Are We Making Ourselves Obsolete?

People want natural, safe, and effective care.  We provide that.  Sounds like a win-win situation, right?

Yet, some acupuncturists  seem determined to shoot themselves (and our profession) in the foot.  For years, a combination of high prices and insider jargon has ensured that the majority of the population won’t even consider acupuncture.  Now, our preferred weapon of self destruction is the FPD.

Proponents of the FPD claim that having a doctorate would allow us to gain respect.  I would argue that it would cause us to lose respect from the people who matter most– our patients.

My patients already have a primary care doctor and often see several specialists.  The last thing they want is another doctor.  It would alienate most of my patients if I started calling myself “doctor,” wearing a lab coat, and making them wear johnnies*.

I wish that I could be passive about this and say that those who want a doctorate should be allowed to get one and leave it at that.  Unfortunately, this is not just an individual choice.  The FPD has the potential to negatively impact our profession as a whole– in tangible ways (by making acupuncture school less accessible to incoming students and making acupuncture treatments more expensive and out of the reach of the majority of patients), and in a less perceptible but just as important way, by turning off our patients and potential patients.

* When I was just out of school, I worked for a BA practice that used johnnies.  One patient said that he would rather kill himself than wear one.  A bit melodramatic, but telling. 

Emily Konstan
Author: Emily Konstan

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.

Responses

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  1. Thanks for the blog, Emily!

    And did I happen to see that Acupuncturists Without Borders is writing about you and your clinic in an upcoming PCOM newsletter??  You are such a rockstar… 

    Cool

  2. title dosen’t matter

    For years, some of my patients have called me doctor. Some call me Brian. Some call me Dr. Rosenthal. I don’t think it matters what they call me, they get the same good service each visit. To me the biggest problem with the FPD is the additional cost of schooling, therefore the debt burden that students, who will then become practitioneers will be stuck with, many for the rest of their lives.

  3. That’s saying something

    As we do a lot of bending over, with all those recliners.  Drafty!

  4. I agree about the costs

    Lots of other blogs have covered the financial issue, so I wanted to come at it from another perspective.  Maybe it’s just us ornery New Englanders, but so many people I meet (not just my patients) are disillusioned with the Western medical system– and we have some of the best medical facilities in the world here!  I don’t want to take on that baggage in my own practice.

  5. If you wear that Johnny hospital style…

    please take a picture and post!  

  6. As a fan of Seth Godin, I

    As a fan of Seth Godin, I just read that post today. I find i funny why you would even apply CA to his line of thinking. I mean, isn’t the whole idea of CA supposed to be reasonably priced, value for the patient?

    And………..do you suppose Seth’s haunting words may bite the whole CA community in the ass eventually as a failure to its own ideal?

    What we are dealing with is a marketplace, people. Eventually, your own prices will go up. (You are shouting at an economic system that will not accommodate your ideals which is essentially accommodated by communism. That is the real battle here you must face.)

  7. I’m not sure how the Guest above

    would know what community clinics are going to do with treatment fees, unless he/she owns a CAP.

    Speaking for myself, I’d lower our fees across the board if I could… 

    I’d remind our reader there are lots of ways at looking at ‘The Market’ and strongly suggest taking a close look at how by current estimates, a paltry 1% of the US pop. uses acupuncture….and how the vast majority of US citizens would be hard pressed to pay current  acupuncture ‘market rates’ given their household income.

    These are among the factors that serve as the backbone for the business side of community acupuncture.  

    However, just as important to many CANers are social and moral facets of offering simple, effective means by which to ease suffering at available rates.  

    You may find solace in predicting the demise of this model, in the face of rising market rates.

    But I sense a failure in this line of thinking to take into account the hundreds of millions of people who will always provide an available market share to those providing affordable health care.  

    Tagging us as communists makes for great finger- pointing – but it doesn’t change financial realities for people in our neighborhoods.  

  8. Well….I mean if you say

    Well….I mean if you say so.

    If I were going to do it on the strict grounds of morality, I can think of a ton of neighborhoods here in the Bay Area that need a ton of attention…and probably a few security guards to boot, if you follow me.

    I think CA serves an excellent business model, a need as it were that seems to go unmet by certain individuals. However to make it appear that only 1% can afford this wonderful medcine is erroneous. The real issue here is still an awareness, not price cutting or the dumbing down of a 5,000 year old medical system.

    And as far as what “you” will do with your prices, well I don’t need to have a CA model. It’s simple. You begin, well intended of course, by cheapening your prices. Naturally there will be price sensitive people who will flock to you if for no other reason they can “afford it”. But sooner or later, you will have undercut the rest of the practitioners and bringing in their patients to you. Seating, availability, scheduling will all become more and more at a premium: supply and demand. Simple.

