Floyd Herdrich has played an integral role in the development of the acupuncture and Oriental medicine profession in the United States.He was a founding member of the Acupuncture Society of Virginia and helped get an independent licensure law passed in that state in 1993. He has also been a board member of the Acupuncture and Oriental Medicine Alliance since 1994, most recently serving as the Alliance's president.
In part two of our interview, Mr. Herdrich expresses his views on the current education levels in acupuncture schools, along with the role of the Alliance and the American Association of Oriental Medicine in the creation of the Vision Search Task Force.
Acupuncture Today (AT): You mentioned the doctoral program and the type of education these programs are offering. What do you think about the level of education the students are receiving now?
Floyd Herdrich (FH): It's great. It's wonderful.
AT: Do you think there are any areas in which the schools could improve? Are they doing enough to prepare students for life after graduation?
FH: That's part of the confusion about the business model. Yes, the schools can do more, and I know schools that are doing more, but it's been a perennial problem, because the economic structure of acupuncture and Oriental medicine is basically entrepreneurial. Look at the number of restaurants that open and close. They're known as the profession for turnover and failures, but that's part of the entrepreneurial model: You've got something, and you take a chance, and you put your particular practice out there, and you either succeed or you don't. Part of that has to do with your personality, your charisma and your knowledge, but it's not for everybody. A lot of people just want to get a job. In any profession, there are people who just want to get a job. There are physicians who are giving up their private practices to work for an agency of some sort. On the other hand, there are also physicians who are giving up their licenses. A particular case that interested me recently involved some West Coast psychiatrists, who were sued by their patients because they refused to prescribe the drugs their patients wanted. In this case, the physicians actually turned in their medical licenses and took out counselor licenses so they could persist in that model.
In the face of the litigiousness of the population and the preparedness of the legal profession to go after medical practitioners, I'm really worried about the first case that we're bound to see in which a patient goes after an acupuncturist, because the acupuncturist did not detect a medical malady that appeared five years later. In the medical profession, you already have patients who, in a malpractice suit, will look at their most recent MRI, and it's clear the patient has a large tumor. The question comes up in court: "Well, doctor, you read my MRI five years ago. Didn't you see it coming?" And the old MRI is reviewed, and the attorney says, "Ah, here's a trace. This could have been the tumor that wasn't clearly detected."
This situation already exists in medical malpractice suits. The point is, acupuncturists have the luxury of very affordable malpractice insurance because we very seldom, if ever, hurt anybody. However, if we start having professional standards creep in state scopes of practice to the point that acupuncturists have the option of ordering MRIs and other medical tests, if anybody in the profession in a given state has that option, it becomes the obligation of all licensed practitioners in that state to be responsible for those tests.
AT: So you could see an increase in malpractice cases, and that could lead to an increase in insurance rates.
FH: Yes! We spend $1,000 or so a year for malpractice based on our history, but when we start getting lumped in with doctors, it's going to go to $50,000 or $100,000 just like doctors. I know obstetricians personally who have given up their practice because their malpractice shot up to $40,-, $60-, $80-, $100,000 a year, and they can't afford it. At the same time, the insurance industry has been cutting back on payments, so they're caught right in the middle. They just look at the business plan and decide to sell Amway.
So, yes - students that came out of my class succeeded and failed 25 years ago probably in the same proportion, or perhaps less, than today, but the complaints from people coming out of the schools today are the same as they were then. Some people feel ill-prepared to go out and take the responsibility for developing a private practice. There's always been an axiom that it takes three to five years to build a private practice. It doesn't matter if it's a legal practice, a medical practice or an acupuncture practice. If you don't have the resources to get through three to five years to where you have a sound practice, you may fail. If people don't face that fact when they go in, they're asleep.
It's not the fault of the schools. I was prepared to build a practice, and knew how to refer a patient to the allopathic profession, based on my diagnosis through acupuncture and Oriental diagnosis, because I was trained on how to refer out way back then. I don't think schools have gotten worse at that training, they've only gotten better.
