The more I learn about the higher education system, particularly through my work looking into acupuncture education, the more naïve I realize I was when I signed up for a private college and took out more than $200,000 in student loans.

I think the higher education system in this country is very good at making money off young idealists who simply don’t know what they don’t know.

I certainly didn’t.

Even now, I regularly learn things about higher education and student loans that shock me. So, here is a list of things I wish someone had sat me down and explained before I enrolled.

Public Schools and Private Schools Are Not the Same

I don’t think I fully appreciated the difference between attending a public university and attending a private college.

Public colleges and universities receive government funding, particularly from state and local governments, in addition to tuition, fees, grants, fundraising, and other sources. Private colleges rely much more heavily on tuition, donations, endowments, and other private revenue, although they may also receive government grants and their students may receive federal financial aid.

Obviously, there are incredibly prestigious and well-funded private universities in this country. Harvard is a private university. “Private” certainly does not automatically mean bad.

But small, tuition-dependent private colleges are a very different financial model from large public universities or wealthy private institutions with enormous endowments.

I wish I had understood that distinction.

The expansion of student lending, particularly the availability of essentially uncapped Grad PLUS borrowing, allowed graduate students to borrow up to the full cost of attendance. That meant the amount a student could borrow was often tied more closely to what a school charged than to what the student could realistically expect to earn after graduation.

That is an important distinction.

Programs like acupuncture are particularly interesting because many students are drawn to them for deeply personal reasons. We want meaningful work. We want to help people. We want to get out of a system that doesn’t feel right for us. We imagine a career that gives us purpose, flexibility, and work-life balance.

Most people in their 20s and early 30s are still pretty bright-eyed and bushy-tailed. We think the world is our oyster. We are choosing careers based partly on what sounds interesting and meaningful, and often not sitting down with a calculator to determine whether the economics actually work.

And I think most students reasonably assume that if a college is accredited, eligible for federal student loans, and offering a professional degree, someone somewhere has determined that there is a viable job market waiting on the other side.

That isn’t necessarily true.

I think this is where some of the disillusionment among acupuncturists begins.

Many people enter acupuncture because they love the medicine and the idea of the career. Then they graduate and discover that they have largely been trained for a profession in which they are expected to create their own jobs.

In other words: become entrepreneurs.

And entrepreneurship often comes with a lot less work-life balance than we imagined.

Your College Credits May Not Transfer

This one shocked me.

Just because a school is accredited and eligible to participate in federal student aid programs does not mean another college has to accept its credits.

Transfer credit is ultimately determined by the receiving institution. Articulation agreements between colleges can make that process much easier because the institutions have already determined how particular courses or programs will transfer. Without those agreements, there may be no guarantee that another school will recognize your coursework.

Perhaps this was just my own naïveté, but I was stunned to realize that after spending more than $200,000 on my education, many of my credits might not help me much if I wanted to pursue another healthcare degree.

If I decided tomorrow that I wanted to become a nurse, for example, I could not simply assume that classes I already completed, anatomy, physiology, pathology, and other biomedical coursework, would satisfy another school’s prerequisites. The receiving institution gets to decide.

I wish I had known to ask before enrolling:

Where do these credits transfer?

What articulation agreements does this school have?

If I decide to change careers, what will this education be worth to another institution?

Those questions never even occurred to me.

Student Loans Are Not Free Money

This sounds painfully obvious now.

But when I was in acupuncture school, the financial advice we received was essentially: get on an income-driven repayment plan, make payments based on your income, and eventually the remaining balance will be forgiven.

That made a $200,000 loan balance feel much less frightening.

What I did not fully understand was what could happen at the end.

As of 2026, certain student loan balances forgiven through income-driven repayment may once again be treated as taxable income. The temporary federal tax exemption for many forms of student loan forgiveness expired at the end of 2025. Public Service Loan Forgiveness is different: PSLF forgiveness is not considered taxable income federally.

Oregon also generally follows the federal treatment, meaning debt that is taxable federally may also be taxable by Oregon.

That creates what borrowers sometimes call the student loan tax bomb.

For example, imagine that you earn $50,000 in the year that $500,000 of student loan debt is forgiven. If that particular forgiveness is taxable, you could suddenly have hundreds of thousands of dollars of additional taxable income.

That does not simply mean you pay your normal tax rate on $500,000, and the actual tax bill would depend on your filing status, deductions, other income, insolvency rules, tax law at the time, and a number of other factors.

But the basic lesson remains: forgiveness does not necessarily mean you simply walk away from the remaining balance with no financial consequences.

The IRS itself now warns borrowers that income-driven forgiveness occurring in 2026 or later may result in taxable cancellation-of-debt income.

I really wish someone had explained that distinction to me when I was borrowing the money.

Understand When Interest Starts Accruing

Before taking out any student loan, understand exactly when interest begins accruing.

This is another area I did not understand well enough.

With certain undergraduate federal loans, the government covers interest while you are in school. But graduate students generally rely on unsubsidized federal loans and, historically, Grad PLUS loans. Interest on those loans can accrue while you are still in school.

That means you can graduate owing significantly more than you remember borrowing.

My acupuncture program was four years long. Some of my loans were therefore accumulating interest for years before I even graduated and entered repayment.

That matters enormously.

One technical distinction is important here: federal student loan interest does not simply “compound” every day in the same way people sometimes describe compound interest. Interest accrues on the principal balance, and under certain circumstances unpaid interest may be capitalized, meaning it is added to the principal. Once that happens, future interest is calculated on that larger principal balance.

Either way, the practical result for a borrower can be brutal: the balance can grow substantially while you are still getting your education.

I wish I had looked at the loan balance every semester instead of thinking about it as some abstract number I would deal with after graduation.

Be Extremely Careful With Private Student Loans

This is particularly important now.

Graduate PLUS loans were eliminated for most new graduate and professional students beginning July 1, 2026, with a limited exception for certain students already enrolled and borrowing for their current programs. New federal graduate borrowing limits also took effect.

That means some schools may increasingly look toward private lending to fill the gap between federal loan limits and their tuition.

Students need to be extraordinarily careful here.

Private student loans generally do not come with the protections available through federal student loans. They do not qualify for federal income-driven repayment or Public Service Loan Forgiveness.

If I were considering private loans for an education today, I would want answers to some very specific questions before signing anything:

• What is the interest rate?

• Is it fixed or variable?

• When does interest begin accruing?

• Under what circumstances can unpaid interest be capitalized?

• What will my monthly payment be after graduation?

• Are there hardship or income-based repayment options?

• What is the median income—not the highest possible income—for graduates entering this profession?

• How many graduates are actually working in the profession five years later?

• How many are employees versus self-employed?

• What percentage of my expected take-home income will go toward these loans?

And most importantly:

If I cannot get federal loans to cover this program, is the answer really that I should take out private loans, or is the price of the program itself the problem?

I think prospective students should be asking that question.

Accreditation Doesn’t Answer Every Question

This may be the biggest lesson I have learned through all of the work I have done around acupuncture education.

I thought accreditation meant much more than it actually does.

I assumed that if a school was accredited, eligible for federal student loans, and authorized to grant a professional degree, that meant someone had looked at the entire picture and determined: Yes, this education makes financial and professional sense.

But accreditation, transferability, licensure, educational quality, employability, and return on investment are separate questions.

A school can prepare you to meet licensure requirements without guaranteeing that there are enough salaried jobs waiting for graduates.

A program can provide an education that allows you to practice your profession without guaranteeing that another university will accept those credits.

And access to student loans tells you that you are eligible to borrow money. It does not tell you whether borrowing that amount of money is a good idea.

Those are distinctions I wish I had understood.

What I Would Do Differently

I hope some of this hard-learned information helps prospective students.

I wish someone had sat me down in my 20s and spelled all of this out for me.

