Boutique Acupuncture and Other Sundry Notions

Recently PCA put out its newsletter that was mostly filled with notices about our new hours, thanks to volunteers, and a welcome to our new hires.I wrote a little article about Community Acupuncture and how it is fostering more community and widening the circles of people who are connected in some way through the clinic.I began the column with the words “One thing I love about CommunityAcupuncture…”Later, I commentedto one of our front desk people, that I wanted my next newsletter to begin something like, “One of the things that really pisses me off…”Anyway, we distributed the newsletter electronically to over 200 people, and had copies available at the desk.One of my friends and fellow acupuncturists received my newsletter and was really upset because I used the words "boutique acupuncture" in the following sentence: “PCA would not exist if it were not for the community of friends and patients that has made it possible over the past year and a half for us to successfully offer acupuncture in a setting that is totally different from the “norm,” and with a fee structure that is atleast half, if not a third, of the going rate in typical private room or“boutique” practices.”

The term “boutique acupuncture” raises some hairs with CA practitioners and other, well, BA practitioners.I don’t always use this term to describe a non-Community Acupuncture practice, sometimes I say “private room” or “standard” because I know that when people become defensive they’re not as open to communication, and for some reason I am compelled to talk about acupuncture, healthcare, politics, economics and social justice whenever I can.What causes folks to react to the word boutique when it is placed with the word acupuncture?Does “boutique hotel” cause discomfort?Some who are offended by the term “boutique acupuncture”feel that it belittles or trivializes Oriental medicine or its practitioners. It has also been suggested to me that “boutique acupuncture” is a dig designed to elevate the status of the burgeoning CA movement.

Rather than being a cheap shot at others, I believe that “boutique acupuncture” creates discomfort which is necessary and beneficial.It is a critique of the way acupuncture is primarily taught and practiced as a business model in this country, and if the individual feels implicated by this critique might I boldly suggest that they are struggling with their own conscience and not some insult I have hurled at them.Boutique acupuncture does not describe the quality of caringthat a practitioner holds for his or her patient, but the manifestation of that caring through a reality based context of economics, class and social structures.As a practitioner you might have the best needling technique, and the purest and strongest qi possible from years of meditation.This will not benefit anyone who cannot pay for or otherwise access your services.

Boutique acupuncture is a descriptive term. The edge implicit to it is one that I am interestedin exploring more, especially with those who are pricked, prodded, or provokedby it.People have said to me that the word boutique implies a superficiality, or falseness.Many words convey layers of meaning some very subtle.The word’s roots are related to the word apothecary and it’s dictionary meaning is a small shop that specializes in a particular range of goods, for example, clothing.The word boutique shares the same root as the word bodega, which in Spanish speaking communities is simply a small neighborhood store that sells food and other sundries.Perhaps the perceived meaning of boutique to mean falseness relates to the empty promises of consumerism and creates discomfort when we think of acupuncture as a fluffy consumer product.Talking with a friend recently about this, she said “boutique” made her think of poodle grooming and nail salons.It is easy for this word to conjure these same images for me, and yet the word boutique is actuallyconnecting the practice of acupuncture to something far more damaging than grooming salons.

If you don’t know about “boutique medicine” also called “concierge medicine,” it is a type of practice, also referred to as a retainer practice,that charges patients an annual fee in order to be seen by the practice on an ongoing basis.Besides the retainer fee, other office fees must be covered by the patient’s insurance, or if the patient does not have coverage, it is and out-of-pocket expense. The desirability of these retainer practices is supposed to be that you never wait to see your doctor, and you have more one-to-one face time with the doctor.Financially, this kind of practice would only be a choice for someone who 1) has the money to cover the full out-of-pocket expense for their medical care or 2) has insurance plus enough discretionary income to afford the annual fees for the retainer.These fees are typicallyaround $1500/annually.At two different “boutique medicine” websites this annual fee was likened to the priceof “one latte per day”, or “a typical monthly cell phone bill.”The marketing points to the target consumers and as the divide widens between those who can pay for services like healthcare, and those who cannot, there will be more of this type of exclusive, individualized service offered. Boutique trivializes medicine in this context, because it makes it sound like something people can order with or without extra foam.  

