So you want to open a CA practice. You’ve reviewed the requirements to be a POCA clinic, and you think: “Sure, okay, I can live with those.” This blog is about what’s behind those guidelines. It’s about the spirit of a CA practice. And I promise, you, this is some of the most hard-core business advice you’ll find on these forums. It ain’t about what kind of chairs you get or whether you practice Tan or Tung or Billy-Bob’s style of acupuncture. There are several things that successful CA clinics have in common, and your best shot at opening a successful clinic of your own is to copy, copy, copy. Not to tweak, tweak, tweak. “Yabut…” you might be thinking. “Yabut, I like the CA model, except for this one thing. I’m going to do it my way, and it will be better. My patients will get better results, I’ll have an easier work life, I’ll make more money, I’ll grow faster, my cash flow will be more steady, my work will be more interesting than the standard CA model.” I’m here to talk you out of trying. You can succeed at CA. Just don’t try.
So here are a few items for your consideration:
If you really don’t want to treat patients who are too fat, too, sick, too broke, too angry, too crazy, too smelly, or from this ethnic group, who speak that language, follow this religion, belong to that political party… yes, you can make it known – in a thousand small ways that would never, ever, get you called in on anti-discrimination litigation – that they are not welcome in your clinic, and they won’t come around and bother you too often. But if you do that, your chairs will not be full enough, and you will probably not make it. If, however, you can genuinely smile and welcome all comers to your clinic, you will find die-hard fans in the unlikeliest of places. Especially among the marginalized populations who don’t often receive respectful health care (think “people who have recently immigrated” and “people who are obese”), if you provide a space they can easily use as their own, they will send every last member of their circle in to see you – you’ll get the fiancée of the cousin of the co-worker of the client of the hairdresser. The webs of connection will be astonishing and delightful. But if you want just a select handful of “types” of patients, your numbers will whither. So don’t try it.
If you really don’t trust your patients to pay you what they honestly feel is a reasonable, sustainable amount for them – if you want to second-guess them based on their hair/car/clothes – if you’re afraid people will try to cheat you on the sliding scale – if you are tempted to provide guidelines, suggestions, and subtle or not-so-subtle direction to influence their choice of what to pay – then you have missed the fundamental trust that underlies this model. If you follow the standard CA model, you are in for a delightful surprise, because patients will pay you everything they have on them – like $16, for example, with $4 of it being in quarters. Patients will break your heart with their generosity. They will bring you fruits and vegetables from their gardens. They will bake you bread and knit you socks. If you are struggling with using the sliding scale and having faith that it will all work out, read this blog post by Lisa B. Just don’t get pushy about the fees. The harder you squeeze, the less the cash will flow. So don’t try it.
If you feel like simple, frequent acupuncture alone won’t help without a lot of lifestyle counseling, you may be tempted to create an extended intake appointment and charge more for it. Or you may do private room treatments and try to get lots of your patients to spend more money for a good ole’ one-on-one come-to-Jesus conversation about their diet, their exercise, their smoking, etc etc. The standard CA model reflects the idea that unsolicited lifestyle counseling is, at best, useless, and at worst, disrespectful. I can promise you that in over 4,000 treatments, not a single patient has asked me “Should I drink more coffee/alcohol or less?” “Should I smoke more cigarettes or fewer?” “Should I exercise more or less?” Why? People know the answers already, and when they feel better, after several days/weeks/months of treatment, they’ll start making changes to these behaviors as they can. If you’re not perfectly clear about why not to do lifestyle counseling, read this blog by Andy. Just don’t get preachy with your patients. If they ask, by all means, kick into gear. That means they’re ready to hear it, and possibly ready to make changes. If (and only if) they are ready, they can succeed. You can succeed as a team. And success breeds more success. The more patients feel better, the more patients will return, and they will refer others to your clinic. Unwanted advice doesn’t respect the degree to which each patient is in control of his/her/their own treatment progress. So don’t try it.
If you think CA is great, but you can tweak it to make yourself a lot of money, you’re ignoring years and years of hard-and-fast aggregate financial results from sustainable clinics. It’s not a model to make you rich as an acupuncturist. It’s a model that can give you a nice, sustainable middle-class income. It’s not for accumulating wealth via the asset value of the business, which will be difficult if not impossible to sell for anywhere near what you put into it in terms of time and effort. It’s not for creating a large clinic with underlings whose work will throw off extra income to supplement what you earn through your personal effort. If you stick to the standard CA model and work hard, you will have made yourself one of the sweetest, most rewarding jobs imaginable. You will be surrounded by people who are suffering – but working on it – and you get to be a witness and even a partner in that every day. It is humbling and awe-inspiring and sweetly funny in different ways every day. But if you need or want to make more than a high-school teacher in your town makes, CA is not a model that can be tweaked to do that. It will break – whatever “clever” thing you try to do. So don’t try it. Please.