    You can try to manage it otherwise but you’ll find that as you become successful in you practice, when you are in demand, your prices will be needing to go up. If not, you will take the losses. And, the very question of “becoming obsolete”- as posed by opponents of the doctoral program (which btw I’m not a huge fan of, either, if that matters)- will then be before you. Only it will be on the opposite end of the spectrum.

    Is CA here to stay? Probably. But I doubt it’s going to be the revolution you hope for. Why? Simply because not everyone will want it. And you’ve been duped into thinking people can’t pay for it, when in reality they simply won’t. Why? Because most are unaware of what can be done for them.

    And alas, that awareness must come from you, the healer. That involves personal initiative, salesmanship even. But alas again, this is something healers frown upon, believing I suppose they are above (or below) the marketplace. Salesmanship is really just communicating potential value. And with that, I ultimately question the self worth and esteem many colleagues have for our medicine.

  9. I am SO CONFUSED

    “you’ll find that as you become successful in you practice, when you are
    in demand, your prices will be needing to go up. If not, you will take
    the losses.”

    By getting busier, you lose money? 

    Needing to go up? Why? WCA has not raised its prices in almost eight years. We figure if we just keep not raising them, eventually the bottom of our sliding scale will line up with the federal minimum wage. And then I’ll be really happy.

    But so far it’s been my experience that the more successful we are, the more money we make. The fixed costs of doing acupuncture: rent, utilities, needles, don’t vacillate wildly. So where do these losses come in? I have a bookkeeper and an accountant and they never explained this to me.

  10. also

    what this debate really needs is a BINGO CARD. I was wondering when somebody was going to say “if you have low prices, you have no self esteem” and you did not disappoint me, Guest not verified. CANners, want to help me out with the rest?

  11. Why were you wondering that?

    Why were you wondering that? Too much truth?

    Bingo indeed.

  12. Bingo!

    We’d have to put “patients would pay for acupuncture if they knew how much it could help them” on the Bingo card — Hey, maybe it’s our patient’s that are “cheapening” our profession!

  13. Our guests comments are uninformed…

    …and plentiful at that.

    Let’s be generous and suggest this person has some community acupuncture 101 homework to do before making any more erroneous assumptions.

    I might even suggest speaking with a CA clinic owner to find out what it’s really like inside the biz side of things.

    Otherwise, they’ll run the risk of writing more comments in the previous vein.

     Feel free to email me, and we can share some reality-based information. 

  14. Sounding like a broken record

    Sadly, I am not shocked at the anti-CA venom of your post.  It is the same tired rhetoric that CAN and WCA have heard since the beginning.  As Lisa and Cris hint at in their replies, we could probably recite your criticisms better than you can.

    However, I am somewhat confused by your interpretation of Seth Godin’s blog.  To me it is clear that the CA movement fits well within his business ideas.  But, since I can’t claim to speak for him, I just sent him an email to see if he would like to comment.

  15. I was thinking a drinking game

    If someone says, “if you have low prices, you have no self-esteem,” drink a shot of goldschlager.  Or an entire bottle of Moet.

    If someone says, “you’re cheapening/devaluing the medicine,” drink a bottle of die da jiu.

    If somone says, “competencies,” drink a shot from the opposite side of the glass while tying a cherry stem with your tongue.

    If someone trumpets “integrative medicine,” drink a bottle of 90 proof rubbing alcohol.

    If someone says, “underserved communities,” drink a 40 of malt liquor, or a bottle of Thunderbird.

    If someone asks “why are you so angry!?” drink a Molotov cocktail.

    (Special for Nora): If someone says “the rural heartland,” drink a case of Schlitz.

     

     

  16. The patients you attract

    The patients you attract will be a direct result of the messages you send out. So, while I’m sure you were trying to be cute, your patients basically do just that: cheapen the medicine, and you’ve provided them with the opportunity.

    With that, I shall await replies with a bingo card of my own.

  17. put this on your bingo card

    They “cheapen the medicine” when they live years or decades longer than they are supposed to with their terminal diseases.  I keep sending that message — that acupuncture saves lives — and you’re right, it keeps happening.

  18. ‘cheapen the medicine”

    thank you thank you thank you!!!

    i really mean it.

