“Federal options for debt forgiveness” is often given as a reason why we must seek Medicare inclusion. And the expense of our education is considered a big factor in why people aren’t entering the field. So why aren’t we laser-focused on what can be done to keep costs down and prevent that debt from accruing?
Wouldn’t that be in keeping with everything we know and teach our patients?
When our patients have a lifestyle that is leading to depletion, we don’t encourage them to keep expending Qi beyond their means, with a promise that if they fight hard enough somewhere down the line they’ll find a miracle cure.
The history of the Acupuncture profession in the US has included a steady increase in the required hours of training. With some state-level variations, required training to enter the profession has gone from 1000 hours prior to 1990 to a minimum 1905 hours as of 2011. If you are in a state that requires herbs it’s 2525.
I have never seen any evidence or even heard anyone arguing that the increase in required hours was a response to a revealed deficiency in the education or preparation of entry-level practitioners. That’s not to say there weren’t and aren’t deficiencies. (A lot can be done to improve education and training without adding hours.) But lots of those early program-grads, the ones that took those shorter programs, went on to have long and very successful careers.
The expansion in hours of education required seemed to be primarily…marketing. We want legitimacy and respect. “The establishment respects education.” They respect “Doctors.” We point to our hours of training with the expectation that “they” will defer to our expertise. And we are dismayed when they (still) don’t.
My best recollection is that my acupuncture-only training in the early 90’s cost about $26,000, or $55,411 in today’s dollars. Multiply by 160% to reflect the increase in hours (it’s a bit complicated because I was in a window when training was described in credit hours), and we get $88,658, which is about what a Master’s degree will set you back these days. Wouldn’t there be less debt with a $56,000 degree? And being mostly out of the workforce for a 2-3 year program, while not easy, is likely to result in less debt than being mostly out of the workforce for 4 years.
There’s another problem with our current degree situation. Prospective students have a much more complicated decision to make than we used to back in the day when it was an MAc or nothing. Now, if someone is considering a career in acupuncture, they need to consider where they might want to practice for their entire career. If they want to keep their options open they’ll be encouraged to get a more expensive OM degree. And if they are worried about building a practice they might feel pressured to go for the Doctorate – for the marketing value if nothing else. And they might learn that for some states there will be additional requirements (Florida and injection therapy training) or credentials (the CA exams). It’s easy to imagine potential students, stuck between choosing a degree they can almost afford but fear will limit them, or a degree that’s a real stretch but keeps their options open, giving up and choosing a different career.
Let’s focus on making acupuncture degrees more affordable. This would make our training more accessible and decrease the educational debt of our future practitioners. Isn’t that a better bet than focusing on a way to access debt forgiveness programs that might be available in the future if we manage to get the massive health-care bureaucracy to let us in?
Anyway, I only started this post to ask everyone to listen to this podcast and read this post. They are great and absolutely worth your time.
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I completely agree that keeping costs down and preventing debt from accruing is crucial in addressing the issue of debt forgiveness in the acupuncture profession. It’s important to prioritize finding solutions that address the root of the problem, rather than relying solely on federal options for debt forgiveness. However, I’m curious about what specific steps can be taken to keep costs down in acupuncture education. Are there any innovative approaches or solutions being implemented in certain states or programs?
There is one school – POCA Tech that has made keeping the expense of an education in line with the expected earnings of graduates. However, I don’t know that it it could be replicated. It depends very much on supporters from within and outside the profession to make this possible. But, if we were, within the profession, willing to reduce the number of hours of education required, that would make a big difference. As I discuss in the blog post, the required education used to be half of what it is now – and our safety record was as good as it is now.
As for solutions in states — making sure that an MAc, without herbs, was sufficient in every state would make a big difference. The herb credential was presented as something that would be optional, and the move to require it came, with perhaps one exception, from within the profession. I know that some in some states that currently require the herb credential practitioners within the state are trying to remove that requirement. And the push back against those proposals come from within the profession, not “the state.”
So, if the profession itself focused on decreasing the hours of education required for a degree and agreeing that an acupuncture only Masters was sufficient to enter the field I think we would have a much bigger impact on our challenges than if we continue to focus on the things we have been focusing on such as fighting “encroachment” and begging to join a massive medical-industrial complex.
After more than 20 years, nobody in the AOM trade can figure out what to do. I call AOM a trade because standards for entry only require a few hours of community college credit, no bachelors degree required. Are any of the programs accredited by the Higher Learning Commission? If so, it may be just a few. I will verify with a friend who actually works at the HLC.
It’s expensive, has an incredibly low return on investment. Students have been duped into believing their degrees can parlay into other areas of healthcare only to be told their credits don’t count towards anything.
AOM is certainly an inter philosophical area of study, but in terms of actually being a mechanism of healthcare delivery, it will always exist on the fringes, much like NDs, DNs, homeopathy, Ayurveda. It’s sad when one sees a fungating mass and the person says they’ve seeing their “oriental herbalist” and “energy healer” who tell them the treatments are causing the tumor to leave the body.
I fully support PTs studying dry needling. I support APNs and PAs learning medical acupuncture. But really, why would anyone want to risk such a high debt load with such poor job prospects?
AOM is dead. Long live AOM
I’m not going to invest energy into the trade vs. profession binary, because I’m not sure it matters. Either can be lucrative. There is certainly a range in what programs require for entry, what accreditation programs have, and the caliber of education they provide. But, yes, I agree the return on investment isn’t great for lots of graduates. That’s why I wrote the post! It would be very beneficial if we focused on reducing the cost of the education, and I think it is very possible. We just need people to get behind it.
The unfortunate reality is that training for acupuncture, much like other skilled trades and academic endeavors, is a business in and of themselves. It’s the business of education and success in the business of education means deriving profits from the product. I recall reading someone in the acupunk community calling debt from acupuncture training the “acupuncture mortgage.” Quite the apropos term, especially considering the limited options and opportunities. Fortunately, people like Lisa Rohleder are doing what they can. I recall asking myself “can I afford the fees I am asking my clients to pay?” I also recall “practice management” course lectures where the Flavor-Aid pushers were postulating that fees should be “slightly uncomfortable.” Then there was the “fake it ‘till you make it” talk that was reinforced by Honora Lee Wolf who advised attending non-profit benefit functions because that was where the money was. (Again, I think one of the acupunks posted a link to the Acupuncture Today op-Ed recommendation). Anyway, there appears to be no consensus on insurance and Medicare. Unlike physicians, who can operate a boutique, “cash only” practice that is financially lucrative, LAcs base is cash only. Some make it, most don’t, such an expensive lesson.
I’m just floored that people thought/think that third-party businesses/bureaucracies would be willing to pay more for acupuncture than the people actually receiving the treatments. Somehow, getting someone else to pay was the way the profession thought they could resolved the disconnect between what practitioners wanted to charge and what patients wanted to pay.
I know people are funny with money. We complain about the price of eggs, and we don’t deprive ourselves of the Boba that costs the same as an organic dozen. I look at what some of my colleagues charge and I feel like a chump for not charging more. And I know that if I were considering starting treatment the prospect of an $800 investment for the first six weeks would be daunting.