Acupuncture Today and the Terrible, Horrible, No Good, Very Bad Numbers

Although I have a whole bunch of other things I really ought to be doing (more on that later), there’s this article in last month’s AT that I can’t seem to stop thinking about. So in honor of my two-year anniversary of being fired as a columnist of AT (thanks for the reminder, Keith! I opened a new box of wine to celebrate!), I’m going to offer you all a little commentary, punctuated by some basic arithmetic. Please, everybody, check my math — are these numbers really saying what I think they’re saying?

The article starts out exuberantly:AOM soaring dramatically! Use jumps 50%! An estimated 3.1 million Americans used acupuncture and oriental medicine in 2007, a 50% increase since 2002, according to a study released by the federal government. (NCCAM, that is, a division of the National Institutes of Health.) Over 3 million!  Sounds good, right?

Well, for about a minute or so, until you remember that the total American population in 2007 was in the neighborhood of 300 million people. (It’s now about 306 million people.) If 3.1 million people used acupuncture in 2007, that’s equal to about 1% of the population. Another way of stating that? 99% of Americans didn’t get acupuncture in 2007.

If you think about it some more, it gets a lot worse. 3.1 million Americans used acupuncture — how many acupuncture treatments do you think that adds up to? I have no idea…but it shows that we’re not talking about treatments, but individual patients, right? How many individual patients do you think it takes to make up an acupuncture practice? A practice that isn’t a hobby, a practice that doesn’t require the acupuncturist to have a day job?

For each of the past two weeks, WCA saw 50 new patients. We had our usual 420-ish total patient visits, but how many unique individuals, besides those 50 new folks, are we seeing? And what would this suggest about acupuncture practices in general?  Who knows? First, WCA is a behemoth among acupuncture clinics, and second, we have some patients whom we’ve been seeing for years and years and years. Relative to other acupuncture practices, our overall visit numbers are much higher, and our individual patient numbers are probably a lot lower, because we have so many “regulars”. So let’s look at a more typical practice. I have a friend, a community acupuncturist who opened her practice a couple of years ago, who sees around 50 patients per week, and I know, because she told me, that most weeks she has about 4 new patients per week. So in the course of a year, she sees 200 individual NEW patients a year. I’m guessing that, to keep up her totals of 50 visits per week, she probably has a total individual patient count of somewhere between 1000 and 2000 unique people per year: that includes all her regulars, all the “tourists”, all the folks who come in twice for a sprained ankle, all the folks who come in during the spring when their allergies get bad and then don’t come back again until next spring — you get the idea. It’s hard to figure out how many individuals we’re talking about in a year when we are counting the weekly visits. But we can estimate.

How many unique individuals do you think we are talking about for a boutique/conventional practice? If a BA practitioner wants to support herself, she probably is going to need more than the 1,000-2,000 individuals per year that my CA friend needs, right? If she’s taking insurance, we know that insurance only pays for a limited number of visits, and it never pays for prevention. And we all know from experience that fewer people stick with long-term treatment in a BA practice. So you are necessarily talking about a wider pool of people. How many? I’d estimate 2,000 individuals per year at the low end.

OK, let’s do the math. In 2007 there were something like 20,000 licensed acupuncturists in the U.S. Maybe it was a little less or a little more, but 20,000 is a nice round number and it’s in the ball park. For the sake of those nice round numbers, let’s assume that every one of those 3.1 million people got their acupuncture from a licensed acupuncturist, as opposed to an MD or a chiropractor  — which we know is highly unlikely, but let’s just give our little profession the benefit of the doubt here. So 3.1 million patients divided by 20,000 licensed acupuncturists is…

155 individual patients per acupuncturist.

The first time I did that, I thought I must have screwed up the zeroes somehow, so I did it again. I did it in reverse. That can’t be right…but if it IS right, what does it mean?

