Office Hours with Angelique and Toby, episode 18. Released January 22, 2026. 59 minutes.
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About this episode
Ryan Hofer, a naturopathic doctor who writes the Debt by Natural Causes newsletter, joins Toby Daly and Angelique Britt to look at the financial strain on acupuncture and naturopathic education. Ryan explains why small, tuition-dependent private schools are structurally vulnerable, what a closure can mean for students partway through a multi-year program, and how tuition, debt, and realistic earnings interact for graduates.
The three discuss the federal graduate loan caps and earnings test that were proposed at the time of recording, the missed opportunity to build nonprofit clinics where graduates could qualify for public service loan forgiveness, and what could help: transparent outcome data, open forums, collective advocacy, teach-out planning, and right-sized credentials. Ryan points to POCA Tech as a lower-cost model and sketches small, state-authorized nonprofit schools that fit training costs to likely earnings.
Topics
Ryan's background and the Debt by Natural Causes newsletter
Why small private nonprofit schools are vulnerable
Proposed federal loan caps and earnings tests (as of January 2026)
Tuition, debt, earnings, and opportunity cost
Nonprofit clinics and public service loan forgiveness
Transparency, forums, advocacy, and teach-out planning
POCA Tech as a lower-cost example
Small, modular, nonprofit schools
A note for listeners: this conversation reflects proposals and figures as discussed in January 2026. Federal loan rules and timelines change, so check current Department of Education guidance before making decisions.
Transcript
This transcript was generated automatically from the published audio and lightly edited for readability. It may contain errors in names and terms.
Welcome to Office Hours. Whether you're new to the acupuncture profession or have been at it for decades, this is the place where we discuss all things Chinese medicine and more. Join Toby Daly, a seasoned acupuncturist of the Saam tradition, and Angelique Britt, a nurse-turned acupuncturist who is brand new to the field as they explore topics in and around the world of acupuncture and Chinese medicine. There's something for everyone here. Drop in anytime.
Toby: Hey Ryan, welcome to Office Hours. Thanks so much for coming to see us. I wonder if we could start off if you give it like a little bit of background, like your professional background for listeners that are in. And then if you could have that background kind of lead into how you started your amazingly named Debt by Natural Causes Substack, that I'm a huge sub follower of. I'm a subscriber. I really encourage everyone to check that out and consider subscribing. You mind giving us your background and then how that led into your work?
Ryan: It's great to be here.
Angelique: Yeah, so I
Ryan: Attended the National University of Natural Medicine, NUNMand I graduated with my doctorate in naturopathic medicine June of 2025. Before I attended that school, I was an English teacher in a variety of settings. So one thing I really loved about naturopathic medicine is the emphasis on education, talking through things, thinking through things with patients, that we try to take a little bit more time. And I also previous to NUNM, I completed a master's in communication where I did a thesis project. And so I kind of I think came in with a little bit of a background of digging a little bit deeper, a little bit of analytical thinking. And while at NUNM, I was the student representative to the board of directors. I started getting into Institutional dynamics and nonprofit governance and how everything works. Like what are the public records that are required of a nonprofit? What's the timeline those come out in these decisions made? While I was at N U and Ocom closed suddenly. And then all those students came over to the school I was at and they were able to finish at N U and They were able to basically finish their same curriculum but at a different host institution. And I just felt like very fortunate that they were able to do that because many times when schools close, students have a very hard time finishing their degree. And that's something that I think about a lot with the state of acupuncture schools and programs, is that there's not a
Angelique: Wow, that was
Ryan: There's not always a lot of them. Sometimes there's only a few in the state. And so if those programs close suddenly and students are in the middle of a three or four year master's degree, it's a huge burden upon them. And it really throws their lives up in the air. And people sacrifice a lot. I know I sacrifice a lot to go to graduate school. And I think a lot of people sacrifice a lot. And I want people to understand the realities that are facing acupuncture programs and naturopathic programs, which is part of the larger reality of higher education too. And so we're we're we're seeing a lot of a need to balance budgets, urge institutions, or close institutions too. And One of the things that fascinates me about naturopathic and acupunctural world is that these are small schools, small programs. They can be very tight knit and there's a very like emotional connection to them, which can be really good, but it also makes it very difficult to talk about the financial realities of what's going on in higher education today.
Angelique: She's
Toby: Yeah. How did you get over that hurdle and start to actually, you know, bring some sunlight into that area? What was the inspiration for that?
Ryan: I kind of just kept following threads. I had some encouragement from people when I would speak out on things, people would say like, thank you. Like that's really valuable. Kind of gets ignored by people in the status quo. I think that there's a lot of incentive to not talk about things. And like I don't like, let's say, answers. Like I don't like being gaslit. Nobody does.
Angelique: But I don't want
Ryan: That's that's a pretty charged term, but I don't like when people actively pretend
Angelique: Let's say That
Ryan: The concern is not real and valid. A little bit, what's the word, pushback against that. That's a motivation. And then the is just so stark that once you see it, you can't unsee it. So it was continually kind of like, okay, there's a big issue here. And the more you get into it, the bigger it becomes in snowballs.
Angelique: So there's a little bit of a Data is
Toby: I'm hesitant to ask this, but what's the state of Chinese medical schools in January twenty six?
Ryan: In distress, there's a lot of it's not it's not and this is part of higher education too. I kinda feel the need to emphasize that it's not totally personal towards these programs. It's not all like because it's not all because they've mismanaged things necessarily. Private s let's say private nonprofits or just small schools are structurally vulnerable.
