Sustainable Acupuncture
Posted July 26th, 2007 by Diana
Most of our conventionally practicing colleagues are a little shocked and perhaps put off to hear their practices described as boutique acupuncture. Many probably believe their patients are from a variety of economic classes, some high, some lower, but most in the middle. If they're like I was, they may think it is mostly a mind set that allows one group to pay for medical care out of pocket, while another group rejects anything that isn't covered by insurance. And their experiences may strengthen all these opinions. Most acupuncturists have treated many clients for whom $60-$70 a treatment is a real stretch, but they do it anyway. But they probably haven't treated most of them for very long, or very often. And less acupuncture often equals poorer results.
What community acupuncture gives our patients, and our communities, is the chance to not just try acupuncture, for four, or six or ten treatments, but the option of having an ongoing relationship with it. In other words, the chance to make it sustainable.
As a sustainable resource, patients can use acupuncture to help their frozen shoulder for two or three months, graduate from treatment when the shoulder is well, but then call us again in six or eight months for post flu fatigue or a sinus infection. They can come in for a series of treatments to quit smoking, but continue once weekly to relieve stress, and therefore make a smoking relapse far less likely. They can have several family members undergoing acupuncture treatment at the same time and not blow their budget out of the water. A sustainable relationship with acupuncture is necessary to see any of its preventative benefits, or to make acupuncture a first choice for those minor everyday maladies that don't really need prescription drugs, as long as there's another option.
The benefits aren't just for the patient, though. As acupuncturists, we have the best opportunity to develop our clinical skills when we have sustainable, ongoing relationships with many or most of our patients.
Folks don’t choose Western Medicine because, “it really helped my wrist a few years back”, they choose it because they have at least some trust that, as a system, it has something ongoing to offer them. For those with the insurance or other means to pay for it, it will follow them throughout their lives, providing options for the many health and wellness challenges they will face over the years. Acupuncture could offer the same thing, more than a fringe technique to sample for one particular problem, but a lifetime of choices, a solid plank in the healthcare platform.
If it is sustainable.
For most of the people in this country, $70, $80 or $100 a treatment is not sustainable. $15, $25 or $40 is.
Having switched from Boutique to Community acupuncture, I’ve seen first hand the difference it makes in the lives of my patients to have sustainable acupuncture. I’ve also seen the difference it makes in my practice. This is how you make a difference in your community. Don’t just show up for people once. Show up for them. Period.
Re: Sustainable Acupuncture
Shichangpu,
Thanks for pointing out the elephant in the room. I wanted to add that my interpretation of boutique which I summed up as "luxury", is more than just about prices unaffordable for most people.
It's about many things, difficult to capture in a single word or example.
I've been reading a lot of the progressive blogs on politics these days, observing how people communicate towards one another regarding causes and positions that individuals hold strongly.
It seems there is a balance to strive for if "our cause" whatever it may be, is to gain momentum in the long run: On the one hand, raising awareness about the perceived deficiencies in institutions (e.g. the acupuncture profession as a whole) would seem to require a little button pushing.
As one of my teachers would often remark: Other people's buttons are their responsibility. So this isn't meant as a license to actively try to offend other people maliciously, just so they can see how ego-centered they are. However, it is a little inevitable that if we start talking about class inequities in health care, and in order to highlight that, we invoke some evocative language (like "boutique acupuncture"), that some people are going to take it personally.
Re: Sustainable Acupuncture
I think that it's really glaring that there are 17 replies to Diana's post and no one comes right out and says that "Boutique" when applied to non-community acupuncture clinics is really cannoting an invisible class structure. It's really about class, we all know we're talking about class, but we can barely say the word class. Jordan's assessment that boutique is like luxury gets close. Right, it's those with higher/disposable incomes that value luxury...
I think that it is good to push people's comfort levels. Most of us went into acupuncture because we want to help people. I am not against people doing private practice, but I am always a little pushed myself when a minority population struggling for change is accused of reverse discrimination. Community Acupuncture is, as was Diana's point, a very sustainable option for patients and practitioners.
