s story:
Our healthcare system has been broken for a long time. In the year before I decided to go to acupuncture school I shepherded my mother through the medical system as she went from emergency bypass surgery to kidney failure to a rehab center to assisted living and finally to another major surgery that was more than her body could handle. I spent every day for six weeks at OHSU, first in the ICU and then on a recovery floor. I drove my mother, who was too weak to even sit up, across the state to the rehab center because insurance wouldn’t pay for ambulance transfer. I talked to doctors and medical teams, I argued with social workers. I met medical professionals who were kind and compassionate (her cardiothoracic surgeon, a charge nurse) and those who were dismissive and rude (a medical student, a social worker). In the months after her death, my father descended into dementia, and I got another ride through the system. Coincidentally, this was also a time in my life that I was seeking a career change.
Acupuncture helped me resolve crippling insomnia that struck after my mother’s death, and I thought, “Maybe this is a way I could help people and begin to change a broken system.”
I should also say, that I’m a lifelong learner. If I won the lottery, I would be in school studying something all the time. I’m greedy for knowledge (Gemini rising, Sag moon – LOL), and acupuncture school lit me up. The concept of the micro (body) as a reflection of the macro (natural world/universe), the simplicity at the heart of all the complexity, the patterns and traditions and models and principles, the art and the science, the circular and the linear. And it’s all connected to the physicality of the body, the points, the skill of needling, the pieces that make the medicine tangible and experiential.
It’s beautiful. And I felt like this was a way that I could make a difference for people.
As I was learning all this wonderful, magical stuff, the seeds of superiority were planted, not necessarily said directly but implied or hinted at: You’re the doctor. You tell the patient what to do. You keep people away from evil pharmaceuticals. We wear white coats so we are respected like MDs. This was twenty-five years ago, and the narrative wasn’t as strong then as it is now. The biomedical component of training seemed reasonable – anatomy and physiology, living anatomy, western pathology – enough to safely and accurately perform acupuncture, know when to refer, understand diagnostic language, and be able to communicate effectively with MDs.
I took my board exams during the last year before the biomedicine exam was added, when we were hearing that biomedicine was going to become a bigger part of acupuncture education and that our school and all the others would be adding a year or even two to their program requirements. We were going to become part of the medical establishment.
And here we are. I recently took the Biomedicine board exam to get licensure in a new state (THAT licensure process is a whole other infuriating story), and I was astounded. The level of biomedical knowledge required to pass that exam far exceeds any practical application allowed by the acupuncturists scope of practice. Why?2
Looking back, I have a good laugh at myself, because I remember feeling so confident (and arrogant) when I launched into the world as a baby acupuncturist. I’d studied lots of esoteric things in addition to the basic curriculum, and I was going to do something special, be amazing, work miracles! And then the first patient walked in my clinic door, and I realized I was all alone — no supervisor, no other students, just me and the patient — and I panicked. What would I do? How would I treat them? Oh, yeah. The basics (thank you Miriam Lee). I’d start there.
I’d keep things simple, and I’d meet my patients where they were, learn their names and their stories, look them in the eye as I checked their pulse, and give them a space to rest and be seen and feel heard. And guess what? This is how I built my practice—one patient and one simple treatment at a time, adding new things as I learned them and letting my patients lead the way. Despite what we’ve been told, these simple things are transformative in a healthcare setting.
And yet, when I built the acupuncture program at the FQHC where I eventually worked, I felt like I was ‘really’ transforming healthcare. I was excited and inspired, ready to share my work with more people and practice as part of a team. I went into the DAOM program believing it would provide me with more knowledge and also a credential that would give me more professional cred. (I was very lucky that the clinic where I worked supported my efforts by allowing time off and providing a lot of support for my Capstone project).
I soaked up more learning, worked with some amazing teachers, published in a couple of professional journals, met some really, genuinely lovely people, and took on a monstrous amount of debt – significantly more than I expected to. I was proud of the title Doctor, because I busted my ass to earn it. And then the other acupuncturist in town spent 10 months and 1/10th of the money to get a DACM and proudly posted the title Doctor on her door, and I realized that no one outside of acupuncture academia knew the difference. OCOM launched their DACM two months after I graduated from my DAOM program.3
I quickly recognized that in the biomedical system, acupuncture degrees are largely meaningless. If you have a license, you can bill for services, and insurance will only pay what it pays, no matter how many letters there are behind your name.
