I’ve been thinking for a while about writing an open, honest account of my investment in acupuncture school for the benefit of prospective students. I acknowledge that this is just one person’s experience. Through my connections with other acupuncture and Oriental medicine (AOM) students and alumni, I’ve come to understand that my journey is not outside the norm of what to expect or how to navigate the decision making process.
It’s useful to know that I consider myself to fall somewhere in the range of the average population. What does that mean to me? Well, for starters, I knew I would need to finance my entire acupuncture education on student loans. The thought of incurring this amount of debt was a more than a bit scary to me. The trend in rising tuition costs would not allow me to work for a few years and save enough money to pay outright for the going education. Like the majority of other AOM students, I didn’t have a trust fund, wealthy parents or a partner who could pay for my tuition and related school costs while keeping a roof over our heads, food in our stomachs and health insurance. In high school, I worked to save some money for college. In college, I worked to make my rent, cover my car payments & insurance and buy groceries. During my AOM graduate studies, I once again knew that I would need to work to make up the difference between student loans and living expenses. I think most prospective acupuncture students find this situation to be a familiar scenario.
The view from outside of the classroom was much different from the experience on the inside. If you are in the process of considering a career in the AOM field and are currently a prospective acupuncture student, I hope you will find at least one worthwhile piece of information from my experience.
What’s the Return on Investment: The Search for Credible, Factual Statistics
I remember how challenging it was to find credible statistical data on acupuncture as a career. I consider myself a pretty sensible person, so I thought it was reasonable to find out what salary range I could expect as an acupuncturist in order to determine if the cost of the education could reasonably be repaid. Long story short, I had a difficult time finding anything unbiased and useful to help me with my decision making process. Knowing what I know now, it’s important to understand that most acupuncturists don’t earn a salary. Most people in this field are self-employed. Information is all over the board. If you dig deeper, more often than not, you will find that the sample size that supplied the data is relatively small and therefore, unreliable to base a major financial decision upon. Available data does not provide anywhere close to the necessary information prospective students need to weigh the costs of this education with the ability to repay student loans all while making a decent living. Not an extravagant living, just a respectable living while responsibly paying back the student loan debt.
Here’s a great example currently available on one AOM school’s website: “According to a recent salary survey available at PayScale.com, $43,000 to $60,000 per year is the average salary of a licensed acupuncturist, depending on the length of time they have been in business. Anecdotally there are those that earn considerably more than that.”
If you go to PayScale.com you will find that only 7 responses have been received as of May 2010. The average listed ‘salary’ is $30,710. There are two problems here that allow for a huge misrepresentation of the profession 1) only 7 responses contribute to this data and 2) most acupuncturists don’t earn a salary because they are self-employed or independent contractors. There are many more examples just like this on other AOM schools’ websites and in their marketing catalogs. How can any school justify presenting this misleading information to prospective students?
The good news for prospective students is that the NCCAOM recently released the results of the Nationwide Job Task Analysis for the AOM Profession https://nccaom.org/news/JTA_press_release.html. So even though the news in the analysis isn’t good, you have a bit more information to base your decision on today than in the past. I strongly suggest anyone considering this career path to sit down and read the report. Key points to take under consideration are that 90% of the respondents in this survey are self employed, 91% see less than 10 new patients per week, 46.5% see 11 to 30 returning patients per week, and 70% gross less than $60,000 per year. Remember, you don’t take home and live on that gross pay. So cut that $60,000 in half after taxes, business expenses, etc. and you will probably be taking home right around $30,000 per year if you are grossing at the top of the range of this respondent group. If you aren’t at the top, you can expect to be living on even less than $30,000 per year. Unfortunately, there are no results for the number of years in practice to allow for a comparative change over time, if there even is a change over time.
My AOM School Experience:
With the information that I gathered in 2003 and 2004, what did I decided to do? I decided to attend a school in the Pacific Northwest. I completed a four year master of acupuncture and Oriental medicine (MAcOM) degree program in four calendar years. I entered school in September of 2005 and graduated in September of 2009. You might be wondering, why not complete the four year academic program in three calendar years as it is promoted by many schools? Actually, I did start my studies on the three calendar year program. I chose to take this route in order to experience the academic demands firsthand. I wanted to make an informed decision about continuing at this pace or transitioning to the four year timeline. I also knew that I could switch to the four year program at any time, but not the other way around. Needless to say, it didn’t take long for me to realize the four year program would work better for me and I made the switch. Simply put, here’s what factored into my decision 1) class, study and work time was pushing me to exist in a 50-60 ‘work’ week 2) time management was no longer the issue, sleep deprivation was 3) my quality of life was becoming unbalanced & frankly unhealthy, but most important contributing factor was that 4) I knew that I could not look a patient in the eye and ask them to find 30 minutes in their day for self care, when I was struggling to do it myself. It’s ironic how the entire program is set up. To remain competitive, new requirements and hours continue to be added to the curriculum without any recognized regard for the expansion of the calendar time. Care for students’ health doesn’t really seem to matter.