     

  19. Let’s talks sense about economics

    Thanks for your exposition on supply and demand. Another alternative to raising prices when demand outpaces supply is to RAISE THE SUPPLY. Acupuncture is not a commodity like oil. There is not a finite amount to go around. There is way too much excess supply right now to worry about demand overpowering supply. By the way, the US is in a DEFLATIONARY cycle right now, that means prices and wages are going down. That may change, but for now that is how it is. But, the whole high price thing is based on acupuncturist time value having parity with MD time value. Does it really? We actually have something which is known in economics as competitive advantage, which means we can actually beat the competition because our overhead IS so low. Look at it another way, if we are really interested in wellness and prevention, it’s got to be cheap enough that a person will be willing to go in and take care of a problem before it’s so serious that they can’t stand it anymore. At $70 a visit, most people are going to be disinclined to do anything about a minor problem. I know I am. At $15 a visit, it’s much easier. Now, if I’m worried about undercutting your business, then we could collude and agree to fix the price at $70 and I could treat fewer people at a higher price, and probably make less money. But I don’t want to subsidize you, get it, I don’t want to earn less so you can earn more. The sliding scale is actually a mechanism that addresses pricing in real time. Yes, now I have all these people around cheapening up the place. Well, I also know how to do a four day report, and to do a close, but to be honest, I never felt really good about it. In my heart of hearts, I just didn’t feel like $70 was a fair price. If you do and you can do it, then great. Keep in mind, that in 1950, it cost about $200 in TODAY’S dollars to stay in a hospital overnight. What does that have to do with anything? It shows that once you tie in to a system of high technology and third party payers, costs become unmanegeable. Finally, stop with the 5,000 year old medicine already. The truth is, you can learn everything you need to know to be a safe and effective acupuncturist (not TCM herbalist) in a month. I don’t mean to be the reincarnation of Hua Tuo, I just mean able to do the job for 90% of the people that come in.

  20. Hey, Guest

    Be our guest!

     

    You mention that you are here in the Bay Area.  I invite you to come check out our clinic.  We pay big fat Bay Area rent in the center of Berkeley where hundreds of middle class and working class and even a handful of upper middle class people come in for acupuncture treatments.  Our sliding scale is based on the standard CA model – it’s all we have to charge to make a decent living and it happily enables patients to come more often so that they can get better faster and stay well.  And then they tell their peeps who have surely heard about acupuncture (this is Berkeley, afterall), but who have never tried it bc perhaps they didn’t want to pay $65 to lie on a table with needles in them not knowing if they’d like it.

     

    I can’t tell you how many people we’ve treated these past couple of months who come in bc they are coming down with a cold or the flu and for $15 for a TaiYin-YangMing balance treatment and a bottle of $10 antiviral herbs, they aren’t having to miss work.  They aren’t likely to pay $65+ to get treated for this.  They can’t afford to get sick bc they can’t afford to miss work, but does it make sense for them to pay more to get better than they would be earning on their work shift? CA is actually a brilliant commerce model that just so happens to serve the needs of lots of people REGARDLESS of what their income level is or whether they have insurance or paid sick leave.

     

    As far as undercutting private practitioners, our clinic actually has a great relationship with many private LAcs in town. They display our cards and we display theirs.  If people feel like they want to have a more comprehensive one-on-one acu experience, they go to them, and then they come to us for follow up.  We aren’t after “their” business.  We’re after the rest of the population who aren’t getting acupuncture bc it’s too, well, precious, if I can use such a term here and not get shot.

     

    Our clinic has a few shifts where we are too busy to take walk ins.  Are you implying that bc of that, we are going to raise our prices to accommodate that growth?  Huh?  Our plans, along with all the other CA clinics who have done so already, are to simply open more shifts and hire more acupuncturists to work those shifts.  And when those shifts get full, we’ll surely be helping some other CANner as they open their CA clinic in town, because the market will hold more clinics.  That’s where the supply and demand part of commerce comes in here.

     

    Come on in.  I’ll treat you to a treatment. I won’t try toimpress you or talk you into anything (although I am known to be pretty charming, so they tell me… oh, sorry, it’s just my low self-esteem talking again). I just think that you’ll be betterprepared to hurl your rhetoric if you actually come visit the dark sidefor a bit.

     

    I am cracking up imagining Richard Tan’s comeback when I tell him thatwhat he’s doing is “dumbing down” our ancient medicine.  That will befun to watch!

     

    But truly.  Please come in for a poke.  

    Berkeley Acupuncture Project

    1834 University Ave @ MLK

    Berkeley  510-845-1100

    https:berkeleyacuproject.com

    info@berkeleyacuproject.com

  21. A month!

    Yeah, sorry.

    A month!

    Yeah, sorry. But the value people place on things does have effect and one of those values is on education and training. Great on you for finding an economic share of the market (that may very well change when the frenzied grab for the masses dies down). I can get behind all that for sure. You help people, you’re earning a living, great.

    But a month training? Careful what you wish for.