Good marketing always considers first who the target consumer is.Who the consumer is, usually cuts across a variety of qualifiers, for example: younger people, older people, sick people, women,  people of color, people who travel for work, etc.But if the bottom line of marketing is to get someone to purchase/use/or consume something, and if this thing involves some sort ofpayment/cost, then it would follow logic that the target market must be able to afford what is being marketed.An objectionable aspect of marketing is that it is often designed to convince people to buy something they don’t need, or spend money that they don’t have.This kind of marketing is deceptive and preys upon people’s insecurities.This kind of marketing can be downright manipulative and predatory.T.V. commercials aired during Saturday morning cartoons, credit offers with outrageously low interest rates that jump to outrageously high rates in a few months, the sheer volume of advertisements seen by the average person in a single day (about 3,000), and the billions spent to spew these messages, all speak to the power of the Almighty Dollar.

“Money=Power”, “Put yourmoney where your mouth is” (yuck!), “The buck stops here,”currency is a measure of value.How value is assigned is sometimes vague and mysterious and seemingly arbitrary.Other times entire systems and institutions, are designed to value one thing over another—think about the electoral system and the right to vote, how about schools and standardized testing, or the “correctional system.”  Institutionalized values are many times designed to value some people over others, also called racism, or classism or sexism.  

Value can mean an expressed worth, for an object, a service, or even a perceived image, or it can mean a moral or principle that governs one’s words and actions.  Many of the internal values that help us to make decisions have been replaced in our culture by the choices dictated by consumerism.The only real choice in this mad model is to buy, buy, buy, spend, spend, spend, and to always be wanting, and wanting more.Satisfaction is obtained not through being or doing, but by getting and having.A boutique is some place you go to shop, or to get.Subtly, the word describes a power dynamic of class.Not everyone has the money (or power) to obtain acupuncture, or any kind of healthcare service.As acupuncturists, we control who has access to our services and we communicate this by where we set up our practices, the environments we create in our offices, the clothes we wear to work, the language we use to talk about what we do, the fees we charge, and how we envision the future of our medicine.

Acupuncture and Chinese medicine in an abstract sense is a set of ideas about the function and well-being of humans and their environment.More concretely it is the use of a variety of practices that facilitate balance, harmony, and health.The context of Chinese medicine has varied over the thousands of years that it has been practiced.It has been medicine to help feudal workers keep working, it has been the royal medicine of Imperial China.It has  been obscured and driven underground, and it has emerged anew in new lands with new cultures surrounding it.Without a social or economic context for its practice though, acupuncture and Oriental medicine is difficult to define, and in the context of  post-modern American culture, it takes on new qualities.

One of these qualitiesis that acupuncture and Oriental medicine is a marketable product.The “product line” consists of aplethora of services including needling, bleeding, fire cupping, use of moxasticks, moxa wool, stick-on moxa,gua sha, ion-pumping cords, patchipatchi sparkers, micro-current, TENS units, cold lasers, tei shin, dermal rollers, plum-blossom needles, 7-starneedles,etc., etc., thousands of herbal products, pills, powders, liquids, topicals, supplements, probiotics,exotic juices, toe spreaders, exercise balls, neck pillows, braces, and the list goes on, and on.Diet and lifestyle advice, qi gong, and the theories from whatever training has been had—Five Elements, TCM, Toyo Hari, etc.—are the pillars of what we call AOM, but they are also marketable angles on the ultimate product: the delivery of treatment and the promise or hope of healing.Acupuncture and Oriental medicine in these modern times is an expansive niche market.Those wishing to exploit these income potentials are like the proverbial kids in acandy shop.

The theories, products and tools of the practice are a mere corner of the market.Other profitable areas included:  schools, degrees, proposed board specialties, national certification, and recertification,proposed new and improved degrees, and post-graduate degrees.There are practice management seminars, billing software, a smorgasbord of continuing education classes that range from a day long practicum on tui-na, to a two-year commitment to flying across the country, staying in hotels, eating out, renting a car, etc. etc.Like the practice of Western medicine, Oriental medicine is susceptible to our societal tendency to value things with higher price tags, more letters, and a perceived unique, custom, individualized flare.Societal values driven by advertising and consumerism are at odds with those with an inherent altruism, the kind we want to feel during the holiday season, rather than the crazed impetus to buy.When I look at Acupuncture Today, what I see first is all of the marketing directed at me, trying to get me to spend my money to be “a better practitioner.”The only thing that I ever read in AT that actually offered me real advice on how to succeed as an acupuncturist, was pulled.Why? Because it didn’t fit into the structures that acupuncture as a profession reveres.

