Jobs Post #2: Investment
(This is an excerpt from another writing project, in progress.)
I have a story about jobs in the acupuncture profession.
Last Saturday, I was working in the clinic, and my schedule was very full — almost over-full. We tend to get busy in the late winter/early springtime anyway, and lately it seems like everybody’s got the same bad cold. Midway through my shift, our receptionist Carolyn asked me if she could squeeze another person in. I looked at the name and realized that she was someone I knew, someone I went to acupuncture school with, lo these many years ago. “Sure,” I said to Carolyn, “put her in, she’s an acupuncturist, it’s not like I’ll have to explain anything to her.” And yet, I ended up talking too long with her and getting behind on my schedule anyway; but I think it was a very instructive conversation, and all of it happened for a reason. This is why.
The acupuncturist, whom I’ll call Jane, told me she had recently lost her job. The weird thing is that I had something to do with creating her job, a long time ago, and I actually never expected it to last as long as it did.
I graduated from acupuncture school in 1994, and unlike most people, I had a job right away. A part-time job and not well-paid, but it was a real job. I wasn’t an independent contractor and the job wasn’t a business opportunity. My employer took taxes out of my paycheck, I accumulated vacation and sick time, I didn’t have to buy my own supplies. Or find my own patients. I worked in an alcohol and drug treatment center for pregnant women, mostly doing the NADA protocol. That program was one of several that used acupuncture, all of them part of the big Portland non-profit Central City Concern that helps people who are often chronically homeless and addicted. I did acupuncture in a number of different Central City Concern treatment programs for about 7 years, off and on.
During one of the off times, I was the first acupuncturist who worked for another big nonprofit, a huge HMO actually, doing housecalls for their hospice program. They had gotten a sizable bequest from someone who thought hospice patients would benefit from acupuncture, and they used that money to create a pilot project. I ran it: provided the treatments, tracked the results, wrote the final report that led them to decide to keep funding acupuncture for hospice patients. By then, though, I was tired of the bureaucracy of a huge HMO, and I went back to working for Central City Concern and trying to treat patients in my tiny private practice.
When I worked for the huge HMO, I was an independent contractor. I hated being an independent contractor (I never could manage to calculate my self-employment taxes correctly) and I kept trying to persuade them to make me an employee. They said it would never happen, and I believed them — part of why I left. I also knew that funding for their acupuncture program was tenuous, and I was fairly surprised when they actually expanded the program after I left and took on two other acupuncturists as independent contractors.
Jane was one of those two. She told me on Saturday that over time, she actually managed to talk the HMO into hiring her and the other acupuncturist as real employees — no more self-employment tax, no more buying her own supplies and trying to keep track of the cost. But they were just barely real employees; they were always categorized as part-time, on-call employees, even when they had worked there for 10 years. Jane tried to get the union to help them, and for a time seemed to be having some success — until, she told me ruefully, the union entered contract negotiations with the HMO and “threw the acupuncturists under the bus” in return for some other, more important concessions.
Throughout all of this, the hospice acupuncture program kept going. Patients loved it — of course they did, people love acupuncture, and a lot of people got a lot of relief from pain and anxiety — and as a result, Jane said, the HMO kept getting bequests to fund it, some in the hundreds of thousands of dollars. And then, one day, some new top executives were hired at the HMO and they made a top executive decision –that no programs should be funded with bequests or donations. It didn’t have anything to do with acupuncture at all, but that didn’t matter; the hospice program, and Jane’s job, ended overnight.
While Jane was working 20-30 hours a week for the HMO, for 10 years, in theory she also had a private practice on the side. But, she told me sadly, she neglected it of course, because the paychecks from the HMO were easier, and now it couldn’t support her. She thought about trying to build it back up and just felt tired.
I thought about the last 10 years for myself, working as an acupuncturist. In 2000, I was working some 20 hours a week for Central City Concern, and Skip was working more than that; Central City’s acupuncture program was how we fed our kids and paid our mortgage. By 2001 we were both having the same bad feeling that this arrangement might not last, that the funding for acupuncture wasn’t really stable. At that time Central City Concern employed something like 10 full time acupuncturists and another 10 to 15 part-timers. When I left in 2001 to get serious about being self-employed, and Skip followed a year or so later, everyone we worked with thought we were crazy.
