Classism and Marketing Conversation (Part One)

Not long ago, an alert reader pointed out a conventional acupuncture marketing blog (www.acupunctureclinicmarketing.com) that had a link to CAN and to The Remedy. Wow, that’s interesting, I thought, and decided to check it out. In general I find marketing to be an intriguing topic, maybe because it reveals so much collective unconscious material with so little effort of examination:  new car = sex = power,  antibiotic spray = maternal love, allergy medication = a joyful life, etc. The revealed material might be appalling but it’s almost never boring. When it comes to  reading about acupuncture marketing, I usually learn something about how the acupuncture world sees itself and how it sees patients, which is almost always useful to me when I teach workshops.
 
This is why I downloaded the first two free chapters of Burton Kent’s new book, Never Market Again: the guaranteed formula for attracting patients naturally.


And then I sent him this letter:


Dear Burton,


first, thanks for putting a link to my website and my book on your site. I

appreciate the help in getting the word out.


Second, we don’t know each other at all, but would you be interested in

having a heart-to-heart talk? In public? Meaning, on the Community

Acupuncture Network blog, and yours as well, if you want.


Here’s why I’m asking.  There’s lots on your site that I agree with

completely: about not spending money on advertising, about generating

word-of-mouth promotion through strong patient relationships, about how sad

it is that so many acupuncturists are so terrified of business that they go

out of business almost immediately. Most of all, I agree with you that

acupuncture saves lives. I’ve experienced this first hand, and it’s

basically why I’m writing to you. Because I think that it’s incredibly

important that acupuncturists can make a living doing acupuncture, so that

more people who really need it can get acupuncture.


And also because it’s my job to educate acupuncturists about classism,

particularly the intersection of classism and business. I teach an elective

at an acupuncture school where we talk about these things a lot; a big part

of what the Community Acupuncture Network does is to help acupuncturists

see through classist thinking, so that it doesn’t get in the way of

growing their practices. Consequently I am always looking for opportunities

to address obvious examples of classism in acupuncture.

In Chapter 2 of your book, “What Will Hold You Back”, you list

“feeling guilty about charging a fair rate”. You don’t define what a

“fair rate” is, and I’m curious what you think it is.  Then you

write:


“There’s another side to charging a fair rate.  Doing so actually helps

people get more value from your treatments.  Think about it this way.  If you paid $1,000 for a course

manual, and you paid $15 for a book, which would you take more seriously?  Which would you be sure to

learn from and follow?  The course manual, right?  But what if the $1,000 manual and the $15 book contained the exact same information? I think you get my point.  The value and importance we place on something

is heavily influenced by price.  By underpricing your services, you make your patients undervalue

your services.  They’ll comply less, complain more, and actually be worse patients because of the price

you set.

Don’t cheapen yourself, your skills or your profession.  They’re worth

far more than you realize. “


Even though you didn’t define “a fair rate” as “market rate”, you

are saying here that patients benefit more (“get more value”) from

acupuncture if they pay more for it, and that when they pay less for it,

THEY ARE WORSE PATIENTS.  This is a brutally classist thing to say.


 If you cited my book in your links, I have to think that you know that I

charge my patients $15 to $35 per treatment -- they decide what to pay on

that scale. My patients, 60% of whom pay at the low end of the scale,  are

not “worse patients”. They don’t complain. They comply with treatment

plans better than any other patients I’ve ever met ( in part because the

treatments are priced so that they can afford to comply). Some of these

patients are being treated for life-threatening conditions: liver failure,

asbestosis, late-stage emphysema. These are real people who are just as

committed to acupuncture, if not more so, than people who pay more for it.

They just don’t happen to have a lot of money. If you make minimum wage,

$15 IS a lot of money.


You have an MBA so you must understand numbers. Have you looked at the the

income figures on any recent census? Only a tiny sliver of the American

population either 1) can afford to pay for acupuncture at market rates out

of pocket, or 2) has insurance that covers enough acupuncture to be

effective for any chronic condition.  If acupuncturists charge market

rates, $75 to $100+ per treatment, they are targeting at best maybe 20% of

the population.


