What It Means

A couple of weeks ago I had an interesting conversation with John Weeks of The Integrator Blog. He had asked me for an update about how things were going, and I mentioned that we had just had a banner week at WCA; 448 acupuncture treatments, including a total of 73 new patients. For most of the past year we've been seeing between 30 and 40 new patients a week, and it suddenly shot up the last week in August. John commented that our patient volume was "quite likely the highest number of any acupuncture clinic in the United States."

I thought about that. As we all know, getting any kind of real numbers having to do with acupuncture and acupuncturists is close to impossible. The only numbers I have seen are for school clinics. OCOM says that their clinic provides more than 21,000 patient visits a year, and that certainly includes non-acupuncture visits such as herbal consultations, shiatsu, and tui na. 21,000 visits a year translates to 403 visits a week -- which means that WCA is doing more acupuncture than OCOM is. OCOM is large as acupuncture schools go, so that means that WCA is providing more acupuncture than most acupuncture school clinics. Interesting, huh?

And then I thought about it some more. If WCA is bigger than most acupuncture school clinics, it's almost certainly true that we are bigger than most other free standing clinics as well. John Weeks knows the alt med industry better than almost anyone else does, anyway, so I'm inclined to believe his assessment. OK. Wow, that's a surprise on all kinds of levels, to think that the biggest acupuncture clinic in the US is located in the Cully neighborhood of NE Portland. Cully is otherwise better known for its high concentration of bars and trailer parks. Maybe I should tell the neighborhood association so they can put up a plaque or something.

Aside from that, though, what does it mean if WCA is in fact the biggest acupuncture clinic in the US? I decided to make a list.

1) It means that the conventional economic model for acupuncture is really, truly, completely not working. Here's the thing:  I graduated from OCOM in 1994. It took me about 8 years to come up with the rudiments of the community acupuncture business model. It took another 3 or 4 before I was in a position to start hiring other acupuncturists. That is a LONG TIME. Shouldn't all those other acupuncturists who graduated at the same time as I did -- or even a little after -- be doing a lot better, since they didn't have to reinvent the wheel? Shouldn't John Weeks have heard of at least a couple of them? And please, nobody give me that line about how it's not about the economic model, it's about how acupuncturists are just not business-minded. You would have to look long and hard to find someone who was less business-minded than me for most of my life. I have a BA in Ancient Greek! I have no previous business experience! If I have created the biggest acupuncture clinic in the US, there is something grievously, wretchedly, tragically wrong with the competition. As the ancient Greeks would say, Oimoi! (Oh woe!)  If the conventional model worked as well as people claim it does, the logical progression in business is that these conventional acupuncturists should be hiring other acupuncturists in order to make even more money off their labor. However, even the most successful conventional acupuncturists I know of almost never have acupuncturist employees. They don't get beyond the mom-and-pop level the way WCA has. A business model that shows no evidence of growth beyond the mom and pop level in over 30 years? Hmm.

2) It means that the professional culture of acupuncture is even more dysfunctional than we thought it was. Here's another thing -- one of the biggest lessons that we have learned at WCA is that acupuncture sells itself. The vast majority of those 73 new patients came to us through -- you guessed it -- word of mouth. Our clinic keeps growing because we just keep attracting more patients. We don't even have a Yellow Pages ad. Yes, we've gotten a lot of great press lately, but when you look at the new patient paperwork where we ask, "How did you hear about us?" the vast majority of answers still say "friend" "co-worker" "wife" or "live in the neighborhood". Why is this natural magnetic property of acupuncture not working for more conventional acupuncturists? Why are they not so awash in patients that they are scrambling to figure out how to hire other acupuncturists? Even with the high fees of the conventional model, there should be some acupuncturist in some wealthy gated enclave who is busier than WCA because they started before we did. I suspect, though, that the professional culture that we acupuncturists have created does not connect at all to the culture of most normal Americans -- of any income. We have this bizarre conglomerate identity of life coaches, spa therapists, junior shamans, and wanna-be MDs that makes no sense to most people. They have no idea what to do with us. In a couple of decades, we have made almost no progress in expanding our patient base beyond New Age types who will try anything just because it's "alternative".  There are lots of people out there -- and there's a reason that only WCA is seeing them.

3) It means that acupuncture isn't a real job -- not yet, anyway. Given the natural magnetic properties of acupuncture, any acupuncturist who stays put long enough ought to get to the point that they are very busy, and need to hire people to help them. As we know, though, an awful lot of acupuncturists don't stay put. They are forever opening and closing their practices, moving from state to state, office to office, and eventually out of acupuncture altogether. Acupuncture is mostly part of the informal economy, a way to make a little extra income on the side, out of your house, while your spouse supports you, a way to trade for massages, a way to write a few extra things off on your taxes -- essentially, a hobby. Not a job.  The few high-volume clinics that employ acupuncturists that I have heard about are "no-fault" or workers comp, and they are run by DCs or MDs, not LAcs. Acupuncturists don't have jobs and don't create jobs. If they did, someone would have created more jobs than WCA by now.  CAN would not be the only resource out there for acupuncturists who are trying to figure out how to hire other acupuncturists. And yet we are.

Back in 2005, when we wrote the Little Red Book and began to try to reach out to other acupuncturists, I had some kind of notion in the back of my head that I was going to try to engage with (challenge, communicate with, debate) the acupuncture profession. My efforts to do so have resulted in a slow but steady erosion in my belief that there IS an acupuncture profession. Finding out that we are the biggest clinic in the US is just the cherry on the top of that particular disillusionment sundae. Kids, we're it. We're not just the cutting edge, we're the only edge, besides being the middle and the handle. Nothing else is happening. This whole time, nothing has been happening. This acupuncture thing is not going anywhere, unless we do something.

