A micro business ebbs and flows with the tides

My CA clinic will be four years old in January, and we are

That is a hard sentence to write, and for a long time I
couldn’t write it, as I had too much judgment about myself, and the level at
which I might be “to blame”, if you will, for this reality.But I am OK with it now.Besides, the CAN website, and all of you,
have meant too much to me for too long for me not to share the truth of my
experience with you.

So here’s a little background.We live and work on a long, skinny
peninsula.This means that rather than
drawing patients from four directions of the compass, we draw from two.Put another way, a smallish # of people live
within a ten or fifteen minute drive of my clinic, and even that # changes
significantly from one season to the next.

We got humongously good publicity from our daily paper in
Jan of 2007…we grew a lot, really quickly, as a result, and added staff.The paper will follow this by shunning you
for years, to avoid “favoring” you, and there are really no other big media to
get any publicity from.

This spring, two more CA clinics started up on my peninsula.Each are “one town over”…ie, in each of the
two directions there is the town my clinic is in, one other town, and then the
town with the new CA clinic.

Then the songwriting and performing “bug” which first bit me
around age nine, got its teeth in a little tighter, and for 14 months I was
content to give the clinic only the attention it demanded and no more, while
filling evenings and weekends with open mics, concerts, jam sessions, and
finally, a CD with 12 original songs that I completed earlier this month.This was a welcome respite from the first 2
years of live, sleep, eat and breathe community acupuncture, but it is possible
I went a teeny bit too far in the other direction.

As a result of all of these forces, and perhaps others that
I’ve not named (the economy, for example), we find our clinic numbers at about
2/3 of what they were a year ago…in other words, enough work for me to do just
fine, with some part time receptionist help, but not enough to employ other
acupunks or office managers unless I am prepared to take a sizeable pay cut ( I’m

I know CAN dogma says more CA clinics = more patients for
everyone, but my experience suggests that in small, non-urban settings the words
“maybe” and “eventually” need to be
added to this concept.I have definitely
seen a drop in patients from one town over since the new clinics got going.I think maybe this will reverse, as the new
acupuncture fans from these clinics gab to friends in my town about how great
community acupuncture is…eventually.

So, I went thru some grief, and anger, and blame….I was
pissed that getting our numbers up to 125/week in 2007 hadn’t just generated enough of
a wave of patient referrals to keep us on the upward trajectory forever
more.I was sad that my clinic was shrinking,
rather than growing, almost four years in.I recriminated myself for having too much fun with music and perhaps not
“taking care of business”, as in continually feeding the clinic marketing

But at this point, I actually feel pretty peaceful with
it.After all, a micro business has to
ebb and flow with the tides.When the
tide comes back in, we can add more staff.

And I have a rockin’ good CD that I love.You hear a few songs from it at :www.myspace.com/outlatemusic

Author: Diana

<p> I had just hit 10 years in practice when I stumbled on the Working Class Acupuncture model in 1995, via Lisa and Skip's "Little red book of working class acupuncture". After reading this 3 times in the first two weeks, I was ready to jump, and two months later I was offering Community Acupuncture part time in my <a target="_blank" href="https://www.acuforall.com/">Cape Cod, Massachusetts clinic</a>. </p> <p> While my boutiqe style practice had always been enough to pay the bills, I was forever needing to recruit new clients, and the ones I had often ignored my recommendations for a treatment plan, mosty due to cost. This made me feel frustrated and not very effective. The opportunity to transform my practice in ways that better support me, my community, and my values has been life changing for me. While it's all still a work in progress, there's no question that this is what I want to be doing, and helping others to do as well. </p>

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  1. ebbing and flowing

    Sing it like it is sister. The truth will set you free…isn’t that how it goes?

    Maybe the same thing is happening for CmmChi…guess time will tell.

    I’m still tinkering with the clinic, and may need to downsize as well. 

    Thanks for your honesty from the other coast…. 

  2. Congratulations!

    Thanks for sharing your story and your music. Your music is fabulous!  I love the lyrics, the heart of it, and even the cover art!  So clever and smart.  And, of course, I couldn’t help but notice your radical tee shirt in the photos!!!


    I hear that you are feeling hesitant and a little sad about this current picture/trend/state of being, but from this end, it seems like you are truly rocking!  pun intended.  


