NCCAOM and the Terrible, Horrible, No Good, Very Bad Numbers

This is the first of a series of posts in which I am going to be blogging about various kinds of data. We are looking forward to the release of this research project soon, and I’m guessing that there will be plenty to talk about. And it’s almost time again for CAN’s yearly Locate A Clinic survey! So I already had a data theme established in my own mind for the next few months of blogging; and then, last Thursday, the NCCAOM finally released their 2008 Job Task Analysis Report,
which includes data on AOM practitioners’ gender, race, income, student
loans, hours worked per week and numbers of patient visits. You can read
it here:

I think the NCCAOM report is going to require a couple of posts, actually. There’s just a lot here. Let’s start with the income data, hours worked, and patients per week, and then I want to tell you a story about an experience I had last week.

This survey was sent to 18,000 active NCCAOM diplomates. 732 of them completed it. As we keep saying, nobody has an accurate count of how many licensed acupuncturists there are in the US, but I’m going to go with Keith’s estimate of about 28,000. As one of my friends pointed out, there would probably have been some very interesting data if the NCCAOM had surveyed inactive or lapsed diplomates about their practices, or lack thereof, as well.  It seems reasonable to assume, though,  that the 10,000 acupuncturists who didn’t get the survey are less likely to be practicing; and that active diplomates who took the time to complete the survey are more likely to be acupuncturists who are still invested in their profession, who are serious about it and who are trying to make it work for them. We’ll never know about the 17,000 plus who didn’t do the survey, most of whom never even opened the email from the NCCAOM. (Doesn’t that seem a little odd, all by itself?) So, if anything, before we look at this data, just based on who sent it in, we should assume that it is somewhat skewed towards the positive — towards acupuncturists who are positively disposed towards their profession and its accrediting bodies. This survey probably doesn’t represent the embittered, the resigned, the ones who have given up altogether and don’t even want to talk about it. It looks like 1.6% of the respondents said they are not currently practicing, and the survey included questions about why, but the answers don’t show up in the report.

OK. Let’s start with income. The report states that 70.1% of respondents have annual gross income “from their AOM activities” of less than $60K per year. That’s an awfully big range; it would include the negative numbers, everyone who is losing money on their practice, on up to the person who is grossing $59,999.99. But wait! Looking back at the actual survey, it appears that the  question referred to smaller increments of income, starting with “less than $20,000”, see there at the bottom of the page? So it would make sense, wouldn’t it, that the categories that people responded to were probably “less than $20,000”, “$20,000 to $40,000”, “$40,000 to $60,000”,  “$60,000 to $80,000” . Right? But the report presents the income data not in increments of $20K, but in increments of $60K: 70% report incomes under $60K,  21% report incomes from $60K to 120K, and 9% report incomes over $121K. That tells us much less.  For all we know, 70% of diplomates have gross annual incomes under $20K, 21% have gross annual incomes precisely between $61K and $62K, and 9% all have incomes “from their AOM activities” of  $125,493.52. (4.1% of the respondents are AOM educators or administrators, and 0.7% have an active MD license; perhaps we’ve just accounted for about half of that upper 9%. What do you think are the odds that the other half own herb companies or are on the CEU circuit?) But truly, we don’t know. Reporting the income data in increments of $60K, when that isn’t how the question was asked, tells us only that we aren’t getting the whole story. Add me to the list of people who would very much like to see the raw data.

But let’s keep going with the data we’ve got. 91% of the respondents are self-employed. 30% are both self-employed and working for someone else, “as an employee or a contractor”. OK, there is a world of difference between an employee and a contractor, but these categories are not separated in the NCCAOM report. Contractors pay 15.3% of what they gross in self-employment taxes; they are also responsible for their own insurance, their own supplies, and generally pay a portion of the overhead wherever they work. Employees get a check, as well as, usually, a tax refund about this time of year — unlike contractors and other self-employed people who are usually scrambling to pay the IRS.  In other words, you can safely assume, for anyone who is self-employed, that what they net for themselves is at best 50% of what their gross income is. So there are two important take-home messages here from the report:

There are virtually no jobs for acupuncturists.

Because almost everyone is self-employed, and there is a huge difference between the net income and gross income of a self-employed acupuncturist, 70% of acupuncturists are probably taking home less than $30,000 a year from their practices.

(Hey, I just noticed something. 9% of respondents gross more than $121K per year. 9% of respondents are also not self-employed, meaning, they have jobs! I wonder if that’s a coincidence.)

These might sound like unduly gloomy conclusions, but wait — we haven’t gotten to the data about hours worked and numbers of patients seen.

