The Future of No-Fault in New York City

I recently decided to move from Los Angeles to New York, filled with visions of unlimited opportunities in acupuncture and Oriental medicine in Manhattan and its surrounding areas. New York was touted as the next big center of attention, poised for an explosion similar to what occurred in the 1990s on the West Coast. New York has always been considered a place where dreams of any kind could be filled if you had ambition and determination. I was interested in moving east to be closer to my family, and New York seemed perfect for my personal and professional goals.

Unfortunately, I chose to move just before September 11, 2001, which of course had an enormous impact on all of us, and definitely left me with doubts about moving to a city under these incredible circumstances. I became determined to become a part of New York and try to begin the process of healing America's greatest city. New York needed people to believe in its vision again, and I felt Oriental medicine could still play an important role in its recovery and future progress.

My first attempts to find employment were met with little enthusiasm immediately following the events of September 11, but in time people began to move forward and I was getting closer to finding work. The most accessible opportunity for LAcs in New York involves working in multidisciplinary no-fault insurance clinics. These clinics provide the opportunity for newly licensed practitioners to gain valuable clinical experience and a steady income, which can often be quite difficult in the first year of practice. The clinics often center around a medical doctor, with supporting physicians in the fields of neurology, orthopedics, chiropractic and physical therapy. There are a variety of practitioners in this environment, which can lead to an excellent combination of Western allopathic care and alternative therapies.

The patients in these no-fault clinics are covered by insurance to receive treatments up to five times per week, including regular consultations with medical doctors; physical therapy; massage; chiropractic adjustments; biofeedback; and, of course, acupuncture. For a new acupuncturist this is often very enticing, because it allows us to work with diverse treatment modalities as peers and enables us to show them what we have to offer to the patients without any limitations on what we choose to do. I found this to be very encouraging and fulfilling, as many patients reported to me that acupuncture was helping them where other modalities had failed. This isn't news to those of us who have studied and worked with Oriental medicine for years, but to hear it from patients who had little or no previous experience with acupuncture was fulfilling.

Having patients come to see me several times per week has allowed me to provide high quality care and achieve excellent results. Patient compliance is higher than in private practice because cost is not as much of an issue; we all know it can be difficult to convince people they should come three times per week in a private setting when they are paying out of pocket for the treatments. The clinics also provide a steady and sometimes high volume of patients on a daily basis, which is excellent for a new practitioner in terms of gaining valuable experience through a large and diverse patient population. Herein lies the problem facing these clinics in the future, however.

In November 2001, I received a bulletin from the State Education Department of New York concerning no-fault clinics and corporate practice. It appears there are concerns about the quality of treatment in the many no-fault clinics in the New York area. It is not uncommon for some of these clinics to receive as many as 100 patient visits per day, and it becomes obvious that time is limited on a per patient basis at such high volume. The bulletin served as a reminder that quality of treatment should not be compromised in any no-fault clinic regardless of patient volume. This seems obvious, but in practice is not always observed, and could lead to the destruction of a very valuable opportunity for all acupuncturists in New York.

I feel quality treatment should be a priority for any acupuncturist working in the no-fault system -- or any other environment, for that matter -- but especially in light of the tremendous opportunity this system presents for the future of acupuncture and in gaining continued coverage by major insurance carriers. Fraud has not been uncommon in some of these clinics, and I urge any acupuncturist working in this system to appreciate and respect the chance they have been given to spread the word of our profession to patients, gain continued and increasing support of the Western medical establishment, and legitimize our care in the eyes of the health insurance community. If we do not provide a positive example of Oriental medicine in this system, there will be little or no opportunity for those who might follow us in the future. This would be a tremendous blow to the progress our predecessors have made in our profession.