Pretty much what we do everyday around here, minus the gongs and drums of course....
Read the story here
Saturday, April 21, 2012
Friday, February 17, 2012
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
Wednesday, February 1, 2012
The Dandelion Harvest, continued...
Tuesday, January 31, 2012
The Dandelion Harvest
Now to see if I can actually pull off cleaning and drying this stuff for future use here at South Austin Community Acupuncture.
Sunday, January 22, 2012
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 13th 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.
Comments on Wiki Qi
What follows are an AOMA students comments on my Wiki Qi blog, and my response to him. I'm re-posting as a blog because the way comments are formatted you can't easily see them. Here goes:
Dec 5, 2011 10:13 AM
Dear Wally,
I have read your blog in reaction to the “Wiki Qi group” at AOMA and I was surprised to read such strong opposition from a man who wants to make acupuncture more affordable to the community. I don’t know who our Wiki Qi group is but I felt it was a courageous step in addressing this increasing gap between loan distributions, education costs and costs of living. I would agree that some points could have been addressed differently. There was a great deal of passion present in that email as there is here in your blog. Opinions around finances in the world today are an increasingly tender spot , as making ends meet has become a little harder. This is why your service at South Austin Community Acupuncture is so important.
The student is the end of the chain when finances are tight. The teachers desire more money, the book authors desire more money, the administrators seek more money and so there is a need to increase profits yearly to keep this cycle going. But the government is not giving students more money and so what is left over to live with is getting smaller and smaller. The School (as you will recall) recommends that full time students do not work because of the demands of full time education. Therefore, many students, as you apparently did, take the full amount allowed. After purchasing books, supplies, rent, food, utilities, gas, etc there is not a lot of wiggle room and for some it will not even cover that much. Where are the students to come up with the financial backing for these increasing costs?
You point out that it’s only a 3% increase in several places in your blog as if it’s too small amount to fuss over and yet just recently UT students faced a 2.6 % increase and said enough is enough and it looks like the students have won. The school will come to the decision this week. All of these seemingly small increases are adding up. There are other places to cut costs. And this does not need to be a cut to teachers or staff but perhaps a freeze on income. If no one got a raise next year it might balance out. The staff then, as well as the students, would need to find a way to be more efficient. Student loan distributions have not had a raise in a while after all. When students get a raise, the financial award can get passed up the chain.
This would possibly have an effect on your girlfriend’s income, who is employed at AOMA and I have to wonder if this is why you are so incensed by the student movement as you are not entirely neutral to the effects this might have on you. We are all personally affected by these changes.
I respect Wiki Qi’s opinions and call to awareness and in fact I respect your opinions too Wally. I would add that both you and Wiki Qi could work a little on how your tone and choice of words may not be doing justice to the points which you are trying to make. If we can work through the oppositions we might come to some agreements.
Dec 5, 2011 10:13 AM
Dear Wally,
I have read your blog in reaction to the “Wiki Qi group” at AOMA and I was surprised to read such strong opposition from a man who wants to make acupuncture more affordable to the community. I don’t know who our Wiki Qi group is but I felt it was a courageous step in addressing this increasing gap between loan distributions, education costs and costs of living. I would agree that some points could have been addressed differently. There was a great deal of passion present in that email as there is here in your blog. Opinions around finances in the world today are an increasingly tender spot , as making ends meet has become a little harder. This is why your service at South Austin Community Acupuncture is so important.
The student is the end of the chain when finances are tight. The teachers desire more money, the book authors desire more money, the administrators seek more money and so there is a need to increase profits yearly to keep this cycle going. But the government is not giving students more money and so what is left over to live with is getting smaller and smaller. The School (as you will recall) recommends that full time students do not work because of the demands of full time education. Therefore, many students, as you apparently did, take the full amount allowed. After purchasing books, supplies, rent, food, utilities, gas, etc there is not a lot of wiggle room and for some it will not even cover that much. Where are the students to come up with the financial backing for these increasing costs?
You point out that it’s only a 3% increase in several places in your blog as if it’s too small amount to fuss over and yet just recently UT students faced a 2.6 % increase and said enough is enough and it looks like the students have won. The school will come to the decision this week. All of these seemingly small increases are adding up. There are other places to cut costs. And this does not need to be a cut to teachers or staff but perhaps a freeze on income. If no one got a raise next year it might balance out. The staff then, as well as the students, would need to find a way to be more efficient. Student loan distributions have not had a raise in a while after all. When students get a raise, the financial award can get passed up the chain.
This would possibly have an effect on your girlfriend’s income, who is employed at AOMA and I have to wonder if this is why you are so incensed by the student movement as you are not entirely neutral to the effects this might have on you. We are all personally affected by these changes.
I respect Wiki Qi’s opinions and call to awareness and in fact I respect your opinions too Wally. I would add that both you and Wiki Qi could work a little on how your tone and choice of words may not be doing justice to the points which you are trying to make. If we can work through the oppositions we might come to some agreements.
Jason McLay AOMA Student
And my response....
Jan 6, 2012 10:19 AM
Hi Jason,
Thanks for your input.
