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

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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.


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  1. I posted this article on my acupuncture student FB group. I got t his response:

    It’s not just tuition. The post compares the number of people taking the California exam for a selection of years between 2008 and 2018. What the post doesn’t bother to mention or identify is that the economy was in the gutter in 2008 to 2010, which caused many people to go back to school to pursue a vocation. People are more likely to go back to school to pursue a new vocation when the job market is tough. The job market—generally speaking right now—is considered relatively good; hence, less people go back to school. The author does not consider the full economic picture when comparing numbers over time. It’s a general problem with the article given that the post only concentrates on tuition and not the complete economic picture that plays into people’s decisions on whether or not to go back to school full time. The decline in those taking the California exam mirrors the decline in the US unemployment rate.

    I could understand this argument if school attendance is down across the board, but it’s not.

  2. I don’t buy what the FB person said. I didn’t go to acu school and go 100+k into debt because the job market wasn’t great. I went because this is need to do this work was in my bones dragging at me. I couldn’t keep helplessly watching people suffer. And I don’t think I’m alone in that. We went *despite* the cost of the high tuition and many years of school-hoop-jumping.

    And yes, granted, some people definitely take out loans and go to school because they’re intimidated by adulting and want to put that off-which i saw at my original acu school. And yes some people want to “weather out” the bad job market and hope to reenter with a new shiny degreee once it’s better.

    But I think most folks, went to acu school to do this work but word’s getting around about lack of immediate jobs (outside of POCA) and the difficuty of private practice.

  3. Also, I vote Giant Sloth. ACAOM and NCCAOM need to figure out how to shrink they’re bloated budget and quickly-they’re part of the reason schools and licensing is so expensive. And expense is a huge freaking barrier to getting a license.

  4. Oof. Can’t edit comments. So a P.S.: 2018 test takers would have enrolled in 2015, which had roughly the same unemployment rate as 2005.

    The poster had referenced the US rate where I thought the California rate would be more specific to people enrolling in California schools, but the outcome for these two years is is the same at ~5.7%

    Yet the 2018 number is 45% lower than the 2008 rate, if my math is correct.

  5. I had a rough idea of how difficult making a living as an acupuncturist would be when I entered school. I saw my mom graduate and enter the profession, eeking out a living. I visited most of my professor’s practices while I was in school. 98% of them has 2nd and 3rd gigs- teaching, supervising, the Chinese professor’s with MD’s working in hospitals and research…

    but I cried when I sat in on my 1st acu class. It was where I was supposed to be. I knew I would be in debt for the rest of my life and probably never own a home. But if I had let the lack of money be the foundation of my decision making about education, I would never have gotten my BA or my Master’s in TOM.

    I was desperately searching for a way to make a living as an acupuncturist after graduation, one that met my values especially, when I found WCA in 2007. I’m still not much of a business person, but I love what I do. And I love CA and affordable TCM. I will do it till I die. And POCA tech, is one way to keep this medicine alive and available to those of us who want to practice it and those of us who desperately need it, like me.

    We need a NADA tech cert in CA. I’m with Bernie, it’s time for an Economic Bill of Rights. I think these acu numbers are reflective of a massive income inequality gap- fewer and fewer people can afford student loans and a basic living. Not that a lot of us, me included, ever could.

  6. I am one of the lucky ones that has a gig at a hospital clinic. Actually, I have *two* hospital gigs, each only one day a week. This is in addition to my private practice. And it hasn’t been easy. I’ve been making a living, but definitely nowhere near where my acupuncture school led me to believe I would be 10+ years into my practice. And definitely not enough to justify my HUGE student loan debt.


  7. Thanks for the point about the hospital gigs! I know a couple of other L.Acs in a similar situation — “hospital gig” often does not equate to “full time salaried position at hospital rates”,sometimes all it means is, “here is an office located on a hospital campus, you can cross your fingers for referrals and meanwhile good luck billing insurance”.

  8. I was offered a pt gig for a local community clinic franchise. Market myself, insurance only… I tried to talk to them about CA. Their bottom line was how much money they could generate. Of course, they would fo very well with a CA model, if they could actually adopt it. They weren’t able to see that yet.