Jobs Post #1: the 4 Rs

Conversation on the AOM Google Group:

LR: “I am not sure how the
“assistant” idea entered this discussion (or the one on the
CAN blog). CAN clinics don’t have assistants; we can’t afford them
any more than we can afford supervisors. We can afford to pay an
acupuncturist generally somewhere between $30-45K (true salary, not
gross income) to do what an acupuncturist is supposed to do: provide
patients with acupuncture treatment. I suppose if we did have
assistants we might be able to treat more patients per hour than we
do right now, but this is not a pressing concern for us. A pressing
concern is hiring L.Acs.These jobs already exist.”


MJ: I injected the assistant idea
because assistants could get paid half the amount you are discussing
and double or triple the throughput of a single practitioner. $30k
net is ~$37k gross, $45k net is $58k gross. So the hourly pay range
you are projecting is $20/h to $28/h which seems relatively
reasonable for a resident or year 1 – year 2 grad. It is nowhere near
enough to support an experienced practitioner or someone with a
family to feed.

I think this particular exchange gets
at a number of very important points that have not gotten written
about yet, anywhere that I know of, so I am going to do my best to
lay the groundwork for the conversation.

First, let’s talk about jobs. I think
we need to be a lot more clear about what we mean when we are talking
about jobs for acupuncturists than we have been so far. In fact, I
want to talk about the 4 R’s of jobs for acupuncturists. The first 3
Rs are “Real, Relevant, and Replicable”. (We’ll get to the 4th
R at the end.)

Let’s start with Real. In the
17 years that I’ve supported myself as an acupuncturist (amazingly,
I’ve managed to support myself ONLY as an acupuncturist, no second
job, no other income streams), I’ve been an employee of a nonprofit
public health agency, a self-employed independent contractor working
for a nonprofit HMO, a sole proprietor working for
myself, and an employee working for a corporation (a corporation that
I happen to own). The differences between being an employee of
something and being self-employed are very clear to anyone who has
ever done both.

Being an independent contractor means
being self-employed, there is no doubt about that. When I was an
independent contractor for the nonprofit HMO, I got paid $65 an hour
to provide acupuncture to hospice patients. My hours varied a lot;
when I was lucky, I got about 5 hours of work each week. That
$65/hour did not include travel time, documentation time, meeting
time, mileage, supplies, or insurance. I had to remember to take
my own taxes out of my checks, at the rate of 30%. So, while I could
claim I was getting paid $65/ hour, there was no possibility of
supporting myself on that $65/hr job. In fact, when I calculated
the time I was actually spending, and subtracted my expenses, it
turned out I was really making about $15/hour. And, of course, I was
working on a pilot project; when the pilot project ended, so did my
employment. It was a great experience, but it’s not what I would call
a Real Job.

I have a real job now, which I appreciate to no end. Why?

I receive a salary, which means a
bimonthly paycheck that is always the same. (My salary is 35K per
year, the same as the 4 other full time acupuncturists who work at WCA Cully.) It’s
much easier to have a budget when you can predict what you are making
– or do any other kind of financial planning. It’s also much easier
to buy a house.

The company, WCA, pays my professional
liability insurance, my licensing fees, and provides all necessary
CEUs (offered in-house).

I am protected by worker’s comp
insurance and unemployment insurance that the company is required by
law to carry.

The company deals with my social
security and income tax withholding (and pays a portion that I don’t
have to pay); I don’t have to calculate and withhold my own taxes. At
tax time, I get a refund, which was never true when I was
self-employed. Not to mention, just doing my taxes is a breeze, since my entire income is reported in my W-2.

The company, WCA, provides all the
supplies I need in order to do my job. It’s someone’s job to order
needles and sharps containers and make sure the clinic is ready to go
when the patients and I show up.

I have 2 weeks paid vacation and access
to a 401K plan and a health savings account, both provided by WCA.

While I’m on vacation, the clinic stays
open and my patients get taken care of by other people. I can return
to a full schedule and not suffer a loss of income in the weeks
following my vacation due to having interrupted patients’ treatment
plans. (See above, “paycheck always the same”.)