60% of respondents work less than 30 hours a week. That includes 19% who work less than 10 hours a week in their practices; 20% who work between 11 and 20 hours; and 20% who work between 21 and 30 hours a week. 47% say they prefer to work part time, while 53% would prefer to work full time. The report states, “this practice characteristic warrants further study to better understand and interpret these findings.” How about this interpretation: given that they owe an average of $56K in student loans, with some owing more than $100K, most acupuncturists would prefer to have a job rather than a hobby — but they don’t, because they can’t attract enough patients. And as for the 47% who say they “prefer” to work part time, is that because they are simply too terrified and overwhelmed to want to do it more? 35% of respondents say they felt poorly prepared to do marketing and PR — in other words — they have no idea how to communicate with anyone about what they do.

Looking at the reported numbers of patient visits, I’m thinking back to my previous post about terrible, horrible, no good, very bad numbers in acupuncture, and it’s making a lot of sense. 91% of respondents see 10 or fewer new patients a week; and 33% see 10 or fewer returning patients per week as well. Which suggests that, for 33% of acupuncturists, 20 patients per week is a record achievement. Another 47% see between 11 and 30 returning patients a week, which combined with that low new patient figure, suggests that for 47% of acupuncturists, 40 patient visits per week is doing really well. I think most acupuncturists who are working would agree that 40 patient visits a week is really just the bottom end of a sustainable practice, just the beginning of creating a stable patient base and decent word of mouth. 80% of acupuncturists are probably not hitting that minimum target of 40 visits a week. This is why 99% of the US population is not getting acupuncture: 80% of acupuncturists aren’t really working. Yes, I realize that is the most negative possible interpretation of those numbers — but the only thing that can refute it is more specific data, which we don’t have. What if the weekly patient visits were reported in increments of 5 instead of 10?  The head of an herb company once told me that he thought most US acupuncturists were seeing about 12 patients a week (this was before the recession). You can arrive at that figure with the NCCAOM report, also: 33% already definitely see less than 10 new patients and 10 returning patients, what if 47% see 11 returning patients and 1 new patient per week? There you go: 12 patients a week, a hobby and not a job. And let’s not forget, these numbers are coming from active diplomates who took the time to answer the survey: a positive skew.

When I mention to patients that the acupuncture profession is in a bad way, they often look at me with surprise. “But,” they say, ” that’s hard to believe! It seems like acupuncture is becoming so much more mainstream, so much more accepted. How can that be?” This is where my story comes in.

One of the things that acupuncture doesn’t really treat is basal cell carcinoma, caused by years of being a lifeguard before people knew what sun damage was. So last Tuesday, I drove Skip to two different medical offices: a dermatologist out in the suburbs where he got Moh’s micrographic surgery, and then to a plastic surgeon downtown where they repaired the results of the surgery. The plastic surgeon’s office was in the most expensive real estate in Portland: a high rise on the waterfront that also happens to be the shiny new “Health and Healing Center” affiliated with a prominent teaching hospital. When you walk into the lobby, this is what you see: an espresso cafe, comfortable chairs and sofas, huge windows looking out onto the water, a bank of elevators with a directory of all the doctors, and a flight of marble stairs. Next to the flight of stairs is a sign with an arrow pointing up. The sign says: spa, wellness, acupuncture. I took the elevator up with Skip to his surgeon but made a mental note. While I was waiting for him, I took the elevator back down, and walked up the stairs, because I can never resist an opportunity to do research on the economics of acupuncture.

At the top of the stairs, on the right is a huge gym. Straight ahead is a reception area with two very polite receptionists. I told them I was interested in learning about their acupuncture services. One of them handed me a menu titled “life wellness services”. At the top is the name of the spa and wellness center, which is clearly not affiliated in any way with the prominent teaching hospital, although if you didn’t pay attention to logos, you might not realize that. Underneath the logo, the menu goes like this: customized massage, acupuncture, facial, personal training, pilates training, yoga training, nutrition coaching, resting metabolic rate assessment, and waxing — eight different varieties of waxing. An acupuncture treatment costs $100 for a first visit, and $80 for a follow-up. They won’t bill your insurance, but they will give you a receipt. (Just like WCA!) I asked about the availability of the acupuncturists, and I discovered that there are two acupuncturists. Each of them works at the spa for two days a week, from 11-7 or from 12-6. A new patient visit takes 90 minutes, while a follow up takes an hour. They see one person at a time. Sometimes they are completely booked, but other times they have same-day availability. Thank you very much, I said, and went down to the lobby to do the math.

