In Which Even They Admit It’s All About the Money

The First Professional AOM Doctorate
Fact Book  (thanks to Jessica for making a link! Note: the authors of the Fact Book have requested that we i>remove this link)is clearly meant to defuse opposition to the FPD. The tone
is even, reasonable, authoritative – tastefully bureaucratic, you
might say. But the amazing thing about the Fact Book is, for alert
readers, how instead of defusing anything, it accomplishes something
entirely different: it crystallizes the essence of why we’re opposed
to the FPD – and it draws attention to all of the reasons why we
should remain opposed. The Fact Book is trying to say: look, the FPD
is really no big deal! And yeah, actually, that is almost true –
the FPD is not such a big deal, compared to all of the other problems
with the acupuncture profession that the Fact Book unintentionally

Check out these quotes:

Quotes removed by author request. Use your imagination, folks.

Translation: This is really all about
the schools. The schools (AKA the folks who brought you the “bloated
Masters degree” ) want to develop a new product. This new product
is much too expensive for anyone to pay for out of pocket – were it
not for this glitch, the new product would have been rolled out
already. The schools need people to be able to borrow money to
afford their new product. How much money? They have absolutely no

And they need to establish consensus in
the profession to allow them to proceed.

Consensus is a difficult thing to
establish, but not only because of our vocal and sustained
organizing against the FPD. It’s difficult for a more fundamental
reason: nobody can get an accurate head count of “the profession”.
Nobody actually knows how many practicing L.Acs are out there. Nobody
knows how many of those are supporting themselves. The NCCAOM is not
releasing its most recent study of practitioner income and
employment. Three guesses as to why they’re not releasing it, and
the first two don’t count. Nobody counts practitioners, and that’s
because we don’t count. The schools and the alphabet agencies have
defined themselves as “the profession”, without including us. If
we demand to be included, they have a problem: how can you even
determine a simple majority, let alone consensus, if you don’t know
how many people you’re talking about?

So they put out a Fact Book that is
remarkably short on facts. Other things they admit they don’t know:
whether transfer credits will be accepted for practitioners who want
to upgrade, exactly how the new title might impact state licensure
and state scope of practice, what a transitional doctorate would look
like, what “competencies” really mean in terms of requirements,
whether the FPD will actually increase research opportunities, and
exactly what impact “newly minted” (oops, was that a Freudian
slip?) FPDs will have on currently practicing L.Acs.

One of my favorite parts was this one:
What effect will the FPD have on job opportunities? Quote removed by author request.
Right, let’s not focus too much on those immediate job possibilities,
since there aren’t any! Studies, uncited of course, have shown that
improved education improves earning power – but what would you bet
those unnamed studies were focused on fields that did have actual
jobs, unlike ours? I’d love to see the study that showed improved
education improved acupuncturists’ earning power, because then
someone would have to measure what an acupuncturist’s earning power
actually is, right now. I expect that process would be terrifying.

And, as to “improved, not necessarily
longer”, on page 6-7, the Fact Book makes clear that getting an FPD
will in fact be longer than getting a Masters simply by virtue of the
increased hours of college needed to enter. The Fact Book is written
in very reasonable, measured language – hey, when you are asking
for someone to essentially write you a blank check, it’s not good to
sound too excited – language that should win a prize for

OK, obfuscate away if it makes you
happy, but don’t expect it to work on us. The problem is we’re in no
mood to allow the schools to do ANYTHING. You’re right, the problem
isn’t the FPD itself; the problem is that what has been happening in
the acupuncture world with federal loan programs for years is
flat-out abusive. We’re telling you now; we’ll tell the USDE directly
if we have to. This is a quote from the CCAOM website:

“How much can an AOM practitioner expect to earn?

There are approximately 20,000-25,000 AOM licensees throughout the
United States. While current data concerning the income of these
practitioners nationwide is not available, recent estimates have
suggested an annual salary range of $30,000-$60,000. It is not
uncommon for practitioners to earn in excess of this amount, with
reported salaries in some instances exceeding well over $100,000.”