When I started my program in the fall of 2005, the entire 36-month program tuition was listed as $47,875. This figure does not include books, supplies, Clean Needle Technique (CNT) certification, the NCCAOM board application and exams, state licensing. This list of items is in addition to tuition costs and the responsibility of the student to cover. I added $10,000 to the tuition to cover the cost of the additional education expenses and rounded up to $60,000 just for good measure. Based on the credit load and classroom/clinic hours listed in the school catalog, I anticipated working 15-20 hours per week to pay for my living expenses. During my decision making process, I regularly consulted school and financial aid administrators to see if my plan was reasonable. I never received any words of concern ‘although each student’s financial needs are different’ it seemed reasonable in their opinion. Additionally, I repeatedly heard that the US will need 15,000 new acupuncturists in the next 10 years, insurance will start covering acupuncture and hospitals will soon be hiring staff acupuncturists. The profession painted itself a nice picture and I, the prospective student at the time, felt reassured.
Here are the numbers that I used to calculate my debt decision being fully aware that during the first couple of years in practice I would likely fall on the lower end of the pay scale:
- Loan Balance: $60,000.00
- Loan Interest Rate: 3.00%
- Loan Term: 10 years
- Monthly Loan Payment: $579.36
- Total Interest Paid: $9,523.83
Once you plug all the numbers into the finaid.org calculator, you get this message “It is estimated that you will need an annual salary of at least $69,523.20 to be able to afford to repay this loan. This estimate assumes that 10% of your gross monthly income will be devoted to repaying your student loans. This corresponds to a debt-to-income ratio of 0.9. If you use 15% of your gross monthly income to repay the loan, you will need an annual salary of only $46,348.80, but you may experience some financial difficulty.”
In 2003 and 2004, student loan interest rates were at an all time low of 2% to 4%. This added to my reassurance that this was an acceptable risk for such a rapidly growing professional field of medicine. Or so I thought. Near the end of the first year, my school administrators delivered the news that tuition rates were increasing only weeks before we needed to sign off on our next year’s financial aid offers. This became an unwelcome and poorly communicated annual event. By July 2006, student loan interest rates had jumped up to a fixed 6.8%. Yes, fixed and quite a historical change. My budget was quickly being blown out of the water. This education was becoming very expensive, very fast. My logical side was telling me to get out, but I didn’t listen. I After all, I was only $18,500 in debt after one year in. I learned more than I bargained for about AOM, the education and the state of the profession while I was a student.
The Acupuncture Mortgage:
Are you thinking of going to school to become an acupuncturist (because when you say you are anything else, most people don’t know what you do.)? If you walked into a bank and asked them for a $100,000 loan on a self-employed living income of $30,000 or less with no collateral, you’d likely get turned down. The bank would probably consider the risk too high to fund. However, in the education market there is something I refer to as the ‘acupuncture mortgage’. Almost anyone can get one as long as they qualify for student loans and meet some basic pre-requisite requirements.
Let me put the acupuncture mortgage into perspective. Students in my graduating class have an average student loan debt of $88,000. That’s the average for my entire class, not the average per student who needed to take out loans. A few classmates were fortunate enough to avoid federal loans to complete their degree. Understanding this, you know that the average debt per student who actually needed to take out loans is much higher than $88,000. By subtracting each of my classmates who paid for their education costs out of pocket, this quickly pushes the school reported average to a much higher personal student average. This explains why I know more classmates who have over $100,000 in student loan debt from attending acupuncture school than I don’t.
Many changes took place at AOM schools between the 1990’s and 2000’s. At my school, tuition changed from an average of $7,000 annually with evening only classes to an average of $15,000 annually with 5, 6 and even 7 days of instruction per week. This curriculum format makes it very difficult to hold a job and expect to be a reliable employee. The school I attended cared very little about outside factors involved in students’ lives when it came to scheduling concerns. In 2010, the tuition exceeds $21,000 annually and the entire three year program tuition is estimated to cost $63,480. This easily translates to over $70,000 in education costs alone. If you complete the four year program in four calendar years, expect your tab to exceed $80,000. Don’t forget to add in your living expenses. If you are considering going to an AOM school, you might want to take a look at my 2005-09 AOM graduate school budget to see if it makes financial sense to you. Keep in mind the recent NCCAOM study finds that 90% of the respondents are self employed and 70% gross less than $60,000 per year.