How do you reconcile your belief that acupuncture saves lives with

encouraging acupuncturists to charge prices that ensure that the vast

majority of people can’t afford it? I have news for you:  when people are

sick enough to need acupuncture to save their lives, they are quite sick and

you are talking about a LOT of acupuncture. If someone has a

life-threatening condition, they need acupuncture twice a week at least for

an unlimited amount of time. No insurance company in the world will pay for

that. So are you saying that only rich people deserve to have their lives

saved?


The gentle, homeostatic nature of acupuncture means that it usually

doesn’t work fast. A lot of acupuncturists fail not only because they

don’t know how to market but because they don’t get good enough

clinical results to generate word-of-mouth referrals. They don’t get good

clinical results not because they aren’t good acupuncturists, but because

their patients are not getting enough acupuncture to DO any good. They

can’t afford to; they can’t come up with $75 to $150 out of pocket for

ten weeks in a row. I know a lot about how results generate referrals; six

years ago, I was treating twelve patients a week; last week, my clinic

treated 442 patients. I don’t even have a Yellow Pages ad. My clinic

employs six acupuncturists, four of them full time.


There is only so much room at the top of the economic pyramid. If you are

serious about doubling the number of acupuncture clinics in the US, you

need to come to terms with how acupuncture works (only frequent, regular

treatments consistently produce results) combined with the economic reality

of most people in America (almost no one can afford frequent, regular

treatments at market rates).  The value of any form of health care is NOT

enhanced when people pay more for it. Your $1000 manual/$15 book analogy is

sadly applicable to the current healthcare system in the US.  Any number of

studies have shown that healthcare in America is more expensive than health

care in other countries, and yet the actual quality is no better. The cost

of health insurance premiums has risen 75% between 2000 and 2008; do you

think all of the people who can barely afford health insurance now value it

more, or get more value from it? Your more expensive = better theory does

not work, not for healthcare, not for acupuncture, not for 80% or more of

potential patients, and not for acupuncturists who are trying to make a

living -- unless those acupuncturists are willing to explicitly write off

80% of the population as not worth treating.


I’m hoping that you might be willing to have this conversation in public

because this is something that the acupuncture profession as a whole really

needs to come to grips with.  I don’t have a problem with acupuncturists

who openly acknowledge that acupuncture at market rates is essentially

boutique medicine for an elite population of patients; they have a right to

run their businesses and select their patients however they want to. I do

have a problem, however, with the suggestion that pricing acupuncture out

of reach for most people is somehow the right thing to do, because more

expensive equals better for everyone.  Lower price does not equal lower

value, not in everyone’s minds; suggesting it does is not only a great

example of classism, it’s part of how America wound up in our current

health care crisis.


Lisa



 
And then we had this correspondence:


Hi Lisa,


Interesting how you bring this up at the exact same time I just finished writing a post about the Sanborn Maxim.  Sanborn Maxim states /“The customers who are willing to pay you the least will always demand the most.”

/(I just scheduled it to be posted May 16th)


About right now you're probably thinking I'm even *more* classist than you thought.  I can see how you would think that, and started writing a response.  But I've removed it, because it would be better to save it for our discussion.


How about you post a reply after May 16th on the CAN blog?  I hope you'll include what you wrote below. We can have a back and forth discussion between blogs - referring to each other's posts.  Or would you rather do it another way?


By the way, Lisa, I grew to admire you while reading your book.  I can totally understand why you'd be miffed (or at least concerned) with what I wrote - I actually thought about you while writing that part of chapter 2.  I'll look forward to discussing it with you.


Burton


 


Burton,


first, sure, I will start the thread on the CAN blog on May 16th and link it to your post. Referring to each other's posts sounds fine.


