A Blue Poppy blog post by Bob Quinn
I came across an article recently in which I read surprisingly that the number of practicing acupuncturists in the US is rather flat when measured over the last few years. It seems that with 3000+ students in the tube in our various schools we would be growing at a steady rate, not holding at a standstill. Apparently, we are losing as many as we are gaining. Not a good situation, obviously, and one that invites speculation.
When I read this, I flashed on a conversation I had a few weeks ago with the dean of one of our acupuncture colleges. She related that across all medical fields enrollment is down in training programs. To deal with this challenge colleges are combining forces in the effort to interest future students in the medical field. I was glad to hear that across lines MDs, DCs, PTs, acupuncturists were collaborating, but why would enrollment be down in the traditionally popular medical field? This field is after all nearly recession- proof.
National surveys tell us that MDs are quite unhappy in their work. Many are looking to work in related fields or in entirely new careers. What is causing all this turmoil? Why now is medicine so unattractive a field to enter?
Let’s assume there are a variety of reasons for the flat number of acupuncturists and not just one riddle to solve. We could postulate that some new acupuncturists find themselves in a saturated market, e.g., San Francisco, Portland, NYC and have a tough time attracting patients; some might be tired of doing battle with insurance companies for adequate and timely payment for services; some might be poorly trained in acupuncture and unable to help enough of their patients to stay in business; some might lack basic business skills and maybe attended schools that did not do a good job teaching these business basics; some might have dropped out due to lack of love of the field, and there could be many more possible reasons. These reasons perhaps describe why some might be leaving the field they trained for, but why are students not enrolling in acupuncture programs in the numbers they once did? Here I suspect finances play a key role. The cost of training to be a Chinese Medicine professional has grown over the years to a level that is tough to justify—from the student’s perspective, I mean, when they calculate likely future earnings. In truth we will never know with any precision why our field, once a rapidly growing one, is no longer growing.
In any event we seem to find ourselves at a crossroads of sorts. Medicine in every culture is important, but we have evolved (devolved?) a system that few seem to enjoy working in, and everyone now seems to be aware of that fact. How utterly tragic! We ought to take a good hard look at that. We cannot create a future worth living if we have insufficient medical providers; that is clear.
Could it be that our medical system itself is a type of pathology, and that is driving people away? We acupuncturists certainly hear story after story of poor treatment in the mainstream medical system. Some of these stories are horrific and heart-rending, but I do not wish to demonize medical doctors. They are not allowed sufficient time to develop a healthy and meaningful relationship with their patients. They fear these same patients will sue them over real or imagined medical errors. We are in real trouble when doctors see their patients as potential foes in court. But there are in fact many such lawsuits and one can well understand and sympathize with the doctors for practicing a protective sort of medicine. It is a sad situation to be stuck in. If the doctors were allowed more time, they could practice a different sort of medicine and develop healthier relationships with their patients, but that would change the financial picture of their employers, and money seems all important in our current system.
What is driving all this? Bringing the profit motive into medicine was probably never a great idea. Medical groups, hospitals, and insurance companies have their eyes on the bottom line, and this drives their decisions. Nothing could be clearer. One gets the feeling at times that they would deny every claim if they could get away with it. Few things in our culture are as Kafkaesque as talking to these insurance companies.
In 2005 I attended a talk by David Eisenberg, MD, a noted researcher; at that time I think he was still at Harvard. He opined confidently that within 15 years there would be a total collapse of our medical system. That only question he saw was: What will replace it? Wow! I was astounded at the boldness of the prediction. If his prediction is true, we do not have many years left until radical change is upon us.
What are we in Chinese Medicine to do? Our numbers are small and our collective financial resources even more meager. On the political stage we are a non-factor. But still we have a role to play in the lives of those who step into our offices. We have collectively treated a significant number of Americans. We are small but not invisible. David was small too when viewed alongside Goliath. I suspect we (with the support of our patients) will have some role to play in whatever system comes next, and it might not be all that long down the road. Things seem to be moving fast.
My hope is that the various medical fields will find in one another natural allies instead of potential competitors, that we can work together to create a system that is more humane., more sensible. If our colleges can cooperate in educating potential students about the medical field, then I hope we practicing professional can as well. It will take a lot for this to happen, but it is possible. At present we see the opposite. Physical therapists and chiropractors are in many states trying to encroach on acupuncture with their “dry needling,” Not a good sign of things to come. Of course, in fairness we should note that in certain states acupuncturists are allowed to give chiropractic adjustments, prescribe homeopathic remedies, inject substances into acupuncture points, order labs, and so on, e.g., the claim could be made against us as well that we have encroached on the territory of other allied medical professionals. We will need to move beyond these narrow battles in the years to come and find in one another allies instead of competitors.
Perhaps I am unrealistically optimistic, but I think in the long run things will get better. Maybe it is more a prayer than a hope. I say this while recognizing that we might well face chaos in the medical system (not to mention in the body politic) in the near term under the incoming administration. I think there is a reason we in Chinese Medicine are licensed now in almost all 50 states. That has happened so fast. Naturopaths, by comparison, have been here in the US far longer and are not even licensed in 20 states. That is curious. I believe there is a role for us in creating whatever the new-to-come will look like.
I hope we can step forward with wisdom when that day comes. After all we practice a medicine that at least has a vision of health as other than a lack of identifiable pathology. That might seem at first a minor point, but it is enormous really. The mainstream medicine has no such unifying philosophy of health. At least there we will have a chance to make a unique, and needed, contribution.
Best wishes all around,
Bob Quinn