DAOM entry or not

[Guest guest]

We are getting to the point where have to decide whether to support and

entry level DAOM or a tiered system. A new national org has just sprung

up in support of the entry level DAOM centered around Deke Kendall's

integrative vision. My dad is a pharmacist who got a four year bachelors

in 1960. In around 1985, the degree title required for all licensed

pharmacists in every state in the US was changed to Pharm D., a clinical

doctorate. In order to get this tile, current pharmacists had to go back

to school. In my dad's opinion, this change had one major effect on

pharmacy and it was wholly negative. It dramatically increased the cost

of drugs to compensate for a much more expensive education. it did not

result in any greater safety and efficacy. My father was chief of

pharmacy at NJ medicaid at this time, so he oversaw all pharmacists using

medicaid in the entire state, so his opinion is not hearsay or anecdote.

He believes the profession and country would have better off with a

multi-tiered system. Keep entry level affordable so the services can be

affordable. If you had to spend 50% more to go to TCM school, most people

would find they could never make enough money to pay back their loans.

Our services are not yet considered essential, so unlike drugs, we could

easily find ourselves priced out of the market or living like paupers in

order to practice.

 

the position of many is that we are fine with entry level masters and DAOM

should only be for researchers, teachers, specialists and translators, not

GP's. Finally, for those who think there will be some simple route to

grandfathering if entry level DAOM's become the norm, think again.

Pharmacists tried to pull the same stunt and regulators told them to get a

clue. there is not a chance in hell that any state board will allow

someone to use the title of DAOM without doing the coursework and

examination. Since the curriculum is different from masters to DAOM,

there is no precedent for automatic grandfathering in the history of the

US for this scenario. and if highly trained western medical professionals

don't get this privilege, what makes anyone think that regulators are

going to look the other way when a bunch of people who had very minimal

education 20 years ago start calling themselves doctor. ain't gonna

happen. and if you support the entry level DAOM because you think it will

get you a title the easy way if you are already in practice, you might

want to investigate this further.

 

 

Chinese Herbs

 

 

" Great spirits have always found violent opposition from mediocre

minds " -- Albert Einstein

[Guest guest]

He believes the profession and country would have better off with a multi-tiered system.

>>>>>Pharmacy is not a primary care profession and does not have "competition"for other professions. We do

 

 

Since the curriculum is different from masters to DAOM, there is no precedent for automatic grandfathering in the history of the US for this scenario

>>>>Actually i believe DC and DO did, although the DOs did have to take some CEU's

alon

[Guest guest]

, " Alon Marcus "

<alonmarcus@w...> wrote:

>

> Since the curriculum is different from masters to DAOM, there is no

precedent for automatic grandfathering in the history of the US for

this scenario

> >>>>Actually i believe DC and DO did, although the DOs did have to

take some CEU's

 

The story I heard was that the title was kept DC so the existing

Diplomates of Chiropractic would be indistinguishable from the newer

Doctors of Chiropractic.

 

rh

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

 

> > Since the curriculum is different from masters to DAOM, there is no

precedent for automatic grandfathering in the history of the US for this

scenario

> >>>>Actually i believe DC and DO did, although the DOs did have to take some

CEU's

 

The difference was there were only slight or no curriculum changes when this

happened. Pharm. D. and DAOM program represent major curriculum changes

over the earlier degrees. We need to be sure we are comparing apples and

apples here. As for pharmacists not being primary care, what does that

matter. I assume you mean that the issue of tiering is not the same for

primary care. yet Western medicine already offers multi-tiered primary care

(MD, LNP and PA). all have differing training, yet all can practice primary

care

in some capacity. so this model exists. the pharmacy example was merely

meant to illustrate the economic issue. I think the other point is moot.

 

[Guest guest]

yet Western medicine already offers multi-tiered primary care (MD, LNP and PA).

>>>Its more about market competitions and the state of OM in the west. Both as viewed by the public and other medical professionals. Until we are seen as having the same level of training as MD's DCs, NDs and DOs we will be viewed as possibly PA level practioners that need supervision etc.

alon

[Guest guest]

This is the same saw I heard when we moved from diploma to Master's entry level in the late 80's. It is true that most folks started with a 1 year doctorate and evolved their education over the years. We were not that smart so we have to move along with everyone dragging thier feet and espousing opinions. Once a degree is in place as an entry level in a state, it is POSSIBLE, if the groundwork and work is done, to get a licensure title to level the playing field of the profession. Matter of fact, in many cases, the bill won't pass without it. There are plenty of cases where a doctorate title is given by fiat.

Admittedly, some states may require folks to compare their training and continuing education to the present educational level, and those who just barely squeek by with the minimum ceu's may find themselves doing more extensive schooling then they might like. But, then again, in 10-20 years, I may retire instead and let the young turks move things ahead. I happen to like learning, so I don't think it would be such a bad thing. However, if the law pases and there are only a hundred or so old folks left without a doctorate, some of these young folks might just feel that we deserve the recognition of a title like theirs for breaking the ground they stand on.

It will be a state by state issue.

