What is Community Acupuncture?

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.

We all know from reading Lisa’s book, The Remedy, that CA was created from the perspective of offering a socially responsible healthcare service through the use of acupuncture and oriental medicine. Community acupuncturists want to provide access to healthcare to the vast majority of people; however, for business longevity, it is my view that we as practitioners need to understand and consistently apply a few basic principles related to interacting with our patients. For my acupuncturist orientations at WCA I compiled a list of similarities and differences between CA and typical acupuncture practice. I would like to share what I came up with here.

This table is my interpretation of the similarities and differences between CA and typical acupuncture practice in North America. I have purposely refrained from interpreting the data to see what other people come up with. Do you agree with the information presented? Please share your own thoughts about these ideas based on your experience as an acupuncturist or acupuncture patient. I’m sure there are some categories that I have overlooked in constructing this table, so please post possible additions and let’s discuss them.

- Moses

Similarities & Differences Between
Community Acupuncture Practice (CA)
Typical Western Acupuncture Practice (TA)

[b]Goal of Treatments[/b]

CA: rebalance body-mind through energy channels

TA: rebalance body-mind through energy channels

[b]Clinic Format[/b]

CA: small front desk area; wide open treatment room with groups of reclining chairs in circles

TA: one or more private treatment rooms with a table in each room

[b]Acupuncture Therapies Used[/b]

CA: primarily distal point acupuncture treatments; some bleeding therapy and electro acupuncture as needed; add patent herbs as needed (about 15% of time)

TA: direct and distal acupuncture, moxa, cupping, massage/ tuina, electro acupuncture, bulk herbs, patent herbs, lifestyle coaching, diet coaching, gua sha, hot rocks, aroma therapy, muscle testing, less practitioner consistency regarding treatment therapies used

[b]Acupuncturist Activity During Treatments[/b]

CA: check pulses, ask questions that help determine acupoint prescription, insert needles and leave the treatment room; walk by patients periodically (every 10 min or so) to check if patients are ready to be unpinned; minimal, efficient discussion (in whispers) regarding main complaints, simple, specific treatments focused on main complaints

TA: check pulses, insert needles on front of body, maybe add any of multiple other therapies, remove needles, maybe insert needles on back of body lots of discussion with patient as therapies are performed subtle; often complicated treatments

[b]Acupuncturist/ Patient Interaction[/b]

CA: less focus on the therapist as healer by having less time involvement with patients; more focus on patient healing; more opportunities to get to know someone due to treatment frequency; acupuncturist reads about patients health history on their intake form and focuses intake questions and treatment on their main complaint; Patient is unpinned after naturally awake, or at a specific time that is determined by the acupuncturist or patient

TA: long discussions about patient health history, acupuncturist needles patient and then times their session; may combine needling with other therapies as they see fit treatments focus on accuracy of application of theory through all of its complexities instead of frequency of treatments

[b]Cultivated Atmosphere/ Mood of Clinic[/b]

CA: casual, comfortable, calming, down to earth, inviting, warm

TA: exotic, exclusive, Asian, inviting, warm, calming; medical, clinical: practitioners often wear white lab coats

[b]Types of Conditions Treated[/b]

CA: all sorts; focus on pain and stress relief

TA: all sorts; some focus on non-medical spa type experiences

[b]Privacy Considerations[/b]

CA: "conversational economy": read the health history questionnaire before seeing the patient; only ask questions that are relevant to creating a diagnosis acupoint prescription; talk in whispers in the treatment room; focus on non-verbal communication during initial intake and follow-up check-ins; refrain from bringing patient charts into treatment room; treat all patients in the same large room have patient fill out paperwork related to financial policy, cancellation policy, health history, informed consent regarding Acupuncture and Oriental medicine therapies, arbitration agreement if required by malpractice insurance carrier

TA: conduct an extensive verbal intake after reading the health history; focus on obtaining and than protecting enormous amounts of personal medical information; treat patients in separate rooms or in rooms with dividers between patients; have patients fill out paperwork related to financial policy, cancellation policy, health history, informed consent regarding Acupuncture and oriental medicine therapies, arbitration agreement if required by malpractice insurance carrier

[b]Intake Duration New Patients[/b]

CA: 5-10 minutes

TA: 30-60 minutes

[b]Intake Duration Returning Patients[/b]

CA: 5 minutes

TA: 15-30 minutes

[b]Treatment Duration New Patients[/b]

CA: treatment is completed when patient naturally wakes up from restful state (average 45 minutes), or at a predetermined time. Patients may rest anywhere from 20 minutes to 2 hours depending on available reclining chairs or tables

TA: 20-45 minutes, always timed by practitioner

[b]Treatment Duration Returning Patients[/b]

CA: 20min - 2hours (average 45 min)

TA: 20-60 minutes or longer

[b]Price per Initial Treatment[/b]

CA: sliding scale $15-$40 plus $10 paperwork fee

TA: $50-$200

[b]Price per Follow-up Treatment[/b]

CA: sliding scale$15-$40

TA: $50-$200

[b]Frequency of Treatments[/b]

CA: primary focus in care is frequency; often 1-2x/ week, or more if needed

TA: usually 1x/week or 1x/month

[b]Bill Insurance for Acupuncture Treatments[/b]

CA: CA clinics do not bill insurance; provide receipts of service to patients that would like to submit a receipt to their medical insurance provider

TA: most typical acupuncture practices bill insurance

[b]Front Desk Operation[/b]

CA: the acupuncturist makes it a point only to be involved in the therapy part of the acupuncture process; all scheduling and handling of money are handled through a receptionist; this front desk structure allows the acupuncturist to stay focused on providing acupuncture care

TA: acupuncturist sometimes has a separate receptionist and sometimes does both acupuncture therapy and reception tasks

[b]Patient Retention[/b]

CA: overall high rate of retention, due in part to financial accessibility

TA: generally medium to low level of retention, based in part on financial accessibility

[b]Numbers of Patients seen[/b]

CA: patients scheduled every 10 minutes up to 6 patients per hour depending on how busy the schedule is that day

TA: patients scheduled every 20-60 minutes; 1-3 patients per hour

[b]Hope and Expectations of Patients[/b]

CA: encouraged by practitioner; given treatment plan

TA: encouraged by practitioner; given treatment plan

[b]Factors Outside of Treatment That Affect Patients’ Overall Treatment Results[/b]

CA: lifestyle, family/ community support, financial resources, work schedule, family/ community responsibilities (demands on time and energy), cultural customs

TA: lifestyle, family/ community support, financial resources, work schedule, family/ community responsibilities (demands on time and energy), cultural customs

[b]Clinic Competition[/b]

CA: very little competition between CA clinics due to the relatively small # of clinics open, and the large target market; CA practitioners actively encourage more CA clinics to open

TA: high level of competition for typical acupuncture clinics in certain areas due to more saturation per target market served in typical acupuncture practice

[b]Support for Acupuncturists[/b]

CA: community acupuncture network.org (CAN)/ National AAAOM/ local state acupuncture association

TA: national AAAOM/ local state acupuncture association