Survey Says: 27,965 Licensed Acupuncturists in the U.S. as of July 2009
But the whole picture isn’t rosy – the current trends indicate that acupuncturists are leaving the practice in high numbers.
** update (8/4/09) ** Wisconsin numbers came in at 401 active licenses, lower than my projected 445. NH licensing reports 110, although I think NH is actually closer to 100. These are the last of any official numbers to arrive until next year’s count. -kz
Total number of Licensed Acupuncturists in the U.S. — July 2009
(Chronology Format)
1st sept july proj’ns
Law State 1992 1993 1994 1996 1998 2000 2004 2007 2009 2009
1973 Maryland 313 259 259 433 433 720 740 798 800 825
1973 Nevada 30 30 30 30 30 29 43 41 45 45
1973 Oregon 143 168 168 256 334 326 576 893 947 965
1974 Hawaii 252 270 276 338 356 405 532 621 624 630
1974 Montana 68 68 68 92 98 117 136 147 147 150
1974 So Carolina 1 1 1 2 73 73 47 113 89 90
1975 Louisiana 1 2 2 3 3 12 17 18 20
1975 California 2798 2829 3049 3692 4387 5321 8566 10700 9402 9700
1978 Rhode Island 24 24 45 60 79 99 131 151 150 160
1981 Florida 399 399 442 537 810 1029 1580 1777 1900 1950
1981 New Mexico 270 270 270 390 390 498 533 574 700 720
1983 New Jersey 45 45 45 62 101 180 367 485 700 725
1983 Utah 22 22 22 27 27 37 64 89 103 105
1985 Vermont 34 52 76 111 143 152 155
1985 Washington 137 144 169 299 274 535 904 950 1142 1175
1986 Massachusetts 356 398 434 524 652 805 941 950 961 965
1986 Pennsylvania 105 105 249 310 310 545 583 500 468 470
1987 Maine 38 39 45 53 59 79 90 120 120 125
1989 Colorado 93 115 143 202 293 386 711 931 1035 1060
1989 Dist of Col. 42 42 42 42 117 128 176 160 146 150
1989 Wisconsin 80 99 108 172 165 133 312 399 401 410
1990 Alaska 9 12 14 28 38 47 62 82 93 95
1991 New York 300 300 500 700 800 1200 2400 2961 3312 3400
1993 Iowa 3 8 19 27 38 60 65
1993 North Carolina 7 67 115 146 227 380 392 400
1993 Texas 154 300 363 409 627 782 842 875
1993 Virginia 3 14 31 80 256 349 406 425
1995 Connecticut 8 98 163 257 295 350 360
1995 Minnesota 13 88 119 316 314 358 370
1996 West Virginia 4 30 40 44 48 35 35
1997 Arkansas 9 17 26 30 33 35
1997 Illinois 224 421 531 631 650
1997 New Hampshire 34 78 102 110 110
1998 Arizona 142 314 441 482 500
1998 Missouri 57 75 82 85
1999 Idaho 45 75 146 160 165
1999 Indiana 48 85 85 90
2000 Georgia 8 132 150 175 180
2000 Ohio 11 69 125 147 150
2000 Tennesee 69 94 108 110
2001 Nebraska 11 15 10 10
2006 Michigan 0 0
2006 Kentucky 31 44 45
2008 Mississippi 0 1
2008 Delaware 0 10
Totals 5525 5640 6545 8694 10623 14228 22671 27633 27965 28761
Estimated numbers of Acupuncturists in each state with no laws, and Michigan:
Alabama 50
Kansas 100
North Dakota 25
Oklahoma 125
South Dakota 25
Wyoming 20
Michigan 100 (michigan has a law on the books but has not finished the details of the implementation of regs for licensing yet)
Total 445
Numbers from 1993 to 2004 compiled by National Acupuncture Foundation (NAF)
Numbers in 2007 compiled by Jerusha de Groote
Numbers in 2009 and projections compiled by KZ
Numbers in bold are KZ 2007 estimates based on linear growth
Notes, Trends, Observations
Notes: Some thanks, assumptions, and considerations in gathering this data:
N1. Thanks to the NAF, which in 2005, posted the 1992-2004 count on their website (link) here in a handy table.