    Sending all good vibes way over to your coast…


    julia in berkeley

  3. Diana, I think your blog is valuable to this movement.

    I agree that if no one is constantly minding the store, business will not grow.  But is clinic growth all we want?  It’s true that we are dedicated to healing as many as we can, and wishing this for everyone.  But sometimes the time is right for fulfilling our other dreams, and those times need to be answered with our full attention.  I was just re-reading my interview with you 2 years ago, when you were “in flow”, and how interesting that you posted this today.  Anyway, I think you did the right thing, and you can always go back to Flow, and you can do this till you’re in your elder years, too, whereas cutting a cd might just be for these years NOW.

  4. hey, thanks!



    I guess what I would like most is to not have to put “start up” levels of energy into marketing the clinic in order to have it continue growing.  I am not sure if or when that would be an option, but I guess we’ll see.

     Glad you like the music!  I just added one more song this morning to the site. 



  5. the truth…it’s a good thing

    Thanks Jordan.  I guess we all need honest reports from all fronts to help us evaluate what is going on … glad I could help.

  6. Minding the Store

    It seems when I get to the “somethings gotta go” point in trying to have work/life balance, marketing is the first thing that gets the boot.  When my clinic gets to the point that it can do all its marketing without me, it will be a happy day.

  7. Thank you


    I just want to echo Lumiel and Jordan in saying thank you for sharing your experience.  We all benefit from your honesty and insight! 

    Fred Wolfson

  8. Thank you

    Diana – you were the first community acupuncturist to inspire me, and you continue to inspire me.  Thank you for your honesty, and for sharing with us your path and hard work.  I know it’s true for us to all think along the lines of being able to help as many people as we can with our medicine, and that our clinics should just “boom” and prosper with little effort after they’ve been established, but as I’ve learned here from a number of folks such as yourself, everyone’s case is different.  I think success can be valued with so much more than just the number of people we have passing through our clinics.  I believe that earning enough to make a living while simultaneously having a balance in life – time for family/friends, time for doing what we love aside from work, time for self-care – rather than constantly living in acu-business-land, worry or stress – that our lives can truly be rich and fulfilling.  Sounds like you’re there. So keep being the rock-goddess-acupunk that you are! You’re still my heroine Smile

  9. um, why are you doing

    um, why are you doing acupuncture with a gorgeous voice like that?

    kidding (sort of).

    It seems like your clinic is still rocking, just not able to pay other salaries right now. As for having “too much fun,” perhaps at the expense of the biz…it is nice to hear you making peace with that too. Life is short. As a newbie, and thus living and breathing CA to the further detriment of the family and my own other dreams, my newest shortish term goal is to demand MORE FUN. And more kickass music.

    So seriously, thanks for the post.

    Your newest fan


  10. I just want to say ditto to

    I just want to say ditto to Justine’s post.  I have followed your clinic from the beginning of my CA journey, and you always inspire me.  Keep enjoying your music, I think the ebb and flow is a good thing when you are pursuing other interests.

  11. food for the fodder

    It is thought ans said that Community Acupuncture is the savior  of the acupuncture profession and acupuncture in general in this country. Perhaps this blog may be suggesting that survival is more complicated then we thought. Is it possi ble thatthe number of clinic failures and graduates no able to make living and unable to stay in the field, are not going to be changed by the CA movement? It is too early to tell, and I don’t think that Diane’s clinic is failing, but this is an interesting development. Don’t you think?

  12. acurose, not in the least bit.

    What Diana’s situation says to me is she is able to maintain two endeavors at the same time – writing & recording music (and playing a steady stream of live gigs) while also maintaining her job as a lead community acupuncturist at her clinic.

    Both reflect her values, talents and interests.

    In her own words, the clinic provides “enough work for me to do just fine”. It would seem a stretch to suggest most any acupuncturists could claim the same.

    It stands to reason that each clinics’ character, shape and size will in some way reflect what its stewards are providing for it – consciously and otherwise.

    God willing, we will each come to know dozens of fully functioning community clinics headed by creative and caring folks like Diana that are just plain busy enough for their owners – and simply available for their neighbors.

  13. CA’s smaller footprint makes it more flexible

    Hey Rosie,

    I’d have to agree with  Andy here. Because we are not beholden to the insurance companies, CA clinics are infinitely more flexible in how they can respond to the ups and downs of business. That makes us a much leaner, more nimble animal on the Acupuncture Serenghetti, and way more adaptable than boutique clinics that get caught in the quicksand of third party billing and narrow classist niche thinking that excludes 90% of Americans

    Sure there are always exceptions – probably on both sides of the BA-CA watershed, but for now, having worked in both models, I feel way more confident that my current CA practice has inherently greater longevity.