I actually thought that relative to some of the stuff Wiki Qi wrote what I said was pretty measured.
I spoke up about Wiki Qi’s email because I thought it was presumptuous and disrespectful to the point of just being dumb. Regarding some of the points you make:
First of all, you say that I “point out that it’s only a 3% increase in several places as if it’s too small amount to fuss over” when actually, not once was this the point I was making. My point was not to be dismissive of the amount or effect of the tuition increase, my point was to address Wiki Qi’s reaction to it - which was pretty over the top.
Having said that, I’m not sure what catalog you are under, but the 2011 – 2012 catalog states the following: “AOMA reserves the right to make tuition adjustments of 4-8% per year that reflect changes in the cost of living and cost of education, subject to governing board approval.” These are the terms you have agreed to by undertaking a program under a given catalog. So yeah, I guess you could say it was only 3%.
The overarching theme of Wiki Qi’s message seems to be that the AOMA administration is irresponsible and incompetent, and that the students bear the brunt for this. I don’t agree with this. I understand it’s hard financially to be a student, and there have been a lot of big changes at AOMA recently, but come on…
It's easy to write a bunch of reactive bs (anonymously no less) about the "school" and the "administration” as if you are writing about a thing rather than actual people. I don’t find it to be particularly courageous or constructive. For me the people that make up AOMA are my friends, colleagues, teachers, and yes – one is my girlfriend. And from what I can tell, they are a fairly capable bunch doing good work with a high level of integrity.
I don’t really know how to respond to your musings about my girlfriend’s income and my neutrality or lack thereof, other than to say yes, my girlfriend is the Director of Finance at AOMA, and no, cost cutting measures that affect her income do not make me angry. Otherwise you’re kind of into the realm of the hypothetical. I didn’t know about “the student movement” for instance.
Regarding your being “surprised to read such strong opposition from a man who wants to make acupuncture more affordable to the community”, I can’t say I follow your logic. I honestly don’t know that there is any correlation between the cost of treatment and the cost of education – if that’s what you are getting.
When I went to school, then president Jim Coombes pretty much made it clear that this was adult education, and that we needed to take responsibility for our choice to be there. He made it clear there were no guarantees of success and encouraged us to borrow as little as we could. So work part time if you need to. My girlfriend did the whole time she was in school.
The cost of education, and the state of acupuncture in the US are complicated issues and my thoughts and opinions about these topics don’t fit neatly into one camp or another. Nor do I see any easy solutions. While the disparity between the cost of an acupuncture degree and the earning power of that degree is a real issue for many, I don’t think acupuncture schools are out to screw you. And yes, if you borrow all the money you can you are going to graduate with a whole lot of debt and be entering a field where you are pretty much on your own. It is something to think about. Most people don’t really think about it I suspect.
Sunday, November 6, 2011
Wiki Qi...you've got a leak.
This will mean nothing to most people. But to those involved in the study of acupuncture and Oriental medicine and AOMA Graduate School of Integrative Medicine specifically, it might mean a little something.
What follows is an email distributed by an AOMA student recently in reaction to a 3% tuition increase.
My comments on this email are this....
I graduated from AOMA in 2004, and am up to my eyeballs in student load debt. I didn't have to not work while in school. I didn't have to borrow the full amount I could. I could have borrowed only the amount of tuition and I'd have about half as much debt. But that's not what I chose to do. I OWN that, and I don't whine about it.
And so, to "Wiki Qi" I say:
First, if you are so all about OWNERSHIP, then speak for yourself instead of hiding behind the moniker of "Wiki Qi" and claiming to represent anyone other than yourself. I guess there's safety in numbers, even if they are imaginary. Talk about transparency issues. If Wiki Qi actually represents numbers of students then say who you are. What are you afraid of? You state below in your ridiculous email that whistle blowers cannot be retaliated against. One could construe from your language that you are actually implying AOMA is corrupt and/or breaking the law. Seriously.
If your perspective is that AOMA is a business and you their customer, and you are not a happy customer - and your dollars are your only leverage - then TAKE YOUR BUSINESS SOMEWHERE ELSE.You seem to view education as a commodity. So go find the better deal. Or better yet, do something else entirely if this is so disagreeable to you.
Your attempt to draw parallels between a 3% tuition increase at an acupuncture school and what has gone on recently with the financial sector in this country is beyond absurd. "Acupuncture schools are flourishing"? What planet are you on? You think somebody's lining their pockets with your 3% tuition increase? You have no idea what you are talking about.
Get a clue, and put your efforts into actually learning something instead of trying to tear things down you don't even know anything about. Talk about arrogance and ignorance.
Here's the "private" email that was sent around:
From: Wiki Qi <wikiqimail@gmail.com>
Date: Thu, Nov 3, 2011 at 3:09 PM
Subject: Raised Tuition AGAIN?! Occupy AOMA! (Please read. This is YOUR education! Own ALL of it!)
To:
Occupy the Bank of AOMA?