N2. In September 2007, Jerusha de Groote of Mississippi collected as many updated numbers that were available at the time,
and added them to the NAF table. I was fortunate to stumble across these on his website at the last minute. Thank you Jerusha, because, as it turns out these mid-2007 numbers are important to see. I’ll explain that in a minute below.
N3. Jerusha was unable to gather a few of the 2007 state totals at that time. These are blank spaces in his 2007 data table. I dug up Wisconsin’s 2007 numbers in one of their old publications. The rest of the 2007 missing states I estimated based on linear growth trends. Based on the 2004 and 2009 numbers, I believe my 2007 estimations for those unknown state totals are very reasonable. These are in bold above (or yellow in the excel spreadsheet).
N4. For everywhere besides Wisconsin, I am extremely confident about the numbers.
I either received email confirmation, or counted them from their state online license databases. So many thanks also to everyone who answered my email requests or helped me navigate some state’s license verification databases.
N5. For Wisconsin’s 2009 numbers, I used 445 as a reasonable estimate based on past growth rate. I haven’t gotten the exact 2009 figure from their licensing department yet.
** update (8/4/09) on Wisconsin numbers, they came in at 401 active licenses. NH licensing reports 110.**
N6. Multiple license holders. I do not account for any practitioners holding multiple active licenses in different states. I’m assuming that this number is small, maybe in the low hundreds, and pretty much statistically insignificant. This would be a little bit more time consuming to track down and figure out.
N7. Six states still do not currently have license laws. The practicing acupuncturists in these states may or may not be licensed, but in any case I made a guess-timation based on yellow pages and web searching of the likely numbers of practitioners in those six states. The total for these states combined is likely in the low hundreds and doesn’t affect the national total significantly as far as I can see. Included at the bottom of the above table.
N8. Please feel free to use the 2009 data collected above without citation. It is public record. If you use the pre-2009 data, please cite NAF and Jerusha as a courtesy to them for spending their time collecting this information.
Data Trends and Observations:
Before we get to “what the heck has happened in California?”, let’s take a quick look at the total national numbers. Suffice to say I’m not a statistician, but I am one of those people blessed/cursed with seeing the world many times in terms of numbers. Anyhow, there are some basic growth trends which are evident from the national totals.
From 1993 to 1998, the totals increased from 5640 to 10,623.
From 1998 to 2004, the totals increased from 10,623 to 22,671.
From 2004 to mid-2007, the totals increased further to 27,633.
From mid-2007 to mid-2009, the totals have increased to 27,965.
I am loosely projecting an overall national increase for the rest of 2009 of approx. 800 more LAcs., to have a total of 28761 by year’s end. We’ll have to see later if I am a good forecaster.
So, we can see that from 1993 to 1998, the ranks of licensed acupuncturists had a net gain of about 1000 per year (5000 over 5 years). From 1998 to 2007 the number of LAcs in the U.S. has basically grown at a net rate of 2000 per year (17000 over 8 1/2 years). In the last two years, the net gain so far is about 200 LAcs. per year.
Based on the previous growth rate from 1998 to 2007, we would reasonably expect the total number of LAcs today to be around 32,000.
If we do reach the 28,800 projection by end 2009, the net gain over this current 2.5 year period would be about 500 per year nationally , a number that is still way down under 2000 per year, or even 1000 per year.
Let’s take a look at things state by state.
Now, what the heck has happened in California?
California had a sharp decline from 2007 to 2009 in its totals. This part surprised me, and is definitely something to keep an eye on. Remember above how I said the 2007 numbers from Jerusha were important? In 2007, Jerusha’s numbers put California at 10,700 total LAcs. Without this 2007 figure, It would have been much harder to see a trend here.
No conclusion is readily apparent why, but it’s easy to see that Cali’s numbers dropped by about 2600 established LAcs in the last two years or so, or about 25% of the total 10,700 listed in mid-2007. At the same time California was gaining about 1300 more Cali exam passees, it apparently lost 2600 established LAcs, resulting in a net loss of 1300.
According to the stats provided by the Cali State Acu board on their website , their annual “test passee” numbers (or new California L.Ac.s ) have been pretty steady.