Angelique: There's there's good there's that Small
Ryan: To the changing landscape. And that's just how it is. You know, schools with under like 2,500 students without an endowment, that's structural fragility. And there's a lot of reasons to view those schools as headed towards closure. So all of that was kind of before the loan caps and the earnings test.
Angelique: So that's
Toby: Talking about that a little bit in detail, I think people may not be really familiar.
Ryan: The loan caps are and the earnings test are part of the One Big Beautiful Bill Act. And the loan caps will begin in July. So there will be no more grad plus loans for living expenses. But essentially up to this point, we've had unlimited borrowing potential from borrowers. One thing that I realize in researching all of this is that.
Angelique: Wow, all of this.
Ryan: This whole sector of education, a large part of graduate school education too, is all supported by federal student loans. And the problem is that when you look at the data, it's it looks like in alternative medicine, those loans aren't being paid back. And so I think it's legitimate for the federal government to say, hey, what are we, what are we doing here? It's a very short time frame, right? It's very sudden to cut off grad plus loans and
Angelique: Like
Ryan: They're also going to limit professional degrees to 200,000 total for the program. And then master's degrees are limited or other graduate degrees. So master's degrees or like academic doctoral degrees are limited at 100,000, but that is also 20,500 per year. So really it's less than 100,000 for most people. And then there's the whole question of will which degrees get the 200K cap? Because that's really important. It's like double the money, the potential loan money. And currently it's very it looks like it's gonna be very narrowly defined, but we're gonna get that proposed rule soon. And so both acupuncture and natur the naturopathic organizations and a lot of other professional organizations, right? Physical therapy, nurse practitioner, occupational therapy, physician assistant, right? They're all gonna try to get the 200K. So again, we're all kind of in this larger trend that's going this larger direction. That's makes it that makes higher education really difficult, especially at small schools. So that's an issue. And we can go through some visuals of what happens when You know, cost of the degree is far over 200,000. Right. Right. How do you do that? Even if you can bring the tuition down, which means that you're cutting tuition revenue at a small school. So okay, maybe you can bring that down and leave a little bit of room for borrowing for living expenses. It's it's very difficult to see how people, you know, live and survive through a three or four year degree. Maybe you can get a part time job or a full time job, that's again very difficult. We all know that I think graduate school is stressful. You're trying to pass tests. So if you're working a job, it's kind of almost it can be counterproductive, right? You're spending all your time at your job, but you should be studying to pass the tests that you
Angelique: Paid a bunch of money to take. So that's the low so then now we're
Ryan: Low cat.
Toby: Just pause on that just for a second. What do you do you think it seems like Chinese medical schools, maybe naturopathic schools too, will have a hard time making the case that they're eligible for two hundred thousand when they when they people haven't been able to pay back their loans, right? Is that is that hamper their ability to say, you know, definitely give us more money?
Angelique: Yeah, I think so. I think that part of this is
Ryan: Saying, they're picking on us, but we're kind of developed to stop what's going on in alternative medicine programs. Like financially, like we're kind of the worst offenders. And so if the rules mean anything, they are going to be applied to
Angelique: The rules. Do you mean that we're the worst offenders? What do you mean by that?
Ryan: Well, I'll show you in one of the visuals. Well, a couple of visuals is alternative medicine programs have some of the worst debt to earnings ratios in the United States. It's predicted that ninety-eight percent of students are in alternative medicine master's degrees that will fail the earnings test. Obvious and stark,
Angelique: That So it's very
Ryan: Now you can we don't know, maybe things will be delayed, maybe Congress will pass a new law because there'll be such a big outcry like stop, this is gonna affect like way too many people. It doesn't get around the actual like earnings that are reported to the IRS and the median debt load of students. So I think it's again in the talk of advocacy and like we gotta and yes, we do have to do this. Like the schools need
Angelique: But
Ryan: The naturopathic schools need the 2K cap. That's existential. They absolutely need that. We would not work with a hundred thousand loan cap. I just, I just don't see it working. So there's like we're kind of putting out one fire at a time. So need to get the 200k cap. I'm not sure about like a doctorate in acupuncture, if that would also be get the 200k cap. There's that issue, but then there's also the earnings test issue, which will look and say, like, what's the earnings that people are reporting? And then for a graduate degree, you compare that to a bachelor's degree. And that's where a lot of the programs don't meet that threshold for earnings. And that's where that I think that ninety-eight percent of students are in failing programs.
Toby: Let me let me just say make sure I get that right. So since you've taken a master's degree program, you should have an earnings bump up. Right. But if you don't show an earnings bump up, then it's saying that the degree is not right, is not worth having loans. Is that right?
Angelique: Yeah. Or like
Ryan: And for bachelor's degrees, they compare it to a high school diploma. And then for master's or doctoral degrees, they compare it to a bachelor's degree. So it's pretty reasonable, you know, if you go to school for four years and the federal government gives you this all this loan money, yes, you should make more than somebody who just did a bachelor's degree. Now we can get into okay, there's jobs in society that we want. Don't make a lot of money. And so, and I agree with that. And I think that education should be widely available and affordable. But at the same time, I can in a way understand the logic behind the earnings test. And you could argue that once you constrain the supply, then the earnings will go up because there'll be less people with the degree.
Toby: Yeah, but yeah, that's true. If we were talking about like mufflers or something, I think that would be good, but healthcare, right, that makes it extra tough.
Angelique: The demand is
Ryan: There, right, of course, and we need more supply, but also we need to be compensated in a way that makes like a middle class life possible.
Toby: But so that there's like multiple problems going on then, right? Yes. Students going in, they have no idea that there's there's a two percent chance of them paying back out their loan, right? Is that right? I forgot ninety eight percent. Though that the loan c can you tell me that ninety eight percent again, please?
