Installment 5: Vocation

Opening Scene of “Finding Normal”

David Fitzgerald: “…I love my job. I was born to do this shit.”

We want to hire people who feel that way about acupuncture. It’s not easy to do, though, in part because acupuncture seems to attract lots of terminally uncommitted people. As well as terminally entitled, terminally selfish, terminally clueless — we could go on and on, and in fact, we will!  This section of the study guide is a kind of laundry list of what we do and don’t want in our employees. We’re hoping our list will offend some people, and they won’t try to work for us or for any other community acupuncture clinic, thus sparing everyone a lot of time and trouble.
Before we get into the list, though, there is an interesting paradox we should look at, and that is the problem of public health acupuncture jobs. Not only did my public health acupuncture job allow me to work with David Fitzgerald and people like him, but it helped me to approach the subject of acupuncture as work. If you don’t get why approaching acupuncture as work is a big deal, you haven’t spent enough time with enough acupuncturists. Thanks to the acupuncture schools, many acupuncturists learn to approach acupuncture as if it were just esoteric knowledge floating in space, blessedly free of any real-world obligations. Having a public health job taught me how to drag the practice of acupuncture down to earth — at least in some respects, at least in the sense that I had to show up at the same time, to the same place, and put needles in people whether I felt like it or not at the moment. I was simultaneously doing acupuncture (consistently, even) and being responsible to other people, a minor miracle in the acupuncture world. However. Since then I have learned to be cautious about hiring acupuncturists who have had previous public health jobs. Meaning, if I could collapse time and my 2002 self could apply today for a job at WCA, I would have major concerns about hiring myself.
One of the great things about having a job, as opposed to being self-employed, is that you are not responsible for creating all of the structures involved in your job all by yourself. You do not necessarily have to figure out how to put together charts, where to order needles, and how the phone needs to be answered. Being responsible for all of those things requires a lot of energy, and this is one reason why entrepreneurs tend to be high-energy people. Many public health acupuncturists end up being public health acupuncturists because they don’t want to be entrepreneurs.(Like myself, post acupuncture school.) Not wanting to be an entrepreneur is not necessarily the problem  (you could argue that entrepreneurs also tend to be crazy); the problem is that, in my experience, a lot of public health jobs attract low-energy acupuncturists. The positive side of low energy is mellow, tolerant, and easy to be around; the negative side is passive, unengaged, and not dynamic enough to attract or retain patients.
The negative side of a public health acupuncturist can be fatal for a community clinic that depends on revenues from patients to stay open. On the one hand, a public health acupuncturist, like myself in 2002, may have a lot of experience doing simple treatments in humble circumstances. On the other hand, those treatments were almost certainly being given to people who were not paying for the treatments themselves. Worse, it is highly possible that the people receiving the treatments were doing so because they had no choice — because their parole officers required them to get acupuncture, or their housing depended on it, or acupuncture was somehow part of something else they had agreed to. This means, that while a public health acupuncturist might have perfected the art of painlessly getting needles into people’s ears, she also might have absolutely no experience whatsoever with building the kind of relationship with patients that helps them to stick with a course of treatment. Further, she might be actively resistant to learning how to build this kind of relationship. From her perspective, she knows what she’s doing; if patients don’t come back, it’s not her fault. So, in short, a major issue with hiring acupuncturists who have previously worked in public health is that they might have adapted themselves to systems and structures which do not exist in community acupuncture, and they might be unprepared to function without those systems and structures, whether they know it or not. They may be used to putting a certain amount of energy into their work, and for a community clinic, that amount might not be enough. Of course, these issues can be overcome; Skip and I were public health acupuncturists for almost a decade. And we overcame them. But we were motivated to overcome them, and not everyone is.
