Are AOM Students Being Misled About Their Career Opportunities?

Since publishing my practice-building book a year and a half ago, I have had the chance to give several courses on practice building, speak to hundreds of students and recent grads, and brainstorm with many of the most experienced practice building teachers in the U.S.  These activities followed 2 years of close communication with the founders of the Community Acupuncture movement – the paradigm-breaking juggernaut that is now the most widely used practice model in the U.S. The one common thread I found from my interaction with all of these sources is the realization that the vast majority of students coming out of our AOM schools don’t have a grasp on what is needed to turn their training into a financially sustainable career.  

As Al Gore noted, some truths are inconvenient. They can also be uncomfortable and awkward, especially when being pointed-out by respectful colleagues. I personally know some of the heads of our leading AOM schools and consider many others I don’t know to be colleagues so saying this is awkward: Many of our schools are misleading AOM students about their career opportunities. I am not saying school officials are consciously lying but that the information being offered-up about careers in AOM is misleading – obscuring the known negatives while building-up false positives with flawed statistics.  This leaves many AOM graduates completely unprepared for the career realities that await them, hinders their chances for success, and is wounding the AOM profession as a whole.

Before citing specifics, let me first state that I am not saying our schools have a responsibility to make sure all prospective students have a clear picture of AOM career opportunities. It would be good of them if they did but it really is the student’s responsibility to do their own due diligence.  However, schools do have a responsibility and moral obligation to not knowingly give misleading information about career prospects when a student or prospective student attempts to do their due diligence and that does not appear to be happening. Case in point: Look at the information given on the Council of Colleges of Acupuncture and Oriental Medicine’s (CCAOM) website under their Career Opportunities section of both their Student and Career Councilors tabs:

“AOM practitioners can create financially supportive careers with flexible work schedules that are rewarding on many levels….. The settings in which AOM practitioners work vary from a multi-disciplinary clinic with other health care professionals, to a hospital, to a private practice. Other career options include teaching, translating, publishing, research, or working with an herb or acupuncture supply company.”

This list of at least eight different settings makes it sound as if there are lots of options for anyone entering this field. The problem is that the best information we have tells us that 88% of AOM practitioners are in solo private practice or otherwise self-employed (from NCCAOM’s 2008 Job Task Analysis). So while the information given on CCAOM’s website might not be an outright lie, it is certainly misleading. If 9 out of 10 people entering this field end-up self-employed, don’t you think schools have a responsibility to tell prospective students up-front that actual jobs in places like hospitals and research facilities are extremely rare and their best chance to create a “financially supportive career” is being self-employed and especially, solo private practice?  CCAOM is made of representatives from more than 50 AOM schools and their website is a logical place for anyone thinking of entering the AOM field to research their career options. Having misleading information on their website is a dark mark on the integrity of all our schools. This organization claims to be “Committed to Excellence in Acupuncture and Oriental Medicine Education” but apparently this commitment has little to do with teaching how to earn a living in AOM.

The fact that self-employed private practice is the only viable career option for the vast majority of our AOM graduates may be an awkward, inconvenient truth for our schools and their students, but it is the truth. This is the “negative” that is being obscured I mentioned above. Entering into private practice requires an investment of many thousands of dollars in start-up money and usually requires many more thousands of dollars to live off of before a practice is established enough to actually earn a living-wage profit. Start-up businesses also require long hours, a smart game plan, and hard work. I can tell you from all the conversations I have had over the last years with students, recent grads and others involved with practice-building that few of our AOM students are being told that they will need to invest many thousands of dollars on top of the money they already invested in their tuition not to mention the crushing burden of student loan debt interest. Even if an individual school has a decent, reality-based practice management course, by the time students get to that course it is often too late to set them straight.  

The thing that is so frustrating to me is that I am one who actually believes many of our AOM graduates CAN build successful, rewarding careers in private practice if they were given the right information from the start. I am working at trying to share what I learned from my 27 years of full-time practice and to support others trying to build their practices. The problem I have found is that because students have not been told first off that they need to be prepared for the realities of practice building, they balk (to say the least) when someone like me tires to give them real-world advice. It is a hard truth they are unwilling to accept because they were never prepared for it as they should have been.  