2009 — 300 so far, with the second (2 of 2) test date upcoming, and another likely 300 new LAcs to be added in California
2008 — 597
2007 — 726
2006 — 707
2005 — 660
2004 — 502
2003 — 723
2002 — 665
So what happened in California and is it a bellweather for the rest of the nation?
Slower economy forcing practitioners to other jobs? Retirement? Practitioners moving out of state? School enrollment must be fairly steady, otherwise the Cali testing numbers would be way down.
Probably a combination of things, but I am guessing that since California has had laws on the books since 1973, it probably has some to do with retirement, and the recessive economy.
So, does California’s loss account for all of the changing numbers?
Well, not all of it.
New York is the next biggie after California. It has experienced slower growth after 2004. From 2000- 2004, New York enjoyed a positive net increase of 300 LAcs per year, but from 2004 – 2009, it looks like the net increase per year is going to average about 200 per year. So, still growing, but not making as large net gains. Down 33% in net gains.
It’s possible New York is also seeing some retirement from the profession, but NY only had 300 LAcs in 1993, so I don’t think it’s as reasonable to assume this as it may be in California.
What about Florida? They are also pretty damn big. From 2000-2004, Florida had a net gain per year of 140 LAcs on average. But from 2004 – 2009, the net gain in Florida is about 70-75 practitioners per year, or a drop in the net gain of 50%.
Colorado has dropped from a net gain of 100 L.Acs per year (2000-2007) to closer to 50 L.Acs per year in the past 2 years. Down 50%.
Texas has dropped from net 80+ per year (2000 – 2007) to closer to 50+ per year in the past 2 years. Down 38%.
Pennsylvania’s total numbers have declined since 2004 from 583 to 468.
Massachusetts’ numbers have been basically at a standstill for the past 5 years, with Maryland steady for 2 years.
So where does all of this go? What does all of this mean?
The first and just about only general conclusion I would draw from this is that practitioners are leaving the practice.
ACAOM reports show self-reported school enrollment steady over years 2005-2007, with the last published total count of AOM students nationwide being 8075 in 2008. Student enrollment numbers have dropped slightly in the Mid-Atlantic/New England region in the 05-07 range (see page 9) , but the rest of the regions are steady or up.
NCCAOM stats show steady in the number of license exam passees (see page 9)
2006 – 1285 NCCAOM passees.
2007 – 1044 NCCAOM passees.
2008 – 1254 NCCAOM passees.
Coupled with the stats from California on the number of passees (above), you get a rough estimate of nationwide passees over the past 3 years, or about 1800 –2000 per year.
2006 – 1992 passees nationwide
2007 – 1770 passees nationwide
2008 – 1851 passees nationwide
These are some numbers previously estimated as a low end for the number of yearly AOM grads. If you add to these numbers the hundreds of test non-passees based on pass rates, then the yearly grad numbers nationwide easily go into the 2000-2200 range.
So where are we losing practitioners?
If the ranks of acupuncturists are growing by almost 2000 passees each year, who we must assume are taking a test to get licensed, it seems reasonable to assume that overall loss has to be from the rank and file. But I don’t think that these totals tell us exactly where we’re losing our colleagues, Year 1 LAcs, Year 2 L.Acs., Year 5? Year 10 ? It doesn’t tell us very much about the elusive “success/failure rate/how many stay in practice for how long” numbers, except that this loss rate has gone up dramatically in the past 3-5 years.
link to spreadsheet attachments
https://www.communityacupuncturenetwork.org/node/3498
Beautiful piece of work!
Thank you! I worked in BA in CAL (as opposed to CA=Community Acupuncture) for 8 years, taught for 4 of those years in a TCM school, and worked in admin at another school for about a year.
Since I moved from CAL to SC last year, I can tell you that I know lots of people who moved out of CA in recent years. Also a lot of the CA passees are foreign-born who go back to their country of origin (mainly Korea) or become acupuncturists as an adjunct to missionary work.
Anecdotal info – There are also some other situations in CAL – some people in CAL get the L.Ac. in order to have “a license, any license”, when they want to practice homeopathy, essential oils, flower essences, feng shui, or whatever. There are also a significant number of chiro’s, ND’s and massage therapists who go to acup school but don’t maintain their licenses.