Hindsight is 20/20. In retrospect, I would be extremely hesitant to attend a small private college that required me to take on significant debt without first doing a tremendous amount of research.

I would look at the school’s finances. I would look at graduation rates. I would look at actual employment opportunities. I would ask where the credits transfer. I would investigate the median income of graduates. I would ask how many jobs exist in the profession and what percentage of practitioners are self-employed.

And I would look at the total cost of the loan after interest, not simply the tuition printed on the school’s website.

Most importantly, if I were taking out student loans, I would have a realistic plan for how I intended to repay them.

I work in healthcare. Many allied health professionals have opportunities to work for hospitals, government agencies, universities, and large nonprofit healthcare systems that may qualify them for Public Service Loan Forgiveness. Acupuncturists can technically qualify for PSLF if they work full-time for an eligible employer, but the problem is that relatively few acupuncture jobs exist within those qualifying employment settings. PSLF eligibility is based on the employer, not the profession.

So we can graduate with substantial healthcare-education debt without the same abundance of employment pathways available to some other healthcare professions.

That doesn’t mean you can’t build a successful career in acupuncture. You absolutely can.

But loving a profession and being able to afford the education required to enter that profession are two entirely different questions.

If I could sit down with my younger self before she signed those loan documents, that’s what I would tell her:

Know exactly what you’re buying. Know exactly what you’re borrowing. Know what your degree will allow you to do. And have a realistic plan for how you’re going to pay for it.

Because at the end of the day, whatever everyone else gets wrong, the school, the accreditor, the loan system, the profession, it is the student who is left holding the bag.

A friend of mine often says, “We have an identity crisis in the field of acupuncture.”

As we’ve been working together to create educational standards for Oregon, I’ve been interviewing employers and other allied health professionals. One thing I constantly find myself explaining is:

1. Acupuncturists can generate revenue by billing insurance for pain management.

2. Acupuncturists are exceptionally good at treating pain.

To be honest, this has been shocking to me. The primary conditions that insurance reimburses acupuncturists for are pain diagnoses. Neck pain, low back pain, knee pain—these are our bread and butter from a billing perspective.

So why am I sitting in meetings with pain clinics that tell me they can’t afford to hire acupuncturists because we don’t generate revenue?

It seems many healthcare systems view acupuncture as an altruistic service they offer to patients rather than a service line that can support itself financially. They’ll bring acupuncturists in for community clinics, educational programs, or volunteer opportunities. But when we ask for a salary and benefits, suddenly the numbers “don’t work.”

One of the major criticisms of our educational proposal here in Oregon was, “If we move to a bachelor’s degree, graduates won’t be able to get hospital jobs.” Yet I recently met with a hospital pain clinic that was eliminating its volunteer acupuncture program because they couldn’t find anyone willing to work for free. On top of that, the hospital had been purchasing needles for the volunteers, so the program was actually costing them money. In a time of financial contraction, they simply couldn’t justify the expense.

I asked them a simple question:

“Why aren’t you billing for acupuncture? Insurance reimburses acupuncture for pain.”

I also pointed out that in their setting, the physician could perform the initial evaluation and follow-up evaluations, billing the appropriate medical evaluation and management codes. The physician could then establish a treatment plan, and the acupuncturist could provide the acupuncture treatments and bill the appropriate acupuncture procedure codes for pain.

It was as if no one had ever told them acupuncture could be billed through insurance.

After years of having acupuncturists in their program, no one had ever figured out how to make the service financially sustainable.

That is a huge problem for our profession.

I’m not sure why our schools—or our national organizations—haven’t done more to educate hospital systems on how to successfully integrate acupuncture into their business models. Hospital positions are often held up as the gold standard of employment, yet many of these systems have never been shown how acupuncture can actually pay for itself.

If we want opportunities in these settings, we have to demonstrate value to the organization.

Yes, patients value acupuncture. Yes, it can become an essential part of a comprehensive pain management program. But we also have to demonstrate financial value. No healthcare system is going to hire providers based solely on altruism. That’s simply not how healthcare economics works, and expecting otherwise isn’t realistic.

Here are a few truths I think our profession needs to confront:

1. Acupuncturists are valuable members of interdisciplinary care teams. If a physician develops the overall treatment plan, that isn’t a slight against our profession. We still determine the acupuncture diagnosis and treatment within that plan.

2. Acupuncture can generate meaningful revenue. But that requires understanding insurance billing and, in many settings, seeing more than one patient per hour. Those are realities of modern healthcare.

3. Pain management is our foundation. Every acupuncturist should graduate confident in treating pain because it remains the primary reason patients seek our care and the primary condition insurance reimburses.

4. We can’t expect graduates to create jobs out of thin air. If schools and national organizations encourage students to pursue employment in hospitals and large health systems, they also have a responsibility to educate those employers about how acupuncture fits into their financial and clinical models.

I love private practice. I own a private practice. But even there, it is impossible to build a sustainable business seeing only one patient per hour. And if we don’t learn how to work effectively within insurance systems, we risk losing opportunities there as well.

Could our profession survive as a niche, cash-only model? Perhaps. Some people would even prefer that.

But with dry needling continuing to expand and compete in areas where acupuncture has traditionally excelled, I don’t think we can afford to ignore these conversations. If we fail to demonstrate both our clinical value and our economic value, we risk becoming increasingly marginalized—not because acupuncture doesn’t work, but because we never learned how to make it work within the healthcare systems we say we want to be part of.

Recently, I was very vocal here while Oregon was preparing for a meeting with our regulatory board. I intended to write about that experience sooner, but I needed some time to process it. To be honest, I still have conflicting thoughts that I wrestle with regularly.

My colleague Bex Groebner wrote a detailed play-by-play of the meeting on her Substack for anyone interested in the specifics. For me, the experience was equal parts confusing and frustrating.

What surprised me most was not the response from regulators—it was the response from within the acupuncture profession itself. We encountered significant pushback from practitioners and organizations, not only in Oregon but from around the country. Representatives from national organizations attended our small Acupuncture Advisory Committee meeting, as did individuals from the New York state association (ASNY) and private practitioners from other states.

It has been astounding to watch so many people invest so much energy into opposing Oregon’s efforts based largely on their own beliefs about what the acupuncture profession “should” prioritize.

As a refresher, Oregon was exploring ways to create a safety net for the acupuncture workforce and educational pipeline in light of the federal RISE Rule and upcoming AHEAD metrics. Our proposal was straightforward. We sought to create a state-approved educational pathway alongside the existing ACAHM-accredited pathway, similar to what already exists in Washington State. We also proposed writing clear educational standards into Oregon rule, again similar to what they already have in Washington State.

Those standards were not developed arbitrarily. They were informed by a 50-state analysis, guidance from the World Health Organization, and feedback from employers. We conducted an employer survey to identify areas where graduates struggle in the workforce so we could focus on preparing students for jobs that already exist. (we are still gathering employer info, if you are an employer, or know and employer, please take the survey here or pass it on to an employer you know). After all, graduating and immediately starting a successful private practice is not a realistic path for everyone.

We attempted to ground our recommendations in data rather than opinion. Unfortunately, opinion often carries more weight than evidence in our profession.

The reality is that the current acupuncture system does not work well for many practitioners. Licensed acupuncturists are down roughly 10% since 2018. At the same time, graduates face significant student debt while entering a profession with limited employment opportunities. Even without federal changes, those trends are concerning. Combined with new federal regulations, they could become existential.

If we want this medicine to survive and thrive, we have to be willing to confront those realities honestly.

One of the primary criticisms of our proposal was that acupuncturists must have at least a master’s degree to practice independently and be respected by other healthcare professionals. Some argued that an entry-level doctorate is the only acceptable path forward.