The Bank of America was “bailed out” by the People -- the taxpayers -- and then it raised their fees as thanks. The public was incensed and protested. The bank recanted.
Does AOMA seem to be acting similarly by raising tuition again? Will they recant?
It seems there may be clear comparisons to protests all over the country and activities on campus: Arrogance and ignorance?
(Come speak your mind at the meetings this week! Follow each other and post your problems regarding this AOMA issue and others on Twitter: @wikiqi.)
Points of concern:
- Why did AOMA ‘build’ the school if they can’t afford it? Why should students “bailout” another poor administrative decision yet again?
- How has this new campus really benefited the student who, according to AOMA’s own numbers, will still be making only $20,000+ one year after graduating? (Typically an education this expensive yields higher rewards/income and such an institution typically offers you more assistance. We get little and the future is even declining. AOMA needs to be investing in ventures that benefit careers and reduce expenses, not just spending money on poor landscaping.)
- What other cost savings can be employed instead of using “bailouts” from students? Shouldn’t AOMA pay it’s “fair share?” Example: The recent website and branding re-launch was quoted conservatively as costing $30,000. Could we have used such funds more efficiently? Where else have we wasted money? (What about using some of those funds for online registration so we needn’t pay 7 staff members to write down schedules on paper and dry erase boards? Technology=reduced costs=benefit to students.)
- We are in a recession. We just lost subsidized loans. We had moving costs with the new campus. The dollar is devalued. The list goes on. Yet the AOMA administration frames the increase as if it is only a small percentage, when our overall costs have gone up and we have received many increases in total. That is a manipulative and short sighted portrayal. A key tactic in marketing: Get them to take a little bite at first, then you can cram more down their throat.
Facts and Questions:
- Acupuncture programs are flourishing, but their students are struggling -- and not just in the U.S. Is that a symptom or a disease? What is the root? Should we be getting charged more money for a diminishing return? Shouldn’t the market dictate that we adapt and not raise costs but lower them? It seems if you want to make money in acupuncture, you need to get into administration or teach, not practice. (If a person could be making more money not teaching, many would likely would not be teaching...)
- On average an AOMA graduate finishes with over $100,000 in debt yet will make just $20,000+ a year after graduating while a Family MD’s median payout for his/her doctorate is $150,000 yet he/she will be making on average $207,000. Granted, we knew this was not Wall Street and we like that! But should the disparity be growing and the schooling getting more expensive?
- The new school still lacks true quiet study space, a consolidated campus, more room, an improved clinic -- all the reasons they cited for moving! It is marginally more pleasant, and it benefits AOMA, the business, and their pursuit of a doctorate program that will pad their pocket books. But the true benefits to an studen are negligible and to a graduate, next to nothing.
- Academia functions like a business in a safe bubble. Much like “greedy” banks have TARP funds. Colleges get paid by Uncle Sam and have to adapt much less to the real economy of the real world. Businesses have been hurting everywhere and downsizing, but AOMA aims to grow and make more money off their private, monopolized market: The Students.
- Increased student jobs on campus are provided by the government more than AOMA and should lower AOMA costs for personnel and therefore tuition.
- AOMA has family and investors under it’s employment that benefit from such increases.
- AOMA constantly has administrative and transparency issues -- like not giving students loan money for months at a time!!! This is not acceptable in a school this expensive, much less an increase of those costs! Generally: You pay more, you get more. What do we get?
Bottom line: As students pursuing a career and a future we must be more vocal as customers in the present. We are indeed customers and our dollar is not only a vote, it is our only leverage!!
Are we getting what we paid for? Paid -- that is the key word.
The school holds all other cards. The one thing that balances is our identity as a customer -- and this identity position has been definitively defended in courts of the U.S. and 3 other countries, for both public and private institutions.
It is less about the reasons (and excuses) the school and the administration spout about costs and expenses. It is about their lack of responsibility. It is about their poor management and planning. It is about them placing the desperate needs of the educational institution and our careers as high on the priority list as their business and money making pursuits.
In the end, this is an acupuncture school and not Bank of America.
Maybe...
*This is a private letter from students to fellow students, initiated by Wiki Qi -- a student organization that meets outside of the school and thinks outside the box.
Thank you for your time. Good luck! This is a great profession!!! We have to speak up and own it.
References:
-YELP, Better Business Bureau, Federal Trade Commission = Since you are a customer and AOMA a business, you can complain here and retaliation is legally suspect if not an outright violation of the Consumer Protection Act and or Free Speech Act.
The same applies for most comments on social networks. There was even another case recently decided in favor of a student out of Florida.
- FAFSA, Texas State Board of Acupuncture Examiners, Texas Health Department = If you have complaints about the school or it’s finances or clinic practices, this is where to go. Retaliation is a legal violation of the Whistle Blower Act.
Note: It was recently defended in court that the Freedom of Information Act applies to colleges/universities. The defense stated that by cooperating and meeting regulatory requirements for federal financial assistance, such programs are, in so far as financial assistance is concerned at least, in effect arms of the government and subject to it’s laws and requirements.
If you want financial numbers, file a petition. They must comply.
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