I maxed out the possible subsidized and unsubsidized student loans offered to me in order to stay afloat. In my third year, I needed to save any extra funds to make sure I could avoid taking out any of the dreaded private Grad Plus loans in my fourth year. The budget should be a good starting point for prospective students to measure their financial decisions regarding AOM school costs. Figure out how much you need to live on annually. Add an extra $1,000 per year for unexpected and unforeseen costs. Plug in your annual tuition. Ask the school for the average annual tuition increases for the past five years, do the math and add that number to your expected tuition. Decide if you’ll be able to work during school. How much do expect to earn? Will you need to extend your time in school? If so, will it cost you more in total tuition? Once you have the all the numbers, go to finaid.org and enter your anticipated loan debt into the calculator. You may get a message like this: “Wow! You’re borrowing a lot of money to pay for your college education. Maybe you should think about attending a less expensive college? A good rule of thumb is that your total education debt should be less than your expected starting salary. If you borrow more than twice your expected starting salary you will find it extremely difficult to repay the debt. Live like a student while you are in school so you don’t have to live like a student after you graduate.” Please take a long look at what this education costs, how you will finance it, your repayment terms along with your ability to earn a decent living. There is more information out there today than there was 6-10 years ago. Do your homework before you start into any AOM program. The acupuncture mortgage can last a lifetime, especially with all the repayment terms offered now.
My Perspective Now:
Let me just start by saying that I truly love this medicine and what it can do. I’ve witnessed some amazing transitions and changes in patients’ lives. However, I wouldn’t suggest jumping on the bandwagon unless you clearly know the financial path you are on. With the rising tuition costs, unless you are prepared, it could financially ruin your future. Don’t count on any loan forgiveness programs to save you as they are not a guarantee. So, knowing what I know now, what would I change? Lots of things. Here’s a list of questions prospective AOM students may want to consider during the decision making process.
Think as long term as possible if this is your chosen career path. Find out what prerequisites you need to complete. Also find out what other classes will transfer into the curriculum prior to your enrollment. Can you take many non-AOM specific classes at a local community college? Did you already take them in your undergraduate studies? Transfer in as much as possible if it will lighten your AOM academic load in order to work and keep some balance in your personal life.
Is tuition based on credit load or programmatic standing? I’d suggest finding a school that charges per credit so you aren’t paying for classes you don’t need to, don’t want to, or aren’t allowed access to take.
What is the five year trend on tuition increases? Ask for specifics so you can plan your budget appropriately.
Are the credits you complete at an AOM school transferrable to other non-AOM schools? Find out exactly what ACAOM accreditation means? Very few school are regionally accredited and this could be very important if you want to transfer to another healthcare profession or decide to supplement your license with another degree.
How often are classes offered? If only once per year, what happens if you need to drop or fail a class? Will you be forced to add another year to your education? Lots of life happens in while you are in school. How flexible is the curriculum at the school you are considering?
How many hours can a student expect to be at school? Ask for the past two years of quarter/semester academic schedules to see how the curriculum actually lays out. Hours vs credits don’t seem to fall into line like most other institutions of higher education. How will the way the classes are offered impact your personal, family or work responsibilities?
Since the NCCAOM study finds that 90% of acupuncturist are self employed, ask to see the full series of business class syllabi. How well will the classes prepare you for the real world? Does the information discuss the different practice models available today. Will you need to take outside classes to get the practical information you need to actually run a business? Consider starting a relationship with a SCORE chapter to get some general small business advice.
What specific job opportunities are available for graduates? Ask for at least twenty alumni contacts so you can contact ten of them yourself. Ask for contact information for alumni who have left the profession to get both sides of the coin. If the school claims that information isn’t tracked, ask why not.
Does the school have an annual job fair? Most institutions of higher learning do. For the cost of this education, it is not out of the question to anticipate this.
Request to be placed with a student for a day so you can get a feel for the experience. Ideally, you want to shadow an intern or a student further along in the program. Try to avoid only talking with first year students if you want to gain a realistic perspective of the overall program.
What percentage of their operating budget comes from student tuition? What scholarships does the school offer? Do the alumni make significant financial contributions to the school after graduation? If not, ask why not.
After graduation, another very important decision that you might want to consider is how are you going to live while you are passing your boards, waiting for your license and getting your practice up and running. Do you have another job, spouse, or family financial support to carry you? What if you can’t meet the minimum student loan payments early in your professional career? Are you going to forebear your student loans (many, many people do) for the first year or more?
In the end, there’s way more to consider about a career in the field of acupuncture and Oriental medicine than what schools you would like to attend and if you’ll be a good practitioner. I truly believe prospective students understand this and are starving for some information that will allow them to adequately weigh their financial options. Mixed in with rising costs of tuition, newly available professional data and student loan repayment options, I hope prospective students will find at least one worthwhile piece of information from my experience as they are considering what it really means to have an acupuncture mortgage of their very own.