August, 2007

I quit my "day job" today! Whoo hoo!

And by day job, I mean as an acupuncturist. My dirty little secret is that I have been working since December for an MD acupuncturist a couple of mornings a week. He bills worker's comp and PI upwards of $300 per treatment (as long as e-stim was involved - and he makes sure it is), and paid me $25 per patient (and that's after I insisted on more money). I go in for a couple of hours and if we're busy walk out a couple of hundred dollars less in debt. The big dirty system.

This community has been posting such insightful and encouraging pieces, I am wondering if this is out of place here. I don't mean to sound too apologetic or negative, I just wrote it up a while ago because I felt it was important to tell someone. Not exactly how stupid I can be, but how easy it is to get priorities mixed up. I call it the Big Blooper:

How Do You Make It Up To An Ex-Patient Who Never Wants To Get Treated By You Again, Or You Never Know When That Next Lesson Is Going To Come Up And Smack You.

What made this even worse than the above is that it took me hours to figure out what I had done wrong. In the name of Apology to all and in the hopes that my confession may avert a similar disaster for anyone, no matter what reason, I tell my rueful story.

This letter is another response to the Acupuncture Today article written by Ms. Dunas, one of the leaders in our acupuncture field. The original article can be viewed here: http://www.acupuncturetoday.com/mpacms/at/article.php?id=31577.

Dear Ms. Dunas,

Your article in Acupuncture Today, “Money Is Qi Is Money”, has provided much for me to consider as a fellow acupuncturist. I appreciate your idea that it is both possible to make a good living as an acupuncturist, and that being successful in acupuncture can be good for everyone involved in the process (the practitioner, their patients, and other businesses via consulting). I found that beyond this general message I have a different point of view on many of the ideas you shared.

This week marks my first year of living in Portland, starting a CA practice as well as being a practitioner. A lot in a years time. It was sometime last week that I realized that I had taken a deep sigh. I didn’t know I was even holding my breath until one day as I was leaving BCA after my shift that I noticed how smoothly the cogs in our machine were running. I felt a calmness that I hadn’t felt before. So with one a year under my belt I thought I’d share a few thoughts.

What makes me feel grounded is connection to other people: community building both personally and professionally.

Whenever I would feel insecure about being a practitioner I would remember those lines form the little red book: frequent and regular, frequent and regular. Many treatments over the course of time will give the best results…

Running with the theme Diana expertly broached in her last blog entry, 'frequent treatments' may either become my personal mantra, the name of my first born or both. I have learned more about the potency of acupuncture treatments this summer - while seeing many patients 2-3/week - than the previous 10 summers combined. All of this is possible because of the bottom line - affordable fees. Period.

I am witnessing folks turn the corner from debilitating long-term pain, weakness and/or emotional unrest, over a matter of days/weeks, instead of weeks/months/never. This has been an education and an honor. Nothing is more satisfying, on a number of levels.

=============

So I just started treating patients in clinic at my school last week and I gotta say, I do think I picked the right profession. If I didn’t know it already, I really know it now. I loved all of it, meeting my new patients, figuring out what they need, deciding which points to use, and alas, testing my herbal knowledge.

My supervisors are lovely, they really let me do my own thing and make gentle suggestions about what they might do differently. So I gotta say all in all, things are going really well. I’m not dealing with anything crazy, just your garden variety aches and pains, but I feel confident that I can do this.

Some of our conventionally practicing colleagues are wondering how Community style acupuncture treatments could possibly be as effective as theirs. My guess is that the thinking goes something like this: “I spend more time with each client. This gives me the information I need to make a better diagnosis. Better diagnosis = better treatment = better results.” In some cases, the thinking may even go so far as, “Those folks who see 4, 5,even 8 people an hour can’t possibly be designing and giving effective, quality treatments at that pace.”.

This really contradicts my personal experience that practicing community style has made me a more effective acupuncturist. So, to try to explain why, I’ve come up with a list of Five Things That Make My Treatments More Effective than when I was practicing conventionally. Here they are, in no particular order.

I am not “Herbalizing” my acupuncture

i recently replied to matt's entry about being lost in the process of creating CA.
"don't be too picky about who you partner up with" was part of the advise i gave, and i need to expand on that notion because my partner got his feelings hurt by the comment, and also because tatyana asked me to do it.
when i was getting ready to open my CA clinic, i had developed a biz plan, floor plan, found a space, applied for a loan, etc... everything was pretty much lined up, but i knew i couldn't pull it all off by myself, and i had decided to hold off on the plans until i found a partner.
then i got a little note from lupine saying that there was this new graduate fellow in New Mexico who was moving to portland to try to have a CA clinic.

Ahh, the first (but not the last) post from The Admin Quadrant of our motley crew...and yet, the theme remains the same.

http://www.theacupreneur.com/public/250.cfm#coach

This article about the need for validation and “professionalism” in the business coaching field has so many parallels to the issues in the acupuncture world we are constantly discussing here on CAN, that I thought I would commiserate with you.