In late 2004 or 2005, I can’t remember exactly, the bottom fell out of Central City’s acupuncture funding, and the program contracted down to 3 acupuncturists. Almost everyone we had worked with got laid off. By then, Skip and I had basically replaced our salaries. In 2005, we made WCA a corporation and made ourselves employees — no more sole proprietor tax returns, no more self-employment taxes! (I really do hate those.)
By last Saturday, when I was having this conversation with Jane, WCA had 7 salaried acupuncturists and 2 part-timers. Also, we have more than 10,000 patient files. We have the only funding for acupuncture that I trust anymore: a large patient base that is happy to pay fees they can afford for treatments that work. WCA made just shy of $600K last year (that’s gross, and of course we spent almost as much, most of it on payroll). Every year we treat more people. If Skip and I had tried to hold on to acupuncture jobs that looked secure at the time, the odds are high that right now we would have nothing. An awful lot can happen in 10 years.
This made me think about investment. The big HMO had no real investment in Jane’s job or in the acupuncture program. Central City Concern has been one of the major supporters of public health acupuncture forever, but because of their funding, there is no way they will ever be as invested in their jobs for acupuncturists as WCA is in ours. Jobs in big corporations, nonprofit or for-profit, potentially come with the benefits that only a big corporation is able to leverage, so naturally acupuncturists would like to have jobs in big corporations. The problem is, though, if you are an acupuncturist working for a big corporation, one of the benefits you can’t count on is stability. Because there is currently no real mechanism and no real incentive for big corporations to invest in jobs for acupuncturists. Skip and I invested everything we had, not really knowing what we were doing, and it paid off beyond all expectation. At the time we looked like we were crazy; now we look like we’re really lucky. We scraped and scrounged and made countless mistakes — we’re probably making a bunch more right now. And yet somehow we ended up creating jobs.
Acupuncturists want stable jobs, providing acupuncture. Patients want acupuncture, and they want it without a lot of conditions or restrictions or interruptions. There should be a direct economic link there, but there isn’t unless we make it ourselves. We have to figure out how acupuncturists who want jobs and patients who want acupuncture can invest in making those jobs a reality; nobody is going to do it for us. Investment is all about taking risks, staking your time and your energy on something that may not be easy or certain — that’s why people aren’t often eager to do it. But where could we be in 10 years, where could our movement be, if we figure out together how to really invest in it?
“Investment is all about taking risks, staking your time and your energy on something that may not be easy or certain — that’s why people aren’t often eager to do it. But where could we be in 10 years, where could our movement be, if we figure out together how to really invest in it?”
That is where all CA is at from each clinic individually and all of us collectively. I agree with what you are saying but from your own experience you can see that most acupuncturists are like most people; risk averse. That leaves a few acupuncturists willing to put their time and resources on the line for a potential gain. Not many of us are willing or capable to build a practice with that level of risk.
From my own experience, it is challenging developing expertise in marketing, business ownership and acupuncture itself. I sometimes wonder if there is a way to “franchise” community acupuncture so that someone can step in and have the process clearly laid out for them, even many of the steps done for them and then to pay into that advantage. Like a franchise. Less like a “starfish” and more like Starbucks. Maybe even competing companies: starbucks and dunkin’ donuts. Each would have a market advantage based on demographics or just customer preferences. However and whatever the market itself demands.
One reason to do that is to consolidate resources which can improve market advantage. It is easier for a franchise to spend money marketing itself than it is for many different clinics to be able to achieve the same effect. But for those who operate independent clinics, the marketing of acupuncture itself would be done by the large franchise. But some people will prefer the friendly corner clinic others prefer the more “generic” franchise model.
Would that improve the chances that acupuncture would survive and actually thrive?
