Acupuncture Profession In Crisis

“Your time is limited so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking...”  Steve Jobs

 

I was speaking with a colleague, a fairly recent graduate of a local acupuncture/Oriental Medicine school. She graduated 5 or 6 years ago and told me that she is abandoning her acupuncture career and training for an alternative career. She also told me she knows five other acupuncturist friends from the same class all of whom are looking for work elsewhere.

None of these acupuncturists are surviving on the income from their practices. My colleague, now in her early 40s, stated she has not been able to buy a house and “will never be able to pay off her student loan” because of her career choice. As I will outline below, this is by no means an isolated experience but a widespread phenomenon amongst a majority of acupuncture school graduates. I will show that to make matters worse the very opposite — that acupuncturists are doing well —  is being actively promoted online.

It has long been rumored in the profession that a high percentage of acupuncture graduates fail in their practices in the first few years. Over 50% is a number that has been suggested for many years now.

Unemployment and underemployment among acupuncture program graduates is as alarming as it is under-reported.

It’s surprising that the acupuncture profession as a whole does not collect income data. Chiropractors and massage therapists have Bureau of Labor Statistics data, acupuncturists don’t. The only serious professional attempt to ascertain an approximate income picture are these two papers:

The U.S. Acupuncture Workforce: The Economics of Practice by Steven H. Stumpf, EdD, Clifford R. Carr, EdD, Shauna McCuaig, MAcOM, LAc, Simon J. Shapiro, DO, DAOM, LAc and

Unveiling the United States Acupuncture Workforce, by Steven H. Stumpf, EdD,Mary L. Hardy, MD, D. E. Kendall, OMD, LAc, and Clifford R. Carr, EdD. Both papers are posted in full below with the approval of Dr. Stumpf. Unless otherwise indicated all the italicized quotes are from these papers

Despite the existence of national organizations representing the training programs, licensed members, regulatory boards, and an accreditation body recognized by Department of Education, the acupuncture workforce remains outside the healthcare mainstream (Stumpf et al., 2010). For example, valid longitudinal information describing the acupuncture workforce is simply unavailable in the U.S. A recent review by Stumpf et al. (2010) describes a handful of published studies that provide a minimal depiction of how licensed acupuncturists (LAcs) practice e.g., how many hours they work weekly, their annual earnings, and employment arrangements. As a result, it is nearly impossible for aspiring practitioners to acquire accurate information about practice characteristics and, thereby, forecast their potential to practice successfully.

In the surveys analysed in these papers the majority of acupuncturists are earning a gross income of $20,000 to $50,000 per year. But to emphasize how painfully low these numbers are we need to remember that up to half of this gross income will be taken up with tax, liability insurance, rent, practice expenses, continuing education, health care insurance, loan repayment and so on. That’s a take-home income for the majority of practitioners of close to $10,000 to $25,000 per year.

Three states together—California, New York, and Florida— account for approximately 15,050 or 52.8% of all LAcs in the nation (Zabik, 2009). Approximately 37.7% of the LAcs in these three states earn less than $20,000 per year (Acupuncture Today, September 2010). For these graduates the reality of paying back their student loan debt may be viewed as beyond their reach.

For a health-care profession seeking attention as a serious player in today’s increasingly integrated medicine this is shameful, reflecting poorly on the nation’s acupuncture schools that continue to churn out unsuspecting graduates.

Generally speaking, the respondents to these independent surveys charge fees between $20 and $65 per patient visit; work approximately 30 or fewer hours per week; and generate median gross incomes between $20,000 and $50,000.

50% of the licensed acupuncture (LAc) workforce is working less than 30 hr weekly; 50% are earning less than $50,000 on average; and the number of LAcs working independently in practice, either in their own office or sharing one, has increased from approximately 75% to 90%.

It would be reasonable to assume that the situation regarding the financial viability of the acupuncture profession is worse than is outlined in this already dismal picture. Income data gathering of the independent groups within the acupuncture profession referenced in the above papers, most focusing on a treatment style, is likely to contain numerous biases in favor of higher numbers of clients seen and income received for their favored treatment approach.