The health and healing center of course has free wi-fi, so I googled the acupuncturists. Both young women, relatively recent graduates, both have other practices outside of the spa. OK, so they almost certainly are contractors rather than employees, because no savvy spa owner would want to take on payroll taxes if there was any way of avoiding it. Let’s sketch out a week for one of them, in which she is 80% booked: with a maximum of 16 possible appointments, let’s say she sees thirteen. Four of them new, nine returning. That’s $1120. Unless there is some extraordinarily charitable arrangement at work here, the spa’s cut will be at least 50% of that; she’s getting not only high-end rent, but also reception service. That leaves her $560. Take out self-employment tax of $85.68 at 15.3% and you get  $474.32. Take out another 15% for regular taxes — and of course she’ll have to withhold all of these taxes herself — and we’re down to $388.64. Let’s see, insurance would come to about $15 a week, two and a half boxes of Seirins at $25, then there’s laundry, and parking…and so, if this acupuncturist is lucky, she’ll take home less than $350 a week. The odds are good that anywhere else she practices, she will make less, because she won’t have the same level of visibility, or a human being to answer the phone and book appointments. She can make just enough money to tread water, to answer an NCCAOM survey and feel good about it, to not quit — at least not for a few years. Her yearly gross income from acupuncture at the spa, if she works 50 weeks at that same rate, would be $56,000 — and yet her true net, after taxes, would be closer to $19,000.

Thousands of people walk through the lobby of the shiny new health and healing center every week, and thousands of them see the sign for acupuncture. And yet, out of all those thousands, 32 of them at most are actually getting acupuncture each week in that facility.  No one would know that by looking, though; in fact, it’s likely that everyone thinks that the prominent teaching hospital is endorsing acupuncture, has accepted it as an equal medical treatment — when in fact, acupuncture is lucky to get billed above bikini waxing. And the only people who are making any real money from acupuncture are the owners of the spa — who are surely not acupuncturists themselves. Hardly anyone getting acupuncture, acupuncturists not really making a living, people who are not acupuncturists taking what profits there are — it’s a microcosm of the rest of the profession.

You can’t separate this microcosm, of course, from the larger reality: if you look at income statistics for the US population, more than 80% of people can’t afford acupuncture at conventional rates. That’s why acupuncturists aren’t seeing enough patients to work full time; “this practice characteristic (that) warrants further study to better
understand”? It doesn’t warrant further study. All it warrants is doing the damn math. The conventional business model isn’t working for the majority of acupuncturists. The acupuncture profession is a house of cards, propped up by the handful of people who are making money from it.  Acupuncture education, and the conventional acupuncture business model, ought to come with a warning label, the way cigarettes do: NOT SUSTAINABLE. May take years of your life and leave you with nothing, except huge student loans. This NCCAOM report should be that warning label. The danger, of course, is that no one will read it. We need to make sure that they do. That everyone does. Pass it on.

Author: lisafer

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  1. Thank you!

    Thanks for the information! I know many of my classmates are  struggling in this economy and it’s great to hear you speak the truth!



    Maria Noth L.Ac.

  2. in search of 60K

    Before going to acupuncture school I went to the library to research acupuncture salaries. I couldn’t find hard numbers, averages, etc. other then a vague 60K range that Lisa mentioned in this post. I then had a long conversation with the financial aid officer at my school; the only concrete information she could give me was that my school’s graduates had a very low default rate on student loans. Hmmm….

    Joseph Goldfedder 

  3. Prospective Students

    Thank you, thank you, for finally giving me something for “prospective students” to read.  I’ve already forwarded this to those who have expressed an interest in becoming acupuncturists.  Now I’m going to print and copy it for in-house distribution…

  4. One solution is for our

    One solution is for our national and state organizations to launch publicity campaigns (got milk?) to educate more patients.

  5. thanks

    for this analysis lisa. i am definitely one of those pople who does not bother to read the emails from NCCAOM – i saw that report in my email box and just could not deal with opening it… beside the fact that i have little faith in anything NCCAOM has to say, the topic of job task analysis sounded ominous and depressing (i guess you are proving that here).

    something else that popped into my head: California has a huge percentage of US acupuncturists and because of our stupid stubborn licensing process we are not required to be NCCAOM certified. Many California grads (unless they plan to move out of state to practice) do not bother to take NCCAOM anymore because they do not have the extra 725 bucks to cough up at the end of a long 3 years of beiing a broke student in debt. So it would be interesting to find out what percentage of California acupuncturists are actually NCCAOM diplomates, because the ones that are not do not even get emailed or surveyed by them.


  6. Add Mass. to that list

    While licensing in Massachusetts requires that you pass the NCCA exam, if you take the test in Mass (rather than in NY or elsewhere) you are not an NCCA diplomate unless, as Tatanya mentioned, you pay the extra fees.  I never received this survey, for the same reason  — I am not NCCAOM certified.



