There is another conversation I wish I never had to have again, and that’s the one where an enthusiastic community acupuncture patient tells me that she has fallen in love with the medicine and she’s going to acupuncture school. I usually start out by smiling politely, continue by biting my tongue, and eventually end up exploding NO! DON’T GO! Sometimes I vary that last part with abject pleading: PLEASE DON’T GO. And the enthusiastic community acupuncture patient is baffled and disturbed. Don’t I want more people to become community acupuncturists? Why, WHY wouldn’t I want her to go to acupuncture school?
Writing that last blog post helped me think about how to explain it better: because acupuncture education is a manifestation of turf warfare, and it’s the students who suffer the collateral damage.
The ACAOM not only defines acupuncture education in the U.S.; because it is recognized by the Department of Education, it allows the schools it accredits to offer their students access to federal student loans in order to finance their educations. The problem with that? If you need student loans to go to acupuncture school — and almost everybody does — then you shouldn’t be going to acupuncture school at all.
Experts suggest that you should cap your total student borrowing BELOW the first year’s expected salary, in order not to have a long-term negative impact on your financial well-being. And yet, according to the NCCAOM Job Task Analysis, for 90% of acupuncture school graduates, there will be no first year salary, because there are no jobs. (I’ll get to community acupuncture jobs in a minute.) The vast majority of acupuncture graduates are going to have to start a business if they want to use the skills they borrowed so much money to learn, if they want to actually work as acupuncturists. Not only is there NO salary for most graduates, it’s a kind of negative salary — right after graduation, you will have to spend more money to start your business. ( I wonder, in this scenario, do the experts suggest that the schools should pay you?)
Let’s revisit the income data from the NCCAOM Job Task Analysis. The majority of L.Acs, 60%, work part time, or less than 30 hours per week. Of that 60%, about 45% earn less than $20K annually from their AOM activities. And remember that’s gross, not net. When you add in the proportion of part time L.Acs earning between $20K and $40K, along with those part-timers earning $41K to $60K, we get a total of more than 80% of part timers working less than 30 hours earning less than $60,000. More than 80%. Gross. Approximately 42% of LAcs working full time (30+ hours per week) earn $60,000 or less, gross. Another 25% earn between $60K and $100K. Still gross. Since we are talking about businesses that these acupuncturists own, not salaries with paychecks provided by someone else, if you want to estimate what those L.Acs are taking home, it’s anywhere from 50% to 70% of their gross — 70% is if they’re doing really, really well. Don’t forget to factor in income taxes of 30%, because that’s what you pay when you are self-employed.
I am looking at the estimated cost to attend my alma mater, the Oregon College of Oriental Medicine, from 2011-2015 for the basic four year Master’s program. Total tuition: $81,525.00 “Realistic total cost of education” (includes books, supplies, boards, licensing, and living expenses): $137,585.00. I’m pretty sure that the cost of attending OCOM is comparable to the cost of attending many other acupuncture schools.
If you plug these numbers into a student loan calculator, first the calculator will remind you that your student loan payment should be less than 8% of your gross income. If you want to pay off your acupuncture education in 10 years, your monthly payment will be about $1600. The minimum annual SALARY needed to handle these payments? $241,668. If you want to pay off your acupuncture education in 25 years, your minimum monthly payment will be $972. Minimum annual SALARY to handle these payments? $145,755. According to the NCCAOM JTA, most acupuncturists gross less than half that.
But you probably won’t have a salary; if you’re lucky, you’ll be self-employed. Remember the part above about how, when you graduate, in order to work, you are going to have to spend more money in order to start your business? Unless you have somehow managed to save that money during school, you will need to borrow it afterwards. With those kinds of monthly student loan payments, no bank will loan you money, because your debt to income ratio will look awful. So if you’re not lucky there’s a good chance, if you took out loans to attend acupuncture school, those loans themselves will prevent you from working as an acupuncturist.
And yet student loans are what keep almost all acupuncture schools in business.