Self reporting, a significant factor in the surveys reported, is likely influenced by “professional shame” in lacking success, and other psychological factors. Independent data gathering is the only sure path to statistical clarity but such scientific and transparent data seem absent in the profession.

Graduates of the prominent acupuncture training program who completed surveys for this paper averaged $86,979 in student loan debt in 2009. At present, ~65% are enrolled in programs that “kick the can down the road.”

I would submit that most acupuncturists can’t support themselves without either taking a day job, getting health-care insurance and financial support through a spouse, not having children, indefinite student loan debt deferment, living in rental accommodation long-term, relying on financial resources accumulated from prior employment, and many other creative or luck based factors.

Acupuncture schools to this day remain stubbornly entrenched in teaching hopelessly archaic and metaphysically-based programs, indoctrinating students into an anti-modern medicine, or at least separate but equal mindset. “Alternative paradigm” and “Eastern Doctor” are labels often used, though oriental medicine is in fact a diverse mix of different theories and practices, not a relatively unified field — such as is biomedicine. Which, by the way, is the largest , most culturally diverse, globally collaborative medicine in history. The term “Western Medicine” is simply not accurate. Chinese, Korean, Japanese biomedical researchers and doctors are major contributors to modern medicine. Either join this global ongoing scientific revolution or remain in increasing obscurity. It’s hard to see it any other way.

It is important to note that the elaborate theory of energy meridians that acupuncture students must learn has no scientific evidence despite a decades long research effort. (Many acupuncturists/researchers have discussed this fact, Yun-Tao Ma Phd. LAc. for example. See also http://www.ivis.org/proceedings/aaep/2000/220.pdf)

Surprisingly, there is excellent scholarship indicating that the theory of “energy flow” and energy meridians was not the basis of ancient Chinese Medicine, but instead a recently added Western metaphysical concept, with blood flow being the central dynamic feature: http://www.tedpriebe.com/documents/Kendall_SJIM_meridians.pdf

http://tedpriebe.com/documents/Anatomical_Foundations_of_Chinese%20Med.pdf

There are strong sub-beliefs within the profession of certain acupuncture styles working better than others. The evidence of treatment efficacy however does not support this apparent diversity, showing no appreciable difference in outcomes between traditional, neo-traditional, new age contemporary and modern medical acupuncture such as Dry Needling. Fads, charismatic teachers, novelty and reference to ancientness continue to generate new acupuncture styles, in effect creating a kind of surrogate evidence of efficacy.

Acupuncture school graduates enter the workforce set up for isolation in the contemporary medical milieu. Questioning and critical thinking is actively discouraged in acupuncture schools, and graduates are often equipped with a New Age attitude that their success or failure depends on their “energy” to attract success, and not on socioeconomic factors and the inadequacy of their training.

Over 90% have no alternative but to develop private practices in a time when increasingly, standard medical practitioners are finding it unviable to do so. Only 4% of acupuncturists are employed in contemporary medical facilities. The few employment opportunities available within the profession often entail low hourly rates, no benefits such as vacation pay or health-care insurance, or other types of professional support. In such low-paid acupuncture industry situations, clients are usually treated in clinics by groups of acupuncturists, thereby diluting the practitioner/client relationship. Treatment of a particular client is often repeated at length with little or no consistent treatment plan.

Insurance reimbursements to acupuncturists are continually being reduced and client deductibles continue to rise. Medical spending is at its lowest rate in five decades.

There is a very limited job market for acupuncturists, with the only significant employers being acupuncture schools and drug treatment programs . . . Opportunities for acupuncturists to participate in the health care system in the same way other providers do are limited

The future, IMHO

We have a profession whose central defining practice (acupuncture) can be just as effectively utilized in a simple, fairly easily learned way, in a form entirely integrated within modern biomedicine. Oriental medicine is not the primary reason clients seek out an acupuncturist, they just want to get better and have heard that acupuncture might help. If they go often enough they may become suborned into the mindset of energy and meridians, but the original motivation holds; desire for improved health. The question arises, is an independent professional future even realistic for acupuncturists?