These are the kinds of advantages that
I think are important to acknowledge, that distinguish a Real Job
from a “business opportunity”. There are lots of business
opportunities in the acupuncture world, and very, very few Real Jobs.
I broke down some of the economics around being self-employed in
this blog post, so I don’t mean to do it again. My point this time
around is, it is NOT EASY to create Real Jobs. It took WCA several
years after we got our business established to be able to do it.
Having employees requires much more commitment, risk, and
infrastructure than having an independent contractor. What do you
think it says about the acupuncture profession that there are so few
people willing to make that commitment, take those risks, and invest
in that infrastructure?

This gets us to the second R, Relevant.
In this context, I’m going to say that a Relevant Job for an
acupuncturist means the acupuncturist is primarily DOING ACUPUNCTURE,
not something else, something fundamentally distinct from
acupuncture. I’m going to further clarify the context and say that a
Relevant Job has to be funded by individuals, groups, corporations or
government entities paying for people getting acupuncture, not paying
for something fundamentally distinct from acupuncture, such as
education.

To quote from an earlier post I wrote
about Martian Geology:

“I’d like to start by looking at the
two basic business models that together make up “the acupuncture
profession”. No, I don’t mean the boutique model and the
community model. I mean the business model that is built on selling
the fantasy of being an acupuncturist, and the business model that is
built on delivering acupuncture treatments to real patients. The
first business model is known as acupuncture education, and it has
spun off a slew of secondary businesses: the business of
certification, accreditation, CEUs, and insurance, to name the big
ones. The first business model is viable and real, largely because it
is heavily subsidized by the taxpayers in the form of Title IV
funding. It and its secondary businesses create jobs and profits. The
second business model is viable at such a small scale and in such
limited circumstances that, unlike the first model, it can barely be
considered business at all; unlike the first business model, it
creates virtually no jobs and no profits.”

So a Relevant Job for an acupuncturist
means that the acupuncturist is spending most of her time doing
acupuncture, as opposed to spending most of her time teaching,
administering, marketing, graphic designing, selling, massaging,
researching, counseling, or any number of other activities – with
a little bit of acupuncture on the side. The infrastructure that
supports a Real and Relevant Job for an acupuncturist cannot be
funded by Title IV student loans. My Real Job is also Relevant,
because it is funded by people paying for acupuncture (in mostly $15
increments).

Speaking of funding, let’s move on to
the third R, Replicable. For a long time we were worried that the
jobs that WCA created, though Real and Relevant, might not be
Replicable. In order to afford the infrastructure to qualify as
Real, the Relevant income stream has to be very steady and
dependable. If you’ve never been an employer, you might have to take
my word on this one, but believe me, you can’t even think about
workers’ comp insurance and payroll taxes, let alone a 401K plan and
paid vacations until you are very, very sure that your income stream
is dependable.

In 2006, WCA provided 10,252
treatments; at that point we employed 3 full time acupuncturists, and
we had never heard of any acupuncture clinic, other than one attached
to a school, doing as many treatments as we did. In 2007, we gave
15,769 treatments; in 2008, 19,818 treatments; in 2009, about 24,000
treatments; and in 2010, we gave 31, 318 treatments. We currently
have 6 full time acupuncturists; we plan to add 3 more full time
acupuncturists in 2011, and another 3 in 2012. But our fear was that
nobody else could do what we did.

We needn’t have worried. We’ve been
asking CANners for their year end numbers, and 4 other community
acupuncture clinics – all of them founded since 2007 – have
reported total treatments for 2010 in the 9,000 to 15,000 treatment
range. So far we’ve heard from 19 community acupuncture clinics (out
of the 165+ listed on the CAN site), reporting a combined total of
122,643 treatments. WCA is not a fluke; our income stream is
replicable. And so are our jobs. Without looking at any lists, I can
think of 5 other jobs around the country that are virtually identical
in all respects to the jobs at WCA, with a salary range of $30-45K.
One of my main goals for 2011 is to create more and better structures
to support more CAN clinics in creating more 3R jobs. (Details coming
in a few more months, comrades, I promise.)

