How to Succeed in CA Without Really Trying

So you want to open a CA practice. You’ve reviewed the requirements to be a POCA clinic, and you think: “Sure, okay, I can live with those.” This blog is about what’s behind those guidelines. It’s about the spirit of a CA practice. And I promise, you, this is some of the most hard-core business advice you’ll find on these forums. It ain’t about what kind of chairs you get or whether you practice Tan or Tung or Billy-Bob’s style of acupuncture. There are several things that successful CA clinics have in common, and your best shot at opening a successful clinic of your own is to copy, copy, copy. Not to tweak, tweak, tweak. “Yabut…” you might be thinking. “Yabut, I like the CA model, except for this one thing. I’m going to do it my way, and it will be better. My patients will get better results, I’ll have an easier work life, I’ll make more money, I’ll grow faster, my cash flow will be more steady, my work will be more interesting than the standard CA model.” I’m here to talk you out of trying. You can succeed at CA. Just don’t try.

So here are a few items for your consideration:

If you really don’t want to treat patients who are too fat, too, sick, too broke, too angry, too crazy, too smelly, or from this ethnic group, who speak that language, follow this religion, belong to that political party… yes, you can make it known – in a thousand small ways that would never, ever, get you called in on anti-discrimination litigation – that they are not welcome in your clinic, and they won’t come around and bother you too often. But if you do that, your chairs will not be full enough, and you will probably not make it. If, however, you can genuinely smile and welcome all comers to your clinic, you will find die-hard fans in the unlikeliest of places. Especially among the marginalized populations who don’t often receive respectful health care (think “people who have recently immigrated” and “people who are obese”), if you provide a space they can easily use as their own, they will send every last member of their circle in to see you – you’ll get the fiancée of the cousin of the co-worker of the client of the hairdresser. The webs of connection will be astonishing and delightful. But if you want just a select handful of “types” of patients, your numbers will whither. So don’t try it.

If you really don’t trust your patients to pay you what they honestly feel is a reasonable, sustainable amount for them – if you want to second-guess them based on their hair/car/clothes – if you’re afraid people will try to cheat you on the sliding scale – if you are tempted to provide guidelines, suggestions, and subtle or not-so-subtle direction to influence their choice of what to pay – then you have missed the fundamental trust that underlies this model. If you follow the standard CA model, you are in for a delightful surprise, because patients will pay you everything they have on them – like $16, for example, with $4 of it being in quarters. Patients will break your heart with their generosity. They will bring you fruits and vegetables from their gardens. They will bake you bread and knit you socks. If you are struggling with using the sliding scale and having faith that it will all work out, read this blog post by Lisa B. Just don’t get pushy about the fees. The harder you squeeze, the less the cash will flow. So don’t try it.

If you feel like simple, frequent acupuncture alone won’t help without a lot of lifestyle counseling, you may be tempted to create an extended intake appointment and charge more for it. Or you may do private room treatments and try to get lots of your patients to spend more money for a good ole’ one-on-one come-to-Jesus conversation about their diet, their exercise, their smoking, etc etc. The standard CA model reflects the idea that unsolicited lifestyle counseling is, at best, useless, and at worst, disrespectful. I can promise you that in over 4,000 treatments, not a single patient has asked me “Should I drink more coffee/alcohol or less?” “Should I smoke more cigarettes or fewer?” “Should I exercise more or less?” Why? People know the answers already, and when they feel better, after several days/weeks/months of treatment, they’ll start making changes to these behaviors as they can. If you’re not perfectly clear about why not to do lifestyle counseling, read this blog by Andy. Just don’t get preachy with your patients. If they ask, by all means, kick into gear. That means they’re ready to hear it, and possibly ready to make changes. If (and only if) they are ready, they can succeed. You can succeed as a team. And success breeds more success. The more patients feel better, the more patients will return, and they will refer others to your clinic. Unwanted advice doesn’t respect the degree to which each patient is in control of his/her/their own treatment progress. So don’t try it.

If you think CA is great, but you can tweak it to make yourself a lot of money, you’re ignoring years and years of hard-and-fast aggregate financial results from sustainable clinics. It’s not a model to make you rich as an acupuncturist. It’s a model that can give you a nice, sustainable middle-class income. It’s not for accumulating wealth via the asset value of the business, which will be difficult if not impossible to sell for anywhere near what you put into it in terms of time and effort. It’s not for creating a large clinic with underlings whose work will throw off extra income to supplement what you earn through your personal effort. If you stick to the standard CA model and work hard, you will have made yourself one of the sweetest, most rewarding jobs imaginable. You will be surrounded by people who are suffering – but working on it – and you get to be a witness and even a partner in that every day. It is humbling and awe-inspiring and sweetly funny in different ways every day. But if you need or want to make more than a high-school teacher in your town makes, CA is not a model that can be tweaked to do that. It will break – whatever “clever” thing you try to do. So don’t try it. Please.

