acupuncturist + APRN training = good career move?

[crabin0]

hi there, i have a career question. i'm currently in graduate school for traditional chinese medicine. one earns an m.s., and then can sit for state/national board exams for a license to practice (the l.ac). after that, people typically go into private practice or join a pre-existing practice, or work at a hospital (this last category is pretty rare, but may be growing?)

we do at least 960 hours of clinical training during the 3.5 years it takes to earn the degree. this involves working in student clinics under clinical supervision, seeing patients at progressively higher levels of autonomy. we use various acupuncture techniques and chinese herbal formulas, as well as give lifestyle/dietary advice. depending on the state we are in, we can be considered as primary care providers - which is a ton of responsibility.

i personally don't feel that this is enough clinical experience. especially because, in the united states (where i'm located and where i plan to practice), patients will be coming to us as a 'last resort', with complicated conditions and presentations and will have already seen many providers before. we do a few hundred hours of training in modern biomedicine, including anatomy, physiology, pathology, pharmacology, diagnosis. but it's basically a joke, compared to what rns, mds/dos, etc. do. we're expected to understand when we see certain serious conditions so that we can refer out.

i think the amount of training that acupuncture students do allows for a lot of mediocrity in the field. which has a lot of ramifications, of course. a way to get past this is to do a a 'residency' or internship with more senior practitioners. another problem is that a significant amount of people don't have very good business skills, and running a small business eludes them. it's hard to get employment statistics for this field - the few that i've come across say something like 50-70% of l.ac's stop practicing within 5 years of earning the license.

i do not want to become one of these people. i love doing clinical medicine, and i see the benefits in our modern medical system. the wisdom in the tradition i'm studying is also incredible, and i would love to combine the two, somehow. fyi, i used to work as an emt, so i have some experience in that field. i'm really interested in primary care, and want to work in underserved/rural areas. i would love to have a stable job. the stability of acupuncture is unknown, as it can take a while to build a successful practice (if you build one at all).

so, i'm considering enrolling in an entry-level np program when i'm done in about a year, and i'm curious what people here think of this idea - how feasible does it sound to open up a practice (in a state where nps can practice autonomously, for example), and do both traditional chinese and contemporary medicine? does it seem like these could complement each other? how possible would it be to see people in hospitals and refer them to my private practice, for example? i've looked at doing an md/do or pa - but i really dig the nursing model, and it seems like the aprn really fills a huge hole that is developing in healthcare. in addition to primary care, i'm also considering specialties in psych or occupational health, as these sound potentially synergistic as well.

it would be cool to have a dialog about this. i'm really keen on hearing what experienced people say.

thanks in advance for comments!

[BlueDevil,DNP, DNP, RN]

Well I have a colleague who is an MD and also a Doctor of Chinese Medicine. He stopped doing acupuncture because it takes too much time and he can't turn over the room. Even though those patients are paying cash, they don't pay enough to make it worth his while. Even with lousy reimbursements, he makes more money seeing 3 to 4 traditional allopathic patients with insurance in the same amount of time, so little by little he had to phase out the TCM and let it go.

It is just one of the realities of modern medicine. Time is money and many of us do not have the luxury of spending our time the way we would like. If you might be in an environment that has less pressure, you might have the freedom to practice the way you want to, even if it represents a financial loss to your practice.

Good luck.

[crabin0]

Thanks for the feedback. Did your colleague do the MD or TCM training first?