Our proposal did not specify a degree requirement at all. It simply left room for educational models that could include a Bachelor of Acupuncture. Yet during the same meeting where concerns were raised about bachelor’s-level education, the Acupuncture Advisory Committee advanced another proposal that appeared inconsistent with that position.

I want to be clear: I am not opposed to that proposal. In fact, I support having multiple pathways into the profession. Different students have different goals, financial realities, and learning styles.

What I struggle with is applying one standard to one proposal and a completely different standard to another.

One of the proposals advanced by the AAC would allow Oregon to recognize NCBAHM Route 4, an apprenticeship-based pathway to licensure. Under this model, a student completes one to two years of study at an ACAHM-accredited institution and one to two years of apprenticeship under a qualified mentor. The pathway culminates in eligibility for the NCBAHM examination and a professional certificate—not a bachelor’s degree, master’s degree, or doctorate.

In other words, the educational credential is actually below the level that critics feared our proposal might create.

I am in support this proposal because, if implemented carefully, it could create a lower-cost route into the profession and improve patient access to care. It also reflects the traditional apprenticeship model that has existed throughout much of acupuncture’s history. Students would have the opportunity to learn in active clinical environments while observing the realities of practice firsthand. Students may also be able to maintain a side job to support themselves without student loans, which could lower the debt burden.

That said, the model also presents risks. Mentors would need to be carefully vetted. There would need to be safeguards against exploitation, poor educational quality, and unsafe clinical practices. Oregon would likely need a robust oversight mechanism to ensure the system functions as intended.

These are important conversations to have.

What I find difficult to reconcile is the willingness to advance a pathway with no degree credential while refusing to move forward a proposal that still leaves room for acupuncture within higher education. If degree level is truly the central concern, then that standard should be applied consistently.

Another concern raised during the meeting was discomfort with moving away from the existing system. Several AAC members expressed confidence in ACAHM and NCBAHM setting standards and questioned whether creating standards for Oregon was even the committee’s role.

To be clear, it is their role. The AAC operates under the Oregon Medical Board, and the Board has specifically directed work on educational standards. The reality is that Oregon has largely delegated that responsibility to ACAHM.

That should give us pause.

The idea that Oregon cannot determine what is necessary to keep Oregon patients and students safe from harm—and must instead rely entirely on an outside accrediting body with its own institutional interests—is worth examining carefully.

It is also important to recognize that ACAHM cannot accredit bachelor’s degree programs. It can accredit certificates, master’s, and doctoral programs. As a practical matter, that leaves students with limited options: obtain a certificate or pursue an expensive graduate-level education.

Why the possibility of a bachelor’s degree is so controversial remains difficult for me to understand.

I recently discussed this issue with someone I have admired since I was a student. She reminded me of conversations that occurred when national organizations were working to expand acupuncture opportunities within the VA system. At the time, VA administrators reportedly struggled to understand how acupuncture education fit within traditional higher education structures. They found it unusual that practitioners could earn master’s degrees without first earning bachelor’s degrees. In the end they agreed to employ acupuncturists based on the argument we made concerning our higher education model. The fear around losing those job opportunities is real, and I do want to hold space for that. However those hospital jobs, and VA jobs are few and far between. The VA employs less than 200 acupuncturists nationally.

Frankly, I understand that confusion from the VA.

If our educational hours are equivalent to those of someone who completes a bachelor’s degree followed by a master’s degree, perhaps we should be willing to ask bigger questions. Would a bachelor’s degree in a relevant science field followed by a shorter focused graduate acupuncture program make more sense? Could clinical training be structured differently? Could education become more affordable while maintaining safety and competency?

I do not claim to have all the answers.

What I do know is that the current system is under tremendous pressure. The federal government is forcing conversations that many of us would rather avoid. We can either react to those changes after the fact, or we can begin imagining alternatives now. There is no reason we can’t have multiple entry points into our profession, as nurses do, based on the interest of the provider. Someone with a certificate may never get that VA job, but maybe they don’t want it. It is certainly easier to be a small business owner when you are not also drowning in debt. People who want to explore higher education models should also still have that opportunity, and those people can create those integrated jobs that others do not want. Acupuncturists are not a monolith, and should not be treated as such.

I never expected the simple act of reimagining the status quo to be controversial. Yet here we are.

For the OAA Task Force on Education, we have been conducting employer surveys and meeting with stakeholders and educators. We’ve made an effort to gather input from a wide range of employers, from very small practices to large, industry-type organizations.

There are some clear themes emerging. If you’re interested in reviewing the data, we have a small sample available on the Acupuncture Workforce Alliance website.

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There are some clear themes emerging. If you’re interested in reviewing the data, we have a small sample available on the Acupuncture Workforce Alliance website.

When we asked employers what matters most, a consistent pattern appeared.

At the top of the list were:

• Patient rapport and warmth

• Clinical reasoning and differential diagnosis

• Biomedical and anatomy knowledge

To me, this top tier reflects what is essential for safety and for being a skilled provider.

The second tier included the skills required to function within a business:

• EMR systems

• Referral decision-making

• Interdisciplinary communication

And at the very bottom?

Credential title.

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Why am I highlighting this? Because it demonstrates what employers actually care about, and it doesn’t always align with how we structure acupuncture education.

At the highest level, employers care about two things: patient care and whether a provider can contribute to a sustainable business model. If a business isn’t making money, it can’t offer competitive pay, provide benefits, or even survive.

And yet, as acupuncturists, we are often trained to be excellent clinicians without being taught how the financial side of healthcare actually works. The “money” conversation can feel uncomfortable, but it’s foundational to the reality of employment and the reality of running your own business.

As an employer myself, I’ve noticed that the biggest areas of training for new hires are not clinical, they’re operational. I spend the most time helping practitioners adjust to a faster pace, refine their charting so that it results in actual insurance reimbursement, and develop clear treatment planning.

If, as a profession, we had been more proactive in preparing practitioners for these realities, the transition into the workforce might not feel so jarring.

This data highlights two key points for me:

Employer input is critical.
Employer surveys are essential for identifying gaps in education. Employers should have a seat at the table within acupuncture associations and national organizations, their perspectives should help shape educational standards.

Education must evolve.
Schools need to equip acupuncturists with the skills to function within modern healthcare systems. This includes workflow efficiency, such as managing multiple treatment rooms, and positioning themselves as valuable, revenue-generating providers.

Updating our educational model is essential if we want to develop a workforce that can thrive in today’s healthcare climate. These are changes we likely should have made a decade ago, but better late than never.

Are you an employer? Please take our survey! We would love your input.

Survey Here!

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I recently recorded a podcast about our proposal here in Oregon (proposal linked here)—the podcast should be coming out next week. My hope is that it inspires people in other states to start thinking about these issues. And if you’re reading this from outside Oregon and you share these concerns, I encourage you to reach out to your state organization and ask what they’re doing about it.

Because right now, the national response seems to be…wait it out.

There’s a belief that these laws will get repealed, and the messaging suggests everything is fine—that maybe a few schools will close, but the profession will be okay. Someone even said to me, “Chiropractic schools have been closing and they’re fine.”

I don’t think that person fully understands what’s happening in the chiropractic profession.

I employ chiropractors. Their reimbursement rates are worse than ours. Many clinics survive by seeing patients every 10 minutes, operating at extremely high volume just to stay afloat. Others rely heavily on personal injury cases or selling DME to Medicare patients to offset losses from low reimbursements.

But I digress.

The reality is this: declining reimbursements, increasing patient volume demands, and crushing student loan debt are not unique to acupuncture. These are systemic issues across healthcare. But because we are a smaller profession with a more niche scope, we feel them more acutely.

And here’s the uncomfortable truth, one that many acupuncturists don’t want to face:

We are not physicians, and we never will be.

