Leadership in POCA Clinics. On being an owner AND an employee punk.

I’m now 7 months into transitioning from an owner punk to an employee punk. Having seen both sides, I have some thoughts and questions which I hope are useful when thinking about how a successful clinic, as well as this whole coop thing is going to work.

When I started working at Providence Community acupuncture in August, I thought I knew everything about how to do this as a punk and about what it takes for a clinic to succeed. In fact, I’m really having to learn it in a different way. It turns out that being an employee punk is not just the acupuncture part of being an owner punk. It’s made me realize some mistakes I made in Philly as an owner and the sense of ownership one needs as employee in order to be an asset and not a drain.

First of all though, why the change in the first place? Why would I give up being a co-owner of a very successful and completely wonderful clinic in my awesome neighborhood to take a significant pay cut as an employee of another clinic? Parenting and the need for our family in N.E.. The need for a second job in the family. Struggles with partnership. Ask me about any of these if you’re interested. I think we need to learn how to be more respectfully up in each other’s business about this kind of stuff. I think the answers are important for at least these reasons. 1) Punk moves will happen from time to time. POCA should be able to help maximize the strengths of the punks and clinics involved, and support or interrupt where something is off about the punk’s move or where it looks like one or both clinics might suffer. 2) Part of our move towards coop-ness means that we get to consider all the ways in which the work of a CA employee can and should be just as important and rewarding a job as that of an owner.
Starting to poke in Providence this summer, I noticed that I was really up against my middle class training about different kinds of work and about status. As much as I philosophically saw all roles in the clinic as interdependent and none more important than others, I immediately felt less significant at Providence Community Acupuncture. Not because of the way I was treated or what was expected of me by Cris and others, but just because of some internalized notion that, as a founder/owner in Philly I was a Big Guy, prone to being shown a certain kind of respect which I somehow didn’t expect as “just” an acupuncturist.

For the first few months of punking in Providence, I noticed I wanted to tell people that I started a clinic. So they’d trust me more? Than the other non-owner punks?  I think this problem is mine; but, its also a cultural one we should all check. We all grew up in a hyper-stratified, status conscious world, whatever our class experience was. Most of us have been exploited as workers, creating profits for owners and getting the totally inadequate scraps. Some of us have managed the exploitation for the owners, and been exploited that way. But, also, we in CAN and POCA spent a lot of time trashing acupuncturists and elevating the social business entrepreneur punks among us.  I’ve now participated in problem-employee conversations as an owner or been privy to them as an employee. I’ve seen at times a thin line between justified rage at employee behavior which exemplifies the problems of “the profession” and patterned complaining about subordinates being annoying. How much of this stratification have we internalized? Has what started as a classism-fighting critique now served to reinforce a classist dichotomy between owner and worker within our minds? As we continue hiring more and more punks POCA clinics will be helping to first of all make relevant the job of acupuncturist by providing real jobs, equitable pay, real connection, and the opportunity to do a ton of poking. And, the systems we’re creating will keep  killing off the “I’m special” crap we all hate so much about practitioners we’ve known. Can our minds keep up with these goals and go ahead and shift our view of ourselves and our comrades as acupuncturist employees to one of deep appreciation and respect? And, how (or will) will we employee punks earn and demand that respect and make ourselves central to the whole project?

So, as I returned to the check-earning world of the employee I was met  with internalized stuff about status and hierarchy. My references were dozens of other working class jobs I’ve had.  The feeling was that I just need to show up and do a good job, that I’m less important. This of course came with the relief of lower expectations, and also the subtle or not so subtle disempowering distancing that happened between me and the larger project, me and my colleagues.

Whats wrong with a little distance between owner and employee, between wage earner and leader? Well nothing if we want our clinics and organization to run like everything else in our capitalist economy. But, its not what any of us really want. And, its not how clinics are going to work. All shifts have to be full. That means everyone has to hold space for roughly the same sized overlapping-but-different circles of patients. Isn’t this the essence of the clinic’s work? All systems, administration, acupunking need to lead to this happening. All hands on deck need to contribute to it or it won’t happen. If someone is feeling less important, less committed to the project, the way they hold space for patients is going to suffer. I think I really got a first hand look at this in my first couple months at ProvCA. There was a way in which i really wanted to/needed to coast for a while. I did, and I believe it really negatively affected the speed at which I drew patients to me.

