Kids! Don’t Do This At Your Clinic!

The other day I was treating one of my regular patients. There was nothing in particular that he was complaining about; he just loves Acupuncture and comes every week regardless. I look at his tongue, feel his pulses, look at him in general, and needle accordingly. This time while I was feeling his pulses he mentioned that his grown daughter, who lives in another part of the country, visited a hybrid clinic (part Community Acupuncture, part Conventional or Boutique Acupuncture) near her. This clinic has been open for almost two years now; one of the four practitioners in fact was at the first workshop that WCA put on. I had recommended that this daughter go there as she needed follow-up treatment for sciatica that she had when she was visiting her parents earlier this summer. So now dad was telling me of her experience.

Dad said, “She didn’t like it much. It was a small room of just a few recliners and she was the only one there the whole time. But what really bothered her was that when the treatment was done the practitioner said to her that if she didn’t like the treatment, they could always try a private room.”

Ouch.

A paying customer lost.

Let that sink in for a second. Think how a customer was turned off and how word of mouth drives our businesses.

I almost don’t know where to begin in commenting on this; there are so many things to comment on in that one sentence, “if she didn’t like the treatment, they could always try a private room.” Okay I’ll start here: If you don’t truly, madly, deeply* believe in what you are doing, you- yeah I’m talking to YOUyou will fail as an acupuncturist. There’s no doubt. You will get another job to pay your loans or get your spouse to pay them for you but fail you will. Guaranteed.

People- patients- pick up on hesitation. They smell dishonesty as well as dogs do. They smell failure too. If you try to do any kind of Acupuncture without believing in it and yourself doing it, you will fail. That’s doubly true if you try to do Community Acupuncture where you need a lot of people to make up for the low prices you are charging. You can’t be half-assed about it. You can’t succeed with 4-7 chairs in the long run. You need a bigger set-up.

To get bigger you must like doing Community Acupuncture. Hey- to succeed in either Community or Boutique Acupuncture you must like doing it as much as you like doing anything else in your life. I understand that when you are newly licensed you are nervous and unsure of your abilities. I was too. But somehow you have to move past that. You must develop confidence in your skills and the only way to do that is by treating enough people. You must learn that the way most every patient gets better through Acupuncture is by getting treated multiple times, dozens of times often, and not by some great whiz-bang treatment. That is the nature of chronic illness: the whole body participates in the illness so you need to slowly convince the whole body that there is another way of living without that pain, and that takes a bunch of treatments. You must learn what I am saying on a deeper level than a sales pitch. You must believe.

The example I began this post with is an example of not believing. That practitioner is either completely unsure of what Acupuncture can do and/or they are using Community Acupuncture as a loss leader. In the end it makes little difference as they are on the road to going under. The clinic can’t support its three practitioners and like the great majority of  Acupuncturists in the US, that clinic is more of a hobby now, one in which its best if they don’t quit their day jobs.

As I’ve said before, its entirely unrealistic to expect most newly licensed Acupuncturists to set up their own clinics and succeed. Realistically they need to work for others until they are comfortable enough to go on their own. Most never will get that comfortable. But since at this point working for others is not an option for almost every Acupuncture school graduate, they must set up a practice on their own. The natural thing to do in that circumstance is to hedge your bet on the new practice. Keep it small. Keep all options of treatment open. Be conservative. Convince yourself that you like a quiet special place to treat. And so you fail. Silly. You’ve already bet up to $100 large on your education-you are all in already!  Getting cold feet right at the end will doom you. Figure out how many patients a week you need to survive and the make your clinic so that it can comfortably treat that many and some more. Hint: if you are doing Community Acupuncture, you need more than five chairs. Don’t think small.

There are many tips in the forums for CAN members to read on the many other issues of owning a practice. The important thing though to be open in your business dealings. Acting like the Acupuncturist at the top of this post will doom you. Don’t go there.

* Thanks to Marshall Crenshaw and his song, T.M.D. 

Skip Van Meter
Author: Skip Van Meter

Skip is Lead Acupuncturist and Co-Founder of <a href="https://www.workingclassacupuncture.org/" target="_blank">Working Class Acupuncture</a> in Portland, Oregon. With the earlier part of his life spent acquiring knowledge about geology, urban planning and teaching high school, he has now been an acupuncturist for 19 years, using about a 1,750,000 needles poking his patients. He likes all things soccer, has three fabulous sons, the best wife in the world, and a great dog and two cool cats.