"Don't people who are financially better off, suffer from the same diseases, heart aches and problems that "working class" people have? Remember suffering is part of being alive. "
Sure we all suffer as humans, but is it the same to have a chronic disease and be able to afford palliative care, or take time off from work, or to hire someone to help you and to be chronically sick and to have to keep working full time to keep health benefits and income?
"Perhaps the term "working class" somehow makes community acupuncture appear lesser or second class to private treatments."
To whom does this term imply something lesser or second class? I think that is really the crux of this.
Re: Sustainable Acupuncture
cheryl, this seems like a good topic for a separate blog or forum thread - i think you have really hit a note that will dispel some confusion and it would be great to hear about others' experiences and thoughts on this.
tatyana
Re: Sustainable Acupuncture
I think it's important to remember/realize that those with a BA practice, giving private treatments, don't have to sacrifice their style of acupuncture by doing CA.
Perhaps what I'm addressing is only at the fringe of this conversation, but the reason I'm bringing it up is that I used to equate doing CA with "giving up" a large part of my treatment style. I've learned that this is a flawed way of thinking in at least two ways. One, as long as the patient is being helped, it really shouldn't matter what style I'm using. Two, who says I can't bring much or all of my style to a CA setting?
Because of Japanese acupuncture (I'll use JA) treatments that I've received, I thought that those practicing JA were unable to have a high volume practice. But a teacher once told me that his JA teacher had a very high volume practice. I've heard the same of other JA practitioners. Other acupuncturists on this blog and on the forum have described ways that they work their particular skills into CA.
All that being said, I'm wondering how many acupuncturists out there are adverse to CA in part because they feel they must fully abandon the way they do acupuncture? I want to tell anyone who thinks this to try and keep your mind wide open. Coming back to the subject . . . regardless of one's approach, sustainability *on all levels* is critical. But I believe there's still a wide range of possibilities for different modalities within a CA framework.
Cheryl
Re: Sustainable Acupuncture
What a great discussion. I think the questions about what to call acupuncture practices who don't use a community method opens up a conversation about communication in general. I have arguments with my Mother about this all the time. "What was the intention behind what you just said?" "Well, I didn't mean it that way!" "Yes, and I heard it that way." So whose responsibility is it to get the actual intention across? The speaker's or the listener's?
One interesting thing about my arguments with my Mother is that when there is a disruption in understanding of intention like I described above, there is usually anger involved.
So I am back to my question: whose responsibility is it to create the communication, to have the communication go smoothly? The speaker's or the Listener's?
I learned in acupuncture school that it may actually be my responsibility to get my meaning across to my listener. So if I am getting feedback from someone that I don't like, or that doesn't match with what I thought I was saying, it seems like its up to me to figure out how to present myself in such a way that the other person gets it the way I wanted them to. This presents me with a fun, creative opportunity to examine what I really mean, and to look at the emotional factors that might be cluttering up the communication such that the other person is hearing something I am not thinking that I am saying. (Since we are all acupuncturists here, I hope I can assume that we have a common understanding that energy moves around sometimes without being seen or heard or felt on a really external level.)
Its sort of funny to hear the argument I have been having with my Mother for years come out in a public place.
Sandy
Re: Sustainable Acupuncture
I suppose I consider myself a bit of a word bird, so let's see if I can dive into this pond without getting anyone wet but myself.
I don't think anyone in CAN would actually use the term "boutique" with the conscious intent to imply that those practices which charge more money are less professional or less medically valid than a CA practice.
To be sure, biases can gradually creep in whenever egos rise up to do battle. Regardless of what words we use, the attitude behind the spoken or written language is far more operative in determining whether the outcome is one of reconciliation or polarization.
I see the introduction of this term as a little light-hearted "pricking and prodding". So far, nobody has said to me that CommuniChi is the factory warehouse of Seattle acupuncture, and if someone did, I would try not to let it bother me. (I might actually feel complimented at this toddler stage of our development). If I was really on the ball, I would grab the opportunity to try to engage the person in dialogue, try to understand them, where they are coming from, if there is something they have to teach me, or perhaps something I can share.
