Holding Space for 161 Patients a Week
I wanted to blog about holding space and how my personal experience with going from hydrogen to tungsten.
Hi I am Jade. I love POCA. I am in a clinic about 500 sq feet in a city in Minnesota with about 27,500 people. We have 7 chairs and one table and one acupunk. On average we see about 125-140 patient treatments a week. The total spectrum is about anywhere 100-160 patient treatments a week. We have been open for about 3 years.
I would love to have a Big Damn Clinic one day when there is a lot of punks to go around. (And I hope to jello wrestle some of you clinic owners in costume for the first graduating class of POCA Tech. :))
But this is a blog about having space and holding space. Lisa talks about this a lot. And others have blogged about it before, but this is what it feels like to me.
Ms. T and Ms. H
What does 160 patients a week feel like? To some people it would be frightening, a terrible mess. But it's the process of learning to open yourself wide and to hold space, LOTS of it. It's a complete retraining, because they didn't teach you that in school. A complete spiritual lesson in letting go of your ego and letting go of control.
So let's tell the story of Acupuncturist Ms. H (Hydrogen) and Ms. T (Tungsten) (Know that we all fall somewhere along the spectrum and I made the progress myself slowly)
Mission and Goals
Ms. H wants to do acupuncture and make a living doing it. She believes that TCM helps people. And her goal is to have a nice busy clinic. And Ms. H tells people she wants to be busy. She doesn't understand what's holding her back. She's a little afraid of the whole 161 patients a week feel. I mean REALLY what a mess that sounds like complete chaos. She is exhausted enough just doing all the stuff that it takes to keep a clinic nice and treat patients (water the plants, dusting, mopping, vacuuming, book keeping, phone calls, answering questions, taking appointments, taxes, etc. etc. etc.).
Ms. T believes in the Working Class Acupuncture slogan “Acupuncture Can Change the World.” Ms. T's goal is to provide as much sustainable, consistent, effective acupuncture as possible. Sustainable for herself in the long run so she can still do it in 15-20 years. So she wants to come out of clinic at the end of day like an exhilarating 5 mile run. Tired and satisfied. She knows what 161 patients a week feels like. It feels like a beautiful run outside. Some nice green grass, some hard little pebbles, some rough patches, some muddy hills, and some rocky slopes. It's super busy, somewhat messy, a little chaotic, and a lot of life.
She can rely on people to run the clinic (water the plants, dusting, mopping, vacuuming, book keeping, phone calls, answering questions, taking appointments, taxes, etc. etc. etc.). They're not going to be doing everything perfectly. But the systems keep the clinic running like a well oiled machine. And the clinic is not going to look nice all the time. But it looks well worn and well used like a much loved old family sedan.
Ms. H really loves acupuncture people. These people are so nice. They talk about acupuncture to everyone. They are about themselves and the world. Their values and world view line up with hers. Nice good people that fill her with admiration when they get better. She gets pretty frustrated when people don't get better fast and she wants to try all this extra TCM stuff. To make the acupuncture work better. She run a tight ship. She likes it when the schedule isn't too tight and the patients come in one every 10 minutes when they're scheduled.
Ms. T doesn't come in the clinic expecting it to fill her, for everyone to love her, for everyone to be instantly healed, for everyone to be people she would love to be friends with. She's just here to put the needles in and make the space wide open to everyone. Like we said again and again on the blogs it's the gruff people with rough edges that she's not sure she likes their politics or world view that come week after week to fill your space that makes it beautiful. She doesn't care who comes in as long as they come in and sit. The clinic is busy, messy, and full of life. Patients come in 3 at the same time and bring two extra friends then for half an hour there's nothing. And she's okay with that. She doesn't expect the schedule to be nice. She just flows with whatever comes a long not worrying about it.
Ms. H loves seeing people get better. She wants people to get better faster. Sometimes she doesn't think the acupuncture is doing so she takes some more time to make a really good treatment for each patient. She likes talking to them and getting to know them and asking them about their condition. She feels like they really like the time with her.
Ms. T loves seeing acupuncture work. She knows that progress is like life and has it's ups and downs.
The acupuncture itself at 161 patients a week is something complete different from what they taught in schools. It's a beautiful celebration that acupuncture plain and simple works. She knows that the needling takes 2-3 minutes and she knows it works. And letting the space and people heal themselves. Sometimes when it's slow she takes 8 minutes to needles and sometimes when there's 4 people waiting she takes two minutes to needle. And it all works. Over time she's really gotten to know her regular and their family and friends. Her patients are part of her community and she sees them everywhere.
The Long Term
Ms. H enjoys the clinic. She enjoys practicing community style and seeing more patients than she's ever seen before. She like her nice clinic run like a really tight ship. But it always feels like a bit too much a bit too exhausting a bit too out of control sometimes. She doesn't really see how people who see 161 patients a week don't burn out. She's getting pretty burnt out already. When she had to take some days for a family emergency/sick day it got way slow. The other super busy acupuncturists must just be different people, high energy ones and their lives are probably a lot more stable than hers.
