Classism and Marketing Conversation (Part One)

Not long ago, an alert reader pointed out a conventional acupuncture marketing blog (www.acupunctureclinicmarketing.com) that had a link to CAN and to The Remedy. Wow, that’s interesting, I thought, and decided to check it out. In general I find marketing to be an intriguing topic, maybe because it reveals so much collective unconscious material with so little effort of examination:  new car = sex = power,  antibiotic spray = maternal love, allergy medication = a joyful life, etc. The revealed material might be appalling but it’s almost never boring. When it comes to  reading about acupuncture marketing, I usually learn something about how the acupuncture world sees itself and how it sees patients, which is almost always useful to me when I teach workshops.
 
This is why I downloaded the first two free chapters of Burton Kent’s new book, Never Market Again: the guaranteed formula for attracting patients naturally.

And then I sent him this letter:

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Dear Burton,

first, thanks for putting a link to my website and my book on your site. I

appreciate the help in getting the word out.

Second, we don’t know each other at all, but would you be interested in

having a heart-to-heart talk? In public? Meaning, on the Community

Acupuncture Network blog, and yours as well, if you want.

Here’s why I’m asking.  There’s lots on your site that I agree with

completely: about not spending money on advertising, about generating

word-of-mouth promotion through strong patient relationships, about how sad

it is that so many acupuncturists are so terrified of business that they go

out of business almost immediately. Most of all, I agree with you that

acupuncture saves lives. I’ve experienced this first hand, and it’s

basically why I’m writing to you. Because I think that it’s incredibly

important that acupuncturists can make a living doing acupuncture, so that

more people who really need it can get acupuncture.

And also because it’s my job to educate acupuncturists about classism,

particularly the intersection of classism and business. I teach an elective

at an acupuncture school where we talk about these things a lot; a big part

of what the Community Acupuncture Network does is to help acupuncturists

see through classist thinking, so that it doesn’t get in the way of

growing their practices. Consequently I am always looking for opportunities

to address obvious examples of classism in acupuncture.

In Chapter 2 of your book, “What Will Hold You Back”, you list

“feeling guilty about charging a fair rate”. You don’t define what a

“fair rate” is, and I’m curious what you think it is.  Then you

write:

“There’s another side to charging a fair rate.  Doing so actually helps

people get more value from your treatments.  Think about it this way.  If you paid $1,000 for a course

manual, and you paid $15 for a book, which would you take more seriously?  Which would you be sure to

learn from and follow?  The course manual, right?  But what if the $1,000 manual and the $15 book contained the exact same information? I think you get my point.  The value and importance we place on something

is heavily influenced by price.  By underpricing your services, you make your patients undervalue

your services.  They’ll comply less, complain more, and actually be worse patients because of the price

you set.

Don’t cheapen yourself, your skills or your profession.  They’re worth

far more than you realize. “

Even though you didn’t define “a fair rate” as “market rate”, you

are saying here that patients benefit more (“get more value”) from

acupuncture if they pay more for it, and that when they pay less for it,

THEY ARE WORSE PATIENTS.  This is a brutally classist thing to say.

 If you cited my book in your links, I have to think that you know that I

charge my patients $15 to $35 per treatment — they decide what to pay on

that scale. My patients, 60% of whom pay at the low end of the scale,  are

not “worse patients”. They don’t complain. They comply with treatment

plans better than any other patients I’ve ever met ( in part because the

treatments are priced so that they can afford to comply). Some of these

patients are being treated for life-threatening conditions: liver failure,

asbestosis, late-stage emphysema. These are real people who are just as

committed to acupuncture, if not more so, than people who pay more for it.

They just don’t happen to have a lot of money. If you make minimum wage,

$15 IS a lot of money.

You have an MBA so you must understand numbers. Have you looked at the the

income figures on any recent census? Only a tiny sliver of the American

population either 1) can afford to pay for acupuncture at market rates out

of pocket, or 2) has insurance that covers enough acupuncture to be

effective for any chronic condition.  If acupuncturists charge market

rates, $75 to $100+ per treatment, they are targeting at best maybe 20% of

the population.

How do you reconcile your belief that acupuncture saves lives with

encouraging acupuncturists to charge prices that ensure that the vast

majority of people can’t afford it? I have news for you:  when people are

sick enough to need acupuncture to save their lives, they are quite sick and

you are talking about a LOT of acupuncture. If someone has a

life-threatening condition, they need acupuncture twice a week at least for

an unlimited amount of time. No insurance company in the world will pay for

that. So are you saying that only rich people deserve to have their lives

saved?

