Hellstrip in Summer
things that get easier vs. things that don't
This is another installment in the hellstrip series (see also: Winter, Spring, and On Selling Out). Summer’s by far the most demanding season in terms of taking care of WCA’s hellstrip garden. Surrounded by asphalt, baking in the heat, that’s when it really earns its name — and no, we still don’t have an outside faucet. I lug watering cans back and forth across the parking lot a few times a week; more often during a heat wave. Of course this makes me think about the acupuncture profession.
To be fair, many of the plants in the hellstrip don’t need to be watered: the goldenrod, the white oak saplings, the snowberry, the Oregon grapes, and the other established natives are adapted to Oregon’s dry summers. The vitex trees are native to the Mediterranean so they love the heat; they’ve just started blooming and they’ll go for months.
The only plants I have to water are the ones that aren’t yet established, like this little flowering currant (see below). It doesn’t look like much now, but if I can keep it alive, eventually it’ll grow into an eight foot tall shrub that’s a fountain of bright pink flowers in the spring. This represents my second attempt at growing a native flowering currant in the hellstrip; the first one didn’t make it through the 2021 heat dome. I made sure to plant this one in a spot that’s shaded by a tall Oregon grape and the biggest vitex tree.
As my sister put it, who’s also a gardener: the more things that grow here, the more things can grow. Established plants not only provide shade, they cool and moisten the hellstrip through transpiration. Every year, being a new plant on WCA’s hellstrip is a little easier than it was the year before. Every year, the hellstrip in summer is a little easier to take care of than it was the previous year, even though summers are hotter now.
I was thinking about this in relationship to the fact that I graduated from acupuncture school thirty years ago this summer. Is it significantly easier for the students who graduated in 2024 to make their living as acupuncturists than it was for me in 1994? (This is on my mind for obvious reasons.)
It should be, right? There’s so much more awareness of acupuncture than there used to be. So many more insurance plans cover it (if you want to take insurance). So many other healthcare providers refer their patients to acupuncture. It’s just generally more acceptable. The profession’s had thirty years to put down roots. Those factors should add up.
But I don’t think it’s easier for new acupuncturists to make a living. Arguably it’s harder, and that’s something that everyone in the acupuncture profession should be concerned about. If you’re an L.Ac. who’s been in business for ten years or more, be honest: do you look at new graduates with envy? Do you think, oh those lucky, lucky kids — they don’t know how good they’ve got it?
Do you think, Oh, if only I’d gotten into this profession later?
Yes, there are more jobs, relatively speaking. But there are also more acupuncturists potentially competing for them. According to the US Bureau of Labor Statistics, there are 9,370 jobs for acupuncturists in the US (crucially, these statistics don’t distinguish full time vs. part time; they assume they’re all full time and calculate wages accordingly.). There are about 37,000 licensed acupuncturists in the US, which suggests a high attrition rate1. (Actually that’s a count of acupuncture licenses — some individuals hold more than one, and we have no way of knowing how many of those individuals are actually practicing.)
When I graduated from acupuncture school, there were virtually no “good jobs” for L.Acs.. My $15/hr public health job was about as good as it got. Now there are — a few good jobs? Maybe some, if we’re being generous — but still, most acupuncturists can’t expect to land one. Just like in 1994, most graduates can expect to start their own businesses, which is approximately as hard as it ever was, except now graduates have more student loan debt and a higher cost of living. POCA Tech’s program represents our best efforts at giving our graduates a leg up on running a small business, but regardless of what we teach, we can’t make small business easy.
Recently I was talking with an L.Ac. who’s been in the profession for about as long as I have, and the topic of Medicare, AKA the prospect of full inclusion for acupuncturists in the US healthcare system came up (with the attendant hope of more high-paying jobs). My friend said, they’ve been promising that since I was in school! The details change, but the basic narrative is always the same: hang on, we’re going to get off the margins and into the mainstream any day now!