There’s vague, and then there’s
deliberately misleading. First, most practitioners don’t have
“salaries”, because they don’t have jobs. Their take home pay
from their struggling practices rarely resembles an actual salary.
And it is indeed extremely uncommon for acupuncturists to take home
$60K to $100K+. Sadly, I can point anyone who asks in the direction
of a recent study that puts the average income of acupuncturists in a
Midwestern state at $20K per year. The only $100K figures most
acupuncturists can expect to see are on their student loan

The problem isn’t so much the FPD per
se; the problem is that the economics of the acupuncture world do not
fucking work. Except for the people who have figured out how to tap
federal student loan money, that is. No matter how foggy your
language is, one thing is clear: you want more of that. The most
important fact in the Fact Book is that the bottom line really is the
bottom line, at least for the schools. And as for what it means for
the rest of us, that can remain murky, because really, who cares?

One of the ironies about blogging about
these issues is how often I get accused of lacking personal
responsibility. It’s interesting to note that a number of people seem
to define “personal responsibility” exclusively as being willing
to silently tolerate a bad situation, because you got yourself into
it, after all. Nobody held a gun to your head and made you become an
acupuncturist, so will you just shut up already? I understand what
these commenters are saying, but I don’t agree with it, I guess
because I have a less limited definition of personal responsibility.
Meaning, I’m an acupuncturist; I’m not going to stop being an
acupuncturist; if I don’t like what the leadership of the acupuncture
profession is doing – or what the people who claim to be the
leadership are doing – it’s my job to respond. I take personal
responsibility for what happens in my field. If I think my field is
in bad shape, and I do nothing and say nothing, then I’m personally
responsible for the bad shape it’s in. As Muhammad Yunus said, we get
what we want – or what we don’t refuse. Opposing the FPD is about
more than the FPD itself. It’s about refusing something that we need
to refuse, if we ever want to get what we really want, which is an
honest economic foundation for acupuncture in the US.

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. let the buyer be ware and let the seller be clear on the price

    I have been doing an informal survey of acupuncturist websites and very few actually list their prices.  Is this related to the schools not really being able to say how much they charge or will charge for a masters or new fpd degree?

    I know so many new grads with 6 figure debt.  They feel buried in it, and some are deferring, or making income-based payments, and just accruing more interest because they don’t make enough to make regular payments. 

    I get that it is hard for the schools to know “exactly” how much the proposed new programs would cost them in terms of hiring staff with higher degrees, upgrading libraries, application fees to ACAOM, publicity for new programs, new catalogues, training for existing staff to understand and be able to communicate about the new programs, etc., etc.  BUT, how are we supposed to buy something if we don’t know how much it costs?  Would you buy a new car if you didn’t know how much it cost? Or how  much more the insurance for it would cost?

    The schools themselves are consumers in a way when “buying in” to supporting or piloting a new degree.  How can students trust schools that would gamble with their tuition dollars to pilot new programs?  If I were a student at a school considering a new pilot FPD program I would think about transferring out NOW, before the whole thing tanks and I would have to end up scrambling for my student records, loan information, etc. to hopefully transfer to a new school, if there were another school nearby, if it would accept my credits, and if it wouldn’t disrupt my life and education so much that I would have to actually drop the whole thing, but keep the debt.

    Some students think they deserve a doctor title for all their hard work.  I wish those students could see that they deserve a good education, that will make them safe and effective practitioners and that won’t bury them for the rest of their career in debt.  

    Student loan debt, whether federal or private, is also a consumer product for banks.  The loans (or “products”) have so many different aspects, rates, ceilings, repayment plans, deferment, qualifications, etc….it really is hard to understand what you’re signing up for.  

    All this talk about what an FPD “could provide” but so little information about what it actually will cost. 