What we do want: people who are smart enough to understand how systems affect them (and their patients), people who can think critically, people who are engaged and dynamic and willing to work hard at relating to patients. What we don’t want: people who are looking for a job as opposed to being in private practice because they don’t like taking responsibility.
What we really, really want are people who believe that acupuncture is their vocation.  I mean “vocation” not in the narrow, technical sense, as in “vocational school”, as in, something you learn how to do in order to make money; I’m Catholic, so I mean “vocation” in the way the Catholics meant it when they came up with the word way back in the Middle Ages, from the Latin “vocare”, which means, “to call”. Your vocation is what you are called to, what you were born to do. A concept in Judaism related to the idea of vocation in Catholicism is Tikum Olam, the repair of the world: the idea that the world has become broken, it needs to be rebuilt, each person has a piece of the rebuilding to do, and you may not necessarily choose your piece — your piece may choose you. (Thanks to Blythe Miller and Gabe Freedman for that connection.)  I’m not at all implying that you need to believe in God to be a good acupuncturist; I’m not talking here about acupuncturists’ relationship to religion or spirituality, but about acupuncturists’ relationship to acupuncture itself. We want to find people who have a relationship with acupuncture in which acupuncture represents something larger than themselves, something that they are responsible to, something that they are not trying to control or possess, but to answer.
A vocation is infinitely more than a job. You don’t abandon your vocation when it’s not going well. You don’t have power over your vocation; it has power over you, and paradoxically, by surrendering to it, you become empowered. You don’t ditch your vocation because you don’t like the hours or the pay or the prospects for advancement. Dealing with the inconveniences and demands of your vocation is one good way to grow up.
Acupuncture is a very inconvenient vocation. There are plenty of other very inconvenient vocations, like farming, and art, and being a parent. No one becomes a farmer with the expectation of making buckets of money, having an easy life, or getting lots of understanding and support from society. People become farmers because they can’t resist farming. They are willing to let farming take over their lives, in part because farming both changes them and allows them to be who they really are — which is the definition for me of a real vocation.
But since I just referred to vocations changing people, I need to make an important clarification. Another kind of acupuncturist we don’t want is one who has bought into the acupuncture schools’ advertising campaign about “the transformative power of Oriental medicine.” We don’t want romantics, and we don’t want magicians. We don’t want people who went to acupuncture school in order to “develop themselves”, or who expect that they will be changing other people’s lives with their special knowledge and the perfection of their example ( see “Malibu Barbie”, above).  Acupuncture doesn’t change you because of what you know, it changes you because of what you do — and in our view, the only meaningful thing you can do with acupuncture is use it to serve other people.  Many people go to acupuncture school because they had a wonderful experience receiving acupuncture, and they find themselves drawn to the medicine. There is a crucial difference, though, between getting acupuncture and giving it, being drawn to acupuncture for selfish reasons and being drawn to acupuncture because you want to help people. Being fascinated with acupuncture, being enchanted by the idea of Chinese medicine, is not the same thing as being called to practice it. A vocation entails both service and responsibility.
Which brings us to the relationship between vocation and working in a social business. The community acupuncture business model is a social business model, meaning, it is not designed to make a profit. A social business is designed to create social benefit — in this case, acupuncture for people of ordinary incomes, and its goal is just to do what it does and to continue to exist. This distinguishes it from a typical capitalist business, which is designed to do what it does and also to wring money out of it — money over and above what it needs to exist, financial dividends which go to the owners or shareholders. This is known as making a profit, and if a typical capitalist business can’t make a profit, it is considered a failure. A typical nonprofit is designed to create social benefits by using money that other capitalist businesses have wrung out of their operations and then donated (often through the vehicle of foundations, which are essentially a place to deposit excess profits). A nonprofit is not designed to exist independently of typical for-profit capitalist businesses — otherwise, where would the money come from? A social business, however, is designed to exist independently; it makes its own money to do what it does.  If a social business were a person, it would be a person with a vocation: doing what it does out of love and the need to do it, determined to survive in the process, undeterred by operating on a shoestring.