Some people look at the acupuncture training as a stepping stone to OM similar to those taking a 500 hour course in massage as a stepping stone to acupuncture. This might be true in your state too, and in fact it was brought up by the California rep at the last visioning task force "town hall", so even CA isn't as inflexible as those who may not want to see an entry level OM degree.

Interestingly, NCCAOM did a survey, and 95%+ of the acupuncturists use herbs in thier practice, but only some %age under 50 (my memory fails me, but look it up in the NCCAOM diplomate news) actually learned enough about herbs to take the national examinaiton or the CA one. Hmmmm, ethics problem anyone?

David Molony

Lugar wrote:

<<

  He believes the profession and country would have better off with a multi-tiered system.  Keep entry level affordable so the services can be affordable.  If you had to spend 50% more to go to TCM school, most people would find they could never make enough money to pay back their loans.  Our services are not yet considered essential, so unlike drugs, we could easily find ourselves priced out of the market or living like paupers in order to practice. 

 

the position of many is that we are fine with entry level masters and DAOM should only be for researchers, teachers, specialists and translators, not GP's.  Finally, for those who think there will be some simple route to grandfathering if entry level DAOM's become the norm, think again.  Pharmacists tried to pull the same stunt and regulators told them to get a clue.  there is not a chance in hell that any state board will allow someone to use the title of DAOM without doing the coursework and examination.  Since the curriculum is different from masters to DAOM, there is no precedent for automatic grandfathering in the history of the US for this scenario.  and if highly trained western medical professionals don't get this privilege, what makes anyone think that regulators are going to look the other way when a bunch of people who had very minimal education 20 years ago start calling themselves doctor.  ain't gonna happen.  and if you support the entry level DAOM because you think it will get you a title the easy way if you are already in practice, you might want to investigate this further.

 

>>

[Guest guest]

Indeed, it is very unusual, for anyone to ever be

" grandfathered " into a degree title. This goes back to a

basic misunderstanding that people have between degree titles and

licensure titles. One can be grandfathered into a licensure title

but not into a degree title - a degree must be earned. Now, what

can occur is that the state can decide that a doctorate is the new entry

level but that the licensure title will not change which may mean that

existing practitioners can continue to practice under their title but

that they may not use the degree or the title " Dr " . This

allows those who do not want to get the degree to continue practicing.

Marnae

At 10:11 AM 5/24/2003 -0700, you wrote:

We are getting to the point where

have to decide whether to support and entry level DAOM or a tiered

system. A new national org has just sprung up in support of

the entry level DAOM centered around Deke Kendall's integrative

vision. My dad is a pharmacist who got a four year bachelors in

1960. In around 1985, the degree title required for all licensed

pharmacists in every state in the US was changed to Pharm D., a clinical

doctorate. In order to get this tile, current pharmacists had to go

back to school. In my dad's opinion, this change had one major

effect on pharmacy and it was wholly negative. It dramatically increased

the cost of drugs to compensate for a much more expensive

education. it did not result in any greater safety and

efficacy. My father was chief of pharmacy at NJ medicaid at this

time, so he oversaw all pharmacists using medicaid in the entire state,

so his opinion is not hearsay or anecdote. He believes the

profession and country would have better off with a multi-tiered

system. Keep entry level affordable so the services can be

affordable. If you had to spend 50% more to go to TCM school, most

people would find they could never make enough money to pay back their

loans. Our services are not yet considered essential, so unlike

drugs, we could easily find ourselves priced out of the market or living

like paupers in order to practice.

the position of many is that we are fine with entry level masters and

DAOM should only be for researchers, teachers, specialists and

translators, not GP's. Finally, for those who think there will be

some simple route to grandfathering if entry level DAOM's become the

norm, think again. Pharmacists tried to pull the same stunt and

regulators told them to get a clue. there is not a chance in hell

that any state board will allow someone to use the title of DAOM without

doing the coursework and examination. Since the curriculum is

different from masters to DAOM, there is no precedent for automatic

grandfathering in the history of the US for this scenario. and if

highly trained western medical professionals don't get this privilege,

what makes anyone think that regulators are going to look the other way

when a bunch of people who had very minimal education 20 years ago start

calling themselves doctor. ain't gonna happen. and if you

support the entry level DAOM because you think it will get you a title

the easy way if you are already in practice, you might want to

investigate this further.

 

Chinese Herbs

 

 

voice:

fax:

" Great spirits have always found violent opposition from mediocre minds " -- Albert Einstein

</blockquote></x-html>

 

Marnae C. Ergil, M.A, M.S., L.Ac.