So while some may still take offense to the term “boutique acupuncture” it is hard not to see thatChinese medicine is for sale, and the majority of “stores” that sell it, are small shops that specialize in these particular practices.I believe that the individual connections many acupuncturists have with their patients, and the level of commitment to the patient’s well being are based on values like compassion and service.I believe that many people choose acupuncture as a profession because they want to be of service to others.There is more than one context in which we can be helpful and compassionate with our medicine, and that “boutique acupuncture” upsets some makes me wonder if they can see the necessity for this range.For most of us, no matter what type of acupuncture we do, there is a bottom line that is if we do not generate “enough” income from our practices—and “enough” may vary—we cannot practice.For our patients the bottom line is, no matter how well we sell them on acupuncture’s effectiveness, with research and doctor like persona, they will not come if they cannot afford it.

Practicing acupuncture may be about expressing your values, but it is not these values that our patient’s pay for and that is why many acupuncturists struggle to make a living at their chosen work.The monetary value, or price tag, is what our patients have to justify in their budgets.Their values may align with ours, and it is likely that they value their health, but if the treatment is not producing the desired effects, or is at odds with other necessities, they cannot reasonably value our treatments the way we need them to.We need them to value what we do in a concrete way that pays the bills too.Having their belief in our medicine, their testimony, their appreciation, is the icing on the cake.We need to have a cake to eat before we ice it.

If the term” boutique acupuncture” makes you feel like acupuncture is being compared to having your nails done, it should.For many people acupuncture is still a non-essential luxury that bears some importance because it makes them feel good.When the majority of acupuncture patients access acupuncture through economic and social structures that are different than the highly medicalized, spa-ified, private practice, prestige oriented, managed care, top-down approach of now, this term will become obsolete.I look forward to the day of “corner-store acupuncture,”“neighborhood acupuncture,” and “breadand butter acupuncture.”

This story was posted on December 1 2008 by crismonteiro.

Comments

  • December 1 2008 at 1:51 PM
    Guest writes:

    Do

    Do “boutique/concierge/retainer” medical practices accept third party insurance, or Medicare? No. They are providing extended medical services which are not covered by Medicare (or other insurance companies). To this end they ask that you NOT submit fees to any insurance company, particularly Medicare, for reimbursement.

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  • December 1 2008 at 4:25 PM
    River Jordan writes:

    invisible Elephant

    Hi Cris,

    Thanks for your incredibly thoughtful, compassionate, and wise analysis of the acupuncture profession. There is much to take home in your critique, and for those who wish, to reflect on as we look in the mirror. 

    I spent time over the weekend with a white friend who is doing a lot of work in learning about white privilege and questioning the societal structures that hold the racist status quo in place. “Racism” or “racist” is probably another word - like “boutique” - that will raise people’s hackles, putting them on the devensive.

    It takes skill, sensitivity, and some bravery to speak your truth in the justice arena, knowing some will likely resist or even counterattack. To make clear your compassionate intent - which will most likely resonant with nearly all acupuncturists - seems critical, and you have done that admirably well. 

     

    All true religions seek to gain access to that level of consciousness which is not ego-bound.&a

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  • December 1 2008 at 4:28 PM
    River Jordan writes:

    Relevance?

    I know the original post was full of many reflections, but I am not able to understand the relevance of your post to the main themes above. Perhaps you could clarify? 

     

    All true religions seek to gain access to that level of consciousness which is not ego-bound.&a

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  • December 1 2008 at 8:42 PM
    Guest writes:

    Hi river. If Chris is going

    Hi river. If Chris is going to prick, prod, or provoke, her statements need to be credible. Do you disagree? Sarah

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  • December 1 2008 at 10:18 PM
    crismonteiro writes:

    Sarah, I have first hand

    experience with every part of what I wrote above with the exception of  the part about boutique or retainer practice.  I included that part to clarify that boutique acupuncture was not attempting to be the acu-version of those type of medical practices… no close parallel even since acupuncture still hasn’t gotten on the managed care boat enough to bail on it.  

     

    I believe you are correct in that boutique medical practices do not take insurance… which makes them all the more the medicine of those who already have access to many resources.  I am wondering your intention in pointing out my mistake?  Does it make the rest of what I wrote irrelevant?   

     

    Cris

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  • December 2 2008 at 12:53 AM
    River Jordan writes:

    best one liner of the week

    “Acupuncture still hasn’t gotten on the managed care boat enough to bail on it.” 

