As California Goes, So Goes The Nation!

Today is my first clinic’s 15th birthday. Happy Birthday OAP!  I’ve been an acupuncturist, running an acupuncture business, and hiring acupuncturists in California since 2008. Note to self:: think twice about opening a small, women-owned business in the midst of a global financial crisis with a business partner who will be out on maternity leave before your clinic has its first birthday.  Actually, then, and especially now, I wouldn’t have it any other way. 

It’s been a tough few years for acupuncture businesses (well, most businesses really) so it wasn’t that much of a surprise when 2022 was by far our most challenging year in terms of HR and hiring ever, even dating back to when we were truly terrible at it. It more than edged out 2020, a year in which we lost about half of our staff. So, that’s saying something. Turns out that “something” may not be probably isn’t what I thought it was. I think my current business partner and I agree (we agree on most things) that hiring and HR issues are our least favorite parts of the job. That stuff is really tough, even in the best times. But if we want to continue being people that run three high volume/low cost clinic locations it is also one of the most vital parts of the job. 

As last year (thankfully?) came to a close we reflected on what was causing our difficulties, why were we having such a hard time getting and keeping a solid staff?  What were we doing wrong? Ultimately we chalked it up to “COVID Chaos”. Over the last (almost) three years we’ve declared that a lot of things must be caused by COVID Chaos. We even have documents, meeting agenda titles, and clinic policies where that moniker wormed its way in, because it fit.  Before COVID we had gotten pretty good at identifying the variables that impacted our successes, our obstacles, and our failures (Yes, we have those too. And failures are definitely something we should all talk about more.)  Anyway, in the olden days we could usually see pretty clearly what was working for us and what wasn’t, and with the variables recognized, we either fortified the good stuff or took corrective action in the areas needing help. In the realm of COVID Chaos though, the variables have become harder and harder to identify. What even are they? The new pattern is that there really aren’t many patterns anymore.

I had a hunch that our schools’ being under enrolled might have something to do with our hiring woes, but getting actual enrollment numbers from schools is next to impossible. Probably just Covid Chaos, anyway. Our two Oakland clinics are in very close proximity to four acupuncture schools, well actually three now, since ACTCM is closing. Tuck this sad news away, it’ll come up again in a bit. Our third clinic is only 90 miles away from the Bay Area, in Sacramento, so over the years we’ve been pretty lucky to have a steady stream of newly licensed, recent grads, who are hungry for work. We were spoiled out here, and we knew it.  Hiring in more remote areas of California, or even larger cities in other states, that don’t have any schools in the region has always been tough. Keep reading, it’s about to get tougher, for all of us.

Anyway, on my hunt for variables, because it’s hard to find solutions when you don’t know what the problems are, I came across this: CALE Statistics!  CALE is the California Acupuncture Licensing Exam for any of you out-of-staters who don’t run around with the name of that beast on the tip of your tongue, or haunting you in your dreams. Sidebar: I still have a recurring dream where I’m in my seat at the convention center in Sacramento. I’m ready, but I lost all of my pencils, and my booklet only has ½ of the questions in it, but I’m definitely not allowed to get up and talk to anybody about it. So, I sit there. For however long the dream lasts, I just sit there, panicking.

For decades CALE has been held up as the gold standard for acupuncture licensing tests. It’s said to be harder and more rigorous than its counterpart, the NCCAOM exams. That’s the National Certification Commission for Acupuncture and Oriental Medicine for any of you lucky enough to have zero experience with the tests used as the gateway to getting licensed as an acupuncturist in the US.  Interestingly, at least to me, neither of these exams have been proven to have any real bearing on whether or not the individuals taking them will go on to become competent and capable practitioners.  People who pass with flying colors go on to lose their license or leave the profession, or anything else weird you can imagine in between those two extremes. People who fail, sometimes repeatedly, may be the same people who got the very best treatment results in student clinic, and they may have a background in business, but they are just really bad at taking tests. Lots of gateways we come across out there have gatekeepers, and in the acupuncture world these two tests are our big, burly bouncers. The numbers here show that, at least in The Golden State, the bouncers don’t always like to let very many people through. And the numbers seem to show that if you’ve tried to get through the gate before but were turned back (you failed your first attempt at the exam) your chances of getting through on future attempts really aren’t all that good. 