And, funny thing, if you really want to work in a social business such as community acupuncture, you need to have a vocation:  since a social business is not designed to wring money out of itself, the main reward you are going to get from working in one is the chance to do what you love to do. There will not be profit sharing, because there are no profits. There will probably not be wonderful benefits or other kinds of perks. Profit sharing, great benefits, and the other upholstery of typical capitalist businesses exist in part to persuade people to participate in the process of wringing money out of their work. Many nonprofits also try to provide comparable upholstery, with the idea of rewarding people for doing unselfish work. The community acupuncture model, however, does not generate enough money for upholstery; we believe that doing the work is itself the reward. If you need the upholstery to feel fulfilled, valued, and comfortable in your work, you don’t belong here; as David Fitzgerald says, do yourself a favor and find somewhere else to go. Another way of saying it: we can’t pay you enough to make you want to do this job. You have to already want to do it, and to be genuinely delighted to find a way to buy groceries while you’re doing it.
One of the hard parts for me about being the owner of a social business is being treated as if I were the owner of a typical capitalist business; as if I were interested in employing people so that they could make money that would in turn allow me NOT to work; as if I were getting something out of my business other than the opportunity to fulfill my vocation. Part of the design of the typical capitalist business model, and the typical nonprofit model too, is the assumption that when it comes to owner and employee relationships, the point is to give as little as possible and to take as much as possible.  (Otherwise known as the opposite of having a vocation, which entails giving as much as possible, because you really want to, and having no interest in taking anything.)  If giving as little as possible isn’t your basic assumption, the typical employment structures don’t fit well. And the reality of being the owner of a social business (a new, poorly understood model) that provides an unfamiliar, poorly understood service such as acupuncture, is that you have to have a high tolerance for struggle and for risk. What distinguishes me financially from my acupuncturist employees is not that I make more money than they do, it’s that all of the business debt is in my name. I took the risks that made all of our jobs possible. I have no regrets whatsoever about that. But when I have interactions with potential employees that suggest to me that they are trying to get as much and to give as little as they can get away with, it makes me very cranky. As well as very discouraged.
So another thing we want are people who have enough sense not to discourage us; who are smart enough to realize that a social business is not business as usual and that jobs for acupuncturists are a result of somebody’s years of effort. These jobs are not supported by other sources of money, as in a nonprofit; they are mainly supported by everybody’s love of doing acupuncture. They need that love to continue to exist; without it, they disappear. The beauty of working in a social business with other people who have a vocation for acupuncture is that nobody has to do everything all by themselves; people's unique talents and abilities all come together to enrich the clinic. I don't know about anybody else, but I don't see how money can compare to the reward of getting to work with other people who are really serious about their jobs and who are all contributing wholeheartedly to something really important.
Acupuncture in the U.S. is young and fragile; if it is to survive, it is going to need a lot of disciplined, serious acupuncturists who want to give their lives to it, unselfishly. Acupuncture will not survive if all it attracts are people who want to use it for their own ends: to decorate themselves with an exotic skill, to make themselves important with a title, to dabble in healing only as long as it’s entertaining. There are a lot of those people involved already.  Our hope is that by creating jobs and filling them very, very carefully, we can encourage a different kind of professional culture, one that’s based on giving rather than taking.

