The Fourth Floor

On nervous systems, North Stars, and the conversation we flew to Minneapolis to have

This post follows The Weaponization of Unity.

In Mandarin, four (四, sì) is a homophone for death (死). When I was taking these language classes in my undergrad, I was taught that the similar sound is why you won’t find a fourth floor in many hospitals and hotels across China. The number is usually skipped, the floor renamed or the elevator button left blank.

The ASA conference was on the fourth floor.

Friday

I took the tram to Terminal 2 and the blue line into downtown Minneapolis, turning over the same questions I’d been sitting with for months. What is the minimum training that keeps an acupuncturist safe? What ensures that someone entering the profession understands the roots of this medicine well enough to practice coherently while they continue their lifetime of learning? What do employers actually need from our graduates?

I checked into the hotel, hung my suit jacket, and went to meet my colleagues for burgers. I was excited to hear from our ASA reps what other states were doing, what people were thinking and whether the momentum we were feeling in Oregon was being felt everywhere else too. They told me that so far, most conversations were focusing on dry needling, an important topic for sure, but I was confused as to why the sustainability of an acupuncture workforce wasn’t on the priority list.

We woke up early the next morning and walked the twenty minutes to the conference hotel. I took the escalators up to the fourth floor.

Saturday Morning

There were bright spots. A panel of practitioners from a large Minnesota hospital system came on stage and talked about their work. These were the unicorns of the profession, existing because of a large NIH grant. The crowd reacted to them as such. They told us about their salaried hospital jobs with healthcare benefits and how their allied health colleagues even clapped when the acupuncturists walked into the treatment room. They brought stories about being recognized as essential parts of the care team. It was exactly the kind of thing our team has been trying to call attention to: we need these jobs to exist as the norm, and we need the employers offering them to help define what entry-level training should look like to fill them.

After this, I wandered the vendor area with a colleague and met a practitioner who runs multiple schools. When we asked how he was planning to respond to the education crisis, he pulled us to the side and dropped his voice to a whisper. That instinct (to lower your voice when the topic comes up) told me something about what kind of conversation was going to be possible here.

The only dedicated space for discussing the education crisis during the entire conference weekend was a lunchtime table talk, set in a loud and busy dining room. It was facilitated by someone associated with a group of acupuncturists I deeply respect, who have been doing meaningful work trying to hold space for these conversations nationally. I had been looking forward to this.

Before lunch I found myself face to face for the first time with a senior ASA leader who also holds positions in exam development and state relations work at NCBAHM. This is a person our team had spent months corresponding with, correcting the record with, offering calls to, sending data to. We had identified this person as the likely source of the misinformation circulating about our work.

I went up and introduced myself. They said, “Thank you for coming to say hi. How old are you?”

“Fifty,” I said, unsure of how that question was appropriate or useful.

They declared their older age, never acknowledging the younger colleague standing next to me. Then they told me about their practice and how they sometimes treat multiple people per hour, often giving services away or charging fifty dollars, “which is a community acupuncture rate.” I support community acupuncture (CA) training and practice on my Substack and so I thought they might be confused that I run a CA practice. I let them know that I currently treat people out of a yurt in my backyard.

Their response was to abruptly tell me about the death of someone close to a family member of theirs. I had to offer my condolences at that moment, which I did. The conversation we needed to have would have to wait.

Saturday Lunch

We made our way to the lunch table for education discussion. Four members of our Oregon team sat down. Practitioners from other states filled in around us. The ASA/NCBAHM leader sat next to the facilitator.

The facilitator opened with an invitation to introduce ourselves and take turns speaking without interrupting. I know this framework well. I run circles like this myself. It works beautifully in the right container. But it wasn’t designed for a room where people were finishing lunches and drifting in and out, and it struggled to hold the weight of what was already present at that table. We arrived carrying two months of documented misrepresentation of our work. That doesn’t dissolve in a circle agreement, especially in a chaotic room with unrecognized power dynamics.

Nobody asked what we were doing in Oregon. And when we tried to introduce the data we’d spent months (for me, years) building, we were told we weren’t being unifying. We were being divisive.

When the table talk ended I found myself hugging the representative from Ohio, who had made space for me to speak even when others wanted to move on. I also had a sincere conversation with a national leader who was clearly interested in an honest reckoning with what was happening in our profession. I appreciated that more than I could say.

And then someone told me I reminded them of another activist in our acupuncture community . This is someone I respect, but whose approach is very different from mine. The person making the comparison wasn’t aware that the ASA/NCBAHM leader at that table had spent months deliberately conflating me with that same activist in order to manipulate a long-time distaste for many folks in the profession and frame our team as trying to deregulate acupuncture and remove the examination requirement in Oregon. The ASA narrative is the opposite of what we are actually doing. It was a strange moment to watch the misinformation arrive at me from someone who had no idea they were carrying it.

We had also been told, as practitioners at the doctoral level with decades of clinical experience and months of interactions and research around this specific topic, that we needed to listen to the experts and the people in Washington. Even though the majority of people we interact with know very little about the AHEAD framework Do No Harm metrics, it is assumed that these people know more than us.

My Sifu, who is from Hong Kong, often reminds me that it is important we teach children not to blindly follow authority but to constantly question. He talks about the communist revolution in China and what happens when people do not fully participate and work to understand the hierarchical structures that would undermine their sovereignty. I think about that a lot in this work. Because here we are, being asked to defer to the very “experts” who created this mess in the first place.

