Flying Home: Starting an Acupuncture Practice

In which I digress from informative posts in order to express my excitement, apprehension, and good-old-fashioned dorkiness about starting an acupuncture practice (or a couple of them) in Portland, Oregon, the land of acupuncturists…

When I started this blog, I was an excited student learning about the systems of acupuncture, Traditional Chinese Medicine, and various Western medical ideas and research. Now I am a rookie acupuncturist, still learning but in more detail, and also running a business. Well, running 1.5 businesses and working for 2 more businesses. For better or for worse, business has entered my world in a major way, and it kind of feels like I’ve been given a power-wedgie by the finance and marketing sectors.

Appropriately, this image is from the Big Brother tv show.

I’m sure it’s counterproductive to view myself in some kind of power dynamic with these abstract concepts, especially with myself initially as the victim. But after going through the motions of creating business entities and then promoting them, I am sooo ready to be the one who surprises ‘finance’ and ‘marketing’ by pulling their underwear above their waistline and deftly depositing them both on matching fenceposts, dangling by their underwear.

To create a more natural metaphor, I will give you a peek into what my past three months have looked like, approximately:

The noble Goshawk, pursuing a Rabbit

I would like to picture myself as the goshawk here, but I am also a bit like the rabbit. This is the world of business, goshawk-eat-rabbit. If I am the goshawk, financial security must be the rabbit. Or “finishing that stupid google ad” may be the rabbit. Whatever. My job as an acupuncturist is to reach the greatest number of people that need my help, and to provide them with the best medical care possible. However, the way this looks in the real world involves a lot of publicity-creation and seeming self-aggrandizement, just to let people know that I exist. Unfortunately as acupuncturists, we don’t have an established system of facilities into which we are funneled. So we get to reinvent the wheel nearly every time.

We don’t have residencies (or very few), nor old-timey apprenticeships (unless we’re really old school), nor large institutions that will hire us as employees and send a reasonable flow of patients our way. No, we must reach out and educate nearly every patient that comes through our door about this form of medicine and how we can help them. I enjoy outreach and education as much as the next person, and I feel like I can execute a plan of action fairly well, so I’m not complaining about actually doing this work. Instead, I am pointing out the differences between how acupuncturists build their practices and how nurses or doctors build theirs.

As acupuncturists, we must set up elaborate schedules full of health fairs, farmers markets, free acupuncture happy hours, and lectures at local libraries. We must lurk around in coffee shops and surprise innocent latte-sippers with our bursts of enthusiasm about the healing power of tea, or coffee, or how seasonal changes effect allergies and how we can treat these flare-ups. We must memorize the locations of all the natural food markets in our metropolitan area and regularly give talks or post flyers in these locations. Really.

Coffee Talk from SNL. They just learned about the benefit of green tea. I think.

There is a good side to the lack of infrastructure in the acupuncture field: we don’t fall prey to bureaucratic profit-harvesting and the streamlining of services to the patients’ neglect or dismay. But in many other ways it creates a huge waste of time and effort, and the process of building a clientele culls the acupuncturists who may be fantastic clinicians but ineffective business-people. Not everyone knows how to make Linda Richman all verklempt over Chinese Medicine.

This is a sad state of affairs, and in extra-sad news, acupuncturists can’t seem to organize themselves into effective advocates for their own industry. We joke with each other about the difficulty of “herding cats,” but the fact is that we are either too busy trying to build a patient base or too busy treating the patients that have found us, since we generally work diligently and passionately to provide exceptional medical care. Our colleges are just beginning to build real equity and gain foundation-level support, and we have very few acupuncture-specific research institutions.

Why am I bemoaning this state of affairs? To give greater importance to the progress that is being made currently in our field of medicine. It takes a gargantuan effort to educate the public about our form of medicine with the minimal level of funding that we currently have. But we are doing a fairly good job of this. Furthermore, our clinical researchers and leading practitioners in the field have done an excellent job of collaborating with leading colleges and universities to create robust studies of acupuncture’s effectiveness. So, there is a silver lining.

We can still shape the field of acupuncture and Traditional Chinese/East Asian/Oriental Medicine in the United States. We can create an effective organizational structure that maintains the integrity of our approach to medicine (hopefully). As more MDs and NPs, NDs and DOs and RNs gain more knowledge and experience with acupuncture, they have begun to create close referral relationships with acupuncturists and TCM practitioners. Hospitals are hiring acupuncturists for their pain management/pre and post-operative/oncology/ rehabilitation wards. And acupuncturists are finally becoming successful enough to hire associate acupuncturists at a fairly living wage.

