Turf Warfare 2: Acupuncture Schools

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.

Author: lisafer

Related Articles

Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


  1. .

    thanks lisa for the great blog. you again point quite clearly to one of the more insane parts of the acu industrial complex. god i totally feel the same way when prospective students who come in to the clinc start asking me about my experience with school. i have to take a few loooooong deep breaths and respond only with a few carefully chosen words at a time. you want to be respectful of someone’s desire to pursue something new and not dump years of accumulated frustration out on to their dreams all at once. and ya, wouldn’t it seem sillly that the person you go to and ask for career advice from(your acupuncturist) would possibly disuade you from following a similar path? if i start to run my sentences on too long while talking with them they become blatant pleas though. “don’t do it, save yourself!”. its a difficult thing to articulate to proepective acupuncturists, because the part of being an acupuncturist is definitely one of the most rewarding things i have ever experienced in my life and being with patients brings so much joy. but being an acupuncturist also carries with it the the biggest debt burden i have ever delt with, which is and will affect me in ways i don’t even know yet for many years to come. its a burden that is so disproportionate to reality in so many ways. it feels good to know there are others out there willing to fight this thing until its not allowed to go on any longer. until we no longer have to tell prospective students that going to acupuncture school just may not be worth it.

  2. Timely

    How funny. One NADA acudetox specialist was just wanting to talk with me about her possibly going to acupuncture school. I have that same horror of her diving into $100,000 debt. I’ll just send her the link to your blog!


  3. Quit complaining 24/7!

    Quit complaining 24/7! Pharmacists are being replaced by pixis machines! Physician assistants make 80k a year and work closer to 60 hours per week! 32 hours for 35k is good.
    Please focus on the positive aspects and not keep talking about everything wrong or you will add unto it.

  4. guest’s response:

    “other professions have it worse (sort of, since they actually HAVE jobs–reread the part about the vast majority of acupuncturists NOT having the $35K at 30hrs) so we should just really not do anything to bring up the facts or do anything to address them. too bad for those future students, they might as well suffer like the rest of us.”

    how is talking about and trying to improve the situation “adding unto it, exactly?”

    which “positive aspects”* would you like us to focus on, specifically?

    *if you read this blog and website in any depth or visit any CA clinic, you would know that we focus on the positive aspects of many, many people getting lots and lots of acupuncture and the possibility that more acu jobs are being created every day in these clinics. this is the result of being willing to stop swallowing the illusions, to start telling the truth, and to work very, very hard for more than 8 years to come up with real solutions.



    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  5. about being positive…POCA, perhaps?

    As an acupunk wannabe, the question of the morality of spending my life savings on this education system versus foregoing the one thing I’ve found that really resonates with who I am and my vision of a life of meaningful work has weighed heavily on my mind for months. So, while I grapple with this seemingly intractable personal dilemma, I’m trying to envision any possible third choice.

    And at the risk of seeming impatient…what about POCA? In reading through years’ worth of posts here in the past six months, I have felt a little like the kid in the back of the room, jumping up and down with my hand stretched way up: “Me, me! Count me in!” What makes me irrationally happy about POCA (without being exactly sure what it will entail) is the thought that, yes! maybe now I, too, can stand up and be counted!

    So my question is: When all of us patients–and acupunk wannabes among them–can hold up our hands and be counted (and pay our POCA dues!), who gets to see that number? (I of course grandly assume it’s big–what atomic mass might POCA have?? Bet it’s higher than tungsten 😉 How can our numbers be used? I want CLIMB–or whoever–to know I’m not a theoretical student; I’m real and ready.

