More about chiropractors and acupuncture

So here's the deal:

When I started all the hubbub about chiropractors practicing acupuncture with only 300 hours training and the pending rule being proposed by the Texas Board of Chiropractor Examiners that would recognize acupuncture as an area of chiropractic specialization with this minimal level of training, I mis-spoke. I got lost in the alphabet soup of chiropractic agencies alien to me and I mis-spoke.


Turns out I was looking at the website of the American Board of Chiropractic Acupuncture, which does indeed require 300 hours to sit for their exam, but the standard referenced in the already adopted 2009 rule and currently proposed Chiropractic Board rule is actually that of the National Board of Chiropractor Examiners acupuncture exam which REQUIRES ONLY ONE HUNDRED HOURS TRAINING! 

I knew this already because I was around when the 100 hour rule went down, but I think on some level as I reread that rule some three years later I wanted to believe there was some kind of attempt at standards that were somewhat reality based. I was wrong.

So as the rules (as of 2009) read and as they are proposed regarding chiropractors practicing acupuncture in Texas, a chiropractor can practice with 100 hours training  (NBCE standards) or around 1500 hours (NCCAOM standards) of training. Which do you think they will choose?

This current proposed rule seeks to recognize as "specialists" chiropractors who opt for the minimal 100 hour training requirement. This begs the question: Is the Chiropractic Board a regulating body or a booster club for chiropractors?

Here's an example of why I have a problem with the co-opting of acupuncture by these jokers. This is from the website of a guy in Austin who apparently has some 30 chiropractors in his family, which if you think about it is in itself just a little bit weird...

"Are chiropractic spinal adjusting treatments necessary with acupuncture?

- Absolutely. Spinal adjustments are part of the acupuncture health care...
Leaving the chiropractic adjustment out of the treatment plan invites failure."

Sorry folks, but this is simply a bunch of bullshit. Spinal adjustments are not part of "the acupuncture healthcare". And this from a guy who "primarily uses needle-less electrical stimulation" but calls it acupuncture. Needle-less electrical stimulation IS NOT ACUPUNCTURE.

This is what pisses me off - the total misrepresentation of what acupuncture is by guys from Iowa in suites.

Chiropractic Acupuncture Specialists

So here we have the Texas chiropractic board proposing rules to allow chiropractors to call themselves Acupuncture specialists if they receive a whopping 300 hours of training and take a test. Specialists...really?

Texas Register

TITLE 22	EXAMINING BOARDS
PART 3	TEXAS BOARD OF CHIROPRACTIC EXAMINERS
CHAPTER 71	APPLICATIONS AND APPLICANTS
RULE §71.15	Recognized Specialties
ISSUE	02/17/2012
ACTION	Proposed

Preamble

Texas Admin Code Rule

(a)The following chiropractic specialties have been approved by the board:

Acupuncture.     (A)Requirements:       (i)Diplomate in Acupuncture from a recognized CCE-accredited institution/post-graduate entity; or       (ii)Three hundred hours of instruction conducted under the auspices of and taught by the post-graduate faculty of a CCE-accredited institution.     (B)Continuing education requirements: Three hours of continuing education in clean needle technique acupuncture every five years. These hours may be counted as part of the total continuing education hours required each year by the board. The hours must be obtained from board-approved continuing education courses. (b)Licensees must submit proof of eligibility to the board prior to recognition as a chiropractic specialist in any of the fields listed in subsection (a) of this section. Licensees are prohibited from referring to themselves as specialists without approval from the board.
This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on January 31, 2012 TRD-201200463
Yvette Yarbrough
Executive Director
Texas Board of Chiropractic Examiners
Earliest possible date of adoption: March 18, 2012
For further information, please call: (512) 305-6716

Community Acupuncture is Integrative Medicine

I came across a story highlighting a recent survey of integrative medicine centers in the U.S. “One of the most striking, though perhaps predictable, conclusions of this study is that integrative medicine is, in fact, integrative. It integrates conventional care with non-conventional or non-Western therapies; ancient healing wisdom with modern science; and the whole person — mind, body, and spirit in the context of community” (italics mine). What communities are they talking about?

