A Post For Those Considering Community Acupuncture

While I am grateful to be able to offer people ideas, support and an opinion on community acupuncture as most of us practicing are, I can’t help but feel that what I am saying has been fairly redundant and, at times, feels futile.  It seems to me there are often people posting within the CAN forums who are trying to decide if this community acupuncture thing is really for them – if they can really do it – if it makes sense – etc; and, similarly I have had phone calls, visitors, meetings for coffee, etc. with numerous colleagues eager to learn about what I do, what I think about community acupuncture, and all the whats, whys and hows of it.  While I am certainly happy to be able to help others (because that’s what CAN is all about!), I do think it is of value for me to share here publicly some of the fundamentals of what I tell each person who comes my way asking about community acupuncture, so I (and all of us) can refer them here as a jumping-off point either directly to joining CAN to learn more if they haven’t yet, or to being able to make a decision that this would not be what they want to do.

I'd love for other CA'ers to throw in some more thoughts about any of the things I address, or failed to address, with your own opinions - after all this is a big giant WE effort, and though we all essentially do the same things, we often do them quite differently.

I know that this blog is pretty much old news for most people who are already practicing, but I think it may be of use to those who are just browsing CAN at this time, checking out the blogs and thinking about community acupuncture.  Good for those who haven’t yet been to a CA training and may not be able to get to one for quite some time, etc.

While I am a community-acupuncture fan all the way, I do think it is important for people to consider whether or not this model is in fact right for them.  While I am certainly enthusiastic about what we do and am likely to talk it up, I do believe like many of us that if practicing this way is not in your heart of hearts then it is not the work you are meant to be doing and ultimately will not be a peaceful or successful path for you.

Before delving into the Q & A’s, I’d like to just start out by sharing a little of my own personal experience - the MOST valuable things I did to prepare myself for starting and working in a community acupuncture practice were:  1) Visiting other clinics and being treated in them – go to as many as possible – and see the set-up and get a feel for what you like and don’t like – then take that information away with you and implement it into your practice, 2) going to a CAN training session, 3) scouring the CAN forums, 4) working part-time in another community acupuncture clinic first (a lucky and rare situation, I know).

To answer some of the most common questions that I have heard from several people considering practicing in this way:

Who do we treat?  - I treat students, people in their 20’s & 30’s, middle-aged, older folks, straights, gays, blacks, whites, Hispanics, secretaries, coaches, social workers, retirees, baristas, unemployed people, teachers, mothers, house cleaners, writers, small business owners, consultants, photographers… essentially all kinds of people – and I love it.

What do I treat?  - pretty much anything that a person would come to acupuncture for – and yes, I do it with them seated in chairs.  I do have tables as well - occasionally I use them, but not as often as the chairs.

What do I/we think of “hybrid?”  What if someone wants a private room?  What if someone needs more time and attention?  What if someone is very “needy?”  Should I alter my sliding scale to a higher rate?  If someone is willing to pay you more for a private session, do you do it?  – We can’t be everything for everyone.  If someone wants a private room, they can go to someone else.  If someone believes there is such a difference for a group treatment than from a one-on-one treatment and thinks they need such a setting, or that they will be uncomfortable being seated in a chair in a room full of other people then they aren’t meant to be your patient if you are adamant about practicing CA style.  If someone is very “needy,” they can go to someone else – or they can figure out a way to be treated appropriately in your setting without requiring exorbitant time and effort from you (this, of course, can be tricky – and is something that can happen to any health care provider in any setting).  
What is important to note is that most of us CA’ers have treated patients who have had treatments on tables in private rooms before and had no noticeably better outcome in terms of quality of care or results as they did to a community treatment.  Ultimately it comes down to the person being able to get acupuncture as often as they need it - this is truly the key - as well as feeling comfortable with the setting they are being treated in and with the practitioner they are seeing.

How can you treat so many people at a time?  How long does it take you to get there?  Do you really have to be so great at Dr. Tan style from day one?  How did you get to that point – how much studying?  - Many of us who practice CA book follow-up visits every 10 minutes and new patients every 20 or 30 minutes.  Of course, there are variations, and many start slower – such as with 3 or 4, eventually working their way up as they get more comfortable with it.  The truth is, nobody who opens a new practice without a patient base is going to automatically be slammed with 6 per hour, hour after hour – so there is little to worry about.  As you get more grounded with it, things will get busier, and it will start feeling more natural and relaxed.  There is also the idea that you shouldn’t worry so much about learning to practice – you practice to learn.  The more acupuncture you do, the better you get – so of course some of the initial treatments that you are doing in this model, if using Tan style for the first time, for example, will be a little hit or miss – a little experimental – not as elegant as you’d like - and, ultimately, you will find out the things that really work and they become your “go-to” strategies whenever you are faced with particular problems.  When I first started I did have to think hard about what to do for shoulder pain, neck pain, upper back pain, wrist pain, etc.  Now it is pretty automatic for me – I have my little bag of tricks that I can go to – and then, as with all acupuncture, if you aren’t seeing results you re-evaluate the situation – did you diagnose properly, did you use the appropriate strategy of points, what else can you do – and try something else.  The more acupuncture you do, the more likely you are to get good results the first time, and when you don’t, you have better back-up plans.
It is also a good idea to start out with a few simple protocols in mind and then branch out from there.  For instance, the Miriam Lee combination (LI-4, LI-11, LU-7, SP-6, ST-36) for many internal medicine issues or Ling Ku/Da Bai/Zhong Bai/SI-4/LU-6 for low back pain.  Then throw in a few other points here and there to add to the basic combination and round it out in a way that is a little more personalized for the patient and for you – jingei pulse can be added if you are into that, or Master Tung, or whatever resonates with you.  Some community acupunctures do Japanese treatments – there are many possibilities!