About six or seven years ago, we were getting to the place in the profession where we were looking at the problem of "curriculum creep." When we became legitimate - and we got that way be accrediting the schools, then legitimizing the outcomes by legitimizing national board certification - we got locked into certain kinds of established patterns. To move from a master's level accreditation to a doctoral level accreditation, you have to show there's a significant difference and need. While the acupuncture schools were just naturally looking into more and more information, the numbers of hours five, six and seven years ago were already approaching what is taken as the definition of a doctor's education. How do you show the difference? The question has been around for 10 years. Could we just morph the master's into a doctorate, or did we have to legitimize ourselves because we're already in a legitimate academic structure? That's question has brought us the clinical doctorate as a postgraduate doctorate, but there are people who still think, "Just call us doctors and we'll be doctors. Give us that title and let us go." That leads into the probability of acupuncturists having the same kind of legal exposure that doctors have, but with only a half or third or quarter of doctoral training to back it up. I'm concerned about that.
AT: I have a few more questions before you before wrapping things up.
FH: All right.
AT: The Alliance and the AAOM are working together; they've got the Vision Search Task Force, and they signed a memorandum of understanding so that they're working for common goals. What's your perspective on the organizations working together?
FH: You've mixed apples and oranges just a little bit. Historically, it's always been said that there were four national organizations. When you look at it, it's actually four functions: education, accreditation, certification, and the practitioners were organized. At a certain point, the practitioner branch became two different organizations with slightly different focuses. The organizations - the AOM Alliance and the AAOM - have worked under a memorandum of understanding over the last several years to put out bridges and work together. We've been working on an ethics model, which we hope to release as a joint document. We worked under some agreement on putting Acupuncture and Oriental Medicine Day forward. There are a number of areas that we've worked together.
The two organizations both participate in a bigger venue, which is the VSTF. That involves both practitioner organizations working together with representatives from accreditation, education and certification. It's a different way of working together. One is part of a bigger community, where we're working in parallel with the other members; the other is the groups directly working together to show where we do have significant agreement about the profession. Unfortunately, we still cannot figure out quite how to put forward both the doctorate as a new role, and the maintenance of the master's level practitioner. That's basically where the difference lies currently. That's the one thing we haven't figured out how to do both in one organization and make clear.
AT: A lot of people aren't that familiar with the VSTF - its organization and objectives. Could you tell us more about it?
FH: As an observer as somebody who put that idea forward, some of the same people who have been working for the unity in the profession over the years put the idea forward three or four years ago. "Visioning search" is a particular model that exists for finding unity in all kinds of communities. It wasn't figured out by the acupuncture profession. The basic concept of visioning search is that all of the stakeholders in a particular broad community are all there, and it's based on putting forward needs and hearing one another's needs. It's a modern-day understanding of the idea that a number of stakeholders have their own view of needs. These needs are put forward and heard, and then somehow when the needs are all out in the open and heard by everyone, then you move to a mutual view that can include those needs.
Over the years, there have been several different waves of visioning that took place among the four functions. The boards of the four function groups used to go into a retreat once a year, at the annual conference; this became five members when the practitioner groups branched out. It became evident that one of the stakeholders was not at the table: consumers and patients. That was something the Alliance has held to all along. Some of our board members have been heavily into consumers' rights. We have a lot of people interested in public health, which is generally underfunded. For instance, the Alliance has an association with NADA, in which some non-acupuncturists use a particular acupuncture protocol in public health venues. We see that as a very legitimate and helpful way to help society.
Some people think only an acupuncturist should touch an acupuncture needle. We don't see that as a way for the medicine to reach and heal society, so our emphasis has been in large part on the consumer, and how they see us. There was a wonderful statement in the visioning hearing at the AAOM meeting by an old-guard practitioner and educator. She said, "We see the patient as the primary care person. They are the one who chooses who's going to help them through their medicine." So the idea that the patient takes on the responsibility of knowing, understanding and having the freedom to choose what form of medicine they choose.