Here are a few institutions in the US that are pursuing top notch acupuncture research:

Columbia University College of Physicians and Surgeons

Massachusetts General Hospital

Harvard University Medical School

The University of Maryland

University of North Carolina

University of Washington

Helfgott Institute

Duke University

The Oregon College of Oriental Medicine

The New England School of Acupuncture

And now we have a listing of integrative medical centers featured in the Bravewell Collaborative’s 2012 report “Mapping the Field of Integrative Medicine”- most of which are pursuing research in acupuncture and TCM.

Participating “Integrative Medicine in America” Centers:

  • Alliance Institute for Integrative Medicine
  • University of Maryland Center for Integrative Medicine
  • Arizona Center for Integrative Medicine
  • Cancer Treatment Centers of America
  • Integrative Medicine Program, Mayo Clinic
  • The Center for Integrative Medicine at the University of Colorado
  • Integrative Medicine Center at MD Anderson Cancer Center
  • Center for Life, University of New Mexico
  • Northwestern Integrative Medicine
  • Cleveland Clinic Center for Integrative
  • OSU Center for Integrative Medicine Medicine
  • UCSF Osher Center for Integrative Medicine
  • Continuum Center for Health and Healing
  • Osher Clinical Center
  • Duke Integrative Medicine
  • Penny George Institute for Health and Healing
  • 11th Street Family Services of Drexel University
  • Scripps Center for Integrative Medicine
  • GW Center for Integrative Medicine
  • Simms-Mann Health and Wellness Center at Venice Family Clinic
  • Greenwich Hospital Integrative Medicine Program
  • Center for Integrative Medicine and Wellness at Stamford Hospital
  • Institute for Health & Healing at California Pacific Medical Center
  • Stanford Center for Integrative Medicine
  • Jefferson-Myrna Brind Center of Integrative Medicine
  • Susan Samueli Center of Integrative Medicine
  • University of Wisconsin Integrative Medicine
  • Marino Center for Integrative Health
  • Vanderbilt Center for Integrative Health

So back to the image of the Goshawk and the Rabbit. As you know, my articles here are longer than the normal blog article, so of course I’m including a personal story regarding the goshawk, Accipiter gentilis. The goshawk’s name is derived from “goose-hawk,” since it is used in falconry to hunt large birds and mammals. Yet its scientific name gentilis derives from the same latin root as ‘gentle,’ or ‘noble.’ The largest of the Accipiters, the goshawk exemplifies concepts of the precision and endurance of hunting, the grace of flying through dense coniferous forests at high speeds, the gentleness of a highly devoted parent, and the mystery of a bird that only appears when its young are threatened (and when they appear, they will relentlessly attack anything in a two mile radius of their nest, including humans).

caw caw

So I was attacked by one such goshawk several summers ago. This particular goshawk was famous in the area for making its valley debut by cold-cocking the owner of a local dude ranch on his morning stroll. He was knocked unconscious and awoke in the trail-dust to the warning call of the female goshawk. Unfortunately the goshawk’s nest was located about 500 yards from my family’s cabin, so we commonly crossed its territory on hikes into the mountains. We gradually became accustomed to its warning call after a few instances of dive-bombings in which my brothers were attacked but I was not present. One morning I brazenly took our dog for a walk up the mountain, and I remember its warning call nearby, as usual. This time, the call was cut short, followed by a pregnant silence through which it swiftly winged its hooked beak and knuckled-up talons directly towards my low back at a ridiculous speed. After a moment in which I felt my brain explode in mortal (yet absurd) terror, I hit the ground, flopping down by a log, and felt the bird pass a foot above me. I proceeded to alternately laugh at myself and gulp in hysterics as the bird chased me down a hillside, and I tumbled through bushes and downed trees to avoid the female goshawk’s repeated attacks with fierce speed.