  7. Wisconsin & Maryland, too

    Neither state requires NCCAOM certification for licensure/certification.  In MD, you can get licensed by simply graduating from an accredited school.   In Wisconsin, we had to take a few of the NCCAOM exams, but not all of them…in fact, we didn’t even have to graduate in order to get certified in WI!

  8. Broken record (mp3 file?)

    Wow Lisa. You sure can be a bummer with that “sustainable business
    model” broken record of yours. Way to look at the business model glass as half
    unsustainable. Seriously though, I think you are wrong about one thing: That
    spa is not making money off acupuncture either. Their overhead for the space
    taken-up by the acupuncture treatment room is probably their least
    profitable use per square foot of space. That is the harsh reality these “Integrative”
    medical clinics/spas face and why so many of them go belly-up after a few years
    kind of like acupuncture practices. It doesn’t have to be that way though. I
    swear to God as I was reading this thread, we had a walk-in (a former patient)
    who wanted to be seen right away and was told we had nothing available the rest
    of this week. We need more well thought-out sustainable models, both for
    practitioners and our profession as a whole, and I am working on it.

    Matthew Bauer

  9. Microcosm of the Macrocosm

    Our government, financial system, and higher education in general form a vast megalopolis built of cards. Why should our profession be any different? What would it be like if other professions started losing faith in their leadership, realized that their problems can not be solved from the top down, and started forming a decentralized network of support that actually helps solves these problems? What if it was a network that didn’t exist for the purpose of siphoning money from the rank and file with the vague intention of using that money to buy its way into a bigger share of government entitlements? What if other professions started scaling their roles to what their communities actually need and can support? What if their passion to do the work they were trained to do carries them through a changing economic reality that won’t let them do that work? I suspect we’ll find out soon enough. I also suspect that the sliding scale community clinic will soon be “discovered” by mainstream medicine. Also, I wasn’t kidding about being paid with chickens in the near future!

    We take cash, check, Visa, and Rhode Island Reds.

  10. Thanks Lisa, but now …..

    I have to bring this up in case people have missed it.  Where did this info come from?

    “Consider the facts in context. There are currently 30,000 acupuncturists and 8,000 acupuncture students in the U.S. Each sees an average of 50 patients per week. This equates to roughly 1.5 million treatments per week and 78 million acupuncture treatments per year.”

    Please note, I am not trying to open a discussion regarding the topic of this article (that’s something our national orgs should have PR all over), just simply wondering where this data is sourced from as 12 other references are cited.  But not the professional data?

    Keep up the good blogging.  I saw similarities to your comments and had more questions & concerns after reading the very long survey results.  The truth doesn’t have to be all glossy & rosey, but it’s certainly easier to get a practice off the ground after graduation when you consider that the odds are you’ll be joining the 80-90% self employed category.

  11. NCCAOM Fees

    Thanks for bringing the cost up Tatyana.  It’s great to have an open dialogue on what it costs to enter and stay in this profession.

    For any students out there reading this blog.  It’s a good idea to plan to allocate somewhere between $1360-$1785 for the NCCAOM board exams.  This dollar amount does not include state licensing fees or other requirements.  If I was in a state that did not require the certification, I would weigh the costs vs. benefits of this….both in the short and long term to made an educated decision.  If you find yourself not needing this option, save the money to help open your practice!

  12. in the AT article, I

    in the AT article, I appreciate MJ’s defense of clean needling technique that we all practice.  The article from Hong Kong researchers he writes counterpoint to is tantamount to a scare piece/hit piece on acupuncture, and is being picked up/rerun piecemeal by worldwide news agencies like it is gospel.  The article from Hong Kong will blow over, and dissipate like a cloud as soon as some other eye candy for the newswires appears.

    But you are right about the above, there are not 78 million acupuncture treatments given in the U.S. each year.  The 2007 NHIS study showed that it is more like 17.6 million.  There are 8000 acu students at last report from CCAOM, and there are probably 30,000 acupuncturists if you count LACs, MDs, Naturopaths, and those few practicing under the radar.  50 average per week, times 52 weeks per year, times 30,000 practitioners, not quite.   nice thought, but not quite.  The NCCAOM ’08 JTA reports much lower averages.  90% of respondents see less than 10 new pts /week, and 80% see less than 30 returns/week, so 50 visits per week per 30,000 Acupunks unfortunatley doesn’t add up, but it would be great if we were all that busy!  If those were the numbers we’d all be making a bigger impact on the collective good health of our country.



  13. Et tu Brute?

    Great to have some numbers to confirm that acupuncture is in the crapper, something we all already know. . .