What got me out of this was acting with leadership. What go me to act with leadership, honestly, was that I was getting paid for doing non-poking, bigger picture work. At ProvCA, Cris uses the administration module system pioneered by WCA. In my case I’m getting paid, gloriously, to do outreach/marketing stuff. I love doing outreach/marketing stuff. I’m good at it when i do it. But, again, I think I really had to fight through the subconscious notions that hey, I didn’t start this place, or I don’t own this place, or I’m not really from here, and that Cris does that stuff so I’ll just add to it a little. In my best thinking I knew I could do it, should do it, but I was slacking. Until I realized  that after a couple months the list I kept for myself with marketing to-dos was getting longer and not much was getting checked off. And, oh yeah, I’m getting paid for this. Anyway, as SOON as I really started cranking on this work my sense of belonging at the clinic really expanded in my mind.

Two specific projects helped shape my growing involvement. These were the organizing of our documentary screening event, and our fifth year birthday party. You have to go talk to people to this stuff. You have to go ahead and arrange child care and go meet people. To ask for help and to spread the word. I think our doc screening event was only marginally successful in getting new patients or spreading the word about POCA. But, it kicked me out of my shit. And, helped me start hitting a stride for organizing the birthday event, which was a decidedly more significant explosion of “aha” moments for acu-newbies. Coming out of that, I  felt more fluid in talking to my patients, knew more about town and so started understanding the little local references. Especially in a city as small as Providence, you can get a degree or two from everyone really quickly. And, as we all know, that really counts for something with your patients. My schedule filled up.

I think the main thing that gets hard to keep doing when our internalized employee/subordinate kicks in is leadership. The coasting I did initially here in Providence was made up of giving up on acting with leadership. “Not my role right now.” Most of us, for many reasons from how were treated as young people to corporate control of the commons, have deep suspicion of leaders. This creates personal patterns of giving as little as possible to those in leadership roles when we feel we’re in a subordinate position. We leave it to Leaders, who get the credit for success  and the blame for failure. We get both sheltered from and denied the essential risk. To the extent that non-owners are individually stuck in patterns of hopelessness about leadership, a structure like theocracy or consensus can only go so far in shifting our power structure to one thats more horizontal. This is true of power structures in our clinics and, of course, in POCA as well.

How do we bridge that gap of empowerment and ownership between owner and employee punk? Obviously, it’s not just up to the employee punk to figure out how to somehow get over their wage earner training. We’ve got to keep finding people who have the potential of being fully on board. But, I disagree with the shorthand we sometimes use that “there are those who get it and those who don’t”. If we don’t figure out how to work with people who don’t get it, we’re fucked. I still don‘t “get it” a lot. We’ve got to help people who partly get it to get it some more. Which is what we’re doing, of course. And why creating a school and apprenticeship system is so important.

As an owner and someone trying to hire punks, I think I focused, along with Ellen, on finding punks who mostly got it. I did less of a good job at continuing to communicate with them, supporting the learning curve while seeking their input. But, once again, the main thing in the way was the internalization on my part that what I did as an owner was ultimately important and what they did was important to the extent that they just figure out how to do their job poking. Being an employee again is helping me clean that part of my shit up I think.

What’s the employee/clinic owner going to do to engage and insist upon the punks full involvement. Of course this needs to be talked about extensively as we move towards the realm of coops. How are clinics going to start reflecting cooperative principles in terms of how/what people are payed and in terms of who really owns the clinic, and in terms of how the jobs are shared? Should owners be payed more than punks at all? What about founders original start-up costs and unpaid labor. How long will we still have owners and employees? What are the best ways to get everyone involved FULLY involved. I wouldn’t be doing community acupuncture or a member of POCA if I wasn’t hopeful about our being able to transform the notion of leadership most of us have inherited.