Even more alarming than the pass rates for CALE though, are the stats on just how many people have been taking this beast over the last several years. TL;DR, Not Nearly Enough!  

From these numbers it looks like the number of test takers has been in a pretty steady decline since about 2017. This is very valuable information because it means we can’t blame the low numbers of test takers on COVID Chaos. This was a preexisting condition! If we take the math backwards then a clearer picture of what must be going on in the schools starts to emerge, even if we can’t get ahold of their real enrollment numbers. Fewer test takers has to mean fewer grads. Sure, some grads from California schools leave the state after they finish school; that was their plan all along. Some wait to take the test until years after they graduate for whatever reason(s). But correcting for that smallish percentage of people who are either waiting, or never planned, to take the California Exam does not explain what I found. 

Y’all, the numbers are BAD. Really bad. This may explain why ACTCM, one of the oldest TCM schools in the country and another gold standard from the Golden State, is closing its renowned and revered doors.  Fewer and fewer people are choosing to go to acupuncture school.  It definitely helps to explain why there has been such a drastic change to the quantity of our job applicants. That steady stream of those hungry new licensees is drying up right before our eyes and we actually have numbers to back this theory up. Sorry Jeff, it looks like the tough stuff is only going to get harder for us. 

Let’s look at this another way. In the five year period (2013-2017) 4920 people took CALE. In the subsequent five years (2018-2022) approximately 2367 people took it. This is adjusted since the second batch of 2022 test statistics have not been released yet.  In the first half of last year only 198 people took the exam. I estimated that another 250 took it in the second half of the year, leaving 2022’s estimated total potentially just shy of 450 test takers. I will definitely update when those new numbers are released, but unless they are way outside the current pattern this is still a 50+% decline over the last five years. I miss reliable patterns but this is not how I wanted them to re-enter my life. 

In 2002, the busiest year for CALE in the last 22 years, a whopping 1259 people attempted to tame the beast. Sadly 616 of those folks were taking it for (at least) the second time. Many have made 5, 6, even 7 (or more?) attempts before the gatekeeper finally let them through. But it’s starting to look like even that is changing. The numbers here, and here, show that lots of people who fail at their first attempt are just giving up now, moving on. You would expect the total number of retakes to also drop when overall numbers are dropping but these recent numbers for the folks making multiple attempts are tanking even faster. These poor grads are taking their big debt, their little diploma, and just cutting their losses. This is super sad for them but it’s also really sad for California employers. I bet some of those folks could have turned into fantastic punks for us, or for any other clinic with jobs to fill. 

I’m assuming that because the California Acupuncture Board (CAB) operates from within our state’s Department of Consumer Affairs that there is some requirement for them to release testing statistics and other data. Yay, transparency! Seriously, it’s hard to come by in the acupuncture world. I have not been able to find similar statistics for the NCCAOM exams (for even one year, much less 22). Update as of 2/11: I found them! Spoiler Alert: The numbers aren’t quite as alarming as CALE’s but they still suggest cause for concern.  More on this in the next post.

Recent rumblings and grumblings indicate that schools nationwide are feeling the same squeeze we are feeling here. ACTCM may be one of the biggest names to bow out of the game but schools are closing nationwide, at an alarming rate. Southwest Acupuncture College, who had campuses in two different states, is also hanging it up. 

Given all of this, there really isn’t anything to indicate that NCCAOM’s testing statistics (and the revenue streams tied to them) would trend in a wildly different direction. As California goes, so goes the nation, right?  So, if we want to keep living the dream out here in acu-land it’s probably time to get up, grab some pencils, get the full book of questions, and run! Well actually, I think we may need to swim sideways. I hear that’s the best way out of a rip current and this one seems to be pulling us toward the cliff.  Whenever I have that dream, at the end, I always wonder why I just sat there.  

Author: WhitneyThorniley