Four Stages and the Acupocalypse, Pt 2

Published in on Feb 16, 2023

Okay, on to Stage 2: Independence-- personal leadership. Central activity: independent contributor. “Colleague”

I first encountered the Four Stages model not in its original form but in another leadership development book, The Extraordinary Leader: Turning Good Managers into Great Leaders, by John H Zenger and Joseph Folkman. (This was during a period of time where I read anything about leadership development that I could check out of the library as well as any book that anyone suggested to me; one of the things I learned was that there are hundreds of good, inspirational books about leadership that are of no practical use to POCA Tech at all.) An early edition of The Extraordinary Leader spelled out the Four Stages model in voluminous detail, and I thought it was the best thing I’d ever seen. Here are some excerpts of how they describe Stage 2:

“These people work autonomously and produce results but may not look beyond their own job. A person at this level:

demonstrates the ability to solve problems in situations of uncertainty and ambiguity; creates new opportunities for themselves by overcoming obstacles or rethinking situations; can be counted on to get work done and bounce back from setbacks without close supervision; deals effectively with people to get work accomplished; helps others find their own answers instead of telling them what to do; offers constructive challenges and alternatives; is quick to recognize situations where change is needed; adjusts work objectives, activities and tasks to align for needed change; thinks beyond the day to day to take a longer term view of the business; understands how their work relates to the organization’s overall strategy”

Nice and specific, right?

Part of POCA Tech’s mission is dictated by ACAHM, as it is for all acupuncture schools:“The statement of purpose for the program must include reference to the training of acupuncture professionals with the ability to practice as independent health care providers in a variety of settings.” Standard 1, Criterion 1.02

So the description from Folkman and Zenger of Stage 2 is a neat match for the kind of work we want our students to be able to do as clinicians by the time they graduate. A huge part of training acupuncturists is creating the conditions in which they can develop good clinical judgment so they can function independently in a variety of situations, especially in relationship to safety issues. It’s not that they can never ask anybody for help once they’re licensed, but it is our job to prepare them to make good decisions on their own, in potentially stressful situations involving patients. For gory details, check out the posts filed under "Incidents".

I’m going to take a short detour here into a misunderstanding some L.Acs have about community acupuncture, because I think it demonstrates how confused a lot of acupuncturists are about very basic elements of practice and business management. It’s not that these elements are particularly difficult to understand, they’re just stuff that acupuncturists don’t like paying attention to (which might prove fatal to the acupuncture profession as a whole).

I’ve been in a few situations where I was VERY surprised to discover that some otherwise VERY smart and knowledgeable people believed that POCA Tech graduates get an acupuncture license that’s different from a standard acupuncture license -- in other words, they seem to believe that POCA Tech grads aren’t full-fledged L.Acs or independent healthcare providers. I’ve heard the words “POCA license” spoken as if it were a thing and folks, IT IS NOT A THING. Tiered licensing might be a little complicated but it’s not that complicated, it mostly has to do with how a state regulates Chinese herbal medicine -- not acupuncture itself. POCA Tech graduates have received licenses in nineteen states, and believe me, none of those states enacted a special category of acupuncture licenses just for them because they attended a school that some L.Acs look down on.

Somewhere somebody got the idea that L.Acs who practice community acupuncture need to be supervised by L.Acs who have a doctoral degree and not only is that not a law anywhere, it’s completely absurd from an economic perspective. The whole point of the community acupuncture model is to lower barriers and reduce costs to patients. It’s a balancing act to keep L.Acs on the payroll as W-2 employees based on charging patients what they can afford to pay -- how could we possibly compensate doctoral-level supervisors in addition to the staff who are actually doing the treatments? Not just what the doctors might feel they deserve to be paid for their fancy degree, but literally anything at all?

Please remember that point about not being able to pay supervisors, it’ll be important when we get to Stage 3 (local leadership). But for now, I want to flag the magical thinking aspect of this particular misunderstanding. Some acupuncturists who believe community acupuncture is inferior to conventional acupuncture made the leap to thinking that licensing laws must reflect their opinions, with absolutely no facts to back that up. I blame the myth of the scholar physician with a hospital job; once you believe in that, you can believe in all kinds of other fantasies.