Tess Bois (formerly McGinn)
One World Community Acupuncture
What we have, in CAN
has always struck me as having all the advantages of a franchise without any of the disadvantages. We share with each other everything that works and everything that doesn’t work. Anyone wanting to open a clinic can easily find all the market research they need in these forums, as well as a lot of love and support, which is more than you get from the average franchisor.
Each clinic bears the individuality of its owner(s) while following a system and path that others in the network have found faith and satisfaction in.
The main problem is that not enough acupuncturists want jobs. If they did, CAP’s would have an easier time finding punks to hire. ‘THE SYSTEM” teaches students to expect to work in a way that keeps bringing up pictures of a Barbie dreamhouse in my head, for some reason. It’s fantasy-land. We all know it, and we know it doesn’t work. But for some reason, when star-struck punks fail they decide that the profession doesn’t work and they go do something else instead of looking for a better way to poke people and make a living. I really, honestly don’t think these people ever wanted to do what it takes to make a living in acupuncture. What they wanted was some boutique fantasy.
How, in the name of all that’s holy ( as my mother used to say) can we ever expect “THE SYSTEM” to take us seriously if we don’t act like health care givers who recognize there’s a hell of a lot of suffering out there and our job is to make treating that suffering as accessible as possible to as many people as possible. We can’t expect to be taken seriously if we’re only open from 11 -2 on Tuesdays and Thursdays.This is not a hobby. There is an unending line-up of sick people waiting to get help.
I get really incensed about all the tire-kickers out there. People think it’s cool to be an acupuncturist. Cool has nothing to do with it. It’s an insult to all those people who struggle to get up the steps to my clinic every week. (I’m on a rant, now.) They have no idea, or interest in how to make a business work. Schools give them the idea that all they have to do is hang up a shingle and people will come in droves offering $80 a treatment.
An integral part of the elitism of the training of acupuncturists is that so few will “lower” themselves to work for other acupuncturists.They all think they can do it themselves. I, for one can’t I’d give my right arm for a good employee, or a partner.
And another thing (I’m on a roll): One of my friends who’s opening a CAP recently went to a party and had to endure the tiresome “you’re devaluing the profession” speech, which I’m sure we’ve all heard. Why can’t people get it through their heads that 6 X 15 = 90. Pisses me off.
I was just thinking about this recently…
One of my patients wanted me to apply for hospital priviledges at the local hospital…and well I have just been procrastinating.
I recently learned an MD had been doing acupuncture in little Winona and there was an RN despersately hospital priviledges but couldn get it…
thats all we hear about from the higher up acupuncturists as soon as we get hospital privileges well… you know what.
the bureaucracy doesnt care who gets better with acupuncture.
acupuncture doesnt make them enough money so its the first thing to get cut.
we can only make a place for acupuncture by creating grassroot community acupuncture clinics that support real patients and real acupuncturists
Jade Community Acupuncture, Winona, MN.
Yeah. What she said.
Who has time for hospital privileges?
Anyway, that’s not why I’m writing.
I was involved in a motor vehicle accident last Labor Day that has had lingering effects on my brain due to a concussion. That’s not why I’m writing, either. I’m writing because I finally got around to seeing some docs and lawyers and whatnot about it, and everyone has said, can you please stop running your own clinic? It’s too much work. You’re too stressed. Why don’t you get a nice job working for someone else, and just work a few hours, like at a hospital…
To which I reply (say it with me, now, folks….) “THERE ARE NO OTHER JOBS.” This IS my job. This is the ONLY job. I cannot go work somewhere else because there IS nowhere else. I live in central NH. I gave up my lovely job working for MAS. So this is it, people. I’m not complaining, not even one little bit. I love pretty much everything about my job (except the taxes, or perhaps even more the preparing of taxes). But this illusion that I can just change jobs at a whim? Nope. Not a chance.
It’s not just lawyers and doctors laboring under this misconception that I can go work somewhere else – how about all those acupuncture students?
And another thing
p.s. I love Pauline.
How do you always seem to hit the nerve Lisa?