I know personally of about 10 people who legitimately retired in the last few years in the L.A. area.
That being said, I also know many people who graduated with me in 2000 who gave up their practice and now do something else completely unrelated (but often related to their previous occupation).
IMO, completely unscientific and undocumented, many people in CAL go to school with a “warm and fuzzy holistic” bent, but are not at all suited to being in business. And the schools don’t teach enough business. Therefore, huge numbers fail in practice, and many more are marginal, as expressed more articulately in other areas of this website.
I don’t know about other places, but feel this covers some of the CAL anomalies. Hope it helps people to understand the un-understandable.
MM
Facinatin’
Lots to look at here. Great job!
I’m gonna spend more time looking at this later but here are the first two things that stood out to me: the ACAOM Placement rates. Like the rest of the ACAOM data its self-reported and not verified. Not a good thing. But looking firther these rates I guess show the percentage of students who passed an exam and got a licence a year after graduating and are thus “practicing” meaning they have a license and could see someone. In theory. Doesn’t say at all if they are supporting themselves. And then they don’t have a 5 year Placement rate or a 10 year Placement rate, etc all of which would go far to answering your query Keith on retirement from the profession. So for me not having Placement rates beyond a year and no data at all on if Punks are supporting themselves are two masive holes. Not of your making of course!
are you going to share this with AAAAAAAAAAACAOM?
I am impressed that you put this together. It’s very interesting. For what it’s worth I thought I would add some info.
In North Carolina there are currently 400 practioners in the numbers you present. My license number is 40?, and Aimee lisense number is somewhere in the 500’s. I know a yoga teacher who tried to get a practice going here in Asheville. By the time his 2 year license renewal came around he did not renew and now his life is all yoga and making mala necklaces. He makes a much better living than trying to run a BA practice.
All of the people I graduated with are practicing to some degree or another. One fellow grad told me last month that he and his business partner (another classmate) are taking out loans to keep there practice open. IN the same breath he told me to watch out because they were going to be “the biggest practice in town” and that I was “selling myself short.” Other classmates work at that same practice as contractors or employees. At least 2 practioners travel down to South Carolina (multiple lisense holders) and other parts of North Carolina to make sure they are seeing enough patients to make ends meet.
Just as I was moving to Asheville to start school, a practioner that I was working for was leaving the business in VA. She was burnt out on running her own business, and she wanted to move back to California where she graduated. She did not take the CAL board, and couldn’t imagine sitting for it, so she went back to corporate America. Fortunately I was naive and foolish as I headed off to acupuncture school and did not spend time questioning her decision, and fortunately she was kind enough not to talk me out of going to school.
A
are you going to share this with AAAAAAAAAAACAOM?
I am impressed that you put this together. It’s very interesting. For what it’s worth I thought I would add some info.
In North Carolina there are currently 400 practioners in the numbers you present. My license number is 40?, and Aimee lisense number is somewhere in the 500’s. I know a yoga teacher who tried to get a practice going here in Asheville. By the time his 2 year license renewal came around he did not renew and now his life is all yoga and making mala necklaces. He makes a much better living than trying to run a BA practice.
All of the people I graduated with are practicing to some degree or another. One fellow grad told me last month that he and his business partner (another classmate) are taking out loans to keep there practice open. IN the same breath he told me to watch out because they were going to be “the biggest practice in town” and that I was “selling myself short.” Other classmates work at that same practice as contractors or employees. At least 2 practioners travel down to South Carolina (multiple lisense holders) and other parts of North Carolina to make sure they are seeing enough patients to make ends meet.
Just as I was moving to Asheville to start school, a practioner that I was working for was leaving the business in VA. She was burnt out on running her own business, and she wanted to move back to California where she graduated. She did not take the CAL board, and couldn’t imagine sitting for it, so she went back to corporate America. Fortunately I was naive and foolish as I headed off to acupuncture school and did not spend time questioning her decision, and fortunately she was kind enough not to talk me out of going to school.
Thank you again Keith, this really shows the “stagnancy” of our profession.
