Making the Invisible Visible

Art by A. Cohen

I have a weird job.

That’s what comes to mind after the first two modules of this school year: The main thing I do at work is try to make the invisible visible.

For Cohort 10, who are in their second year and just starting clinical internship, I taught the first of a series of classes about holding space. That’s a big topic and I realized recently that we need to talk about it at three different levels: holding space for yourself as a practitioner, holding space for your patients, and holding space for the clinic as a whole (which has a lot of overlap with safety culture). Anyway, we started out with holding space for yourself, which includes the need to set a positive, supportive, encouraging tone for how you talk to yourself about work. All acupunks, but new interns especially, need to cheer themselves on! That goes double for entrepreneurs. Cohort 10 is a thoughtful and engaged group so it was a fun class. One student pointed out that holding space is a form of invisible labor.

For Cohort 11, who are starting everything at POCA Tech, I taught a series of classes about leadership, trauma informed care, and safety culture, which included an in-depth discussion of all the ways we depend on them to self-organize in their cohort, and all the leadership opportunities that are available as a result of attending a DIY little school that runs on a shoestring.

I’m sure there’s a lot of invisible labor built-in to any small school. POCA Tech has to try to make it visible, though, because we need the students to help with it so we can keep our tuition costs down — and of course it’s good practice for running their own businesses in the future. The school doesn’t work unless we share the responsibility of taking care of it.

If you’ve read previous posts, you know that we’re big on being clear with students about what kinds of things they should expect to do for themselves in their acupuncture careers — including all the invisible things — as opposed to assuming that somebody else in the acupuncture profession will handle it for them.

I’ll confess to having a steep learning curve, personally, around responsibility. Due to circumstances in my family, I developed a knack for picking up responsibilities that other people didn’t want. If I did it quickly and quietly enough I could keep a fragile sort-of peace, and nobody even noticed; it was all invisible. That (unfortunate) strategy was pretty good preparation for solo entrepreneurship, where you really are responsible for everything, but it stopped working so well once a lot of other people were involved with WCA, and it didn’t work at all for POCA Tech.

These days I try to be clear and kind and explicit about who’s responsible for what — and when there’s a responsibility that nobody seems to want, I try to open up a conversation about it. I try to make it visible and figure out who it belongs to. As opposed to just adopting it myself, like a stray dog.

That’s my actual, formerly-stray dog, Audrey. (She’s wonderful. Thanks, Multnomah County Animal Shelter!) She’s all the stray dog I need.

So when an entire system’s broken — the way acupuncture education is broken — whose responsibility is it, exactly, to address the problem? Elaine Wolf Komarow of The Acupuncture Observer sent me an article about nurse-midwives in California:

One of (the state’s) two programs for training nurse-midwives has stopped admitting students while it revamps its curriculum to offer only doctoral degrees, a move that’s drawn howls of protest from alumni, health policy experts, and faculty who accuse the University of California of putting profits above public health needs.

Howls of protest, huh? Elaine noted the difference between this situation and the acupuncture profession, where virtually everybody, apart from some ragtag malcontents (hi malcontents!), thought entry-level doctoral degrees were a great idea. As far as I can tell, virtually everybody still thinks that — and the ones who don’t, won’t admit it in public. The howls of protest, in my experience, only come in response to projects like POCA Tech.¹

It’s not just about the doctoral degrees, though. Can we take a short detour to make something else visible? From my cursory research, the cost of an acupuncture Master’s degree (with or without herbs) ranges anywhere from $50K on the low end to about $85K on the high end. Because of the way those programs are structured, though, most of them make it difficult for students to work much, which means that they’ll need to supplement their living costs somehow. So a student who needs loans to attend acupuncture school (and most students do) is likely to not just borrow around $50K or so for tuition, they’re likely to borrow much more over three or four years. The total could easily reach $100K. As the OPB articles showed, thanks to the miracle of compound interest, someone who graduates from acupuncture school $100K in debt is likely to be $200K+ in debt ten years later. And that’s the low end.

This, dear readers, is bonkers.

Art by A. Cohen

And it doesn’t seem like anybody in the acupuncture profession wants to take responsibility for it. I get that there is no line in any individual person’s job description that says, verbatim, “address the fundamentally self-destructive state of acupuncture education.” There’s nobody whose boss is going to wander by their office on a Tuesday and say, “Hey, how’s the project of dealing with our broken system coming along? Can we get a report soon? Maybe before any more big pieces fall off?” However, it seems unfair that if the topic of responsibility comes up at all, it tends to be assigned to the students. Buyer beware, right?

But what happens when the buyers start to beware en masse? When it’s clear that acupuncture education itself is something that people should beware of?

In 2024, these are the acupuncture schools that have closed (so far): AOMA (almost 30 years old); OCOM (40+ years old) and now Acupuncture Massage College, also 40+ years old — actually the oldest acupuncture school in Florida — which closed with no notice at all. Students got an email saying, don’t come to class today, we’re done, good luck with your careers. I’ve heard from reliable sources that two other acupuncture schools, each 30-some years old, are in trouble as well.²

I understand that very few people want to take on responsibility for the financial imbalances of acupuncture education in the way that POCA Tech has, where we do whatever we have to in order to keep tuition below $25K. I’ll even concede — see above — that I’ve tried to take on too much responsibility, in various ways. (I’m working on it, writing about it helps.) And being the person who steps up to responsibility when other people won’t is not exactly a fun gig!

But we’ve reached the point that unless somebody does something³, the entire infrastructure of the acupuncture profession is in jeopardy. Everything that’s holding it together depends on people’s willingness to take out student loans for acupuncture school. Which is a bad deal for the people taking them out and we know it! We all know it. It’s only invisible if you refuse to look.

1. Where, according to our critics, we’re devaluing, debasing, dumbing down and destroying acupuncture medicine. Impressive, right?

2. If you’re a real nerd about this topic you can look at this directory of formerly accredited institutions from ACAHM and you’ll see that what’s happening is unprecedented. In the past, troubled schools closed from time to time, or ACAHM revoked their accreditation — but there wasn’t a wave of established schools in seemingly good standing just running out of money.

3. HR 3133 (still with a zero percent chance of being enacted) doesn’t count.