As many readers of Acupuncture Today know, I have long been a vocal critic of the quality of acupuncture and Oriental medicine (AOM) education in the U.S. and Canada. For a number of years, I placed the blame for the educational failings of our profession squarely on the shoulders of the school owner-operators for putting profits first and academic standards second.

From my point of view, our teachers are not paid enough to allow for a dedicated, full-time, truly professorial faculty, and matriculation and graduation requirements are too low, due to the need to pay for teacher's salaries (and other operating expenses) entirely from tuitions. This second deficiency means that too many marginal students are allowed in and allowed to continue from class to class, in order to meet schools' budgets. Before researching the history of modern Western medicine in North America, I believed these problems mostly were due to the avarice of school owners. Having researched the history of modern Western medicine in North America, I now realize I was wrong. Mea culpa. Given the fact that essentially all of our schools lack adequate endowments, our current system and level of education are the only ones we can have.

At the beginning of the 20^th century, there was a plethora of small, privately owned medical schools in the U.S. which funded their operations primarily from their students' tuitions. As a result, these "mom-and-pop" schools, composed of rudimentary physical plants and facilities, let in a varying quality of students; hired part-time physician-teachers of any and every style of medicine with varying academic credentials who then provide minimal clinical experience; and passed all but the most egregious of students. If this sounds familiar, it should, because the economic forces at work at that time in the world of modern Western medicine were the same as those currently at work within the AOM world in North America.

In order to understand this situation better, it is necessary to look at the Flexner Report. The Flexner Report is commonly regarded as the most important event in the history of American and Canadian medical education. It was a commentary on the condition of medical education in the early 1900s and gave rise to modern medical education ... The Flexner Report triggered much-needed reforms in the standards, organization and curriculum of North American medical schools. At the time of the Report, many medical schools were proprietary schools operated more for profit than for education.¹

Flexner visited each of the medical schools in operation at that time and compared each medical school to Johns Hopkins, an institution he and others considered ideal. In particular, he considered five criteria for excellence during his visits:

1. School entrance requirements;
2. Size and training of faculty;
3. Sum available from endowment, fees and budget;
4. Quality and adequacy of labs, qualifications and training of lab teachers; and
5. The relationships between the school and its associated hospitals.²

Note that Flexner included a school endowment as one of his essential criteria for judging the academic quality of a medical educational institution. Until or unless a school has an endowment to pay (or at least help pay) for teacher salaries and other operating expenses, Flexner believed you cannot have a highly educated and skilled cadre of professional teachers, adequate academic standards and policies, or a qualified student body.

The following quotes from the published histories of two American medical schools emphasize the importance of such an endowment. (In both quotes, the italics are mine.)

The first is from the online history of Yale University School of Medicine.

At the Bicentennial [i.e., 1901], the Medical Department of Yale University was still housed in inadequate quarters ... The medical course was four years long, as it is today, but college education was not yet a prerequisite for admission. The greatest needs of the school were an endowment to help pay for salaries, a closer relation to the New Haven Hospital, and better facilities.³

The second quote is from the online history of the Washington University School of Medicine.

To insure excellence in clinical training, Brookings negotiated teaching affiliations with the trustees of St. Louis Children's Hospital and the yet-to-be-built Barnes Hospital. Finally, he raised an endowment from leading local citizens and obtained foundation grants sufficient to make the school independent from tuition as its sole income ... Most important in his success was financial support from the Rockefeller-sponsored General Education Board...⁴

At the same time as the publication of the Flexner Report, so called captains of industry such as Rockefeller and Carnegie, were attempting to deflect popular criticisms of their rapacious business practices and great wealth. For these "robber barons," charity, in the form of educational endowments, was one of their advisors' preferred ways to good PR. With Rockefeller and Carnegie leading the way, educational endowments became a fashionable status symbol for the other newly rich. These are where most of the Western medical colleges in existence today got their original endowments and why they still exist. Those that failed to attract such endowments soon went under. They simply could not compete. For instance, in 1904, there were 160 MD-granting institutions in the U.S. By 1935, there were only 66, and 57 of those were associated with a university.⁵

Recently, Bruce Robinson, MD, and past president of the now defunct Meridian Institute in Monterey, Calif., agreed with my analysis of the economic factors militating against quality AOM education in North America today. I described my assessment of the intrinsic dichotomy between academic quality and a tuition-based budget to Dr. Robinson. He said he had experienced this problem first-hand when he was president and that it was this very problem which led to the demise of the school. Those who know Dr. Robinson know he is a highly educated individual. And for those who remember the Meridian Institute, know that the mission statement of that college was to provide the highest quality of Oriental medical education in a 21^st-century setting. Nevertheless, the school only managed to survive a few years. Originally, a single generous businessman had pledged to provide the college with a $2 million endowment. However, when his business went bankrupt, so did the Meridian Institute.

Unfortunately, I see no Rockefeller or Carnegie on the AOM horizon. So, unless Bill Gates takes a sudden interest in our profession, how do we remedy our current situation? First, I encourage all North American AOM schools to ramp up their external fund raising. Realistically, this means hiring someone whose job it is to solicit donations and submit grant proposals. Secondly, I encourage all North American AOM schools to create an endowment fund with its own bank and investment account. Third, I encourage these schools to create an alumni office if they do not currently have one. This might be the same person soliciting donations and writing grant proposals. The purpose of this office is to keep track of the whereabouts of alumni and stay in touch, while soliciting donations and bequests specifically for the endowment fund. (I graduated from college 42 years ago and still receive several solicitations per year for that school's endowment fund.) Fourth, and perhaps most importantly, I encourage all North American acupuncturists to pledge $100 per year for the next 10 years to the endowment fund of a school of their choice. However, the school must guarantee that these donations will only be used for the endowment. If only 200 alumni from each school made such a pledge, each school would have an endowment fund of well over $200K at the end of that time, given conservative investment returns. In addition, when a school can demonstrate to external donors that its endowment is supported by its graduates, they are more likely to make matching grants and bequests. And fifth, I encourage all North American acupuncturists to include a bequest to the endowment fund of the school of their choice in their will. If there is not some deus ex machina to remedy our educational dilemma, then it is up to us to remedy it ourselves.

References

1. Anonymous. Flexner Report: Birth of Modern Medical Education. Available here.
2. Ludmerer K. Flexner's Impact on American Medicine. Available here.
3. Anonymous. Medicine at Yale, 1901-1951. Available here.
4. Anonymous. Origins and History of the Washington University School of Medicine: Reorganization and Growth, 1909-1929. Available here.
5. Anonymous. Flexner Report. Available here.

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Click here for previous articles by Bob Flaws, LAc, FNAAOM (USA), FRCHM (UK).

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