Fractals, or What I Learned at the BDC Workshop

Whew! The Big Damn Clinic workshop was a lot: a lot of fun, a lot of people, a lot to take in. Most of us at WCA spent all last week trying to recover. Now that I’m mostly back to normal, or for what passes for normal for me, I’ve been thinking about what I learned that weekend.

I taught a breakout session called Skills for Owners. Because of the way we set up the breakout sessions — so that everyone could attend all of them — I taught it four times in a row. Which was interesting, because depending on the group, the same information got delivered a little differently each time. By the end, I think I figured out what I was trying to say, so I thought I’d do a blog post about it.

Owning a community acupuncture clinic is a lot like punking in a community acupuncture clinic.

1. Transparency is very important.

Just like we can’t successfully treat every patient who walks in to a community acupuncture clinic, you can’t successfully employ everybody who wants a job in a community acupuncture clinic. You can only work with people who get it — “it” being the stringent limitations of time and money and how difficult it is to run a social business in a capitalist culture. Most of us know that if a patient walks in to our clinic and says something to the effect of, “But when I get acupuncture I expect to talk for an hour to my practitioner and then get some aromatherapy before getting needled on both sides of my body and finally wrap it up with a nice long tui na session, what do you mean I can’t get that here for $15?!”, pretty much the only thing we can do is politely give her a referral. But actually, that situation doesn’t arise very often, especially when your clinic has been up and running for a while: partly because word of mouth takes care of it, and partly because we have all learned how to be transparent. We run low-cost, high volume businesses, and we try to include a lot of people. What you see is what you get.

It’s the same with employing people. You can only work with people who get that our clinics run on very narrow margins, and it’s quite a feat to actually make jobs on top of keeping our doors open. You need to let people know what the realities are. For instance, WCA pays $10,000 in payroll taxes every month. That’s money that nobody gets to take home; it’s the cost of employing people. You can’t have people thinking that it’s unfair that they don’t get merit raises every 6 months — or any of the other perks of working for a nice, well-funded, middle class nonprofit. That’s not what we are.

WCA has had fantastic luck with our employees. Except it’s not really luck. The people who work for WCA all get it. They all want to take care of the kind of people that come into our clinics, and while they all would love to be paid more, they also understand that if we were all making upper-middle class salaries, those people would no longer be coming into our clinics. They’ve decided that it’s worth it to them.

2. Another aspect of transparency: don’t try to front.

Just like when a patient says to you, “I have rare disorder X. My last acupuncturist specialized in X. Tell me, what do you know about X?” we all know that the correct answer is, “I really don’t know much about X. Please tell me about it, especially your experience of living with it” — you should never, never pretend that you know more about being an employer than you really do. Be very direct and very honest about what you don’t know, what you don’t do well, and what you are still learning about. Just like not everybody wants you to treat them, not every potential employee will like you or want to work with you. The more upfront you are about this, the more quickly and cleanly people can make their own decisions. You don’t want to employ someone who will constantly be mad at you because they want you to be something you’re not — like, say, an experienced manager.

3. You don’t really make jobs for people — you hold the space for them to make jobs for themselves.

Just like you don’t heal for your patients: you hold the space, they do the healing. Being an owner in a community clinic is mostly about learning how to hold space for other people to do things as opposed to trying to do everything for everybody. I’ve mostly gotten myself in trouble when I have tried too hard to take care of people that I employed.

One of the best things that happened to me over the last couple of years is that I finally read Melodie Beattie’s books on codependency, starting with Codependent No More. Those books should really be required reading in acupuncture schools, because most people who want to take care of other people have a codependent streak a mile wide. Even if you don’t, reading those books will help you enormously in supporting your patients who are caregivers or who have relatives with substance abuse problems. Actually, all community acupuncturists should have copies of those books, just to hand out to all of those patients who insist on making appointments for their family members who don’t actually want acupuncture.

So yeah, I got a lot out of those books, especially in terms of my business and my relationships with the people I employ. I used to think that if only I worked as hard as I could and did my best, everybody else would magically do a good job. If you’re an owner, you can save yourself some time and agony by pro-actively working on your own codependency issues before anything comes up with any of your employees.