The status quo means increasing marginalization and a “99%” type scenario, with a few practitioners doing well and the majority struggling or failing. Income by acupuncturists will decline further as will professional standards. Getting acupuncture may become like having a chair massage. As the above income data becomes more commonly known, acupuncture schools will likely see a fall off in enrollment.

Simple acupuncture techniques like Dry Needling, and Biomedical Acupuncture based on contemporary science and physiology, will be increasingly appropriated by other medical professions. These approaches, sensitive to evidence-based updates, have shown the same outcomes as traditional styles in studies, yet can be taught in a short time to appropriately medically trained individuals.

Many researchers have pointed out that the type of acupuncture doesn’t make a difference in outcomes: To quote Dr. Andrew Vickers, a longstanding acupuncture researcher:

The type of acupuncture didn’t seem to make a difference to the results, said Dr. Vickers. “Some acupuncturists will tell you not to go to such and such a person because that person doesn’t put the needles in the right way, or they don’t use the right theories, or they’re not as well trained, but the particular type of acupuncture you get doesn’t seem to make a large difference.”

http://www.medscape.com/viewarticle/770646

 

A Possible Alternative

The acupuncture profession as we now see it may well become an obscure historical  entity harking back to a proud isolated alternative medicine  mindset of the 1970’s.

Acupuncture colleges that have the foresight and freedom from current metaphysical dogma could develop primary care programs similar to those of NP’s and PA’s and teach modern biomedical acupuncture and functional medicine based herbology and nutrition. If they did this, high quality students would be attracted and new jobs for graduates would become available within the medical establishment. Current  practices and products could be sifted by the transparent clarity of modern scientific medicine, brought into the 21st century through critical review and evidence.

Such colleges could also teach short acupuncture courses to other medical professions, having some play in what is inevitable anyhow.

These colleges would have an ethical responsibility to link success of their programs to the ability of graduates to pay down their loan debts in a prescribed period of time, thereby linking curriculum to actual job markets and the contemporary medical ethos. This responsibility, it seems, is currently evaded by most acupuncture schools.

The colleague I mentioned at the beginning of the article stated that although she enjoys the work, she would not choose to be an acupuncturist if she had her time all over again. Another colleague who has been in practice 15 years expressed the same sentiment. One wonders how many others among the nation’s practicing acupuncturists would concur?

Misinformation abounds on the web…

“A licensed acupuncturist after one year out of school can expect to make $45,000 a year and up. After five years in practice, one’s income should approach $100,000.

$200,000-300,000 a year is not unrealistic within 10 years in practice.”

From acufinder.com

“The starting salary of individuals in this profession averages $49,844 annually. Salaries after 10 years of practice peak at $133,700 annually.”

From toptenreviews.com

This website actually places ‘acupuncturist’ as a job receiving the highest salary among nine other medical professions.

“Average annual salary for a Licensed Acupuncturist is $51716 based on statistics in the U.S. as of 2013.”

From jobgeeks.com

Note the over-sell, the casual misinformation, the confusion of ‘salary’ with business revenue, and the attractiveness of it all for the unsuspecting applicant prepared to put themselves into major debt. A debt they are likely not to pay off in over 10 years in practice, or even in another career.

Even the Council Of Colleges Of Acupuncture and Oriental Medicine (CCAOM) happily perpetuates this deception. Note the following FAQ from their website –

How much can an AOM practitioner expect to earn?

There are approximately 20,000-25,000 AOM licensees throughout the United States. A recent estimate, which is based on job postings, reports an annual income range between $30,000-$60,000 and notes that gross annual income can be as much as $105,000.

CCAOM must know that there are very few “job postings” for the 20,000 to 25,000 acupuncturists mentioned. What is the hope for honesty and transparency if a major professional organization prefers to present myth over truth.