The author has decided that by sharing our business model in an open, honest and transparent (not to mention accessible) format, we are somehow undermining the many hours and dollars of business coaching work that he is trained to do. We are undervaluing his profession and are a menace to society. (This all sounds familiar, right Community Acupuncture folks?)

Today in Practice Management class I learned that how much you charge your patients is how much YOU are worth. Okay, that sounded a little off to me, so I raised my hand and questioned, "Don't you mean to say that you think how much you charge your patients is how much your services are worth?" But, no, that was not what was trying to be conveyed to us future acupuncturists. And although I don't agree with either of those concepts, I definitely do not agree with the notion that my worth as a human or as an acupuncturist can be measured or is equivalent to a certain price. Otherwise there could be no sum large enough, right? One billion dollars per treatment! Still, not enough! And, although I grew up "religious" and may have different views then some, isn't it just wrong to compare human worth with money? (maybe I am being too dramatic about the teachers views, but who wouldn't be upset?)

I am in the planning stages of opening a community acupuncture clinic. I was attracted to this business model because I want to bring acupuncture to people of average income and because I want to create a successful business that will sustain me throughout my life.

The Money=Qi article has caused quite a stir among the community acupuncture network members. I hate that article, but I understand why it exists. There is so much fear around money in our field. We have all heard of the business failures and how hard it is to make a living practicing acupuncture.

Alright. I've decided that my son will only allow me to blog via haiku.

Hmm. Now I've decided that since I am still breastfeeding him, my haiku talents are not coming to me. All that blood is still making milk.

Now here's the difference: I've decided that all of the above is ok. Before my son turned 1 year and before I started my CA practice I would have had a lot of trouble being ok with "going with the flow", and accepting myself and my reality as it is. Instead, my M.O. was giving myself the hardest time possible. I was never just o.k. somehow I was letting someone down and usually it was me in another person's clothing.

I'm learning from my patients each day. Allow whatever comes to come. And trust that it is right.

I truly adore and trust the practice of acupuncture and its philosophical roots. But not until now have I seen how simple and powerful it can be when it isn't dressed-up and talked-out and given fancy tea and a large bill.

Last Tuesday I came home from work and had a weird impulse to see what movies were playing that night. I rarely or never go to movies in the middle of the week, but nonetheless, there I was, searching online, when I came across a movie entitled “Finding Normal”. And then I understood my impulse (though it was still weird!), because “Finding Normal” turned out to be about some people I knew -- some really amazing people that I used to work with.

So I was supposed to blog last week, but time got away from me, like it always does about everything.

I can't say that this will be as interesting as the post about Felice Dunas's questionable article, but it is tangentially related. It's about money.

I work at WCA. I make a good wage, and it's a good place to work. Basically, this is my job--it pays most of my really important bills--the expenses that I have to send a check in the mail to someone I don't know, or have met a hand full of times. I am soooo thankful for this, but in the end, I am disenfranchised from my labour, someone else owns it, and as such I do things their way, on their clock, etc. Also, it's not nearly enough to live on, I'm accruing more debt as we speak. With out this job at WCA, I'd have been forced to leave the profession at this point, so believe me, I am nothing but grateful.

Ok, first off I'm posting a little ahead of schedule, partly because the WCA gang is coming to the Bay Area next weekend, when I am supposed to post (woo hoo), and partly because what I wanted to write about ties in kind of nicely (I think) with Korben and Jordan's recent posts, and some of the comments to Korben's post.

I was going to wait until I had less "shenpa" around this subject to write about it, but turns out I'm still pretty mad (if you don't know what shenpa is, allow me to recommend "Getting Unstuck," a series of talks by Pema Chodron - I got them on CD from the local public library).

Now, if you haven't read it already, please go read the following:
http://www.acupuncturetoday.com/mpacms/at/article.php?id=31577
I knew right away I was going to disagree from reading the title. I actually don't have enough time to post a really eloquent reply, but here are some of my reactions:
*I really, really hate it when people claim that money is just a form of qi.

Yesterday, CommuniChi participated in the First Time Latino Homebuyers Fair hosted by our landlord, El Centro de la Raza. It might have seemed an odd mix - one acupuncture clinic alongside a dozen or so banks and mortgage companies greeting the public and giving information about our services. It was a tremendously successful event for us.

We introduced nearly 20 people, almost all Spanish speaking, to a complimentary acupuncture treatment. What made it possible in many ways is the fact that our clinic is located inside a dynamic community center engaged in multiple arms of social justice activity.

Although our clinic is still less than 9 months old, I am beginning to realize the extremely good fortune we have to be located in a community center such as El Centro. If this year is typical, my guess is that each year, CommuniChi will have the opportunity to participate in such community events 4 -6 times a year.

Bicycling to my very first clinical assistantship almost 10 years ago, I felt pretty jazzed, a little scared, and hugely hopeful. I was looking forward to connecting with patients as a caring student of Chinese Medicine with lots of attention to spare.