Huntington Herbs & Acupuncture

(631) 549-6755

[Guest guest]

Indeed, it is very unusual, for anyone to ever be "grandfathered" into a degree title. This goes back to a basic misunderstanding that people have between degree titles and licensure titles. One can be grandfathered into a licensure title but not into a degree title - a degree must be earned

>>>Well in CA all DOs were grandfathered (or granted) into MDs. Anyway that is not the main question. Its what going to occur with the schools and state of the profession as viewed by the public and the medical world. Therefore what is going on in the schools and entry level that should dominate the discussion

alon

[Guest guest]

" Interestingly, NCCAOM did a survey, and 95%+ of the acupuncturists

use herbs in thier practice, but only some %age under 50 (my memory

fails me, but look it up in the NCCAOM diplomate news) actually

learned enough about herbs to take the national examinaiton or the CA

one. Hmmmm, ethics problem anyone? "

David Molony

 

I agree that this is a medical ethical problem, but I'm not so sure

this is or should be a political/legal problem. When we in Colorado

added herbal medicine to our scope of practice, we originally wanted

passage of the NCAAOM herb test (or some other method of

credentialing) as a prerequisite for those people wanting to practice

herbal medicine. However, our legislature declined to go this route.

Instead, they mandated disclosure of training, i.e., specifically the

number of hours of formal education in herbal medicine for anyone

practicing it. This disclosure has to be included on the written

disclosure form given to all new patients during their initial visit.

 

So what's the method of protection of the public using this method? If

anyone falsifies the number of hours or scope of their training

(either verbally or in writing), that is fraud, a criminal offence.

What this means in practice here in Colorado is that it is the

consumer's responsibility to assess the credentials of their

care-giver or prospective care-giver. If consumers are too lazy or

ill-informed to check out and consider the credentials of a potential

care-giver, that's their problem. The state has declined to act in

loco parentis.

 

I'm not so sure this isn't a bad model. Yes, our schools need to be

better, and part of that is being clear about things like scope of

practice and medical ethics. But I'm not sure that creating more laws

is the best way to improve some of the short-comings of our

profession. The more I think about our profession, its traditions in

both China/Asia and North America, our strengths and our weakness, the

more I think a tiered profession is the best solution. We've already

made what I believe to be a bad mistake by conflating acupuncture and

internal medicine. I hope we don't continue to compound that mistake.

 

Bob

[Guest guest]

, " Bob Flaws " <

pemachophel2001> wrote:

the

> more I think a tiered profession is the best solution. We've already

> made what I believe to be a bad mistake by conflating acupuncture and

> internal medicine. I hope we don't continue to compound that mistake.

 

 

Interesting point. Maybe its time to raise the issue of why we get educated in

both herbs and acupuncture, while this is not the case in china. 4 years of

just herbs or just acupuncture would be pretty extensive training, would

deserve a doctorate and would allow study of chinese along the way. One

could argue that the main reason american internal medicine specialists don't

get adequate herb or language training is because they are forced to study and

practice so much acupuncture along the way. It is actually my understanding

from chinese teachers and other reporters that chinese students do not get

many more hours of classroom TCM training than american students. Part of

the reason their programs are longer is that the students enter right from

high school and also complete what would be considered prerequsite work in

the US (biology, chemistry, etc.). So there may be plenty of " time " to learn

internal medicine and chinese language if one did not also study acupuncture,

tui na, orthopedics, qi gong. these are all worthy subjects, but they have

never been considered essential study for internal medicine specialists by

most of my teachers. So, instead of moving towards an " advanced " version of

the current mishmash degree, perhaps we should consider moving towards

multiple educational tracks, all leading to some form of licensure. the public

would probably be better off if internal medicine speialists studied only that.

 

How about:

 

1 year tui na degree

 

3 year L.Ac. - acupuncture only

 

4 year DAOM - mostly herbs with basic TCM acupuncture only, NO ortho,

massage, qi gong, etc.

 

1 year postgrad - advanced acupuncture for DAOMs (optional)

[Guest guest]

I have a number of points to make.

 

One, the present economic and legal climate still favors acupuncture,

not herbal medicine. I don't think an exclusive herbalist could make

a good living at this point.

 

Two, as you've pointed out, sometimes the combination of herbal

medicine and acupuncture brings better results.

 

I agree that for the majority of the profession, specializing in one or

the other may be best. However, for many individuals, it is, in my

opinion, possible to master both subjects. . . as long as one realizes

that the thinking, diagnosis and protocols for each are quite

different. All of my teachers use both and are quite proficient at

both.

 

 

On Wednesday, May 28, 2003, at 09:50 AM, wrote:

 

> So, instead of moving towards an " advanced " version of

> the current mishmash degree, perhaps we should consider moving towards

> multiple educational tracks, all leading to some form of licensure.

> the public

> would probably be better off if internal medicine speialists studied

> only that.

[Guest guest]

> How about:

>

> 1 year tui na degree

>

> 3 year L.Ac. - acupuncture only

>

> 4 year DAOM - mostly herbs with basic TCM acupuncture only, NO

ortho, massage, qi gong, etc.

>

> 1 year postgrad - advanced acupuncture for DAOMs (optional)

 

 

 

Frankly, I don't think you need three years to learn acupuncture if

that's all you are asked to learn. Other than that, I think your

proposal is a good one. However, from the little I know about various

state and national organizations, it is a no start position. The

juggernaut has already got up a pretty full head of steam. I question

whether such a radical suggestion can even get a fair hearing, let

alone be implemented at this point in time.

