"All our progress is an unfolding, like a vegetable bud. You have first an instinct, then an opinion, then a knowledge as the plant has root, bud and fruit. Trust the instinct to the end, though you can render no reason." Ralph Waldo Emerson
Our profession has grown because of the great efforts of those who trusted their instincts in the early days of acupuncture in America. In all my experience in business, healthcare, educational administration and various roles in our professional organizations, my instinct tells me our profession is at a tipping point. Another unfolding is occurring and I am grateful to be able to share my perspective.
We have made tremendous progress in the last 30+ years and there are a number of positive indicators, especially strong cross-organizational collaboration, which gives me great hope for our future. But, I am concerned about a growing sense of disharmony emanating from some members of our profession and I think the root of the issue might be found in our different approaches to the challenges we face. My hope is to stimulate discussion on these issues, promote expanded cross-organizational collaboration, motivate you to either join or renew memberships in both your state association and the American Association of Acupuncture and Oriental Medicine (AAAOM) (www.aaaomonline.org), promote attendance at the World Conference on AOM and Integrative Medicine in Baltimore in 2011, AND convince you to volunteer your time and expertise. By doing so, you will further empower these organizations to work on behalf of a greater percentage of our professional members and thus create a richer vision for our future in healthcare.
Because of the current complexity of our profession, it takes multiple organizations to support our various endeavors and each of these organizations is integral to our future success. Their ability to communicate and work together with a common vision for our profession is critical. So, six years ago when the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) initiated an annual meeting of eight AOM organizations to discuss issues of common interest affecting the profession, an important step was taken. The 2009 meeting was attended by representatives of the AAAOM, Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM), American Organization for Bodywork Therapies of Asia (AOBTA), CCAOM, Federation of Acupuncture and Oriental Medicine Regulatory Agencies (FAOMRA), National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), National Federation of Chinese Traditional Chinese Medicine Organizations (NFCTCMO), and Society for Acupuncture Research (SAR) and resulted in the development of the following vision statement and goals (www.nccaom.org/news/index.html) that are guiding our current collective efforts.
"By 2014, acupuncture and Oriental medicine (AOM), an independent, licensed profession, will be fully accessible to the public throughout American healthcare."
I believe this kind of collaboration is indicative of our maturation as a profession and the leadership of the CCAOM and all of the participating organizations should be commended for their efforts.
Another benchmark for our maturing profession was the action by the U.S. Dept of Labor and Statistics to label acupuncturists as a bright-outlook profession. (http://online.onetcenter.org/help/bright/29-1199.01). This is an extremely important step in the profession's effort to gain recognition of "Acupuncturist" as an independent occupation/profession with federal government agencies. This recognition could lead to additional research funding, expanded awareness and access for patients, but it will take a significant organized effort and extensive data collection by our various organizations. For example, the recent release of the NCCAOM's 2008 Job Task Analysis (JTA) (www.nccaom.org) was the culmination of years of work by the NCCAOM, included significant volunteer effort by members of our community and will play a role in helping us achieve the vision previously stated.
This kind of community effort ultimately contributes to positive outcomes in independent research conducted outside the profession. Take, for example, the article Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007, by Nahin, Barnes, Stussman and Bloom (www.cdc.gov/NCHS/data/nhsr/nhsr018.pdf). According to the article, in 2007, 38.1 million adults made an estimated 354.2 million visits to CAM practitioners, at an estimated out-of-pocket cost of $11.9 billion.
"Despite the overall decrease in visits to CAM providers in 2007 compared with 1997, visits to acupuncturists, a progressively more regulated and professionalized CAM provider group, increased over this same time period, with 17.6 million visits estimated for 2007 (79.2 visits per 1,000 adults), or three times that observed in 1997 (27.2 visits per 1,000 adults)."
The authors further speculated that, "The increase for acupuncture may in part be due to the greater number of states that license this practice and a corresponding increase in the number of licensed practitioners in 2007 compared with 1997, as well as increased insurance coverage for these therapies. Large numbers of articles in the lay press about the benefits of acupuncture were published during this period, increasing awareness in the general population. Together, greater opportunity and increased awareness may explain much of the observed increase in adult use of acupuncture. "
In my opinion, the growth in terms of patient visits noted above is a direct result of the efforts of all of our affiliated organizations, their staff and of course, the volunteers. Although in this article, I focus on only a few of the organizations, it is important to acknowledge and applaud the work and effort of all individuals that are or have been affiliated with our medicine. Whether you are a student, teacher, practitioner, researcher, supplier or patient, your efforts are paramount to our success. Thank you!
As we expand in numbers and our diversity increases, it is inevitable that we will face challenges that can either divide us or become the catalyst for creating a new platform for our profession to operate from. I've selected several areas to consider and have provided a few suggestions for next "right steps."
First, our most pressing challenge is many licensed acupuncturists struggle to have financially viable practices. We can do more to support our practitioners in creating successful practices in a variety of settings. As a first step, I suggest we consider creating a task force that includes both internal and external representatives that will contribute new expertise to our task of developing viable options, alternatives and business models. I, for one, would be happy to participate in that process.
Our second challenge is to make an informed and appropriately timed decision on when, if and how to move to the optional First Professional Doctorate and to identify the ramifications of that decision since our biggest challenge is the financial viability of our profession. Although years of effort have already gone in to this evolving process, I am not aware of an economic impact analysis of this decision. I suggest our leadership consider expanding the role of the doctoral level task force and request a financial analysis of the impact this decision might have on our profession.
Third, the current economic climate is creating numerous challenges for all of us and the impact of federal legislation is currently unknown. Again, my instincts tell me we are at a tipping point in our profession. Successful professions have actively engaged with well-organized state and national professional associations that have the financial resources to effectively promote and lobby on behalf of the profession at every level. The financial resources typically come from membership dues and are the lifeblood of every professional association. My question, given the economic climate, is whether we have enough members and financial resources to meet the current and expanding needs of the profession? My concern is that we do not have enough of either. If my concern is well founded, then I humbly and with all respect suggest the following:
And when we receive data, like that from the 2008 JTA report, that gives us pause and tends to confirm fears relative to practice viability, we will have the resources in place to create a plan of action and to mobilize an effective response.
Many of us have had the instinct that Emerson spoke of. We know, through personal experience, that our medicine provides enormous benefit to the patients that seek it out. No matter the challenges we face individually along our path, collectively as a profession we must trust the instinct that this medicine is worth the effort. Our training teaches us to consider the whole person when diagnosing and treating disharmony. Please keep this in mind as you reflect on the progress we have made as a profession, the challenges we have overcome and the future opportunities all of us will face.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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