Second, wow, I now feel even worse than I did before. You a) read my book, b) grew to admire me (? ) and c) thought about me  (?!) while writing that passage. And you don't get that what you wrote is insulting, especially to my patients?  You don't realize that the exact argument you're making in that passage is the kind of thing that kept me from even thinking about creating the community model for seven years or so -- and is the argument that's used against acupuncturists who practice community acupuncture in general?  You don't get that you are making my life harder?  I was sort of hoping you had linked to my book and WCA by accident or something; knowing that you actually read what I wrote is really depressing.


I guess this will be an interesting discussion.


Lisa



Lisa,


Also, one other thing - that part of the book was NOT directed at you or the CAN business model.  I just realized the way I worded my reply might have come across that way.

I think it's a great business model, and I hope it becomes much more common.


Burton


So here we go: www.acupunctureclinicmarketing.com


And for those of you who may be thinking, geez, Lisa, why do you bother with this stuff at all? I must say that I had the same thought -- but since teaching a class at OCOM, I’m aware that the idea that” patients won’t value your services unless they are expensive”, is in fact alive and well, at least at OCOM, and that it really does stop some students from thinking critically about the realities of making a living doing acupuncture.  So I thought it was worth a try.


Your comments, please!

This story was posted on May 20 2008 by Lisafer.

Comments

  • May 20 2008 at 7:30 AM
    SuzefromOz writes:

    Maybe I’m missing his point…

    but if I could get a $1,000 course manual for $15 I’d buy it in a flash

    ....and I’d probably be back next week looking for more!

    ...and I’d be keen to brag to all my friends about the bargain I got and insist they go there too!

    If your mechanic started charging you $500 for a service instead of $150 because he wanted your respect, and wanted you to look after your car better, what would you do?

    beep, beep! (that’s me heading to another mechanic! :-D )

      0 likes
  • May 20 2008 at 10:26 AM
    River Jordan writes:

    I wonder if Mr. Burton

    I wonder if Mr. Burton admires the CAN model, not because of its social justice element, but because it represents another targeted marketing technique (to his way of thinking) that has great potential to make money.

    So even if Tiffanys, Saks and Nordstroms, etc. stock more valuable merchandise from a purely materialistic viewpoint, Walmart is fantastic for its shareholders (according to this line of thinking).

    Cynicism is a smokescreen for laziness and fear. Clear light mind awaken! Pierce through all layers of doubt and delusion! Inspire me onwards in ceaseless waves of selfless activity.

      0 likes
  • May 20 2008 at 12:05 PM
    Guest writes:

    Both - and more

    I admire the CAN model both because of the social justice element and the potential for word-of-mouth.  There’s a lot more to it - for one thing, it’s a very, very elegant approach to running a clinic.

    I’ll be posting more on Friday.  In the meantime, the link to the “Sanborn Maxim” article is:
    http://www.acupunctureclinicmarketing.com/sanborn-maxim/ and if you’d like to see the free chapters, they’re available here.

    By the way, comparing CAN to Walmart is inappropriate to my way of thinking.  Low price is only PART of what CAN offers.  Walmart also implies low quality - and I don’t think CAN-style acupuncture is of low quality, is it?

      0 likes
  • May 20 2008 at 4:14 PM
    River Jordan writes:

    analogies

    Burton, Glad to hear you appreciate the social justice element in CAN. Analogies aren’t necessarily equivalents - but only draw parallels between certain aspects of phenomena. I probably could have chosen a better analogy if my brain was fully functional at the time of my last post - I merely meant to draw a parallel between volume (of goods moved - Walmart - and people served - CAN). I’ll try to check out your work in more depth if I can expand the volume of time in my day a bit more!

    peace,

    jordan 

    “Consciously restrain your mind from recollecting the past or anticipating, fearing, or hoping about the future. Simply focus on the present moment and do not allow your mind to chase after external objects or events. Do not objectify things, but rat

      0 likes
  • May 20 2008 at 6:59 PM
    Dana writes:

    Burton - I just went to your

    Burton - I just went to your website and I’m quite personally offended myself.  I’m a person who earns a low wage.  The implication from you in subtle ways, and from your commenters in a big way is that my status as a person who needs a reduced fee means that I am more likely to be a poor patient than someone who is wealthy and able to afford a high payment.  You are implying that my class status is an indicator of morality.  That is the offensive part.