Investments are a tricky thing for sure. We can be sure of our investments in the moment and even with the best of plans, the perfect advice they can be lost to forces beyond our control within seconds. I have been in practice (mostly BA) since 1994 like you, and have had a variety of different experiences. I’ve worked in a hospital, worked in my own private office, worked out of doctor’s offices, chiropractor’s offices, out of hotel rooms (detox program in Beverly Hills, that’s an entire novel!);worked in the Worker’s Comp arena, until that dried up overnight! Now I’m in the corporate game, managing the Health Coaching program for American Specialty Health…talk about insecure security…and every day planning to open up my own CA clinic. I’m working at Nautilus Holistic Health in San Diego on my off hours Wed PM and Sat afternoons building momentum and loving it! Thanks to you and Skip and all of the CA community. The more I read the more it feels less like community and more like family!
To make sure this has been written:
Hospital privileges – even on the odd chance they are granted to ‘punks – are worthless in a vacuum. There also needs to be a functioning program behind these keys to the institution.
“We have to figure out how acupuncturists who want jobs and patients who want acupuncture can invest in making those jobs a reality; nobody is going to do it for us.”
Are you saying all the insurance companies aren’t suddenly going to realize how great acupuncture is, and start reimbursing us whatever amount we think we are worth which will create tons of jobs, as we were told 10 years ago in practice mgmt. class would happen any day, and I bet they are still telling students?
It’s time to face reality for those who still believe that, no one cares about acupuncture except acupuncturists and the small minority of the population that have become acupuncture patients. We have to do it ourselves because there will be no bail out for us.
As an acupunk who has privileges at two Connecticut hospitals, I can say that Andy is exactly right.
How do we help our patients
How do we help our patients help us (help them)?
You mention that acupuncturists *and* patients have to invest in creating jobs. I’m sure there are many paatients who would be on board with this if only they knew how. Have we (as an organization) started to think about what tools we can give them?
Great comments, everyone!
Thank you. And please stay tuned.
Please hold that thought, Emily, for a couple of weeks. Sorry to be cryptic here, but the tools turned out to be a little more complex than we thought, and are requiring more preparation and explanation. As in, I was thinking in terms of a hammer, and the appropriate tool looks more like, oh, an iPhone.
we can only make a place for acupuncture by creating grassroot community
acupuncture clinics that support real patients and real acupuncturists
Ad Astra Acu
It seems like a lot of the
It seems like a lot of the “jobs” start-up and smaller CAPs create for acupuncturists are really more of business opportunities.
What we are looking for is someone who is just as energized about building a CAP as we are. Problem is someone who is energized about building a CAP prob wants their own CAP. They dont want to work at one for a few hours a week as an independent contractor. and punks who dont want to/ cant build a CAP of their own dont really want that either.
I think it is a myth that acupuncturist dont want jobs. Its just that a lot of our “jobs” arent real jobs.
The bigger clinics that can offer a real hourly wage, decent amount of hours, and ultimately a salary have no problems hiring. (some acus still think this is beneath them but who cares because plenty of punks are willing to work)
If we can figure out how to collectively close the gap between smaller CAPs and big/ established CAPs in real job creation it would help build some strong CAPs that are open for lots of treatment hours.
I am starting to think that a CAP needs to be open at least 5 days a week to be successful. How can we tell someone to come everyday for a week if we are only open 3-4 days a week with split hours? how is that getting serious about treating patients?
Ad Astra Acu
I’m confused, who says
I’m confused, who says acupuncturists don’t want jobs? I’d love a job, I’d work my butt off to get and retain patients for someone else who would handle the business crap I hate. I’m self employed because I have no choice, many acupuks are in that boat with me. It’s true that a real job has to provide a livable wage, not just a few bucks for working a couple hours here and there.
10 years ago while in school, I was constantly told that jobs for acupuncturists would be everywhere in a couple years, I’ve given up waiting for that.
It’s definitely better to be open 5-6 days a week, but it can work with 4 days. I work 4 days and my patients get enough treatment to get better, that’s what matters to me.
time and semantics
I hear what you’re saying but disagree in part on 2 things.