  2. If I were a student, and

    If I were a student, and facing a doctorate in acupuncture, I’d go to chiropractic school instead. I’d have a much broader scope of practice, still get to do acupuncture with a little extra training, and could actually get a job after graduation. Plus, I would be more confident that the school wouldn’t bankrupt itself before I graduated.

  3. Whenever I think about the FPD the quote, “You can’t build a house on a crumbling foundation,” keeps popping in my head. I think it was Lincoln, I can’t remember.

    It seems like whoever is at the helm of this thing needs to take a step back and ask why there is so much dissent instead of trying to push it forward. 


  4. inspiring post

    Thanks Lisa,

    Many gems in this one.  I wish every acupuncturist who is either “sitting on the fence”, or just plain apathetic would read it.

    It also struck me how one sided this debate is. The silence is deafening, and one can only conclude that by issuing policy statements like “the Fact Book”, the proponents of the FPD are a) relatively few and therefore unwilling to engage in open debate, because b) there positions are basically indefensible.

    Last I checked there the 3? week old Facebook group opposing the FPD had close to 800 members…


  5. I was in the shower thinking about all of

    this FPD stuff and I need to know something,


    What is a payback plan look like for a student who has 

    borrowed $60,000?  How much do they pay for licensing fees and to maintain their NCCAOM (is that still the name for it?) in case they want to move?  Once you graduate, what do we all pay annually to maintain our licensures?  

    Let’s speculate how much an acupuncturist can make at a hospital with a doctorate?  How many acupuncturists with doctorates will hospitals be looking for?  How about research centers?  With a FPD will acupuncturists have the skill set required by a research hospital to use research methodologies and lead a research team?  Or most likely will you be a research assistant or research coordinator?  How much will they pay for those jobs (for research ass’ts and coordinators for non pharmaceutical studiesn they make about $17 per hour for part time work and subject to the longevity of the grant funding)?  Are they in demand right now?  

    If you are a hospital staffer, how much will you get paid?  do you have to find your own patients?


    Is this information known?…I know Winchester Hospital in Boston’s perimeter has an acupuncturist on staff?  I know that UCSF has hired acupuncturists to do research in the past, is it a growth industry?  How about Hennepin County Medical Center in Minneapolis?  Are acupuncturists still employed there?  Is Pat Culliton still there?  What does she think about the FPD?  Mass General has acupuncturists on staff to treat side effects of cancer treatment but my patients tell me the hours are not very user friendly.  UCSF has the same program as I am assuming MD Anderson, Memorial, Sloan and Kettering?  Why have we not seen any developments from these major centers?  Is the demand for staff acupuncturists growing but we lack the skill set to be hired?

    I think I know the answer to these questions but what about hearing from the schools.  Not about the hopes but what is really -in real time- happening that requires the profession to upgrade to FPD?  

    This “Fact Book” is not detailing this kind of information.  Serious students will want to know the job market, REAL potential, not hopeful.  Is the field competitive or just simply closed?  They will want to know why they will be making monthly payments of $____________ per month on a $60,000 loan if they can’t get a job.  If they have to start their own businesses with no capital, that will be another $___________to add to “potential” income.


    I’m not sure that acupuncture schools are aware but the higher priced schools in the major universities and colleges are losing students because parents fear the debt load that those colleges are asking them to take on to finance their children’s education.  Sine acupuncture is a post-bacheloreate degree, I am assuming parents are less apt to pony up the dough for graduate school, that will largely be the burden of the student and his/her family (if that is the case). 

    How are you ever going to integrate the payment schedule of a student loan into your household budget by practiticing acupuncture even if you manage to get a job at a prestigious university doing research?

     Anyone reading this who is researching the possibility of acupuncture school?  Have you found out anything about your future after you graduate?  Or am I in a bubble and can’t see all the great jobs out there that don’t require I get on a cruise liner or move to Costa Rica to work at a spa?  Well Costa Rica I wouldn’t mind, it is supposedly the happiest country in the world.