Occasionally one can find clear criticism of the confusing presentation of income data, deliberate or otherwise, as with this post questioning the Oregon College Of Oriental Medicine’s graduate data by Lisa Rohleder LAc – OCOM Redefines Acupuncture as a Hobby for Girls

That would be “the Sugar Daddy business model”, in which an acupuncturist asserts that  he or she is successful in his or her practice, because in reality he or she doesn’t need to earn a living, since his or her partner/husband/ wife has a real job and supports their household. Plenty of acupuncturists, regardless of gender, claim this kind of success. https://www.pocacoop.com/prick-prod-provoke/post/ocom-re-defines-acupuncture-as-a-hobby-for-girls

 

 A Decision Based On The Facts

Remember the quote above from Steve Stumpf et al. “it is nearly impossible for aspiring practitioners to acquire accurate information about practice characteristics and, thereby, forecast their potential to practice successfully.”

So if you’re thinking of going to acupuncture school here’s how it probably shapes up. Not inevitable, but likely, based on the experience of the majority.

For the first few years after graduation it’s touch and go if you are even able to stay in practice – most likely you will be struggling to set up a private practice outside the support employment offers. If you survive that, statistically speaking you need to have a spouse to support you and to get health-care insurance through. Or you will need another source of income such as another job, an inheritance, savings, something. Frugality is good!

If you gain employment in the industry, such as detox clinics or low cost public health facilities, you will be part-time, without benefits, often treating the same individuals over and over with a vague or no treatment plan. There will be no union watching out for you.

In some measure you will be deferring your $80,000 to $100,000 loan debt, so forget about buying a house and treat your old car well. You will feel the need to learn new acupuncture styles and do business development courses. There are plenty of people ready to bill your credit card for these.

You’ll need to keep up with CEU’s, and pay Liability Insurance. You’ll find yourself with a whole set of beliefs that other medical practitioners don’t seem to care about. You’ll wonder why the Law Of Attraction isn’t working for you…

Or you may be one of the lucky ones – your acupuncture program would have quietly encouraged that feeling all through your training.

But, for sure, you are a good person, sincerely wanting to help others, and life is indeed an adventure of endless learning, not a bank account. Stay flexible, be creative, jettison most of your acupuncture college training, re-discover your own thinking. Learn from your clients: they, your real teachers will be paying you! Change direction if needed. Enjoy making small differences, as in real life; they are the differences that count. Good luck.

 

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Workforce_CHPR_Dr. Stumpf_2010 CHPR374640_Mainstreaming_Stumpf

CHPR374640_Mainstreaming_Stumpf

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May, 2013

Thomas Martin LAc.

http://www.wellnessclarity.com/?p=183

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 The following is a letter from a recent Acupuncture School  graduate who read the above post. The statistics outlined in the post reveal that Michael’s difficult journey, which by no means has yet ended, is shared by a great many. Their plight, in most cases, is not from personal lack of talent or hard work but from deliberate and passive misinformation  disseminated from professional schools and organizations.

Hi Thomas-

Thank you for your blog entry “Acupuncture Profession in Crisis”. 

I had a rough two years after graduating from Tri-State Collge of Acupuncture in 2011. I simply couldn’t make any money in acupuncture (I lost money, actually). With that, my confidence dropped and eventually had such a problem with anxiety and panic attacks that I stopped practicing. I have $140K debt (including personal) and was so optimistic that I would pay the loans back. But working in acupuncture in NYC means community acupuncture, which was half of what I made as a waiter. 

It’s very sad, but I knew that if I didn’t leave, I would be wasting precious time that could be used to find a profession where I could make better money. 

While it makes me angry, to think the school promised so much, I kick myself for not looking further. I don’t want acupuncture to go away, but I think people need to know the facts. 

Thank you again. I hope more people thinking of going into acupuncture will read this entry!

Best-
Michael 

October 2013

Thomas Martin LAc.

 

 

 

 

Posted on December 20, 2012, in acupuncture, Acupuncture Professional Reform and tagged , , , , , , , , , . Bookmark the permalink. Leave a Comment.

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