    Any evidence that “community acupuncture” offers anything better in terms of pay?

    What’s the point of stirring all this s#!t if at the end of the day, “community clinics” only net similar numbers? $20k is not going to pay off $60k in loans regardless of how good you are for the community or how busy you are. . .

  14. seriously?

    There are a couple of points.

    First, look at this quote from the CCAOM website about acupuncturists, under the section directed at “career counselors” :

    “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.”

    This is completely misleading, and it’s directed at people who are presumably encouraging other people to consider acupuncture as a “career”. The word salary implies that there are jobs, which there aren’t; the numbers quoted are actually not salaries but ranges of gross income, which should be divided in half at least to figure out take home pay; and it is absolutely fucking uncommon for acupuncturists to earn well over 100K. Maybe you know that acupuncture is in trouble, but there are currently some 8,000 acupuncture students who mostly have no idea. There are a couple of thousand people every year who go to acupuncture school who deserve to know what they can really expect in terms of a “career”.

    We’re still figuring it out, but it looks like community acupuncture, done according to the model, should result in salaries — real salaries — of between $30K and $40K or so. You’re right, that still is not commensurate with student loan debt. And that’s the other point: given the data about what acupuncturists using any business model can realistically expect to make, acupuncture education costs too much, takes too long, and doesn’t prepare people for reality. That is the part that needs to change.

    So I’m a traitor for pointing that out? I didn’t think I needed to clear this point up, too, but OK: my loyalties are with patients first, and other practitioners second. I never pretended to have any loyalty at all to the schools and the accrediting bodies; basically, I think of them as predators. So find a better Shakespeare quote.

  15. Thanxxx…

    …For posting this. I read the report while s(h)itting on the throne–like when i decide to read AT…really good for clearing out the lower jiao from the lower orifice.

    I kept looking for how many surveys were sent out and what the response rate was, and I could not find it. Where did you find the numbers? (perhaps I was just skimming too quickly to avoid the LV invading (and constraining) the SP/ST). Nice to see the 25% response rate.

    I will say that when I first received the survey, I had just started grad school in an allied health profession that actually has job potential, so I was not practicing more than 10 hrs/wk, nor putting forth the effort to grow the practice (I KNEW things were going to tank–glad I started school). The online survey was adaptive and I was initially kicked out b/c I was practicing so little, so I went back and fudged it so I could actually complete it (unless there was another survey that I completed…I don’t fully recall…but I do distinctly remember completing an NCCAOM survey that initially kicked me out b/c I wasn’t considered “in” the profession–I think I also indicated that I was back in school pursuing a career in a health profession that will actually pay me money–the largest of all health professions).

    They really did skew the numbers favorably. Perhaps a letter campaign should be started…perhaps there should be news releases questioning the results. Really, 60k and under??? What did they make brownies with Huo Ma Ren that was NOT denatured?

    Unfortunately, I do predict AOM will be transformed in about 10 years, and it will not be to the liking of the schools or the alphabet organizations, or for those that drank the kool-aid. Perhaps we should take a cue from Chirotalk proboards and go from there (they’ve become the bane of the DC, aka “Dog Crapper” profession).

  16. Another option

    I just found out about Income Based repayment for my student loans.  Apparently, they’ll base my payment off my tax return for the previous year, and after many years of paying it off, they’ll write off the unpaid amount.  I’ve got way more than 60K in debt, so that seems like a pretty good option.

  17. I have been on the Income

    I have been on the Income Contingent plan for years, it has saved my life! I’m surprised how few people seem to know about it.  If you earn under a certain amount you can pay nothing, although I always tried to pay what I could so it wouldn’t keep growing so much.  The Income based seems to be even better, I’m going to switch. After 25 years on the IB plan the loan is forgiven, unless Obama does get that reduced which I think is a possibilty.   

    The only thing to keep in mind is that under current law the discharged amount is taxable as income unless you work for a non profit, there are people and a few lawmakers trying to change that because saddling a person with a big tax bill defeats the purpose of loan forgiveness.  I recommend anyone with a student loan to become knowledgeable and active in the politics of it.

  18. So glad to see that the

    So glad to see that the founder of CAN and someone who does what, monthly CEU workshops? has “loyalties” that are “with patients first”, maybe you should spend more time with those patients and less sowing false hope, which, yes is betrayal, a betrayal from which you are profiting.

    “We’re still figuring it out, but it looks like community acupuncture, done according to the model, should result in salaries — real salaries — of between $30K and $40K or so.”

    In a survey of what?
    “37 out of 94 LOC clinics responded for a 39% response rate.”
    Hmm. . .

