Cockroaches of Acupuncture, Part One
some notes on survival, from a survivor
Welcome to the Cockroaches of Acupuncture series: Part One, Part Two, and Part Three.
Everybody seems to be in agreement that the acupuncture profession in the US is in trouble. This is progress! What everybody doesn’t agree on, however, is what to do about it. In this post I’m going to tell you what I think we should do about it; also, I’m going to attempt to NOT put the non-acupuncturists in the audience to sleep. Describing the problem and potential solutions in language that laypeople can understand is challenging but worth a try (I appreciate you, non-acupuncturists! Also acupuncturists who are not from the US!). But first, I’m going to tell you why you should listen to me.
Because I’m a cockroach.
There are 4600 species of cockroaches, all described as “common, hardy, and capable of tolerating a wide range of conditions”. Most of them are also described as “large, dirty pests”. I’m a cockroach of acupuncture. And I have a cockroach vision for the future.
Calling ourselves the cockroaches of acupuncture started out as a joke by my friend Whitney and over time evolved into a useful shorthand for the art and mindset of survival in community acupuncture. I know that lots of people won’t like the metaphor, but that’s kind of the point: lots of people (particularly acupuncturists) recoil from talking about survival in the same way they might recoil from seeing a cockroach. There’s a surge of UGH and NO and WHY, just under the surface of conversations like this. I want all that out in the open.
So if you’re like, ew, survival, maybe stop reading now? (Or go read this post and see if a dose of Lucille Clifton’s poetry helps.)
Because survival’s my area of expertise. Since I got my acupuncture license almost thirty years ago, I’ve experienced most of the scenarios and conditions that acupuncture has to offer. I was lucky enough to get a job right out of school, where I worked in multiple public health settings doing lots of 5NP: a detox, a treatment center for mostly unhoused people, and a residential treatment program for mothers and children. I did hospice work, including as an independent contractor for Kaiser Permanente’s hospice acupuncture pilot project in 1999 (aka integrative medicine for people who like that term). I rented a succession of private offices where I treated patients individually. I worked out of my house. I’ve built or helped build pretty much every kind of organizational structure that’s possible in the acupuncture world: a self-employed solo practice, a group practice with subletters, a group practice with employees, a 501c3 nonprofit clinic, a 501c6 professional association, a 501c3 accredited acupuncture school. Also a multi-stakeholder cooperative. (Not bragging, just showing you my weird resume — because I hope you’ll believe me when I say I know, from experience, how these things work. I’m all about the nuts and bolts.)
In school I learned TCM and Japanese acupuncture and Jin Shin Do acupressure, as well as 5NP. I’ve gotten a lot of bodywork myself, including an early version of what would now be called somatic therapy. As a patient I’ve been treated in private practices, public health settings, and community clinics; I’ve paid for treatment out of pocket, on a sliding scale, and (briefly) with insurance.
And in all those places and roles, I’ve never found anywhere that funding for acupuncture or associated therapies was something practitioners or patients could take for granted. Everybody had to work at it, no matter who they treated or what they charged. Paying for acupuncture and getting paid for acupuncture has been an issue — and sometimes an insurmountable obstacle — in every scenario I’ve experienced. And yet hardly anyone in the acupuncture profession has been willing to talk about that.
I learned recently that some people assume that I was able to make WCA and then POCA Tech because I had some other source of income — that I was able to do something idealistic with acupuncture because I didn’t have to worry about economic survival. Nope. WCA was my strategy for economic survival, and it’s been paying my family’s bills since 2002. I think that’s relevant. Also I’m about as idealistic as a cockroach. (To be fair, before writing this post I didn’t know that some species of cockroaches are social: They practice collective decision making, resource sharing, and even parenting. But being social and being idealistic aren’t the same thing.)
Whitney is also the person who coined the term acu-pocalypse, meaning the end of the acupuncture profession as we know it, caused by its organizational infrastructure running out of money. I’ve been hesitant to write about the acupocalypse here for a number of reasons, but the topic is becoming unavoidable. The acupuncture school that I graduated from 30 years ago just announced that it’s closing. OCOM was considered one of the best schools and it used to be one of the largest. The end of OCOM (right on the heels of AOMA) is a giant warning sign.
For WCA, deciding to make our own little acupuncture school (in the same town as OCOM) was about trying to survive in a professional environment that was decidedly unfriendly to community acupuncturists. In my experience, survival is a choice and a commitment. You have to actively want it. And you have to want it more than you might want other things like status, respectability, idealism, or even your preferred image of yourself. You have to give up trying to prove anything to other people and just pay attention to keeping yourself alive in your environment, which often requires making things as simple as possible. Survival is like a math problem where you’re always looking for the lowest common denominator.