Its highlight, and self-fulfilling, statement: “Integrative medicine is now an established part of healthcare in the United States.” An established part of healthcare based upon a survey of 29 integrative medical centers. Twenty-nine? That's not even one for every state. It seems to me that they are missing some communities. (In all fairness, they were able to identify 60 integrative centers nationwide, but only surveyed 29.)

It made me recall a book that a friend gave to me: We've Had a Hundred Years of Psychotherapy...And the World's Getting Worse. It's co-authored by James Hillman and Michael Ventura. (Ventura currently writes a bi-weekly column called Letters @ 3am that appears in the Austin Chronicle.) The book is a collection of dialogues—conversations, letters and phone calls—that look into the role of therapy. Right off the bat Hillman points out that we are ignoring the impact the environment has on us: “By removing the soul from the world and not recognizing that the soul is also in the world, psychotherapy can't do its job anymore. The buildings are sick, the institutions are sick, the banking system's sick, the schools, the streets—the sickness is out there.” Ventura takes it a step further and says, “Our inner knowledge has gotten more subtle while our ability to deal with the world around us has [...d]istnegrated.”

Disintegrated? Sounds like we need something that's integrative. And so these integrative medicine centers have been popping up and trying to re-establish the foundation of modern healthcare: take our technological breakthroughs in Western medicine, which look at the individual as a machine made up of discrete parts, throw in a dash of “ancient healing wisdom” that knows that the whole is more than the sum of the parts, and voila: ideal healthcare.

Integrative medicine centers are more “patient-centered” and address the “full range” of health issues, because it sounds like that is one of the big missing variables that will help fix the healthcare boondoggle—or at least make those who can afford the doggle happier. But these centers are palaces, generally slick and high-dollar. What community is that in the context of? I look and see that the “regular per session cost is between $115-$124” for acupuncture at one of these centers. That range is so small you should just say it costs $124, you’d save it in employee time wasted on explaining who is at the high end and who is at the low end.

But my main point isn't even about dollars and cents. Practitioners can charge what they want to charge and if people are willing to pay it, then that's no fault of theirs. However, the survey also pointed out that “63% of patients seen are self-referred.” That means more than half the people who get treated with “alternative” or “complementary” therapies are initiating the search themselves—some of them from within that particular healthcare system itself and some who are just looking around for it and an integrative medicine center is all they can find or seems the most credible. “If I’m going to pay a lot of money for this, I’d rather go to a Center.” And that’s really the main point: integrative medicine centers are popping up because people want these alternative options. It’s a market. Something their communities have not had before.

Integrative medicine centers do some great things: they are more apt to be part of the cross-talk between mainstream medicine and alt-stream medicine; they conduct research on alternative therapies to try and examine what has essentially been learned through tradition; and they are on the front line for a lot of patients within the system who have decided their healthcare community is not providing everything their soul needs to be healthy. Yet, is that changing the healthcare environment enough?

I find that one of the great things about the community acupuncture set up is that it goes beyond the idea that a market is available and wants to re-integrate the idea of health with the environment—at least the immediate environment where you are getting care. We often admit here at South Austin Community Acupuncture that we have health concerns, and while we don't overtly talk about them all in front of one another, we do put the healing process in a more public setting—to me that gives soul to healthcare. Gone is the doctor's office waiting room where everyone avoids eye contact with everyone else, because you don't want to have anything to do with someone else's illness. From Hillman and Ventura: “The illnesses are your teachers...[d]evaluing the illnesses and suppressing them removes you from these figures.” And in real communities, illness is not isolated.

