Special Issue - Monkeys, Chestnuts, and New Proposals for Acupuncture Education
Saving the Acupuncture Profession While Helping Millions – Part 25
I titled this series “Saving the Acupuncture Profession While Helping Millions” because I wanted to share my thoughts on how our profession might move forward during a period of major change.
The biggest change currently threatening the survival of our schools, and the infrastructure of the U.S. acupuncture profession itself, is the coming shift in federal student loan policies.
In Part 22 of this series, I shared news about new, lower-hour acupuncture training standards being proposed by our accreditation commission, ACAHM. ACAHM is currently asking members of the profession to complete a straw poll indicating which, if any, of three newly proposed pathways they prefer.
Because these proposals seek to address what I believe is the most immediate threat facing our profession today, I felt I should offer my perspective. The deadline for the straw poll is June 21, and I encourage everyone to participate.
However, I have committed myself to being honest with readers throughout this series, and the truth is that I do not believe the differences between these proposals are especially significant.
In fact, the situation reminds me of a story told by the great Taoist philosopher Chuang Tzu about a monkey trainer and his monkeys.
The trainer told his monkeys that he would give them three chestnuts in the morning and six in the evening. The monkeys were outraged.
So he changed the arrangement and told them they would receive six chestnuts in the morning and three in the evening.
The monkeys were delighted.
Of course, they were still receiving the same nine chestnuts.
While I am sure those involved in developing these new education proposals see meaningful distinctions between them, my honest assessment is that the differences are relatively small compared to the larger challenges facing acupuncture education.
I will provide resources at the end of this article for those who want to study the proposals in greater depth and form their own opinions.
For my part, I want to focus on what I believe is the much larger issue.
What Is Missing?
The biggest problem I see in acupuncture education is not the exact number of classroom hours required.
It is what has been missing from our educational system for decades:
The ability to consistently provide high-quality, hands-on clinical training.
For more than 45 years, most acupuncture schools have struggled to provide students with sufficient real-world clinical experience across a wide range of medical conditions.
That type of experience is what helps create practitioners who are truly ready for independent practice.
Schools can increase classroom hours.
They can increase patient observation requirements.
They can require students to complete a larger number of treatments.
But the fundamental problem remains the same:
Most schools simply do not have access to enough patients with enough diversity of conditions to provide the depth of clinical training students need.
The one exception I am aware of is ORCA (formerly POCA Tech), the community acupuncture school.
From what I understand, ORCA works hard to ensure students receive extensive hands-on experience through community acupuncture clinics and prepares them specifically for employment or independent practice within that model.
However, even that approach has limitations because students receive less exposure to treatment methods that are not commonly used within the community acupuncture setting.
The Demand Problem
Why has it been so difficult for acupuncture schools to provide stronger clinical training?
The answer is the same problem I identified in the very first article of this series as the profession’s greatest challenge:
Demand for acupuncture remains too low.
Because demand is low, we do not have large numbers of busy acupuncture clinics serving enough patients to create robust internship opportunities for students.
Likewise, we do not have large numbers of hospitals providing acupuncture services at a volume sufficient to train acupuncture interns the way medical doctors are trained through hospital residency systems, or the way acupuncture students are trained in China.
The challenge is not simply educational standards.
The challenge is that the entire ecosystem supporting acupuncture education is limited by low public demand for acupuncture services.
And until we address that underlying problem, debates over shifting educational hours up or down may have far less impact than many people hope.
The Bottom Line
I understand that some people oppose reducing the number of training hours required for entry-level licensure as an Acupuncturist. Most, I believe, feel that way because they worry it will make us appear less professional than other healthcare providers.[1]
In other words, it is often a status concern rather than a concern about the training’s actual comprehensiveness.
I do not dismiss that concern.
However, I do reject increasing training hours and educational costs solely for status.
The solution is actually quite simple:
If you want higher training hours, perhaps including a doctoral title, then you should also increase the scope of practice in a way that justifies those additional hours.
Training standards are supposed to be designed around the scope of practice that a license permits.
Fewer hours should generally correspond to a narrower scope of practice.
More hours should correspond to a broader scope of practice.
Yes, that would likely mean some form of tiered licensing system. But that may be the only realistic way to satisfy both those who want the lowest practical hours and costs and those who want the additional status associated with higher training hours, advanced degrees, and professional titles.
Developing training standards based on the scope of practice is the only honest and legitimate way to justify those standards.
But even then, training will remain incomplete, regardless of the number of hours required or the scope of practice allowed, if students do not receive enough quality hands-on clinical experience.