 

Bob

[Guest guest]

Z'ev,

 

I disagree that practitioners could not/cannot earn a decent living

doing just internal medicine. I did just that for 10 years. In my

experience, it all depends on how one advertises oneself and the

results one gets. I believe people only care about results. If you are

well-known for getting results with a certain type of disease, I don't

think people are that concerned about or fixated on the modality used.

I believe that what the consumer wants is affordable, effective

healing without side effects. When I was still actively seeing

patients and making my living that way, most patients came to me

because they had heard I was the best person in town for alternative

gynecology, not for acupuncture and not for Chinese medicine. Patients

came to me mostly not from other acupuncturists but from practitioners

of other modalities who tried to treat them for the same diseases and

failed.

 

As for being good at two modalities, I don't believe that Chinese

medical theory is the only or necessary foundation for effective

acupuncture. It is my experience that, if it were not for the

generalized magic of acupuncture plus the given of placebo effect,

many practitioners who do both acupuncture and Chinese herbs would not

be getting the results they do. In other words, I question what it

really takes to be " good at acupuncture. " Further, if one does both

herbs and acupuncture, one can get the herbs wrong and still, it

seems, get an ok outcome, i.e., an outcome which allows one to stay in

practice.

 

As I have said before in this forum, I think dual modality treatment

is a double-edged sword which helps assure acceptable outcomes but

mitigates against true mastery of Chinese internal medicine.

 

Bob

[Guest guest]

Bob,

You raise many issues in your last post. I agree with some of your

positions, others not. Some of these issues are complex, and to move

forward, I would ask what we should focus on.

 

1) the issue of a multi-tiered educational system vs. a DAOM

entry-level degree

2) the pros and cons of separating or combining internal medicine with

acupuncture-moxabustion in clinical practice

3) should acupuncture-moxabustion be rooted in traditional theory and

practice

and

4) the relationship historically of acupuncture and internal medicine

theory and literature.

 

I think any of these topics would be fascinating. However, when I try

to respond to your last post, I find it difficult to be conclusive

because of the complex considerations surrounding each of these points,

each of which require an in-depth discussion.

 

 

On Wednesday, May 28, 2003, at 11:46 AM, Bob Flaws wrote:

 

> As for being good at two modalities, I don't believe that Chinese

> medical theory is the only or necessary foundation for effective

> acupuncture. It is my experience that, if it were not for the

> generalized magic of acupuncture plus the given of placebo effect,

> many practitioners who do both acupuncture and Chinese herbs would not

> be getting the results they do. In other words, I question what it

> really takes to be " good at acupuncture. " Further, if one does both

> herbs and acupuncture, one can get the herbs wrong and still, it

> seems, get an ok outcome, i.e., an outcome which allows one to stay in

> practice.

[Guest guest]

Z'ev,

 

Your pick, although I don't think any of this is really open for

change at this point in time. My feeling is that the die is

pretty much cast on most of these issues.

 

Bob

[Guest guest]

Bob - does this really solve the problem? How does Colorado define

" formal training? " Do they require ACAOM

accreditation? As those of us who are in the daily grind of

teaching now, many students are capable of passing individual classes

(with a " C " ?) and yet when it comes to Comprehensive

Examinations or the NCCAOM exam they simply do not cut it. But,

they are able to document their " formal " education, even though

they cannot meet what the profession has determined to be minimal

standards for practice. Patients cannot find out what grades a

student received, nor can they find out whom they studied with or what

sort of training they had. The NCCAOM at least gives an objective

measure of minimum competency - the variation in educational standards

does not supply that.

At 03:06 PM 5/28/2003 +0000, you wrote:

" Interestingly, NCCAOM did

a survey, and 95%+ of the acupuncturists

use herbs in thier practice, but only some %age under 50 (my memory

fails me, but look it up in the NCCAOM diplomate news) actually

learned enough about herbs to take the national examinaiton or the CA

 

one. Hmmmm, ethics problem anyone? "

David Molony

I agree that this is a medical ethical problem, but I'm not so sure

this is or should be a political/legal problem. When we in Colorado

added herbal medicine to our scope of practice, we originally wanted

 

passage of the NCAAOM herb test (or some other method of

credentialing) as a prerequisite for those people wanting to practice

 

herbal medicine. However, our legislature declined to go this route.

 

Instead, they mandated disclosure of training, i.e., specifically the

 

number of hours of formal education in herbal medicine for anyone

practicing it. This disclosure has to be included on the written

disclosure form given to all new patients during their initial visit.

 

So what's the method of protection of the public using this method? If

 

anyone falsifies the number of hours or scope of their training

(either verbally or in writing), that is fraud, a criminal offence.

What this means in practice here in Colorado is that it is the

consumer's responsibility to assess the credentials of their

care-giver or prospective care-giver. If consumers are too lazy or

ill-informed to check out and consider the credentials of a potential

 

care-giver, that's their problem. The state has declined to act in

loco parentis.

I'm not so sure this isn't a bad model. Yes, our schools need to be

better, and part of that is being clear about things like scope of

practice and medical ethics. But I'm not sure that creating more laws

 

is the best way to improve some of the short-comings of our

profession. The more I think about our profession, its traditions in

 

both China/Asia and North America, our strengths and our weakness, the

 

more I think a tiered profession is the best solution. We've already

 

made what I believe to be a bad mistake by conflating acupuncture and

 

internal medicine. I hope we don't continue to compound that

mistake.