At the community acupuncture clinic, in the large treatment room we are all focused on wellness. It creates a web of relationships that is often missing from the health care system today. And that is probably why community acupuncture has exploded onto the scene over the past few years. When South Austin Community Acupuncture opened five years ago it was one of the first ten or so community acupuncture clinics in the entire country. Now there are 161 across the United States. That’s an incredible growth rate. It’s the kind of growth rate that speaks VOLUMES about the “context of community.” It also speaks volumes about the state of the acupuncture profession to create jobs, but that’s beside the point. Whether you come in with friends or strangers, you still find something in this community. And community is, as Ventura calls it, “simply the actual little system in which you are situated.”

-- and here's Ventura's column from earlier this year remembering his friend and collaborator, James Hillman

Fwd: Won’t Somebody Please Think of the Profession?!?

Here's a link to Lisa Rohleder's latest blog, this one on turf warfare and the acupuncture profession. I tried to link to it from Facebook, but the url kept getting lobbed off so you wouldn't be redirected to the actual blog, so here you go:

https://www.pocacoop.com/james-restons-appendix/post/wont-somebody-please-think-of-the-profession


Regarding turf warfare and acupuncture, in Texas it is a particularly sordid tale.

It was under cover of darkness one legislative session that the chiropractors got a hold of the acupuncture statute and changed the definition of acupuncture to suite their needs. Subsequently, then attorney general, John Cornin ruled acupuncture to be within the chiros scope of practice solely because they had stuck the words "non-incisive, non-surgical" into the definition. Jim Mattox had previously ruled that acupuncture was not within chiropractors' scope. So simply by jacking with the definition of acupuncture in an already lacking statute, chiropractors were able to freely practice acupuncture with absolutely no training requirements. This went on for some twelve years or so until finally a couple of years ago the Chiropractic Board ruled that 100 hours of training was sufficient.

So even if you don't give a damn about turf warfare, it's hard not to see the whole thing as slimy. My perspective on the chiropractic profession in Texas - which apparently is pretty well known for its aggressiveness and perpetual creep of scope - is definitely colored by having an understanding of how this all unfolded. On the whole, I hardly think the motivations for their glomming onto acupuncture were altruistic.

I can only wish we had a practice act like the fine folks in Oregon do (one of the first states to license acupuncture in the 70's), just for the sensibleness of it's language. Here in Texas acupuncture was not a licensed profession until 1992, and our practice act is just not very well worded.

The acupuncturists' last legislative effort in Texas, in which we were trying to add a couple of more things we could treat (stress, allergies) without the requirement of referral from a physician, actually got caught up in a fight between the medical doctors and the chiropractors over needle EMG, and was dead on arrival because one side or the other had inserted language into our bill they insisted must remain - none of which had anything to do with acupuncture.

So yeah, turf warfare is, um, really weird, and truth be told has little if anything to do with the day to day reality of how I practice. The backdrop of how things have unfolded in Texas is none the less particularly strange. You want to see an alternate reality? Go visit the capitol when the legislature is in session. I've been cornered by chiropractic lobbyists down there, it's a weird scene. It really does lead one to question what really is important? and what kind of a world are we trying to create anyway?

You see, with the community acupuncture model of practice, things that are just commonly accepted as the way it is are so turned on their heads that everything is changed. What we are doing is so outside those systems that it really does call into question much of the "conventional wisdom" around professions and exclusivity.

Community acupuncture clinics are choosing to step outside that paradigm altogether, and to do something completely different - to create entirely new systems that better serve us as acupuncturists, and most importantly better serve our patients. 

Instead of fighting for a piece of the pie (a mindset that fundamentally is one of scarcity) or a place at the table within disfunctional and broken systems, we're just gonna build our own table and bake our own pie, thank you very much.

The Dandelion Harvest, continued...

So this morning I embarked on the process of cleaning the many pounds of dandelion I harvested. This is cleaned dandelion on an improvised drying station (hey, I'm figuring this out as I go). I estimate this to be about 1/100 of what I collected! Called a couple of farms to see if they could help me get it all cleaned. Learned a little about their processes, but no takers...

