Akerfelds pitched in the major leagues in parts of five seasons, from 1986 to 1991 for the Oakland Athletics, Cleveland Indians, Texas Rangers, and Philadelphia Phillies.

[1] Akerfelds made his major league debut with the A's in 1986, giving up four runs by getting the final 11 outs in a 10–1 loss to the Minnesota Twins.

Akerfelds was traded to Cleveland in July 1987 and spent the rest of the 1987 season in the majors, appearing in 16 games, 13 as a starter, with a win–loss record of 2–6 and a 6.75 earned run average (ERA).

After spending all of 1988 down in the minor leagues, he was removed from Cleveland's 40 man roster, then selected in the Rule 5 draft by the Texas Rangers in December 1988.

After his retirement as a player, Akerfelds spent eleven years as bullpen coach for the San Diego Padres, starting in 2001.

[10] He continued to coach for the Padres in the 2011 season, regularly balancing his treatment plan with the team's schedule.