Let’s be really, really conservative, and say that an acupuncturist of any variety who wants to have any kind of a steady income needs about 1,000 individual patients to show up at her practice at some point in the course of a year. We know that’s too low a number, but let’s use it anyway to compensate for all those acupuncturists who say they’re not practicing because they don’t want to right now, just had a baby, are going to China to study, whatever; let’s pick a low average because we know a lot of acupuncturists are not busy “by choice”. So 1,000 times 20,000 — if that were happening, the federal government should have found that 20 million people got acupuncture in the course of 2007. But no, they found out that it was only about 3 million. That is a whole lot less than 20 million. In fact, 3.1 million is  only 15.5% of 20 million.

Just for fun, let’s take 15.5% of 20,000. That comes out to 3100. 

3100 is a generous estimate of how many of those 20,000 acupuncturists are actually working.  If you estimate individual patients per acupuncturist at the higher range of 2,000 per acupuncturist per year and do the same math, we’re looking at 1500 acupuncturists or so who are actually working — in the whole entire US.

That suggests a failure rate of at least 85%, probably higher.

So what that “soaring” AOM use of 3.1 million patients in 2007 really means is that the acupuncture profession is screwed even worse than I thought it was…and wait…this is 2007 we’re talking about, back before the recession kicked in.

Last year, I had a very short, very unpleasant tenure as the president of the Oregon Acupuncture Association (it was even more unpleasant for the Association than it was for me). I took that job mostly in the hopes that I could do a survey of L.Acs in Oregon to find out how many of them actually working, and how many patients they were seeing. The survey didn’t happen, for a whole bunch of reasons, but I did get to look at a lot of mailing lists for L.Acs, and I got to know a bunch of people, and I think I got a pretty good sense of the lay of the land. When I think about it now, I’m pretty sure that of the 800 or so licensed acupuncturists in Oregon, I can only come up with a list of about 20 or so that I know are busy — by which I  mean busy seeing patients, not dependent on a spouse, not employed by a school. Let’s say my list is way too short and multiply it by five — and remember too that most of those 800 acupuncturists are actually in Portland, because most of the people in Oregon are also in Portland, so I might actually know what I’m talking about here. 100 acupuncturists working. 15.5% of 800 is 124, so yeah, similar numbers. And Oregon is one of the states that has a relatively high number of acupuncturists.

OK, and now I have to ask — why is that terrible, horrible, no good, very bad 3.1 million number splashed triumphantly on the front page of AT as if it were good news? Why is there not public consternation throughout our profession about what it really means? I’ve wanted forever to do a survey of acupuncturists, but the government saved me the trouble: counting patients is a much better way to figure out what’s really going on. But why am I the one, yet again, who is doing the math here? Isn’t there somebody more qualified who should be analyzing these numbers? Why am I the one bringing this up?  Because our profession cares so little about patients, we don’t even know how many of them we need, that’s why.

Another thing that these numbers mean, all you new acupuncturists who are nervous about the market being “saturated” (like it is in  Portland, right?): it’s not. Not at all. The truth is more complex and problematic than that. It makes me think of that G.K. Chesterton quote: Christianity has not been tried and found wanting; it has been found difficult and not tried. The market for acupuncture has not been tried and found wanting; it has been found difficult and abandoned by acupuncturists, en masse. That’s what those numbers really mean. 3.1 million patients, somewhere in the neighborhood of 1500 to 3,000 practicing acupuncturists, after 20 years or so of the acu-establishment’s efforts to mainstream acupuncture in America, that’s it? On a fundamental level, our profession is not trying. So take heart, new CAN acupunks: you are doing something that almost nobody has tried yet, something so different that it is going to take the market a while to understand what you are offering. What we’re doing isn’t difficult because we’re doomed, it’s difficult because we’re new. And ultimately it will work because we are trying.