Author: korben

I'm an acupunk and owner at Kindred Community Acupuncture in Pawtucket, RI. I co-founded Philadelphia Community Acupuncture in 2007, and moved to Providence in 2011 to be close to family after the birth of my son, and to work with the inimitable Cris Monteiro at PCA.

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  1. Korben, I’m glad you went from PCA to PCA if only because you wrote this blog. Good smart questions and observations here, thanks! As someone who went from a 4-worker/owner CA “co-op” to a sole prop with PT employees, I think a lot about how hard it is to build new social relations. I think about the fuzzy job descriptions and lack of review processes we had at Grassroots; and about the ways I might encourage (or subtly discourage) employees to have a sense of ownership at DCA. Would love to talk about this more when I’m feeling clearer but wanted to thank you in the meantime.

  2. As someone who is edging towards bringing on another punk in the near future, all these questions have been front and centre in my mind. I look forward to more dialogue about this!

  3. great thoughts on helping employees ‘get it’ by giving a sense of ownership- and of the danger of ‘feelings of importance/ status’ for owners – thanks for the blog!

  4. Thanks for a well thought out post Korben. You articulated many of the issues that I struggled (and some that I am still working on) with myself in the process of moving from struggling owner punk to PT employee punk to full time w/ a module punk. I think that there is a necessary level of commitment to really see your schedule fill up. Mostly I think it is a commitment to seeing lots of patients. It seems like you have to want MORE all the time. Having a ravening, insatiable hunger for treating as many patients as possible is necessary to really build and maintain your weekly numbers. I think that having a module (administrative duties) helps with this, because you focus a little more on the clinic. But you also see how the whole thing depends on needles getting into people. Lots of needles into lots of people preferably, so having that hunger is really necessary. My shifts are still building at Hillsdale but I think they are moving in the right direction because everyday I get a little more hungry.

  5. This is great, been waiting to read this for a while. It’s especially interesting to me, having been an employee of PhillyCA and now an owner of BOA. Being an owner makes me realize just how much I took for granted as an employee. I could, as you said, coast, and being fresh out of school, I felt I needed a few years just to get comfortable with poking and it’s power. I have absolutely no perspective on how my numbers were while starting out, it just seemed effortless to me. I definitely didn’t stress about it as much as I probably should have! I loved my job, loved being there and the new role it gave me in my community, and didn’t really worry about how many people I was treating, they just seemed to appear. But maybe my situation was unique, having a longer historical connection to that building and that neighborhood than anyone who has worked at PhillyCA so far that I’m aware of, including its owners. I find myself now as a clinic owner in another town really missing that sense of relaxation I was able to have around patients there. In the first six months as an owner, I haven’t had any problem filling my schedule, but I have felt much less relaxed around patients, more concerned about my numbers compared to my partner’s, and much more anxious at work. I’ve tried blaming that on NY vs Philly, or subtle differences in clinic culture, or our space, or whatnot, but I think it comes down to feeling the heaviness of leadership, and not knowing how to relax into that role. However, on the flip side, being able to create this humming thriving thing is a sense of empowerment that I never got as an employee. I’m interested in hearing more about how the module system might be used as a bridge between the traditional “owner” and “employee” states of being, and how we might compensate for unpaid labor and different levels of risk/responsibility, as we contemplate hiring our first pokers in the near future.

  6. Great perspective here Korben. Thanks for the insights. My situation is similar in the sense that I have been running a CAP for just shy of 3 years and have now decided to share the job with another punk. It was an interesting process of letting go of the feeling of control I thought I had over the clinic. Now I am really excited about having a partner and all the benefits that go along with that.

  7. “I think we need to learn how to be more respectfully up in each other’s business about this kind of stuff.” BOOM. Korben, you rock. Can we please session on this stuff when I’m hiring my first punk? (I’m going for it, btw. I’ll be on the same side of the continent as you, this summer.)

  8. I appreciate the complexity of this post as I feel we at SCA are beginning to contemplate a move toward cooperative ownership. We are one owner and two employees (one with almost two years history and another new to us). I can feel some of the challenges and rewards of this shift but sense that it is much more complex than I know. Can anyone direct me to current conversation on the topic?
    Thanks, Nancy