    All true religions seek to gain access to that level of consciousness which is not ego-bound.&a

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  • December 2 2008 at 1:29 AM
    Guest writes:

    Hi Cris. My uncle has a

    Hi Cris. My uncle has a “boutique/concierge/retainer” medical practice. Now that he limits his practice to 500 patients, he’s able to see his patients more frequently and regularly. He’s able to do this because he no longer takes insurance. Moreover, at least 3/4 of his patients are people that don’t have health insurance. Why does he have so many uninsured patients? Because he wanted to make his practice accessible to those that need care but can’t afford it. He does this by charging each adult patient $50/month. Each patient can see him as often as they need to without any additional out-of-pocket expense. This is very different from how you portrayed “boutique/concierge/retainer” medical practices to support your overall theme. Granted that there are those that cater to “those who already have access to many resources.” I showed him this tread, and he really didn’t understand why CAN needs to prick, prod, or provoke when it can simply lead by example. He commented that it appeared to him that CAN was trying to sale/validate CA to patients and other L.Acs when it doesn’t really need to. So, my intention in pointing out your mistake is to say that inaccurate statements, even if it’s only one, can hinder the rest. Sarah

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  • December 2 2008 at 10:01 AM
    crismonteiro writes:

    Hi Sarah,      You seem to be pricked in some way

    by my mistakes and inaccurate statements, but say nothing about the rest of what I wrote.  My misrepresentation of “boutique/concierge/retainer practices” still really isn’t that far off the mark and yet it seems to create a lot of doubt  for you about the rest of my comments.  

     

    I have only done a little research on the type of practice your uncle has, but it seems to me that some of these practices do accept limited insurance, and the number of such practices according to the Society for Innovative Medical Practice Design only lists 42 practices nationwide that provide reciprocal services for patients served by similar practices.  http://www.simpd.org/nationalcarenetwork/indexdir.cfm  

    This year SIMPD reports between 200-300 members which if each of these practices serve 1,000 patients and 3/4 of them are uninsured, that is still only 225,000 patients.  This is less than 5% of the 46 million uninsured Americans and while every bit helps, it would be inaccurate to represent these type of practices as the solution to the problem of so many uninsured people.

     

     I actually like the idea of simplifying the delivery of Western medicine, particularly primary care and I am glad people like your uncle have decided to try something other than “Mangled” care.   But the reality is that these doctors, like us, need to have patients that can pay their fees.  While some of these patients may be the same ones who cannot afford health insurance, the larger looming problem of a healthcare system driven by greed and profit, in the guise of science and progress is not going to simply follow the lead of a few altruistic practitioners without a bit of hell raising.

     

    The parallels between “boutique medicine” and CA are actually closer than BM and BA.  Both BM and CA have emerged from a economic reality, but I believe both must convey to their patients a true desire to work outside of the existing systems driven by the values of Big Pharma and Big Insurance.   One value of community medicine, whether acupuncture or otherwise, is the quality of the relationships present.  A selling point of BM practice is the face time with the doctor.  CA does not generally provide a lot of face time, but it does provide a lot of silence, and a peaceful break from the busy environments most of us live and work in.  A lot of BA practitioners want their face time with patients and see it as a necessity.  A lot of CA practitioners see “a lot” face time as an impossibility within the model of offering treatments in the $15 to $40 range.  However, if you survey patients of CA clinics, as many of us do, the majority of patients actually comment on how caring and friendly the practitioners are.  They feel cared for AND they can afford to come for treatment.  At this point I would not want the extended face time with my patients even if it were possible.  My treatments are more focused than ever and I am able to convey my concern for my patients without a lot of talk.

     

     Boutique acupuncture practices generally provide services in a way that is dictated by the people who can afford acupuncture at $65 on up.  Different populations need different things from healthcare, and different populations want different things from healthcare.  The label boutique in part describes the patients being served by the practice model of acupuncture taught in our schools. Does this mean these patients are superficial? or shallow?  No, nor does it follow that most people need or even want a lot of talking about yin yang theory or damp foods in order to benefit from acupuncture.  We don’t need to sell patients on acupuncture with a lot of talk and explanation, if they can access this service they can judge for themselves its effectiveness.  

