Why It Is So Hard to Become an Acupuncturist in California

Krit Chanwong

Acupuncture is a widely practiced part of traditional Chinese medicine. It involves sticking multiple needles into strategic parts of the body. Some believe that acupuncture is effective at relieving pain. Others believe that acupuncture’s benefits are largely illusory, attributable to the placebo effect. Regardless, everyone should be free to get and practice acupuncture. In California, however, restrictive occupational licensing constrains many aspiring acupuncturists’ ability to make a living.

Forty-six states and DC require acupuncturists to be certified with the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). To obtain certification, aspiring acupuncturists must hold a degree from one of the 49 accredited schools of acupuncture. Aspiring acupuncturists also need to pass at least two of four exams administered by the NCCAOM. The number of exams required differs by state. Delaware, for example, mandates that its acupuncturists take all four NCCAOM exams. On the other hand, Pennsylvania mandates only two exams.

California does not recognize any NCCAOM certification. Instead, the state has its own licensing rules. Aspiring acupuncturists in California need to graduate from one of 29 universities accredited by California’s Acupuncture Board and take California’s acupuncture licensing exams. According to the People’s Organization of Community Acupuncture (POCA), California’s acupuncture licensing exams “has been held up as the gold standard for acupuncture licensing tests.” The high regard given to California’s exam is due to the test’s increased rigor and depth when compared to the NCCAOM’s.

As Figure 1 shows, the number of people taking California’s acupuncture board exams has fallen dramatically since 2020.

California’s high barriers to entry mean that consumers pay more for acupuncture. A 2019 study found that the median price of a first acupuncture in four California cities was $110, which is 16 percent higher than the national median price of $95.

Moreover, California’s high barriers to entry into acupuncture mean that businesses have a harder time hiring qualified candidates. The Oakland Acupuncture Project, for example, reports that “2022 was by far our most challenging year in terms of HR and hiring ever.” In fact, as Table 1 shows, the number of acupuncturists in California from 2018 to 2022 has declined by two percent. This makes California the only state with more than 1,000 acupuncturists to experience a shrinking acupuncturist labor pool.

High prices and employee shortages may be justified if California’s exams really do ensure that consumers receive higher-quality acupuncturists. However, POCA seems to think that “neither [California’s exam nor the NCCAOM’s] have been proven to have any real bearing on whether or not the individuals taking them will go on to become competent and capable practitioners.”

Acupuncture licensing is just one small example of California’s licensing mania. For 20 years, California was ranked 49 out of 50 in Cato’s Freedom in the 50 States survey for occupational licensing freedom. A 2023 Archbridge Institute study found that California requires occupational licensing for 189 occupations, which is higher than the national average of 179. These licensing regulations harm all Californians: a 2018 Institute of Justice study suggests that California’s licensing regime costs 195,000 jobs annually—perhaps one reason the Golden State has one of the highest state unemployment rates.

California’s crackdown on the freedom to choose and work comes at a large cost to prosperity. The state should consider reforms that liberalize the state’s overregulated occupational licensing regime. One reform that would help improve California’s job market is universal license recognition, whereby the state recognizes out-of-state licenses. This idea is not radical: it already exists for driver’s licenses and for physicians in over forty states. My colleague, Marc Joffe, has written extensively on the economic benefits of universal license recognition.