Melody's Musings

The last time we gathered here to discuss the elephant in the room and I got distracted with the backstory of how I, specifically, got here to this very moment. It might have seemed like a trauma dump. If it did, I'm not even sorry because that was just a glossing over of my lived experience and not even a detailed account of some of the harrowing adventures I've been on. You see, I'm an elder millenial who has been tired of the trials presented by late stage capitalism for a very long time and I've been able to see that the game is rigged against me since I was a literal toddler and my parents tried to explain the economy to me. Yes, I said it- even a toddler can see that the way we do things doesn't make any sense. Now to the meat of the issues and I'm really not sure how to organize the information in a way that doesn't come out as word vomit.

The student loan rules: the student loan game has been rigged for a very, very long time. The most recent attempt to fix the system functioning just as it was designed to do by trapping people in inescapable debt for daring to dream of moving above their station of abject poverty just does a more direct job of doing just that. This means that only the richest students under the current system of education and loans will be able to afford to take out the loans to complete an acupuncture education. There are a couple of schools that have been working towards making the education required to become an acupuncturist more accessible and I do think this is a start in the right direction.  That said, I don't know if this model will necessarily appeal to or be a good fit for every future acupuncturist. I also think there's a good chance that the current administration's changes get thrown out in court in a year or two.

The cost of an acupuncture education: I started to address this above. The average cost of an acupuncture degree that does not include undergraduate studies is somewhere around $120,000. It is one of the longest and most expensive master's degree programs. Does it need to be? I'm not sure. I can tell you that even at the end of my program where I felt very well prepared not only for my board exams but also for clinical practice, I knew enough to know just how much more there was to learn and I feel that there could be arguments made for both more and less education. As a matter of fact, the whatever our acronym is now organization formerly known as NCCAOM just polled the profession on whether or not acupuncture should have an entry level bachelor's degree. While I'm not totally against that, I do think that it would potentially cheapen the credential those of us who have already attained the master's have earned so far. That said, the bachelor's level with a direct path into master's might allow for some to go into less debt while working towards their acupuncture licensure- especially those coming from associates level programs or massage therapy programs who might otherwise have to get a bachelor's degree before entering into a master's program. I also sort of feel that for the work level and amount of debt one goes into for an acupuncture master's that the degree probably should be a doctorate like that of the physical therapists and chiropractors. It puts our degree on level with them and removes some of the patronizing they do in our direction because we "only" have a master's degree.

Dry needling and other scope infringement: this has been a favorite rant of mine for a hot minute so you can skim if you've heard it before. It bothered me for a while that Chiropractors, PTs and massage therapists all do cupping and gua sha (but some call it Graston- because white people still be out here playing Christopher Columbus like he wasn't a monster or think that something is more scientific when you take a traditional practice and name it after yourself- also looking at you Gaskin). Eventually, I kind of got over that because I thought "well at least we've still got needles." Well now the dry needling has pretty much taken over and while we're arguing about both who owns the needle and who wields it better there's very real patient risk being played with and experiences with acupuncture needles being ruined by folks that not only don't do what we do but are TRYING to do what we do. One colleague recently pointed out that in the dry needling PT groups, they're all trying to learn traditional chinese medicine and work completely out of scope on issues that have nothing to do with muscles. Not only retaining needles but needling points nowhere near the motor points they're supposed to stick to. So often, I'll come across an article about someone causing a pneumothorax and it's some dry needling PT down in NYC but they call that person an unlicensed acupuncturist... sorry no we don't claim them. The safety issue is real and I don't think it's overblown in the least. 30 hours of education and no supervision for needling is absolutely insane to me but yet somehow these things get passed in legislation. The physical therapists have real money and real lobbies working for them. Most acupuncturists are broke, burnt out and working for themselves by themselves. Our collective organizations failed us long ago when they didn't take enough issue to really try and stop this from becoming an epidemic. Now we're trying to do damage control but it is largely too late and that's not to say to give up that's to say the strategy has to change drastically when something is well under way. We saw that with the literal pandemic not long ago.