I’m not opposed to Medicare inclusion for acupuncturists. I’m just aware that HR 3133 has a zero percent prognosis of being enacted. Meanwhile the lobbyists who are taking the NCCAOM’s money will gladly keep taking it, regardless, and the NCCAOM will keep paying them, just to keep the narrative going. (It’s part of the NCCAOM’s marketing — why would they stop?) But expecting HR 3133 — or any of its successors — to get the acupuncture profession off the margins is like me expecting the City of Portland to show up one day and transform WCA’s hellstrip into a lush green golf course.
Something I’ve learned from decades of small business is that pretty much everything comes down to processes and relationships — and there’s nothing to do except work on them constantly. There’s no single person, event or development that will make everything okay. There’s no one moment of arrival. Success is about incremental progress and constant, methodical investment — also, not expecting anybody to save you.
So yes, I’m trying to make the point that the acupuncture profession in the US is in worse shape than WCA’s hellstrip garden. Because our little ecosystem is slowly gaining traction. It’s steadily becoming more habitable, year by year, for the next generation. It’s not counting on the powers that be to transform it into something utterly different than it’s ever been.
Every gardener knows that some plants don’t survive. Sometimes you know why (see above: heat domes) and sometimes you don’t. When students graduate from POCA Tech, we hope that all of them will have thriving practices. We hope that if they’re self-employed, they reap the benefits (including the endless opportunities for personal growth, which you get whether you want them or not). If they’re employees, we hope they enjoy the camaraderie of working with other practitioners. If they become employers, we rejoice that they’ve created opportunities for other acupuncturists. Mainly we hope they help a lot of people and take satisfaction in serving their communities. But a certain percentage of graduates never practice at all, sometimes for reasons beyond their control. (POCA Tech’s percentage is low, but it’s not zero.) There are all kinds of ways that somebody’s life can change that make it difficult or impossible for them to practice.
It takes time to build an established garden; you lose some seedlings every year. If new graduates are burdened with continually increasing amounts of student loan debt, it doesn’t improve their odds of survival. It’s not good for the overall ecosystem of acupuncture in the US, either. Six-figure loans are a powerful incentive for someone to go back to their prior career in tech or nursing or whatever previously paid their bills, as opposed to hanging in long enough to build an acupuncture practice, let alone one big enough to employ other acupuncturists. I built one of those and I know how hard it was. If I had had a prior lucrative career to fall back on, I might well have done so.
Even though every summer I wish fervently that we had an outside faucet to water the hellstrip, many other aspects of running WCA and POCA Tech are getting easier. A decade or so ago, we went to a lot of trouble in two areas: starting an affordable school and converting WCA to a 501c3 nonprofit. (So much paperwork!) Those efforts didn’t pay off immediately, but as of today, they look like the best decisions we could’ve made. Our long term practitioners are getting out from under their student loans through Public Service Loan Forgiveness. Our newer practitioners are mostly people we trained ourselves, who didn’t have to take out loans for acupuncture school in the first place. We DIY’ed ourselves into a better place. If we hadn’t, I’m not sure WCA would still have multiple clinics. It certainly wouldn’t be growing in the ways that it is now.
(The acupuncture profession could DIY itself into a better place too, if it wanted to.) (It doesn’t want to.)
Although the acupuncture profession’s gained ground in terms of public acceptance, overall its economic stability is worse, not better, than it was when I graduated in 1994. Now its strategy for survival is basically to be saved by the government. Where can we expect to be in another ten years?
As my friend Whitney has noted, look at California. As of 2024 there are 7708 acupuncture licensees in California for a population of almost 39 million people — down from 9543 in 2009. (A percentage of those licensees probably don’t live in or practice in California, but are hanging on to a California license because they’re so hard to get.) By my count there are 15 acupuncture programs in California, which has always had the most acupuncture schools of any state and has been producing graduates since the late 1980s. Acupuncture as a profession is losing traction in California, not gaining it.
Big fan of the hellstrip articles Lisa! Have you read Braiding Sweetgrass by Robin Wall Kimmerer by any chance? If not, you would love what she has got to say about the wisdom of plants and plant communities and Indigenous scientific knowledge.