     

    My hope is to “sell” to you and others who are drawn to CAN for some reason that there is much work we need to do and without some fire in our bellies, the giant machines bearing corporate logos aren’t just going to back away.  I don’t think it is possible to just think that CA is a good idea without becoming aware of the classist, elitist, greedy way that acupuncture is being “legitimized.”  As the practice of medicine in this country moved away from the patient/doctor relationship to the patient/insurance company and doctor/insurance company/drug company model, surely there were some who protested.  The grab for power and money by the AMA and others made sure to silence those voices as much as they could by “debunking” practices like herbal medicine and midwifery, those that were less profitable.   CA has been accused of “cheapening” or “devaluing” Oriental medicine.  Does this in any way limit the effects we have with our patients?  Not at all, but it may scare some acupuncturists away from trying this model.

     

    I don’t believe that I will need to “sell/validate” CA to patients.  I do believe that letting them see the fire in our bellies is integral to the success of our clinics and  our ability to change the dominant structures of our profession.   It is mainly acupuncturists who doubt the ability of acupuncture to do good, unadorned and without white coats, adjunct therapies, lifestyle advice, and price tags that patients can “commit to treatment with.”

     

    A few more questions as I am interested in your uncle’s type of practice:

    —why did he decide to do this type of practice?

    —what are the demographics of the patients he sees?

    —what type of marketing does he do?

    —Does your uncle think that most of the “boutique medical” practices are in

    business in an effort to help uninsured patients?

      

     

     

    Cris

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  • December 2 2008 at 10:18 AM
    Kung Fool writes:

    What about the Poodles?

    I don’t like it one bit that poodles are being

    picked on in this piece.  After all some of my

    favorite four legged friends are poodles and

    if they’re good enough for the first family,

    they should be good enough for everyone. 

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  • December 2 2008 at 2:28 PM
    Guest writes:

    “Hi Sarah, You seem to be

    “Hi Sarah, You seem to be pricked in some way by my mistakes and inaccurate statements, but say nothing about the rest of what I wrote.  My misrepresentation of “boutique/concierge/retainer practices” still really isn’t that far off the mark and yet it seems to create a lot of doubt for you about the rest of my comments.” You assume too much here. I didn’t say anything about the rest of what you wrote because it stands on its own. Were you looking for a pat on the head? “I have only done a little research on the type of practice your uncle has, but it seems to me that some of these practices do accept limited insurance, and the number of such practices according to the Society for Innovative Medical Practice Design only lists 42 practices nationwide that provide reciprocal services for patients served by similar practices. http://www.simpd.org/nationalcarenetwork/indexdir.cfm” First, they can’t accept insurance for extended medical services. Second, SIMPD doesn’t represent all “boutique/concierge/retainer practices.” “This year SIMPD reports between 200-300 members which if each of these practices serve 1,000 patients and 3/4 of them are uninsured, that is still only 225,000 patients. This is less than 5% of the 46 million uninsured Americans and while every bit helps, it would be inaccurate to represent these type of practices as the solution to the problem of so many uninsured people.” I never represented it as such. So, how do CAN’s numbers compare? “We don’t need to sell patients on acupuncture with a lot of talk and explanation, if they can access this service they can judge for themselves its effectiveness.” This was my uncles point. “why did he decide to do this type of practice?” Because he wanted to make his practice accessible to those that need care but can’t afford it. “what are the demographics of the patients he sees?” He provides services to people in a rural town, mainly working class. “what type of marketing does he do?” He doesn’t do marketing. He thinks it’s unethical. “Does your uncle think that most of the “boutique medical” practices are in business in an effort to help uninsured patients?” Yes. By the way, I’m a CA patient, and I’ve liked reading your posts the most. That’s why I stated that “you assume too much here.” I agree with what seattle jill has stated in another tread, and, so, I will no longer be participating on this forum. Sarah

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  • December 3 2008 at 11:05 AM
    Nora writes:

    naming

    Cris, I haven’t commented yet because there is so much here.  But I really appreciate you taking on the issue of terminology.  Naming is an activity loaded with power, and I’m glad that you are not shrinking from the responsibility it entails.  I’ve got your back - not just because you’re calling things like you sees ‘em, but because you are thinking hard about it and calling on all of us to do the same.  Thank you!

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  • December 3 2008 at 9:11 PM
    crismonteiro writes:

    The connection

    I am making between boutique medical practice and boutique acupuncture practices is that they both are marketed towards a particular type of consumer, that is one who has the money to pay the price for the services offered.  Some boutique medical practices find this model a better way to offer their services to a wider audience, and to include those  who may have limited access to care through other means like health insurance.  In this way Boutique Medicine is more like Community Acupuncture.