To me, boutique acupuncture (BA) is another name for luxury acupuncture (but more poetic and provocative), and that seems to be the meaning which most people are highlighting when they use the term BA. It does not necessarily imply all other meanings associated with that word (e.g. non-essential, If you look up any word in the dictionary, often times there are many referents listed for each word, and not all meanings are implied in any single usage.
I can see how the term BA might push some people's buttons and raise their hackles, particularly if they are assuming the term is being used in a certain way, but perhaps pushing a few buttons in our profession isn't necessarily a negative outcome in striving towards CAN's broader goals of social justice....as long as there is no underlying malice directed at anyone in particular.
Still, I'm not fixed in my view and I am open to being educated further on the possible harmful effects of using this word. Perhaps whoever coined the term, if they are listening, could weigh in with their opinion?
Okay, now tell me if I'm all wet, covered in algae, with slime dripping off me!
Re: Sustainable Acupuncture
I've called it the "conventional American practice model"
How many times have you called it that? Add acupuncture in there and say that 10 times fast! lol
Re: Sustainable Acupuncture
I've called it the "conventional American practice model", but that won't make sense when conventions change and there is more diversity in practice models available.
Re: Sustainable Acupuncture
It sounds like I was defending the word, but actually I have shied away from using "boutique" since the conference in MN, many of the practitioners found it insulting and that is no help to anyone. I usually say "private practice" but I don't love that either.
Re: Sustainable Acupuncture
I agree with much that has been said already regarding CAN type care and traditional practices but I have been considering the term "boutique" for a while after some difficult conversations with fellow acupuncturists that I respect.
I wanted to respond to the comment earlier:
I know people find "boutique acupuncture" offensive. Maybe we need a better word, but it really doesn't mean "spa" To me a boutique is a small place to receive individualized service on unusual products, it also implies expensive. I don't find that insulting at all."
The thing about boutiques are that they are luxury experiences, artistic rather than medical or clinical, most commonly used to refer to shops selling women's designer clothing. It does strongly suggest that a boutique practice is less professional/medical/therapeutic than a CAN practice. Its indicative in the term "boutique" and I can see how they find it offensive. While there are some greedy, unscupulous practitioners that I don't mind insulting, to use it as a general term to define traditional practices (in the us)is therefore problematic. I do think we need a better word. So far, I have started to just call them traditional or private practices. doesn't feel perfect either. any word merchants out there???
Re: Sustainable Acupuncture
Glad to see this is a good debate.
I've checked in several time today, and I'm very happy with the conversation. It's always nice to see where everyones' heads are at. I like the idea of a carry over effect into the children, my wife who used to teach in the worst part of Brooklyn started doing Yoga Breathing with her 3rd grade class and really so an improvement with some troubled children, it would be nice if it was re-enforced from other avenues.
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I think the exciting part of this conversation is the large percentage of the population who now have access to acupuncture and relaxation through CA clinics. I truly believe that if the people of world relax, and are internally harmonized, then who knows what would happen next on a global level? Teachers in our American schools are notoriously lower paid than some other occupations. What if we could offer them as much treatment as they needed? The carry over effect to our children would be wonderful. I could go on, but maybe you get the picture...
~"Pollyanna"
Re: Sustainable Acupuncture
"private style practice can be sustainable, agreeably not by everyone"
Patients who can afford private treatment are well covered but those people are a fraction of the population. CAN is here to serve everyone else. If people want to pay more for private treatment that's fine, but most just don't have that option, that's why we need CAN.
I know people find "boutique acupuncture" offensive. Maybe we need a better word, but it really doesn't mean "spa" To me a boutique is a small place to receive individualized service on unusual products, it also implies expensive. I don't find that insulting at all.
Re: Sustainable Acupuncture
I agree that there will be patients that may like private treatments so they can have more time with the practitioner. If they are able and willing to pay for this then that is their decision, and the practitioner's to charge more for this service. However, I do not want to spend all of my time with a few patients and charge a much higher rate if I can help more patients. So a CA practice is also a personal choice for me as I want to reach as many people as possible and make acupuncture accessible to as many people as possible. Money aside, there just are not enough hours in the day for me to see as many patients in a private practice as I can in a community setting.