That doesn’t make us less valuable. We are highly skilled, effective practitioners. Some of us work in hospitals and research settings. Others thrive in community clinics or private practice. We are not a monolith, and our education shouldn’t be either.

There should be multiple entry points into this profession.

If someone wants to pursue a doctorate, conduct research, and has the time and financial resources to do so, they should absolutely have that option.

But if someone wants to become a safe, competent practitioner and enter the workforce without taking on massive debt, that pathway should exist too.

And no acupuncturist should graduate with the level of debt that an MD carries.

I’m sorry, but we are not MDs. We don’t have the same scope, the same liability, or the same employment pipelines with PSLF options readily available. Expecting acupuncture students to take on equivalent financial burden is, frankly, absurd.

What has been especially disheartening is seeing some of the response within our own community.

I’ve seen acupuncturists advocating to increase student loan caps—pushing for $50,000 per year—rather than reconsidering the structure of education itself. I’ve seen support for lawsuits aimed at preserving access to unlimited borrowing.

Because apparently, financial ruin is preferable to rethinking the system.

What makes this even harder is that many of these perspectives come from practitioners who didn’t graduate with this level of debt. They didn’t experience the current system, and so they don’t fully grasp how predatory it has become.

I’ve been talking about student loan issues for years. I remember when Biden ran on student loan forgiveness, a promise that, while partially addressed, was never fully realized.

And when I used to speak about this, I would hear the same dismissive responses:

“You signed the promissory note.”
“You’re an adult, you should pay it back.”
“Why did you take out that much?”
“My tax dollars shouldn’t fund your choices.”

Meanwhile, I was working 60–80 hours a week. Seven days a week. Building a practice during the day, waiting tables at night just to survive.

Eventually, I stopped trying to explain it. Because the truth is, if you’ve never had student loans, you will never fully understand.

And even beyond that, the system itself has changed. Practitioners who graduated in the 80s and 90s simply did not face the same financial reality as those graduating after 2006. It’s a completely different experience.

So if you’re someone advocating for raising loan caps to $50K per year, I ask you to pause and reflect:

Do you really want young people entering this profession already in financial ruin?

Because that’s what you’re advocating for.

During the podcast, someone’s comment came up. They had said to me on Facebook:

“You’re a dreamer. Dreams die hard.”

We talked about that, the audacity to dream. The audacity to imagine a future that is better for students, practitioners, and patients.

And right now, that feels…audacious.

If you look at the Portland acupuncture Facebook page, you’ll see people acting as though questioning the status quo is an attack on the profession. As if reimagining the system is somehow destructive.

But in my view, the status quo is what dies the hardest.

And that, to me, is the most disappointing part.

So if you’re reading this and you believe there has to be a better way, I want to leave you with this:

You have permission to dream.

Permission to question.
Permission to challenge what isn’t working.
Permission to imagine something better.

You don’t actually need my permission—but sometimes it helps to hear it. Especially when the loudest voices are trying to shame you into staying quiet.

Audacious goals are what change the world.

In my last post, I mentioned that in trying to reimagine the educational landscape of acupuncture, I felt like I had stumbled into a bit of classism within our profession. Someone responded that this argument is a distraction. Maybe “classism” isn’t the right word, maybe it’s just culture wars. But either way, it’s worth unpacking.

In a recent conversation with a colleague, I referred to acupuncture as a blue-collar job. I’ve said this many times. To me, acupuncturists fit squarely into the middle class, working class, what I think of interchangeably as blue-collar work.

That comment sparked a strong reaction. A colleague asked me, on a public listserv full of people, to explain myself. It was clear she was offended.

So I looked up the definition: a blue-collar job refers to work involving manual labor or skilled trades. Think manufacturing, construction, plumbing, automotive repair.

And that’s when I realized I had touched a nerve.

The offense wasn’t really about the definition. It was about the comparison to a trade.

We have been sold a very expensive education with the promise that we are “doctors.” But when we get into the real world, when we see that many allied health professions don’t take us seriously, and our pay doesn’t reflect our loan burden, it can be a bitter pill to swallow.

And in response, it seems like many acupuncturists turn inward. We start engaging in culture wars within our own profession to maintain some sense of hierarchy or superiority.

We argue about who is more legitimate:

• Those who can read classical Chinese

• Those who practice TCM vs. Five Element vs. herbalism

• Those who believe acupuncture should be offered as near-devotional service at minimal cost

There are a lot of strong feelings tied up in identity.

But what gets lost in all of that is the reason we should be doing this work in the first place: patients, and their ability to access care.

Personally, I’m not interested in the culture wars. I find them to be the real distraction.

I have a doctoral degree. It has not given me more clout or more income than my master’s degree did. The idea of people practicing with a bachelor’s degree doesn’t threaten me. It doesn’t diminish my education.

If anything, it simply reflects that I chose to invest more time, energy, and money into my training.

But as a practitioner, what actually matters is clinical experience. Palpation skills, clinical reasoning, needle technique, these are developed over time, through practice. Not just through credentials.

When I entered this profession, I was working in a hotel and found it completely soul-sucking. I wanted to do something meaningful, something that contributed to humanity, while still allowing me to pay my bills and maintain some level of work-life balance.

I was drawn to a career that valued lifelong learning, and where your skills would deepen over time. I thought, I will probably never be independently wealthy, and if I have to work till I die, I might as well find something I love, and is not too hard on my body.

That’s still what I value.

The credential itself doesn’t give me meaning. The work does.

So when we talk about systemic change, we have a choice.

We can acknowledge what’s not working. We can accept that the emperor has no clothes and start rethinking the system.

Or we can cling to our credentials, clutch our pearls, and continue drowning in debt as a profession.

The choice is ours.

The profession is what we make of it.

I believe all forms of acupuncture have value. I believe they all serve different patient populations and needs. And I believe there is a future where students, practitioners, and patients can all benefit.

But that future requires us to move beyond internal divisions, and start focusing on access, sustainability, and reality.

As I stated in my last post, when I became aware of the impending federal changes to higher education, I felt it would be irresponsible not to act, especially when there is actually a clear solution to this problem. One that I would argue was needed even if were weren’t staring into the barrel of a gun.

What I didn’t expect was just how controversial that solution would become.

I’m going to try to lay this out as plainly as possible, speaking only from my own experience and my understanding of the criticism.

When I went to acupuncture school, I entered with a bachelor’s degree from a state university. In my (admittedly naïve) understanding of higher education, I assumed there was a clear progression: bachelor’s → master’s → doctorate.

So I was surprised to find myself in a program where many of my classmates had what amounted to the equivalent of an associate’s degree, or less. There wasn’t even a requirement for an associate’s degree in a specific field. Students only needed 60 credits of post-secondary education, in almost anything.

There were a few basic requirements—Bio 101 with lab, Psych 101, maybe one additional science—but beyond that, the rest could be anything. Literature, for example. No shade to literature lovers out there, but acupuncture is a science.

That didn’t sit quite right with me. We were being told we were in “medical school,” yet there was no consistent educational foundation required going in. I tried to rationalize it—acupuncture is its own system, after all—but it stayed in the back of my mind.

I also didn’t understand why my master’s program took 3–4 years. Most master’s programs are closer to two. There were a lot of classes that felt like filler, things that could have been continuing education instead. My schedule was uneven: first and fourth years were intense, while the second and third felt sparse. Some classes were redundant. Others felt unnecessary.

No offense to my school, but our nutrition and business classes were not rigorous. I had undergraduate classes that were more demanding than some of my master’s coursework.

At the same time, I watched classmates struggle significantly with the workload. And I couldn’t help but wonder: was that because some of them had never gone through a full undergraduate experience and weren’t prepared for that level of study?

