The NCCAOM has put out a call for public comments on their Code of Ethics for the acupuncture profession. The Board of Directors of the POCA Technical Institute wishes to respond in a spirit of sincerity and in the hope of creating progress. If you support this letter to the NCCAOM, please sign this petition.

As adherents of Liberation Acupuncture, we believe that as health care practitioners we cannot ignore the role of structural violence in our patients’ lives and in our own. Paul Farmer et al, in the article Structural Violence and Clinical Medicine, define the term this way:

Structural violence, a term coined by Johan Galtung and by liberation theologians during the 1960s, describes social structures—economic, political, legal, religious, and cultural—that stop individuals, groups, and societies from reaching their full potential [57]. In its general usage, the word violence often conveys a physical image; however, according to Galtung, it is the “avoidable impairment of fundamental human needs or…the impairment of human life, which lowers the actual degree to which someone is able to meet their needs below that which would otherwise be possible” [58]. Structural violence is often embedded in longstanding “ubiquitous social structures, normalized by stable institutions and regular experience” [59]. Because they seem so ordinary in our ways of understanding the world, they appear almost invisible. Disparate access to resources, political power, education, health care, and legal standing are just a few examples. The idea of structural violence is linked very closely to social injustice and the social machinery of oppression [16].

Farmer adds: we also have to recognize that there is an enormous flaw in the dominant model of medical care: as long as medical services are sold as commodities, they will remain available only to those who can purchase them.

And so we must begin by acknowledging that we are confronted with an environment which makes an honest discussion of individual practitioner ethics at best difficult and at worst, meaningless.

There are a number of aspects of structural violence which affect the functioning of the acupuncture profession but the most egregious, with respect to a discussion of ethics, is the impossibly skewed ratio between what it costs to become an acupuncturist (schooling, NCCAOM credentialing, and licensing fees) and what an acupuncturist can expect to earn, according to the NCCAOM’s own research. Based on the 2013 Job Task Analysis, 42% of practitioners have gross incomes of less than $45,000 per year. An earlier JTA suggested that the majority of L.Acs, 60%, work part time, or less than 30 hours per week and of that 60%, about 45% earn less than $20K annually from their AOM activities. At the same time, it is now commonplace for new graduates to bear educational debt in excess of $100,000 -- and even as high as $200,000 and $300,000. Standard student loan calculators recommend that graduates would need a job with an annual salary of $138,000 to be able to pay off $100,000 in debt.

Very few jobs for acupuncturists exist at all, and we know of none whatsoever for new graduates that pay $138,000. The 2013 JTA suggested that acupuncturists who have been practicing for 10 years can earn a gross income of $52,000. Since 90% of acupuncturists are self-employed, most new graduates are facing the prospect of starting their own businesses when they are essentially crushed by debt. Naturally, many try to make this untenable situation work by charging as much as possible for their services, which makes acupuncture inaccessible to the people who arguably need it the most.

Structural violence is embedded in longstanding “ubiquitous social structures, normalized by stable institutions and regular experience”. Virtually all of the stable institutions of the acupuncture profession have participated, one way or another, in creating a situation in which neither new graduates nor most potential patients are able to meet their needs with respect to acupuncture.

How can we possibly speak with integrity to current students and new graduates about their personal ethics as practitioners when we know that they are caught up in a system that exploits them? They are mortgaging their futures in order to fund our current institutions.

We call upon the NCCAOM to make our profession as a whole more ethical by leading the way towards reducing both the disproportionate financial burden on people trying to enter our profession and the ongoing credentialing burdens on struggling practitioners.

Particularly in this time of increasing economic inequality, we must look at the role not only of individuals but of institutions in creating a just and ethical society. The NCCAOM has taken on a leadership role in the acupuncture profession and this position comes with great responsibility.

We therefore ask the NCCAOM to demonstrate leadership by honestly confronting the ethical dilemma facing the entire profession at this time. How can we continue to allow the costs of education, credentialing and licensing to rise when we have so much evidence that suggests that most practitioners cannot make a living that allows them to shoulder this burden?

Sincerely,

Andrew Wegman, L.Ac.

Stephen Kingsbury, L.Ac., MAOM, MBA

Jade Fang, L.Ac., MAOM

Sr. Eileen McKenzie, FSPA, RN, CA

Robert Hayden, L.Ac., MAOM

Amy Vance, MSW

Lisa Rohleder, L.Ac.

Board of Directors, POCA Technical Institute