[zenman]

i personally don't feel that this is enough clinical experience. especially because, in the united states (where i'm located and where i plan to practice), patients will be coming to us as a 'last resort', with complicated conditions and presentations and will have already seen many providers before. we do a few hundred hours of training in modern biomedicine, including anatomy, physiology, pathology, pharmacology, diagnosis. but it's basically a joke, compared to what rns, mds/dos, etc. do. we're expected to understand when we see certain serious conditions so that we can refer out.

they are coming to you because western medicine has not worked for them. so, in these cases, you'll be using chinese medicine, correct?

so, i’m considering enrolling in an entry-level np program when i’m done in about a year, and i’m curious what people here think of this idea - how feasible does it sound to open up a practice (in a state where nps can practice autonomously, for example), and do both traditional chinese and contemporary medicine? does it seem like these could complement each other? how possible would it be to see people in hospitals and refer them to my private practice, for example? i’ve looked at doing an md/do or pa - but i really dig the nursing model, and it seems like the aprn really fills a huge hole that is developing in healthcare. in addition to primary care, i'm also considering specialties in psych or occupational health, as these sound potentially synergistic as well.

it would be cool to have a dialog about this. i’m really keen on hearing what experienced people say.

thanks in advance for comments!

i think it can be done but you might want to check out if there is any problems in referring patients to your own practice from the hospital's clientele. you might also want to really look at your niche. i might for example use the five element model and apply it to my practice as a psych np. otherwise you might just get confused trying to mix two different modalities.

[BlueDevil,DNP, DNP, RN]

Thanks for the feedback. Did your colleague do the MD or TCM training first?

I had to ask him, because I wasn't sure. He was an MD first. He still does acupuncture for a very few select patients; they constitute a handful of people he has seen for over 15 years and is willing to lose money for, lol.

[crabin0]

Thanks for the reply. I can see the potential for confusion! It's something I'm thinking about a lot - and one of the reasons why I posed the question in the first place - does it make sense to try and integrate these things? Or do they serve entirely different purposes?

I envision using the clinical training in NP to enhance my Chinese medicine skills - for example, while seeing patients in that model, to be simultaneously thinking about their presentation, diagnosis, and treatment from the TCM standpoint. Not necessarily to even do any TCM techniques with them (aside from perhaps lifestyle/dietary advice, which is quite complementary with current research) but to use my clinical experience in modern medicine to educate my observational/diagnostic skills in TCM.

Are you also an acupuncturist in addition to a psych NP?

[zenman]

No, I studied acupuncture but found it overly theoretical so switched to Zen Shiatsu where we touched people in the first hour of class. Saved myself $25,000!

[Psychcns]

I have studied several healing methods. My favorite is Breathwork. I tried integrating it--too confusing. I do it now separately for people who are interested.. But it influences my psychopharmacology practice in that I bring to the session another kind of awareness. I do yoga too-- for myself.. Besides Breathwork, i Have studied reiki, massage, tai chi, karate. Have received acupuncture, chiropractic, homeopathy, and likely sampled other modalities.

[crabin0]

Yeah... I practice qigong/taiji daily, and I plan to one day teach these things... it's one of the best things I think people can do for themselves (exercise/movement... especially if its along the more 'energetic' side, i.e. yoga, taiji and other 'internal' martial arts)! It's inherently empowering for a person/patient to make that kind of commitment to their health.

[Psychcns]

I am reading a fascinating book now about treating anxiety and depression with restorative yoga. Written by a psychologist. Who is going

To do the clinical trials to measure the efficacy? And which patients will spend one hour per day for their health when they can take medication?

[BlueDevil,DNP, DNP, RN]

I have many patients who would prefer that, actually.

[crabin0]

I am reading a fascinating book now about treating anxiety and depression with restorative yoga. Written by a psychologist. Who is going

To do the clinical trials to measure the efficacy? And which patients will spend one hour per day for their health when they can take medication?

I'm pretty sure there are some clinical trials for this (yoga) already. There are trials showing tai ji does things like lower blood pressure and other healthful benefits. Which is a similar kind of practice (movement coordinated with intention and breath).

I know plenty of people who do all kinds of things in place of medication - exercise, art, yoga, diet, lifestyle, mindset, meditation, etc etc. It seems like pharmaceuticals are used in the US/westernized society as a solution for problems that are often better addressed through other means.