“Shoulds” vs. desires – the “right way” vs. the “wrong way” – A few people who are considering working in this model ask me what “the way” is to doing things – “should they do things this way or that way?” - the answer is, the way that works best for you.  Obviously if you are a member of CAN and an avid reader of the forums you will find a goldmine of information – and with that, you can do what you’d like.  In addition, if you visit several community acupuncture clinics (HIGHLY RECOMMENDED!), have a treatment and take a look around, you will find the things that you get excited about and would want to do in your own space, and the things that turn you off and you would never want to do in your space.  And the things that you will keep in the back of your head as possibilities to implement in the future, perhaps.

Can I do the work part-time?  Can I divide my time between two careers?  If you want to have your own clinic, I would highly suggest NOT dividing time between two careers – some ‘punks do have part-time jobs that they transition out of as they start their clinics and get them going.  Obviously you have to make the decision and know whether or not you will have enough qi, time and money for all these.  Having a “part time practice” that is only open a couple days a week is not substantial enough, because you will end up doing your patients a disservice – if you really want them to be able to get better, you have to be available enough for them to come as often as they need to.  And if you are only open once or twice a week, this isn’t going to cut it.  If you want to practice community acupuncture and seriously want to in your heart of hearts but it isn’t going to work for you to do this more than part-time, then your best bet is to find a clinic where you can work as an acupuncturist without having to run things.  Running things takes a lot of extra time, work, energy and planning – especially in the beginning.  Until the clinic is up and running and things seem to be going smoothly, it is an awful lot of hard work.

What do you think of a partnership vs. a solo practice? -  I think this depends on your personal preferences, what you want and who may be out there to work with.  If there is someone you are considering partnering with, make sure you are upfront and honest with them about all the things you want, and don’t compromise too much or you will risk being resentful and unhappy.  Make sure you are on the same wavelength with how you’d like to run things, and that you feel that you can each put in the same amount of time and effort.  Consider whether having a partner will make you more or less motivated.  There are ups and downs to both situations – when you have a partner you have someone to cover for you if need be, or to take care of 50% of the tasks (ideally) – however, you also have to take time to make decisions together – which could be an awful lot of decisions – and this also takes emotional energy as well.  If you are the only boss, you call all the shots and do things your way – but you also have a little more pressure in some ways to make sure it is all done, without having someone to help you out.  On the other hand, you don’t have to worry about trusting someone else to get things done – so, it’s really a matter of personal preference.  One of the most wonderful things about being a community acupuncturist and having your own practice is the autonomy associated with it.  You can choose the way you want to lay out your space, what you want for supplies, how you want to schedule people, hours, the way you interact with people, the routine for getting them in and out, etc.  There are ways to learn this – trial and error being most common, as well as asking patients for feedback and hearing their comments.   Start with something and if it doesn’t work to your liking, change it.

Where should I put my clinic?  What size do you recommend?  What kinds of chairs do you use or would you recommend?  Where did you get your supplies?  Do you recommend heat lamps, blankets, towels and/or sheets?  LLC vs. Sole Proprietorship?  How much were your start-up costs? …  For all these nitty gritty details AND MORE, join CAN and READ, READ, READ the forums – you will find whatever you need – plus more!  And if you don’t – post a topic, ASK questions and you will likely get feedback!

Best of luck to y’all with your decision-making and acupuncture careers, whatever they may be!

This story was posted on January 15 2009 by Justine.

Comments

  • January 15 2009 at 11:52 PM
    david villanueva writes:

    A couple of comments.

    I have not had anyone yet ask for a private room. I think this may be because most of my clients check out my website first, before their visit. And also, they read the Welcome Letter to new patients, once they’re in the office, which describes how the office is set up.

    Re LLCs—not allowed in California for acupuncturists.

      0 likes
  • January 16 2009 at 9:20 AM
    Guest writes:

    Excellent, Justine

    Great summary and a great post for those considering a CA to read.  THANKS!