But while we’re on the subject of doomed, let’s revisit conventional acupuncture.  CANners, I’d like  you to tell me: how many acupuncturists do you know, really know, in your home state who are busy? If you started your practices recently and can still count your patient files (unlike at WCA,  where we need a forklift to deal with our files), how many individual patients do you think you will treat in a year? Is the picture as bleak for acupuncture as I think it is? And extrapolating from these terrible, horrible, no good, very bad numbers, and factoring in the recession, how long do you think it will be before community acupuncture clinics are providing the majority of acupuncture treatments in America? How long before we are the majority of acupuncturists? How do you feel about the large responsibility that is coming your way? ( I think we’re doing pretty good in terms of fulfilling our responsibilities so far — and hell, at least we’re trying, not just to reach patients but to help acupuncturists.)

Thanks for following me through the Arithmetic of Doom there, thanks for listening yet again. Hopefully now I can stop obsessing about that article and those numbers and get back to my ever-extending to-do list, because in other news, we just signed a lease for our second location. WCA Jr., opening spring 2009. Detailed blog posts coming soon — and yes, it will be fully staffed by monkeys.

Author: lisafer

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


  1. Acu vs Homeopathy

    Interesting that Homeopathy is more popular than Acupuncture, 3,909,000 for Homeopathy vs 3,141,000 for Acupuncture.  When you think that “Homeopathy” here includes anyone who bought a vial of Arnica or that flu stuff at the store and not just office visits, that’s all the more damning. I love Homeopathy but it practically defines “fringe” in the medical world of the USA. Acupuncture is below that.

  2. 4815162342

    i think personally the numbers are lower than anyone wants to admit to.  it’s really challenging to get a good fix on what’s going on with the profession, even in good economic times I have found other acupuncturists reluctant to share their numbers,  unless they are doing really well.  There was a job analysis survey by NCCAOM in ’03 (can’t find it online but AT has a blurb), and i thought they did another one last year.  One of the bullets from the ’03 survey highlighted the fact that 49% of respondents saw 11 – 29 patients /week.  I’m not buyin’ it.  maybe 49% of respondents, but not 49% of the total the U.S.

    I suspect that very few, maybe 10, 15, possibly 20   are busy enough here in Tucson to make a sustainable living just from needling in private practice.  There’s so much potential here and everywhere.  One million people in Tucson and one CA clinic.  egad.


  3. Boxed Wine…

    …that’s classy.  Will you be opening a real bottle for the grand-opening of Junior?

    Hey, what was the problem with surveying acupunks in OR?  Did you actually get a survey put together, one that you could post in the forums?  If you have time, I’m interested in hearing more about that…

  4. Thanks for doing all the

    Thanks for doing all the math for us Lisa.  I wish we could see your post published in AT as a counterpoint to their article. 

    To combat such horrible numbers, anybody up for a survey of CANers?  How many of us are making it- seeing enough patients and supporting ourselves?  Or for newer clinics, on track for supporting their acupunks in the future?  Has anyone actually set up a CA clinic and failed?  If so, why? 

    This article also begs another question, what is keeping the rest of America from getting acupuncture?  Lack of practioners in their area, lack of affordability, not aware it could help them??

    The numbers are horrible but I’m eternally optimistic about CA…and my clinic isn’t even officially open yet. 🙂 


  5. About those schools

    Let’s see…. About 50 schools, each graduating, let’s be conservative and say 40 students each. 2000 students graduate each year. So going by Lisa’s numbers of those 2000 graduates maybe 300-400 will actually to make a living in our business. If there are any students reading this, oook around in your next class and realize that 8 out of 10- at least- will fail.


    Ann- I wonder if Will tells his students that.

  6. I’m going to need a bigger filing cabinet.

    Lisa, I don’t know whether to laugh or cry – all your posts lately are about how there really is no acupuncture profession.

    I actually was really inspired by this because it kind of made something click in my brain, something I should have already known and which was just in my peripheral understanding: that it really is a numbers thing.  I think it was the number 1000 that did it.  If I have to have 1000 patients on file before I can really reliably give 50 treatments per week, then I just have to get a *lot* of people to try it.  Which is what I want to do anyway.  But it takes some pressure off knowing that business can only go so well until then.  A lot of those 1000 will be “tourists” – my main goal with them is just to make sure they don’t have a negative experience, and then let them go and on to the next patient.  It’s almost like acupuncture as speed dating, only not so monogamously oriented.  Theoretically there should be some kind of tipping point where it gets easier for the new clinics to get to 1000 (because more people are willing to try it and have more reasonable expectations for it), but obviously we’re nowhere near that.  