I’m not sure the acupuncture profession really wants to survive and I doubt that it’s willing to prioritize the lowest common denominator. In my experience the acupuncture profession is allergic to everything low and common.
Says the cockroach.
Another term for “prioritizing the lowest common denominator” is being inclusive.
On the off-chance that this line of thinking is unfamiliar as opposed to revolting, though, I’m going to share an outline of what I’d do, in the window of time we have before we arrive at peak acupocalypse. (With one big caveat, I’m not going to address the possibility of de-regulation. That deserves its own post and Tyler and I will get into it next month.) So:
I’d start by figuring out who’s invested in surviving and how much discomfort they can tolerate, versus who’s going to bail and go find something easier to do with their lives. (No judgement! This is hard, and if I’d had better options I might have taken them myself.) I wouldn’t put any energy into the people who are going to bail, or the people who only want to argue (there’s no shortage of those in the acupuncture profession). Survival takes energy, you can’t waste it on arguing.
I’d see if the people who are invested in surviving can agree on the lowest common denominator, and then put their efforts into preserving it. From my perspective, the lowest common denominator is a safe, legal, independent acupuncture practice: the ability to become a licensed acupuncturist (L.Ac.) without any kind of supervision from another healthcare profession, or the requirement to have another type of healthcare license. It’s what Miriam Lee made possible, fifty years ago, and most acupuncturists have been taking it for granted ever since.
In most states, L.Acs have to graduate from a school that’s accredited by ACAHM, and they also have to be credentialed by the NCCAOM. If enough acupuncture schools go out of business, ACAHM won’t have enough revenue to survive; if not enough people want to take the NCCAOM tests, the NCCAOM will run out of money, at which point there will be no legal route to creating L.Acs in most US states, including Oregon. Existing L.Acs could still practice, but we’ll be on our way to extinction.
It’s math time! What’s the minimum revenue that ACAHM and the NCCAOM can survive on? I’d draft a plan for that. Kind of like the pandemic, but without all the federal rescue funding! (Full disclosure, my idea of minimum revenue might be significantly different from other people’s due to my class background.)
Next, how many L.Acs do we need to maintain the most basic infrastructure on a shoestring budget? How are we going to recruit and train enough of them, while being honest with them about the risks involved? (Can we agree that lying to prospective students about their futures — including lying by omission — is a bad idea?)
I’d create and share a template for acupuncture education that doesn’t require federal Title IV money (because there’s a good chance that access to student loans is going away — see Gainful Employment Regulations.) There are two such schools currently, and ours is one. Bonus points for figuring out a shorter Master’s degree program and how to get state laws to allow it, because I promise more people will go to acupuncture school if it’s shorter and less expensive! Access to student loan funding changed everything for acupuncture in the US circa 1990, but we need to imagine a future without it.
I’d resurrect apprenticeships and figure out how to support and promote them. The subject matter expert on acupuncture apprenticeships in the US is Jersey Rivers, my co-director at POCA Tech.
And here’s the big one: I’d give up any attempt to unify how acupuncturists practice and accept acupuncture’s natural diversity. The credentialing process for acupuncture doesn’t have to be based on Traditional Chinese Medicine theory; it could be based instead on acupuncture safety and ethics, the true lowest common denominator. Did I mention that I know how a Job Task Analysis works, because POCA did one? Overhauling how acupuncturists are credentialed wouldn’t be easy and there would be so much screaming — but it’s not impossible, and I guarantee you we’d have more L.Acs if the credentialing process were saner and more connected to the (diverse) reality of practice.
For everyone who hasn’t fallen asleep and who isn’t throwing up, there you have it. (By the way, that outline could be tweaked to address how to recover after an acupocalypse.) Being a cockroach, I like this cockroach vision of acupuncture: diverse, inclusive, safety-oriented and economically sustainable — even if its infrastructure has to run on a shoestring. And maybe eventually it wouldn’t have to, but that would require time, patience, and humility.
Wikipedia says: The American cockroach has been used as an ingredient in traditional Chinese medicine, with references to its usage in the Compendium of Materia Medica and Shennong Ben Cao Jing. In China, an ethanol extract of the American cockroach, Kāngfùxīn Yè (康复新液), is prescribed for wound healing and tissue repair.[6]
Stay tuned for more cockroach extract.