Decades ago when I started practising acupuncture the possibility of practising in a hospital was outside of the realm of possible outcomes to me; there just weren’t many opportunities back then. Now hospitals throughout the U.S. are attempting to recruit acupuncturists. This turning of the tides is due to the fact that the FDA, NIH, AMA, VA and the U.S. Department of Health and Human Services all advocate acupuncture for pain relief as I have detailed in other blog posts ad nauseum. Licensed acupuncturists were on the fringe many years ago, but no more; the critics and haters have been silenced due to the overwhelming science proving the value of Chinese medicine. The opioid crisis has kicked open the doors to healthcare job opportunities because acupuncture is efficient at treating pain.
The new reality is that now there are not enough acupuncturists to fill all of the positions opening up and you may well find yourself with the opportunity to practice acupuncture at a hospital. Acupuncturists are now being assimilated into mainstream medical settings of all kinds. This now allows acupuncturists to treat underserved populations that could not afford the cash-based spa-type acupuncture that dominates availability of acupuncture in the U.S. While this development should be viewed as positive, there are some possible downsides to working in hospitals and their “integrative” clinics. I would like to share some of my experiences and hopefully, other experienced acupuncturists will also add insightful comments who practice medicine in hospitals. I have taken the liberty to make some generalizations, and your experience may not reflect these observations:
- Hospitals are like slow-moving barges; nothing happens quickly. While the folks who are interviewing you are excited about their new project that has been recently funded and they are hoping to be up and running in 30 days, it will be 6 months before HR clears you for employment most likely. This time-lapse can cause financial uncertainty and stress when you are expecting to be employed in 30-60 days.
- Like any corporation, hospitals will resist hiring you on full-time and may try to pay on a fee-basis per patient you treat. This is especially disadvantageous to you as the VA and most hospitals do not require patients to cancel their appointments with a 24-hour notice; there are tons of no-shows in these settings.
- If you do go with compensation per diem, you are not salary and should insist on only working the hours you have patients, and only performing patient care and related charting. Also, make sure that you are paid appropriately for any orientation or computer training classes; these really add up. Also, ask that your computer be ready to go on the first day of work; I just spent 6 hours at a VA hospital of my own time trouble-shooting technical details that should have been remedied before I got there. Poor communication and follow-through is an ongoing theme during your initiation period and these can lead to frustration for you, but you should be paid for this time.
- Better, ask for benefits associated with 32 hours, or a fulltime position. Hospitals would not expect to attract nurses without offering benefits and no-one else working around you is being asked to do so without benefits (except for the other “alternative” medical practitioners; you are now in a position to negotiate better terms for employment. Re-negotiating or changing the terms of your employment will take a very long time, so negotiate these terms from the beginning.
- Prepare to be investigated; there will be an exhaustive background check that may likely include contact information from past colleagues, friends, and neighbours. Remember that it is customary to ask permission of the referral source prior to listing them as references.
- There is a drug test and a physical ensuring that you will be able to work an active job on your feet all day long. With this in mind, buy shoes like the nurses wear.
- Hospitals are money-making corporations, but not fun ones like Google where you are playfully throwing Nerf-balls around the room. Most licensed acupuncturists chose this profession for altruistic reasons but never anticipated the possibility of a tension-filled work atmosphere with unfulfilled co-workers counting down their days to retirement. Luckily, we have the best job in the world and can focus on all of the patients who are benefitting from our efforts.
- Charting is a true burden when working with hospitals and the VA. The practice software is cumbersome and not intuitive to the practice of acupuncture; it takes a lot of time away from caring for patients. You will not be able to see more than 2 patients an hour and chart your SOAP notes correctly most likely. Treatment note templates will become your friend. I have practised in four community clinics where I treated up to seven patients an hour, so I am fast. However, this type of efficiency is impossible in these settings. This is important to know if you are getting paid per-patient.
- Check your ego at the door; TCM-speak and theoretical debates as you experienced in acupuncture school will not be well-received. You will not likely have work-mates who you can consult with. While you can include phrases such as, “Spleen Qi Deficiency”, and “Kidney Yang Deficiency” in your treatment patient notes, avoid them with health care workers who are not educated in Chinese medicine. How does acupuncture work? Hospital answer: nobody really knows.