    So please don’t misunderstand what I’ve said previously. I had the flu last week, so it was my week for complaining. But with a clearer head now, I see that my clinic will do just fine in the long term. I have to cut back my hours for my employees for the moment. If I want to get big again, I know I can.

    Like Diana, I too have other inspiring dimensions to my life and it’s important to not let those areas get stale. 


  14. at the last workshop

    I suggested that everybody read this article on small business, written by someone who is not an acupuncturist.

     The community acupuncture business model is just that, a business model. Business is not easy, not fail-safe, not anything or anybody’s savior. I really would not recommend business in any way, shape or form to anyone who is looking to be saved. 

    Business is a creative endeavor, and creative endeavors generally require making choices. I think at some point most people have to make the choice between their business continuing to grow, and being the main creative thing they do, or stabilizing their business at a point where it supports other creative things they do. Life is short and it’s really important to do what you love. 

    When I read your blog, Diana, I thought of two things: one, that for a long time I used to tell people that being an acupuncturist was like being a musician — you were damn lucky if you could do it steadily and/or make a living doing it; and two, I thought of you at WCA’s first workshop ever, spontaneously writing and performing a truly lovely song about community acupuncture. Congratulations on balancing your passions.


  15. I dare say “saving

    I dare say “saving acupuncture” is not the same thing as “saving” individual acupunks.  Nor do I remember anyone claiming that surviving (much less thriving) was uncomplicated; indeed, that’s part of the reason we simplify where we can.  At least that’s my reading of it.  Finally, I don’t think that Diana is that unusual of a case, for all the
    reasons mentioned; but not everyone is telling us about these kinds of
    situations. Certainly the details are interesting and potentially quite helpful to people.

    Thanks, Diana, for being so open, and explicit.  And of course: rock on!  Or as Whitsitt would say, m/ m/

  16. thank you to all of you

    for reflecting “life balance” as a value, rather than just business growth.  I love having a CAN clinic, and I am not willing to put certain other endeavors on hold until a) my next life or b) my retirement, which is dubious at best.

     Lisa, the song in question didn’t make the cut for this CD…maybe next time.  I’m glad that is a fond memory for you — it is for me, as well.




  17. You make beautiful

    You make beautiful music!

    And marketing is pretty endless. WOM is powerful, but free days, flyers, are staples. 

    Marketing drives me crazy sometimes too when I can’t seem to find the energy for it. I have some unpaid interns helping me from the local uni and that’s motivating me more. The small business counseling I get for free from SBA really helps too. It’s nice to talk to someone else about it. 


    Growth isn’t always a good thing. Sustainability over time, rather than burning out from fast growth. I have been trying to not let my clinic take over everything. Going out at night isn’t a new opportunity to find new bulletin boards around town 😉

    Good luck! Keep on rockin!


    Jade Community Acupuncture, Winona, MN


  18. yes

    As someone else who tries to balance producing music, acupuncting, raising chickens and vegetables, and having a family (along with the ancient English aristocratic art of doing nothing from time to time)… I salute you and your success!

    One thing that struck me is that as other CA clinics opened near you, it took some of the pressure off you so that you could focus on other things that call to you.  Sounds like everyone is getting their needs met.

  19. One early CA clinic in Colorado, two ladies who run

    a hybrid, have deliberately kept their operation small and slow.  They make enough to earn a decent living, and they’re not interested in expanding.  They are very happy with their clinic and their professional lives.

    I kept my clinic small for two reasons:  I was always distracted by other activities, so could not devote all my time to my clinic; I knew I was going to move away, but couldn’t wait to try this model in ’06, so promised that I would just launch this one as a “practice” CA clinic.  It’s modest, my income is modest (but more than I’ve ever earned before – yay! ), and I don’t market.  Patient referrals and online explorers are the only source of new patients.  I try to maintain a steady balance in life, so I’ve hit a level of growth that’s slow and steady, and doesn’t get me too excited.

    Yeah, I don’t consider Diana’s report as negative.  It simply shows another dimension of our CA operations.  Hmm, I’m starting to get too wordy.  That’s it, just my 2 cents.