Failure to meaningfully integrate into the healthcare system: Perhaps this is announcing my own bias going in however I want to bring up an anecdote about chiropractors without disparaging a profession I actually collaborate with quite a bit. There was a time when the Chiropractors and Osteopaths were one profession but the Chiropractors branched off on the premise that they believed that all disease can be addressed by manipulating the spine. By limiting themselves to this one technique and belief they, in essence, removed themselves from the mainstream healthcare sphere and limited their scope in so doing. In contrast, Osteopaths now make up around 25% or so of the medical providers within the mainstream healthcare system. They learn spinal manipulation however they also learn holistic and biomedical healthcare and have prescribing privileges just like MDs and NPs. I know for a fact that Chiropractors don't limit themselves to just the spine any more- they do make supplement recommendations and can order some limited imaging but their scope is a fraction of what the Osteopath is. I think in this way, acupuncture is kind of like chiropractic. It's hard to get insurance to provide coverage for acupuncture. It's a little bit easier to get them to cover chiropractic and then when it comes to the rest of healthcare often easier still except of course that the health insurance game is also rigged and working exactly as it is now designed to- taking your money without providing the service you paid for (I digress). I do feel that by resigning ourselves to just trying to protect our needle rights misses the point entirely. We don't have to reinvent the wheel either- we can see clear examples, especially in China where acupuncture is so integrated into their healthcare system that you can get acupuncture in the hospital if you would like it. There are some limited examples of this: I've got credentialing to perform in-patient services specifically in labor and delivery at both Strong and Highland hospitals however this is a private pay situation and as a result, makes the services harder to access for those who might actually use them. Acupuncture is integrated in some ways in the VA system and there are pros and cons to that arrangement as well. The problem is that if we don't find a way to make actual jobs in acupuncture available, especially for those who don't want to own their own business, it will largely remain either a luxury health service or community style. I also take issue with how insurance billing and codes work for acupuncture because it's clear whoever wrote all the policy regarding pulling out and placing new needles every 15 minutes has never actually had acupuncture or practiced it (I digress again). If we don't find ourselves a seat at the table, we don't get consulted on the very rules that we are then subjected to. No one is going to pull us up a chair- we need to proactively change the landscape ourselves. No one is coming to save us. We're the protagonist here!

Failure to meaningfully agree: Yeah, I said it I'm calling out everyone for being out here with all their differing opinions and arguing about everything instead of picking their battles and actually working in solidarity. I said what I said. Some wanted to work towards getting the ability to bill medicare, which is what the rest of insurance billing is based on. It would have been a wonderfully productive step with carveouts for those of us who don't want to bill medicare. Then all the naysayers with private practices that don't bill insurance chimed in and said "nah" and that insurance billing is for the fishes. Well yeah, I don't bill insurance either but how are we going to protect access to the medicine if swaths of us are leaving the profession within a handful of years because we're burnt out and can't make a living? I'm aware insurance reimbursement is a whole other issue but that's a problem that is easier to address once the issue of being able to bill them in the first place is addressed. Some of y'all don't know how to prioritize and it's not even the ones with ADHD who struggle with it more supposedly than those without it. Things like this are part of why we can't seem to work together on a bigger marketing campaign to fight the onslaught of dryneedling or raise awareness about what acupuncture can help with or any number of other initiatives to help each other. Part of that is capitalism working as intended. After all, that rugged individualism has us all feeling like our own islands. That's not an excuse people- humans are a species that evolved in community and community is how we get through this!

So... what do we do to meaningfully navigate this labyrinth? Can the profession survive all the strikes and challenges against it? I'd suggest that perhaps in accordance with that last point- failure to meaningfully agree- that maybe we all agree to a multi-pronged strategy designed to address different aspects and challenges and that each of the acupuncturists among us pick something we agree with to work on! You see, we can all probably agree that we love acupuncture and don't want to see the profession we have poured our hearts and souls into to crumble beneath us and that I think is the one unifying factor we can all rally around. I would love to see something productive actually come out of the discussions in the groups rather than just talk and substacks and blog posts and podcasts. I would love to see us all come together and save the profession that saved me. I think we owe it that much. And yeah, it might not look exactly as it does right now- but that would be a good thing!