All of the biggies started small. It takes time to grow, get stable,and then be able to offer stable jobs. Call it a “business opportunity” or whatever semantic, to me that doesn’t change the reality of the work. I considered my own journey a real job from the start. I’ve worked my ass off to get to the point of being paid. I worked other jobs while the numbers grew, always with the goal of being a full-time punk.
Second, about the myth that acupuncturists don’t want jobs. This has been written about in many threads, but I believe that Acks want jobs, but there is a HUGE mental disconnect between job reality on the ground and with Ack job seeker thoughts made of fantasy, entitlement, and privilege. I believe that many just don’t want to do the work or aren’t prepared to.
location location location
I have explored moving elsewhere to work for a CAP, and that would be a fabulous way to learn while earning, and then eventually start my own CAP in my hometown.
However, my roots are pretty deep in my town and people are waiting for me to start what might be the first CAP in VA (I didn’t even see VA on the Locate-A-Clinic map?).
So while I have considered both relocating and also buying an established CAP, I found that deep within myself there’s no place like home. Geography aside, I’d gladly work for someone else (at a CAP) it in a heartbeat if there was a CAP in VA that was hiring.
I’m hoping to be able to afford to hire people to do the stuff I don’t enjoy – accountant, lawyer, maybe some front desk/reception/filing help once I’m busy enough.
I’m eternally grateful for all these wonderful discussions!
counting the days until you open in virginia
i’ve had several patients with virginia family members asking about a community clinic down there. it sucked to say there wasn’t a single one in the whole state. sorry hon, but you are meant to be the first CAP in VA!!!
@linda- dont remember if
@linda- dont remember if anyone mentioned that acus dont want jobs here but it has definitely been written about on CAN and yes it is possible to get a clinic going and help people on 4 days a week. Its just not ideal for growth imo. From my own experience limited hours and days loose patients.
@keith- I guess my point is in order for us to grow faster and be more successful as a whole jobs at smaller CAPs need to be more appealing to a larger audience. There are plenty of CAPs that have been trying to higher someone for a long time with little or no luck.
There is definitely a lot of fantasy. entitlement, privilege floating around but I dont think this is the primary problem. Yes there are people who are willing to work as an independent contractor for a few hours a week but not enough. Established practices were once small and did make it through to become big. Others have hit blocks on size because they are having hiring problems.
Maybe it has nothing to do with the terms of employment big caps can offer and more to do with their reputations and years of existence. I dont know. Just some thoughts here.
If- as Lisa hinted- there is something in the works to help with hiring issue then i think that would be huge! If not then I think we smaller CAPs can still make it to being a big practice it just might take longer.
Ad Astra Acu
check out this interesting blog post
written by Seth Godin, sent by Elaine, about sizing of businesses. Makes me wonder: is the entire acupuncture profession wrong-sized?
“…adding more people didn’t add a significant enough amount of revenue, and fewer people would have cost us our customer base.”
Seems like the *timing* for adding people is crucial; as well as perhaps starting with enough (and not too many)? Also thinking about energy: if you are a go-getter, natural entrepreneur, can you scale up to the right size quicker? (And if you’re not, how do you not burn out before you get to a scale that’s energetically sustainable?)
Thanks for your
Thanks for your rant. I’m not sure I can agree with everything you’ve said, HOWEVER, it was a great way to get me worked up too (in a good way).
Ironically, I’ve never been told that I’m devaluing the profession. I’ve talked to other acupuncturists in the area and they either have no comment aside from “Its great to meet another acupuncturist”, or slight confusion when I explain what I do – OR I meet acupuncturists who are glad that I am doing what I am doing.
This may have to do with the fact that I never notice when someone is talking crap about me. Even in grade/middle/high school, people just didn’t seem to pick on me, and I was strange. Plenty to pick on. I was just merrily going on my way. Maybe they are talking crap about CA clinics in this area, but I just don’t hear it. And I just don’t care if they are.
jobs and debt…
this reminds me of the “acupuncture mortgage” blog…
Are there any acupuncturists
Are there any acupuncturists who ended up posting to this blog??