Cockroaches of Acupuncture, Part Three
transparency, love, and what you can do
Welcome to the Cockroaches of Acupuncture series: Part One, Part Two, and Part Three.
Thank you to everyone for your patience with what’s turning out to be a roundabout writing process on a difficult topic. I’m figuring this out as I go (the concept of wayfinding never stops being useful around here). I didn’t expect to be writing this much about the acupocalypse and I certainly didn’t expect this many people to be interested. And if you’re like wait, why are we talking about cockroaches? Part One is here and Part Two is here.
Upon reflection, maybe I should have just started with: The system that we have in the US for educating, credentialing, and regulating acupuncturists — what we call the acupuncture profession — is unsustainable. It’s living on borrowed time. It’s hard to say how long exactly but I’d estimate maybe ten years, give or take, before it collapses under its own weight?
A number of people have asked, what can I do? Well, that depends on who you are — more about that in a minute. But I think we need to start with the question, why hasn’t anybody done anything about it yet?
For some people, there’s no incentive to do anything about our unsustainable system. For others, there is an incentive but they don’t realize what’s happening; they don’t realize they have something to lose even as they’re losing it. Systems can seem abstract and hard to wrap your mind around, so I’m going to try to make this as concrete as I can.
Michael Smith of NADA once told me, “In America people don’t understand acupuncture, but they do understand schools. So they put their energy into making acupuncture schools, not acupuncture practices.” Having had experience with building a small acupuncture practice on my own and then a big group practice with other people before building an acupuncture school, I can testify that they are indeed extremely different. (And there’s the added twist that a lot of acupuncturists don’t realize that they have to build anything at all; more about that problem — and how it got us to the acupocalypse — here.) Mike’s pithy summary (he was really good at those) is another way of saying that as long as there was student loan money available to fund schools, and people willing to borrow, there was an economic incentive to create and maintain acupuncture schools.
I think a lot of people were shocked when AOMA announced it was closing with only six weeks’ notice, because from the outside AOMA appeared to be fine. The sudden closure was incredibly disruptive to most of AOMA’s stakeholders, particularly the most vulnerable ones — the students — but they had little opportunity to prepare because the mechanisms by which AOMA became unsustainable weren’t transparent to them. AOMA was a for-profit school, and so it was positioned to feel the effects of the Gainful Employment regulations even though they haven’t fully kicked in yet.
From my perspective, being on the inside of an acupuncture school, I’m going to venture a guess that the owners of AOMA knew that the school was in deep trouble long before the announcement — but they had no incentive to give the students more notice because every single day that students were still paying tuition into an unsustainable arrangement was in the owners’ economic interests.
It’s not just for-profit schools, though. I don’t think you can underestimate the impact of the US having no safety net to speak of. Anybody who has a job (especially a stable, middle-class job) has a huge incentive to hold on to it as long as they possibly can. Our unsustainable system of educating, credentialing and regulating acupuncturists has created some jobs for some people (though not very many). Some people have spent decades in those educating, credentialing and regulating jobs; now they’re approaching retirement. Restructuring an unsustainable system would be a huge amount of (probably thankless) labor that wouldn’t benefit them personally and might jeopardize whatever security they currently have.
Similarly, many rank and file acupuncturists won’t suffer personally from the collapse of the system. Even if state laws change in the future, they’ll grandfather in anybody who already has a license, so those of us who have acupuncture licenses now will almost certainly be able to keep them. After a certain point there just won’t be any new L.Acs coming in, which many acupuncturists simply won’t care about, while others will actually see it as a plus. RIP L.Acs but hey, less competition! ¯\_(ツ)_/¯
So those of us who have something to lose from the impending acupocalypse are the ones who will have to do something. We can’t expect people who have no incentive and no investment to intercede on our behalf. (Pro tip from a cockroach: don’t expect anybody to save you.)
So who are we, the ones with something to lose?
Well, let’s see: If you have a business that employs acupuncturists, markets to acupuncturists, or depends on acupuncturists in any other way, and you hope to be in business ten years from now — or if your exit plan is to sell your business to an L.Ac — you should be concerned. If you’re a patient who hopes to be getting acupuncture ten years from now, unless you’re absolutely confident that your current practitioner will still be practicing then (and I hate to say it, but you can never predict that 100%), you should be concerned. If you’re a 5NP advocate in a state where the 5NP laws require involvement from an L.Ac, you also should be concerned. And if you’re thinking you might want to become an acupuncturist and you’re not yet in school or ready to go right now…you get my drift.
Speaking for myself, I just signed a ten year lease on a new space for POCA Tech, so I’m all the way in on being concerned.
Note to everyone who came here for reasons other than the acupocalypse: our tenant improvements in the new space are almost done! We have sinks now! I promise I will get back to writing about POCA Tech and WCA soon.
Anyway, the point I want to make is that those of us with something to lose from the impending acupocalypse are in the same position as the students of AOMA. It’s quite possible that we’ll get a lot less notice than we need before our lives are seriously disrupted by the collapse of an unsustainable system. I’m an advocate for transparency because transparency is almost always on the side of vulnerable people.
Before I get into what we can do, let me take a short detour (really short, I swear) and talk about what the AHM Coalition is promoting as a solution to the acupuncture profession’s crisis: HR 3133, the Medicare bill. I’m not against Medicare coverage for acupuncture, it would obviously help a lot of people! However, this law being enacted would not, by itself, fix our unsustainable system. And if you click on the previous link, you’ll notice that the government legislative tracking website gives the bill a 0% chance of becoming law. Suggesting that HR 3133 is a remedy for the acupocalypse is a good example of the kind of magical thinking that set us up for our current problems.
The bare minimum of what we need now is a plan for what will happen to the infrastructure of the acupuncture profession if more than half the schools close, which is possible (likely?) with Gainful Employment. A realistic plan, with math! No magical solutions, no deus ex machina, no expectations that this problem will somehow resolve itself. A plan that we can enact with the resources we have, not the resources we think we should have. And we need to know what that plan is — especially those of us who are running businesses that depend on L.Acs. Ten years isn’t that long when you’re dealing with systems (if we even have ten years).
If you’re a decision maker in the AHM Coalition and you’re reading this — that’s what you can do, you can give us a plan. Soon. Please don’t be AOMA.
If you’re not a decision maker yourself but you somehow have the ear of a decision maker, please ask them on behalf of their stakeholders to make and share a plan.
If none of the above apply to you, your role in making a future for acupuncture in the US is — at least right now — a little less defined but just as important. What you can do is make a positive contribution, in your own way, to the general culture around acupuncture. This is not about yelling at people on social media, in fact it’s the opposite (what Jade said!). This isn’t an ideological argument so the less yelling, the better. There’s no substitute for overhauling the system, and that’s going to be hard work. You can help create an environment in which that hard work can happen. You can experiment with believing in a better future and then practice holding space for it. (POCA Tech students know all about this.) You can give the decision makers a chance to do the right thing. Light a candle if you’re into that. If they don’t come through, we’ll figure out our next steps without them.
I’ll tell you a cockroach secret: survival’s about love, about loving your future into existence. Love, like cockroaches, is “common, hardy, and capable of tolerating a wide range of conditions”. It will survive the acupocalypse.