  6. I agree.

    I agree. Lisa, you are such a Negative Nancy! Please focus on ALL the positive… um… two or so positive… um… Find something about our professional infrastructure that is positive and cling to it like a nearly drowned passenger of a sinking cruise ship clings to a Floating Personal Device! You don’t want to be seen as someone who found something wrong about her profession which negatively impacted both the profession and the people it is supposed to serve, recognized that very problem was affecting communities everywhere, and decided to get off her ass and make real world change. Do you?
    Just take a look at this list of other whiners: https://www.facebook.com/topic.php?uid=39955037712&topic=6123  Mahatma, psssh. What a buzzkill! That radical Jesus with all his “Do unto others” nonsense.  Who wants to follow the example of people like these? So, please stop everyone. All this critical thinking is making me feel uncomfortable.

  7. The next time, a patient

    tells me he/she wants to go to acupuncture school, I’ll refer them to this blog, and advise them to read all the blogs on CAN about acupuncture education, before they consider applying to a school.

    There’s a lot to the topic w/c cannot possibly be covered properly in a 1 or 2 minute conversation. I think it would take more than one article for someone with a rosy picture about being an acupuncturist, to accept the reality of the situation.

  8. Another blog post to refer prospective students to…

    This one is from last year https://www.communityacupuncturenetwork.org/blog/guest-blog-dollars-and-sense-information-prospective-acupuncture-and-oriental-medicine-students

    Near the end is a list of questions that every prospective AOM student should be able to get answered prior to their enrollment. If they can’t get truthful, evidence based answers (ie: alumni surveys that disclose the number of respondents and methodolgy used to perform the survey or income gained from the actual acupuncture practice/patient interaction vs. other part-time jobs), the potential student shouldn’t waste a dime on the non-regionally accredited ‘ACAOM accreditited’ school as their credits likely won’t be worth anything if they decide/try to transfer to a state college or university. 

  9. LOL — Floating Personal Device

    I also thought it was pretty funny that the Guests Not Verified now think that WCA acupunks are paid *well*. It seems like just yesterday that WCA was devaluing the profession YET AGAIN by failing to offer upper middle class professional compensation.  Let’s take bets on how long before the Guests decide that the real problem here is that those of us making between 30-40K are crushing the profession with our unreasonable income demands. If we were really good sports, we’d be like the acupuncturists with “fellowships” at Beth Israel — you know, the folks who are paying to work in hospitals. Now there’s a positive attitude.

  10. I think you are doing

    I think you are doing amazing work as community acupuncturists. I want you to succeed and change the healthcare system ( your doing that now)

    I beleive that energy flows where attention goes. Why give any more attention to whats wrong and instead focus more on whats right and the direction that things are headed. (Nothing that you want is back there..)

    Keep up what your doing, acupuncture WILL change the world!

  11. that’s how

    “manifesting” (Abraham-Hicks, etc) gets such a bad name amongst people concerned with social justice issues:

    1)when it’s used as a means to shut people up;

    2) when it’s used as a justification for lying; and

    3) when it’s used without any compassion.

    There are probably other ways that aren’t occurring to me at the moment, and this might be an interesting conversation in its own right. Guest, I’m thinking that we might have done some of the same reading. I believe that the people you are quoting also say something like: “the worst thing you can do is something that you believe to be wrong for you.” It doesn’t sound like you actually read my post, but what I started and finished with was my reason for writing it: that for me it is wrong to encourage people to go to acupuncture school — especially when they are inspired by what I am doing — when I know full well that they don’t have the information they need to make a real choice. I don’t want to participate in a system that deceives people, because it feels bad to me. 

    Personally, I don’t think you have to choose between using concepts related to manifesting and having some basic integrity. Acupuncture is NOT going to change the world unless we take some responsibility for creating better systems than the ones we have now.

  12. The reality of debt

    I too, have ambivalent feelings about my acupuncture education and how I feel about people prospectively becoming students themselves.. I’m in my 11th year of practice since graduating school, and somehow, I’ve managed to get by on what I’ve made as an acupuncturist working for myself.  I think that puts me in the “successful” category of acupuncturists.  Which is laughable.  I’ve done it by maintaining my student’s perspective on quality of life and expectations of what I should be able to afford.  I’ve had my community acupuncture clinic for 2 years now.. which is beginning to offer me a reliable and steady income-still looking to gross less than 50,000 this year (which is personal income, not my business’ gross) Pretty good.  In the last couple of years though, I also started a family.  Do prospective students think about this when agreeing to take on massive debt?  Do they think about trying to buy a home on top of starting a practice on top of their debt?  Do they think about having children and childcare and college on top of a home and school debt? 