Anyway, getting back to Folkman and Zenger’s take on Stage 2, I realized that their definition describes a self employed person in addition to an independent health care provider. To be an entrepreneur, you have to get yourself into Stage 2, where you’re able to create opportunities for yourself as opposed to waiting for someone else to create them for you. And guiding people into the Stage 2 entrepreneurial mindset doesn’t happen automatically, it takes intention and effort. A lot of acupuncture students start out with the unfounded belief that there must be more ready-built structures for them to plug into as acupuncturists than there actually are, and they’re not exactly happy about accepting the responsibilities that come with entrepreneurship.

It’s common for acupuncturists to suggest that acupuncture schools should teach more business and practice management. I wouldn’t necessarily disagree with that, but teaching skills without being clear about the level of self-leadership needed to enact them isn’t helpful. A person at Stage 1 who took fantastic classes in marketing, bookkeeping and acupuncture business management but who can’t put any of it into practice without supervision isn’t going to be able to run a small business. It’s not about what you know, it’s about what you’re able to motivate yourself to do.

Of course Dalton et al weren’t writing about the Four Stages for self employed people, they were writing for people working in big corporations -- and maybe the most important point here is that for the most part, we don’t have those in the acupuncture profession. There aren’t job fairs at acupuncture schools where big employers show up eager to recruit new graduates, in part because the acupuncture profession hasn’t produced very many businesses that can employ anyone besides their owners. The NCCAOM and the ASA think that Medicare inclusion will cause big employers to appear with jobs in hand just in time to pull the acupuncture profession out of its downward spiral. I’m actually really curious how many people who believe that Medicare inclusion will save the profession have actually tried, themselves, to create jobs for acupuncturists. (If that’s you, seriously, please get in touch!)

The freedom and individuality of Stage 2 is what many acupuncturists want most; Stage 2 is all about doing your own thing, and doing it well. The positive aspects of Stage 2 are autonomy, competence, entrepreneurship, being able to build your own world. I had no entrepreneurship in my background until I became an acupuncturist and being a small business owner is, hands down, one of the best things I've ever done for myself. That level of empowerment was life changing. I had no idea I could lead myself in a Stage 2 way until I did it, and that self-sufficiency was an amazing experience.

(A side note: I’ve noticed that some people who are unhappy with their work are sort of stuck halfway out of Stage 1 but not yet in Stage 2. They don’t want anyone to tell them what to do, but they’re unwilling to accept the kind of responsibility that would allow them to have the autonomy they need. Sometimes it’s about risk aversion, which is another reason it’s important to talk openly about risk.)

The negative aspects of Stage 2 are also all about doing your own thing, as anybody who has tried to work with acupuncturists can attest. Stage 2 is where you find divas and silos, where nobody communicates or reaches out, where individuals don’t look beyond their own jobs and their own immediate interests to the point that it’s incredibly hard to get anything done. The fragmentation of the acupuncture profession is in part about a bunch of people at Stage 2 who want personal freedom more than they want anything else, and as a result, there’s an inability for acupuncturists to come to consensus about minor details, let alone big problems. This is something that the ASA and I would probably agree on.

The acupuncture profession has an infrastructure problem. People at Stage 2 won’t put any energy into infrastructure if it doesn’t directly benefit them in the short term, because they don’t look beyond their own jobs. Lots of L.Acs don’t care whether L.Acs become extinct as long as the acupocalypse doesn’t affect their own practice in the next few years (and they might even be happy about the lack of competition). The infrastructure required to create future generations of L.Acs is mostly invisible to them, so they won’t put any effort into saving it. To avoid the acupocalypse, enough people would have to pay attention to what lies beyond Stage 2 to do the kind of organizational and leadership work most acupuncturists aren’t interested in doing. It might seem basic, but there’s nothing more fundamental, when it comes to business, than what people are willing to pay attention to.

Next up: Stage 3 and the Acupocalypse.