Angelique: So this was
Ryan: From the Department of Education, when they're talking about the earnings test, figuring out how do we wanna language this and the rules. So most common master's degree programs that fail. I didn't put in that little comment with the red light that this is all original. Eight percent of Title IV students in master's degree programs in alternative and complimentary medicine fail the proposed rule. So right. Only two percent of students are in programs that result in earnings over. This bachelor's degree threshold.
Toby: That's almost shocking. I feel like I want to just pause there for a sec. So people are taking on these gigantic loans and then, you know, putting three to four years of their life aside and then they're not gonna ninety eight percent of them are not gonna make any more money than they would have if they had not gone to that program, right?
Ryan: Yeah. And then you're talking about right the time, the opportunity cost. You're talking about the burden of the debt now. So you're not gonna be able to get a car loan, a home loan. You're gonna, you know, be kind of figuring out different ways like do I file jointly? Do I file separately with my partner? Right, to present my income in the way that will get me kind of the lowest loan payment. But it's
Angelique: It's the
Ryan: Test is meant to
Angelique: Dress.
Ryan: The problem that exists in alternative medicine graduate degrees. Like if any rule that gets at this issue would affect us. And I think that's the uncomfortable truth is like, cause we're trying to try and to a lot of people want to try and like advocate and kind of like survive and then survive. Like, hey, like we actually have a serious issue here. We it's been an issue for the past two decades. I don't think there's ever been
Angelique: Survived this and then survived this and it's
Ryan: An alternative medicine sector of employment that would support the debt level of graduate, a graduate degree. That's actually the problem. And if we can just face that, then maybe we can start talking about solutions to that. But if we're just trying to keep the debt money flowing, and if we're just like, what's gonna happen to the schools?
Angelique: And that
Ryan: You know, we have to equally say what's happening to alumni from these programs and what's going to happen to the students coming into these programs. And y the earnings test is also called the do no harm earnings test, which is pretty aptly named. And I think that us in alternative healthcare should really sit with that are we doing a lot of harm by watching this cycle of debt continue?
Angelique: So to be s just to be clear, so what you're saying through all of this from these statistics is that essentially those of us that have gone to alternative medicine schools and that have incurred debt, ninety eight percent of us won't be able to earn enough to sufficiently pay them back.
Ryan: Unlikely you'll make more than people with bachelor's degrees.
Angelique: Across any field? Like are we talking like is it is it an apples to apples comparison, like healthcare bachelors to healthcare masters? Right. There's establish that bachelor.
Ryan: Different ways that they establish a bachelor's degree threshold. There's a whole formula and it's some sometimes they use the same field, bachelor's degrees in the same field. And then sometimes they use just like bachelor's degree in your in the state that the school is located in. So there's there's several different ways of establishing what's the actual bachelor's degree threshold. It's likely you won't make more than a bachelor's degree holder. That's thing, is like.
Angelique: But
Ryan: I kind of like the debt to earnings comparison when we get into this, which was part of the previous like Biden administration accountability metrics, but that's now gone away. But you know, you could say, well, debt, but your earnings are high. Or you could say, Yeah, you're not making more than a bachelor's degree, but the debt's actually not that high. And then you can also get into issues of a lot of healthcare professionals.
Angelique: There's a lot of Dad.
Ryan: In other fields don't pay off their debt, they go and work for the government or they go and work for a nonprofit and they do 10 years of qualifying payments and they do public service loan forgiveness. And I think that's I think that's a really key thing to look at because this is the this is the big thing we missed in alternative medicine is that we should have been building a public service loan forgiveness pipeline because then we would be doing similar
Angelique: That's
Ryan: Loan forgiveness as all other healthcare professionals. But we don't have that. Unfortunately, the biggest nonprofits are the schools themselves. And so everybody who's working for the school is getting public service loan forgiveness qualifying payments, but very few graduates are because most graduates go into private practice. So this is one of the things where it's real traffic. If we had keyed into this 10 years ago,
Angelique: Graduate. Logged.
Ryan: Then we could have been incubating all these nonprofit clinics and showing people how to make those work and how to make those viable. And those could have then been hiring new graduates as they came out. You know, you can imagine a scenario where somebody worked for two years at a nonprofit in a residency type of arrangement. They decide if they like it, if they don't like it, but either way you've got two out of your 10 years under your belt. And then there's hope, right?
Angelique: Graduates.
Ryan: Then there's a plan. You're twenty percent done. You can you can plan that out. But if you're just in private practice making less than you would have made with a
Angelique: Bachelor's degree.
Ryan: And the interest is capitalizing on your loan principle. It's just like it's just hopeless. I mean, that's why people just kind of zone out and disassociate from it and say, Well, I'm just gonna make twenty five payments on income-based repayment. And then unfortunately you get hit with the tax bomb on if you get it canceled with income based repayment, then you have to pay taxes on. So you're gonna get a huge tax bill from the IRS.
Angelique: Amount.
Toby: You think Ryan, like thinking about it like in a different way, it's I thought, wow, it's amazing that the schools are closing. But i it's it's probably safer to say it's amazing that the schools ever got started in the first place.
Angelique: I think that there was a sort of loophole that a lot of graduate degrees through
Ryan: Took advantage of through the I think nineties and early two thousands, right? Enrollment kept going up. And the message was like, education is good. This is a good thing, and it's worth it. You know, you're gonna pay it back. And all of that has kind of been flipped on its head now. And everybody's saying, like, hey, is this worth it? Like, why shouldn't I go do an apprenticeship in a trade, right? Instead of spending four years and then more.
Angelique: For a bachelor's degree after that.