    I’m lucky to have a very supportive partner, willing to forgo his own dream of starting a business and willing to support our family for the large part while I try to decrease “OUR” debt now so that someday we can be free of it.. do people think about trying to have this semblance of a normal life when getting excited about loan forgiveness after not being able to make more than a tiny loan payment for years?  Just another reality check for any soon to be students to consider!

  13. When I decided to go to acu

    When I decided to go to acu school, I knew it would likely mean that I would not be able to afford children.  I probably wouldn’t have had children anyway because I have never wanted to bring any new people into the world humans are destroying.  I did think I might adopt a difficult to place child who might not have a chance otherwise, or foster parent with eventual adoption. Now I’d have to decide if any child would actually be better off with me because of my debt.  I won’t be able to put anyone through college and still have any savings for my old age.   

    My education debt is my child, all of the cost and difficulty, but none of the joy, that’s pretty sad, but it’s the reality of our ridiculously overpriced education, and our countries screwed up student loan industry.  I wish more people were interested in fighting for student loan reform, there are so many changes we need to make that could help make everyone’s education easier to pay for, and stop the schools from continuing to abuse the system.  At the very least we should all be standing up for eliminating the taxes on loan forgiveness, some politicians have already brought this up, if everyone with a loan stood up for it, it would happen.   

  14. i owe +100k


    Unfortunately, I read all this advice after I took out all the loans.  Why did I do it? BC I loved the medicine, I thought that I could make it work. I’m a year out of school with a small child, I’m married and I’m terrified.

    I’ve been wanting to open a CA clinic ever since I heard of the notion.  In fact… I don’t really want to practice acupuncture unless I can do it this way.

    I’ve got 15000 to start up, I’ve got a reasonable rent on a space.  and I’m just frozen.

    I’m reading this and the “don’t go to acupuncture school” blog and I one hundred percent see the truth of it. But the damage is done I owe over 100 thousand dollars in loans.  My only hope is to do IBR.  I have a few questions about it, maybe you or others can answer.

    In your blog about telling patients not to go to acupuncture school you mentioned to remain qualified for IBR you need to not make over 35K a year.  

    Is that before or after taxes?  I’m guessing before, but  thought I’d ask anyway.

    Does that include “staying open” costs?  Like if it costs me a thousand dollars to keep my doors open a month, is that part of the 35K?


    Also you mentioned better hope my spouse doesn’t earn a decent living.  Which, right now he doesn’t, but do you have an idea what that means?  what is the cap for him, if I need to stay on IBR?

     also, in the worst case scenario, and they garnish my wages dt default, can they garnish my husbands, or just mine? 

    I hope as you do to change the culture of acupuncture school, which now seem to me to be somewhat vulture like.  but for the rest of us what do we do?????? 

    I am not looking to make tons of money, just want to earn “a decent wage” and raise my family.  Being a CA practitioner is my dream.  I’m losing hope….


  15. You will be okay!

    Whoa, take a breath, you will be okay.  If you have 15K to start up you are in good shape, and can start a very successful clinic.  You are a long way from needing to worry about default and such.  You can earn more than 35K, and still be on the IBR plan, you can earn A LOT more than that and qualify, people who make 80-90K are on it, it just means their payments are higher, maybe $800-$900/mo, or less depending on family size but with that income you would be okay.  

    You can file taxes separately form your husband and have it only include your income, but that would affect your tax due so you would have to look over everything before doing that.The IBR caps your payments at 15% of your discretionary income which is based on some calculation of 150% of the poverty level. Math is no my strong suit so check out the website link at the bottom, it will help answer some questions.