Within the first twenty minutes of my time at this hundred-bucks-a-pop clinic with multiple waterfall dioramas, I had all the contact I would ever have with the owner and principle acupuncturist. He asked me to take needles out of a patient in room #6, and then he told me to put on deodorant and to never ride my bicycle in if I was going to smell like sweat. I was asked to do some filing for the rest of the shift.

OK, I thought. Yeah, that must be right. I’m a big fan of paying a lot of attention to what makes patients comfortable and uncomfortable, and of generally being a conscientious community member, where sometimes it makes as much sense for me to get out of the way as it does to be very powerfully who I am.

I have been in a small bit of a funk. I am finding little motivation to sit in front of a computer screen, and even less creative juice to think of what I might want to blog about this month. So I think the best thing is to just see what comes up, right here, right now!

It seems to be that in Boise, ID, every one skips town for, oh, the entire summer, leaving this place a virtual vacant lot for the cave dwellers who aren't going kayaking down the north fork of the Payette, or backpacking in the Sawtooths. And this adventurous spirit has seriously interrupted the wonderful growth we had been experiencing throughout the spring months. But the larger issue, I'm suspecting, is really my perception of the whole thing.

Gosh, so many intelligent posts...allow me to dumb it down and rant this week.

I've been in satire-land lately as the acupuncture sitcom gets ready to air. It's terrifying in many ways. My Kidneys feel like they're sucking on lemons of fear. Yesterday, did I really record a disco song about a smorgasbord that relates to acupuncture? There goes that "Acupuncturist of the Year" award. Forever. Tear.

However, I'm so inspired by what's-her-name-with-the-orange- book, by helping me think out of the box of this profession. Of course, if the sitcom flops, I'll blame her, kind of like how you're now supposed to blame your friends if you're overweight.

I sent photos of my new clinic to Skip, Lisa and Lupine, and Skip suggested that I post the photos on the blog so that everyone could see what my clinic looks like.

I must say that the treatment room is really much nicer in person than the photos portray as I usually have some soft lamps on, but had to turn on the overhead flourescent lights to get a good picture (yuck).

The clinic, Minnesota Community Acupuncture, opened May 14th. We have 1,742 sq feet with a lobby, conference room, practitioner office, private treatment room (where I treat children using Shonishin), and a 29 x 30 CA treatment room with 16 recliners.

I'm now working on ways to maximize the space usage for marketing purposes. This includes free health seminars on specialized topics such as allergies, menopause, etc.. I've also considered finding a massage therapist who would be interested in using the mostly unused private treatment room, however, I haven't started that searh in earnest yet.

Planting Seeds

I gave a talk about CA at my acupuncture alma mater last December. I knew that one of the secrets of success in the WCA model is Jingei pulse diagnosis so decided to teach it if the students were interested. Then the word got out to the local L. Acs. and I thought I should offer them Nuts & Bolts. A bunch of people came to my clinic to observe this new business model and I found that wasn’t working as my patients were trying to take care of the observers. So I put together a conference similar to the one I went to at WCA. I added treating the participants so they could see the flow and I could stop having observers.

A couple days ago Lupine emailed me a link to a web-page that talked about what to expect if you wanted to become an acupuncturist. It included how many acupuncturists there are and expected income, both for a first year acupunk and five years out.

Needless to say we were surprised by some of the claims in part because they were different than what we were aware of from Acupuncture Today and Acufinder.com and in part because, well, they seemed preposterous. So I decided to look at the claimed numbers of the three sites and see what they actually meant.

Okay. Here's the first site that Lupine ran across:

http://www.healthcare-trainingcenter.com/jobs-acupuncturist.asp

So these folks say there are 10,512 acupunks nationwide (US) and they do between 9-12 million treatments yearly. This (the numbers of acupunks) differs than what Acupuncture Today uses when they try to attract advertisers: 16,105.

http://www.acupuncturetoday.com/list/info/aculocatorzip/

I have been thinking about CA non-stop since I listened to Lisa Rohleder speak this spring in Maine. Its a revolution about which there are so many things that I agree with, there is no possible way that I can keep myself from creating a clinic that uses the CA principles. I feel a little bit on fire with the thoughts of where this concept will go. Something Lisa said in the conference that caught my attention is that “insurance is not going to save us.” That statement caught my attention.

...on the very interesting topic of "collective healing" and group focused healthcare in general, in a guest commentary yesterday in the The Integrator Blog. Check it out at:
http://theintegratorblog.com/site/index.php?option=com_content&task=view...

Go Karlo!

What is Community Acupuncture?
(practitioner/ patient interaction)

We have recently hired two new acupuncturists at WCA and part of my job has been to orient them to the basic flow of the clinic and discuss the acupuncture approach we take in general at WCA. It seems to me that the main points I covered with the new acupuncturists could be beneficial to restate here. After all, for acupuncturists that are just becoming acquainted with community acupuncture (CA), the main question to address is what is CA exactly and how does it differ from typical acupuncture practice in North America? Is setting up chairs in an open space and using a sliding scale of $15-$40 enough to be considered CA? The only truthful answer I can think of to this question is, well, yes, and no. By definition the structure of CA is very simple, yet through my experience, the day to day clinical interaction is often misunderstood.