I found myself completely humbled and in awe of an animal that hurled itself bodily towards its source of threat. Goshawks apparently defend their nests from bears and other large animals regularly. They mate for life and have a large range, requiring large tracts of wilderness to successfully reproduce. How does this relate to me? Well I shall tell you. I do not require large tracts of land in order to reproduce, but I do understand the idea of hurtling directly at the goal with fierce speed. As I returned from Bangkok in May of this year, I felt inspired to collaborate with a variety of medical professionals in Portland, rather than just hang my own shingle and build up a practice around myself. This task is daunting to someone completely new in this field of medicine. I took creative collaboration as my goal, and this spirit of hurtling myself precisely towards this achievement has helped me to work with a wonderful team of practitioners here. The goshawk also embodies the idea of creating and protecting a home, and I feel like I have created this home in Portland. Now if the field of acupuncture can learn to gather our resources in a similar way to achieve a larger goal, we could create true collaboration on a larger scale!

So I am going to take the next few posts to investigate and interview in greater detail some of the structures and people in the acupuncture field (US and internationally) that are inspiring to me. Stay tuned!

Now as a reward for yet again making it through the ramblings of my article, please go to 5:41 in this video and watch for 6 seconds. Thank you!

And for another bird of prey’s insights: Thank you Sam the Eagle:

Dr. Satya Ambrose introduces the Chitari Foundation

***NEWS FLASH***

An incredible development is brewing in the hearts and minds of Portland’s health care practitioners, and its name is The Chitari Foundation. Their first project is the Chitari Center of Collaborative Medicine, a non-profit, in-patient skilled nursing facility where practitioners from all medical disciplines can work collaboratively to help severely ill patients who need a broad spectrum approach to healing. Their combined expertise, highly coordinated to treat life-threatening and intractable conditions, bridges the gap between an outpatient integrative clinic and a large Western hospital.

The Chitari Center will join the ranks of such innovative, integrative medical institutions as the Mayo Clinic, Memorial Sloan-Kettering Cancer Center, Cancer Treatment Centers of America, Stanford Center for Integrative Medicine, Osher Center of Integrative Medicine at Harvard, Duke Integrative Medicine, and the Center of Integrative Medicine at the University of Maryland. Of course, as this new center will be located just outside of Portland, they will be building a strong sustainability, community, and educational component into their physical space and their long-term vision. They plan to collaborate with local organic community farms to bring fresh food to patients, and they will use teaching gardens to offer on-site preventive medicine education for inpatients and visitors. The Chitari Center promises to be much more than an excellent medical center: they will offer transformative education retreats, collaborative research teams, and integrative models of mental, emotional, physical, and spiritual health and wellness. Yes, they know that this is a tall order, but it gets even taller.

The Chitari Foundation’s vision is to create a global model of wellness where all people have access to collaborative medicine. Chitari means “meeting place” in Nepalese: the meeting of medical disciplines, the true meeting of the doctor and patient in a place of respect and support, and the meeting and fostering of community. Remember, the term ‘hospital’ developed from the phrase ‘place of hospitality.’ The Chitari Foundation’s vision embodies this original intent, while encouraging everyone to help create the world in which we would like to live.

The Chitari Foundation is the brainchild of Dr. Satya Ambrose, who in 1983 co-founded the Oregon College of Oriental Medicine (OCOM), one of the nation’s leading colleges of Traditional Chinese Medicine and the first college accredited for their Doctorate of Oriental Medicine program [full disclosure: Dr. Ambrose was my teacher during my time at OCOM, and I interned in her teaching clinic]. Dr. Ambrose is heavily involved in both OCOM and the National College of Naturopathic Medicine (NCNM) here in Portland, not only teaching at both locations but also offering her private practice in Damascus as a place for observation and internship in both Naturopathic and Traditional Chinese Medicine.

Dr. Ambrose can often be seen treating patients with a cluster of 3 or more students and interns surrounding her and her patient; the observers and interns function in a coordinated, octopus-like manner as an extension of Dr. Ambrose’s vibrant, bubbly presence, filling herbal prescriptions, taking notes, and following her lead in the administration of treatments. One gets the impression that they are devoted to Dr. Ambrose for reasons above and beyond her extensive knowledge, experience, and high rates of success in treating difficult cases that have stumped all other providers; she has a magnetic and joyous quality that lifts the spirits of those around her.

Dr. Ambrose teaching biochemistry. ::song interlude!::

Dr. Ambrose is now funneling her abundant energy towards the creation of the Chitari Center of Collaborative Medicine, an oasis of integrative care in the Willamette Valley. She has gathered a crack team of physicians and administrators to bring this vision to fruition, allowing this center to be built collaboratively from the ground up, with an integrative and holistic approach from all angles of development.