[1] I also understand some people worry that lowering training standards would give insurance companies an excuse to lower their reimbursement rates. There is no basis for that fear and I will offer more on that in a future article.
Resources
Below is a link to ACAHM’s proposals for new training pathways, including the straw poll, followed by additional resources that explore both ACAHM’s three proposals and the proposal developed by the Oregon Association of Acupuncturists:
ACAHM Program Revision Proposals and Link to Straw Poll
I completely agree that the core issue around education is clinical experience rather than number of classroom hours or type of classes. In fact, I'd say there are a few classes currently part of the curriculum in most Chinese medical schools that could be cut in favor of more clinical experience.
We could, theoretically, address this gap inside our own community with externships. Farm final year students or fresh grads out to existing clinics and have them practice for 6-12 months under someone already established. We could structure it like a residency where these folks get paid or receive some sort of stipend for completing this part of the training. Honestly, the schools should have been creating relationships with hospitals and clinics of all types specifically for this purpose. Since the schools, with a few exceptions, have largely failed at this endeavor maybe we step in to fill the gap.
I'm not really on board with your focus on demand. I realize demand something of a catch-22 situation. We need demand to drive wages and the need for practitioners, but we need practitioners in place to help drive demand.
I’m in a rural part of the middle of the country. I’m busy, LAcs around me are busy, PTs doing dry needling are busy, chiropractors offering “acupuncture-like” services are busy. I routinely hear people saying some variation of, “I’d rather not take a pill.” To me, the problem isn’t demand. The problem is presence and making the rest of the medical system comfortable with us/comfortable referring to us.
I’ve been thinking along the lines of tiered licensing, I’m just not sure how it would work.
I definitely agree that improving clinical experiences (higher numbers of patients with diverse conditions in various settings) would be much more beneficial than in increasing hours and the expense those hours would entail for students. Hours are surely more about status, and i get that - practitioners want to be able to practice within the medical community (respect is a real part of that). We are lucky to be given the opportunity to practice in ways that the pioneers who brought this precious medicine to the US were not, and yet, the student debt crisis is real and its own form of present day practitioner persecution from within the profession itself. These issues need to be addressed with a restructuring, and improving clinical training with access to patients (demand, education, research opening access) would be helpful along with direct employment building efforts from schools that should have been happening long ago. The moment is now. We are the ones we’ve been waiting for.
To expand on what i mentioned above about demand, education, and research, i do believe there is a demand issue in the sense that people lack awareness and education about what acupuncture can do. It is not promoted by the medical system as a viable option, when in many cases should be the first line option presented, simply based on the evidence. In 2026, only 2.2% of the US population has tried acupuncture. Biomedicine doesn’t understand it and the research is strong and getting better but either decision makers don’t read it, expect even more from it, or have their hands tied financially so that they can’t make the decisions they should surrounding the acupuncture evidence base. One of my missions is to help improve the quality of research so that decision decision-makers cannot possibly find any way to say no. This also involves educating the biomedical community and creating stronger educational foundations grounded in biomedicine that also offer future nurses and doctors the chance to learn about acupuncture through electives, give future acupuncturists a much stronger foundational ability to code-switch, and provide foundations in reading, interpreting, and designing research. Those abilities should be honed and expanded in Master’s and Doctoral programs. I’ve been very disappointed to see higher education degrees in acupuncture provide hollow skills in these areas. I do believe a bachelors entry level solves many of these issues for the profession; I support the idea of a tiered educational system. Strength of research is an important one because it has the potential to drive accessibility, and people might be more willing to learn about and willing to try something that they have been granted access to by decision-makers — this offers a confidence that the therapy has been vetted and understood to work. I also believe that some degree of education needs to come first, so that people understand what they are missing, seek it, and demand it, because that can also drive access. And this would improve students’ clinical experiences. still, schools should have been forming relationships with potential internship sites and employers for over 30 years now. But, we always have to start where we are. And this is where we are now. We need to understand the past so that we can ground ourselves in the present and look forward with clear vision. This is one of the reasons I really appreciate Matthews Substack. We need to understand the history and I’m so grateful for practitioners who are willing to share it and to continue working on these issues.
All of these issues that Matthew mentioned, that the previous commentary mentioned and that I am talking about here are interconnected, not necessarily in linear ways. I believe they all deserve focus and attention from the acupuncture community. Unfortunately, not everyone agrees, and the few of us who are willing to volunteer our time to promote such efforts feels enormous. Yet, I am heartened by recent efforts in Oregon, California, and Washington and the ability of small groups of people to come together to try to change the tide.