In addition to glossing over the evidence that private practice is the only viable career for most entering the AOM field, the possible income figures offered-up for AOM practitioners are all flawed and inflated. There are two major mistakes that keep being made in the few attempts there have been to measure income levels for AOM practitioners. One is that these income surveys ask for the “gross” income or terms to that effect. Asking gross income is OK when asking those who work as employees and get a paycheck that states their gross (before tax) and net (after tax) incomes but not when 9 out of 10 people being surveyed are self-employed and have overhead expenses. Without going through the trouble to make sure that you are not mixing-up the “gross” income of a business from the gross taxable income of the business owner after overhead expenses are subtracted, any figures for “gross” income are useless. Overhead expenses can run as much as 40%-50% in a practice. Statistically, that creates a huge margin of error. Confusion about those figures is a common problem as seen when the Obama administration was proposing raising the tax rates on individuals making over $250,000 and many complained that it would hurt “small” businesses because they were thinking of the total income of the business, not the taxable income after expenses.

The second major flaw in these income figures has to do with not knowing how many people who do not respond to these surveys are actually out of business and have quit the AOM field altogether. Those practitioners would likely have been at the bottom-end of AOM incomes before they abandoned their “financially supportive careers” and their lost figures would have lowered the income averages significantly.

A striking example of overestimating average AOM income figures is seen in a study titled “Changing Demographics of Acupuncturists”. It was conducted by four employees of the Oregon College of Oriental Medicine (OCOM) and published in the Fall 2012 edition of the American Acupuncturist, the (peer reviewed) Journal of the AAAOM. This paper reported on a survey conducted in 2010 and compared to a similar survey done in 2007 that was sent to OCOM graduates at years 3,5,7,9, and 13 post-graduation. The response rates were around 55% and included 82 graduates in the 2010 survey and 86 in the 2007 survey. The estimated average income for those working full-time was at nearly $106,000 per year in the 2010 survey and just over $72,000 in the 2007 while part-time income was at nearly $31,000 per year in the 2010 survey and just over $33,000 in the 2007. Again, neither survey attempted  to understand if these “gross” income figures were after overhead expenses were subtracted or not nor was the possibility of some graduates being out of practice and earning no income even mentioned as an unknown data point that would skew the estimates. While not accounting for these two critical factors is the unfortunate norm in AOM income studies, what is striking to me is that this study was reviewed by the AAAOM peer review process and apparently neither the study’s four authors nor the peer reviewers caught these fatal flaws.

I don’t want to be all negative here. I applaud OCOM for at least attempting to survey their graduates -something all schools should be doing but, I suspect, very few are. Even if the $106k figure in the 2010 survey was including rather than subtracting overhead expenses, that seems like good news although the devil is in the type of details their surveys did not tease-out. I also understand OCOM has been working with the Oregon Association of Acupuncture and Oriental Medicine on compiling research on acupuncture to educate state officials and expand the list of covered conditions for acupuncture treatment within Oregon’s public health insurance coverage. That is fantastic as most AOM professional associations struggle with resource problems and desperately need the type of help some AOM schools could provide. This seems like a great model of collaboration I wish other schools and professional associations would emulate.

To my mind, the most telling information within the Changing Demographics study was the authors admission that  “little research about the AOM profession has been undertaken, and little is known about AOM professionals. “ …. “high quality research into the incidence and specific causes for practice underperformance has not been undertaken.”…. “ the acupuncturist community has not engaged in any kind of large-scale standardized research that would settle this question profession-wide.” These statements are absolutely correct and raise two questions: Why not be upfront and tell all prospective AOM students that little is known about AOM professionals’ income but we do know that most all have only private practice/self-employment as a career option? And also – why has the research that needs to be done not been done?  

No doubt, people will say that there is no money to carry-out the type of research that could tell us what is happening to our AOM graduates. Really? Is the problem no money or no desire to make it happen? Again, CCAOM has over 50 member schools who collectively take in millions of dollars a year. True – that is gross income before overhead expenses (see, that wasn’t so hard to remember) but still, even if those schools chipped-in just 1% of their annual budgets, that would go a long way to funding the type of study that would finally allow them to be able to tell AOM students what is realistic to expect. You will never get all the schools to contribute, you say? Well, how about this? For some reason, the CCAOM has for years been in charge of administering the Clean Needle Technique process required by many states for licensing/certification. Maybe portions of those fees would be better spent on funding the type of research that would then allow the CCAOM to post fact instead of fantasy about AOM careers on their website.   

 Look, I am not being critical just to be critical. I have no doubt that schools want to see their graduates have successful careers.  I can appreciate that running an AOM school is very complicated and many constantly struggle to stay afloat. But the fact that our AOM graduates are so unprepared for the career realities that await them actually hurts the schools too. This issue has been swept aside for too long. I have no doubt that great strides could be made in career preparations if this were to be made more of a priority.  I am dedicating this stage of my career to this and would love to work with schools or AOM organizations to find creative solutions – that is, if any of them will have anything to do with me after reading this.  

Matthew Bauer