The gentle, homeostatic nature of acupuncture means that it usually

doesn’t work fast. A lot of acupuncturists fail not only because they

don’t know how to market but because they don’t get good enough

clinical results to generate word-of-mouth referrals. They don’t get good

clinical results not because they aren’t good acupuncturists, but because

their patients are not getting enough acupuncture to DO any good. They

can’t afford to; they can’t come up with $75 to $150 out of pocket for

ten weeks in a row. I know a lot about how results generate referrals; six

years ago, I was treating twelve patients a week; last week, my clinic

treated 442 patients. I don’t even have a Yellow Pages ad. My clinic

employs six acupuncturists, four of them full time.

There is only so much room at the top of the economic pyramid. If you are

serious about doubling the number of acupuncture clinics in the US, you

need to come to terms with how acupuncture works (only frequent, regular

treatments consistently produce results) combined with the economic reality

of most people in America (almost no one can afford frequent, regular

treatments at market rates).  The value of any form of health care is NOT

enhanced when people pay more for it. Your $1000 manual/$15 book analogy is

sadly applicable to the current healthcare system in the US.  Any number of

studies have shown that healthcare in America is more expensive than health

care in other countries, and yet the actual quality is no better. The cost

of health insurance premiums has risen 75% between 2000 and 2008; do you

think all of the people who can barely afford health insurance now value it

more, or get more value from it? Your more expensive = better theory does

not work, not for healthcare, not for acupuncture, not for 80% or more of

potential patients, and not for acupuncturists who are trying to make a

living — unless those acupuncturists are willing to explicitly write off

80% of the population as not worth treating.

I’m hoping that you might be willing to have this conversation in public

because this is something that the acupuncture profession as a whole really

needs to come to grips with.  I don’t have a problem with acupuncturists

who openly acknowledge that acupuncture at market rates is essentially

boutique medicine for an elite population of patients; they have a right to

run their businesses and select their patients however they want to. I do

have a problem, however, with the suggestion that pricing acupuncture out

of reach for most people is somehow the right thing to do, because more

expensive equals better for everyone.  Lower price does not equal lower

value, not in everyone’s minds; suggesting it does is not only a great

example of classism, it’s part of how America wound up in our current

health care crisis.

Lisa

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And then we had this correspondence:

Hi Lisa,

Interesting how you bring this up at the exact same time I just finished writing a post about the Sanborn Maxim.  Sanborn Maxim states /“The customers who are willing to pay you the least will always demand the most.”

/(I just scheduled it to be posted May 16th)

About right now you’re probably thinking I’m even *more* classist than you thought.  I can see how you would think that, and started writing a response.  But I’ve removed it, because it would be better to save it for our discussion.

How about you post a reply after May 16th on the CAN blog?  I hope you’ll include what you wrote below. We can have a back and forth discussion between blogs – referring to each other’s posts.  Or would you rather do it another way?

By the way, Lisa, I grew to admire you while reading your book.  I can totally understand why you’d be miffed (or at least concerned) with what I wrote – I actually thought about you while writing that part of chapter 2.  I’ll look forward to discussing it with you.

Burton

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Burton,

first, sure, I will start the thread on the CAN blog on May 16th and link it to your post. Referring to each other’s posts sounds fine.

Second, wow, I now feel even worse than I did before. You a) read my book, b) grew to admire me (? ) and c) thought about me  (?!) while writing that passage. And you don’t get that what you wrote is insulting, especially to my patients?  You don’t realize that the exact argument you’re making in that passage is the kind of thing that kept me from even thinking about creating the community model for seven years or so — and is the argument that’s used against acupuncturists who practice community acupuncture in general?  You don’t get that you are making my life harder?  I was sort of hoping you had linked to my book and WCA by accident or something; knowing that you actually read what I wrote is really depressing.

I guess this will be an interesting discussion.

Lisa

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Lisa,

Also, one other thing – that part of the book was NOT directed at you or the CAN business model.  I just realized the way I worded my reply might have come across that way.

I think it’s a great business model, and I hope it becomes much more common.

Burton

So here we go: www.acupunctureclinicmarketing.com

And for those of you who may be thinking, geez, Lisa, why do you bother with this stuff at all? I must say that I had the same thought — but since teaching a class at OCOM, I’m aware that the idea that” patients won’t value your services unless they are expensive”, is in fact alive and well, at least at OCOM, and that it really does stop some students from thinking critically about the realities of making a living doing acupuncture.  So I thought it was worth a try.

Your comments, please!