Acupuncturists As Endangered Species

Thanks to our intrepid comrades Tyler Phan and Elaine Wolf Komarow, we have news from May's CCAOM meeting. And the news is…fascinating. Or possibly apocalyptic, depending on your perspective.

Being the data geek that I am, the big moment that I was really sorry to miss was the release of ACAOM’s 2019 enrollment data for their acupuncture schools. But Tyler took pictures! Here are the numbers of students enrolled in ACAOM schools in 2019:

Master’s 5538

Professional Doctorate 580

Total post grad DAOM 463

Total  6581

You can take a look at ACAOM's 2009-2018 data here. The 2019 numbers represent a decrease of about 3% in total enrollment from last year, and a decrease of 20.5% in total enrollment over 5 years.

But what’s more interesting, I think, is to look at the data from the perspective of people entering the acupuncture profession. I learned from a reliable source that, out of the 580 Professional Doctorate students in 2019, 75 of those are transitional doctoral students, or people who already had a Master’s who wanted an upgrade. So:

In 2014:  7889 Masters students, or, people entering the profession

In 2019: 5538 (Master’s) + 580 (Doctoral) – 75 (transitional doctoral, so not entering the profession) = 6043 people entering the profession

6043 7889 =  76.6 %, or a 23.4% drop in people entering the acupuncture profession in the last five years. Every year, there are somewhere between 300 and 400 fewer than the year before.

At that rate, we have about 16 years before the number is zero.  We don’t have any good data on attrition rates for the acupuncture profession, but a 23.4% decline of people entering the profession over 5 years, I think, is getting uncomfortably close to the profile of a species that gradually stops reproducing before it dies out entirely.

Comrade Jersey Rivers sent me these numbers of first-time California licensing exam test-takers:

February 2008: 501
February 2010: 409
February 2013: 428
March 2015: 350
April 2018: 272

There’s some discussion that the most recent drop in numbers could be attributed to a change in how the California test is scheduled. However, that doesn’t account for the 30% drop in first time test takers (otherwise known as people entering the acupuncture profession) from 2008 to 2015. Remember what people always say about California and the rest of the acupuncture profession, when they’re arguing for increasing educational requirements? “As California goes, so goes the nation”?

Some people believe that this decline isn’t going to continue — it’s going to level off, and soon. The reasoning here is that the entry-level Masters’ degree for acupuncture was indeed bloated, and too expensive. Now that there’s an entry-level doctorate, though, prospective students will feel like the $90K tuition is worth it to enter the acupuncture profession.

I know. I can practically hear your eyes rolling, comrades.

Personally, I suspect that prospective students have been doing the math, and will continue to do the math, about whether or not an acupuncture degree, no matter what you call it, is a good investment when there are still almost no jobs on the other end. Let’s look at the most recent income data for acupuncturists, courtesy of the California Acupuncture Board — page 19 of this document. 42.7% of acupuncturists with a gross income of under $40K, and the majority — 23.3% — with a gross income of under $21K. 59% have gross incomes of less than $60K. The way the survey is presented strongly suggests that these numbers represent gross receipts for acupuncturists’ practices, as opposed to what they take home after business expenses — so we can speculate what those numbers look like if you shave off 30%, or 50%, and then factor in self-employment taxes.

This is reminiscent of the NCCAOM’s income data from 2008. (Please correct me if I’m wrong, but when I went looking, I couldn’t find any income data from the NCCAOM more recent than 2008, even though they’ve done 2 surveys since then.) In 2008, the NCCAOM reported, 70.1% of acupuncturist respondents had an annual gross income from “their AOM activities” of less than $60K. The majority of L.Acs, 60%, work part time, or less than 30 hours per week. Of that 60%, about 45% earn less than $20K annually from their AOM activities.

According to the NCCAOM, 91% of acupuncturists are self-employed. According to the 2015 CAB data, 1% of acupuncturists are employed in hospitals. I realize this is a minority view, but I’m going to continue to insist that creating doctoral degrees for acupuncturists is not the same thing as creating hospital jobs for them. The vast majority of acupuncture school graduates are facing the daunting task of establishing their own small business. And while 11.1% of them will earn, according to the CAB, over $100K (is that gross or net?), the majority will not have enough work or enough income to justify a $90K investment. No matter what you call it.

The math just doesn’t work anymore, and prospective students appear to be figuring that out.

Another interesting development announced at CCAOM was in regard to Defense to Repayment, which means schools that misrepresent the employability of their graduates and/or what they can expect to earn, can face serious consequences. I hear from talking to new POCA Tech students that there are multiple acupuncture schools out there who are still blithely assuring prospective students that they can make $100K right out of school, the minute they hang a shingle. According to the CCAOM presentation about Defense to Repayment, this kind of misleading promotion can now open the door to class action lawsuits from misled students. I wonder what acupuncture school recruitment is going to look like in the age of Defense to Repayment, and what impact it will have on enrollment numbers.

Finally, the take home message from CCAOM is that nobody in power wants to take responsibility for the steadily declining enrollments/the approaching extinction of an independent acupuncture profession. ACAOM says they only accredit the schools; the market isn’t their problem. NCCAOM says they only provide credentialing; the market isn’t their problem. As numbers decline, we can expect that both ACAOM and NCCAOM will respond by charging higher fees to those that remain. (Will this eventually affect POCA and POCA Tech? You bet. There’s a point at which the math won’t work for us, either.) CCAOM has no mechanism to discuss enrollments at all; they just passively receive the news from ACAOM once a year.

The fact that the math doesn’t work is, officially, nobody’s problem and nobody’s fault.

This is where the concept of structural violence comes in handy. If acupuncture is unavailable to the people who need it most, it’s officially nobody’s fault. It just…happened.

There are, actually, things that ACAOM and NCCAOM could do to address the fact that the math doesn’t work, and POCA has requested them. The most energetic response we got to our request, alas, was an attempt to block POCA Tech graduates from practicing in Utah.

So yeah, it’s not looking good. I hear CCAOM is considering possibilities for “an AOM mascot”; maybe they should check out this list. Personally, I’m partial to the quagga.

Author: lisafer