     

    Some boutique medical practices, intentionally or otherwise, are capitalizing on the dysfunctional system of healthcare we have in the US.   The advent of a two tiered system may not be that far off, and healthcare for the wealthy will be the area of care that many doctors will strive to be in.  The standard for acupuncture practice until recently has been in a way, capitalizing off of the dysfunction of the overall healthcare system.  Acupuncturists have been waiting for the “insurance boat” to come in for a very long time, but in the meantime have done very little as a profession to increase access to acupuncture.  Acupuncture has been primarily a service available to those who can pay the standard acupuncture fees, or something practiced in a public health/free or very low fee clinic setting.  This is essentially a two tiered system.

     

     The overall theme of my piece is that we have a responsibility to see ourselves and our roles as practitioners within a greater context; one that we do not control as individuals.  But without being able to see, describe, or name that context, we also will fail to change it or to ally with others who may feel,think, or see the same things we do. 

    As a patient of a CA clinic it would seem that we share an alliance already.  Seattle Jill writes again and again that she is the voice of dissent so that we will not become complacent in our positions, yucking it up together, all in agreement here on CAN.  Having someone respond to this post with some doubt about my credibility and accuracy is exactly what I was hoping for.  But I was also hoping for a discussion, or a dialogue.  I didn’t intend to insult you or your uncle or his intentions and I am sorry if I did.  I would still like to understand your challenges and their connection to the rest of the piece…

     

     

    Cris 

     

     

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  • December 5 2008 at 2:09 PM
    Guest writes:

    More expensive, but more value?

    Hi,

    Nice post, I agree with a lot of what you say. I’m wondering what you opinion is of the relative value of a comm. acu. treatment is vs. a private treatment. I’m just getting started in community acupuncture so this is a question I don’ t have answered for myself yet. It seems to me that as a practitioner I can give a better treatment when I have an hour to focus on one single patient. If I’m just giving that patient 15 minutes in a community setting, they aren’t getting as good of a treatment because in a private treatment I can do both sides of the body, spend time on moxa, cupping, etc.. Now when we start talking money, these differences in effectiveness might be more than canceled out. For example, if a private treatment is 20% more effective than a comm. acu. treatment, but it costs 300% more, than it is probably worth it for the patient to choose the cheaper option. But still I hesitate to say that there is NO practical place for private, more time consuming, and therefore more expensive treatments in the AOM model.

    Thoughts?

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  • December 7 2008 at 9:25 PM
    crismonteiro writes:

    If the value of an acupuncture treatment

    could actually be determined by the number of needles used, the amount of time spent by the practitioner with the patient, the number of hours of training that a particular practitioner has in any given specific modality, etc., etc,  we would still have to factor in the time a patient spends traveling to and from the office, the possible loss of time from other activities taken up by the acupuncture treatments, the mental anguish a patient may encounter because a spouse, doctor, friend, etc., doesn’t actually believe in acupuncture, etc. etc.  

    I know this is an exaggeration but my point is that the value ANY treatment has is determined solely by the patient.  That said, a lot more “stuff” can be done with a longer treatment, but what insures that any of it will be more or less effective?  If you saw a patient 5 times in one week and used more or less the same point prescription, wouldn’t you have a better sense if it was working than if you saw them say twice in a week for three weeks and tried  local and distal treatments, moxa once, cupping twice, ion cords another time?  

    The value the practitioner brings to the treatment setting has two parts in my opinion.  The first part is the practitioner’s intention—if  my intentions are focused and clear to me that has more value than if I am worried that I have to try this and that, and maybe this other thing.  This is the value that I generally do not question in other practitioners, no matter how they are practicing.  

    I will assume when someone says they love how they are practicing it is because they value what they do, and how it serves themselves and others.  I want to believe that every healthcare practitioner/ teacher/ parent / role model has only purely altruistic intentions, but I know as humans, this is not our only motive.  Since we are practicing acupuncture as a profession altruism is one amongst many motives like making a living, being of use, gaining prestige, or respect, using our minds, being creative, etc.

     

    The second value that we bring to the treatment is more amorphous until you begin to really see it and then it becomes much more solid.  The second value is tied inextricably to the things that we as individuals value.  Our values are the standards, the judgements, and the discerning that we do as individuals.  Many of our values we inherit or are conferred upon us as members of different groups.  Sometimes our membership in certain groups is clear, like I am a woman, or I am a person of color, or I am a person with a lot of education.  Often we come to value the things that we are or that are valued by the groups we belong to.   