So I apologize for taking forever to
get to the 4th R, which is actually the point of this
post. Michael said that the jobs we are creating pay “nowhere near
enough to support an experienced practitioner”. (As an experienced
practitioner, I have some other things to say about that, but that’s
another post.) I am assuming that he means that an experienced
acupuncturist should be making an upper middle class professional
salary, which would be, what – $70K? $80K? With attendant vacation,
benefits, etc.

The thing is, in my 17 years in this
profession, I have never come across a Real, Relevant, and Replicable
job for an acupuncturist that paid an upper middle class wage. What I
want to know is – where R those jobs? Do they actually exist?

Seriously. This is a call out to
everyone in the acupuncture world. Can you identify a job for
acupuncturists that meets all the criteria of WCA/CAN jobs, but pays
something that Michael would consider acceptable? It can’t be a
position for an independent contractor or a sole proprietor (in other
words, not a “business opportunity”); it can’t be directly or
indirectly funded by tuition for acupuncture education (or any income
stream other than fees for acupuncture treatment); and it must be
proven to be replicable. Also, I hope this goes without saying – it
has to actually EXIST in the present. Someone has to be receiving a
W-2 for this job in the next month or so for it to count –
actually, several someones, if it’s Replicable.

Because I’m not sure such a job is
possible in the real world. I’d like to see some evidence that it is
possible. And if nobody can give me any evidence to that effect, I
would say that has some profound implications for our discussion
about education.

As I think I’ve mentioned –
repeatedly – I am a scarred veteran of the acupuncture world, not
some dewy idealist noob. I graduated 17 years ago in a class of 30 or
so people. At the time, if anybody had voted who would be most likely
to be employing 9 full time acupuncturists by the end of 2011, I
guarantee you, nobody would have picked me. Including me! I was the
least business-minded student you could imagine. So why did none of
my classmates become employers before me? After all, they didn’t have
to reinvent the wheel the way I did. If the conventional business
model for acupuncture works as well as everyone outside of CAN seems
to think it does, why are conventional acupuncturists not creating
jobs for other acupuncturists all over the place? That’s how
capitalism is supposed to work, right? You start a business, and
eventually you have enough customers that you need to hire other
people to help you out. Eventually you don’t have to work at all; you
sit back and make money off the labor of your employees. (And you
want them to be employees, not independent contractors, because this
is such a good deal for you that you want the structure to be as
stable as possible. You want to keep these people making money for
you.) Presumably, if that were happening, lots of acupuncturists
using the conventional model would be highly motivated to hire. There
would be lots of acupuncture jobs, and they would be Real, Relevant,
and Replicable. Also, well-paid. 

If these jobs aren’t there, it suggests
that the conventional business model for acupuncture does not work
well enough to found a profession on.
It doesn’t create a stable and sustainable enough income stream to support an infrastructure that generates jobs.  If there are no Real, Relevant
and Replicable jobs outside of community acupuncture, it further
suggests that the actual market value for an acupuncture treatment is
somewhere around $20
. And that acupuncture is not an upper middle
class professional occupation, it’s a lower middle class/working
class vocation
. I have a theory that the only stability for an
acupuncture business is in a high volume of patients; and a high
volume of patients is only possible if the business is accessible to
people of ordinary incomes. Which demands a low cost of treatment,
payable out of pocket.

Michael also wrote, “When we reform
the model I think we need to take CAN, private, medical clinic, and
hospital models into account and design accordingly.” I appreciate
the inclusion of CAN on the list, I do, but I also want to challenge
those other models to show that they can create jobs. The NCCAOM JTA
shows that the majority of acupuncturists are working part-time and
for themselves. The most recent example I read of an “opportunity”
for acupuncturists to work in a hospital entailed those
acupuncturists paying to be able to work there
. Does anyone have some
data that would cause me to re-evaluate my analysis? Where R the
Real, Relevant, Replicable jobs?