Ryan: I do think it's kind of it is kind of weird to me, amazing to me that it's lasted this long. That it's lasted this long because it's so bad. The situation is truly, truly bad when you look at the data. And it's a great, I think, question of group dynamics and governance and incapacity to speak things, inconvenient truths. Yeah. I mean, but that's that's capitalism and right. We don't we don't speak openly about A lot of things in society.
Toby: You think like maybe the students just aspiration to help people with Chinese medicine just covered up that clear black and white. And the schools didn't help, right? 'Cause the schools it's not in their interest to say, wow, this looks really bad for you guys. Are you sure you want to do this? You know, there's there's no there's no incentive for the school to say that, right? No. Even though they know they have the numbers in front of them.
Angelique: It yeah, yeah. Yeah.
Ryan: That's delving into a yeah, another whole aspect of this, which is kind of informed consent and misrepresentation through omission. So if a school has data from an alumni survey, so they know roughly the median net income of their graduates, shouldn't they then share that? With prospective students. Isn't that isn't that important information that someone would use to make a consequential financial decision? I think it is. And you also get into this issue of accreditation that the accreditors are kind of putting the stamp of approval. When you get accredited, when you're accredited, then you can accept federal student loans. So that's the gateway. So then it's like, well, what have the increditors been doing all of this time? Cause it feels Control did not include talking about the realistic career outcomes, let's say, of these degrees. Which is kind of crazy. It's a why are we doing this in the first place, right? Education's supposed to result in a better situation for people. But I think it did rely a lot on idealistic people who wanted to help and who felt they were getting plugged into, let's say, a niche.
Angelique: Which is like
Ryan: Lineage that would then provide a kind of identity and a and a some guidance and some mentorship, which can be really valuable things. But the problem is like when you pair it with financial toxicity, it becomes something else. It becomes my view is medicine's like amazing and wonderful, but it's in this corrupted container. And the containers falling apart.
Angelique: So how do we solve it?
Ryan: What's good?
Toby: Right. That I'm turning that on you, Ryan. How do we salvage
Angelique: Let us know how to do it. We gotta do it together.
Toby: We have this sinking ship and with lots of holes in it. We'd like to know what do we need to do, Ryan? Go.
Angelique: Well
Ryan: We can have conversations like this to begin with. We can have gatherings and forums and Talk with people about what we can realistically salvage from all of this. I think the doctoral programs are a lost cause. It's gonna without the debt money, who's gonna pay for that training? You would have to have familial wealth to fund, you know, like four years of number of credits and four years of education and all of that. I guess maybe exist as like a
Angelique: So
Ryan: Like a tiny private school with very few people. But as far as like I don't think the doctoral degrees are the future. I think probably like a licensure pathway is realistic. So g basically go back to licensed acupuncturist, right? Instead of all this extra and with and then you do continuing ed training. Maybe you can modularly add stuff on.
Toby: But even the master's degree is in trouble, right? Even th those schools that are offering the master's degree, they might not exist.
Ryan: Right? Yeah. I think I think the timeline is currently, as things stand, the earnings test results happen July twenty seven. That's when everybody gets notified that they passed or failed officially the earnings test. And I'll show you another graphic on this important and impactful, I think, to people. The Department of Education released a new data set.
Angelique: Substack that was very So
Ryan: Basically had the earnings and the thresholds. And this was for prediction purposes. And this is, I think, where you get the 98% of students in failing programs. But I narrowed down that data set and put it in kind of an easily to view format. And so you can see that almost all of the master's degree programs that had data are the median earnings are under the threshold.
Angelique: That
Toby: But I'm looking at it right now by a huge margin, right?
Ryan: Yeah, so you've got AIMC master's level median earnings forty one K, earnings threshold sixty-one K.
Toby: It's not even close to getting there.
Ryan: Right. So it's definitely looking like a fail schools. And the problem is that you can't really do anything to change this because this is all four years after graduation. So they're going to take the earnings from 2025, and those are people that graduated four years previous to that, around there. And so they're going to look at their IRS filings and calculate the median earnings. And then they're going to compare that to the bachelor's degree threshold. And then they'll say, Okay, you pass or fail in July twenty seven.
Angelique: It'd be like a school that they pass or fail. Right.
Ryan: Right. They're telling school that, but then if the school fails, they must notify all current and prospective students. So
Angelique: I see. Any school doing well? I mean this looks We can call that Okay, so
Ryan: Let's see.
Toby: Brian, is there any school that's doing close? That's too that's too high doing well because these numbers are
Angelique: What's I went to the New England School of Acupuncture and then I did a doctoral program through Taoist Traditions. So I Daoist Traditions on the Okay, you can see their master's degree is far below. Let's see is any
Ryan: Your school, Angelique. I think Everybody c okay, so EDP University of Puerto Rico, not familiar with that. Probably a different sort of
Toby: They're dead even though. It's not like they're thriving there, Ryan. They're dead even.
Angelique: It's under MCPHS. MCPHS absorbed new English School of Acupuncture. So I bet that's So forty five K versus
Ryan: Right, okay. Okay. Sixty two K, not really close for the master's degree. Let's see. So Norin did their first professional N D degree did under this measurement did sixty one K versus fifty. They might pass.
Angelique: So Okay, so that Fifty seven K. So that's And that's for doctor. I've never doctor, not acupuncture. Right. Okay.
Toby: I never heard of that school too, Ryan. Do you know anything? What with is there a secret sauce in that school or something?