  6. Thank you

    I would like to thank David Bock, President of the Wisconsin Society of Certified Acupuncturists, for uploading this document to the WI_OM yahoo forum (of which he is the moderator).  Furthermore, I would like to thank him for giving all members permission to widely distribute it.  Per David’s email on December 11, 2009: “Please pass along the fact book to those who have questions who are not on this listserve.”

  7. Jessica, I’m so confused…

    Will Morris, one of the authors of the Fact Book, wrote in a recent comment, “I believe the AAAOM FPD Factbook will do an excellent job of clarifying matters.”

    It will not do such an excellent job if we aren’t actually allowed to read it.

    I think when people write things like, “please pass it along” and “clarify”, they don’t mean what we think they mean. Hmm, what do you think they mean?

    We seem to have a similar problem with the term “consensus”.

  8. .

    so where is the sanctioned viewing area for the fact book? seems like it would be helpful if it was easily accesible and distributed, huh? funny too, a google search for it brings up this blog a few times, but no sign of this elusive manuscript. its so hot when it plays hard to get.

    nice blog lisa.

  9. .

    ya know, as scary as this stuff is sometimes, sometimes its just silly. ridiculous. the fact book is beig RETRACTED?!?! maybe they just wanted to put it out for a quick editing job by lisa before writing the final draft. she should really be charging for this.

  10. Great job, Lisa.

    “the problem
    isn’t the FPD itself; the problem is that what has been happening in
    the acupuncture world with federal loan programs for years is
    flat-out abusive. We’re telling you now; we’ll tell the USDE directly
    if we have to

    Why don’t we tell the USDE now? I think we should. It’s immoral what some people are trying to accomplish w/ this FPD.

  11. So, how much will the FPD

    So, how much will the FPD cost, Lisa?

    All education has a price tag attached. Every recent graduate of ANY university or technical college seem to have substantial debts related to receiving their training, be it good or bad training…….

    I am on your side of the debate, for reasons too long for me to write about, but I find that I resist the whining about student financing as that truly is certainly applies as a problem across the board….I hear medical students have larger student debts than any other student body post graduation……Can, for instance, the professional acupuncture organizations start building a means of grants or other funding to help pay for graduate education for the acupuncturists (like many other professional organizations do for their “newbies”?)

  12. Jobs…

    i think this has been said before, but the main difference is that there are jobs for people who graduate with an MD, and most other medical degrees for that matter.

    LAc’s are turned out with few to no job prospects and overwhelmed with debt. 

  13. If I had graduated with an

    If I had graduated with an MD, nursing or most other medical degrees I could easily find a non profit job, work for ten years, and have my loan forgiven.  I can’t find any kind of job in acupuncture, I wish I could, I don’t really enjoy running my own business right now, but it’s my only option. I don’t believe that a FPD will suddenly create acupuncture jobs where there are none, no one has properly expained that magical idea.

  14. Medical school students

    Medical school students graduate with an average debt of $140,000. That’s not that much more than what many AOM school students graduate with. There’s a shortage of medical doctors, which means they have job opportunities to pay back their debt. But there isn’t a shortage of AOM practitioners. Why? Because, relatively speaking, there isn’t a demand for AOM practitioners.

    If there’s no demand for AOM practitioners, why does the number of AOM schools keep increasing?

  15. Chiropractic?

    The chiropractic field is riddled with its own problems. Insurance reimbursements are down, there is a glut of chiros out there, and chiros often operate as PCPs…which really is a joke: They did not go thru a 3 year residency of 36 hrs on, 24 off, 36 on again, this after attending pre-med, taking MCATs and applying to med school, HOPING that your GPA, MCAT scores and letters of recommendation get you into the school of choice. Then there is competition for the residency programs–again, GPA, MCATs, and recommendations come into play here as well.