Or maybe the Chaos Marxists said it best: the correct market value of something which doesn’t actually exist is zero.

Edited:

Thanks to the suggestion of alert reader Meaghan, I am pleased to announce a VERY SPECIAL OFFER. To the first person who sends me evidence of a Real, Relevant, Replicable Job with an Upper Middle Class Professional Salary, I will send you your very own TOASTER! To take advantage of this opportunity, you must send, along with your name and your address, the names of the people who hold this job, the names of the organization(s) or person(s) who employ them, a description of the income stream that supports the job, and a short description of the job’s characteristics (salary, benefits, etc.) But don’t despair — if you are the second person who sends me evidence of such a job, I will ALSO send you your very own toaster!  Same for the third, fourth, etc. Plenty of toasters here.

Edited Again: But it can’t be the SAME job. If there is only, say, ONE Real, Relevant, Replicable Job with an Upper Middle Class Professional
Salary for acupuncturists out there, you do not ALL get toasters for telling me about it. I mean, come on.

lisafer
Author: lisafer

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Responses

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  1. Realistic!

    Great post.  The words “business opportunity” remind me of Multi-level marketing. Which begs the question: where *are* the toasters?

  2. 17 Years of Experience

    You had my attention before, but now you really have it.  

    Thanks Lisa.  

    Renee 

  3. Business Models

    Lisa, Lisa, Lisa  – Please tell me you didn’t run out and buy a bunch of toasters wholesale because I don’t think
    you will be giving many (if any) away. I am working on promoting a private
    practice model that would have the goal of allowing solo-practitioners to earn
    somewhere in the area of $60k (before self-employment tax and after expenses) a
    year and places the value of acupuncture at about $40-$50 a treatment. This
    model is taken from my own 25 years of my practice being the only source of
    income to support my family of four. In addition to publishing a book on this
    subject later this year, I plan on offering some supportive services – probably
    web-based – to help those trying to employ my model and put it to the test. I believe this model is
    reasonable and replicable but that is just my belief at this point. Time will
    tell if my theory on this is correct. I hope my efforts in this regard will
    expand the options for practitioners as I think this profession needs different
    models to better serve the public and practitioners. But here is the thing CAN’ers
    should know: Guess who it was that prodded me to get out there and share with
    others what I was able to accomplish in my career? Lisa. Keep-up the good work
    little sister. Perhaps one day you will be able to recommend my model as another
    viable option.   

    Matt Bauer

  4. thanks, Matt

    and 2 quick clarifications:

    1) I never said those toasters were gonna be *new*. 

    and, 2) you’re right, I totally support you getting your model out there, but it’s still not what I’m talking about in this post — or is it? I can’t believe I never asked you this before, but have you ever hired another acupuncturist to work with you in your practice as an employee? Why or why not? Does your insurance model lead to job creation (I mean Real Jobs, not better opportunities for people to be self-employed)? If it doesn’t, can you explain why it wouldn’t? In other words, does an insurance-based practice create a robust enough income stream to lead to the infrastructure to have acupuncturist employees?

  5. Hmmmf.

    MJ’s idea that $28/hr for full-time needle work “is nowhere near enough to support an experienced practitioner or someone with a family to feed” seems out of touch with my reality.

     I know very few acu-punks who would not strongly consider a $28/hr 35 hr/week position, just treating folks. The reason is, as Lisa has argued ably, there aren’t any jobs that pay an executive salary – which is what Michael seems to be envisioning.

    It also leaves me wondering what Michael would consider a commensurate wage/salary for a practitioner with a moderate amount of experience or no family to help support.

    And what does ‘experienced’ mean? How many years? With how many patients seen on average each year?

  6. I’d take a $28/hr 35 hour

    I’d take a $28/hr 35 hour workweek in a heartbeat and I have $80,000 in debt.  I couldn’t get a job anywhere else paying that and I’d probably do it for even less.  Maybe it is my workingclass mentality but I could make our family of 5 quite happy on that plus my husbands income (which is only $20/hr as a Physical Therapy Aide).