Angelique: Sonorin? Yeah, I don't I don't looks like they're somehow their graduates are have
Ryan: No, no, I The training, the business training makeup practice, I think profitable. I should say there's a number listings for Sonoran, because they used to be class one two, which was underneath medical, and then they switched into this other code. And their previous coding, that cohort did fail, the earnings test. So remains to be seen, right? Because you could have a few like a
Angelique: To like prime Say that another classified five. Like
Ryan: Like a group of high earners that kind of pulls the median up. Right. During that cohort measurement. But the next one's gonna be like twenty five earnings from people that graduated four years prior.
Angelique: So from our quick scan here, it does not look like any of the acupuncture schools made it. Is that in
Ryan: Right. None of the ones in the Department of Med Education's data passed. You can see Saint Catherine, that's a master's degree in alternative health. That's some other alternative health degree.
Angelique: So that's not good, Joe.
Ryan: That's not good. And so what that means is you fail July twenty seven, all the students get notified. So if I'm a prospective student, I'm thinking, Whoa, do I want to start a three year commitment here? And at that point, the schools will be able it looks like these do these rules aren't final, but this is in the draft rules. The schools can choose a teach out, a voluntary teach out. They have 120 days to choose. That can do yeah, what that can do is that can preserve loan access for the students who are already enrolled. Because if you don't do that and you fail again in July twenty eight, which it looks they're so right, they're so far off, it looks like they're gonna fail in twenty seven and twenty eight. If you fail two times out of any three consecutive years, then everybody the program itself gets cut off for
Angelique: What is that? What's a Even if it's seated, even if it's in the middle of another university, like New England School of Acupuncture, for example, even though it's if it's part of CPHS. Right. This so it'll just get closed. Like goodbye.
Ryan: This is programmatic accountability. Well, you don't have access to loans. So students can write, pick take out a private loan or pay for it. So I think I like to think that the schools will choose the teach out option in order to give ensure that the current students can actually take out loans to finish and then you get like one or two years to finish as many no new students, no new students can come in and then you just finish it out. So that's my kind of that's how I think about the timeline.
Angelique: So you have to private lead.
Ryan: That we're on. This is after the loan caps, also. So first you got to survive the loan caps, then you got to survive the earnings test.
Toby: So it's a one two, right? In the Chinese medical schools look poor for both.
Angelique: Right. It
Ryan: They yeah. It's not looking good. And I don't the only thing that the only thing I can see that can change it is advocating somehow getting the rules changed or delayed or like doing a lawsuit, like a class action lawsuit with like a big group of schools to say, Hey, like delay this 'cause it's gonna harm us. We don't think it's legal.
Angelique: Stop.
Toby: Root problem's still there. Chinese medicine education is too expensive compared to reimbursement later on.
Angelique: Yes, yes.
Toby: So that's what th so th that may be a stopgap to keep this system that's not working well but going longer.
Ryan: To benefit who is my question. I understand it benefits the employees of the schools because that's paycheck. But knowing what we know, I really recommend somebody entering into this. I wouldn't.
Angelique: Would we
Toby: Yeah, before reading your substack, I would say, yes, it's a great profession. Again, I graduated in the sweet spot two thousand two, right? I feel like that was, you know, again, it was great education, wasn't crazy expensive, easy payoff and things like that. So until starting to read your work, I just thought, well, everything's going similar to then how I left it. But I was shocked to see, you know, th these numbers like you're showing us, right? It's it's it's really sobering.
Angelique: Yeah, it's it's
Ryan: Hard because it can be very fulfilling work. We're helping a lot of people. It has an identity emotional aspect to it also. But I think it's I don't think it's right for people who are kind of already in the in-group with kind of grandfathered status and like these privileges that have accrued over time. I don't think it's right to ignore the reality today. For students. And I think that there are ways there's possibilities, right? You can imagine possibilities, but they take a ton of work because you're gonna have to get legislative changes. You're gonna have to work out how to standardized testing work for a different type of credential. The people who work at the schools of the future, I don't think they're gonna be getting paid 200,000 or 150. I think that needs to come back into alignment.
Angelique: But True, right? That
Ryan: With the earnings that most of the professionals in the sector are, you know, making.
Toby: Is that right? I mean you have data on that, showing people that work in the schools make one fifty to two hundred
Ryan: K a year? Yeah. I mean the audits that I look at. Uh-huh. Yeah. You know, which is not like totally out of line for higher ed or let's say larger corporations, but that's the problem. It's like you can't kind you kind of can't have it both ways, right? You can't say like this is a heartfelt, idealistic, mission driven, purpose driven group, tribe, and then say, but it's administered and governed in just like all these other higher ed and corporate settings. Right. Right. And I had a lot of problems with the way with things I saw at my school that I thought was like, this is not aligned with our values and this doesn't make sense, which is when you sort of run up against we're operating within capitalism and we can no longer pretend that works or that is in line with our values of do no harm, education, open discussion, let's say democratic governance of things. So it's all there's so many intersecting issues going on here that it's kind of overwhelming, but it's also it's fun to be engaged in. And I should I should have said this up front, but I'm on the board of Polka Tech, the other acupuncture school in Oregon, and they're graduating people with under 25,000. In debt. So they're graduating licensed acupuncturists for under twenty five K.
Toby: I know that's a that's a small school though, right?
Angelique: What
Ryan: Community acupuncture. Yeah.
Toby: Yeah, what's their cohort? Do you know?
Ryan: Like fifteen.
Toby: So that's one avenue, right? That's gonna looks like it will survive this, right? Because they don't take loans, right? But they're immune to this. Right. Yeah. We everyone's really depressed now with liver cheese stagnation, Ryan. So look forward a little bit ahead and help people that have listened this far. So going forward in the future, a boutique school like that, do you think that would be good? And then like you mentioned before, a you know, a really robust school that does herbs and everything like that, maybe a pipeline for Loan forgiveness or something like that because we want to incentivize those people to come into the we need to educate them. We want to incentivize them to do that work with a loan forgiveness, you know, public work thing. You think maybe like that's two possible it's pretty dark, Ryan. So two possible pinpoint light things. Poca tech model and a public loan forgiveness kind of model.
