Financial Challenges & Warning Labels: How Much Does a Licensed Acupuncturist Earn?
Written by John Weeks
Monday, 04 October 2010
Financial Challenges & Warning Labels: How Much Does a Licensed Acupuncturist Earn?
Summary: My own dark humor about the
licensed CAM professions of acupuncture and Oriental medicine (AOM) and
naturopathic medicine (ND) is that they have gained enough
recognition for their students to go into debt, just not enough yet for
their graduates to get out of it. The
2008 Job Task Analysis of the National Certification Commission for
Acupuncture and Oriental Medicine (NCCAOM) included a set of questions on income, education debt and practice settings to enhance the profession's self-knowledge. Publication of the findings has kicked off a round of sometimes
acrimonious soul-searching over how licentiates are
doing economically. One leader concludes that the profession
should have a warning sign that entry into the field can be hazardous to
one's financial health. Here are some data and commentary.
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NCCAOM: Data gathered to assist profession stimulates debate
Something happened on the way to the publication of the 2008 job task analysis (JTA) of the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). Certification organizations survey practitioners regularly
to ensure that exams reflect clinical practices. For this JTA, however, NCCAOM added questions related to practitioner income, practice settings and student loan debt in order to fill gaps in the profession's self-knowledge.
The outcomes weren't pretty. In fact, a widely-read analysis by an activist referenced a children's book about a boy named Alexander and called the findings "the Terrible, Horrible, No Good, Very Bad Numbers." The writer, Lisa Rohleder, LAc, co-founder of the Community Acupuncture Network (CAN), concludedwith this:
"Acupuncture education, and the conventional acupuncture business model,
ought to come with a warning label, the way cigarettes do: NOT SUSTAINABLE. May take years of your life and leave you with nothing, except huge student loans."
So what do the numbers say? The following table captures key findings.
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Selected Outcomes from Income-Related Questions About Licensed Acupuncturists
Added to the 2008 NCCAOM Job Task Analysis
Ave. spent on loans Mean debt burden from loans High-end debt load
$55,984
$45,891
$100,000
Ave. Gross Income
< $60,000 year
(<$20,000 year) $61,000-$120,000 > $121,000
70%
(16%-43%)*
21%
9%
Time/wk Working as LAc
<30 hours/wk
<10 hr/wk
11-20 hr/wk
"Prefer to work part-time"
59%
19%
20%
47%
Practice Settings
Self-employed/Solo practice
Mix of self-employed/employed
91%
30%
Preparation for Practice:
% Poorly Prepared
Clinical topics Business and marketing topics
3%-10% 15%-35%
* The variation was reported state by state, with New York (42.5%)
on the high end of those grossing <$20,000 and
Washington State on the low end (15.7%).
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The income figures relate to gross rather than net. Costs of rent, supplies, advertising, professional fees, malpractice and staff costs, if any, must be subtracted before any money comes home. So must costs of loan repayment. The 2008 NCCAOM survey did not capture net income.
Ward-Cook: NCCAOM's CEO
The original NCCAOM report included no breakdown, as included in the table above, on the percentage of practitioners who were in the truly horrible, no good very bad categories: grossing <$20,000 or grossing merely $21,000-$40,000 per year. Rohleder and others asked for more. NCCAOM CEO Kory Ward-Cook, PhD, CAE, responded with an interview and additional data that were published as Snapshot of a Profession in the September 2010 Acupuncture Today.
Ward-Cook spoke with the Integrator about the data and controversy. She explained that the economic questions are not typically part of a JTA. Why were they included? "The profession asked us to do it." The profession was in a quiet campaign to be recognized as a profession with the US Bureau of Labor Statistics and the data were viewed as potentially useful. (NCCAOM and other allies were successful in gaining a listing with the BLS' O-Net before the results of the JTA were published.)
Rohleder: Community acupuncture leader raises questions
On her view of the meaning of NCCAOM's findings, Ward-Cook lines up with Rohleder: "I agree with her analysis. It's sad (that practitioners are making so little). This is the first time this information is coming out. A lot of organizations aren't going to like it. It's lower than they have been saying." The US Bureau of Labor Statistics O-Net, for example, states that media $31.36 hourly and $65,220 annually. She adds: "There appear to be schools where students thrive, and some where they don't."
Ward-Cook, who has taken considerable criticism from Rohleder and others, states bluntly: "Instead of criticizing the messenger, let's address the problem. Maybe we don't need to graduate so many. Maybe we need to figure out how to employ them. We've got to figure out if the profession will be a two-tier system or non-tier, whether it will be doctoral level or non-doctoral or both. We have to figure this out."
Related Integrator articles related to LAc income:
Comment: As a close observer of these fields, these data are not surprising. Yet in the full weight of their confirmation of dreary suspicions, they are nothing short of awful.
Educators often like to view their job as done when they have graduated their students. In this perspective, practice success is in the hands of the individuals and the state and national professional associations.
The picture here, however, is one not of gently
ushering graduates out into a welcoming world. Rather, these data
suggest that for many, graduation is a push onto an ice flow.
Unfortunately, the national professional association for AOM, perhaps
reflecting these anemic data, has thus far been intractably and famously
weak, despite the hard work of many. State associations are typically
as strapped.
A starting place in addressing these hard realities is for the schools to acknowledge the very high percentages of graduates who view
themselves as very poorly equipped in real
world skills. These include practice management, marketing and public
relations and collaboration with other professionals.
The deeper issue is whether educational institutions, in emerging fields
such as AOM, have a different level of responsibility for their
students' future than academic programs for established professions. One
strategy with which some are involved is an effort to identify and then enhance the "competencies for
optimal practice in integrative environments" led by the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) with which I am involved.
A core question is whether educational
institutions, in emerging fields such as
AOM, have a different level of
responsibility
for their students' future.
Or do we simply have a situation of excess capacity? This is one scenario Ward-Cook notes. Few who have benefited from acupuncture (and I count myself among them) would believe that just 1% of people could find an acupuncturist helpful. Yet that is approximately what the 3.1-million users in the NCCAM/CDC data on CAM use in 2007 works out to be. Rohleder, using rough
arithmetic, suggests that, were the profession thriving and practitioners working to capacity, that number
would have been closer to 30-million.
Short of the arrival of a thick walleted angel, the AOM profession's most significant financial potential for driving a coordinated response to opening access to acupuncturists is the schools. Perhaps they will work in partnership with
the professional associations or others such as ACCAHC. Those proprietors and administrators may not like it. But it furthers them, as well as their graduates, to invest in crossing this great water.
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