    My experience has been that acupuncturists as a group in the US are mostly white, or Asian, highly educated, and often from backgrounds with some economic privilege.  Our schools, and regulatory bodies are largely comprised of the same demographic, as are our patient base.  We are taught in school that a two-sided treatment is better.  We are taught that a white jacket will get us more respect, and probably it helps with our novice self-sentiment when we are first practicing in school clinic.  

      

    What we learned in school are the techniques of AOM, these can be seen in a vacuum with no inherent values other than their usefulness of relieving illness.  The actual practice of AOM cannot be seen in a vacuum.  As soon as you chose a location, a business name, a practice persona, you are instilling every technique you ever learned with values.  If your values tell you that it is more important to try seven different adjunct modalities to help one person so be it, but recognize it for what it is, your own choice.  If your fees must reflect this choice, so be it, but own the reality of what that will mean for some people, that they cannot afford your help.  I am not here to judge people for choosing that, truly. But I am here to get them to see the choice they are making has been made by no-one else but them.  

     

    So this is where someone might feel that I am getting personal when I describe the way they practice  as a “boutique acupuncture.”  You ask: “is there is no practical place for private, more time consuming, and therefore more expensive treatments” ?  Sure there is a place, but lets recognize that place as being a manifestation of values that those who solely offer this style of treatment, and those who continually seek this style of treatment have.  I am not saying that these practitioners or patients are bad, or evil, but I am identifying them by what they value.  I am in part identifying their class values, or their economic values (e.g. something that costs more is worth more).  

    My values are manifesting in used recliners, that hold my sleeping patients while they nap affordably (to them). My values have led me to do simpler acupuncture treatments, primarily using distal point, one-sided, with very little adjunct therapies.   Some call this “cheaper” but really I don’t see how it is less than everything a more expensive treatment offers. 

     

    Carl, you say you are a new practitioner in a CAP.  In time, I believe you will be giving awesome treatments in 5 or 10 minutes, if you aren’t already.  Your patients will show you the proof.

     

     

    Cris

      0 likes
  • December 10 2008 at 1:59 PM
    Guest writes:

    I agree, but…

    Thanks for your reply, Chris. I agree with pretty much all of what you wrote. However, I have a few more tidbits to throw in for the sake of the conversation.

    You posed the question, “A lot more “stuff” can be done with a longer treatment, but what insures that any of it will be more or less effective?”

    I have seen several studies that suggested patients who were treated with more “stuff” got better fuller and faster than those just receiving needles. These studies generally featured a combination of 2 or more of the following: needles, massage, cupping, gua sha, herbs, etc. Not that these few studies I saw make it true, but I thought it was interesting enough to bring up. It should be noted that all of these studies were Chinese and were therefore cheap or free and given numerous times per week.

    Also, I don’t really think charging more for longer, more involved treatments necessarily takes you out of the working class market. I consider acupuncture to be something between a technician and an artist. Maybe like a skilled craftsman, even comparable to a plumber or a mechanic. Craftsmen generally charge for their time, if a job is more complex and takes longer, the price is higher, if it is simple and short, it’s cheaper. It wouldn’t be fair to say a mechanic is screwing the working man because he charged 4x as much for a job that took 4 hours than one that took 1 hour, right?

    I’m a believer in the comm acu model (in theory, I don’t have much personal experience yet to confirm it), so my question isn’t comm acu vs. private tx. It’s more like: While comm acu might be good enough for most people, aren’t there some problems that merit an increase in time, energy, and therefore price?

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  • December 10 2008 at 5:28 PM
    crismonteiro writes:

    One of the punks that works at PCA

    lamented recently that with 5 pt./hr there wasn’t as much time to deal with “knotty” problems.  

     

    To my way of thinking about complex layered issues is that it usually has taken a variety of factors to get the person to that place, and no single acupuncture treatment is going to change that. Having said that, I think multiple treatments have a good chance of making the slow change, glacial is how Lisa R described it somewhere.  CAP have that advantage in asking our patients to commit to the long process both in and out of the clinic that will ultimately decide how and when things change.