4. Just like a punk’s patient numbers are almost always about how much space they have inside them — how much emotional energy they have to form relationships with other people — how many people you employ is in part a function of how much internal space you have for that. I believe in both cases, there are things you can do to expand your interior space: minimizing distractions in your life, being centered, having a meditation practice or something similar. Big clinics don’t just happen; they require you to work on yourself.

(This was the part of the breakout where I told people that I didn’t have any hobbies and they probably couldn’t have any either, if they wanted a BDC. If you heard rumors that Demetra says she could play the piano much better if only I would let her practice, this is why. Demetra’s piano playing is just fine, as is her ukulele playing, and yes, actually, you can have hobbies, and even a family — I did not in fact confiscate anyone’s children during the workshop. )

But Big Damn Clinics will test your priorities and push your buttons. Don’t underestimate the emotional energy you’ll need to employ people.

5. Be patient with other people and yourself.

None of us really know how to do this yet. A lot of what you do as a punk is to be patient and trust the process. Owning a clinic is exactly the same.

6. Whenever possible, pay people equally for equal amounts of work.

At WCA, all of the full time people who have been there the longest — me, Skip, Moses, John, Cortney — make the same amount of money for roughly the same amount of work, though the nature of the work varies. For other full time punks, their pay is pretty close to ours as well. Pay equity does wonders for morale. The treatment room in a community clinic works as well as it does in part because it equalizes people: everybody is being treated the same, and so there is a lot of room for a very interesting kind of flow. Making our pay structures similar to that has made us pretty happy, and we recommend it.

The flip side of that goes back to #3: don’t pay yourself less than you pay your employees, or at least, don’t do it for very long. It’s OK to do for limited times and strategic reasons (planning the clinic’s growth) but it’s unsustainable in the long run.

So! Teaching that session four times, plus having conversations with so many lovely people over the weekend, helped me figure out what the most important part of the BDC workshop was for me: I finally understood that the community acupuncture movement is a fractal.

Cris has been saying this for a while and I didn’t really get it, probably because I couldn’t quite see it. But at the workshop, I saw it. Nature is full of fractals, some more subtle than others: ferns, clouds, salt flats, pineapples, lightning, rivers, lungs, and blood vessels. Maybe the most obvious natural fractal is Romanescu broccoli. At the BDC workshop, community acupuncture looked to me like a head of Romanescu broccoli — like, how did I miss that?

Wired says that fractals are patterns formed from chaotic equations and contain self-similar patterns of complexity increasing with magnification. If you divide a fractal pattern into parts you get a nearly identical reduced-size copy of the whole. I always thought one of the most important things about the community acupuncture model was that it was organic — which includes having an element of chaos — but it’s only now that I’m seeing that it looks the same at every level. At every level! Being a patient is like punking is like owning is like making POCA.

One of the things I felt like I could never quite explain to anybody, over the last ten years, is why I was always so hell-bent on working out the next level of the model. I have often thought — and sometimes other people have said — that I should have been happy that my clinic — one clinic! — worked so well and left it at that. Why did Skip and I spend so much time on setting up CAN? Why did we want to make 2 more WCA clinics? Why was I so determined that CAN had to phase into POCA? Certainly none of those things have made us any more money than just focusing on one clinic would have — in fact, all that next-level stuff has definitely cost us not just money but time and energy and trouble. I’ve had business advisors politely suggest — right before I fired them — that I was not rational. And it was true, I was stubbornly irrational. But now I feel vindicated because SEE, it’s a FRACTAL!

The fractal nature of the movement is, I think, what keeps it from just dissolving into the corrosive capitalism that defines “business as usual” and that surrounds us. By now we’ve all seen plenty of examples of what happens to community acupuncture when the next level of the movement isn’t there to reinforce it. It breaks down into all kinds of weirdness, and then usually, it just breaks down.

One of the challenges right now, as we set up POCA Tech, is to make sure that it is still part of the fractal. Because the organic patterns of community acupuncture aren’t the only blueprint for POCA Tech; there’s also the ACAOM accreditation manual. I think we’re in the process of figuring out how to keep our fractal intact as we venture into an entirely new level of bureaucracy. So please stay tuned for a blog on that topic — soon, I hope. And in the meantime, eat some broccoli.