    Your income is based on what you actually earn after expenses, if you bring in 35K, but spend 20K keeping the business open your income is only 15K, (actually less because it is based on AGI which is your taxable income, not gross income,) at which point you would owe $0 on your loan, but interest accrues so it’s best to pay what you can.  Try to focus on getting your practice going, there is no point in stressing over the loan, it’s there and it sucks, but you will be okay, there are plenty of option to avoid default if you were to ever get to that point. 

    IBRinfo :: Help is here!

    Here is another site for those interested in what’s going on with student loans and reform.  

    Project on Student Debt: Home

  16. Your welcome.  Lisa has

    Your welcome.  Lisa has made great points, and she’s right to discourage people from attending acupuncture school because it’s a hard road, and the system is a mess, but those who already have loans don’t need to panic, they can still start successful practices. 

  17. I want to encourage those of

    I want to encourage those of us with loans to get involved in student loan reform.  This can also help reign in acupuncture schools, they shouldn’t have such free access to all that money.  It’s so important that we do what we can to help ourselves and future students.  There are many issues that need to be looked at, if we stay involved we can change this greed based system.  We can also force the schools to act more responsibly with loans, so others don’t end up with our nightmares.  

    Removing the tax burden on any loan amount that is forgiven is already on the table, a bill has already been introduced, and will be reintroduced soon, we just need to stand up for it.  It seems likely that there will be some of us who do not fully pay off our loans, and will end up with forgiveness, having a big tax bill at the end of that would be horrible.  I will certainly feel much better when that issue is settled.  My loan will be forgiven in 15 years, and because I quit practicing for so many years it’s only grown, forgiveness day will be like getting out of jail for me as long as I’m not faced with a big tax bill, which would just be a transfer to a different jail.

    Here is a Facebook page supporting the bill that would remove the forgiveness tax:

    H.R. 2492 – Loan Forgiveness Not Income Act (11) 

  18. AGI is key.

    Linda is right.  The AGI (adjusted gross income) is the key ingredient for deciding what your monthly student loan payment is if you are on the IBR or ICR plan.  Look for this line item on your latest tax return.  Depending upon how you file you might be able to bring this way down.  Then again, you may not.  AGI does not = disposable income.  AGI does not = real money that goes into your bank account.  But keeping your AGI low is key for student loan repayment decisions.

  19. I get what you’re saying…

    But going to China is not an option for a whole lot of people, like those with kids and spouses with jobs and other responsibilities that keep them tied to a particular place.

  20. State of the State

    I had to work a second job, but I am living testement that it is possible to repay your student loans (I paid my 20 year loan off in 10).

    I am all for students getting an honest up front slap in the face about the cost of school, the potential to take on too much debt, and the reality of what you can expect to earn.
    But if it is your passion, do it. Just be honest with yourself because paying off student loans is not easy — you will sacrifice in order to do it.

    If I knew about the CA approach 10 years ago I would have been less, not more scared, about taking loans to get the degree.  Some things are more important than money (actually most things are more important than money…) in the grand scheme of your life.

  21. ACAOM in Trouble with USDE

    Though ACAOM’s newsletters have stated that the Commission was found to meet all the Department of Ed’s requirements for approval, as recently as 2006, if you go to the US Department of Ed’s website (https://www2.ed.gov/about/bdscomm/list/naciqi-dir/2011-spring/staff-analyses-6-2011.pdf) on page 120, it seems that ACAOM is in trouble. ACAOM was found in violation of 23 requirements for USDE recognition and the USDE is requiring ACAOM to meet the requirements within 12 months or, according to USDE regluations (34 CFR 602.36(e)(3)(i), the Department may pull its approval to ACAOM as an accrediting agency. I’m surprized that ACAOM posted the USDE’s decision on its website (https://www.acaom.org/hot-news/); it looks like ACAOM could loose USDE approval.