Elizabeth
good thought about the
good thought about the license numbers.
next time i’ll ask for the last license number issued in each state to see how many have left since licensing began in each state.
last update to numbers
Wisconsin and NH numbers came in with an official count. So all the numbers are solid now. 27,965…..
Keith, you are a big damn hero
I can’t believe you slogged through all those lists — oh my God, the tedium. Wow. Thank you. Real numbers!
Looking at Oregon — so we have 900 plus acupuncturists here? Ha. No we don’t.
In terms of the OR license numbers, people who got licensed last fall were in the 1200 range, so you’re talking 25% attrition right there (300 or so missing licenses), but of course it’s a lot higher than that, because a lot of people who aren’t practicing keep their licenses. The fee isn’t high — $280 every 2 years — so it’s not a big deal to hold on to your license in order to treat a handful of people. You can see that’s what’s going on by cross checking business phone numbers and web listings with numbers of licensees. Most of the folks holding acupuncture licenses are not working as acupuncturists, unless I’m completely wrong about everything and they have all gone underground in a desperate attempt to avoid being trampled by those mobs of patients wanting acupuncture.
The thing about Oregon, though, is that we really do not have a lot of people here, definitely not the population raw material for acupuncture-seeking-mobs. Once you go outside the Portland metro area, there are no other big cities — a few small ones, sure. The majority of those 900 plus OR licensees live in Portland — meaning, if they’re busy treating patients, odds are that I would have heard about them. My brief experience with being on the board of the state acupuncture organization convinced me that there are maybe 100 acupuncturists making something resembling a living in Oregon. OK, let’s be generous and say 150. The other 800 or so are working part time if they are working at all.
So since the numbers are overly generous in their implications to start with, if they show a significant decline, things are REALLY bad.
Very Enlightening Information
I started acupuncture school back in 2007 and was licensed in 2002 in NC. After 4 years of student clinic and 5 years of practice using the ‘spa’ model, I was terribly bored and was dreading going in to the office every day.
My situation was a little different with a very busy practice from the get-go, so there was not the business struggle as I had owned a business for 17 years prior to the practice. I really thought there was something peculiar about me (ie… was the fact that I am a Fire element make me too vulnerable to patient energy? Was I lacking compassion? etc…)
I had taken a “sabbatical” a couple of years ago and developed a thriving .com herb business, all the while I know that I could be making such a difference with my acupuncture also. But I just could not see going back in to that practice model.
After reading the blogs here on the CAN website, I was re-inspired to practice again. I joined, and ordered the book. Thanks to everyone in CAN for providing a model that is a true alternative to the ‘spa’ acupuncture model, and for letting me know that I was not alone. Hopefully it will reverse some of those acupuncture ‘dropouts’ like me. I am going to look at office space today.
Woops-wrong date
Catherine Browne, L.Ac.I actually started acupuncture school in 1997, not 2007.
Rhode Island Numbers
Here in Rhode Island we have the distinction of having the license title “Doctor of Acupuncture.” In our tiny state of 1 million people over 400 acupuncture licenses have been issued. Of these about 150 are currently valid and a whopping 46 are pending.
If these numbers were a real reflection of the state of the profession here in Lil’ Rhody that would mean that we were pretty near saturation of acupuncturists with almost 1 acupuncturist for every 5,000 people.
What the acupuncture numbers for Rhode Island actually reveal is the extreme insecurity of many non-resident practitioners who think that having a doctor title will benefit their credibility and practice. The RI license is $410 annually so what I think happens is people apply for their RI license, get the nifty wall license issued by the state with the Doctor of Acupuncture title, and then hang that on their wall to make them feel better about themselves. Then they let their license lapse… only 150 are even currently active.
In states like California the law explicitly says that you can’t call yourself a doctor unless you are one, including a PhD, or a RI DAc.
By my estimates if you counted all the people licensed in RI who ACTUALLY LIVE HERE or close enough to practice here there would be maybe 75. Of these geographically plausible RI acupuncturists probably only 50 are really working here in the state and despite what NCCAOM is passing around as good news, we know that most acupuncturists, whether they can call themselves a doctor or not, are not very busy.