     

    Perhaps this would be clearer if we replaced the phrase “reduced fee” with black or gay.  Would you then recognize that a conversation about how gay patients are too needy or aren’t serious about treatment is offensive?  The same rules apply to class.  Your web page encourages people to blame patients based on broad generalities instead of exploring their own behaviors to discover why their practices are not successful. 

      0 likes
  • May 21 2008 at 1:41 PM
    Cheryl writes:

    socialized medicine

    Think of all those people utilizing socialized medicine, and consequently paying small sums for treatment.  Per Burton’s (and others’) belief, there are entire countries of “poor” patients.  To me, it’s nonsensical to think this way.

      0 likes
  • May 21 2008 at 7:55 PM
    KevinW writes:

    Do you really want acupuncture to be a luxury?

    Here’s another perspective on this idea of charging more to get patients to value acupuncture.

     

    A basic tenant of economics holds that demand decreases as prices rise –  e.g. we buy less gas as prices go up.  This is called elasticity of demand and it holds for most products and services.  In fact, this tenant underlines our whole economic system.

     

    However, elasticity of demand does break down for one group of products.  Economists call them “luxury items” and, among other properties, demand for a luxory item increases as it becomes more expensive.  For example, think of diamonds.  As they get more expensive people find them more valuable, even though they have no inherent value or function.

     

    So if we aim our services at patients where value increases with price, are we positioning oriental medicine as a luxury item?  Do we want to do this?  Going back to the analogy of diamonds, the company De Beers certainly does – they use their monopoly of both production and distribution to artificially inflate the price of diamonds.  As the price goes up people want more diamonds and De Beers takes in more money.

     

    But do we as medical providers really want to go down this path?  I don’t.     

      0 likes
  • May 21 2008 at 8:24 PM
    Skip writes:

    Great comment Kevin

    What it makes me think of is that luxury items are normally… hell always… labeled luxury by the consumers.  But in this instance, Oriental Medicine, it’s the sellers that are trying to label it luxury.  And the consumers aren’t buying.

      0 likes
  • May 23 2008 at 4:18 PM
    Guest writes:

    Burton’s website

    I just read your website blog-you know, the one about firing patients who are always late, drain your energy, etc.

    I was amazed at how throughout all of the postings, the subject never strayed from “I”. Every single posting was about how the treatments and patient interactions were affecting the practitioner…there was almost nothing about how the patients were being affected.

    I think this is the core difference between the CAN philosophy and the other philosophy-the foundation of community acupuncture is service to others, whereas the foundation of the other is service to self. Fire a patient? I can imagine only a tiny number of instances where that might be appropriate-and they all have to do with safety, not with timeliness. Someone doesn’t show up on time to their appointment? Have them pay for the missed appointment but for crying out loud don’t tell them they can’t come back. Someone “draining your energy”? Then strengthen your personal boundaries but don’t blame the patient. They need your help-something is out of balance if the patient is chronically late or excessively “needy”. But guess what? Acupuncture can help, and isn’t that our job?

    On a last note, and to return to the original topic, I cannot imagine a population of patients who are more appreciative of the services they receive or more empowered about their own health than the patient population of WCA (probably the other CAN clinics feel similarly). It is interesting to me that the person advocating for the theory “higher price=higher value” is the one who is also talking about needing to fire patients. Coincidence or correlation?

      0 likes
  • June 1 2011 at 6:13 PM
    Guest writes:

    Sounds like a classist

    Sounds like a classist self-justification.
    It irritates me when people try to justify their tiny worldview in order to decrease their own guilt.
    Acupuncture is acupuncture!

    really, Do we really want to become a profession like some chiropractors that rip off insurance companies by marking up costs so much when insurance is involved. IE, chasing ambulances, and billing and sucking up every last dollar our of someones PIP insurance.
    YUCK

    this kind of behavior from other medical professions has made the acupuncture & insurance issue what it is.

      0 likes

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