The Chitari Foundation is hosting several fund-raising events throughout the summer. You can donate to them directly HERE.
From the founder:

What stage are we at? We have carefully designed the programs. We have made an offer on a beautiful retreat center with 83 acres of old growth cedar, river frontage, and tremendous healing energy. We are now actively doing fundraising and we need your help.
This summer we will have two fundraising events.

*We will be holding a Benefit Concert on Saturday, July 7th from 1:30 to 5:00 pm in Colton, Oregon. A flier is attached below and more information is available at our website, http://www.chitari.org.

*We will also be hosting a Benefit Dinner Party at Starfire Clinic and Farm near Damascus, Oregon on Sunday, July 29 from 3:00 to 7:00 pm with a tax-deductible $500 per plate minimum donation. To confirm your attendance, call 503-658-7715. For more information on Chitari, go to http://www.chitari.org.

We are creating a revolution in medicine. We have a powerful vision. And we have found a site worthy of the ideals of Chitari. Join us to help make our collaborative vision a reality!
Thank you,
Satya Ambrose
Dr. Satya Ambrose, N.D., L.Ac

I interviewed Dr. Ambrose as she was first bringing this team together; this interview took place in June 2011, and small additions have been added with Dr. Ambrose’s participation since that time.

BG: What inspired the idea of Chitari?
SA: I had the idea when I was in Junior High. I thought, “We need a place we can go that is clean and safe, has clean food, and where people can heal.” Because my mom was sick, I was really into health food, and recycling, and all kinds of stuff. We can’t separate our health from the environment. And it’s a worldwide thing. We have to do it all over the world, we can’t just do it in one spot. That’s why Chitari will be international, and it will be a place that helps clean up.

BG: What are the main components of this vision?
SA: One is a clinic that takes the patients that are the most complex, for example the Lyme [disease] patients or the patients that have illnesses that are not being handled by anyone. For them, natural medicine is not working and conventional medicine is not working, and there’s no place for a lot of the people that I see.

BG: So it’s not just that they’re falling through cracks, it’s rather that there’s not even a crack to fall through.
SA: Yes, there isn’t the support to find the multiple things that are causing the illnesses. So, there are three other components of Chitari. [One is] that people need an inpatient facility. They need to change what they’re doing or they’ll have a heart attack, or they’ve already had a heart attack. There are people that are diabetic and they’re losing their eyesight. There are patients like that: they aren’t on a good diet, and they’re losing their eyesight, and if we put them someplace [where their diet and lifestyle could be managed], they would stop hemorrhaging. So it’s a hospital.

BG: So when they’re in the hospital, what kind of therapies would patients receive?
SA: It would be a whole group of people, a pod of people that see them. They would initially get interviewed by somebody who is a practitioner that is also trained in conventional medicine. From there, a team would be established for them who would devise a treatment plan and help them, together. Then we’d do research on what works.

So research is another component, and the research will investigate diseases such as Lyme Disease. And then there will be research on the culture of health, for example how to clean up a neighborhood, how to make it healthier. That will be integrated into the schools.

BG: That sounds like a radical idea. How do you measure the culture of community health?
SA: Yeah, there’s ways of doing it. We’re actually doing it in our neighborhood [in Damascus] with a group called Civic Ecology and it’s funded by the Obama Administration. They have a systems approach to making sustainable green neighborhoods that are economically and ecologically and livable places. So we [look at how to create] trails, green space, clean water, places for animals, farms, places for agriculture, and community gardens, in order to step that up. That’s what our society should have.

BG: So will Chitari be integrating the community garden aspect as well?
SA: Yes, we would ally with local community-supported organic farms. So, [the aspects of Chitari besides the inpatient hospital facility include:] research, education (since in order to heal people need to be educated and to make good choices), a farm to support us, and an association with other farms.

BG: So with Chitari, you have experiential learning, research and education, and ground-up support in the community. So I understand that you are envisioning branches of the Chitari Foundation in several locations across the globe- how do you create a unique facility that reflects the community of which it is striving to be such an integral component?
SA: Every community would need a different part of Chitari, depending on what they’ve already got and what their Strength, Weakness, Opportunity and Threat is. We do the SWAT analysis, see what’s there, and address the problems. In Damascus, Oregon, transportation is a problem. We’re shipping food from other places like California instead of buying local. But we have a pretty nice organic food store, and community farmers markets and stuff like that. So we can help those support the community, and help the community support those.

