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.
Hey Jeff - I am on the road but with a little time and wanted to respond to some of your points: Having acupuncture interns students/grads getting hands on training at existing clinics would be great but there is a big problem. Most acupuncture clinics are quite small and to bring in someone to train on the patients that clinic has been successful in getting in their door, will be difficult to do. The people running those clinics will be taking a gamble. It would be one thing if we had clinics with 20-30 Acupuncturists working them to add a few interns and to maybe offer a big discount for those patients seen by those interns but because the demand for acupuncture is so low, we don't have hardly any big clinics.
You can bet many schools tried to find those type clinics and struck out just as most did with hospitals. The way it should work and most schools tried this is for the schools to have big clinics with students working there. I live near a dental school and they have a schools clinic where people have students work on them for discounts. Most acupuncture schools tried and failed to pull this off. Why - because of low demand for acupuncture. I
f people were clamoring for (as they SHOULD be) schools could build busy clinics to give their students good hands-on experience. It takes a lot of trust to let a dental or dental hygienist student work on you but people do it because they want those services so much and at lower fee they are willing to risk it.
I hear what you are saying about demand. Sure - some acupuncturists are busy and especially in more rural areas where word of mouth spreads more easily. But with only 2% of Americans using acupuncture a year, I don't get how people don't think that is way too low. We should be seeing much more demand considering the many things acupuncture can help people with and better than other alternatives.
We shouldn’t just be focusing on trying to place students in acupuncture clinics - though I think it should be an option. I also disagree that you need a big clinic with multiple acupuncturists to make something like that work. For thousands of years Chinese medicine was transmitted via apprenticeships and some of those were single doctor and one or a small handful of students. I’m a solo practitioner running a fairly busy clinic and I’m looking at taking on a hybrid student in the next few months.
Where the schools fell down was in creating relationships with hospitals and clinics outside Chinese medicine. Bastyr, PCHS, and a very small number of other schools place students in local hospitals to participate in grand rounds. That kind of experience would help a number of Chinese medicine practitioners and it’s the kind of experience that is extremely difficult to obtain on our own.
If “demand” is such a big problem, why are PTs who are dry needling pretty busy? Why are DCs who are dry needling or offering “acupuncture lite” pretty busy?
My counter argument is it’s not a demand problem, it’s a language problem.
Thanks for keeping the conversation going. I think these are helpful to have and I don't expect everyone to agree with me. I think when it comes to the subject of getting students from our schools to get good hands on training, the by far best route would have been for each school to have developed their own clinics with the patients having the option to be treated by one of the instructors with students observing, or by a student with an instructor observing. That is the model most schools in the earlier days tried to make happen. Most could not do this successfully because of low demand. These were schools with a lot of resources and some great teachers with a lot of experience but those type clinics almost never took off as needed to give a good deal of hands on experience for their students.
Even the bigger schools with students observing in hospital grand rounds did not get hands on experience on how to manage patients although I think that experience was valuable for them.
Yes, most acupuncturists in China were apprentices under a solo practitioner so that basic model can work but that is not something schools with dozens of students can really make happen today in the numbers they need, I don't believe. I do think there are ways for apprenticeships to be more used and we should work on those but that might not fully solve the hands on training needs for our schools.
As for PTs staying busy with dry needling, they market that as quite different from acupuncture. With them having higher demand for their services and already established in mainstream medicine and having so many patients, it is easier for them to tell their patients about this new, additional service they now provide - that is not acupuncture.
If we could get to the point that 10% of Americans, rather than 2%, were getting acupuncture each year, it would totally change the way our services are seen and valued, especially by the insurance companies. They now see us as such a small niche that they hardly bother trying to deal with covering acupuncture.
I wish you luck finding a student that works out for you in your clinic. I tried for years to bring someone into my clinic to eventually take over for me. I finally was able to do that with a young man I have known since he was 13 when we were neighbors and I treated his mother. Like those apprenticeships in China, usually that handing down your knowledge happens with close connections like family. Trying to find the right person that makes the right fit for you and your patients is not easily done in my experience. Thanks again for your valuable thoughts!