    Chiropractic colleges will accept you if you have graduated from a 4 year institution (although some may still allow 60 hrs of college credit–equivalent to an AA), some recommendations and demonstrate the ability to pay for school or obtain financial aid.

    If you looked at health professions that default on student loans, Chiropractors have an incredibly high student loan default rate (HEAL loans):
    These are figures from 2003
    859 chiros defaulted for a grand total of just over 73 million
    The next highest group were dentists–314–at almost 39 million

    Keep in mind that there are more dentists than there are chiropractors

    Google chirotalk proboards, and read the postings about the problems with the profession. Since TCM seems to want to follow in chiropractic’s footsteps, I can only predict similar outcomes.

  16. Whose choice is it anyway?

    If there are no jobs and you have no income, why study acupuncture? Why did you make that choice to begin with?

    You cannot both argue that the system is screwing you over AND use the system to argue FOR your case….

  17. ah, but…

    guest, your argument would make sense if the schools actually admitted to the no jobs and no income thing BEFORE prospective students sign on the dotted line, if they gave them the truth of how hard it really is to actually make a living doing acupuncture, but they do not – otherwise the schools would be smaller and they would be run differently. they would, you know, actually have to take some responsibility. in fact they mostly never give students a sense of how things really are, even while students are in school, they keep deluding  them about the realities of practice in the real world. yes, we get to have trust issues when a new bill of goods comes along, we get to ask questions and expose the facts or lack there of to our peers.

  18. Question…..(gotta love ’em) 🙂

    Noted. But schools alone can clearly not be held responsible for a student’s choice to study acupuncture?

    Something made the potential student want to look into becoming an acupuncture student to begin with. If they stop seeking information from the minute they get the schools perspective, well….. Shouldn’t a student also be personally responsible for researching job opportunities, business viability, etc? All schools, in any industry and market segments, market themselves as the end-all-be-all. And none of them are…

    I hear you, and I hear that you are raising a real issue. But I do not believe that acupuncture is different than all other struggling professions and industries out there currently attempting to revamp themselves in order to build better business models and preserve income and education levels. Education is too expensive and painfully inadequate in nearly every profession; at least if one is to believe the statements made by recent graduates and employers…..

    Sounds to me like there are several different issues being discussed in this debate, and maybe teasing them apart might help shed more light on which road to choose from here.
    The cost of education is one issue….the viability of the profession is another issue….and the quality and structure of education provide yet another issue or two….

    Has someone done the actual market research, viability studies, comparison studies, etc, etc, to actually say what the market for your service looks like? Please point me in the direction of this information as I find this discussion interesting and would like to educate myself some more prior to issuing statements.

  19. per Michael Jabbour

     The explanation is that it was an internal document that was inappropriately distributed without the permission of the authors/contributors by one of the reviewers/editors while it was a work in progress. We gave it to the reviewers in order for them to provide feedback and critique prior to release and made it clear to them it was not for release.

  20. Ah, and I AM aware that I am

    Ah, and I AM aware that I am “swearing in church” given Lisa’s statements above related to personal responsibility and her relationship to said, but I take personal responsibility (!) for my own opinion and bring it up anyway…. 🙂

  21. Guest: I’m having a hard time…

    …accepting one’s ability to be accountable while remaining anonymous at the same time.

    What PIHMA is doing is ignominious; this president’s association with a professional governing body would be comical if it weren’t so plain wrong.

  22. I am happy to identify

    I am happy to identify myself, Andy. Just didn’t seem necessary given the amount of “guest” comments on the existing strings…..

    My name is Anita Pascoe, I reside in Salt Lake City, Utah, and I am not (as you may have figured already) an acupuncturist.