    “1) CA is beginning to make a living for more owners: 3 clinics are reporting owners making $42-48 K per year. 5 clinics reporting owners making $34-38K per year. 5 clinics reporting owners making $21.6K to 28K per year. ”

    How about those other 24 clinics? Can I assume that they’re in the under $21k range? What about the other 57? Many of your arguments against this stupid NCCAOM “model” and survey apply directly to your own “model” and survey. Could it be that CAN’s view is skewed positive? Let me guess, you and your partner are 2 of those 3 making $42-$48?

    “basically, I think of them as predators.”
    Yeah, ditto to you, how much of your salary comes from poor desperate lac’s who are vulnerable enough to buy your “we’re the GOOD guys, and OUR model works” routine? It helps that you can sell your false hope on a sliding scale, doesn’t it?

  19. I don’t think you’ve been

    I don’t think you’ve been paying attention, un-named one. If your villains were making a bunch of money, they deserve it; but, most of it is going back to CAN so that we can have this discussion and figure out how to have people in the US and elsewhere actually get acupuncture and acupuncturists actually make a living. I’m making 40 and treating hundreds of people that I love every week. My life is rich. It’s hard to make it work, financially, for my artist wife and myself and our baby. But, we’re doing it. A lot of our needs are met by our community.

    Did you get duped by someone? I’m sorry. Don’t insult people who take CA workshops by chalking our interest up to vulnerable naivite. Maybe people actually want to figure something out. For a pretty good percentage of people who do the workshops, they DO figure something out, that changes their lives in a way they’re incredibly grateful for.


  20. False hope?

    There are many happy practitioners in this group.  The hope seems real.

    After 15 years of what has been considered a pretty darn successful BA practice, I can say I’d have been happy to see 30-40K last year. 

    What useful options do you have for the poor desparate L.Acs., taught a model that won’t work for most of them?  (It doesn’t work for almost any health professionals these days.)

     Why so pissed?

  21. word.

    What he said, though I don’t own a clinic or make 40K.  Our clinic is definitely suceeding, I’m making a decent enough living for my family and me, and (most importantly) I’m having the time of my life doing this.

    Actually, what’s even more important than all that is that soooo many more people are getting acupuncture because of CA and CAN.  People who never had it before, and never would have had the opportunity otherwise.  Thousands and thousands of people.  That’s what you really need to look at when you evaluate whether or not Lisa is really focused on patients.

  22. Thanks for this Lisa, keep

    Thanks for this Lisa, keep it coming.  Despite whatever you may think about about this blog post, I have not been able to refute the facts that our education is too long, too expensive, our treatments too costly, and average practices unsustainable.  It is not rocket science to realize that most people cannot afford our services.  CA is a viable model that is making a huge difference in my practice and community period.  I don’t need statistics to tell me that most of my colleagues have either quit or are struggling to get people in their doors! 

    In terms of the education, Quebec has an interesting model.  They offer a three year program to residents of Quebec, and while there is reportedly a bit of a waiting list, the tuition is $0!  Yep, free!


    ps. not that Lisa and Skip need defending, but I can guarantee you they are not getting rich offering their weekend workshops on CA! And if they are earning some money from it they certainly deserve it!


    Thanks Lisa


    Michael Victoria, BC

    “sing’in rooty toot toot for the moon!”

  23. gawd, not this again!

    lisa, skip do i need to tell yet another person that i have been to your house and that you are NOT rich? whoever you are, you sound upset and disgruntled. there are so many happy acupuncturists on this site, all sharing information, supporting each other and rejocing in the fact that they are actually using acupuncture on a daily basis to make a difference in their communities and getting paid for doing it. you might want to get a bit of that medicine, see how it tastes. wealth has many forms; stability, consistency, community, dignity are all major quality of life riches in my book.


  24. Thank you

    Lisa and all at WCA for getting this started. Could not have possibly be doing what we do without y’all.

  25. Murray Hill Neighborhood

    Murray Hill Neighborhood Acupuncture and Chinese Medicine, LLC

    Address: 1926 East Park Place Milwaukee, Wisconsin 53211

    Open seven days a week by appointment. Phone 414 906 8881.

    6 comfortable recycled lounge chair

  26. thank you

    Murray Hill Neighborhood Acupuncture and Chinese Medicine, LLC

    Address: 1926 East Park Place Milwaukee, Wisconsin 53211

    Open seven days a week by appointment. Phone 414 906 8881.

    6 comfortable recycled lounge chair

    As a nurse, one of the reasons I went into acupuncture approx 10 years ago was because of all the lying and cover up I saw first hand when I worked in an ICU unit many years ago, even to the detriment and sometimes death of the patients. Since I couldn’t be a part of it, I looked and looked at what to do and found acupuncture, which I found incredibly humane and kind and very much centered on the patient. Over the years I am watching it change toward the Western model, including the arrogance and lying. Finding this group has been a godsend to me. It’s one thing I hang on to. That there are other people out there who care about patients first and care about truth. Can’t thank you enough.