Ryan: Yeah, those are the those are the two main things. So the POCA Tech is connected with working class acupuncture. So which is a several nonprofit, nonprofit clinics. It's a nonprofit that operates several clinics. Employees of these nonprofits are getting PSLF qualifying payments while at the same time they are w actively working to create a model that
Angelique: That's Stops that.
Ryan: Student debt problem. So that's I think a great pathway to pursue. The thing is like that involves legislative, you know, structures and those people don't get paid very much, the people who work at those nonprofits. So we I think partially is we need to sort of decide where we're at, where we're located. We really can't do the, let's say, middle class professional 70 to 100K, you know, stable jobs in the schools. There's no funding left for that. There's a couple of years of funding. Here's what I'm afraid of. I think we're gonna like waste the remaining funding trying to save the sinking ship that can't be saved. Rather than what I hope will happen is that everybody sees the writing on the wall, is a dignified teach out, graduates all the current students. Sells all the assets or the extra assets and then says, all right, now we can change our mission or we can donate the leftover assets to a different nonprofit that has the same mission of educating, let's say, acupuncturists or naturopaths. So you can either mutate or you can kind of close one and sort of bridge the funding into another one. But I think what's going to happen is that the we'll try to
Angelique: Status quo.
Ryan: Preserve itself as long as possible.
Toby: It seems like th this is like five alarm fire and it seems weird to say, Well, let's just stay in the house. You know? Let's just stay in the house. Yeah, yeah.
Angelique: Well I know for well for the for those
Ryan: Those of us who aren't, you know, getting 70 to 100 K per year from the burning house, then it's like, stop, what are you doing? But when you're in it and saying, like, I don't want to have to go, you know, look for a job and start a private practice, like you want to kind of go, it's it's it's easy to look the other way. So that's what I'm kind of I think that's what this next six months is about. And once we get the final rules, it's kind of saying Hey, look, like the earnings test is going to happen in this way. But yeah, even then, though you can probably rationalize it, right? It's like, well, there's going to be a lawsuit and like we don't know for sure yet. That's where the consumer protection piece comes in is, you know, making sure prospective students have access to this information because they're the ones putting their lives and their careers on the line. Right. They're the ones taking the risk. They're the ones providing the debt. If there's no students, then there's no debt money. Also and it and enrollment was going down before all of this anyway. Yeah, it's just really important to have open discussion about the numbers because and I wanna I'll show you one more slide here.
Toby: I'm not sure if we can take right.
Angelique: So unless I can handle one more slide, yeah.
Toby: This is the upswing part? Okay.
Angelique: Rainbows, I need rainbows. If sorry, not rainbows. If
Ryan: It's not if you're a prospective student, you know, head to the sub stack, check out the sheet, the spreadsheet that I keep is kind of some basic information about the schools. You can see if they have some red flags, like a low financial responsibility composite score, or if they're on heightened cash and cash monitoring.
Angelique: I know
Toby: You tell us what those what those mean?
Angelique: Well the
Ryan: Financial responsibility composite score is a calculation with numerous factors. And if you get below one then these you get flagged by the Department of Education. Like
Toby: A C is there on your slide, is point nine.
Ryan: Yes. Yeah. And then you get put on the heightened cash monitoring list, meaning you have to do some things that prove you're not gonna close suddenly and take a bunch of student loan money with you or use it all. So there's that aspect and then there's the earnings list. So I'm sorry, that is my hopeful my hopeful thing is like be informed. For the school you're you're probably cooked, but people who are
Angelique: But for
Ryan: Interested in alternative medicine, like you can educate yourself, protect yourself and find and ask about these issues, right? When you go say like, what data can you share with me about the earnings of your graduates and the median debt? And if the school's kind of like, we don't know.
Toby: But no school can say positive things in that area, right?
Angelique: No. Yeah.
Toby: No, but so no school no school that we no school can say to just make sure I have this right, Ryan. So no co school can say if you come here for three or four years taking this amount incredible amount of debt, you're gonna have you're gonna be able to make more money than you would otherwise. No school can say that, right?
Angelique: Yeah, see. Probably.
Ryan: I don't know what they would be basing that on. You know, they might say that like anecdotally, which is why it's important that we have median numbers. Because anecdotally you can say like, look, this alumni, they're successful, they're concessive. They started this successful herb company. They started
Angelique: Here's a graduate, here's an almost They started this product, right?
Ryan: Well yeah, but you have no way of knowing if that person you don't know their debt load, you don't know if their family supported them, you don't know if their partner has a corporate job that provides health benefits. Like you really need to look at the media the median earnings and the median debt and have people chew on that and compare it to their own situation.
Angelique: Yeah. Right.
Ryan: And the great thing is once this becomes common knowledge and people are doing that, then the resources and the energy will start shifting into sustainable models. So there's my I don't think you can get to the happy place without going through the data filter.
Toby: Okay, Ryan, but that was two sentence of happy things and an hour of darkness. So that's good. But I think you're this is why we wanted to have you on, right? Julian I've been so looking forward to this, right? Because we wanted to know. We really wanted to rip this band-aid off. And you're the only one I know of that's ripping this band aid off. So we really appreciate you taking your time to show us. So we've ripped the band aid off. Yeah, we've got we've got to figure out what we want to put on that wound. It's time to get creative, I guess, because it's the fields open for how to affix this, right? Again, naturopathic schools, Chinese medical schools, these are so valuable, but they're they're run.