Within the clinic environment there was a ceiling on how much I could earn because revenue generation was limited by the scope of practice defined by my licensure, which does not take degrees into account. The schools don’t talk about this when they’re recruiting you. And those jobs and professional pathways they promise? They’re few and far between, and even if you are fortunate enough to build your own, like I was, the suggested salary and prestige are seriously exaggerated.
Working in a biomedical environment is hard – there’s a reason doctors experience astronomical rates of burnout. It’s not nearly as hard for an acupuncturist, but learning the work flows, navigating the complex EHR system, dealing with the referral process, attending meetings and meetings and more meetings, being in a largely chaotic environment – it’s exhausting (for jing, qi and shen).
Having an acupuncturist in that environment is great for patients, but I’d hardly say it’s transformative. I became another cog in a giant churning wheel, and while I helped educate a few young doctors about the benefits of acupuncture and saw a few patients I might not otherwise have worked with, my impact on the larger system was minuscule.
Which doesn’t mean it was pointless or even unsuccessful. I think the program was a great success, and I feel like I succeeded in doing what I set out to do there. There are many acupuncturists with different temperaments, who would have thrived in that environment.
The failure was in the narrative and expectations I was fed by the school and the profession that wanted my money.
to be continued
POCA Tech offers a Master’s level Certificate, not a Masters degree (and definitely not a doctorate). That’s a choice; it’s not a punishment or a sign that we don’t comply with the same Master’s accreditation standards as other acupuncture schools. We’ve been fully accredited since 2018, though some acupuncturists still refuse to believe it.
In addition to Amy’s perspective on acupuncture degrees, please consider this quote from the first OPB article about the closure of the Oregon College of Oriental Medicine:
“The student said OCOM marketed itself as a medical school — so they looked into transferring to another school to become a nurse or physician’s assistant. But none of their credits would have transferred. A spokesperson from Oregon Health & Science University said, in theory, OHSU could accept appropriate transfer credits for a bachelor’s or graduate degree but it would not be expected as the curriculum at alternative medicine schools is highly specialized….To find out that years of school credits are basically meaningless anywhere else was really a blow to me,” the student said. “I felt like they lied to me.”
We didn’t want people signing up for our acupuncture school thinking they were getting credits that they could transfer to a more mainstream health care degree. Because that’s not true for any acupuncture school! So we didn’t make a graduate degree at all. We’re not into status for its own sake; see also, On Shame and Class and the Acupocalypse.
Indeed. See also, The NCCAOM vs POCA Tech by Jennifer Kehl, RN L.Ac.
I think physical therapists and nurse practitioners have been sold the same bill of goods as far as a "doctoral degree" is concerned. In most hospital systems physicians get very touchy about who is called "Dr." Even psychologists who have earned the honorific have been told not to use it in a hospital setting which is really ridiculous as far as I am concerned. (I get called Dr. or Doc because I write the prescription. I say very emphatically that I am not a physician or doctor, but folks don't pay attention. I write the prescription.)
Nurses are told that if they want to understand "systems" better, they need the Doctor of Nursing Practice. Notice the word "systems." It isn't meant to become a better practitioner, but a better administrator, I guess.
By the way, I have a Master's Degree in Nursing. I earned it about 15 years ago. It cost me about $50,000 or so. I don't have a BA in Nursing - I have a 2 year degree in nursing. I have a BA in another area, but that is a different story. It took me three years to earn the degree. I worked full-time as an RN. I still had to take out loans because I had a life as well - mortgage, bills, and husband to support. I paid back the loans with a bit of luck and three years of service in a Community Mental Health Center. (A Community mental health center doesn't foster the same kind of community as Community Acupuncture does.) I won't ever take on the debt to get a Doctor of Nursing Practice degree.