Has CAN figured out how to place acupuncture in the mainstream?

May 18, 2010

The Community Acupuncture Network: Grass Roots Needling Therapy
The marriage of working class politics and acupuncture might on the face of it seem an unlikely match. After all, working class politics and grass roots organization conjures images of class struggle, marching in the streetsCANlogoWEB.jpg and fighting for one or another form of liberation. Images of acupuncture could not be further afield: meditative contemplation, pursuit of harmony and balance with a strong dose of zen references and the ubiquitous Taijitu (yin-yang) symbol. Of course, pursuing balance in Chinese philosophy involves resolving conflicts…and this is where CAN defines its own qi.
Lisa Rohleder is the Founder of the Working Class Acupuncture (WCA) Clinic in Portland, Oregon. She is also one of the founders of CAN, the Community Acupuncture Network which has become a national and international network of private clinics that adhere to the specific CAN principles: group treatment spaces, sliding fee scale not to exceed $40 per visit or $15 for the initial visit, and the clinic must be open a minimum 3 days a week.
These principles differ greatly from positions taken by the national professional organization – AAAOM – on the same issues. In fact they differ greatly from probably every healthcare profession that is profit-based. This is an important distinction because it forecasts the growing healthcare reform movement where the single-payer model will establish flat rate fees for providers. It is highly unlikely anyone will see $15 flat rate fees for an initial appointment with a physician. In fact, the initial visit is usually more costly than the standard follow-up.
How can CAN set the fee so low? Don’t they know how they are damaging the acupuncture profession by limiting the ability of providers to earn a living?
Setting a fee at $15 is the flash point for sending a message to the entire profession, in particular the leadership of the acupuncture establishment. Much is out of balance within acupuncture. It is time to support the providers and patients by radically increasing access which in turn radically impacts income. A $15 fee on a scale that tops at $40 puts treatment within reach for many “working class” folks. And it gives licensed acupuncturists that have given up a chance to go to work in their chosen field.
Unemployment and under-employment in acupuncture is no longer a secret. The word is out as the most recent survey by the national certification body – the NCCAOM – has found that half the licensees (LAcs) are working less than full-time and 70% gross less than $60,000 annually (pg 19). These already grim findings are carefully reported so as to conceal what is likely the even more grim truth; a substantial number of LAcs have left the field because they are unable to work at all.
CANempireWEB.jpgCAN is the only organization that seems to offer a solution with their cash and carry model. Many LAcs who find their way past the vilification CAN suffers from the “establishment”, and are not ready to give up, adopt the CAN model. While their success is anecdotal their gross numbers are impressive. CAN boasts 162 clinics and ~1,000 individual members. Pretty good for an a decentralized start-up group. By comparison AAAOM counts ~3,000 members.
If the fight was to win recognition and endorsement by the acupuncture leadership then CAN would be fighting an uphill battle. However, this is not the case. CAN’s fight is to win the hearts and minds of LAcs disenchanted with AOM leadership. And CAN may be winning this battle on the ground, if not yet in the media.
Which brings me back to acupuncture stereotypes.
A May 1, 2010 article in the New York Times titled “Acupuncture is Popular, But You’ll Need to Pay” would seem to be a huge endorsement of the CAN model where fees have been brought down to street level. Unfortunately, it actually damaged CAN by reinforcing acupuncture stereotypes which CAN seeks to undo.
After the writer glided through the research supporting clinical effectiveness of acupuncture including osteoarthritis, depression during pregnancy, and chronic headaches she began to describe fees that begin at $65 and can hit $120. She noted how the general absence of insurance coverage helped impede access to care. She closed by suggesting options and specifically referencing the CAN model and their extremely friendly low fees. Then she made an about face.

“If your problem is not serious or complicated — say you are suffering from stress or headache pain — consider visiting a community acupuncture setting, where fees can be as low as $15 a session. You receive a brief assessment and then are treated, fully clothed, in an open room with other patients. It is the acupuncture equivalent of a chair massage.”

The suggestion is that acupuncture in a CAN clinic is not “serious”….because the fee is too low…or because you did not change out of your clothes…or because you are sitting in a chair when poked. This is too bad. Of course, there is no research that associates fees or wearing a gown or lying on a table with treatment effects. The writer’s sudden and illogical switch can only be attributed to not checking with CAN first and more likely consulting with someone outside CAN for “insight”.
There are numerous issues with the acupuncture profession that inadvertently support this kind of misinformation. I have addressed some of these issues in a forthcoming publication titled Mainstreaming Acupuncture: Barriers and Solutions in the CAM journal Complementary Health Practice Review.
The irony is that the NYT article complains about how fees obstruct access to acupuncture treatment and correctly points out that CAN offers the only model in this country that seeks to immediately address this barrier to access to care. Maybe the old marketing axiom that bad publicity is better than no publicity will hold true.
CAN makes their model available to LAcs willing to embrace the three basic principles: treat in groups, keep the fee unquestionably affordable, and open your doors at least 3 days a week. The CAN model is definitely disruptive to the other model which is to think of LAcs as MDs who practice a medicine cloaked in mystery that cannot be understood by anyone except the provider.
As Richard Dawkins has said “”There is no alternative medicine. There is only medicine that works and medicine that doesn’t work.”
Acupuncture is a medical treatment works well for certain conditions such as pain. The CAN movement makes acupuncture affordable.

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