    Here’s a related question for you folks who have been in practice for awhile: what’s your experience about what point – how many patients average per shift, or what % of capacity – the qi of the treatment room really start kicking in?  Because it really does feel that at a certain point it becomes a lot less work – partly because there’s more word of mouth built up, but partly I think because the room is doing a lot of the work.

  7. I saw that article…

    …and I had the same reaction.  Actually, I laughed out loud standing right there in the student lounge at my school.  Another student asked me what I was laughing about, and I told her.  She didn’t think it was that funny.

    I guess whoever wrote that article was banking on the fact that 95% of people who read it aren’t going to think critically about it.  They’ll just see the headline “AOM use soars” and maybe the byline “use of acupuncture has doubled” and leave it at that.

    The prevailing attitude amongst my classmates in relation to this issue seems to be “don’t ask, don’t tell”.  In other words, they don’t want to hear any bad news about the state of our profession.  School is stressful enough as it is, and if they start to think about how they’re actually going to pay back all of the debt they’re incurring, well… it becomes overwhelming pretty fast.

    Fortunately or unfortunately I’m one of those people who wants to hear the cold, hard truth even if it scares the s$#t out of me or sends me into a depression.  It’s way more unsettling for me to just put my head in the sand and ignore reality.  Denial doesn’t work well for me.  Sometimes I wish it did.

    The “artihmetic of doom” is certainly terrifying from a certain perspective.  But then again, as Lisa pointed out, it’s also a reason for hope.  99% of the population is a completely untapped market!

  8. Not a bottle — just a really big box!

    We designed a survey, but I don’t know that we kept it. There were lots of different kinds of problems, most of them with the OAA itself — but regardless, the thing about surveys is that acupuncturists don’t answer them. I had thought about actually calling all 800 L.Acs in Oregon and asking them, flat out: how many patients do you see? But now I don’t think it’s worth it. I think I know the answer — and it does make much more sense to ask patients, because they have no reason to lie.

  9. All of the above…

     Lack of practioners in their area, lack of affordability, not aware it could help them??

    But ultimately I think it comes down to this dysfunctional “professional” culture we’ve got, where we don’t think about patients enough to even realize that we need to count them. In the acupuncture world, patients don’t count. All that counts is our self-referential bureaucracy. It’s amazing that we have any patients at all.

    Not that I’m bitter about this or anything. 

  10. beyond filing cabinets

    We’re going to actually need to figure out how to go paperless, because the physical space that our files take up is becoming a problem. They are engulfing the clinic(and you’ve seen how much space we have!). When we figure out how to do it, we will definitely let you all know.

    Sometimes I look at our files and think, no one would believe that this many people were actually willing to try acupuncture unless they saw this. It’s kind of stunning.

    But yeah, it is a numbers thing. At this point I feel like my goal with ALL new patients, even the ones I don’t think are tourists, is to explain the general parameters (you need to get a lot of acupuncture for it to work) and then just to make sure they have a good experience. They will make the decision to come back or not based on how they feel with the needles in, so the only thing to do is to get the needles in as fast as possible. “Like acupuncture as speed dating, only not so monogamously oriented” might be my new favorite way to describe how to do new patient intakes. (I have some theories about the intersection of community acupuncture with polyamory, but that’s another post.)

    And yeah, I know, I can’t quite get over the fact that there is no acupuncture profession, and I can’t seem to stop talking about it. The really great irony in it all is that I think I’m finally not so angry anymore — not because I miraculously became nice, but because it’s hard to be angry at something that apparently isn’t there. It’s a mirage. And that makes me have faith that eventually it WILL get easier for new clinics to attract people, because we are NOT a mirage, we are really here, and at some point, that is going to sink in with patients in large numbers.  