The evidence of their stewardship is right in front of us: graduates carrying six-figure debt, a lack of jobs and income so low we are about to lose access to graduate loans and an accreditor so financially fragile it faces simultaneous pressure from a federal recognition review, new earnings metrics, and more and more school closures. These are not the outcomes of competent stewardship. They are the outcomes of a system that optimized for its own survival over the health of the workforce it was supposed to protect.

Deferring to that expertise is not humility. While it might be performing unity, in truth, it would be complicity dressed up as professionalism. I already did that when I taught at the schools, when I participated in a system that was harming our students. Back then I didn’t understand what I was doing. I understand now. And I will not be part of it any longer.

Later that afternoon, as I moved through the room talking with people from other states, the ASA/NCBAHM leader was there too: never engaging with me directly, but appearing at the elbow of people I was mid-conversation with, leaning in, whispering, then moving on. Their power in that room was so established that they felt they could behave that way openly. The question of incompetence or design was answered for me in those moments.

A Walk to the River

After lunch, my colleague and I walked down to the river to let our nervous systems reset. She was quiet for a while and then said: “I thought coming here, being around other acupuncturists, I would feel supported. Instead I feel attacked.”

So did I. Our whole group did. Was that the point?

That evening was the ASA conference dinner. One hour in a large room with no agenda and no structure. There was noise and distance. Our team and one of my students sat together at a table largely by ourselves. After the majority of the leadership left, we took the next round of busses back to the hotel with the other attendees.

Behind the National Curtain

On the bus, one of our younger team members handed out some cards she had made. These cards asked for folks who wanted to join us for drinks in the evening. This was an act of joy and simultaneously an attempt at collaboration with other states. They had a black background with gold lettering.

Acupuncturists After Dark, one side read.
Join us for an honest conversation behind the national curtain, said the other.

From the back of the bus we said take one and pass it forward.

After we disembarked from the bus, we walked to a British pub nearby. Some practitioners from other states joined us and it was lovely to talk with them. We also noticed some folks from state associations who went to sit in another room of the bar. These people had been warm and welcoming to us when we first arrived. One of my team members and I walked over to sit with them, since there was space on the couch.

“Can we sit here?” I asked.

“We don’t want to talk about the Alliance,” one of them shot back at me. They meant the Acupuncture Workforce Alliance, the group we formed to try and figure out how to make more jobs like the unicorn jobs that were presented to us that morning.

I looked confused. She continued: “We don’t want to talk about politics. We’re just talking about our families.”

“We have families too,” I said. “But okay.” And the two of us walked away.

Here is another word that is weaponized: politics. Our work to ensure that our profession survives this administration, to protect the workforce, to create a safety net for graduates and to ensure Oregonians can access acupuncture care is, apparently, political. But buying into the structures of institutional power that maintain the status quo at the expense of that workforce? I guess that’s just how things are.

Sunday

Sunday morning opened with a panel on obstetrics and birth, highlighting four practitioners doing beautiful, rigorous work integrating acupuncture into maternal care. This is the kind of work that reminds you why this medicine matters and what it can do when it’s given room to show up fully. I was moved by it.

And then the ASA/NCBAHM leader, who was part of the panel, took the microphone.

They veered from the conversation to tell the room they had been on Facebook that morning and had seen conference posts tagging the ASA with gratitude and the meaning people were taking from the weekend. And then, they said, someone had tagged them in one of these posts, questioning why national certification standards matter and why a job would require NCBAHM certification.

Through days of this person’s whispers, the people in the room had been “educated” to believe that this was the crux of our work, even though our work is about the regulation of acupuncture in our state and the maintenance of safety in our state. Of course, many turned to look at us. That was the point.

On stage, the ASA/NCBAHM leader continued with a defense of national certification standards, though I’m not sure who that was for. I don’t think anybody in that room has ever opposed or argued against the need for a comprehensive examination for acupuncturists.

We went to the ASA Facebook page and clicked on “mentions.” We reviewed the four posts from the conference that weekend that had tagged the ASA. We checked the ASA/NCBAHM leader’s Facebook page as well. We found no such tag. No such post.

A week later, I sent a formal written request with screenshots of all the tagged posts from the conference weekend up to that Sunday morning. I asked for a screenshot of the post they had referenced from the stage.

We are still waiting for any kind of response from that individual.

My North Star

Before I came to Minneapolis, our team had each identified a North Star, something to hold onto when things got hard. Mine is a sixteen-year-old girl in rural Oregon who wants to study acupuncture and bring the medicine back to her community. She needs the pipeline to stay open and she needs it to stay accessible. She needs to get through without massive loan debt so that she can go back home and work.

I held her onto her while I walked that fourth floor. I held onto her on the bus. I held onto her at the bar and at the river and in the loud dining room where we were told our data was divisive.

Sunday afternoon brought an incredibly inspiring research panel and a beautiful presentation on moxa. It was the kind of afternoon that reminded me the profession is full of people doing serious, committed work. These people deserve honest institutions that serve them.

That evening, after the conference ended, a few of us found a quiet corner of the bar at the venue. Representatives from other states pulled up chairs. They had real questions about OBBBA, about what Oregon was actually proposing and we followed curiosities around what the numbers meant. We listened and talked for a long time.

That was the conversation we had flown to Minneapolis to have.

It just couldn’t happen on the fourth floor.

The next week, these institutions followed us home…