I also don't feel comfortable charging that much for a service that I could not afford at that price myself. Rather than pick and choose who I will lower my price to on individual basis, I'd rather have my prices the same for everyone so I don't have to worry about the person that needs a "discount". I've been in practice since May and my average fee has come out to $ 25 a visit. I do have patients paying $ 15 for a treatment. I schedule patients every 15 minutes. I have had to convince people to pay less because I need to see them more often, and I'd much rather be insisting they pay me less and feeling good about it. Other patients paying more support the patients that pay less, and this is how the model works, and I don't have to worry about it. The key is the volume of patients will support the acupuncturist.
Acupuncture is effective in either style of practice, but you have to be honest with yourself and know what it is you want to give to the world. We're all different, and our patients are different. There is lots of room at this table for all of us to do good in our community whichever way we choose to serve.
Re: Sustainable Acupuncture
Perhaps, my writing was a little unclear. I in no way meant to lessen the effectiveness and necessity of CA. I was trying to express that both models work and are effective, but different. I do use all the treatment methods in CA as I do in private treatments, but they are modified a little.
I have never had a patient tell me they felt short changed, and I'm sure patients understand that each person gets an individualized treatment. I simply said that I wonder if any patients felt that way without mentioning it. I also did not intend to make it sound that patients don’t get similar results as private treatments, but some people would rather pay more for private treatments which allows for more patient-practioner interaction. I also feel that a good majority of my private patients do stay on until there conditions improve. I don’t feel that we a “cheapening” the field by performing CA, but I understand why the word “boutique” ruffles feathers.
The main points I was trying to convey, obviously not that effectively, is that both models work well, but there are definite differences in the mechanics of operation and that a private style practice can be sustainable, agreeably not by everyone.
When I originally posted this I was typing while Jason was and posted shortly after he had finished, I hadn't read his post and was not responding to it. The model definitely makes money and opens up treatment to more people, more often. By treating more people at less money a practitioner can easily earn the same or more than treating less people for more money.
Re: Sustainable Acupuncture
I find that CA acupuncture treatments can be just as powerful and effective as private acu treatments, and don't necessarily take longer to solve a problem. When I see a need to do some moxa or gua sha or bleeding, I find a way to do it, quickly, and I doubt that the other patients feel shortchanged. What I like about this new way of treating people is that I get challenged to think fast on my feet, I spend more time studying for my patients at night, I get juicier cases, I'm learning more, I'm meeting more great people, and I'm making more money than I did with my former practice. for me, it's a good fit.
I don't think I give bare bones acupuncture. A lot of my patients get a hefty dose of advice and explanation where it's needed, and I sometimes offer handouts for them to take home on topics that are too complicated for me to explain to them.
Jason, there is a certain rhythm that arises in a practice where many patients come in for treatment, and the practitioner knows how to treat them. Sometimes it feels like a dance of some sort. I think you might appreciate this if you observe at a CA practice that's been up for a while. It's like comparing you giving a lesson to one private student or giving a class to about 15 eager and talented students. You feel the qi moving more rhythmically and powerfully; it fills the room. I can dare to suggest this because I trained for two years in an Aikido dojo in San Diego.
I suggest that you visit other practitioners and ask to observe. After a while you will get a feeling for what you prefer, and what you choose will be right for you.
Re: Sustainable Acupuncture
Nobody is advocating everyone give up a private style of practice if it is working for you and your patients. CA isn't "the best" it just serves more people. Many members have "mixed" or "hybrid" practices.
The argument that private treatments are more effective than group treatments is incorrect. Most people quit private treatments long before they are completely healed, once they are feeling a little better they have to stop the expense. That is where community acupuncture is more sustainable unless you are treating clients wealthy enough that cost is no object.
Jason, you should join, you will see our goal is to make money. We are not providing charity at all. The founding clinic makes far more money than most expensive practices and that is what we are all working to achieve. We just happen to get an altruistic benefit in the process.
Re: Sustainable Acupuncture
I just logged on shortly after this was posted and feel a little on the fence about this topic.