I also questioned why acupuncture wasn’t structured as a post-baccalaureate program. I had a friend who completed an accelerated post-bac nursing program and went on to work in the ER. Her training was intense, focused, and rigorous, arguably more so than parts of my own education, which often relied heavily on rote memorization.

I’ve never considered myself the smartest person in the room, but I am a hard worker. And if acupuncture school didn’t feel particularly difficult for me, I had to be honest with myself, it probably wasn’t that difficult overall.

Fast forward to now, and the problem becomes very clear.

As I discussed in my last post, under the AHEAD metrics, 98% of acupuncture programs will fail the Department of Education’s new lending guidelines. Why? Because acupuncturists with master’s degrees do not, on average, out-earn someone with a general bachelor’s degree within the first four years of practice.

However, acupuncture programs do pass when measured at the bachelor’s level.

So what does that tell us?

It tells us that acupuncture education is likely misaligned with its current degree designation.

It suggests that these programs could, and perhaps should, be structured as bachelor’s degrees or post-baccalaureate programs.

And if we did that, a lot changes.

Costs would drop significantly. Bachelor’s-level credits are typically half, or even a third, the cost of master’s-level credits. Students would gain access to Pell Grants, subsidized loans, and more scholarship opportunities.

We could still ensure that entry-level Licensed Acupuncturists are safe and effective.

We could also create post-bac certificate pathways that attract professionals from adjacent fields, nurses, nutritionists, allied health providers, people who want to integrate acupuncture into their work. That kind of cross-disciplinary collaboration could strengthen the entire profession.

Acupuncturists already value lifelong learning. Continuing education is required to maintain licensure. So instead of relying on scattered, often low-quality CEUs, we could build structured, high-quality educational pathways that lead to advanced credentials, master’s or doctoral degrees, earned over time while practitioners are working and earning income.

That would reduce debt. It would reduce burnout. And it would create practitioners who are more financially stable, and therefore better able to focus on patient care. On top of that you would have actual clinical experience to bring to masters or doctoral study, thereby getting more out of your degree overall.

It would also reduce the pressure to charge high cash rates simply to service student loan debt.

In short, it could be a better system, for practitioners and for patients.

So why haven’t we done this?

Because our programmatic accreditor, ACAHM, is only authorized to accredit master’s-level programs, and they require those programs to be three years in length.

This is part of why we are exploring an alternate, state-approved pathway to licensure in Oregon.

A state-based pathway could ensure that all approved programs actually teach to Oregon’s scope of practice, which, notably, is not guaranteed right now. It could also allow for bachelor’s-level programs and more flexible educational models that meet the specific needs of the state.

For example, Oregon is currently struggling to recruit providers in rural areas. A state-driven model could prioritize training that prepares practitioners for rural medicine and incentivizes workforce distribution where it’s needed most.

This could be a highly valuable pathway.

And yet, it has been incredibly controversial.

That part has surprised me.

When I talk to acupuncturists, I hear the same things over and over:

“I don’t think I’ll ever pay off my loans.”
“I’m financially stressed.”
“I can barely pay my rent.”
“I have to DoorDash on the side.”

When we survey OAA members, the number one response is: insurance companies need to pay us more.

And while that may be true, we’ve been working on increasing reimbursements for years, with very little success.

Insurance companies have more money, more lobbyists, and more power than we do.

We should keep pushing, but we also need to be realistic.

Right now, the lever we actually have control over is the cost of education.

The main criticisms I hear about shifting to a bachelor’s-level model are:

• “It devalues the profession.”

• “Insurance companies will pay us less.”

• “You can’t safely train acupuncturists at that level.”

I take issue with all of these.

First, we’ve already been moving toward entry-level doctorates, and reimbursement has gone down, not up. So that correlation doesn’t hold.

Second, are we really saying we can train nurses to safely insert IVs at a bachelor’s or post-bac level, but we can’t train acupuncturists to do their job safely within a similar framework?

And third, what does it actually mean to “devalue” the profession?

Acupuncture is valuable. Full stop.

Its value doesn’t come from the letters behind our names. It comes from the outcomes we create for patients.

What I continue to notice in these conversations is an undercurrent of something else, something that feels a lot like classism.

But I’ll save that for the next post.

Recently, after stepping into my role as President of the OAA, a member reached out to me about new federal regulations under the OBBBA. I wasn’t surprised to hear about the RISE Rule and upcoming loan caps. The Department of Education is eliminating Grad PLUS loans and placing a $20,500 annual cap on graduate loans for many programs, including acupuncture.

To be honest, I actually support loan caps.

As someone who graduated from acupuncture school with far more debt than I anticipated, I’ve often wondered why any responsible system would allow young people to take on massive loans, knowing many will never realistically be able to repay them. I was raised to believe that money doesn’t grow on trees, and that debts should be honored. But the system we’ve built doesn’t reflect that value.

When I entered acupuncture school, I was told, “You have to spend money to make money,” and that the field was growing, that there were plenty of six-figure acupuncturists. But when I graduated, my reality looked very different.

My first job had me working four days a week, 11am to 7pm, seeing four patients an hour, and I was making less than $1,000 per month. I eventually left and went into private practice, but for the first three years, I still had to work in a restaurant to make ends meet. I worked seven days a week, often two jobs a day: acupuncture in the morning, serving tables at night.

Meanwhile, I was making income-based loan payments of about $300–$400 per month, and my balance kept growing. Over 3 years, nearly $50,000 accrued in interest alone. To make a meaningful dent, I would have needed to pay around $2,000 per month for at least ten years, an unrealistic expectation for many in our field.

So yes, when I heard about loan caps, I thought it was reasonable policy.

Tuition has risen 40–60% over the past 20 years. That’s not sustainable, especially for young people who may not fully understand how six-figure debt will shape their future. Starting a career buried in debt is not a strong foundation for anyone. And realistically, who can afford $26,000–$28,000 per year in tuition alone?

In that sense, loan caps may force programs to lower tuition, and that could ultimately be a good thing.

However, what truly concerns me is the piece that many people are overlooking: the AHEAD metrics, now referred to as the “Do No Harm” metrics.

These metrics evaluate a graduate’s adjusted gross income four years after completing their degree and compare it to a benchmark. In simple terms:

• If you have a bachelor’s degree, you’re expected to earn more than someone with only a high school diploma in your area.

• If you have a master’s degree, you’re expected to earn more than someone with a bachelor’s degree.

On the surface, that may sound reasonable. But when applied to acupuncture, the results are alarming.

According to Department of Education estimates, 98% of students are currently enrolled in acupuncture programs projected to fail this earnings test. Check your school here.

That means four years after graduation, the average acupuncturist is earning less than someone in their area with only a bachelor’s degree, while often carrying six-figure debt.

So what does this mean in practice?

A Timeline for What’s Coming

RISE Rule
July 2026: Loan caps go into effect. Students will not be able to borrow more than $20,500 per year. Many acupuncture programs already exceed this in tuition alone, without even factoring in living expenses. There is currently a bill being explored to raise these loan caps to $50,000 per year, which is about what I took out for my MAc. I do have a hard time with the idea of fighting for students to be in debt, but I digress.

AHEAD Metrics
July 2027: Programs are evaluated based on earnings data from 2023 graduates. If they fail, they must display a financial warning label on their websites, essentially stating that the program may not lead to financially viable outcomes.

July 2028: Programs are evaluated again using 2024 graduate data. If they fail a second time, they face two options:

• Enter a teach-out period (stop accepting new students and close after current students graduate), or

• Lose access to federal loans entirely

If federal loan access is lost, current students would be forced to either pay out of pocket or turn to private loans, which are often even more predatory than federal loans.

These policies will devastate acupuncture education as we know it. Many schools will not survive.

And yet, there’s an important nuance here.

Despite these challenges, acupuncture as a career is actually becoming more viable in many ways.