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.
Thank you so much for your feedback and your work. Kelly - as you know, I am trying to help correct a HUGE mistake in acupuncture research regarding the low dosage of treatments used far to often that brings the average effectiveness rates of acupuncture down. That is why so many policymakers are not strongly supportive of acupuncture - the evidence is not so strong when you do big revues - especially those using sham/placebo controls. The “Acupuncture is nothing more than placebo” stigma has hurt our growth immeasurably. We need practice guidelines to guide researchers on clinical protocols and so we can justify to policymakers why poor clinical quality studies should not be included in efficacy/effectiveness reviews. You are one of the very few people who get this and the only one from a professional association open to working on this. Talk soon!
We already have tiered training standards because of the California state requirements. NCBAHM requires 1900 hrs but CA requires 3000+.
Here in Maine, lots of people are trained to meet CA standards and want to expand our scope to allow the ability to order lab work, but others do not have that level of training. We already have a secondary license to be able to customize herbal formulas. We’re already working with tiered training and licenses.
Hi Naomi - thank you for your comments and your reading my articles.
The tiered training standards I am referring to are a different type than what you referenced. Yes, we have California with more hours than other states but none of the hours increases in California came with increases in scope of practice except herbs and even that took some years.
When I went to school on the early 1980’s in California, our required hours were 1350. This was just when herbs were being added to the scope and a few years after herbs were added the hours were increased to (I think) 1850). But I have always been able to practice the full scope even though I had less than half the hours current grads have.
The reason I mention tiered training with tiered scope is that I know those that want the lowest entry-level training that still trains people adequately and those that want Acupuncturists to have Doctor titles will never come together. These tensions have been with us for decades and then erode our ability to work on many other important issues.
I say this not thinking it will happen. To get a system with an entry level with lower hours and costs that has one scope and then another with higher hours and scope in most all states would require passing legislation in many states to change their current systems of regulation Acupuncturists. We don’t have the ability to do that. We don’t even have a way to get enough of us to agree to try to make that happen.
Thanks Matt, I am learning so much about the history of our profession as I follow along with these conversations!
I understand and agree with your point here and also your point about focusing on increasing demand for acupuncture. My comment was meant to agree with you!
I am adding the point that when people complain about the idea of tiered training or stackable degrees, that we are currently in a situation with a lot less clarity. My MSTCM from a California based school had over 1000 more training hours than some other masters degree holders, all of our degrees have different names -MAc, MAOM, MSTCM. It’s already a very piecemeal quilt we have stitched together, and it is confusing for other providers to understand what a degree and license mean.
The state I currently live in (Maine) addressed the additional scope question with herbs by adding a secondary license. As someone who is involved with my state organization, I am quite aware of the effort it would take to change our scope. Our state regulatory board wants to be able to follow what the NCBAHM is requiring. Standardized tiered training standards might actually make it easier for us to push for scope of practice changes for certain levels of training at the state level.
Hi Naomi - I understand your point now and agree. Thank you! Our trading standards and scope are all over the place. part of that was because it was the only way to get states to allow any sort of licensing. And then there were those like Florida and New Mexico where the Acupuncturists wanted their scope expanded. It would be easier moving forward if we had much more unity in training standards and scope. But that would take going back to so many state legislatures and trying to get them to agree to change their laws and that sure seems beyond our present capabilities. Happy you are finding these posts and comments helpful. Let me know if you ever have any questions for me or info you want to share.
I can't understand a profession (or ANYONE in a profession) arguing that we we should base a particular requirement on the hope of maintaining a higher level of insurance reimbursement. Insurance rates will NEVER be what practitioners (of any type) think is appropriate. And higher reimbursements lead to higher premiums, which no one wants. This is ultimately the consumer's money. It seems ass backwards.
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.