  11. Yes!

    I can’t wait for the polyamory post! (And definitely keep us posted on paperlessness, and Spawn of WCA.)

    And yes, I guess I approach all patients that way, too – after all, you don’t really know who is a “tourist” until they don’t come back.  But even if I do get a sense right away, I don’t feel like my time with them was a waste (short initial intakes help with this!).  Now they have more of a sense of what acupuncture is about, and they had a pleasant experience (for not a lot of money).  They could come back in a year, they could send in their friends, or they could just go on their merry way.  Next!

    P.S. I love Judith Viorst!  “The Tenth Good Thing About Barney” is one of my favorites.

  12. 4 8 15 16 23 42 … 10.8 hours later …

    (this reply updated with California stats 2/17/09)

    here’s a fun little nugget dug up on the nccaom website:


    check out the n=number of test takers column.

    especially school FTTT and other FTTT (add these together)

    just for the acupuncture module, the total number of FTTT declined from 2006 to 2007 from 1633 to 1153.  whoa.  decrease of 30%. *

    California’s numbers * (people who pass the exam):  california also nicely breaks down the numbers school by school, and over time you can get an idea of numbers of graduates from each school.

    Overall numbers of Calif. pass-ees here (which i am roughly equating to number of graduates, but not including the unknown variable of some who just can’t pass the test):

    2008   —  597

    2007   —  726

    2006   —  707 

    2005   —  660 

    2004   —  502 

    2003   —  723  

    2002   —  665

    2001**-   295 **  (600?)  – see below

    2000   —  637


    *Cali publishes its pass rates on its acupuncture examiner board website going back to 2000.  I am assuming that the number of people who pass the California exam roughly corresponds to the number of new licensees in California each year.  California also has a significant number of people who fail the test each time, so I am only looking at passers.  I am guessing that a fair number of non-passers retake the exam, trying to pass, so i am hoping in some way that these numbers indicate to some degree the numbers of students graduating from schools in California.  There are a small number of non-California school test takers, but let’s leave them out for now, it’s a small number.

    **  2001 pass numbers for California seem to be an outlier and statistically insignificant.  Cali only listed one group of pass rates for 2001, every other year they have listed pass rates every 6 months.


    Initial conclusions:

    It would seem, based on these numbers that there about 600-700 new licensees in california each year, and somewhere between 1200 and 1500 more nationwide (if NCCAOM’s stats stay consistent year to year).  That’s around 2000 graduates per year (roughly), nationwide. Personally, I thought this number (2000) would be smaller because i know of quite a few small schools that graduate < 10 per year.


  13. paperwork reduction, faith, and mirage-like profession

    Things are picking up again after a little winter downturn here at CommuniChi…and we just got our second 4 drawer filing cabinet ($10 from a garage sale).  Last week we had 81 patient visits, our best so far this year. I didn’t count the number of newbies, but I’m guessing close to 20-25 this month so far. 

    The one concern I have heard about paperless storage is security and the possibility of having your computer hacked, but perhaps there are safeguards to prevent this.

    Regarding minimizing paper – Our initial pile of paperwork is four sheets – eight sides: history, registration, consent, arbitration. We write the first first treatment directly onto the upper corner of the registration form – that way, if the person is a tourist and doesn’t come back, we don’t waste a whole sheet of paper just for one treatment. If we switch to an insurance company that doesn’t require arbitration, that will cut the initial paperpile by 25%.

    Once they come back for return treatments, we use a return visit form which is a two sided sheet of paper with about 25 to 30 lines on each…enough for 60 treatments.  A few of our patients have come in for around 100 visits and are getting close to a 3rd sheet of paper.

    The mirage-like profession: “it’s hard to be angry at something that apparently isn’t there.” I’m going to meditate on that all day.

    thanks for the reality based faith and inspiration in the promise of trying something truly different – community acupuncture.