Bob

 

 

[Guest guest]

Todd -

I have to disagree with you about several things:

First of all, practitioners in China do study both acupuncture and

" herbal medicine. " There are separate departments for

Acupuncture, CHinese Medicine, CM Pharmacy and Tui Na/Qi Gong. But

there is a great deal overlap.

Secondly, the hours completed in our Master's degree programs are much

less than what is completed in the Chinese M.B/B.S.

Over the course of the 1st 4 years of study, students in China complete

about 3900 hours of didactic (in class) training. That includes

about 800 hours of " pre-req " work (including Phys Ed, Govt and

English -) and about 930 hours of " western medicine "

training. This leaves 2170 hours of CM study - but that number does

not include any clinical training. In fact, students do very little

formal clinical training until they reach their 5th year - this year is

devoted entirely to the clinical practice of CM. The breakdown of our

programs is quite different. Using a round # of 3000 hours (which

is much higher than some schools actually do), about 850-900 hours are

clinical and another 500 -700 are western med. This leaves about

1500 hours of CM training. With that ratio, indeed, you could say

that perhaps " too much " emphasis is placed on the study of

acupuncture (a highly debatable statement) but the realy problem is

simply that our hours do not compare to the hours of training done in

China.

In the Zhong Yi ( Dept) course include: FTTCM, Diagnosis,

MM, Form, Acupuncture, SHL, Wen Bing, GOlden Cab, Nei Jing, Internal Med,

Peds, Gyn, Traumatology, Dermatology, Classical Chinese, History of Med,

and Divergent Schools of thought. Students also study Tai Ji (as

part of their phys ed requirement) and sometimes Tui Na.

In the Acupuncture Dept, the overall numbers are about the same.

The courses include:

FT, Diagnosis, MM, Form, SHL, WB, GOld Cab, Channels, Points,

Moxibustion, Qi Gong, Acu Tx, Tui Na, Internal Med, Peds, Gyn,

traumatology, Classical Chinese, History, Divergent schools.

Although historically the study of " chinese medicine " and

acupuncture were indeed separate in China, they have converged and

separated many times. As for specialization, it is in the clinical

phase of the training, and after graduation when doing a residency or

working as a junior practitioner in a hospital that the real

specialization begins. This is like medical school here - the

specialization does not occur in med school, it occurs afterwards during

clinical practice.

I do not believe that separating acupuncture out from our training is the

way to solve the problem. In fact, I think that many schools do a

very poor job of training students in acupuncture. We teach points, point

functions and TCM theory but most schools really leave it at that.

When students start to get the deeper knowledge that is out there

regarding acupuncture, they can create a much more elegant and effective

treatment - and then the " power " or " magic " is really

present. I can see adding more hours in advanced coursework so that our

programs more closely resemble those in China.

Perhaps this means that I am in favor of the DAOM as entry level.

Thre is no reason why our entry level training should be any less than

that in China. I think we just need to come to grips with the fact

that to really be trained in this medicine requires more than 4 academic

years completed in 3+ years and that we need to find ways to improve our

clinical training. In any given day a student in a Chinese

hospital may be seeing 20 - 60 patients. Our students in one

3 - 4 hour shift are seeing maybe 4 or 5 patients. (and they do this 3 -4

times per week instead of 6 days a week) Yes students in China are

undergrad students and have to complete some extra stuff, but they are

studying a foreign language while doing their training and many of them

find ways to do informal clinical training by following teachers who

allow them to do so. Too many of our students continue to enter

these programs thinking that it will be a cakewalk - after all it can't

be as hard as medical school can it? I think we need to work to

disabuse them of this notion - it can be as hard as medical school - it

is medical school and we need to strive to produce practitioners who have

the same sense of ownership of their medicine that physicians do.

 

Perhaps we made a poor choice of degree title long ago when we chose to

go for Master's degrees rather than a doctorate. Because this is

" higher ed " perhaps we should have gone straight for the

doctorate (as the chiros did) and then used the medical model of being

able to also get a Ph.D - so you had a clinical degree and a

research/academic degree.

This of course also becomes a political issue in the sense of what

different states will allow. NY originally leaned toward the

doctoral degree as entry level but was convinced to use the master's

because there were no accreditation standards for the doctorate at that

time. Trying to change their minds now could be a nightmare.

Other states will have similar issues.

I hear a lot of complaining about the schools in these discussions, but I

have not really heard any concrete statements about what the schools

should be doing to get better. I have certain ideas - some of which

I have expressed - but I am curious where other people feel the

inadequacies lie and what should be done to improve them.

Marnae

At 04:50 PM 5/28/2003 +0000, you wrote:

--- In

, " Bob Flaws " <

pemachophel2001> wrote:

the

> more I think a tiered profession is the best solution. We've already

 

> made what I believe to be a bad mistake by conflating acupuncture

and

> internal medicine. I hope we don't continue to compound that

mistake.