I agree that many cannot pay $60-150 a week for extended periods of time, but I do see how the term "boutique" can be offensive to practitioners who only treat in a "private" setting. It appears that both models of clinic operation are valid and necessary. I was running a successful private practice in Long Island, NY for nearly 7 years before moving to MD (in Baltimore <1 year) and have recently (2-3 months) starting to switch some private hours to community style. Even though I didn't officially offer a sliding scale I did frequently reduce rates, adjust fees for multiple visits per week and setup payment plans for those who needed it. I think the problem private practitioners have with being termed "boutique" is that it implies that patients are coming in to get a facial and a rub down and only suffer from the disease of having too much money. Don't people who are financially better off, suffer from the same diseases, heart aches and problems that "working class" people have? Remember suffering is part of being alive.
Perhaps the term "working class" somehow makes community acupuncture appear lesser or second class to private treatments. I've only been using the community model for a short time and I really enjoy it and believe it is a necessary step to reach the larger mass of patients who cannot otherwise afford it. I have seen it work quite nicely and I've gotten the same compliments I'd get after private a treatment, but there is definitely a difference in the treatments performed in a one-on-one setting and in a community setting. Treating on recliners and not having patients in gowns limits certain points and techniques. Perhaps private treatments can accomplish more in less time.(Not arguing, just looking at both sides) Also, I often wonder when I am in community treatment and I do something different (ie: moxa, earseeds, tuina, cupping) for one patient do others feel cheated?
On a side note, I have offered free community style treatments to many of my private patients (yes, all of my patients, not just ones with less means) and some of the less well off patients have said they would rather scrape together the money to have the private treatment.
This term "sustainable," is also debatable. Every patient wants to get results, that's the reason they came in the door. If it takes 6 private treatments, at higher cost individual treatment cost and a short period of time vs. 20 treatments at a lower individual cost and a longer period of time to achieve the same results it may be a very hard choice for any patient regardless of their financial situation. If private treatments get people back up and running to where there is more time need between treatments isn't that sustainable as well?
I'm not trying to start a fight only voicing my personal dilemma and maybe trying to justify running both clinical models and being a "mixer." Oddly enough, I'm okay with that term.
It appears that arguing over a clinic model is about as effective as arguing over a style of acupuncture. Everyone will say the model they are using is the best. After all, if it is working for you and your patients isn't that all that matters?
Re: Sustainable Acupuncture
I enjoy your post, and I agree with what you're saying.
The only question I pose is then how do you make a good living?
I am not an acupuncturist, but I am considering going to school to become one. And I think if you can not take care of yourself, you are of little service to your patients (this is not an implication).
Besides my job in finance (so now you know why I want to switch careers), I also teach Aikido, and I firmly believe that the higher the quality I have to offer, the more that the output of my energy must be reciprocated by my students in effort and financial compensation.
But, equally as strong is my conviction that I must accept anyone who is sincere to study Aikido, regardless of if they can pay the full amount (and dismiss anyone who isn't sincere, regardless of their financial contribution).
I am not sure I would call this a sliding scale, but I don't have a better word for it. If a student can pay $125 a month for all the classes I have to offer, then good. If a student can only pay $40 a month, then OK and I keep that between them and me, with the idea that as they develop and grow, so will their life situation... that person may eventually become my top student and have a lot to offer the world through Aikido.
But I am not too sure this can be a reality in acupuncture.
So, my question to you is how can I open a practice, charge a decent amount so I can provide for my wife and kids, and yet not exclude those in need who maybe can not pay $50 or so a visit ?
I'll tell you this: my own acupuncturist charges $45/$50 dollars a visit, and I think it is well worth it, but I have not known him to ever turn away anyone, and neither would I. It would show a lack of compassion, a lack of quality, and a lack of good business sense because receiving $20 instead of $50 a visit is still better than receiving zero dollars for no visits, and on top of it knowing that someone who needed help didn't get it...
I just happened to this website, so I will try to check back or join, but a reply to my email address would be appreciated: jah@kuritajukuaiki.com.
Thanks!