A Letter to the Editor

The following is my response to a recent practice management article published in Acupuncture Today. I have emailed it to the editor, but given that Acupuncture Today is actually not the open forum they claim to be, I seriously doubt it will see the light of day. And so I am posting it here. This is the same publication that canned Lisa Rohleder of Working Class Acupuncture for her articles on community acupuncture and social entrepreneurism. Interestingly, Lisa was the only author in the history of the publication whose Acupuncture Today online talk back forum actually had any activity. Now the talk back forums are gone. 

Here’s my letter:

In the spirit of Acupuncture Today being “committed to bringing an open forum to the acupuncture profession” I’d like to make some comments about Lawrence Howard’s article, “Many Offices, Many Lessons”. While some of Mr. Howard’s observations offer valid insights into human nature, some represent – to me – a mindset that as healthcare providers we have an ethical duty to transcend.

I congratulate Mr. Howard on his 13^th anniversary of being a practitioner, but have to question the implications of working in more than 24 offices in 13 years. Is this accomplishment a result of the keen self awareness that ‘the likes of those he has worked for or with’ apparently lack? While bouncing around from clinic to clinic may offer a unique perspective, it is hardly a position from which to write about practice management with any authority.

I say this as someone who has been out of school about seven years and successfully owned and operated my own clinic for the last five years.

The notion that “through patient education, the practitioner encourages the patient to raise the dollar value they assign to their discomfort” is nothing short of absurd, and quite frankly morally reprehensible. Yes, Mr. Howard, some people have to “self discharge” because they can no longer afford treatment. Assigning greater value to ones discomfort unfortunately does not equate with greater means, or better outcomes.

And yes, sometimes fees do correlate with patient success. I see it all the time in my clinic, but based on my direct experience of 5 years and nearly 20,000 treatments given to date, it is not at all as you say it is.

How one structures their practice, whether insurance based or cash based, high cost or low cost, high volume or low volume, is a matter of personal preference. I have no issue with people charging whatever they want, however they want, for their services. But this idea that “high fees attract only the most committed patients and consequently have the highest chance of success, and thus referrals”  is one that needs to be put to rest once and for all.

High fees attract only patients that can afford to pay high fees, and sure, if someone can afford high fees they can probably afford to get as much acupuncture as they want or need. But patients are committed to treatment for all kinds of reasons, and people stop coming for treatment for all kinds of reasons, and treatments succeed or fail for all kinds of reasons. To attempt to correlate high fees with greater commitment, or greater success is false logic, and from my perspective seems to be nothing more than the musings of someone who hasn’t been in one place long enough to know any better.

From what I can tell people have a higher chance of success if they can afford treatment. It’s that simple. Likewise, people refer if they see good results. It has nothing to do with how much they pay. I know this to be true because I charge $15 - $35, have committed patients, get great results, and have a vast network of referrals.

Your $300 quit smoking example is a good one. I think people basically are going to do what they do regardless of what they pay, but again their chances of success are improved by their ability to access the medicine. For example I have a social worker on a very limited fixed income coming to me for the NADA protocol currently, which we charge $10 for (that's right, I charge $10 for about 20 cents worth of needles and a couple of minutes of my time). She was distressed because with frequent treatment her budget was being stretched at that price. I offered her treatment for $5 instead, and she’s doing great. At the end of the day will she stop smoking and stay stopped. Who knows? But at least she now has the same chance as someone paying $300 has.

I’m not saying everyone should charge less, or practice how I practice, but this notion that people who can’t afford high priced treatment need merely to be educated or more committed needs to stop.

Perhaps acupuncturists would be well served by focusing on their commitment to their patients instead of their patients' commitment to them.

The Party of Special Things to Do or... The Great Good Place

Yesterday I turned 48. It was a particularly good birthday, celebrated pretty much all weekend. Kelly and I had a first little gathering at our home we've been making together, I beautifully landscaped a corner of the yard I'd been struggling with for years, and I spent my actual birthday doing what I love to do the most - lots of acupuncture for lots of people. The Party of Special Things to Do indeed (a Captain Beefheart reference). Wrapped it all up doing another one of the things I do quite expertly - watching TV in my sleep on the couch. Woke up to a lovely PBS segment on surgeon turned potter, Cliff Lee.

Last week I had a patient tell me his brother used to be a cook at Armadillo World Headquarters. As a result he got to sneek in to many great performances there...Van Morrison, Frank Zappa and Captain Beefheart, and on and on...He was telling me this because he noticed the clinic's armadillo logo and domain name (Acupuncture World Headquarters) and he got it. It's not so often people get the nod to the 'dillo which is our homade branding effort, so it's always fun when they do.

There's another thread that runs through all this though, which was made crystal clear to me during the recent community acupuncture workshop held here in Austin, put on by the fine folks of Working Class Acupuncture with an additional hand from Alexa of East Nashville Community Acupuncture. What I'm talking about here is the notion of "the great good place" as put forth by urban sociologist Ray Oldenburg. Thanks Alexa, for sharing this.

Turns out what Ray Oldenburg is articulating is what community acupuncture clinics are doing. Who knew?

I have at various points attempted to make this connection. I've added language to our website, I've taken it away. At the end of the day, this is what the Armadillo references are about - the commonality of the great good place. The 'dillo brought people together in a strange sort of way - bikers, hippies, cowboys, students. Music was the great leveler. Community acupuncture brings people together in a similar sort of way. In our case, acupuncture is the great leveler (or maybe it's the recliners!). I never cease to be amazed as I look around the treatment room at the variety of folks there: the fireman, the teacher, the grandmother, the cancer patient, the musician, the mom, the job seeker...all doing their part, just by being here together, to make this the great good place it is.

So happy birthday, and
Good night Austin, Texas - wherever you are!

Talking about acupuncture

The work of Portland's Working Class Acupuncture (WCA) and the community acupuncture movement that they have spawned raises many important issues and questions about acupuncture.

Five years ago, when I was fresh out of acupuncture school, the issue I saw WCA addressing was that of how to have an acupuncture practice that thrived - very important stuff when you're sitting on 100K in student loans and entering into a profession where largely there are no "jobs" per se. Apparently most acupuncturists make very little money, and many are out of practice within a few years.

Working Class Acupuncture's solution (a new model of doing the business of acupuncture) was and is brilliant. The fundamental premise: charge less/see more people.

By charging less, many more people can first of all actually afford to get acupuncture where before they perhaps could not. But even more importantly, charging less allows people to use acupuncture more realistically and in ways that get better results - i.e., a short course of  frequent treatments for acute scenarios, or long term treatment over the course of potentially months in the case of chronic problems. It also, of course, makes just dropping in when you feel the need more doable.

By seeing more people, from the perspective of the acupuncturist, you get your hands on more bodies and you gain experience rapidly, which makes you a more confident and skilled practitioner. Also, seeing more people means more people spreading the word about your work - which makes growing and sustaining your business happen more easily.

And lastly, there is the paradigm shift that happens when you make using acupuncture realistically something more widely affordable. Namely, acupuncture in this context becomes less about the technical or healing prowess of your acupuncturist, and more simply and directly about the act of getting acupuncture. This is huge.

Chinese medicine is still very alien to many, including many of those who practice the medicine. The culture of the medicine is steeped in antiquity and it's history abounds with lore about miraculous cures. Out of this arises notions about acupuncture and Chinese medicine and how it works that verge on magical thinking, and often the expectation that acupuncture will work in short order where Western medicine has failed. Sometimes it does, and hence the lore of miraculous recoveries. Mostly it takes a lot of doing.

So this brings us to a couple of other topics: How acupuncture works, and what an acupuncturist does...
Next time.