 

Interesting point. Maybe its time to raise the issue of why we get

educated in

both herbs and acupuncture, while this is not the case in china. 4

years of

just herbs or just acupuncture would be pretty extensive training, would

 

deserve a doctorate and would allow study of chinese along the way.

One

could argue that the main reason american internal medicine specialists

don't

get adequate herb or language training is because they are forced to

study and

practice so much acupuncture along the way. It is actually my

understanding

from chinese teachers and other reporters that chinese students do not

get

many more hours of classroom TCM training than american students.

Part of

the reason their programs are longer is that the students enter right

from

high school and also complete what would be considered prerequsite work

in

the US (biology, chemistry, etc.). So there may be plenty of

" time " to learn

internal medicine and chinese language if one did not also study

acupuncture,

tui na, orthopedics, qi gong. these are all worthy subjects, but

they have

never been considered essential study for internal medicine specialists

by

most of my teachers. So, instead of moving towards an

" advanced " version of

the current mishmash degree, perhaps we should consider moving towards

 

multiple educational tracks, all leading to some form of licensure.

the public

would probably be better off if internal medicine speialists studied only

that.

How about:

1 year tui na degree

3 year L.Ac. - acupuncture only

4 year DAOM - mostly herbs with basic TCM acupuncture only, NO ortho,

 

massage, qi gong, etc.

1 year postgrad - advanced acupuncture for DAOMs (optional)

 

 

[Guest guest]

>

>

> Frankly, I don't think you need three years to learn acupuncture if

> that's all you are asked to learn.

 

I agree. However it would take three years to be a primary care L.Ac. in a

western med system. But only 2 if you could dispense with all the primary

care, which would be fine if acus wanted to accept a role as a type of

bodyworker rather than a form of GP medicine. the education would be cheap

and services affordable. internal med without acupuncture is already

affordable because you don't have to come to the office so much. I somehow

doubt those who do solely acu would want any diminishment in their stature,

though.

 

[Guest guest]

 

 

This really is an interesting conundrum. Two years for learning

acupuncture only sounds very reasonable to me. I was initially taught

by a Chinese gentleman to do acupucnture in six months, at which point

I went in practice. Later, I did a three month Chinese training.

Either of these were supposed to be adequate for entry level if one

already was some sort of licensed health care professional. My

experience was that, for some, either of those were adequate. For

others, they were inadequate. When I ran a small school myself here in

Colorado, we graduated two classes of 2-year acupuncturists, a number

of whom are very much in practice (12-15 years later) and quite

successful therapeutically. We did not teach herbal medicine to either

of those two classes.

 

While one can legally just be an acupuncturist, at least in this state

if not California, one cannot legally just be a Chinese herbal

practitioner. Although I made my living a number of years

essentially just prescribing Chinese herbs, I was able to do that

legally because I was a registered acupuncturist. So even if we were

able to separate back out acupuncture and herbs educationally and let

people study only one or the other, legally, the herbal students would

not be able to practice.

 

As an example, there is an herb school here in Boulder which teaches

a Chinese herbal medicine track. Their students do not learn

acupuncture. At the end of their training, they graduate with a

certificate from their school but absolutely no license or other legal

imprimatur to practice. These graduates are never told that the

practice of herbal medicine is the unlicensed practice of medicine. So

many of them do it anyway. But they are sitting on a powder keg. All

it'd take is a single phone call complaint to the Board of Medical

Examiners to pop any one of them who is not otherwise a licensed

health care practitioner with herbal medicine in their legally

mandated scope.

 

Bob

[Guest guest]

, Marnae Ergil <marnae@p...>

wrote:

> Bob - does this really solve the problem? How does Colorado define

" formal > training? " Do they require ACAOM accreditation?

 

No. They specifically refused to create a Board of Acupuncture-Chinese

Medical Examiners to determine such standards. It's a problem-driven

system, and, so far, there haven't been any or very few problems that

I know of. I don't know of anyone prosecuted for fraud in terms of

statements about their education or credentials.

 

Although the Colorado (Republican) approach is not a perfect system by

any means, I was offering it as a potential option to a more in loco

parentis (Democratic) solution. I guess I was simply trying to

stimulate " outside the box " thinking about such issues.

 

As those of us who are in > the daily grind of teaching now, many

students are capable of passing > individual classes (with a " C " ?) and

yet when it comes to Comprehensive > Examinations or the NCCAOM exam

they simply do not cut it. But, they are > able to document their

" formal " education, even though they cannot

meet > what the profession has determined to be minimal standards for

> practice. Patients cannot find out what grades a student received,

nor can > they find out whom they studied with or what sort of

training they > had. The NCCAOM at least gives an objective measure

of minimum competency > - the variation in educational standards does

not supply that.

 

Agreed. However, when you say a potential patient cannot find out how

a student did in school, why not? If I were to ask a potential

practitioner that question and they hesitated to tell me, that would

put the kibosh on it right there and then. As for who they studied

with, that should be ascertainable as well as a syllabus of their

courses. I can't see how that is protected by confidentiality.