    Careful on what assumptions one makes.

  7. Jobs

    I believe my model will eventually allow people to end-up creating jobs but
    this again is something that will need to be proven over time. I have been
    referring several new patients to other acupuncturists because I was too busy
    and for years I held my patient load at a level I could manage because I did
    not want the hassle of trying to hire anyone. I have just moved into a new,
    bigger location that will allow me to bring-in another practitioner but, what
    you and other C.A. practices have done creating JOBS – no. My hat is off to you
    all. I will have a section in my book describing just why no one should hold
    their breath hoping for A/OM jobs and say the one possible exception is the
    C.A. practices. It is one thing to have a successful solo practice (that is
    what I will be promoting) and another to build a practice to the point you can
    bring-in a partner or independent contractor, but real jobs, as you correctly
    point out, is a whole other beast. No one else has done what you all are doing
    and you are so right to point this out. There is talk and there is doing. 

    Running a successful solo practice requires keeping your overhead down and
    that means affordable office space. When a solo practitioner thinks of hiring
    an employee, they will be doubling the number of providers. That will mean
    needing nearly twice as much space and twice as many patients.  That is a very difficult transition as the
    solo practitioner will need to go through a period of making less money and
    never know for sure if the new arrangement will work out. It is far easier for
    those rare busy practitioners to just turn away business and stay flush
    themselves.  

    And what about those hospital jobs that seems to be
    so many “leaders” Holy Grail? What do you think will happen if those jobs start
    to materialize? The schools will crank-up their recruitment efforts and flood
    the market with dozens of applicants for every possible position. I hope those
    jobs will happen someday but the reality is for the foreseeable future, we will
    need to better train those in how to actually build successful private
    practices while supporting the C.A. model’s ability to recruit qualified
    employees.

  8. More on your questions

    Sorry
    – I didn’t really answer you about insurance. My model relies on insurance only
    within the context that it relies on using every possible source of income.
    Over 25 years, the percentage of my income from insurance has fluctuated. For many
    years, my insurance income was only about 30% but I still did very well. It is
    now more than twice that but that is just because I have been getting more and
    more referrals from one particular insurance plan. One of the reasons I moved
    my clinic was to get an office that gave me better visibility so that I could
    do some marketing IF THAT ONE INSURANCE PROGRAM WAS TO GO AWAY. No one should
    ever “rely” on any insurance income as stable any more than grant money. My model
    is to have a diversified income stream with insurance as a part and especially
    for newer practitioners as they need to learn the insurance ropes to give them a
    well rounded understanding of the ins and outs of different types of income
    streams. I am actually uncomfortable having so much of my income from insurance
    and am taking steps to better position myself if that stream dries-up.  My practice is based on “Every little bit
    counts” both in getting results for my patients and in keeping my practice income
    secure. Hey – maybe that is what I will call my book. I don’t have a title for
    it yet.  

  9. I love this post!

    I am sick of people comparing real acupuncture jobs to sham acupuncture jobs.  Of course the sham job will have better pay and higher “status” — it is not required to actually exist.

    I was also glad you pointed out that a job is not the same thing as a business opportunity.  After 15 years as a self employed acupuncturist, and the concept of a paid vacation or unemployment insurance (to say nothing of workman’s comp) no more than a distant, pre-acu dream, I think your company sounds like a great employer.

  10. $28/hour

    According to the USBLS, $20 – $28 per hour is spot-on for health care employees’ hourly wages in 2009:

    LPN and LVN = $18.70 median/$19.25 mean

    Medical & clinical lab tech’s = $26.79 median/$27.14 mean

    Radiologic technologists & technicians = $25.88 median/$26.36 mean

    Registered nurses = $31.38 median/$32.57 mean

    One point missing is that most Community Acupuncturists (excluding Midwestern Super Punks) work just over 20 hours per week.  Nurses (and other healthcare employees) work ahelluva lot more hours than we do: “More than half of RNs work at least 40 hours per week in their principal nursing position and another 24.2 percent work 32 to 39 hours per week…27.5 percent report that they worked overtime averaging 7.5 hours per week and received pay for such work.”