Ryan: Yeah. I mean currently, yeah, it's it's not sustainable and it's I think gotten caught up in this student debt crisis. And it's yeah, it's it's a very it's unfortunately one of the worst examples of the student debt issue in the United States. So yeah, we don't who knew? Like who knew we would land right in it, but here we are.
Toby: Naturopathic schools and Chi Chinese medical schools finally exceptional in one thing that we didn't want to be. That's that's too bad.
Angelique: The example
Toby: Yeah, it's the example but yeah, how not to manage a school.
Angelique: Yeah, sort of. There are
Ryan: There definitely are a lot of things that could be changed, but like now is the time to do those things, right? Like now is the time to make a lot of changes so that you can do a two year teach out. So that's kind of the contingency planning of asking, like, okay, wait, how much money would we need for a two year teach out if we weren't accepting new students for those two years? But that needs to be happening now. And so anybody listening to this, you know, you can
Angelique: That could That
Ryan: Start talking about it in your professional state association. You can talk to it about alumni. You can ask your school and you can start imagining asking, looking for other models, looking for sustainable models. All right.
Angelique: So much like the death of our profession. Like I'm just listening, like looking at those numbers and looking at how terribly acupuncture schools are doing financially for those of us that went to school and that's all of us basically. It's just like goodness gracious, what are I mean, I it just feels just acknowledging like the dark hole of sadness in my chest at this moment. Yeah. That's hard. So when we learn CPR, you know, it's like we have to start to delegate, like you call 911 and you get the AED. So like
Ryan: Yeah, yeah, hard.
Angelique: Who do we point at to be like you need to decide? Is it the deans of the school? Like at the at the lowest level, like is it the deans of the school? Is it the presidents of the colleges? Like who do we talk to? Like the students I know several students who are still in acupuncture school who when they hear this are gonna die. Like what how do we mobilize?
Ryan: I think I mean if you're currently in the school, you'll probably, you know, be able to finish as far as the like because the earnings test happens July 2027. Now that still means like every student should be asking about like the financial health of the school in the near term. Right. So yes, those forums.
Angelique: Or like the There's there's those
Ryan: I think the state associations are really important. I don't think it's fair to rely on, you know, students to spark a change. But I think it needs to be people who are have the license, have the credential, and are saying we want something to continue. We want this to continue in one form or another. And if
Angelique: Already
Ryan: You know, like when your school says, like, hey, can you give us some money? Then alumni can say, How are you how are you viewing the earnings test to ask those specific questions and really push for a specific answer? And I think that collective action, I think that state associations need to start taking collective action, as in writing open letters and having the entire board sign them, as in the state associations, right. I think they should be writing to the schools, their local school and the was it C A H the acupuncture, the group that all the schools are a part of, the national school group. I
Angelique: Group. So yeah, 'cause I here's here my th what I like were about like
Ryan: I think is that like we're a we need to be this needs to be public, right? All of this data is now public and there's gonna be more data with the earnings test because the Department of Education is gonna make this whole website and it's gonna show all of this information, median earnings, median debt, time it takes to graduate, you know. So it's all gonna be public soon enough. And so these are public issues that affect a large number of people. And somehow those of us who already have the licensure and want it to kind of continue because we value it, I think that we need to band together and have and make clear demands. And I think that'll go a long way.
Toby: Ryan th something th this making demands, it seems a little bit like so you're saying get some lifeboats going off this ship.
Angelique: Yeah, or I would say like
Ryan: We're all getting in the lifeboat. Yeah. And you can join us, but we're not gonna stay here. We're not gonna keep acting like this is normal and like everything's fine. Yeah.
Toby: We're g we're gonna look at the walls of the house and say, That's on fire. We gotta get out of here. Yeah, I mean it's again, it's really sobering to think about. And but again, hopefully there's opportunity, right? Because th this the root was sick, right? Of the of this of this education. So now we gotta we gotta just abandon this, plant a new root. So again, these are so valuable, naturopathic medicine, Chinese medicine so valuable. So we've gotta We've got to do other things. It's cool that we have POCA Tech is like, you know, they figured a way to do it without taking federal loans. I mean, that's that's amazing. That's must be so much incredibly hard work to be able to do something like that. But at least at least we have one example of how to do this rather than just starting from scratch, right?
Angelique: Yeah, yeah. Yeah.
Ryan: And there's there's examples for naturopathic medicine too, you know, some states the privileges differ between states. So you can have a right sized credential where the cost of the training makes sense relative to the earning potential of the services that most people offer.
Toby: That sounds so reasonable what you just said. Sounds so reasonable. It's amazing that's not the standard, you know?
Ryan: I don't know. Yeah. Right. Right. Yeah. I mean
Angelique: There's there's just a lot of like heartfelt there's a lot
Ryan: Felt there's a lot of ideological priors that come into it, right? In terms of like this school, you know, this school can't close, or this is like this means like the death of the whole project. And I don't see it that way. A lot of schools are going to close just in higher just in general, you know, over the next few years. There'll be mergers, consolidations, but You know, just because your alma mater closes, it doesn't mean that there's no way to get acupuncture to more people.
Toby: But it is gonna be through n something new, right? It th this model is just a hundred percent not gonna work. So it's gonna have to be through something new.
Ryan: I think so. Yeah. I think it's been the current model has been funded through unpayable student debt for the past twenty years. So and that's and it's been ballooning, right? The cost has just gone up and up and up and the cost of living goes up and up and up.
Toby: I heard about this, right? It's you take on D level amount of debt and then get like a hair salon salary. That's just not gonna work, right?
