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What higher ed could learn from affordable acupuncture

Posted in Higher Education

Much of the pontificating about costs in higher education claims that it’s become fundamentally unsustainable. There’s the famous likening of teaching in higher education to live string quartet performance – something that can’t be compressed for efficiency, done by fewer people in less time, or scaled up. Unless you settle for something far less than this original notion of quality, the thinking goes, costs will spiral along with the number of people you need to do the job.

Perhaps we do conceive of teaching too much as an artisanal enterprise, but it’s also hard to know what exactly the critics have in mind when they ring the sustainability alarm. The implication seems to be that something has to give, but what? The “disruption” crowd, abetted by budget-pressed administrators, pushes for yet-unspecified deep changes, faculty push back with the usual references to meaningful credentials and deep learning, and nothing moves.

In the disruption debates, we hear a lot of comparisons between higher education and other sectors. The music industry is a favorite, what with the references to unbundling and wholesale demolition of entire aspects of the infrastructure in favor of efficient delivery. I tend to be more partial to a view I heard once from a journalist turned administrator, likening our situation to that of news reporters right before the Web wiped out print media.

But there’s another unlikely-sounding analogue that I think is worth a look: acupuncture. You may or may not gravitate towards this particular health care approach, but it’s an important component in the alternative and complementary medicine toolkit. The point here isn’t how acupuncture works; it’s how it’s delivered, and at what cost.

In the United States, getting acupuncture has traditionally meant seeking out an independent practitioner and setting up an individual appointment, where you will spend time first discussing your aims for therapy and other concerns, then getting your needles placed, then hanging out while the needles do their thing. That plus the time to remove them and wrap the appointment up is a one- to two-hour affair, much of it spent in one on one time with you and your practitioner.

This is where sustainability becomes an issue. Acupuncturists study for years to get licensed, so quite reasonably, qualified people are expensive. Insurance may or may not pay, and even if it does, not all practitioners want to take on the burden of dealing with billing (would you?). Patients are therefore usually looking at an out of pocket cost of $75 or more for a session.

This would be manageable but for the fact that acupuncture is meant as an ongoing course of therapy. Treated as a one-shot (sorry) fix, it is unlikely to do much; even going once per month is probably not adequate. The ideal course of therapy would involve 1-2 sessions per week for several months, which starts to add up to a sum that, if not exactly comparable to a college tuition bill is a significant bite for nearly everyone.

So when it’s done in a way that actually delivers results, acupuncture is out of reach for most people – that is, unless you overhaul the 1-to-1 treatment model. Such an overhaul has actually taken place, and unlike in higher education, it’s been done mindfully and in a way that doesn’t devalue the practitioner’s skills.

The community acupuncture model, such as that advocated by the POCA organization, aims to deliver the essentials – treatments by qualified professionals, geared to the problems the patients want to address – while creating efficiencies that let practitioners serve more patients in less time.

Key to this is that you’re treated in a group setting rather than one at a time. Picture a large room with mellow lighting and recliners; white noise machines by each one help ensure that your conversation with the acupuncturist remains private. The practitioner circulates from person to person, offering short consultations, setting the needles, and coming back to take them out after the 45-minute wait time.

It’s is a different experience than a traditional private treatment session. But the essentials are still delivered, and the cost savings are stunning. At our local POCA clinic, you pay on a self-determined sliding scale, $15 to $30 per treatment. There’s no insurance involved, and the system is built for efficiency, with many patients skipping an elaborate reception ritual and simply checking themselves in via an iPad station (saving costs through technology!).

What can we in higher education learn from this? First, it’s an interesting contrast to our own commitment – or lack thereof – to really tackling the cost issue, in a way that is realistic about what we can and can’t do at scale, and while remaining focused on the ideals of expanding access. Too often, our cost discussions, such as they are, are mired in posturing and accusations about what people ought to be willing to pay for and what they are actually getting.

In this one corner of health care, practitioners have stepped up to take seriously the question of who gets to access their services and how they can expand that. Notably, it’s not about creating a professional underclass, and it doesn’t just shift costs to a new payer, or onto the debt burden of clients. It looks to deliver the essentials only – having made the effort to determine what those are –  and passes the savings on. Yes, practitioners have a different set of working demands, but for those who go into it with eyes open and expectations set accordingly, it’s sustainable.

Is anyone in higher education open to this? One new venture, Minerva University, has some glimmer of the idea, steering completely clear of expensive university infrastructure (gyms, counseling centers, tutoring programs) in its setup. It’s hard to know what to really make of Minerva, as it exists in the fog of hype and techno-fetishism obscuring a lot of educational innovation today, but if it does end up making a mark, I think that will be owed at least in part to that philosophy.

And the course redesign movement has long espoused the idea that it’s better to be upfront about the fact that large, cheaply-delivered courses do not in any way replicate the small-class experience; rather, the idea is to look for ways to challenge and support students that work at scale.

But, on the whole, we continue to talk past each other, trading barbs about corporatization or being stuck in the past. It would be nice, for once, to set the rhetoric aside and take an honest look at what success could look like.