June 25, 2026

The Cost of Entry—Loans, Schools, and Sustainability
Bex Groebner

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It’s not news that there are changes afoot in the world of education. You’re probably already well aware of the closure, over the past few years, of schools with a long history. There are concerns with loan debt that have been an issue since Obama was president. Most recently, the changes to student loans that not only fundamentally affect the acupuncture trade, but will change the landscape for graduate education in a notable way. 

In this conversation with Bex Groebner we untangle the intersection of education, accreditation, federal student loan programs and professional accountability. We explore how changes in funding will put financial pressure on schools that built a business model based on the higher loan caps of GRAD+ loans. How student debt affects those who are mortgaging their future on loans that many cannot pay back. Along with what could happen if the levels of student enrollment drop to the point where our accreditor (ACAHM) and certification organization (NCBAHM) lose the funding needed to sustain their business activities.

Bex suggests that in an uncertain world, it’s best to have a back up, and that is a large part of the motivation behind her work at the Acupuncture Workforce Alliance. Most of all, she’d like to see an acupuncture education be accessible, affordable and within reach of anyone who’d like to learn this medicine so they can serve their communities, and be able to support themselves and their families.

In this episode, we discuss:

  • The Future of Acupuncture Education Is at a Crossroads
    Changes to federal student loans are forcing the profession to confront whether its current educational model is financially sustainable.
  • Acupuncture Is More Than Needling
    The real value of the medicine lies in its way of understanding health, relationships, and healing—not just in the use of needles.
  • Acupuncturists Serve as Bridges
    Practitioners often help patients navigate between traditional healing approaches and conventional medicine because they have earned trust within their communities.
  • Student Debt Has Become a Professional Crisis
    Many graduates leave school with debt levels that cannot realistically be repaid through acupuncture practice.
  • The Profession Has Avoided Looking at the Numbers
    Schools, organizations, and practitioners have often relied on assumptions and optimism instead of honestly examining educational outcomes and financial realities.
  • Blaming Student Demographics
    When accountability metrics were proposed, ACAHM argued that acupuncture graduates are difficult to evaluate because many are self-employed, have children, volunteer extensively, or enter practice later in life. Bex sees this as shifting attention away from the deeper question of whether the educational model itself is economically viable.
  • Accountability Is Coming
    Government scrutiny of educational programs is increasing, and acupuncture schools will need to demonstrate that graduates can earn enough to justify the cost of their education.
  • Educational Institutions Are Not the Enemy
    The current problems emerged through a series of decisions made by people trying to do their best, but the system itself now requires repair.
  • The Profession Needs Clearer Workforce Planning
    Training programs should be connected to the actual jobs, skills, and needs of the communities practitioners will serve.
  • Who Gets to Define an Acupuncturist?
    One of the central questions beneath the entire discussion is who should determine educational standards: educators, accreditors, employers, practitioners, licensing boards, or communities. The answer will shape the future identity of the profession.
  • The Need for State-Level Solutions
    As federal systems become less predictable, Bex argues that states need their own pathways to preserve acupuncture education and licensure. Waiting for national organizations to solve the problem may no longer be enough.
  • A Smaller Profession May Be Emerging
    The era of easy educational expansion appears to be ending, forcing a reconsideration of what is essential and worth preserving.
  • Acupuncture Needs a Stronger Professional Identity
    The profession must define itself by its unique contribution to healthcare rather than by defending ownership of specific techniques.
  • This Is a Time of Grief, Adaptation, and Renewal
    Like a seed carrying its essence through winter, the profession is being asked to identify what is most important and carry it forward into an uncertain future.

Acupuncture is preventive medicine, which means our job starts with gathering the right data efficiently and doing the hard work of differential diagnosis to figure out where the problem is actually coming from. From there, build a plan that includes contingencies, adjustment points, and clear referral conditions, because good clinical reasoning doesn’t stop at the working diagnosis.

Bex Groebner, DAc, LAc

 

I’m a licensed acupuncturist practicing in Oregon and Washington, and the Clinical Program and Training Director for the Acupuncture Relief Project, where acupuncture is integrated into primary care in rural Nepal. Before acupuncture, I studied physics, worked as a chef for a decade, and spent years as a legal advocate for a domestic violence shelter — a background that shapes how I think about systems, data, and who gets included or left out.

I’m a former faculty member at NUNM and OCOM, a past board member of the Oregon Association of Acupuncturists, and a founding figure of the Acupuncture Workforce Alliance. I run The Local Healer acupuncture clinic in Portland, where I work primarily with Medicaid patients. I also write Needling to Get to the Point, a Substack newsletter on acupuncture policy and workforce reform.

Links and Resources

Visit Bex on her clinic website, and read more about the challenges and opportunities facing our profession on her Substack.

The Acupuncture Workforce Alliance is worth a read, even if you don’t live in Oregon.
One of their projects is an Employer Survey. Even if you don’t live in Oregon, your input will help to identify key skills that employers are looking for in new employees.

Oregon licensure town hall on YouTube.

In this conversation we mentioned the Acupuncture Relief Project.

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