Ms. T loves doing community acupuncture. She loves her busy, messy clinic that is filled with life. It feels very cobbled together sometimes and a bit chaotic, but the systems keep it running along. She takes the time she needs for herself. She takes sick days and vacations knowing that it is more important for the clinic for her life to be sustainable in the long term. She develops systems to tell patients when she has to take off and starts a promotion when she gets back. She goes with the flow of the clinic knowing it's busier at parts of the year and slower in others. It's a living being, a living space with its own ups and downs. And filled with life.
This is great, Jade! I definitely felt like Ms. H for a yucky bit, but that jump to Ms. T felt so right and good. Reaching out for help and letting go makes all the difference. I am averaging about 160/week right now and it feels much better than the 120/week I was doing without any help. Letting go really helps everything.
I so needed to hear this right now. Every bad dream I’ve had in the last year (had one last night) has been about the clinic being too busy, chaotic and out of control. Tons of people coming in and I can’t treat them all without getting flustered and worried that I am making people wait.
Thank you Jade! You are awesome!
Yeah Suzzanne I definitely go back and forth between Ms. T and Ms. H. And it works so much better if I can just let go and stop freaking out about the last time I carpet cleaned.
Yeah, Ashley I definitely have those too. Until I take a deep breath and say to myself. Hey this too busy is GOOD. Then savor it. 🙂
Thanks, Jade. Very helpful.
Awesome Jade. It was such an honor to meet you at ‘the big dmn clrinic’ workshop – I was inspired!
So, I now have a receptionist and ‘volunteer wrangler’. I have seen 70 folks this week and more are pouring in due to having someone who can go out and put up flyers for our promotion, answer the phone, and do all that other stuff that kept me from being able to see more than 3 pts/hour!
soon, I’ll break 100 if I can!
Thank you so much for being YOU!
Thanks, Jade, for this thought-provoking blog. What I notice is the importance of being okay with the mild chaos that higher numbers brings, while having done your homework around the systems needed to keep the shop running smoothly. I’m definitely feeling a lack of clear systems in a couple of areas and this is a good reminder.
Yeah- what Woolfie said: every next “level” of busy-ness shows me *exactly* where my systems need tweaking – and where I need to ask for help. And sometimes where I need to set some boundaries – Ms. T isn’t a saint! or at least I hope she isn’t. I think she’s probably having too much fun to be a martyr.
Thanks for another great post, Jade!
Ms. T is definitely there for the long term. She’s not about being a saint or a martyr. She has good boundaries is and just about being a real human being faults and all. She knows when to relax about thing and let go so she can have fun and be there for the long haul 😀
It was great meeting you. I am so happy you made the leap. It’s scary :)So glad to hear you’re doing well.
Thanks Jade, this is awesome. Letting go of the Ms. H persona is definitely liberating.
Isn’t it funny how busier clinics feel so much better? I feel all chaotic and crazy when there’s a schedule gap. At then end of a shift with 16 somehow there’s all this stuff left to do. After 30, all charts are done and put away, all people greeted, poked, and goodbyes done… your Ms. T is an inspiration!
Thanks Jade, – great reminder!
172 + 13 freebies = 185 treatments this week! I am going to ask my boss for a vacation! 😀
Great post, Jade! It’s amazing what happens when you get into that Ms. T mindset. Its like the limitations you thought you had just get blown away. I remember thinking I could never handle 161 treatments a week, and now it’s no big deal. One of my punks did over 200 treatments one week- granted, he was working extra hours while I was at the POCAfest, but dang!
Ok. You’re all blowin’ my mind again. When Lisa brought out Tungsten, I was just getting to 100 tx/wk and burning out. I was like “Damn! I’m supposed to be ok with this?” Now 100 seems leisurely, but 160? I can’t even wrap my mind around that yet…
Jade, you mentioned 7 chairs in 500 sf. Can you please tell us more about your layout? Are all the chairs in one big circle? How big an area do you have for reception/bathroom/etc? Also, the closing hours on your website and when people leave, or when the last one starts? I’m trying to get some sense of how many you see per hr.
I’m in an expensive, big space now and am thinking of downsizing, but want to make sure it won’t hurt business too much… $2281/mo for 1350sf with 9 chairs and 2 tables to $1160 for 617sf with 7 or 8 chair (closer together than in the big space) and 1 table.
Anyone else feel free to chime in, too. Or email me. thx!!
Yeah when you first get to some new number like 100 or 140 or 160 you burn out for the first few weeks but then if you get your systems firmed up. It gets easy again.
I have six chairs in one big circle and a chair and one bed in a tiny closet sized room. It’s really cramped. Hours are when the last person starts. I don’t see that many an hour really since I am just one punk (not by choice) I work more hours. I think Moses, Jessica, and a few other people see more per hour than I do.
You might want to post that in a forum to get some more feedback and contact clinic support. We’d need a lot more details about your situation to give sound advice.