    I have toiled with nurses, therapists. and other healthcare providers. They work frequent double-shifts, overtime (at time-and-a-half), and moonlight for competitors.  The annual salaries cited reflect a composite of those factors.  Acupuncturists in community clinics are being paid equitable hourly wages.  Those punks who want to make comparable annual salaries need to start working ahelluva lot harder.

    [EDIT: And for those who want parity with physicians, have you thought for a minute about how much time they work?  This blog from the AMA averages their on-the-clock hours at 80 per week. “You logged more than 80 hours at work this week. You were on call several nights. You have not been able to spend quality time with family or friends in days. You are not sleeping. Your health is suffering.” $28/hour at 80 hours/week for a full year would provide a six-figure-annual-income, if that’s what you really want…but at what cost?  I say no thanks to an acu-job which would mirror physician or nurse lifestyles (if it even currently exists!?).  I’ll take my working class wages in a stable community clinic, keep my health and enjoy my family.]

  11. and still no answer…

    I find it fascinating that if you had given some “philosophy” of the profession or some criticism with no call to action, the Will Morris’ of the world would be the first to respond.

    But the call to action with no response?  Return those toasters ASAP.

    Tess Bois (formerly McGinn)

    One World Community Acupuncture

    Fitchburg, MA

  12. Lifestyle

    I think considering the lifestyle that goes along with our work is also a really positive point.  Sure, we could choose to work longer hours and tire ourselves out but we don’t have to.  I have to say I’m pretty content with what I’m making and with hours that I enjoy working.  I get the rest and time off I need for my own health and happiness and with that I can bring the best of me to my work every day that I’m there.

    One of the reasons I never wanted to be a doctor or nurse was that I didn’t want to work crazy hours, overnight, on call, etc.  It’s not the kind of lifestyle I want to have.  I enjoy my routine hours, my solid nights of sleep and not having to be responsible for emergency/urgent situations at odd hours.

  13. great points!

    Seems like I treat alot of nurses who are exhausted from those long hours.  I’d rather go home and play with my baby after work than, you know, keep working until I can’t.  BTW, my less-than-WCA wages are plenty to support my family of 3 for now.

  14. Rather overwhelming

    and I seem to have missed the boat, but, a few thoughts.  Speaking for myself, the lack of a response had primarily to do with the passing of the holiday lull in my paying “job” and being hesitant to wade back into territory where the final word is likely to be something along the lines of “you just don’t understand,” but here goes.

    I think you are correct about all the advantages that come with having a “job” (though lots of jobs don’t have the things you suggest — lots of people around here work without 401K’s and health insurance, and if you work on commission you don’t have a steady paycheck).  I also think that many people go into this profession well aware that there are no “jobs,”  that they will be in private practice.  They may not understand all the repercussions of that choice, but it may well be what attracts a lot of people to this profession.  If I hadn’t wanted the freedom of my image of the independent acupuncture life, I would have become a Nurse Midwife.  Lots of acupuncturists used to be nurses — they had a job and didn’t want that anymore.  It may be that what it says about the acupuncture profession that so few are willing to make that commitment, take that risk, etc. is that the profession did not have the imagination to come up with a plan that worked and/or, we didn’t want to take those risks, etc.  My calculus was always that my freedom from dealing with bosses and/or employees was worth a lot to me.

    I do see how hiring assistants, if that were an option, would free-up the acupuncturist so they could do the Relevant stuff — and, at the same time, increase profits beyond hiring another L.Ac., and, might also have the benefit of making some of the employer/employee dynamics easier, and could provide for all those things that make a job a job in your calculus.  I wouldn’t want to do it, but it doesn’t seem like such a far out idea.

    I don’t recall that capitalism has anything to do with hiring people and making money off the labor of others.  That may be one succesful business model, but capitalism means private ownership and a free market economy.  One of the things a free market means is that if your business model is better — your product is more desirable, for whatever combination of reasons, you’ll gain market share.  I’ll need to adjust, the competition will serve the market.