The Dandelion Harvest

Yesterday I harvested dandelion (Pu Gong Ying) from my yard until my back hurt and my hands were sore and plant stained. It was a beautiful cool and drizzly day. I've been thinking a lot about sourcing plants locally, and trying to grow herbs and exploring what can be grown locally and regionally.  So here ya go...

Now to see if I can actually pull off cleaning and drying this stuff for future use here at South Austin Community Acupuncture.

A Letter to the Editor

The following is my response to a recent practice management article published in Acupuncture Today. I have emailed it to the editor, but given that Acupuncture Today is actually not the open forum they claim to be, I seriously doubt it will see the light of day. And so I am posting it here. This is the same publication that canned Lisa Rohleder of Working Class Acupuncture for her articles on community acupuncture and social entrepreneurism. Interestingly, Lisa was the only author in the history of the publication whose Acupuncture Today online talk back forum actually had any activity. Now the talk back forums are gone. 

Here’s my letter:

In the spirit of Acupuncture Today being “committed to bringing an open forum to the acupuncture profession” I’d like to make some comments about Lawrence Howard’s article, “Many Offices, Many Lessons”. While some of Mr. Howard’s observations offer valid insights into human nature, some represent – to me – a mindset that as healthcare providers we have an ethical duty to transcend.

I congratulate Mr. Howard on his 13^th anniversary of being a practitioner, but have to question the implications of working in more than 24 offices in 13 years. Is this accomplishment a result of the keen self awareness that ‘the likes of those he has worked for or with’ apparently lack? While bouncing around from clinic to clinic may offer a unique perspective, it is hardly a position from which to write about practice management with any authority.

I say this as someone who has been out of school about seven years and successfully owned and operated my own clinic for the last five years.

The notion that “through patient education, the practitioner encourages the patient to raise the dollar value they assign to their discomfort” is nothing short of absurd, and quite frankly morally reprehensible. Yes, Mr. Howard, some people have to “self discharge” because they can no longer afford treatment. Assigning greater value to ones discomfort unfortunately does not equate with greater means, or better outcomes.

And yes, sometimes fees do correlate with patient success. I see it all the time in my clinic, but based on my direct experience of 5 years and nearly 20,000 treatments given to date, it is not at all as you say it is.

How one structures their practice, whether insurance based or cash based, high cost or low cost, high volume or low volume, is a matter of personal preference. I have no issue with people charging whatever they want, however they want, for their services. But this idea that “high fees attract only the most committed patients and consequently have the highest chance of success, and thus referrals”  is one that needs to be put to rest once and for all.

High fees attract only patients that can afford to pay high fees, and sure, if someone can afford high fees they can probably afford to get as much acupuncture as they want or need. But patients are committed to treatment for all kinds of reasons, and people stop coming for treatment for all kinds of reasons, and treatments succeed or fail for all kinds of reasons. To attempt to correlate high fees with greater commitment, or greater success is false logic, and from my perspective seems to be nothing more than the musings of someone who hasn’t been in one place long enough to know any better.

From what I can tell people have a higher chance of success if they can afford treatment. It’s that simple. Likewise, people refer if they see good results. It has nothing to do with how much they pay. I know this to be true because I charge $15 - $35, have committed patients, get great results, and have a vast network of referrals.

Your $300 quit smoking example is a good one. I think people basically are going to do what they do regardless of what they pay, but again their chances of success are improved by their ability to access the medicine. For example I have a social worker on a very limited fixed income coming to me for the NADA protocol currently, which we charge $10 for (that's right, I charge $10 for about 20 cents worth of needles and a couple of minutes of my time). She was distressed because with frequent treatment her budget was being stretched at that price. I offered her treatment for $5 instead, and she’s doing great. At the end of the day will she stop smoking and stay stopped. Who knows? But at least she now has the same chance as someone paying $300 has.

I’m not saying everyone should charge less, or practice how I practice, but this notion that people who can’t afford high priced treatment need merely to be educated or more committed needs to stop.

Perhaps acupuncturists would be well served by focusing on their commitment to their patients instead of their patients' commitment to them.