Author: lisafer

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  1. Lisa, thank you for this blog and for the BDC workshop! I had a few big ah-ha moments there, which I am now having again reading this:

    1) Holding the space for patients is the same as holding the space for employees. Very fractal-ey. You have to want lots of people around you, period. Holding the space for lots of patients came pretty easily for me, but I realized that I haven’t necessarily been holding the space for lots of co-workers. That’s changing now.

    2) Lisa your talk about transparency was a huge revelation. I am so glad I can now stop pretending like I know how to be a perfect employer. I mean, I know a lot more than I did a few years ago (thanks mostly to my comrades), and I try very hard not to break any laws, but a lot of the time, I have no idea what I’m doing. In fact, after the workshop I wrote a memo to my staff and fessed up about being clueless on a great many things. It felt great. And guess what? People are now asking how they can help! My days of doing everything are numbered.

    3) Thank you for giving me permission to not have hobbies. I’ve actually been beating myself up for quite some time for always wanting to work and not having time for anything else and not being well rounded enough. I’ve been so hard on myself for all the things I don’t do, like I don’t practice the piano enough (actually I think we could start a lame-ass POCA band with all of us playing the instruments we love but never have time to practice), or once again I did not put in a vegetable garden this year, or geez I really want to start ballroom dance classes, or I should take more nature hikes, or I need to learn Spanish now!, or why can’t I knit anything more sophisticated than a dishrag? But the truth is, if I wanted to devote more time and energy doing those things, I would do it. At this point in my life, what I really want to spend a good chunk of time doing is working. I may not always feel that way but it’s the way I feel now, and I’m done apologizing for it. Thank you.

  2. I knew you secretly wanted to do lifestyle counseling, Lisa – broccoli, indeed!

    Seriously, thanks for a great breakout and great workshop. And in re: hobbies, I actually brought my knitting to do on the plane and ended up reading business-related books instead! The bit about co-dependency was a revelation, too…more for the reading list.

  3. Yay, Alexa and Nora and Jade, I’m glad it was useful! I’m trying to figure out something witty to say about how fractals can’t be well-rounded, but I don’t actually know enough math to make jokes about it.

    I heard comments from a couple of non-punks over the weekend that they noticed that all of the conversations they overheard consisted of shop talk. Constant animated shop talk. Even one of the bus drivers mentioned it. No wonder it’s hard to have hobbies.

  4. Right, fractals can’t be well-rounded because they’re so focused on doing their thing. Like a head of Romanescu broccoli is really good producing things that look like little versions of itself, but it won’t produce anything that looks radically different. It doesn’t have the energy or resources for that.

  5. I love the fractal analogy…it has integrity and works on so many levels. Thank you for these insightful posts…you point about expanding our interior space and minimising the distractions – that was a fortune cookie moment for me – just what I needed to hear.

  6. Now I get it!

    I was totally fascinated by these broccoli when I first laid eyes on them about a year ago, piled up on a table at the local farmer’s market, along with the “normal” cauliflower and broccoli. They had a magnetic effect on me–I had to pick one up, the patterns and the color grabbed me. Those PATTERNS! I bought one, took it home, photographed it, and ate it, all the while marveling at this natural work of art, this glorious and unusual phenomenon of the natural world.

    I had no idea I was looking at a prime example of a fractal. I had never heard the word before. So yes, CA is very much like this extraordinary broccoli. Who knew?

  7. I appreciate the efforts you have made and continue to make by sharing in public forums. You keep me on-track and re-thinking what I am doing on a daily basis (or whenever I get back to the forums and blogs!) I think by now my clinic would have dissolved into disfunction if I wasn’t so stuck on reading nearly everything that is written here. Thank you Lisa, and all other contributors.

    I wish I could have been at the BDC workshop, if you run another, I will do my best to be there. I sure feel like I missed something, well, big.

    I had regular broccoli for dinner… 🙂

  8. Thanks so much Lisa! Inspiring as usual. The BDC was so thought provoking that I have pretty much been obsessed with work ever since. Though I still manage a few minutes at night to practice my ukulele and I am still caring for my child (thanks for not confiscating him!). Other than that spinning spinning spinning in the pattern of a beautiful broccoli fractal– cool!