The degree requirement for practitioners is called an MSAOM (Master of Science in Acupuncture & Oriental Medicine). This program on average requires 3.5-4 years of full time study and involves over 1000 hours of training that is overseen by professors who have also worked/are working as practitioners in this field.
Upon completion of this degree, the Texas Medical Board requires all four of the NCCAOM board exams to be passed before a license to practice will be issued. The boards are timed, adaptive, computer based exams with about half of each exam consisting of case study questions. They test the individual on these topics: BioMed (western medicine), Foundations (TCM diagnosis), Acupuncture (and other modalities), and Herbs (pharmacology of several hundred herbs & formulas).
Upon passing these 4 exams the NCCAOM awards the designation of Diplomat of Oriental Medicine. Then the Texas Medical Board will award the designation of L.Ac. and a license to practice within the scope of TCM.