    I guess I’m not sure what the upset is.  The profession developed to serve a model, which it has done for the past 15 or so years.  That model is not perfect and is not a “job” based model.  New models are being developed to serve a greater/different market.  There was no guarantee that all who were interested in the profession could succeed with that model (not everyone gets a pink car from Mary Kaye).  Those who have not succeeded are spreading the word, and, in short order, I suspect the profession will adjust by making a better product.

    You are right – there aren’t jobs, the profession wasn’t built on that model.  You developed a new model and are now figuring out a way to develop the workers you need for your model to be successful.  Yes, it would be great if all of this was easier — if we knew then what we know now.

     

  15. $300.00 for acupuncture!

    $300.00 for weekly acupuncture! If that is not the antithesis of what we are about, I don’t know what is!!!

  16. I couldn’t get any of their

    I couldn’t get any of their services links to work so I called them (they’re in my local area).  Chick who answered the phone (who, oddly, didn’t answer with the company name and ‘can I help you’ but with a ‘this is so and so’) said acupuncture is $85/treatment.  I don’t know what is up with those “memberships”.  $85 is still pretty nuts but it doesn’t make my eyes bug out of my skull like $300 does!

  17. very clarifying

    We keep saying “you don’t understand” and you aren’t sure what we’re upset about. I think I see why.

    The upset is that the profession developed around a model that makes acupuncture exclusive. The exclusivity is built into the structure.

    Yes, there is no need to be upset, if you are not bothered by the fact that so incredibly few people have access to acupuncture, relative to the number who  desperately need relief and could get it if they did have access. This is primarily what bothers us. It doesn’t sound like it’s what bothers you. Other things, other kinds of dysfunction, bother you about the profession. But you seem to basically accept the exclusivity part.

    The truth is, a model in which delivery of services depends entirely on individual, untrained and unsupported entrepreneurs is a model that doesn’t prioritize those services actually being delivered. Because the model isn’t about service, it isn’t about relieving suffering for patients. It’s about practitioners having the freedom to not deal with bosses or employees, to have the idealized life that they want. (The fact that it remains an ideal for most of them wasn’t even perceived as a problem until we started complaining so loudly about it.  I’ve also met lots of nurses who became acupuncturists — unless they have a spouse who supports them, they’re still working as nurses.)  That’s leaving out the part about how the few patients the model IS designed to serve, at least in theory, are very specifically and clearly defined — by the constraints of the model itself — as having a great deal of privilege.

    That model didn’t evolve by accident, and it didn’t fall out of the sky. It’s based in the profession’s fundamental priorities. 

    I don’t believe that it’s just about knowing things now that we didn’t know then. (When exactly are you talking about? I think I was there for that “then”.)  When I read Larry’s latest terrific blog post, it hit me again: it really is all about what we want. If providing acupuncture to LOTS of people, people of ordinary incomes, was something that mattered to the profession, it would have been happening all along. Because just like acupuncture itself, it’s not rocket science. Stable jobs with livable salaries are an expression of the intention to provide lots and lots of acupuncture, as well as an expression of the faith that lots and lots of people want acupuncture and will benefit from it. “Lots and lots” implies “ordinary incomes”.

    I’m not criticizing the existing model for not being perfect, I’m criticizing it for not giving a fuck. If the profession gave a fuck, it would look completely different. If anyone needs a refresher on what giving a fuck looks like, I suggest this trailer, 2:04 to 2:11

     

  18. Hmm…

    I keep reading that this profession developed to serve a business model, as though a business model were a pre-formed structure that had to be adhered to for better or worse.  There is something about this that really strikes me as backwards – businesses don’t develop to serve their model, their model is the reflection of their hypothesis about what the customer wants, how the customer wants it, and how the organization/business/profession can best meet those two things (that’s a paraphrase from the “business model” wiki).  Based on what the boutique acupuncture profession looks like as a whole, I’d say no one ever came up with such a hypothesis – there was an image of what the practitioner’s life should look like, and things proceeded from there.  This is putting the cart before the horse entirely, and trying to get the horse to push the cart for a couple decades has resulted in what the field looks like today.  So you don’t have a business model per se, you have a byproduct of not asking or knowing what the customer wants/needs and how they want/need it.  If the boutique version had been what the customer wants/needs and how they want/need it, there would be much more business success.