    All true religions seek to gain access to that level of consciousness which is not ego-bound.

  14. It gets worse

    Just as telling about the state of denial this phantom
    profession is in was the second big good news story that is really a very bad
    news story plastered on the other side of Acupuncture Today “Battlefield
    Acupuncture!” While great news for the military personal getting this simple,
    effective therapy, it spells big trouble for the incredible shrinking acu Dr. profession.
    The real story here is that a medical doctor is teaching other medical doctors
    a protocol of five ear points that is so simple to learn they plan to
    eventually teach soldiers in the field to do these treatments also. And what
    path do the leaders of the acupuncture profession have us on? Increasing
    training hours! Put these two stories together and we see a trend of non-traditionally
    trained acupunks with much closer ties to medical establishments competing to
    treat 1 % of the U.S.
    public. Hooray!

  15. There is another way to look

    There is another way to look at that issue.  We can and will change that 1% number. The more people who learn about acupuncture the better it is for those of us who choose to make acupuncture accessible, we don’t need to worry about market saturation or competition, we just need to get the word out about the benefits of acupuncture.  Those soldiers will get out of the military, and if their experience was positive they will show up at CA clinics (most former soldiers aren’t wealthy).  They will tell their families about the benefits and the fact that it is being used in the military will help people take it more seriously.

    This could even be helpful to the idea of a tiered profession. 

  16. Another great essay, Lisa!

    Another thing to factor in, is that in cities that have acupuncture schools, many of the acupuncture patients are actually seeing student interns, not LAc’s. 


  17. Let’s do a survey

    Seeing that none of the non-profit associations have got their act together, I’ll volunteer to do the survey. Let’s make it a joint effort between Acufinder and CAN

  18. We’ve seen about 800 appts

    We’ve seen about 800 appts so far this year with probably 120 new patients, not including promotional new people.  It’s so hard to project our numbers across the whole year because we plan to hire a acupunk within the next few months which will open our hours.  We also may rent the space adjacent to ours which would expand our hours exponentially plus allow us to hire at least 3 more. 

     How long before CA is the norm?  Good question.  My guess…2 years.  I have nothing to base that on but my gut, which is also telling me that I want to eat a tamale right now so take it for what it’s worth.





  19. CA chatter in Seattle

    A lot of established acupunks are making moves as if to open CA clinics…I know at least one of them will be a hybrid – which I advised against, so we’ll see. I think local acus are feeling the effects of the economy…and the horrible, bad numbers.


    All true religions seek to gain access to that level of consciousness which is not ego-bound.&a

  20. And Will Morris

    Hi Ann – That statement is not entirely accurate in that I did not communicate that “I am not concerned about the future of schools,” given an extraordinarily complex dialogue that ranged across a number of topics. Here was the essence of what I was attempting to communicate:

    I did say that I believe that acupuncture will survive and continue regardless of what happens to schools.My core message and concerns in that conversation were these:

    patient access to care, regardless of class.

    practitioner success

    The imbedded message for me is that the success of a school is dependant upon the success of items 1 and 2. 



  21. Just got a Seattle visit

    We were just visited by some very lovely Seattle ‘punks interested in CA.  I advised against hybrid models.  I can’t remember what was their take on the whole hybrid issue. 

    It is nice to hear that there will be more CA in your area.


    Here in the Bay Area, we get visited or emailed on average once a week by currently licensed ‘punks and students who are interested in CA.  The storm seems to be picking up.




    Circle Community Acupuncture

    San Francisco

  22. Numbers

    I’m a little wary of both calculations. Can we really trust that figure for number of patients? Where does it come from? I agree with what someone said above, that acupuncturists do not report numbers of patients, especially the ones doing well. For example, I know a clinic doing only fertility and charging over 80 per treatment where up to 25 patients a day are seen by one doctor with 2 rooms. Always full. Those patients will never be reported by the doctor, and many of these patients are actually likely to not admit getting treated.