Author: lisafer

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  1. Here! Here!

    thanks again for putting the fine point on it.

    i love this: “(a vocation) both changes them and allows them to be who they really are”

    for me the change has been the process of letting the “at first small voice” (uncertain in the face of the acupuncture culture programming) have greater and greater strength, moving me unequivocally in the direction i was heading all along.

    thanks so much for this post! i  just had this discussion with some classmates: that acupuncture (medicine in general) is not a career choice, it’s a vocation. they were horrified! and resistant–but we “deserve,” etc.

    i’ve felt the way we talked about in another blog recently: that maybe we see it as a failure of communication somehow if we can’t convince patients about the benefits of acupuncture treatment or, in this case, other professionals about the benefits of CA. i’m beginning to see that it really does have the element of you get it or you don’t, end of story. maybe i’m wrong, but endless explanation of CA to someone shopping for a career is like trying to promote religion at the mall. hmm, that just popped out–i’ll come back to that in the morning and see if it’s really what i meant…

    these are some of my favorite “getting down to it” CAN discussions yet. thanks, lisa. i’m working on a little fundraising to get Finding Normal asap! (we just moved the biz and are at “critical expenses only” (like needles!) for a bit.) if anyone has a copy they’re not watching over and over right now and would like to share for a week or two, let us know…


    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  2. thanks so much for bringing

    thanks so much for bringing up these concepts of social responsibility and being drawn to the work of helping people through acupuncture at a deep level, beyond “trying a new career”. These discussions have the potential to make a lot of students and current acupunks become more self-aware and pehaps self select into or out of practicing community acupuncture more clearly and quickly. The idea of a vocation holds a lot of meaning. Yet, to my mind, so does running a social business, as defined by Yunnus. If you recognize that a CA business suports itself just enough to create a stable and consisitent social benefit (acupuncture), instead of piles of money above and beyond the business operating expenses, that ought to be a large clue as to what would motivate you to run a CA biz in the first place. As I understand it, the idea of having a relationship to acupuncture as a vocation and running a social business are concepts that really fit well together. Seems like a Sun Si Miao approach to running a biz…

  3. Nonprofits as symptoms

    Just to be fair (?) to non-profits, most of the really large ones are actually funded by the government.  Essentially, they serve as a cost-cutting measure–see, many of them provide social services that the government SHOULD be providing, but chooses not to.  Whether it’s not politically expedient or whatever, one of the main “hidden” reasons is that all the benefits that government employees are entitled to make these services very expensive.  A large portion are person to person type services, so payroll is often huge.  The government can’t cut labor costs like a non-profit can, so they funnel grant money to these entities that can then pay people less etc. etc.  All the while, requiring government oversight via grant renewal/nonrenewal.  They are more of a symptom of our sick society than the disease itself.  Just sayin’. . . 

    Much like the way we don’t pay teachers and social workers enough, acupunks are in the same boat, and should know it from the start.  We live in this sick society where helping people actually puts you at severe dissadvantages all around.  Therefore, if you really want to do this, be prepared to have your work be your ONLY reward.  Not unlike a “vow of poverty”, not to beat the religious (very Catholic) example into the ground.  

  4. You seem to be describing what it takes to create change: depth of commitment, motivation, engagement, critical thinking, a sense of responsibility and having a vocation. You may be right about what it will take to change healthcare, impact communities, make acupuncture accessible in a way that’s dynamic and widely utilized. But having a vocation is privilege, not necessarily a reality for many socioeconomic groups. There can be a disconnect between vocation and working class, unless you assume that working class means a certain set of values and stability, rather than work=making ends meet.

    Eventually, what I’d like to see is for people to enter the acupuncture profession without it being a vocation, a huge undertaking, a mass of responsibility and debt but hey the work is rewarding. I want a future with lower barriers to entry for practitioners, reasonable job opportunities, basically a lot more normal than things are now. Maybe you can still call that a vocation. But I’d like to see people be able to say ‘hmm, acupuncture is a pretty good 18-month degree. I won’t get rich but maybe I’ll do that rather than getting a degree in business or education or medical testing.’ Becoming an acupuncturist should be easier than being a social activist or reformer.


  5. there’s so much to say…

    Liss, if you save all your blog posts, you can just tape them all together to make the next book.

    Unfortunately, I wholeheartedly agree that this profession “…attract(s) lots of terminally uncommitted people. As well as terminally entitled, terminally selfish, terminally clueless…”

    And the shiny, exciting, fascinating, secret, magical, mystical medicine does seem to pull in people who don’t seem to know how to work.