  27. Listing your clinic

    There is information here ( about how to get your clinic posted on the Locate-A-Clinic page; scroll down to “Setting or editing your Clinic Listing and user profile”.

    If you meet the guidelines on this page ( and are a member of CAN, we’d love to have you list your space with us…

    (Sorry for the long address; I can’t get my hyperlinks to work today.)

  28. just the facts

    first, thanks everybody, for all the kind words.

    Devilsad, actually, I really sympathize with your bitterness. The whole “false hope” thing deserves a longer response, another blog post, which I’m working on. In the meantime, though, there are a couple of factual things. The owners at WCA, of which I am one of three, make $35K a year. I saw 85 patients last week. I love my patients, but I don’t think it would be a good idea if I spent more time with them than I do already. This seems to be working, I don’t want to mess with it.

    I do appreciate the irony of us being on the CEU circuit while snarking about it. We started doing workshops because we were drowning in acupuncturist inquiries. I was spending crazy amounts of time consulting with people for free, and it had to stop; workshops were our solution. Here’s the interesting thing — doing lots of workshops requires significant infrastructure, and what that means in the long run is that doing the workshops pays for the infrastructure, and not much else. When we do workshops, we don’t see patients, so workshops have to make up for the income we miss by not seeing patients, as well as for the other people’s wages who deal with registration, make copies, getting the certificates — you get the picture. I think there are ways to make money on the CEU circuit, but we haven’t really figured that out. Probably because we don’t care that much, and we’re not good at money. We’re sloppy and chaotic and we find it boring. There are any number of community acupuncturists who are a lot better at handling the money end of things than WCA is — I would guess those are the owners making 48K, the ones who have their act together. We basically just break even, every year, as we muddle along and  keep adding acupuncturists. The thing we are slowly figuring out is a sustainable staff structure. So the truth is, none of my salary comes from desperate L.Acs. Some part of my non-acupuncturist business partner Lupine’s salary does. But if it weren’t for Lupine, there wouldn’t be CAN, and there wouldn’t be any hope of figuring out the aforementioned sustainable staff structure. It’s kind of like our merchandise — we have these great t-shirts and tote bags. But all they do, financially, is allow us to keep making t-shirts and tote bags. What we really depend on, what at least 90% of our budget comes from, is acupuncture. Acupuncture in $15 to $35 increments, that adds up to a bunch of $32K to $35K jobs, and not much else. Probably none of this makes you feel any better about what we’re doing, but I wanted to say it, in part because I don’t want anybody who is looking for entrepreneurial genius to look at WCA. 

  29. spreading the word!!

    In regards to getting the word to the public… I was recently informed that a local, prominent hospital in Detroit, Michigan just did a news expose on it’s Acupuncture program! I’m a student in South Florida who will be returning to Detroit upon graduation. Despite the economic situation up there, and the blog I’ve just read, I still have to have optimism and faith. Like any self employed individual, an Acupuncturist has to be creative in getting clients through the door, and even more creative in getting them to return. If your own community is not creating awareness… get out there and do it your self!!!! I believe as an Acupuncturist, or any health provider for that matter, it is important to spread yourself throughout the community, making yourself available to all levels of income. The Community Acupuncture Network seems to be making this possible!!! Regardless of the monetary outcome, I can say I truly look forward to healing my home town 🙂 Good luck to all the Acupuncturist in this country… I wish you all the best!

  30. Hi Bridget!

    Community acupuncture is alive and thriving in Metro Detroit with clinics in the city proper, Livonia and Ferndale.  We will be here to welcome you back!  Hopefully you will consider pursuing community acupuncture here, there is room for so many more practitioners.

  31. Licensing and examination fees are all very interesting….

    Yes, i do recall the very heavy cash outlay for the AOM boards…i didn’t even bother with the herbal boards, and only took the Acupuncture diplomate exam. Why pay $500 for the OM diplomate, then all the exam fees when it isn’t even required. To add insult to injury, it costs $500 to get a license in my state and they are issued/renewable every odd year. So if you, like me, took boards in an even number year, you would have to pay $1000–$500 for the initial license, then another $500 months later to renew. If you took your boards in january of an odd year, you could either wait until june for the renewal, or pay $500 to get your license in january, then another $500 in june for a full 2 years…the state WILL NOT PRORATE,

    Just for comparison, I’ve just registered for my NCLEX-RN. The cost is $200 for the exam, and the license fee in my state for 2 years is $88. The Dog Crapper license in my state is 3 years and somewhere in the $200 range…many DC’s who also get traditional AOM training at an “accredited school” of AOM get their initial Acu licsense and becom LAc as well as DC. Then they never renew their LAc because they can practice acupuncture under their DC license and not have to do double the CEUs.

