Wayfinding 02
June 4, 2026

Realities of the Math
Ryan Hofer

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We’re at a moment where the structure of loans and professional education is changing. Not just for the acupuncture profession, but across the entire educational landscape. While it seems the storm has suddenly blown in, it’s been brewing for a while.

In this conversation with Ryan Hofer we discuss the reality of Grad Plus loans, the true cost of them in terms of the interest they generate, and why the “math doesn’t math” for a lot of people entering the field right now. We explore the various ways loans can be resolved,  and the shame and anxiety that graduates experience when they realize they are in over their head financially.

There’s also this uncomfortable question about how we got here—how a business model based on student debt became the default, and what happens when that faucet finally gets turned off. 

Change is coming and our profession is going to have to find a way to work with far less money coming for student loans. And we also need to reckon with the unsustainable debt that practitioners of an earlier generation did not need to face.

In this episode, we discuss:

  • Return on Investment (ROI) and the “Math” of Debt: A primary theme is the disconnect between the median debt for graduates (approximately $260,000) and their median starting earnings (around $48,000). Hofer argues that the “math doesn’t math,” making it nearly impossible for many to pay back their loans traditionally.
  • The Impact of “Grad Plus” Loans: Discussion on how the 2005 introduction of Grad Plus loans allowed students to borrow beyond tuition for living expenses. While this increased access to education, it also catalyzed a massive spike in graduate student debt.
  • New Federal Regulations (RISE and AHEAD): The conversation explains upcoming federal changes, particularly the “One Big Beautiful Bill Act,” which implements loan caps. A major point of contention is why certain professions (like MDs) get a $50,000 annual loan cap while others are limited to $20,500.
  • Income-Based Repayment and the “Tax Bomb”: The reality of running out the clock on 25–30 year repayment plans. Hofer highlights the “tax bomb,” where the forgiven loan amount at the end of the term is treated as taxable income by the IRS.
  • Public Service Loan Forgiveness (PSLF): The strategy of working for nonprofits or government agencies for 10 years to have debt canceled. Hofer notes a failure in the acupuncture/naturopathic community to build robust nonprofit employment ecosystems similar to those in conventional medicine.
  • The Business Model of Schools: The critique that many schools rely on the “fantasy” that debt is repayable to attract new students. Hofer suggests the business model of these institutions is fundamentally tied to the availability of federal student debt.
  • Challenges of Self-Employment: The vast majority of graduates end up as self-employed entrepreneurs rather than being integrated into larger healthcare systems with established benefits. This lack of a stable employment ecosystem forces new practitioners to manage massive debt while simultaneously bearing the risk of building a small business from scratch.
  • Institutional Viability and School Closures: The trend of acupuncture schools closing suddenly (like OCOM and PIHMA). Hofer discusses the ethical implications of schools recruiting students while on shaky financial ground and the need for “dignified closures.”
  • Right-Sizing the Credential: A debate on whether a doctorate or master’s degree is necessary for entry-level practice, or if “right-sizing” to a bachelor’s level education would reduce the debt burden and better align with actual earnings.
  • The “Demographic Cliff” in Higher Education: The broader societal context of declining enrollment across all of higher education due to fewer high school graduates and a shift in how younger generations perceive the value of expensive degrees.

Having  a default rate of 2% does not mean people are making meaningful progress on repaying their loan. It just means that they are on some sort of payment plan.

Dr. Ryan Hofer, ND, MS, MAT

Ryan Hofer is a licensed Naturopathic Doctor in Oregon, a health educator, and an advocate for transparency in higher education accreditation. His Substack, Debt by Natural Causes, covers education and debt within Naturopathic Medicine and Acupuncture.

He is the Executive Director of the Pain Relief and Education Collective, works with the Acupuncture Workforce Alliance as the Regulatory and Policy Lead, and has a private practice in Portland, Oregon.

He recently represented student loan borrowers at the Department of Education’s Accreditation, Innovation and Modernization Negotiated Rulemaking.

Links and Resources

Visit Ryan on his website or on LinkedIn.

You can stay up to date with his writing on graduate debt and government policy on his Substack.

He’s part of the Acupuncture Workforce Alliance and Pain Relief Collective.

If you’re interested in policy, here is a link to the Negotiated Rulemaking for Higher Education 2027.

 

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