When I graduated, jobs were scarce, and many of us had to create our own opportunities. Today, there are more employment options than there were a decade ago. But because many practitioners came up through hardship, working multiple jobs, building from scratch, there’s a tendency to view the profession through a lens of burnout and scarcity.

I often hear people say the field is “saturated,” but that hasn’t matched my experience.

There are fewer than 40,000 licensed acupuncturists in the United States. Compare that to approximately 246,000 physical therapists. PTs have a well-funded national association, a strong job pipeline, and have steadily expanded their scope of practice. I’ve never heard PTs describe their field as saturated.

A robust workforce is not a weakness, it’s a strength.

At the OAA, we are actively working to respond to these changes. We’re exploring solutions, engaging stakeholders, and thinking critically about how to adapt. We’ve received both support and criticism, often from unexpected places.

Much of the criticism, in my view, comes from fear. And that’s understandable. Change is disruptive. But it’s also inevitable.

As a business owner, I’ve had to learn how to navigate change constantly. And right now, the reality is this:

If we do not adapt to these new federal regulations, especially the AHEAD metrics,

we risk setting the profession back decades.

Ignoring that would be irresponsible.

Those of you who know me personally know that I’ve been outspoken about the predatory lending practices tied to student loans. I recently spoke on the podcast Needling to Get to the Point about this very issue.

When I first graduated, I was in complete shock at how high my loans were. I genuinely felt like I had done something wrong. I felt ashamed.

As I moved further into my career as an acupuncturist, that shame turned into anger—specifically toward the school. I started to see the reality of the profession: how few jobs were actually available, what insurance companies were reimbursing, and how those reimbursements were declining year over year.

And the truth is…….. they knew.

They knew what the job market looked like. They knew what reimbursement rates looked like. Meanwhile, I was a student with no real understanding of the ecosystem I was entering. I trusted what I was told:

• “We’re going to become Medicare providers in the next couple of years—that will expand job opportunities.”

• “None of our students are in default on their loans.”

• “The Affordable Care Act has increased access to insurance, which means more patients.”

• “You can easily make six figures as an acupuncturist.”

I believe the school had an ethical responsibility to be honest about the state of the profession. I love what I do—but I would never have taken out the loans I did if I had been given full transparency.

When Trump passed the “One Big Beautiful Bill Act,” which includes significant restrictions on student loan borrowing, I understood where it was coming from.

Do I wish the SAVE plan had remained intact for those of us carrying massive debt? Yes.
Do I wish there had been a cap on compounding interest? Also yes.

But here’s the reality: across professions, people are carrying multiple six figures of debt—and most aren’t paying it back.

They’re also not defaulting. Instead, they’re enrolling in income-based repayment plans and waiting 10–25 years for forgiveness, paying as little as possible along the way. It’s not because people don’t want to pay—it’s because the numbers don’t work.

Someone graduating with $100K–$300K in debt, stepping into an entry-level salary, cannot realistically make meaningful payments while also covering the cost of living in America. Students are being set up to fail before they even graduate.

So where does capitalism fit into all of this?

We live in a free market. Colleges and universities are businesses, and they can charge whatever they want. Period.

In basic Economics 101, we learn that markets rise until they hit a ceiling, until consumers are no longer willing to pay. At that point, the market corrects itself.

That’s what we’re seeing now with higher education.

Education was sold to us as the path to a better life, the way out of rigid class structures, part of the American Dream: work hard, and you can become anything.

Then in 1965, the federal government began guaranteeing student loans through the Higher Education Act. Schools saw that guarantee and raised tuition. Loan burdens ballooned.

By the time Obama took office, people were already sounding the alarm. In response, income-based repayment (IBR) plans were introduced, allowing borrowers to pay around 10% of their income with forgiveness after 20–25 years.

But instead of solving the problem, it enabled it.

Schools continued raising tuition, using IBR as justification: “Don’t worry! you’ll only pay a percentage of your income.”

And people kept borrowing.

Now, I believe we’ve finally hit the tipping point. Enrollment is declining across the country, not because people don’t value education, but because they’re no longer willing to take on massive debt for the promise of a better life.

The reality of six-figure debt has caught up.

That debt follows you everywhere:

• Want to buy a house? Your debt-to-income ratio is too high.

• Want to buy a car? Lenders see that $300K liability.

• Want to start a family? Good luck balancing childcare, housing, and student loans.

The weight of it hangs over you like a storm cloud.

The bottom line: the gig is up. Students are no longer willing to pay these prices. And with the OBBBA restrictions, the federal government is no longer willing to guarantee those loans either.

The market is correcting itself, and it’s going to be ugly for the institutions that relied on this system.

Schools will close. It’s going to be a bloodbath.

Messaging from the System:

I attended a webinar last night hosted by the AHM coalition. In acupuncture, this coalition includes the accreditor (ACAHM), the council of colleges (CCAHM), the national professional organization (ASA), and the certifying body (NCBAHM).

In other words, all of the organizations that are supposed to provide checks and balances have now aligned.

The community showed up expecting answers and a plan.

What we got instead was a recap of problems we already understand, complaints about why the situation is unfair, deflection from the underlying causes, and no clear path forward.

The president of ACAHM (who earns six figures annually) made statements like:

“This will impact our education pipeline. Patients will lose access to care. Only those who can access private loans will be able to attend school. Care will become limited to affluent communities.”

And their proposed solutions?

• Practitioners and patients should lobby against the mandates

• Maybe pursue legal action against the federal government

• Students should take out private loans to cover tuition

What was missing?

Any plan to make education more affordable.
Any plan to reform the system itself.

Once again, the burden is placed on students, practitioners, and patients.

Apparently, a six figure salary doesn’t guarantee competent leadership.

Hope on the Horizon:

While our national coalition is not offering realistic solutions, there is some hope.

There are schools actively trying to build programs that don’t rely on student loans—like ORCCA here in Oregon and Middle Way in Washington. I’ve spoken directly with directors of acupuncture schools who are thinking outside the box and working to find real solutions to keep their programs alive without putting students into crushing debt.

I’ve also been in touch with incredibly smart professionals who have thoughtful, innovative ideas about how to move this profession forward.

As President of the OAA, I’ve created a task force focused on education. We are actively exploring rule changes in Oregon that would make it easier for low-debt, sustainable schools to exist and thrive.

There are people paying attention. There are people who care. And there are people doing the work.

Unfortunately, it looks like this is going to be a state-by-state effort.

But the answer is not to prop up a failing system.

The answer is reform.

End Note:
You can find a detailed timeline of student loan programs from Boston University.

If you want a deeper dive into the OBBBA and its impact on acupuncture, check out my friend Bex’s Substack—she’s been covering this extensively from an investigative lens.

By Dr. Danielle Reghi, DACM, LAc

There’s been a lot of angst in the acupuncture community lately. One of the major acupuncture colleges here in Portland just closed its doors, and although two others remain, there’s a growing narrative circulating in student and practitioner circles: “There’s no money in acupuncture.”

I couldn’t disagree more—but the truth is, this topic is layered and nuanced.

The Bigger Picture: The Healthcare Industry at Large

Let’s start here: the entire medical system is struggling right now. Providers across disciplines—acupuncturists, doctors, nurses, and others—are being asked to do more with less. Hospital systems and insurance companies are operating with increasing pressure, and in many cases, corporate profit is prioritized over provider sustainability.

Meanwhile, insurance companies are seeing record profits. In 2024, Kaiser reported $12.9 billion in net profits, and United Healthcare came in at $14.4 billion. And yet, reimbursement rates for providers haven’t budged to match inflation. In fact, we’ve seen the opposite: reduced rates, bundled billing codes, and entire codes being dropped.

Acupuncturists are part of this system—we take insurance too, and we’re affected. But even so, you can make money in this profession if you run your business with intention and clarity.

