By Eric Brand

The NCCAOM recently released the results of their 2010 survey. I like reading statistics, and despite the fact that elective survey responses can be slightly limited in terms of their scientific accuracy, the NCCAOM surveys provide significant insight into our profession. It is difficult to compile national statistics in general- for example, I don’t think there are any truly reliable figures out there that show how many acupuncturists are currently in practice in the U.S. Nonetheless, the NCCAOM survey asks some very interesting questions and the responses tell us a lot about how our community sees itself.

Follow up:

For example, when asked “what do you consider yourself to be?” 40.7% listed “Acupuncturist”, 55.9% listed “Oriental medicine practitioner”, 0.8% stated “Chinese herbologist”, 0.3% said “Asian bodywork therapist” and 2.3% said “other.”

These two questions and their responses are very interesting. When I lived in Taiwan, I quickly learned that nobody there uses the title “acupuncturist.” For that matter, they don’t have a special word for “practitioner,” as in, a doctor that is not officially a doctor. The title for what we do in the Chinese world is simply “Zhong Yi” (short for zhong yi yi sheng or zhong yi shi), which translates to doctor of Chinese medicine. In Chinese culture, a TCM doctor is not akin to a second-class citizen in the medical world, so they just use the same normal title of doctor that MDs use. Coming from the U.S., we are trained to never use the word “doctor,” yet when we make up our Chinese name cards there is no other title to use besides doctor.

In the Chinese world, we aren’t acupuncturists, we are doctors of Chinese medicine that happen to be able to do acupuncture. Using the title of “acupuncturist” would be strange because it would sound like you weren’t a full doctor but rather a physiotherapist of sorts. Ultimately, the thing that is emphasized in the Chinese world is the global medical training in diagnostics, theory, etc, there is not emphasis in the title on a single skill such as acupuncture or herbal medicine. Often when Chinese people hear that you are a TCM doctor, their first question is “can you also do acupuncture?” Acupuncture is considered to be a bonus skill, you are not just a TCM doctor, you are a TCM doctor that can also do acupuncture. By contrast, you would never mention on your business card that you can prescribe herbs- being a TCM doctor implies that you know how to prescribe herbs. When you are a “Zhong Yi” everyone assumes that you can do herbal medicine, to state it explicitly would be redundant.

In the statistics above, it is interesting that only 0.8% of respondents primarily viewed themselves as herbalists that don’t use acupuncture much. By contrast, in Taiwan, Hong Kong, or mainland China, I would estimate that 80-90% of TCM doctors exclusively practice herbal medicine. Acupuncture is prevalent but acupuncture is only used in one or two departments in the hospital. In TCM hospitals, there is an acupuncture department and often a traumatology department or rheumatology department that also uses acupuncture, but typically all the departments like gynecology, internal medicine, pediatrics, etc are all primarily herbal medicine. At least 80-90% of the total patients seen by Chinese medical doctors don’t receive acupuncture at all. Thus, there is a major difference between the perceived central therapeutic focus in Chinese medicine when comparing East and West.

When acupuncture first came to the West, it was seen as very exotic. Most world cultures have a traditional history of herbal medicine, but only the Far East had acupuncture. Acupuncture really attracts interest and attention, particularly because a healing modality that requires no ingestion of medicine is conceptually quite foreign and unusual. It is not surprising that acupuncture was the thing that really stirred interest and made headlines, but ultimately it is important to realize that acupuncture is the minority modality rather than the majority modality when it comes to TCM practice in China. I love to give and receive acupuncture and I think it is a great therapy, but I think it is interesting that many practitioners in America identify themselves based on the therapy they use (acu) instead of the conceptual system they use (OM/TCM).

Here is another of the questions:

When asked “what is your current role?” 93.8% said “practitioner,” 3.5% said “educator,” 0.6% said “administrator,” 0.4% said “funded researcher” and 1.6% were currently not practicing AOM.

This stat is also very interesting because it appears that nearly 94% of the people in our profession essentially have the same job. In the Asian world, the profession is much more diverse. Many professionals in Asia are funded researchers, pharmacists, merchants, scholars, advisors, etc. In the NCAAOM survey, 91% of respondents said that they were self-employed, while 30% were both self-employed and employed by others.

Overall, these numbers suggest to me that we tend to focus too much on a single model of a professional identity and lifestyle. Over 35% of respondents said that they felt “poorly prepared” in terms of marketing and PR, and we constantly hear complaints that students find difficulty finding work after graduation. Perhaps we are too focused on the idea that private practice is the ultimate goal of all graduates. Many graduates like to work for other companies rather than fending for themselves, and there are many potential industry jobs available in areas such as herbal quality control. Unfortunately, our teaching programs rarely introduce students to career tracks and lifestyle models beyond private practice. We often have little training in areas such as research or advanced herbal pharmacy, and there is hardly any competition for the jobs in these sectors. Unfortunately for the academic community and industry, there are relatively few graduates that have the skills to fill these jobs.

Cultivating greater diversity in our profession will ultimately be a great service to our medicine. If we had more students coming out with specialty skills relevant to herbal industry or scientific research, our profession could quickly grow in new directions and many more graduates could enjoy opportunities such as being a “funded researcher.” Being a funded researcher is great- it is a fun job and it helps the development of the field. As a community we need to embrace an identity with greater diversity and we need to realize that the ultimate destiny for our graduates is not always going to be private practice.

Most of us choose Chinese medicine because we like to help people and most of us enjoy treating patients. Treating patients is very fulfilling and rewarding, and it is the ultimate test of our skills. However, we need end the stigma around academia in our profession so that the people that focus on research are not derided because they are not in clinical practice. When it comes to talking to people within our community, I look forward to the day when people ask “what do you do with Chinese medicine” instead of asking “where do you practice?” Likewise, when it comes to talking to people outside the community, I look forward to the day when I can tell a stranger that I practice Chinese medicine and they understand that this means I know much more than acupuncture alone.

I love acupuncture and I love treating patients. Helping people in clinical situations is ultimately the most fulfilling aspect of my job when it comes to Chinese medicine. But I also love to bury myself in books and embark on field tours for herbal research. When I think about what I do, I would never refer to myself as an acupuncturist. Acupuncture is just the tip of the iceberg when it comes to what I do. I do see patients and I love seeing them- it keeps my clinical skills fresh and it satisfies some aspect of my human nature. But asking ‘where I practice’ is just the wrong question, because in my own eyes my work with Chinese medicine goes way beyond my work with patients in my hometown. As our profession matures, I think it needs to grow out of this one-size-fits-all model. We are all in the same field, but we don’t all have the same job by any means.