Your Mom Doesn't Work Here

Published in on Jan 30, 2023

According to the NCCAOM and the ASA, the acupuncture profession is in crisis. So what do we do now?

To reiterate, “we” means people who care about the future of acupuncture as an independent occupation (the L.Ac) for some practical, non-ideological reason. That means you want or need to hire L.Acs, your business depends on L.Acs in some way, you want to retire and hand off your clinic to a new L.Ac someday, or you care about patients having access to acupuncture treatment outside of the pharmaceutical/insurance/healthcare industrial complex. If that’s not you? You (probably) don’t have to worry.

The NCCAOM’s and the ASA’s answer is: try to get legislation passed that requires Medicare to cover acupuncture performed by L.Acs, and everything else will (magically) fall into place. My answer is really different, and it requires some substantial background, so if you’ve got the stomach for that, keep reading.

First, some background about this blog. Acu Safety Nerd is a significant way we communicate with POCA Tech people and POCA Tech-adjacent people: students, faculty, Board members, volunteers and donors. One way or another, POCA Tech is connected to a lot of people who want to hire L.Acs, whose businesses depend on L.Acs, and who care about patients having access to treatment. The idea that L.Acs may be in the process of becoming extinct is a big concept for all of us to wrap our minds around.

Acu Safety Nerd grew out of POCA Tech’s response to the pandemic. A lot of people speculated, worried, or hoped that COVID would kill community acupuncture. So yes, COVID was a serious reckoning. One of our Board members describes COVID as a stress test -- that we passed. This blog was part of how we passed. The looming acupocalypse is another stress test for our little school, goes, let’s do it again.

Early on in the pandemic, a student asked the POCA Tech administration, “How are you going to keep us safe?” That’s a big, fascinating, provocative question and I thought about it a lot. The more I thought about it, the more it opened up a rabbit hole, like the rabbit hole in Alice in Wonderland, or maybe like the tunnel in the movie Coraline.

(Side note: my clinic treated a lot of the animators at Laika while they were making this film, including the people who built the tunnel and the mouse circus, they were all lovely people with neck pain, and one of the highlights for me of being an L.Ac, ever, was treating the people who made the mouse circus.) Anyway! This question about safety led to places I never expected to go, including the topic of leadership development and also an old, seemingly dry and boring article called "The Four Stages of Professional Careers" that transformed the way I look at my problems.

Before we talk about the concepts in that article, and how I think they apply to surviving the acupocalypse, let me talk about my problems (briefly, I promise):

It’s shockingly difficult to maintain any kind of acupuncture organization. Membership organizations for acupuncturists are especially hard (Elaine Wolf Komarow has written extensively about this, for example please see: but really her whole blog is about that). Acupuncture schools are pretty awful in their own right, though in a slightly different way, ask me how I know. I do think part of the awfulness can be traced back to the acupuncture profession’s history as Tyler Phan describes it -- it’s not like there was ever a healthy foundation.

Setting that history aside for the moment, though, I’ve observed that acupuncturists (at least in the US) have a lot of trouble navigating the tension between autonomy and security. We struggle to understand the tradeoffs between the two, and this can result in a weird, tortured, destructive relationship with organizations. Acupuncturists want all the advantages of belonging but they also don’t want anybody to tell them what to do, ever. I’ve been on all sides of this dynamic myself, so no judgement.

The myth of the scholar physician with a hospital job is actually a great example. Acupuncturists are not good at recognizing real world limits. We believe it’s possible that we could get to practice our “complete system of medicine” entirely in the way that we define it and on our own terms (autonomy) under the benevolent umbrella of the healthcare system (lol) which will value us and pay us well (security) and of course be grateful to us for bestowing our enlightenment upon it (also lol). We believe it’s reasonable to have a relationship with organizations, our own and other people’s, where we offer nothing other than criticism and demands while receiving all the support we want in exactly the ways that we want. And we really, really, really do not want to dirty our hands with things like building or maintaining infrastructure. We became acupuncturists because we found something we thought was interesting (acupuncture medicine! so interesting!) and we genuinely believe that somebody else will take care of all the boring parts behind the scenes and ask for nothing in return.

This plays out in the acupuncture profession’s bizarre relationship to safety issues and safety data, in the way we want to talk about safety only when it might be a useful weapon (at which point we want to scream at the top of our lungs about it) or when we want to take pleasure in judging other people’s mistakes. During COVID was when it began to dawn on me that POCA Tech needed to do something extremely different than anything I’d ever seen in relationship to acupuncture safety. The question “how are you going to keep us safe?” isn’t the question we want to train our students to ask of anyone. What we want is for our students to ask themselves, “how can I participate in creating more safety for everyone, myself included?” because once they graduate and are responsible for a clinic, creating safety for everyone will be their job. If they’re expecting someone else to do it for them at that point they’ll have a big problem, and if we allowed them to get all the way through school with that expectation, then it’s pretty much our fault.

Advocating for ourselves is important, sure. But the problem is that advocating for ourselves is all that most acupuncturists want to do ever. We don’t want to make things for ourselves, we want everyone else to make things for us -- to our exact specifications, naturally (and we have high standards!) So the crisis in the acupuncture profession is I think a natural consequence of our twisted love-hate relationship with organizations and infrastructure. Most acupuncturists do not want to pay attention to the structures that allow them to be an L.Ac -- so what a surprise, those structures might go away.

My friends (and also my not-friends, for anybody hate-reading this, hi!) there’s no point in mounting a coordinated effort to survive the acupocalypse if that effort is only going to get torn apart from the inside by acupuncturists themselves. My answer to the question of what do we do now is not, “scramble to try and clean up this mess while everybody yells and throws rocks at us”. I have better things to do and I bet you do too.

At POCA Tech we realized that if we wanted to survive COVID, we had to get very, very specific with our students (and faculty and staff and volunteers) about what we wanted them to do and what we didn’t want them to do, and so far (fingers crossed!) it’s working. I don’t know if it will also work for addressing the acupocalypse, but I am sure that we need to get very specific about the problem before we attempt to start building anything that resembles a solution.