Hey Jeff - I am on the road but with a little time and wanted to respond to some of your points: Having acupuncture interns students/grads getting hands on training at existing clinics would be great but there is a big problem. Most acupuncture clinics are quite small and to bring in someone to train on the patients that clinic has been successful in getting in their door, will be difficult to do. The people running those clinics will be taking a gamble. It would be one thing if we had clinics with 20-30 Acupuncturists working them to add a few interns and to maybe offer a big discount for those patients seen by those interns but because the demand for acupuncture is so low, we don't have hardly any big clinics.
You can bet many schools tried to find those type clinics and struck out just as most did with hospitals. The way it should work and most schools tried this is for the schools to have big clinics with students working there. I live near a dental school and they have a schools clinic where people have students work on them for discounts. Most acupuncture schools tried and failed to pull this off. Why - because of low demand for acupuncture. I
f people were clamoring for (as they SHOULD be) schools could build busy clinics to give their students good hands-on experience. It takes a lot of trust to let a dental or dental hygienist student work on you but people do it because they want those services so much and at lower fee they are willing to risk it.
I hear what you are saying about demand. Sure - some acupuncturists are busy and especially in more rural areas where word of mouth spreads more easily. But with only 2% of Americans using acupuncture a year, I don't get how people don't think that is way too low. We should be seeing much more demand considering the many things acupuncture can help people with and better than other alternatives.
We shouldn’t just be focusing on trying to place students in acupuncture clinics - though I think it should be an option. I also disagree that you need a big clinic with multiple acupuncturists to make something like that work. For thousands of years Chinese medicine was transmitted via apprenticeships and some of those were single doctor and one or a small handful of students. I’m a solo practitioner running a fairly busy clinic and I’m looking at taking on a hybrid student in the next few months.
Where the schools fell down was in creating relationships with hospitals and clinics outside Chinese medicine. Bastyr, PCHS, and a very small number of other schools place students in local hospitals to participate in grand rounds. That kind of experience would help a number of Chinese medicine practitioners and it’s the kind of experience that is extremely difficult to obtain on our own.
If “demand” is such a big problem, why are PTs who are dry needling pretty busy? Why are DCs who are dry needling or offering “acupuncture lite” pretty busy?
My counter argument is it’s not a demand problem, it’s a language problem.
Thanks for keeping the conversation going. I think these are helpful to have and I don't expect everyone to agree with me. I think when it comes to the subject of getting students from our schools to get good hands on training, the by far best route would have been for each school to have developed their own clinics with the patients having the option to be treated by one of the instructors with students observing, or by a student with an instructor observing. That is the model most schools in the earlier days tried to make happen. Most could not do this successfully because of low demand. These were schools with a lot of resources and some great teachers with a lot of experience but those type clinics almost never took off as needed to give a good deal of hands on experience for their students.
Even the bigger schools with students observing in hospital grand rounds did not get hands on experience on how to manage patients although I think that experience was valuable for them.
Yes, most acupuncturists in China were apprentices under a solo practitioner so that basic model can work but that is not something schools with dozens of students can really make happen today in the numbers they need, I don't believe. I do think there are ways for apprenticeships to be more used and we should work on those but that might not fully solve the hands on training needs for our schools.
As for PTs staying busy with dry needling, they market that as quite different from acupuncture. With them having higher demand for their services and already established in mainstream medicine and having so many patients, it is easier for them to tell their patients about this new, additional service they now provide - that is not acupuncture.
If we could get to the point that 10% of Americans, rather than 2%, were getting acupuncture each year, it would totally change the way our services are seen and valued, especially by the insurance companies. They now see us as such a small niche that they hardly bother trying to deal with covering acupuncture.
I wish you luck finding a student that works out for you in your clinic. I tried for years to bring someone into my clinic to eventually take over for me. I finally was able to do that with a young man I have known since he was 13 when we were neighbors and I treated his mother. Like those apprenticeships in China, usually that handing down your knowledge happens with close connections like family. Trying to find the right person that makes the right fit for you and your patients is not easily done in my experience. Thanks again for your valuable thoughts!