BG: By creating the correct structure for that?
SA: Yeah, so we’re making a community center that will teach people how to cook well, how to grow foods with training in agricultural stuff, how to recycle, and things like how do you do something like clean up your yard without burning it? Cause out there everybody burns, which is really bad. So there’s other ways of doing things. We’re forming neighborhood associations where people get together and talk about issues like that.

So, we will support [community health education projects] and then provide medical and health prevention, treatment, and recovery approaches within the clinic and hospital. The hospital will have an acute care unit, and also a place where people who are chronically ill can go to get assessed and revamped.

BG: So the people who would be patients at the hospital would fall into a couple of different categories: the acute patients and the chronic illness patients for the inpatient clinic. Would people be able to just pop in for checkups too?
SA: Yeah, they could come too, [in order to relax, recharge, and learn]. Every year Daniel and I try to go to a clinic in California, the True North Clinic, where we just rest. They have exercise programs and a really wonderful diet, and [while we’re there Daniel and I] reconnect to each other, to who we are, and to what our beliefs are. We learn new things, we lose a little weight, and we come back [to Oregon] kind of charged up and think, “Oh yeah, we can do this!” So really, in a similar way, Chitari is a center for cultural change.

BG: Who should get involved, and do you have anything to add?
SA: What I’m hoping is that everybody will be involved; that it will be a community event. We have to change the world. And so ideally everybody will plant trees, and plant a garden, and recycle. And have a guest at their table, essentially, where you put money in to feed somebody who is not there, in order to contribute something to help bring good food to people throughout the world. And the food at the table will be edible, and the water will be clear.

[Projects like the Chitari Foundation] will impact everybody, and I know that people really want this in their lives if they have access to it. So we just have to encourage them to have the self-esteem and the support to embrace it and go after it, because it’s not MY project, it’s everybody’s. So it has to be a cultural phenomenon to make this change happen.

We have a choice of either really going downhill right now or uphill. Or having rainbows (laugh). We have technology and the ability to really create an incredible sustainable culture. And so it’s kind of a choice, but it’s not really a choice if you want to survive and have quality.

BG: Thank You!

******

The Chitari Center of Collaborative Medicine will advance Portland’s already international reputation for integrative health care. Portland is home to prestigious schools of Nursing, Naturopathy, Traditional Chinese Medicine, Chiropractic, and Massage Therapy, so it’s no surprise that Portland boasts numerous integrative clinics, such as the Providence Integrative Medicine Program, The Quest Center for Integrative Health, and Oregon Health and Sciences University’s (OHSU) Women’s Primary Care and Integrative Medicine Center for Women’s Health. It therefore comes as no surprise that last month, Portland hosted the Consortium of Academic Health Centers for Integrative Medicine‘s third International Research Congress on Integrative Medicine and Health.

Integrative medicine functions at the cutting edge of health care; it represents a national (and long-overdue) medical re-strategization of priorities. Integrative centers create a medical team to fit the needs of the patient, rather than focusing on how the patient can fit into medical systems or disparate medical departments. A February 2012 report by the Bravewell Collaborative nonprofit defines integrative medicine as “an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person’s health. Employing a personalized strategy that considers the patient’s unique conditions, needs, and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health.”

Bravewell Collaborative’s 2012 report Integrative Medicine In America: How Integrative Medicine Is Being Practiced in Clinical Centers Across the United States examines data from 29 integrative medical centers across the US. Fifteen of these provide in-patient services, including the University of Maryland Center for Integrative Medicine and Duke Integrative Medicine. These medical centers are not only at the forefront of patient care modeling, but 86% of those studied are participating in clinical trials or outcome-based research as well as offering provider education, acting as important hubs of communication within and between fields of medicine. The report concludes that “integrative medicine is now an established part of healthcare in the United States,” evidenced by “the strong affiliations to hospitals, healthcare systems, and medical and nursing schools as well as the centers’ collaborative work with, and growing referrals from, their own health systems.” The American public and medical professionals are increasingly accepting this model of health care as their patient base expands. The Chitari Center of Collaborative Medicine will join the ranks of these important institutions in order to continue the advancement of patient-centered health care.