- You might not break down the walls any time soon; promises of exciting positions should be questioned sceptically. You know that you can benefit patients postoperatively or in the ER, but unless those positions have been created it is going to be years before they become a reality in a large corporate setting. Do not accept an acupuncture position in a hospital with hopes of influencing the role of acupuncture down-the-line if humbly treating patients does not appeal to you.
- You will need to grow some thicker skin; acupuncturists are a commodity in this culture. You know your value, but the practice of acupuncture has not yet been established in these settings generally. Many in the establishment even resent your presence as they were misled for years about acupuncture and traditional Chinese medicine being quackery. Be patient; soon their own patients will start providing positive feedback about acupuncture and they too will become part of the reformed doubters we meet every day.
- Some VA acupuncture positions are part of feasibility studies and the positions are temporary, however, no-one mentions this during the hiring process. Ask how long your position is funded for before moving your family across the country for a job.
- These corporate entities simply see an acupuncturist as replaceable employee sticking needles in the back of a patient and relieving pain in the back; they have no idea of the complexity of healing pain and are just looking for an L.Ac. to fill a position in their grand plan for integrative practice to fill new regulations and marketing requirements. I overheard one hospital clinic manager bragging to a co-worker that he just “burned-out” another acupuncturist.
- Don’t expect an Integrative Clinic to allow for any meaningful communication or cooperation among multiple modalities. While hospitals suggest that this new integrative care model means that all of your doctors and providers are closely communicating a patient’s specific condition, regular round-table discussion are not likely to be your reality.
- You are a threat to an “integrative practice” as you can replace any position of other practitioners in an integrative practice: acupuncturists are experts in nutritional counselling, tui-na massage therapy, pain relief, and emotional balancing. We not only evaluate patients and form a diagnosis, but we are able to apply an effective treatment and prescribe natural herbal therapies…all of this in about 30 minutes. We ARE integrative therapy and do not require an army of practitioners. This realization is forming in other health-care practitioners minds as licensed acupuncturists become more prevalent in traditional healthcare settings; expect recoil
- Your logistical needs may not be met. Many integrative practices have been retro-fit from former general practitioner practices; the rooms were originally designed for MD visits and are much too small for acupuncture tables. Imagine a tiny room with a massage table and a 6’4″ patient with feet hanging over the table and nowhere for you to work your way around the table to apply needles to the other side of the body. I just visited a new clinic location where I found that my two practice rooms only had chiropractic tables for my use; uhgg!
- Don’t expect any support in turning rooms and rooming patients. This is often promised, bet seldom delivered. Also make sure that sheets, sheet disposal, and necessary supplies are close by so that you are not running all over the clinic to turn over rooms.
- Patient education is out! You won’t have time to explain how acupuncture works, even though this is one of your favourite subjects. Many of the “Integrative MD’s” I’ve encountered are acupuncturist want-to-be’s; don’t get sucked into educating these folks as it will result in you being more rushed throughout the day and unable to fully care for your patients. Whatever you do, don’t try to educate anyone in TCM. Have some books placed in the waiting room to refer patients to.
- Scheduling can be an issue as there is no understanding that you may be able to see patients every 30 minutes, but it takes a full hour to actually treat the patient from start to finish. You will need to have a full hour lunch break, especially when treating VA patients who tend to be in extreme pain and are high-need. Insist on scheduling that allows for an hour lunch break. I have been scheduled with a 30-minute lunch, but the last patient before a noon lunch was scheduled at 11:30; the patient’s needles had to be removed at 12:20 so I got no lunch at all for weeks-on-end.
- You may not be allowed to prescribe herbal medication.
- Be safe in the clinic and know the exit routes. One of the VA hospitals I presently practice at had an incident in which a patient with PTSD came in and shot his doctor and several other healthcare workers actually killing people. Because acupuncture is effective at treating PTSD you will have patients who have emotional imbalances.
- Get everything in writing. Follow-up your second interview where you were offered a position politely outlining everything discussed, including your pay rate.
Even knowing all of this, I still treat at two hospitals as I am on a mission and think that it is crucial for Chinese medicine to become more available to all people. This is the medicine of the future and I am excited about having a front-row seat to history being made. It is a bumpy road right now; patience and centering are necessary for traversing these obstacles. Luckily, as licensed acupuncturists, we are incredibly adaptable and can traverse these less-than-perfect conditions. If you have worked for a hospital or similar entity please share your experiences and insights with others so that we can all support and learn from each other and elevate the practice of acupuncture.