     Contrast that with CA – What does a person want/need? Freedom from suffering/illness/pain.  How do they want/need it? In an affordable form.  On the issue of workers – the CA model is already successful, having people ready and able to fill the jobs that this success has created will make it *more* successful.  

  19. Replicable

    One clinic position is not replicable.  Def not toaster-worthy…unless there are dozens more of these somewhere.

  20. face palm

    Why did I not think to ask him to do a speech at the conference? I wonder if I could get him to do a guest appearance or something during the keynote. Anyway, one way or another, we should make sure that you meet him. He would be happy to know how many people he’s inspired, I’m sure.

  21. Not a job.

    Whole Health said: “All our doctors, acupuncturists, and therapists are independent practitioners. The cost of running a medical practice is very expensive as you know. We can’t afford salaried staff…We will invest in advertising and book patients for independent practitioners and simply get a reasonable booking fee.”

  22. No hypothesis

    I think you are generally correct — though I think it did not develop only from an idea of what the practitioners life should look like but also from familiarity with only one small bit of the potential market.

  23. I suppose I do

    understand the upset, it is the blame that is more baffling.  In my experience the model did pretty much fall from the sky.  It fell from the sky onto a group of folks from a particular background (since we’re talking about the “white” business model) and, for a few decades there was enough to keep those folks busy.  There was nothing that encouraged them to look outside the world they had created.

     Here is what I think about when I watch the trailer — I suspect if you looked at the life of many addicts you would find a past littered with people who gave a fuck.  People who agonized and schemed and did their best to help the addict.  However, those people did not have the knowledge and wisdom to translate their care into effective action.  In fact, much of what they did made the problem worse rather than better.  It took the development of 12 step programs — and it took them some time to work out the kinks — to begin to come up with programs where giving a fuck could be combined with effective tools to help people.

    I get the frustration that this wasn’t addressed before, and I get the frustration that not everyone is supportive of exploring what lies behind the curtain.  It is still my contention that the current situation comes from a lack of forethought, a lack of awareness, a lack of vision rather than the presence of all of those combined with a desire to limit access. 

  24. true income

    Lisa, you really have done a remarkable thing with WCA, and have shown yourself to be an astute bsuiness woman with a social conscience, proving that this is indeed poosible.

    In the interestes of transparency, I have something to point out.  Yes, your salary is $35K.  However, you own, or are part owner, of WCA.  Presumably you benefit from its annual profit or receive an annual share (if co-owned). If you do’t take a money-based profit from your corporation, your equity and personal assets continue to grow as a result of your ownership. If it is a nonprofit organization, you probably draw some sort of CEO reimbursement.

    I don’t think you can equate yourself with the acupuncturists your corporation hires when it comes to making a living from acupuncture.

     

  25. Answers

    Kathleen, I am co-owner with Lisa of WCA, a for profit company.

    – WCA makes no profit. None. All money goes to salaries. Lisa and I draw no extra “profit” whatsoever.

    – Equity…hmm. We might-might I say-be able to sell WCA for $10K. Maybe $15-20K if we were very lucky. I base this figure on knowing what several other community acupuncture clinics (say 15 or so clinics) have sold for, or not sold for in the case of a few that could get no offers at all.  

    You are right though that we can’t equate ourselves with our employees who make the exact same salary.  We have the burden of owning a business that actually owes $35K right now and if we went under that’s what we would still owe. (What we owe in a convoluted way is what it took to set up CAN.) The employees of course could walk away with no liabilities. So you could say that we are in a worse position than our employees. 

    When we say this is a social business we actually mean it. We actually are transparent.