      0 likes
  • January 16 2009 at 10:13 AM
    Ben writes:

    Excellent post for those searching for info on CA

    One thing I can add, is that as of late, it seems a lot of the acupuncture form is centered around Dr. Tan’s Balance Method and Tung Style acupuncture.  I think some reading various posts come to believe that they need to do these styles to run a CA style of clinic.  This is absolutely NOT true!

    Chinese acupuncture of all different styles can lend it self to treating patients in chairs.  So if your considering CA but have a different way of needling, please do not be discouraged or think to have to change the way you treat with needles.

    all good medicine,

    Ben 

    The People’s Acupuncture Clinic

    “health for the people… by the people.”

    http://www.thepeoplesacupunctureclinic.com

      0 likes
  • January 16 2009 at 11:20 AM
    Nora writes:

    Patients’ FAQs

    Great post, Justine.  I think a lot of times what trips up potential CA punks is that acupuncture/CM students are taught to worry about things that are not essential, or that patients don’t necessarily worry about.  Sure, occasionally you have a patient who is a loud talker (perhaps due to poor hearing), or a patient who is “demanding”, or a day when patients cancel, or don’t show, or come late, or come early, or drop in curious—or in acute pain, or bring along an unscheduled friend who wants to try it…often all on the same day.  It’s really fun (and great practice for life!) to be able to roll with this kind of thing, and it’s because of the whole setup being simpler, more elegant. 

    I think that’s what I’d like to communicate to potential CA punks: you think it’s going to be harder or more complicated, but once you unlearn a lot of what you learned in school, it’s MUCH easier and simpler.  It may be partly a process of self-selection, but I think this kind of practice evokes less “needy” or “demanding” behavior - partly because
    they’re not left alone in a room, full of needles.  It’s so easy to
    glance around the treatment space and see if someone looks a little uncomfortable, and so
    easy to correct that.  The other night I had a few patients “cooking” and one of them started coughing - a loud, painful-sounding cough; I
    came over and whispered that I was going to add a needle for his cough,
    inserted SI1, and he didn’t cough for the remainder of the treatment.  So easy!   I also never have people faint anymore.

    In terms of what patients actually care about, I’m curious about other practitioners’ experience with FAQs.  Now that I’m living in a very different kind of town, it’s interesting to notice that most potential patients still ask the same kinds of questions, the main two being “can acupuncture help me with ________?” and “how much does it cost?”  Sometimes they ask if it hurts; sometimes they ask how it works.  Very occasionally (once they are already in the office) they ask me where I studied, or how long it took; sometimes they ask if the needles are sterile.  I’ve never had someone ask to see my license or my diploma.  Around here, people don’t necessarily know that acupuncture is “supposed” to cost upwards of $50 per treatment, so when they find out how much I charge, some of them say, “oh, that’s reasonable,” and others just nod and I can see them making mental calculations.  Nobody is weirded out by the sliding scale, or the open room, and lots of people offer up their own spontaneous understanding of the reasons for it (including the community qi).  It’s really cool.

      0 likes
  • January 16 2009 at 11:29 AM
    Nora writes:

    you don’t HAVE to…

    Hey Ben, on principle I agree with you, but:

    1) Other acupuncture systems can be more—or more rapidly—efficacious, which increases both patient and practitioner satisfaction; 

    2) Dr. Tan’s system in particular mostly relies on points students already know, AND lends itself to distal treatments, which makes everything easier (same goes for Jin Gei tx);

    3) It’s fun to keep learning, and to have different tricks up ones’ sleeve.

    In general I suspect that the most important thing is that the treatments work well for patients, and that the style resonates with the practitioner - and I think these things are linked (I have the experience of duplicating other practitioners’ point prescriptions and them not working as well - I think because I didn’t understand the reasoning behind them and therefore had a hard time focusing my intention).

      0 likes
  • January 16 2009 at 12:21 PM
    chrisk writes:

    Nice post, Justine

    I think this will be very useful for folks considering CA.  I especially agree that visiting as many CA clinics as possible is an essential part of the learning process.

      0 likes
  • January 16 2009 at 1:51 PM
    chaitime writes:

    .

    just wanted to say thanks to the experienced CAers chiming in adn keepin it real… these posts are SOOOOOO helpful. 

      0 likes
  • January 16 2009 at 3:42 PM
    Ben writes:

    I have never seen evidence of one method being more efficacious

    I would agree it may be true that we all may be able to be more efficacious with one system or another, but  I fail to see practitioners who have mastered their craft being less efficient or effective than Dr. Tan.  In fact, I would argue the opposite.

    Just because our education is lacking in a certain method, doesn’t make another that we have understood  in more depth better than the other.

    all good medicine,

    Ben 

    The People’s Acupuncture Clinic

    “health for the people… by the people.”

    http://www.thepeoplesacupunctureclinic.com

      0 likes

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