If you examine the NIH statement referred to by this NCCAOM press release, you will see that
“U.S. adults also spent approximately $11.9 billion on an estimated 354.2 million visits to CAM practitioners such as acupuncturists, chiropractors, massage therapists, etc.”
This like saying that every American got ONE CAM treatment last year and then 50 million of them got a second one, or that 1.5% of the US population got 10 treatments each last year (including chiropractic and massage therapy)
EGADS!
That was some really good cumbersome work you did!
Thank you so much for some hard facts. I wonder how the next part would be to get numbers of practitioners doing more than 5 patient visits per week. Maybe that would be too depressing but useful to bring to all the associations and National people to help them try to get their heads out of the sand and actually encourage workable business models.
In Massachusetts I am by far not an expert on how many practitioners are in practice but in my little neighborhood in central Massachusetts, by far the busiest practitioners are M.D.’s who have taken the 200 hour acu course through Harvard. One of them is booked 6 months in advance and doesn’t take new patients. The other one practices in my little town and is very busy. My understanding is that more and more family practice docs who are disillusioned with their medicine are changing their practices over to acupuncture practices. It would be interesting to see how those folks fit into the numbers.
Therein lies the rub
As I think all of us commenters are sayting in one way or another is that this data gives no indication of the State of the Profession: how busy are we, how many of us are making a living, what is the dropout rate past the first year, etc. I would say that there are two reasons for this:
1) Our organizations are too poor to conduct such a survey which would be a lot more detailed than what Keith posted above. I am including the state acu organizations as well as all of the national ones plus the schools.
2) The schools in particular don’t want that information because it would make them look bad. The info that Keith posted shines the best possible light on the schools, and even there some of it gives me pause; looking at practitioners 5, 10, 15, 20 years after graduation would probably be worse, much worse. We’ve talked about this issue a year or two ago and it’s not just us who think this.
So I think we won’t ever get any better info than what Keith has compiled unless we do the survey ourselves. Maybe in a couple of years we could tackle that as a group efort as CAN keps getting bigger and we split the work among a few hundred of us?
Amaro’s article – analysis of 2006 poll
interesting tidbits contained here:
What does it take to succeed in Acupuncture Practice?:
also, i am hopeful we could see the results of the 2008 Job Task analysis survey soon.
The devastating truth of simple number crunching
Hello all,
I found this post because I was doing a little research for a class of mine over at NCNM. The class is, unfortunately, a business class, which is supposed to prepare us to be our own person and use the tenents we’ve learned from Chinese medicine to create a thriving business. During class the teacher made an emotional comment that the oft-cited statement that 80% of acupuncturist graduates are not practicing shortly after graduation was mostly urban myth. I made it my mission to see for myself.
Anyway, in my search up pops all your wonderful research. For sh*ts and giggles I thought I’d crunch the numbers with the 2007 NHIS data on number of patient visits made to acupuncturists (17.6 million). For the 27,633 acupuncturists licensed in 2007 this would give them about 636 patient contacts per year. This kinda sounds like a lot, but is really about 12 patients per week if you’re working 52 weeks out of the year. And, even if you’re charging $75 a pop for a treatment your gross income (before ANY kind of overhead or taxes) is only about $48,000. This is much less than the big figures sometimes thrown around about potential earning power. And actually, if you look at the total out-of-pocket costs per year spent by patients on acupuncture it comes out to about $30,000 (although this does not include insurance reimbursement). Interesting stuff. The average number of visits by a given patient per year is also only 2 times, which is a horrendous track record.
I still haven’t been able to confirm nor deny the myth of the 80% graduate-to-practitioner loss. I guess the data doesn’t quite exist yet.
All the best,
Adrianna
data is hard to come by, but …
there is some other workforce data available. The acupuncture guild has a position paper that lists all of the known economic data regarding acupuncturists hours and income.
It’s now January 2010, and we’re still waiting for the official release of the 2008 Job Task Analysis data from NCCAOM. However, there have been “pre-releases” of the data.
see also here for more :
https://www.communityacupuncturenetwork.org/node/4023#comment-21171
best, keith
Thank you so much for your
Thank you so much for your help, this information is great! I’m excited to follow these leads where they go.
Adrianna