Open Letter to the Leaders of the Profession

[Guest guest]

The following is a letter sent by Lisa Rohleder (Working Class

Acupuncture) to approximately 100 prominent figures in the American TCM

world. She addresses many important issues regarding the state of our

profession, and is of particular interest to me as a student preparing

to enter the professional world. I wonder if anyone on this forum has

any comments.

Thank you,

David M. Lesseps

3rd year student

 

 

 

The purpose of this letter is to open a dialogue.

 

Acupuncture Today recently published an article in its September 2007

edition, titled Money is Qi is Money, by Felice Dunas.

 

http://www.acupuncturetoday.com/mpacms/at/article.php?id=31577

 

That article has stimulated a great deal of discussion among both

acupuncturists and patients, and has intensified a desire to hear from

you, our leadership, what your true intentions are for our profession.

 

Many people were outraged by what they perceived as the crass

materialism that “Money is Qi is Money” seemed to them to be promoting.

Other readers were certain that the article was intended as a satire.

Felice Dunas has subsequently clarified that she was trying to treat a

serious subject -- how practitioners receive financial compensation --

with some levity.

 

http://www.acupuncturetoday.com/mpacms/at/article.php?id=31598

 

 

Unfortunately, the ideas that Felice Dunas stated in jest --

acupuncturists should charge as much as possible, acupuncture fees

reflect acupuncturist self-esteem, patients love shopping so sell big,

expensive stuff -- are presented in earnest in practice management

classes all over the country. She humorously equates undervaluing one’s

work with “trading treatments for garden vegetables back in the 1970s”,

but unhappily, the decade that the acupuncture profession is really

stuck in is the 1980s, back when superficiality, avarice, and big hair

were all in vogue, and no one had ever heard of sustainability.

 

 

The 1980s were also the years when unprincipled chiropractors were

treating insurance like a slot machine, and somehow that became our

model for professional success: both packaging acupuncture as if it

were a subset of chiropractic, and resolving to take as much as we

could get from whoever seemed to have it. But now that insurance has

become increasingly problematical, and at least 80% of Americans cannot

afford acupuncture at market rates, the ones being taken are

acupuncturists themselves.

 

The national leadership of the acupuncture profession in America

currently seems to represent 1) those people who by virtue of seniority

no longer need to make their living by actually practicing acupuncture

-- those who have secured teaching jobs, lucrative consulting gigs, or

have figured out how to work the CEU circuit; and 2) those companies

and institutions whose revenue stream is provided either by acupuncture

students or by acupuncturists who do practice. As a result, the

national leadership inhabits a dramatically different economic reality

from that of most rank and file acupuncturists who are trying to make a

living practicing acupuncture. In 2005 (the most recent year for which

figures were available from IRS Form 990), the compensation for the CEO

of the NCCAOM was $210, 538. Since conservative estimates suggest both

that two-thirds of acupuncturists are no longer practicing five years

after graduation, and that current graduates are carrying unprecedented

levels of debt ($100,000 or more in student loans), this suggests that

the acupuncture profession is essentially afloat on the credit of

individuals whose only mistake was to love Chinese medicine enough to

want to study it. This is an unsustainable situation if ever there was

one.

 

Recently I received a telephone call from a lawyer who wanted to know

why one of his clients, my patient, was able to pay out of pocket for

her treatment while another of his clients had a $16,000 bill for

acupuncture. Both of these clients had been in auto accidents and had

received comparable amounts of treatment. His client with the $16,000

bill, who had a head injury, had been repeatedly reassured by her

acupuncturist that her insurance would pay and she didn't need to worry

about it. He had also failed to inform her of the actual cost of the

treatments. Her lawyer was calling me because her insurance settlement,

unfortunately, was not going to be sufficient to cover her acupuncture

bill and her acupuncturist was threatening to take her to collections.

The lawyer remarked grimly to me that it would only take a few more

$16,000 acupuncture bills before legislators began to get interested in

the price of acupuncture -- just as they became interested in the price

of chiropractic in the early 1990s in Oregon, after a decade of

outrageous billing.

 

The 1980s are long gone; it’s 2007 and the US is in the middle of a

health care crisis. There are national epidemics of pain and

depression, both eminently treatable with acupuncture, and yet most

acupuncturists are severely underemployed, and the fastest growing

acupuncture “specialty” is facial rejuvenation. We are in desperate

need of leadership that is both timely and accountable -- accountable

to the majority of acupuncturists who are not making a living

practicing acupuncture and to the majority of patients who cannot

afford to receive acupuncture. We need more than self-interested guild

politics; we need more than the creation of yet another regulatory

board. “Money is Qi is Money” makes light of a sycophantic amorality

that embraces acupuncture as medicine by the rich, for the rich, but

many acupuncturists would have trouble distinguishing the author’s

whimsy from the reality in which we find ourselves.

 

Article 4 of the NCCAOM Statement of Ethics, under the subheading

“Commitment to the Public”, used to read : “To make an effort to keep

fees within the reach of the general public, and to have provision for

flexibility in fees for low income patients.” That article disappeared

from the Statement of Ethics some time ago without explanation. For

many of us, however, the need to make a living by providing treatments

to people in our own communities, who like ourselves are not rich, is a

primary concern for us. Just as we inhabit a different economic reality

from you, our leadership, we are concerned that we inhabit a different

ethical reality as well. We see little evidence of interest from you

either in the ability of rank and file practitioners to make a living,

or in the health of the hundreds of millions of patients who cannot

afford acupuncture at market rates.

 

For further clarification, please see the following article:

 

http://theintegratorblog.com/site/index.php?

option=com_content & task=view & id=354 & Itemid=189

 

 

Felice Dunas has publicly clarified the intention of her article. We

are asking you, our leadership, to clarify your moral vision for

acupuncture as a profession. We are asking you to be accountable to us.

Your comments may be posted on the Prick, Prod and Provoke blog, on the

home page of the Community Acupuncture Network, where this open letter

is also posted: www.communityacupuncturenetwork.org

 

Sincerely,

 

Lisa Rohleder, L.Ac.