Ryan: That's and it's it's continued also in that way because the that conversation has not been given any seat at the table. And I think it's been repressed and pushed down and pushed into a lot of private conversations. And that's why I say like to be like to be a public element of this change. And I would
Angelique: This has like there has
Ryan: Encourage people who are involved in the organizations and leadership to not make all these decisions behind closed doors and to say, Well, we're the leadership group, so we decided this is what we're doing. Everybody get behind us and the we're done talking about this. You know, it's like we need open forums where people get to speak their mind and their peace and submit data for everybody to look at. You know, there has to be, I think, a democratic
Angelique: Like
Ryan: Conversation about all of it, you know, as opposed to like good news, this board, this nonprofit board decided. So here's what we're gonna do.
Toby: It's definitely a time for fresh ideas, right? So that makes sense, right? To try and open the aperture as wide as possible and take in some fresh ideas.
Ryan: Yeah, I think so. I think it's a great way to say it.
Toby: Right, Angelique, ask Ryan one final question and then try and elicit something positive out of them. Nope.
Angelique: Pressure. I guess like when you can look forward, let's say, let's say that people listen and let's say that they do, you know, the two-year plan of educating the current students and then deciding it's time to really go in a new direction. Like what do you see happening in the next five to ten years for both acupuncture and I guess, you know, the complementary and alternative medicines and integrative medicines in general? The hopeful scenario.
Toby: Yes, for once, Ryan.
Angelique: That there would be small
Ryan: These nonprofit schools in would just be let's like one building, like a house, you know, and this would be and it would by the relevant state board to teach hours taught there would count towards the state licensure. And so you would have something like a you know two year
Angelique: So say like Be authorized.
Ryan: Modular program that students could take while working part-time or they could kind of do a little and then leave and then come back. And then those hours would count towards getting a license in that state. And it would be something like, yeah, cohorts of like twenty people. And the like, you know, the faculty like teaching part time and it was more of a passion project for them.
Angelique: There'd be like a faculty that's probably like
Ryan: Because they wanted to get this information out there. And there would be, you know, a couple administrative people who didn't get paid very much, but it was enough to live, getting paid a living wage. And then those graduates would be working at and starting nonprofits. So there would be a sort of nonprofit incubator aspect. And the people who had already done that would come back to tell the current students about that and say, this is how I did it. You can come and work for us, or you can, if you want to start a new pr nonprofit with a different mission, like we'll help you. And you guys should all be on the boards of all these non other nonprofits that are doing this work. And then all the previous generation of graduates with the doctoral degrees and the master's degrees would be teaching at that school and then working at those nonprofits too on the way to their public service loan forgiveness payments. So That's the kind of sustainable type of system that I can imagine. But it takes a lot of work to set up and to wade through and create.
Toby: Yeah, but it sounds like maybe this is how Chinese medicine school started initially with like passion projects, right? And so it's like it's it's run its course, so now it's gotta be like next generation's gotta step up.
Angelique: Yeah. Yeah. Yeah. So
Ryan: I think s I think it's yeah, that's I think it just kind of took a couple wrong turns and really got pulled into the money and the credential and the status project. And once it's hard because once that status quo was funded, then all the funding just goes into continuing it and maintaining it. So there's no like fund for innovation that I know of.
Toby: Yeah, you need somebody really against the grain like POCA Tech to say, I'm I'm not gonna take that money and I'm gonna figure something out. One school, right? I think that's only maybe middle way also middle.
Ryan: Right, doesn't take federal student loans. But the tuition at POCA Tech, the twenty K is based off of how much a new practitioner can make in their first year.
Toby: But that's not mandated by the government. That's just common sense.
Ryan: Yeah, that's and because they're committed to not exploiting students. And
Angelique: That's that's that's the piece.
Ryan: That has been missed is that I think that the institutions have ignored the outcomes for students for so long that it just kept building up. And now there's this government kind of hammer coming down.
Toby: Th this hit me in the gut earlier when you said, Yeah, do no harm. Obviously that I feel that cellularly and then yeah, the fact that we didn't do that to the students makes me a little ill.
Ryan: Yeah. It's it makes Yeah, it's hard and you can see why people don't wanna talk about it. Yeah. Openly. Unc it's really uncomfortable.
Angelique: Very uncomfortable. But I'm so glad that you did.
Toby: Yeah, that's what we're so appreciative of, you spearheading this whole thing, right? Because otherwise I don't know who does this, right? I guess we just wait for the government numbers to come out, but you were on this so early and it'd been putting so much sunlight on this so early. So yeah, we really appreciate you all the hard work you've been doing there, all this time you set aside to talk to us today, right? It is just really valuable for the Chinese medicine communities. Keep up the good work. Everyone should really subscribe to his Substack too. He's he's on it and yeah, clear, transparent, and then and then his understanding of it, right? And then we're really gonna need that kind of guidance going forward.
Ryan: Yeah, thank you. Thank you for saying that. And it's it's gonna be a big year. Yeah. Yeah. So but I'm I'm I'm I'm optimistic about now recognizing the problem so that things can start to change. 'Cause there's still there's still a little bit of time.
Angelique: Is the stat clearly seeing? Yeah.
Toby: Yeah, we've got the di you've given us the diagnosis right now.
Angelique: Yes. Yeah, yeah. Yeah. There's mu and there's there's multi
Ryan: Simple ways to approach it. Yeah.
Toby: And thanks, thanks so much for your time. We really appreciate your time. Okay, everyone, thanks for hanging in for this long conversation with Ryan. Everyone, take good care.
Ryan: You're welcome. Thanks so much. Thank you.
