The winds of change have turned into a nor’eastern. The signs that we have entered a new era for this profession are easy to see if we look. Begin with the decline in the number of acupuncture training programs. The federal Gainful Employment Guideline

s have put the squeeze on all for-profit vocational education programs which are unable to show graduates are able to earn a living and pay off their student loans. Since at least half of all acupuncture schools are for-profit, and no schools of which I am aware collect data on graduate employment, these schools will be forced to shutter over the next three years. This is not a surprise for the schools. I attended a meeting in March this year hosted by the Council of Colleges (trade association for the acu schools). In that meeting the President of ACAOM predicted half of all AOM schools would be closed in three years, the result of enforcement under the Gainful Employment guidelines.

What does this have to do with mainstreaming acupuncture? Mainstreaming is the establishment of acupuncture in the medical mainstream; alongside physical therapists, physician assistants, nurses, physicians, etc. The schools have historically emphasized training around TCM, paying less attention on what might be the role of LAcs as a part of mainstream medicine. Graduates have almost no practical experience of what it means to work in the mainstream. This would include having had clinical experience in mainstream settings and learned how to bill insurance. How do we know this? The latest data show approximately 80% of LAcs work in a solo practice. Fewer than half bill insurance. No more than 5% work in a mainstream setting such as a community clinic, physician practice or hospital. The more pressure that is placed on schools to track work outcomes for their graduates, the more likely some of the schools (perhaps the non-profits) will begin to spend much more time preparing LAcs to work in the mainstream.

The mainstream argument often elicits a protective response along the lines of protecting Chinese medicine principles. The two traditions – mainstream versus TCM – are NOT inseparable, forever linked like twins from the same egg. Allegiance to Chinese medicine does NOT come with a commitment to oppose mainstream medicine. The self-appointed philosophers who advance this doomsday argument are dwindling in numbers and followers. Although I do not really know, I believe that working in the mainstream is not an issue for many of our Guild members who are avowed LAcs happy to bill insurance and write proper progress notes. I am aware at least some of our members work closely with physicians and other professions who routinely participate in the mainstream medicine.

In conversation with a physician who refers to qualified LAcs I explored this subject; is it possible for an LAc to work in the mainstream and still practice according to Chinese medicine principles? Her reply (paraphrasing) was “I passed the medical licensing exam. My license permits me to do anything medical. But I do not practice anything. I practice according to my strengths and interests and I stay within my scope. I have been interested in herbs and nutriceuticals for a long time. I refer to LAcs who I believe share my interest and know how to use herbs cautiously. Once the patient is in my office I practice according to what I know and believe. But I never lose sight of what is best medically for my patients.”

These are the facts.