The Visioning Search Task Force has a series of meetings - about two a year - with participants from all four functions of the profession. They became sensitive to the fact that the consumer/lay member public has not been present much in those hearings, but the opinion has been that after the conclusion of this preparatory phase, there would actually be a visioning search format put forward whereby all of those people would be present, and at that meeting, which has not yet happened, the actual "vision" would bubble up. There has been a lot of preparatory work over the last several years, which has looked at the people in the main part of the industry, with only minimal participation by the consumer. Hopefully, that would be a bigger part of the final vision search.
AT: You know, I'm a consumer. I wouldn't mind being a part of things.
FH: Well, you ought to be!
One of the first annual conferences of the Alliance was in Washington, D.C. One of the plenary speakers at the conference was from President Clinton's think tank. He had some very interesting things to say back then. One of the scenarios they could see was that in about eight years, the HMOs would have stripped out all the savings to be had from improved management. When that happened, we would see the rate of the costs of Western medicine increase as fast or faster than it ever had. The HMOs didn't really stop anything; there was just this period where management would save money. So, here we are. We know that HMOs are "dropping out" all over the place, and that health care costs are escalating as fast as they ever have.
The speaker also said that the think tank could see that in about 10 years, we'd see a time where most of indemnity payment for health care would disappear. There would be regional shock trauma units for major medical intervention, and for the most part, all other forms of health care would go to fee-for-service. Now, we're seeing that come to reality. Insurance hasn't yet disappeared, but we see it shrinking. I watch the practice my wife has been in for 15 years - an obstetrics practice with 35,000 patient records - and its staff shrinks and expands over the last decade in six-month increments when the insurance industry cranks down, or opens up something. We also know that doctors in many cases have been given mandates: "You had 12 minutes to see a patient; you now have nine." That's a fact. I'm not making it up.
We have this industrial machine going on, with medical professionals making snap judgements and carrying out routine, by-the-book medicine. They're having a hard time performing a science and art to healing. It's become very codified, and a lot of doctors are dropping out - not in waves, but I know doctors personally who have dropped out and gone to sell Amway, because they could not make the business model they had in mind when they went to school 20 years ago. It just doesn't work that way anymore.
I don't take medical insurance. I've never filed an insurance claim for a patient. I don't intend to, and I don't think it's necessary, because patients come to me because they want to get better, and they think that I can help them - and in many cases, I can. That's the basis of my practice, as a master's trained acupuncturist back when it was 1,200 or 1,500 hours of education, not 3,000. It's got to be better with 3,000 hours than it was with 1,500, but my practice is sound.
AT: Any final thoughts you'd like to share?
FH: Well, there's the subject we talked about earlier: the recognition and support for the doctorate level of training, which is a legitimate form of academic growth and specialization, and the view that there will be a class of practitioners who will be doctors of Oriental medicine and may very well focus on primary care, but that's just going to be a class of Oriental medicine, not all of Oriental medicine.
The current economic structure, with mainstream, insurance support, doesn't have a place for 15,000 doctors of Oriental medicine. However, the American culture certainly has a place for all those people, and in their own level of economic existence, but the medical profession isn't looking to expand in that way. One of my younger colleagues told me she filled in at a medically owned personal injury clinic in California, had a slot for an acupuncturist. She said she was being asked to see 27 patients before lunch and told me, "I don't think I was helping them."
You can't industrialize acupuncture. This isn't China. If it was, and everybody walked or rode a bicycle to work, and everybody had the same salary, and the workers were told to take a week off, go back to the clinic and get well - if this culture could let people take a week off when they got sick, they'd probably come back well even if they didn't go to a doctor, but our culture doesn't allow that. So to try the old Chinese model of going to the clinic every day for a week and coming back well - as one of the Chinese mentors I sat before said, "That's in China. Over here, we're lucky to get a patient in once a week."
It's a different culture, and it's got to be a different model of medicine. It doesn't go straight across the board because it worked in China.
AT: Thank you.
FH: You're welcome.
Editor's note: Part one of Acupuncture Today's interview with Floyd Herdrich appeared in the January issue.