This story was posted on September 28 2008 by Lisafer.

Comments

  • September 29 2008 at 9:05 AM
    Nora writes:

    two reactions

    My two initial reactions to this post:

    1) Hysterical evil genius-type cackling: bwaahahahaha! 

    2) The soberer part of me just peacefully saying: okay, then, we are the grownups, we’re responsible.  Time to really tune into what our values are, and apply them to our work.

    Thanks for modeling both the evil genius part and the getting down to business part, Lisa.

    (Okay, I actually have a third reaction, which is unprintable, about the schools and certification agencies, who seem to think there is an acupuncture profession - or at least money to be made.)

    Here’s the link to the Integrator update on WCA, in case folks are interested and missed it:

    http://www.theintegratorblog.com/index.php?option=com_content&task=view&id=488&Itemid=93

      0 likes
  • September 29 2008 at 11:50 AM
    bmiller writes:

    schools

    speaking from the perspective of someone who is about to be done with acupuncture school, i could not agree more with this post.

     whenever i talk to fellow classmates and hear about their grand plans for a one on one practice, i really feel bad for them. the schools are doing such a poor job of preparing students for the reality of what they will actually have to do to repay their student loans. it’s like there is a huge wall of denial that is preventing progress toward the realization that what you learn in school simply does not work in the real world, end of story. time for everyone to start a new chapter.grin

    Blythe

     

      0 likes
  • September 29 2008 at 12:21 PM
    Lisafer writes:

    thanks

    Nora, for posting the link. I was so busy bwahaha-ing that I forgot.

      0 likes
  • September 29 2008 at 4:24 PM
    Nora writes:

    Ha!

    More likely you were too busy DOING ACUPUNCTURE!

    Bwaaaahahahahahaaa! (picture me rubbing my hands together maniacally)

     

      0 likes
  • September 29 2008 at 5:30 PM
    Guest writes:

    bwahahahaha

    I’ll have to remember that (evil genuis cackle) the next time I play “let’s hide under the covers from the big monster” with my 5 year old.

    Seriously though, thanks again Lisa for your passionate engagement with helping the acupuncture profession out of its delirium and general infatuation with itself.  By creating CAN, you have helped far more than 448 patients/week….maybe several thousand per week???

    Also, I would like to recommend the article in the Integrator (see Nora’s link above). However, in that article, I had a question about the stated benefits for your staff - it says “no health benefits”. Hmmm. I thought everyone got to receive acupuncture as much as they like at no cost…can you clarify? (That would certainly seem like a pretty substantial benefit, and one worth noting in John’s blog if indeed it is true).

    Second, I am not clear exactly on the distinctions between a socially responsible business and a social business and a nonprofit…quoting from the article:

    “A social business is not a ‘socially responsible business’ and it is not a nonprofit. It functions completely differently. The structure of a socially-responsible business is to make a profit and then use the money for good. The structure of a nonprofit is to subsidize doing good with money that has been made some other way. The structure of a ‘social business’ is not to make a profit at all, but to create ‘social dividends.’ “

    So from the last sentence, if a social business is structured not to make a profit, it would seem that the only difference between it and a non-profit is the legal structure(?) and the fact that nonprofits often acquire their funding from outside sources (e.g. government grants). Of course, these are large differences. For example, a non-profit that receives its funding from grants, does not necessarily have to prove its worth via direct feedback (i.e. revenues) from the people it purports to serve. A social business does (i.e. if the acupuncture services are of low quality, then it has difficulty surviving.)

    Serena and I have been cautiously embracing the idea of offering free treatments to veterans every week.  Does this go against the grain of “social business” thinking?  On the one hand,  free treatments do not generate revenues and therefore, would seem to be unsustainable in the long term. On the other hand, it would seem obvious that social dividends are being created. I would also like for CommuniChi to hire staff, and create those benefits for our profession, and I think we are getting close. However, hiring staff is one social dividend, helping veterans is another, creating a hub of community where people get to experience deep relaxation is a third. So, there are many ways to define “social dividend”.

    I’m not sure if that is a question, or just my typical ramble….

    Jordan

      0 likes
  • September 30 2008 at 1:15 PM
    Lisafer writes:

    Yes

    to all of that, Jordan. You’re right:  in terms of “benefits”, all of our staff get unlimited acupuncture for themselves and one designated family member. (And obviously if somebody had an undesignated family member get really sick, we would treat them for free.) The Integrator article actually got put together out of a hodge podge of other emails that I sent to John, and somehow that piece got lost in transit.

    And yes, there are a lot of ways of interpreting “social dividend”. I think the key piece is Dr. Yunus’ basically brilliant point that the goal of capitalism does not need to be to make money. That a business does not need to be structured to make extra money beyond what it needs to exist. That you do not have to skew your operations to make pure profit before you can think about doing good. I love this so much because I think there’s some essential classism embedded in the structure of non-profits—the idea that those of us at the bottom of the economic ladder need to depend on the ones at the top to make it possible for us to do anything meaningful, that social good is necessarily made out of the scraps and leftovers of the lucky ones who have more than enough. So yes, once you have a social business, you can do whatever you want with it: give free treatments to veterans, hire staff to offer right livelihood to more people, whatever. You don’t need the approval or the financing from anybody else. You get to choose the social dividend you create, because you own the means of production. Your responsibility is just to make enough money to stay in business—whatever that is for you. To me this seems like the most freeing thing in the world.

      0 likes
  • September 30 2008 at 2:26 PM
    River Jordan writes:

    Clear as sunshine

    thank you

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

      0 likes

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