 

But again, my point here is not whether passage of the NCCAOM test

should or should not be a legal criterion. (I wanted it to be here in

Colorado.) My point was merely the recognition that consumers need to

take some responsibility themselves. Turning over all responsibility

to the state is, I think, dangerous.

 

Bob

[Guest guest]

, Marnae Ergil <marnae@p...>

wrote:

-

>

> I have to disagree with you about several things:

>

> First of all, practitioners in China do study both acupuncture and " herbal

> medicine. "

 

Most of my chinese teachers informed me that they did not practice

acupuncture at any time after early in TCM college before coming to the US. I

have read other reports that actual classroom training was pretty skimpy. It

was my understanding that one did little or no acupuncture in clinical

rotations if one chose nei ke. I appreciate the detailed curriculum you listed.

 

PCOM devotes 616 hours solely to acupuncture point location, channel theory,

point function, orthopedics, massage,tui na, etc. and 378 solely for herbs, none

on classics and chinese language. About 900 hours of clinic, 420 of TCM theory

and internal medicine combined. Rest is 900 western med and misc.

 

While not debating the value of acupuncture, my point is merely that one does

not have to study these 616 hours to practice internal medicine and I wish

that was an option. There are different wys we could use those hours instead.

Options keep down health and education costs. Why do we need a monolithic

profession.

 

As for clinic, I completely agree. Many months ago I did the math for

everybody on how many cases they actually get to follow in their internship.

In reality, students should be required to do a postgrad internship before they

are allowed to practice indepedently. They should get paid for this internship.

One year might be enough if it was 40 hours or more per week of clinic and

nothing else. If our laws mandated this, would our institutions be able to

support this. We would need paid residencies available for all grads. Is this

possible?

 

>

> I do not believe that separating acupuncture out from our training is the

> way to solve the problem. In fact, I think that many schools do a very

> poor job of training students in acupuncture.

 

Indeed, but isn't this another reason to separate it and do it justice in its

own

program as Bob has long argued.

 

When

> students start to get the deeper knowledge that is out there regarding

> acupuncture, they can create a much more elegant and effective treatment -

> and then the " power " or " magic " is really present.

 

I have found that students either tend to excel at acupuncture or herbs, but

rarely both. I think demanding deeper study of acupuncture would only

detract even further from what I see as already all consuming, my study of

herbs. And not everyone finds the study of both rewarding. I know many

more students who reject herbs studies than those who reject acupuncture, but

the split is still there. While you ar no doubt correct that these studies have

historically converged and diverged on many occasions, perhaps the current

convergence has outlived its usefulness and it is time to consider some more

divergence. currently, a number of schools teach acupuncture only programs.

Yet no law sanctions the practice of chinese medicine solely as herbology,

which is as many have practiced it.

 

And I would point out that acupuncturists who go to acupuncture only schools

are often regarded as more skilled in this art than their peers who went to

more eclectic TCM programs. This is because they have been narrowly

focused. If this added focus led to better skills and knowledge, wouldn't the

same be true of an herbs only program. While some who go the route you

propose would end up true scholar doctors learned in all the healing arts,

many would end up jacks of all trades and masters of none. My concern is

what approach would best serve the public and society. And I think that may

be a tiered system with early educational specialization in modalities to insure

expertise, control costs, etc.

 

[Guest guest]

Dear Colleagues -

 

The Visioning Search Task Force article is going up on the Acupuncture Today site for the July issue. Much of what is being discussed here regarding the state of the field and education would be useful for the task force to receive. There is a listed in the article that can be posted to with some of the pertinent discourse that has taken place in the CHA forum.

 

Will

[Guest guest]

Rory -

I concur with you on this, it is from a solid foundatin that a reasonable choice of focus can be made.

 

Will

 

 

In my opinion, given all the factors to be considered at present, the educational system should be set up so that choice of modality specialization should not preclude the necessity to study both herbs and acupuncture.

[Guest guest]

--- In

, Marnae Ergil

<marnae@p...>

wrote:

 

When

> students start to get the deeper knowledge that is out there

regarding

> acupuncture, they can create a much more elegant and effective

treatment -

> and then the " power "

or " magic " is really present.

---------

At 7:25 AM +0000 6/3/03, Todd

Luger wrote:

I have found that students either

tend to excel at acupuncture or herbs, but

rarely both. I think demanding

deeper study of acupuncture would only

detract even further from what I see as already all consuming, my

study of

herbs. And not everyone finds the study of both rewarding.

I know many

more students who reject herbs studies than those who reject

acupuncture, but

the split is still there. While

you ar no doubt correct that these studies have historically converged

and diverged on many occasions, perhaps the current convergence has

outlived its usefulness and it is time to consider some more

divergence.

--

 

I don't think you or anyone has shown

that there is a good reason for divergence. Student preferences on

their own are an insufficient reason to change anything. Much more

important is the effect on the profession of Oriental medicine in the

context/s in which it is practiced in the US. The requirement that

herbs and acupuncture be combined in training has served the

profession very well so far, and I cannot see what has changed so that

we should want to change that.