  23. Dishonesty…

    I think we all could learn a thing or two about the Chiropractic profession. Case in point is Life University loosing its accreditation from the CCE (the credentialing body of Chiropractic colleges) for fraudulent claims. Alan Botnick, DC was the sole graduate responsible for Life loosing its accreditation. Perhaps an investigation on hospitals who actually DO hire acupuncturists are in order (not an RN or a PT who went to a TCM school who could serve a dual role). I’ll bet in Phoenix, there aren’t any.

    So the issue is where does receive its information on salaries from? From the associations such as AAAOM, CCAOM? or from credentialling/certification bodies (AOMA, NCCAOM)? is not BLS statistics…but then again, BLS receives their salary data from professional associations. 200k/yr? That can’t be personal gross (or adjusted gross). Perhaps what the practice generated, but most certainly not the salary. If a practice did that much annually, there are high expenses–business logic dictates that gross salary is roughly 1/3 gross revenues–and I’m sure everyone knows how to do that.

    Also, there is such a thing as “Borrower’s Defense” for student loans. It would be very interesting if every acupuncturist tried to have their loans forgiven under borrower’s defense. You know what would happen? That might launch an investigation into the TCM education industry and could result in TCM colleges losing the privilege of participating in student loan programs…then the TCM education industry will topple…and the dust remaining are the 27000 practitioners that remain. No new growth to the field, FPD dreams gone bye bye.

    Interesting polemic proposition, eh?

  24. Regarding PHX

    As far as I know, there are 3 acupuncturists employed by hospitals in PHX, all part-time. PHX is a massive city so that number is pretty insignificant.

    If anyone knows better, please correct me. 

  25. You’re correct…I did a

    You’re correct…I did a search from PIHMA’s website–they claim that their graduates have been hired by Banner Health in Phoenix. So I went to the bannerhealth site–lo and behold, there is One acupuncturist working there.

    So I then checked PIHMA’s site again under their “alumni excellence” section and the sole acupuncturist at bannerhealth has her own private practice as well…suffice it to say this person probably ain’t making a living at Bannerhealth. So then I checked BannerHealth’s jobs section…would you believe there are no positions for acupuncturists available at any of their facilities? Not one…so this notion of being “widely practiced” and “fastest growing” is blowing wind out of the lower orifice of the lower jiao. 3.1 million have used acupuncture (NHIS survey from 2007) out of a U.S. population of 308 million??? Sure, a significant portion of the population indeed!

    And I’m Zhen Nong reincarnated

  26. $60,000 in student loans….

    …sounds like good place to be at.  The group of masters students (n=82) that graduated from OCOM in September have an average indebtedness $88,545.  Let me stress the word ‘average’ because for the few students who paid out of pocket, this puts a large group of recent graduates at over $100,000.

    Instead of focusing on the FPD, I’d love to see AOM schools and organizations focus on building entry level jobs for acupucturists to walk into after graduation.  Until there’s a substanial (50% minimum) placement rate, why would adding more time in school and loan debt really help treat patients.

    ditto Blythe’s comment….can’t build on a broken foundation.

  27. jobs….

    Well, that’s the risk for attending any trade school. They can only train, but there is no guarantee of success–think of the massage therapy training industry–it is a business, and the average career span for a massage therapist is approx 3 years–but training is a relative bargain compared to TCM trade schools. I think we should really start calling them what they are…trade schools because they most certainly are not colleges because real colleges and universities are regionally accredited.

  28. Different strokes for different folks

    I can’t put a price on good health, and the form of acupuncture I have learned at TAI SOPHIA supports the model of learning how to take care of myself rather than buying a product. Good book – Disabling Professions, with Ivan Illich and other essay authors. We have a choice to make – create powerful professions to convince others they need us so we can make money, or we acknowledge the uniqueness of humans to take care of themselves and be fully powerful in their lives. I chose the latter, though it won’t make me rich in money, it will make me and my patients rich in health. I’m for diversity rather than standardization. When chairman Mao standardized/simplified the Chinese language, he started the process of losing the rich history of China through destruction of language. The same will happen to acupuncture if we standardize.