If somehow you manage to land a real job, with a real salary — not an acupuncture business opportunity, not a rented room in a holistic medical center, not an independent contractor position — most likely it will still be hopelessly out of scale to what you borrowed to become an acupuncturist. My clinic, WCA, will pay all its full time acupuncturists $35K this year for 32 to 35 hours of work per week — with paid time off, paid liability insurance premiums, paid license fees, paid continuing education, worker’s comp insurance and all the other perks that cost employers money. (If you divide the clinic’s gross income by the number of full time acupuncturists, we’re all still doing better than 70.1% of the acupuncturists who responded to the NCCAOM Job Task Analysis survey.) Our big goal is to get everybody closer to $40K in the next couple of years. I don’t know of any community clinics offering salaries of more than $45K. You can earn more than that if you start your own community clinic, of course — but don’t forget about how you have to come up with money to do that. Awhile back I put out a call for acupuncture jobs that offered upper middle class salaries, and I even offered a toaster to the lucky person who reported one. But such jobs are rarer than hen’s teeth, rarer than rainbow-tinted unicorns, and I haven’t given out a single toaster.
When I started acupuncture school, exactly 20 years ago, the arithmetic worked better. I graduated with a total of $37K in student loans, $10K of it from my undergrad degree. If I could offer time travel as a benefit to my prospective employees, the enthusiastic community acupuncture patients who want to go to acupuncture school, I wouldn’t need to be writing this blog.
But something happened in the intervening 20 years: acupuncture education blew up like a balloon. And these bloated programs, culminating in the distended, turgid, tumescent FPD, are all about competing with other professions; they’re all about turf warfare. It wasn’t good enough for acupuncturists to have a 3 year, night-school, Master’s degree; we had to have a full time 4 year program like the chiropractors. And if we have a full time 4 year degree, then by God we deserve a doctorate. The PTs have a first professional doctorate! Because, as one school owner said, a first professional doctorate will keep our graduates on the same playing field as other “doctoring professions”. What playing field he was talking about, I have no idea; we are definitely not playing on the same field as the people with jobs. We’ve never even been inside that particular stadium. I’d say that we’re playing stickball in the alley, except the tragedy is that so many of us aren’t playing anything or anywhere at all. Anecdotal evidence suggests that a horrifying percentage of acupuncture school graduates never actually practice. We’re obsessed with the idea of other professions stealing our medicine, but really, why shouldn’t they? So many of us aren’t even using it.
But what about IBR? Income Based Repayment, the federal government’s gift to over-educated, underemployed, deeply indebted Americans? IBR has been the salvation of many acupuncturists. Which should tell you something, because IBR works best if you make not more than $35K per year, never plan to make more than $35K per year, are OK with never paying off your student loans, and can stand the possibility that you might someday be taxed on the balance when the government forgives it after 25 years. Oh, and you’d better not have a spouse with a decent income, because you won’t qualify. (More — much more — on that topic soon, in a blog not written by me.) At this time, through IBR, the government is functionally subsidizing the acupuncture education of many graduates who can’t make their loan payments, and possibly never will, and very likely are not even working as acupuncturists. IBR requires those graduates to forego what most middle class Americans would describe as financial security. Who loses in this scenario? The graduates, the government, and most of all the patients who are not receiving acupuncture from all those non-practicing acupuncturists. Who wins? Only the schools, who are doing such a good job at keeping our medicine out of the hands of people who might corrupt it by, you know, using it or something.
Which gets me back to the topic of sin.
My church is loopy in many, many ways, but one way in which I think it’s not is in its teachings about economics. Catholics recognize “social sins”, like polluting the environment, widening the divide between rich and poor, excessive wealth, and one I’m thinking about right now which is “creating poverty”.
That’s what turf warfare does; that’s what acupuncture education does in its present incarnation. For most people, it creates poverty. I would love to employ all of those enthusiastic community acupuncture patients who want to become acupuncturists. But I can’t stand the thought of encouraging them to take on debt that they very possibly might never repay, on the salary that I –or anyone else I know — can offer them. And this situation is almost as bad for those of us who are acupuncturists now, especially those of us who own clinics. If we want to move or retire, how can we sell our clinics to graduates who are more than $100K in debt? Who will be able to replace us? Unless we change the state of acupuncture education, the community acupuncture movement has no future. Turf warfare has created poverty for the entire profession.