     

    Charging more for some pt. and not others, especially in a CAP is a whole other can of worms with a lot of implications.  I know that one size does not fit all, but I think what we are providing is not the whole jumpsuit, if I can stick with this strange metaphor for a second.  I think we are in someways unzipping the jumpsuit with acupuncture.  We can’t provide “whole health” just an access point.  But when the services we offer for “an acupuncture treatment” bring different price tags I think a confusing message gets sent to both the patient and to the practitioner. What we offer with just acupuncture, and limited adjunct therapies, is a whole lot.  If I think a patient would really benefit from chiropractic or PT or massage, I would ask if they had tried these things.  My own experience as an acupuncturist has been to suggest other things when change doesn’t happen right away.  It’s more a vestige of my BA practice.  With CA I am way more comfortable asking someone to come in for a couple of months with 2-3 tx per week before I say acupuncture isn’t helping with this or that.

     

    It is just going to take some time to figure out each patients’ needs from us, but that figuring has to be within some parameters.  With CA one of those parameters is 10 or 12 minute treatments.  But again, we probably get many many more repeat visits from our patients.  I have a patient who is coming for her 100th visit next week… and we’ve only been open 2 years.  BTW  I still haven’t “made her healthy,” nor do I think I can.  She comes because she gets something from the treatments, or the clinic, or the contact….  another patient, who came for less than a dozen treatments total, during her recent rounds of chemo, dropped by today.  She had a hard time relaxing during the treatments, and was worried about picking up germs because of her suppressed immune system, I was never sure if we had helped her.  She came by today to tell us that she was doing better, walking 3 miles a day, finished with the chemo for now, and hopefully forever and she wanted to make a small gift to the clinic… of $250.

     

    I know these 2 anecdotes don’t directly address this pressing question of doing more to do more, but they’re good examples of how our trying to think and quantify our benefit to others isn’t really our place, but the patients.  

     

    Glad you’re on board with CAN.

      

     

     

    Cris

      0 likes
  • December 10 2008 at 5:32 PM
    carl writes:

    Good point,

    a CA clinic doesn’t need to provide complex treatments. They provide a service that can serve a huge swath of the population very well. If a patient feels like their treatment needs more one-on-one attention then they are free to go that route, and pay for it. After all, CA doesn’t really charge less $ per hour than BA, it just frees up the practitioners to see more patients in the time available.

      0 likes
  • December 17 2008 at 12:04 AM
    andy wegman writes:

    Excellent conversation.

    Carl,

    It’s not only that CAPs “don’t need to provide complex (read: multiple modalities beyond filiform needling) treatments”, but I’d maintain they can’t, as there simply isn’t enough time.  As Cris and Lisa and others here have mentioned, frequent treatments trump other modalities, as a rule of thumb.  I also have experienced this to be true.  And so outcomes in CAPs are not adversely effected by the absence of secondary modalities.

    ——

    You see yourself as a Craftsmen (I see what we do as punks more akin to an old-fashioned Pin Setter in a bowling alley.  A Crafty pin setter if you will.)

    Following this notion, and your premise, “if a job is more complex and takes longer, the price is higher, if it is simple and short, it’s cheaper”, doesn’t it stand to reason also that complex clinical situations will take longer to unravel, ultimately requiring a greater number of treatments/money spent - while the reverse remains true as well?  This is the case no matter what rate you charge for your services - $75/hr or $15/hr.

    In CA you are still getting paid for the length of time you are involved in the “job” - brief or lengthy. Furthermore, neither party ‘gets screwed’ because unlike many craftspeople, one of the most excellent advantages we have as acupuncturists is the majority of the work we do on a given “job” is done while we cease to be actively engaged in the hands-on work.  We just need to provide time and room for our co-joining craftiness to manifest.  This allows us the unique option to work on lots of jobs at once.  And this, of course, is the practical basis for our ability to charge a lower rate while participating in an equitable exchange.

    And ultimately, lots more folks get to experience the fruits of our craft…

      0 likes
  • December 17 2008 at 9:36 AM
    Linda inDetroit writes:

    I agree that frequent

    I agree that frequent treatments usually trump using more modalities, but I feel we are closer to craftsman than pin setters.  Most of us spend a significant amount of time and money improving our craft by learning new techniques (Tan/Tung, auricular, hand sytems, scalp…).  Our skills do affect treatment outcomes, if they didn’t there would be no point in learning anything new.  I agree with the general CAN idea of putting the healing more in the hands of the patient and getting the practitioner ego out of it, but it’s too much to pretend our skills don’t matter at all.  I don’t study my craft to charge more money, I do it because my patients deserve the best results possible.

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