The Myth of Working Less and Earning More

One common misconception I hear from new grads is this:

“If I work for myself, I’ll make more and work less.”

The reality? Being in private practice is rewarding—but it’s not a shortcut to a 3-day workweek. It’s still a job, and like any job, it takes time and energy. You might not work a traditional 9–5, but you need to put in real hours.

I encourage practitioners to think about work in terms of patient volume rather than hours. In my experience, the sweet spot is 10–15 patients per day, or around 200 patients per month. That might mean working 3.5–4 days per week. If you prefer to see fewer patients per day—say, 8—you’ll need to work more days to make up the difference.

If you’re seeing fewer than 8 patients a day consistently, your income will reflect that.

The Reality of Running a Business

Starting your own business isn’t for everyone—and it certainly won’t let you coast. Any small business owner will tell you: you’ll work harder than ever in the early years.

In my first two years, I made $24K annually. I had to wait tables to make ends meet. I worked seven days a week. Looking back, I’m not entirely sure how I did it—other than sheer refusal to give up.

But I made it through. Now, acupuncture is my full-time job. I don’t wait tables anymore. I don’t work multiple jobs. I have a career that fulfills me, supports me, and allows me to make a real difference.

Defining Success: What Does It Look Like for You?

When people ask me, “Can I make money doing acupuncture?” I always ask them:
“What does success look like to you?”

If your definition of success is becoming a millionaire or driving a luxury car, acupuncture might not get you there on its own. Sure, some people have found major financial success in this field, but often through business expansion, teaching, products, or multiple ventures.

But if success looks like doing work you believe in, supporting yourself with one job (not three), and making a meaningful difference in people’s lives—then yes, acupuncture can absolutely provide that.

When I left my corporate job, I did it because I wanted more than just a paycheck. I wanted purpose. I wanted pride in my work. And I knew I’d likely be working until retirement, so I wanted to love what I did.

Today, I do. And I feel successful.

Final Thoughts: Your Why Matters

So, can you make money doing acupuncture?

Yes. But it takes work.

Get clear on what success means to you. Be honest about your “why.” Did you enter this field because you’re passionate about helping people? Are you committed to showing up even when it’s hard?

Like any job, you get out what you put in. Not every day will be easy. Some parts of the job will be more enjoyable than others. But if you love the work, that effort feels worth it.

I still do parts of my job I don’t love—but I’d rather be doing this than waiting tables or working in hotels. And most importantly, I’m only doing one job now. That feels like success to me.

Acupuncture won’t make you rich overnight—but it can give you a career that’s rich in purpose, sustainability, and impact.

At first glance, both options seem similar: you're working for someone else, right? But the differences go well beyond how you're paid. This article breaks down the key distinctions to help you make an informed, confident choice.

What It Means to Be an Employee

Being an employee is the more traditional model. You work for a business at an agreed-upon wage and schedule. In exchange, you follow the company's policies and procedures. Here's what that includes:

✅ Benefits of Employment:

• Legal protections under state and federal employment laws

• Eligibility for benefits like health insurance, sick leave, 401(k), and paid holidays

• Biweekly pay with taxes automatically withheld

• Reduced tax liability compared to independent contractors (no self-employment tax)

• Eligibility for unemployment benefits if laid off or furloughed

In Oregon, employment status includes:

• A set schedule and compensation agreement

• Coverage by workers’ compensation if injured on the job

• Protection under anti-discrimination laws

• Clear job expectations and defined duties

For more details, check out the Oregon Employment Department or Bureau of Labor and Industries (BOLI).

The Reality of Being an Independent Contractor

As the name suggests, independent contractors operate as their own businesses. While you may work under a clinic's roof, you are technically a separate entity entering into a profit-sharing arrangement with your host business.

✅ What to Know About IC Work:

• You negotiate your own rates and split agreements

• You are responsible for your own taxes, including self-employment tax (set aside ~30%)

• You are not covered by employment protections (e.g., sick leave, unemployment)

• You pay for your own malpractice insurance, licensing, and business expenses

• You are not eligible for employee benefits unless outlined in your contract

• You maintain full control over your schedule and patient care decisions

• Technically, you should bring in your own patients and collect your own payments, although many clinics assist with this

This setup can offer great freedom and flexibility. You have the potential to earn more and build your own brand while leveraging the support and reputation of an established clinic. But you also take on more risk, responsibility, and administrative burden.

For a deeper dive into Oregon's rules on IC relationships, visit the Oregon Employment Department.

What to Watch For in Contracts

Whether you're being hired as an IC or employee, always read contracts carefully and consider having a lawyer review them.

Common red flags include:

• Vague language about expectations or compensation

• ICs being told how to treat patients (this could be considered misclassification)

• Lack of clarity around who provides supplies, handles billing, or sets pricing

The most frustrated practitioners are often those who didn’t fully understand the expectations of their role until after they’d already signed on.

Which Path is Right for You?

There’s no one-size-fits-all answer. Some people love the stability and protection of being an employee. Others thrive as independent contractors, enjoying the autonomy to build their own brand.

Here are a few questions to ask yourself:

• Do I want to grow a business or show up to a steady job?

• Am I financially ready to manage self-employment taxes and business expenses?

• Do I want full control over my schedule, or do I prefer structure and support?

Either path can be a great fit—as long as you go into it informed.

Disclaimer: I am not an attorney. This article is based on my personal experience, consultation with legal counsel, and publicly available information from state agencies. Always seek your own legal advice when reviewing contracts or setting up a practice. Most legal trouble in this industry happens because people simply don’t know better—but unfortunately, ignorance is not a defense.

Still unsure which route is right for you? I’d love to hear your thoughts or answer your questions in the comments!

✅ Take and Pass Your Board Exams
It’s daunting, but necessary. You can’t get licensed without them, and you can’t practice without a license. My advice? Don’t delay. The material is fresh after school, and waiting doesn’t make the process feel any less intimidating. Make a study plan, stick to it, and get it done.

✅ Register for an NPI Number
This is your National Provider Identifier, and it’s essential—especially if you plan to bill insurance.
➡️ Register here (it’s free):

https://nppes.cms.hhs.gov/#/

✅ Start Your CAQH Profile
CAQH is one of the key databases that insurance companies use to credential providers in Oregon (and many other states). Even if you don’t have your license or malpractice insurance yet, you can begin entering your information now.

💡 Tip: The form can feel confusing because it's also used by MDs. Just skip irrelevant questions or check “not applicable.” Be thorough—insurance companies will bounce back incomplete apps.

➡️ Start your profile here:

https://proview.caqh.org/

✅ Get Malpractice Insurance
Every provider needs coverage. I recommend CM&F Group—they cover modalities like fire cupping and electroacupuncture, which aren’t always included in basic policies. They’re also reasonably priced.
➡️

https://www.cmfgroup.com

✅ Begin Insurance Credentialing ASAP
Once you’ve finished your CAQH and have a practice address, start submitting applications. Some employers will help with this, but they’ll still need your documentation.

Yes, there are credentialing services out there (typically ~$800), but I recommend saving your money and doing it yourself—or getting support from your employer. It’s time-consuming, but not difficult. Even if you’re considering a cash practice, credentialing gives you options. You can always drop panels later.

✅ Find the Right Job Fit for YOU
Be honest about what you want. If private practice is your goal, don’t wait—start building now. If you prefer employment, seek out a clinic that truly aligns with your values.

💡 Tip: Think abundantly. Don’t accept a job just because you “need something.” It doesn’t serve you or the employer. Hiring and training is an investment. Everyone deserves to work in an environment that feels aligned and fulfilling.

Whether you are interested in the field of Acupuncture, you have just begun your Chinese Medicine education, or you have graduated and are in the midst of your education, here are some tips to consider.

