Credentialing requirements vary by state, leaving providers to navigate a complex regulatory landscape. All states require a license to practice acupuncture. In some states, MDs, DOs, and DCs require extensive additional training and licensing to deliver acupuncture treatment. In contrast, in others, the requirements are less stringent, which can limit the supply of providers. With varying training requirements and levels of familiarity, some providers may not feel comfortable offering acupuncture treatment, even if they meet regulatory requirements to do so. Some hospitals and healthcare systems also vary in institutional credentialing requirements, imposing further challenges to practice within these settings.

Over the last decade, there has been a notable decline in the number of trainees enrolled in acupuncture training programs, leading to the closure of many programs. This may lead to an accelerated decline in the number of licensed acupuncture providers in the United States.

Acupuncturists report low reimbursement rates, difficulty obtaining reimbursements, and more patient no-shows when delivering care to individuals, particularly those on Medicaid. Given these low reimbursement rates, some practitioners opt to only accept privately insured or self-pay clients.

There are various professional identities to balance for acupuncture care. Acupuncturists are trained in the ecosystem of traditional Chinese medicine, while other providers receive additional training to apply the modality of acupuncture within their individual clinical environments. This may be confusing for patients, healthcare systems, regulators, and referring providers.

The acupuncture profession has not developed widely available integrated clinical training opportunities, thereby limiting the availability of a highly qualified, licensed acupuncturist workforce for integrated care settings. Further, there are few advanced postgraduate training opportunities widely available to early-career acupuncturists.