Author: MichelleRivers

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  1. Hear, hear! thank you so much for this clear, helpful blog, Michelle. It IS one of the “sweetest, most rewarding jobs imaginable.”

    I think one of the best parts of CA is how it creates this opportunity to listen and see what your community needs and getting together to make it happen.

    I just told a veteran comrade today how I am so grateful for the early clinics sharing their example and holding the door open for so many of us to follow. It’s just what we tell patients: “trust the process, it will work.” good advice.

  2. Goddammit, Michelle, why didn’t you write this blog, like, ten years ago? It would have saved us SO MUCH TIME. I think, from here on out, I will simply read this out loud at the start of every workshop.
    And it really IS “humbling and awe-inspiring and sweetly funny in different ways every day”.
    Also, LOL @ Billy-Bob’s style of acupuncture.
    Thank you.

  3. And this, punk!, is why you should move to Chico and work with Michelle. This is all just so true. I wish everyone got it like you get it. Also wish that those of us who do get it could articulate the “it” like you do. Thanks!

  4. “Patients will break your heart with their generosity.”

    So true.

    Michelle, this is a fantastic blog. Thank you. It’s so timely as CS circle is meeting tomorrow to discuss things that this blog points to directly.

    As some of you saw, I posted a picture of a payment from a patient that was $20, $5 more that the lowest on the scale. It consisted of one dollar bills, quarters, dimes, nickels and pennies. I’m sure this is not rare amongst us. It humbled me more than anything in recent memory.

  5. Thanks for this Michelle. So well said.

    Beware of tweaking indeed! If you want to see a lot of people and not charge them a lot of money (these 2 go hand in hand) then look to people who are doing that now and copy them. The model works and is repeatable. Keep it simple.

    Why does POCA care what you do in your clinic? Because there’s still so much need out there for accessible acupuncture and we want successful, sustainable clinics to send our friends and family to. It will save you time and money and heartache.

  6. Michelle! Yes!! This is awesome and incredibly useful. Thank you!

    And you are so right. I wish there was a way to viscerally transmit the rewards of having a patient community built on trust. It is beautiful and strong. I remember being laughed at in my “Practice Management” class when I brought up trusting patients; Marilyn Allen basically called me a fool and most of my classmates cast me pitying looks. It is very sweet now to be 18 months into my practice and seeing 80-100/patients/week with whom I have beautiful trust-based relationships. I say this for the benefit of any doubting students out there reading this- Michelle speaks the truth!

  7. awesome blog michelle. i think you hit it on the head. look at all the most successful clinics and across the board they’ve all done the same thing.

    “If you think CA is great, but you can tweak it to make yourself a lot of money, you’re ignoring years and years of hard-and-fast aggregate financial results from sustainable clinics.” love this.

    will remember this blog for boulder next weekend.

  8. Why do I love working in a CA clinic? Because it is one of the “sweetest, most rewarding job imaginable”. Why do I love you all? Because all I have done is copy/paste, copy/paste, copy/paste.

  9. OK, I am part of the fan club, thanks, Michelle this is an awesome post. I might add something about accessible hours, perhaps “If you think being open two hours on Tuesday morning and Noon to three on Friday is going to help you build a Community practice of people who mostly work and mostly don’t have privilege oozing out of their ears, don’t do it, it will not work.”

  10. Here here to “one of the sweetest, most rewarding jobs imaginable”!

    What works, works. The ground work has really been laid. No need to re-invent. Work hard and enjoy.

    Thanks Michelle

  11. Thanks, Michelle. The Yabuts are one of the most interesting and infuriating parts of talking to other acupuncturists about this. I always want to say back, “Yabut, my clinic rules and my patients are the sweetest. Why the hell would I want to tweak it?”

  12. thank you.
    everyone already said everything, but i want to second the ‘required reading’ for potential CAP punks. and i am interviewing for a new one this week and i will print this for the candidates, for discussion during the interviews.

  13. Hi, From a new guy/ Acupuncture-OM student, who has recently had and loved my first 2 CA treatments perspective, you just beautifully described what I was attempting to wonder how to translate into the beginnings of an idea of how to build a clinic for my friends and the working class community Of Memphis, TN when I return from school before being led to this website. Thank you all for the efforts/energy put into building this from scratch and the generosity to share your hard-eared wisdom.