 

You say that students rarely excel at both

acupuncture and herbs. That is not a reason that they shouldn't study

both. What they choose to emphasize in their future practice is a

choice they are then able to make, either in the final year of school

or after graduation. The fact is that many students are not much good

at anything yet, and many probably should not be pursuing a career in

OM. I teach in two schools that offer a separate acupuncture only

program, and these students are in general no better at acupuncture

than those in the combined program. OTOH there are a few excellent

students in both programs. My conclusion is that there are a few

excellent students, and then most of the rest, and a few that terrify

me. The reasons expressed by most students for doing the acupuncture

only track are usually along the lines of 'I can't be bothered to do

the extra work', and not 'my passion is for acupuncture, and

I'll be happy to refer out for herbs'.

 

As someone has pointed out, a majority of

those surveyed with acupuncture only training, also prescribe herbs.

This a very strong argument for insisting on combined training,

regardless of student preferences.

 

As to the idea of a separate no acupuncture

training in Chinese herbs, do you think this is viable for those

without another license to lean on?

 

California has a successful working model

for OM education and licensing. In any event I'd like see to some

justification for divergence that takes account of all the

professional ramifications, not just personal

preferences.

 

currently, a number of schools teach

acupuncture only programs. Yet no law sanctions the practice of

chinese medicine solely as herbology, which is as many have practiced

it.

 

And I would point out that acupuncturists who go to acupuncture only

schools

are often regarded as more skilled in this art than their peers who

went to

more eclectic TCM

programs.

--

As stated above, this has not been my

observation. Yes, there are some highly skilled acupuncturists --

those I've met were mostly trained in both herbs and acupuncture, and

often other modalities, and this didn't detract from their ability to

do acupuncture with a high level of skill. Some were trained only as

acupuncturists, yet they are not necessarily better than those who

were trained in other modalities as well. There are also many

graduates of acupuncture only programs who are, let's face it, less

than exceptional. To make your claim meaningful would require a

detailed study, and such a study might well not show a correlation

between the number of modalities studied in school and eventual skill

in any one of them for a large population of students.

 

This is because they have been

narrowly

focused. If this added focus led to better skills and knowledge,

wouldn't the

same be true of an herbs only program. While some who go the route

you

propose would end up true scholar doctors learned in all the healing

arts,

many would end up jacks of all trades and masters of none. My

concern is

what approach would best serve the public and society. And I

think that may

be a tiered system with early educational specialization in modalities

to insure

expertise, control costs,

etc.

--

In my opinion, given all the factors to be

considered at present, the educational system should be set up so that

choice of modality specialization should not preclude the necessity to

study both herbs and acupuncture.

 

Rory

--

[Guest guest]

> In reality, students should be required to do a postgrad internship

before they are allowed to practice indepedently. They should get

paid for this internship. One year might be enough if it was 40 hours

or more per week of clinic and nothing else.

 

I believe Mercy College is looking at creating something like this in

concert with several hospitals in NYC. Blue Poppy Institute is also

discussing the possibility of creating something like this here in

Colorado. Something like a clinical finishing school. At the moment,

we're thinking along the lines of providing room and board plus some

classroom lectures in exchange for working in a clinic under

very focused (apprentice-like) supervision. I've been wanting to

create a CM hospital-cum-spa here in the U.S. for many years and I'm

just about ready to actively try to mnaifest that. My idea would be

for the spa to help defray the costs of the hospital.

 

> Yet no law sanctions the practice of chinese medicine solely as

herbology, which is as many have practiced it.

 

I think this is the real problem with separating these two arts back

out again. Until or unless people who only practice Chinese internal

medicine can practice legally, I see no possibility of this happening.

 

>My concern is what approach would best serve the public and society.

And I think that may be a tiered system with early educational

specialization in modalities to insure expertise, control costs, etc.

 

I agree, but I don't see it happening for the above-stated legal

reason. What about doing something like what I was told was the way

the Shanghai College did things back in the early 80s? Have two tracks

with two different certificates at the end: an acupuncture-moxibustion

track and an internal med track. In the acupuncture-moxibustion track,

teach only a very bare-bones course on Chinese medicinals, emphasizing

ready-made meds. Make it as simple and stripped-down as possible so as

1) not to take up a lot of time and 2) not to use too many brain

cells. Then, in the internal med tract, teach the minimum necessary to

allow students to become licensed as acupuncturists. I believe this

could be done in one semester like in the three month courses taught

in China. Again, the goals would be 1) shortest amount of time and 2)

minimum use of available brain cells. For instance, only learning the

100 most important points. It is my experience that one can pass the

NCCAOM acupuncture exam just by learning what they teach in China in

these three month courses (not get a 100% but nonetheless pass).

 

Using this approach, the courses would mainly train practitioners to

knowledgleably communicate and refer to each other as well as allow

the internal med students to become Lic.Ac.'s. In a pinch, the

int.med. graduates could do some simple acupuncture when necessary.

Likewise, the acu-moxa grads could prescribe some simple ready-made

meds when necessary.

 

If you have any suggestions about how to separate these two arts

educationally and still allow the int.med grads to practice legally,

I'm all ears.

 

Bob