• Work in a clinic:

If you are considering a career in Acupuncture and Chinese Medicine it may be a good idea to get a job in a small acupuncture studio doing reception, marketing, or the like. While acupuncture is becoming more mainstream, the amount of jobs in larger health care settings like hospitals are not as plentiful as the job in smaller clinic settings. Getting some experience in a clinic will only help you as you become a practitioner.

• Get very clear on your why, and your mission:

If you are coming to the Acupuncture profession because you want to make money, or you just thought it would be fun, or you don’t know what else to do, this may not be the job for you. Being an LAc is the most rewarding job I have ever had, but it is certainly a hustle. It requires passion and dedication, and is one of the lowest paid jobs in health care. It is not for the faint of heart.

• Learn how to talk about things with an open mind, and an educational approach:

One of the first questions I get when I tell people I am an LAc is, “Oh, so does Acupuncture really work?” I always think this is funny because no one would ever ask their doctor if being a doctor actually helped people. I consider patient education to be one of the main responsibilities of my job. People really don’t know that it takes multiple years of post graduate education, along with multiple board exams to become an LAc. People don’t really know what Acupuncture is, even if they have had it before. Sometimes they just come in because nothing else has worked, and they really don’t think this will work either. Whatever it is, you need to be able to meet them where they are, and answer their questions in an informed way.

• Get Involved:

Most states have Acupuncture associations. These associations are there to advocate for the medicine as a whole, and practitioners alike. The best time to get involved with an association is as a student. That way when you graduate and are enjoying the hustle of filling your practice, you already have an idea of current events in the community as a whole.

• Make some Decisions:

Decide now if you want to be an employee, or if you want to go straight into private practice once you graduate. It might seem like you are jumping the gun a little bit, but school is an amazing opportunity to talk to your teachers about their jobs. Some of them may actually work in hospitals. Ask them for honest feedback about that experience. Some of them likely own their own private practice, ask them what the pro’s and con’s of that experience are like. Then be honest with yourself about which would suit you best. This will help you to lay the groundwork for setting yourself up for success.

• Always act with professionalism and Integrity:

This may seem obvious, but unfortunately it needs to be said. You are involved with people’s health, and your patients see you as their health care provider. Get familiar with the code of ethics around your new profession. A few examples are: Dress like the professional you are. Speak like the professional you are. Don’t practice without a license. Don’t date/ have sex with your patients. And understand diversity, equity, and inclusion / trauma informed concepts.

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Does Acupuncture Work?

One of the first questions I hear from people who are new to acupuncture is:
“So… does acupuncture actually work?”

It’s a fair question—especially in a culture that still sees acupuncture as fringe or unproven. Unfortunately, there’s a persistent myth that acupuncture is either a placebo or lacks scientific backing. As a practitioner, I spend a good part of my time educating patients on what acupuncture is, how it works, and why it’s a legitimate, evidence-informed form of care.

It can be frustrating, to be honest. Most acupuncturists spend 3–4 years in graduate school, complete national board exams, maintain state licensure, and fulfill continuing education requirements—all to be met with skepticism about whether our medicine “actually works.”

One of my favorite responses to the question is:
“Insurance covers acupuncture.”
And it’s true—medical insurance only covers treatments that have been shown to be effective and medically necessary. That said, just like any healthcare provider or modality, not all acupuncture is the same, and not every practitioner will be the right fit for every person.

How Does Acupuncture Work?

At its core, acupuncture works by stimulating the body’s natural healing systems. Here's how:

✅ Increases blood flow to targeted areas, promoting healing.
✅ Activates the parasympathetic nervous system (the “rest and digest” state), which is the only state in which healing can occur.
✅ Works with different tissue types, depending on the treatment area.
✅ Can target muscle motor points and Ah Shi points (similar to trigger points).
✅ Stimulates the release of endorphins and neurotransmitters like serotonin and dopamine, helping reduce pain, ease anxiety, and improve sleep.
✅ Helps restore function and slow degeneration related to chronic inflammation.

Prove It.

I’ve treated countless patients who came in skeptical but left as believers. One of my favorite examples is a case from early in my career—when I was still growing into my confidence as a practitioner.

A 42-year-old artist came in with debilitating neck pain. She’d been diagnosed with a bulging disc at C7/T1, with pain radiating down her right arm and reduced grip strength. She couldn’t hold her paintbrush. She couldn’t sleep through the night. Her doctor told her she would need surgery—but she couldn’t get in for surgery for another 7 weeks.

Desperate for relief, she turned to acupuncture.

I recommended she come in twice a week for the full 7 weeks leading up to surgery. After her first treatment, she experienced improvement. By the end of the treatment plan, she was pain-free. When she returned to her surgeon, he told her she no longer needed surgery.

She followed up occasionally for maintenance, and four years later, I reached out to ask if I could share her story—anonymously, of course. She told me she’s still doing great. No pain. Occasionally a little stiffness, but nothing that interferes with her life or her art.
You can read the full case study here.

Final Thoughts

Acupuncture works—but like all medicine, results can vary. Every body is different. Not every provider will be the right fit. My best advice: find someone you resonate with, someone you trust, and someone who takes the time to understand your needs.

But yes—acupuncture absolutely works. I see it every day.

To start, I want to share my journey into acupuncture and how I ended up here.

Growing Up with Natural Medicine

I was raised in Hawaii, where natural medicine was a big part of the culture. My parents, in their own ways, leaned toward alternative healing.

My mom was fascinated by homeopathy—Arnica gel for bruises, soy milk instead of dairy, brown rice over white. She valued home-cooked meals and traditional family life but had to work, something she still wishes had been different.

My dad’s interest in alternative medicine was more complex. His mother was in and out of hospitals for bipolar disorder, putting full faith in doctors to the point of calling them “God.” My father, diagnosed with ADHD as a child, was sent to a mental hospital at age four and put on Ritalin. It shaped his complicated relationship with medicine—on one hand, he relied on it; on the other, he saw corruption.

He struggled with addiction for most of his life, caught between rehab programs and prescriptions. Doctors were his best drug dealers—handing out Oxy, Vicodin, Dilaudid. By the time he passed away at 50, he had tried alternative treatments for his liver and maintained normal liver enzymes, but the cycle of addiction was too strong.

Growing up, my parents avoided doctors unless it was absolutely necessary. I was taught that diet was 90% of health, to let fevers burn out, and to be cautious with medications.

Discovering Acupuncture

After college, I entered the corporate world and quickly realized it wasn’t for me. Despite my degree, I was expected to work low-wage jobs to "gain experience." Student loans loomed, rent was barely affordable, and I couldn’t see myself climbing a corporate ladder I didn’t even want to be on.

I knew I wanted to work in healthcare—something meaningful. Then I stumbled upon acupuncture. When I visited acupuncture schools, I felt inspired. I attended a talk about using acupuncture in addiction recovery, and I immediately thought of my dad. That was it. I was in.

Acupuncture school was the best educational experience I’ve ever had—blending biomedicine and traditional Chinese medicine with a diverse group of students and teachers. I loved the idea that this was a field where you only get better with time, where lifelong learning is encouraged, and where you can make a real impact.

I graduated in 2016 and have been practicing ever since.

The Reality of Acupuncture as a Career

For the most part, acupuncture has lived up to my expectations. I love treating patients. I know I help people. But, as with any career, there are challenges:

• The student debt is worse than I ever imagined.

• Running a business is rewarding but exhausting.

• Acupuncture is still niche—fighting for legitimacy in mainstream healthcare.

• Insurance & bureaucracy add layers of frustration.

So, I’m creating a space to talk about all of it—the good, the bad, the deeply frustrating. If you’re in this field, curious about acupuncture, or just trying to navigate a career with meaning, I hope you’ll stick around.

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