    So it made me review the acupuncturists I know (lots)…and there is a clear line between worker and non-worker. A lot of the really earnest, dedicated workers might be on their second or third careers. But they worked hard all through them all. And didn’t have family members paying their way.

    Lots from the other group were on their 2nd, 3rd, or 4th degree… terminal students. It seems to be a great course of study to avoid getting a job…takes forever, then they don’t even need to get a job, they’ll be too busy “healing.”

    The workers are the only ones who will work at work; what are the others going to do? And I think most community acupuncturists have found their vocation, but I also think it would be ok to have an employee who knows how to work.

    The problem… people who “can think critically, people who are engaged and dynamic and willing to work hard at relating to patients” seem to be entrepreneurs with the drive, energy, and passion to just go do it.

    This is a very timely post. The work is absolutely its own reward. If it were not for student loans…and the lengthy schooling, so much of which is not useful… maybe it wouldn’t seem so mysterious and romantic, and would attract more worker bees. I want an acu-tech program at community colleges!!

  6. “The work is absolutely its

    “The work is absolutely its own reward. If it were not for student
    loans…and the lengthy schooling, so much of which is not useful…
    maybe it wouldn’t seem so mysterious and romantic, and would attract
    more worker bees. I want an acu-tech program at community colleges!!”


    yes, yes, yes…thank you fror saying this!

  7. a great vocation example

    While reading the magazine “Mother Earth News” tonight, I came across an interview with farmer and writer Joel Salatin. The whole article is a great example of a vocation and a man who lives to be a farmer. There are many similarities between his work and his service to the community and that of acupuncture. Below are a few clips from the article, but for those who want to read it all, here is the link.

    “As early as I can remember, I’ve wanted to be a farmer. I love growing things. I appreciate the emotional steadiness of animals. Every day when I go to move the cow herd, they are glad to see me. The pigs always come over to talk. None of these critters ever asks you to fill out licenses or threatens litigation. They never talk behind your back or conspire to overthrow you. And to watch the land heal, with ever-growing mounds of earthworm castings, is better than any video. Indeed, walking through a dew-speckled pasture in the early morning after a blessed nighttime thunderstorm, the ground literally covered with copulating earthworms — what could be more magical than that?”

    “I had my own laying hen flock at 10 years old, pedaling eggs on my bicycle to neighbors, selling them to families in church. The fast-paced, frenzied urban life disconnected from the ponds, the trees and the pasture never held much allure for me. Go away? Why? Where? I think I was planted here. I think God tends my soul here. It’s not for everyone, but it satiates my soul with wonder and gratitude.”

    “Like all geezers, I’ve learned a lot just through experience. Because I’m a third generation-Christian-libertarian-environmentalist-capitalist lunatic I don’t have a conversion epiphany to share. I’ve just always been weird.”

    ….”Second, most farmers are marketing Neanderthals. Either they really don’t want to be around people, or they don’t know how to interact with them. A successful marketer needs to be a bit theatrical; a storyteller, schmoozer, gregarious type. And that’s not typical, especially among John Deere jockeys.”

    “I certainly never thought our farm would top $1 million in annual sales, but it happened. We still have no business plan or marketing targets. But we’ve been blessed with a family of enough variety to put together these six foundations for a whole, and that has made all the difference. And I’m a schmoozer.”

    “The problem is that our culture tells bright, bushy-tailed young people that farming is for backward, D-student, tobacco-chewing, trip-over-the-transmission-in-the-front-yard, redneck Bubbas.”

    “When was the last time you heard a group of parents bragging? Ever hear one say, “Well, you can have your doctors, lawyers, accountants and engineers. My kid is going to grow up and be a farmer.” Ever hear that? Not on your life. The biggest obstacle is emotional — overcoming the cultural prejudice against splinters and blisters. That is why I talk about economics and marketing, along with the mystical, artistic elements of the farm. Yes, it’s a lot of work. But what a great office. What a noble life. What a sacred calling.”