Thank you for your comments a lot of good points. I’m on the road right now, but will reply more fully later. Thanks again.
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.
Thank you so much for your feedback and your work. Kelly - as you know, I am trying to help correct a HUGE mistake in acupuncture research regarding the low dosage of treatments used far to often that brings the average effectiveness rates of acupuncture down. That is why so many policymakers are not strongly supportive of acupuncture - the evidence is not so strong when you do big revues - especially those using sham/placebo controls. The “Acupuncture is nothing more than placebo” stigma has hurt our growth immeasurably. We need practice guidelines to guide researchers on clinical protocols and so we can justify to policymakers why poor clinical quality studies should not be included in efficacy/effectiveness reviews. You are one of the very few people who get this and the only one from a professional association open to working on this. Talk soon!
We already have tiered training standards because of the California state requirements. NCBAHM requires 1900 hrs but CA requires 3000+.
Here in Maine, lots of people are trained to meet CA standards and want to expand our scope to allow the ability to order lab work, but others do not have that level of training. We already have a secondary license to be able to customize herbal formulas. We’re already working with tiered training and licenses.
Hi Naomi - thank you for your comments and your reading my articles.
The tiered training standards I am referring to are a different type than what you referenced. Yes, we have California with more hours than other states but none of the hours increases in California came with increases in scope of practice except herbs and even that took some years.
When I went to school on the early 1980’s in California, our required hours were 1350. This was just when herbs were being added to the scope and a few years after herbs were added the hours were increased to (I think) 1850). But I have always been able to practice the full scope even though I had less than half the hours current grads have.
The reason I mention tiered training with tiered scope is that I know those that want the lowest entry-level training that still trains people adequately and those that want Acupuncturists to have Doctor titles will never come together. These tensions have been with us for decades and then erode our ability to work on many other important issues.
I say this not thinking it will happen. To get a system with an entry level with lower hours and costs that has one scope and then another with higher hours and scope in most all states would require passing legislation in many states to change their current systems of regulation Acupuncturists. We don’t have the ability to do that. We don’t even have a way to get enough of us to agree to try to make that happen.
Thanks Matt, I am learning so much about the history of our profession as I follow along with these conversations!
I understand and agree with your point here and also your point about focusing on increasing demand for acupuncture. My comment was meant to agree with you!
I am adding the point that when people complain about the idea of tiered training or stackable degrees, that we are currently in a situation with a lot less clarity. My MSTCM from a California based school had over 1000 more training hours than some other masters degree holders, all of our degrees have different names -MAc, MAOM, MSTCM. It’s already a very piecemeal quilt we have stitched together, and it is confusing for other providers to understand what a degree and license mean.
The state I currently live in (Maine) addressed the additional scope question with herbs by adding a secondary license. As someone who is involved with my state organization, I am quite aware of the effort it would take to change our scope. Our state regulatory board wants to be able to follow what the NCBAHM is requiring. Standardized tiered training standards might actually make it easier for us to push for scope of practice changes for certain levels of training at the state level.
Hi Naomi - I understand your point now and agree. Thank you! Our trading standards and scope are all over the place. part of that was because it was the only way to get states to allow any sort of licensing. And then there were those like Florida and New Mexico where the Acupuncturists wanted their scope expanded. It would be easier moving forward if we had much more unity in training standards and scope. But that would take going back to so many state legislatures and trying to get them to agree to change their laws and that sure seems beyond our present capabilities. Happy you are finding these posts and comments helpful. Let me know if you ever have any questions for me or info you want to share.
I can't understand a profession (or ANYONE in a profession) arguing that we we should base a particular requirement on the hope of maintaining a higher level of insurance reimbursement. Insurance rates will NEVER be what practitioners (of any type) think is appropriate. And higher reimbursements lead to higher premiums, which no one wants. This is ultimately the consumer's money. It seems ass backwards.