    I smell the fallout coming from this.

  32. Half truths are still lies.

    Lisa, I love this. I’m sick of people putting the best possible spin on things. This happens everywhere I look.

    A half-truth is still a lie – a lie disguised as truth.

    You are right that the so called “salaries” are gross rather than “net”.

    Also, I’ve met quite a few acupuncturists who have a little space, treat a few patients a week – and their income goes straight to overhead. Most of them are embarrassed about it, and I could see them neglecting to fill out the survey.

    Think we can turn your post above into worksheet form so anyone considering acupuncture as a career path can do the math for themselves? Most people don’t consider overhead .. taxes … insurance… or anything like that – and they really, really need to.

  33. the numbers

    I really appreciate the dedication you offer in respect to investigating the realities of data and information that is often so casually conveyed by sources such as the NCCAOM and acupuncture schools.  Reporting of the facts, without skewing them to support a paticular view is rarely found, as well as the willingness to participate in the consequent reality (as per the data).  Both of these elements are essential for us to accurately asses our circumstances. 

    We all benefit when we have honest and reliable interpretation of data.  This is in stern contrast to the universe-is-with-you style of propaganda that prey’s upon our willingness to be hopeful and sometimes our tendency for denial of what is not pleasant. Once again, thank you for your attention to detail in these matters, and taking time to convey the results.


  34. And the NCCAOM makes it even worse

    With a pay to play cost of around $3k-$4k the regulating agency for Acupuncture nationally, the NCCAOM, makes a bad situation even worse. After racking up to $135k in student loans to get their Masters degree in O.M., practitioners must deal with a costly, non-transparent, non-regulated, non-nationalized regulating board that creates exam questions from thin air. The majority of the NCCAOM tests are designed simply with one goal: to fail a particular number of students and to limit the number of new professional acupuncturists entering the field. There’s one catch: you’ve already borrowed those student loans and you are certified as a Master of OM, but you just can’t work. Therefore you have no way to repay your loans. I submit to you that the NCCAOM should be abolished.
    I have thus far paid $2100 to pass two of four exams (failed some too), and I have now, half way through the process, resolved to boycott the NCCAOM and simply practice somewhere that NCCAOM certification is not required. Please keep in mind that even after extorting exorbitant pay-to-play startup costs from students the NCCAOM continues to burden struggling acupuncturists with hundreds in annual dues and continuing education requirements.
    Lets take for instance the BIOMED board. The questions are just all over the map, there is no way to prepare for it. Even doctors wouldn’t need to know such a wide range of random information in their practice: that’s why they specialize. And yet BIOMED is less than 1/3 of my degree program, my primary focus in studying OM is on how to be a good acupuncturist and herbalist. We are not even allowed to make western diagnosis, we must refer out.
    The NCCAOM returned my exam results to me LATE, as though they had completely forgotten about me. Eventually they sent an email with an apology, and let me know how to log into their web site to check a test grade. They had to explain it because their web site is such a mess that you would never find your grades online without instructions (and yet testing is the only thing the NCCAOM does…. ????)
    Its a sick game, and the NCCAOM’s exorbitant pay-to-play costs, lack of response to some emails, lack of timely response to other emails, lack of telephone contact availability, refusal to let students see their exam results in detail, use of test questions that are not even remotely in our scope of practice, and otherwise arrogant response to terminating professional careers for some AOM students is an issue that has gone too long without being properly addressed. For more information please visit my new and coming web site to blog about it at:
    I honestly believe I could have passed the BIOMED exam if I tried again and just kept on studying random BIOMED stuff. You have to study random because the scope of questions is just ridiculous. In any case I still had 3 more chances to try. But to be perfectly honest I think the BIOMED board is more of a craps shoot than anything and I refuse to pay another $300 to roll the dice. The way they do it these days (2011) is that you and all the other students take a test for 2 weeks, and then they compare all the students who took a test for those 2 weeks, compile the data, and the lower portion of the “class” is failed. You never see your exam again, there is no transparency in grading, there is no way to see if what they are telling you is accurate, no way to verify your grade, and its 2 months before they give you a P or F.
    Therefore, dear NCCAOM, our love affair is now over. You’re just going to have to live without me. That means you won’t get an application fee from me, and it also means you won’t get my annual dues. No more crap shoot test fees either. Sorry, but this is the way it has to be, its really whats best for us both.