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.

Responses

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  1. hybrids…

    wow, that practitoner’s comment was sort of ridiculous. how would being in a private room help her patient more? that was definitely a moment of undermining your own practice.

    in the community acupuncture practice development class i am currently teaching the issue of “hybrid” practice has come up repeatedly. it seems that’s what most of my students are expecting to set up. i am so glad that  i will have the opportunity to discuss with them what i know about doing this and what others on CAN have shared. it is hard to do successfully (maybe impossible in the long run? i guess time will tell). it was impossible for me, because it felt that i was somehow presenting the community part of my practice as “second grade”. i never wanted to do that because i loved the community part of my practice and enjoyed it so much more on every level than my “boutique” or private-room style practice. so i just scrapped the private room office as quickly as i could.

    we have an 8 chair / table combination in our clinic. it feels like a minimum – i would like to have a space with about 12-15 eventually. i think i understand what you mean about needing to be bigger to succeed in the long run, although i am not sure it includes everyone. it would certainly help those acupuncturists that are not cut out to run a business if we have a bunch of bigger clinics where they can work. thanks for the words of wisdom, dude….

    tatyana

  2. advice from George Eliot

    I’m currently reading Middlemarch (finally – it is SO good, I can’t wait to re-read it in a few years), and the following passage stopped me in my tracks when I read it last week, as it addresses this subject so nicely.  In it, a somewhat feckless young man named Fred gets some career advice from Caleb, the father of the girl Fred has always loved and longs to make himself worthy of:

    “You must be sure of two things: you must love your work, and not be always looking over the edge of it, wanting your play to begin.  And the other is, you must not be ashamed of your work, and think it would be more honorable to you to be doing something else.  You must have pride in your own work and in learning to do it well, and not be always saying, There’s this and there’s that — if I had this or that to do, I might make something of it.  No matter what a man is — I wouldn’t give twopence for him…whether he were the prime minister or the rick-thatcher, if he didn’t do well what he undertook to do.”

     

  3. I’d love to hear from people

    I’d love to hear from people who have smaller clinics.  Is it true that we can’t earn a sustainable income with 4-7 chairs?  It seems to me that some canners are in the 6 chair range and doing well.  Not everyone can or will open  giant clinic in the beginning or has a partner, if it’s “huge or boutique” many will choose boutique and that’s sad if it isn’t true. 

  4. Two parts to your query

    Although I do not own a small CA clinic I have seen a bunch and WCA did start out smaller than it is now so I see two aspects to your question.

    The first is economic. WCA was started on the assumption that we could treat four people for $15 in the same one hour time that most other clinics were charging $60- then the going rate for BA clinics in Portland.  Great!

    But in terms of how many recliners we needed, since we were letting patients stay as long as they needed and patients in recliners go deeper and stay longer than patients on massage tables (recliners are more comfortable) one of us needed eight chairs once we were regularly seeing four people per hour. 

    Its possible to have a time limit for people and some CA clinics do this or have done this. For us, curtailing a treatment just seemed wrong. Patients need to stay as long as they need and the idea that at the time was current in Portland that you can leave the needles in too long proved to us to be exactly false. So we needed eight chairs per practitioner.

    At WCA we get an average of $19 per patient.  Some clinics get more- $20-22/patient.  So sticking with one practitioner working at maximum efficiency of four patients per hour at $20/patient that’s $80 gross.  Not net. That’s not profit in other words and seeing four or more patients per hour will get you to be wanting a paid receptionist (say $9/hour) besides the other costs  of rent and what have you. Yeah I know other clinics get by without a receptionist but I also regularly hear complaints about this practice from patients who get treated at those clinics too: too much scurrying around by the Acupuncturist that results in not a fully present practitioner.  Not good if you depend on word of mouth.

    Finally most Acupuncturists start to lose effectiveness when they start working more than 25-30 hours per week.  They can work more than that for a little while but it really wears on you in the long run. Maximum efficiency of four patients/hour times 25 hours (not realistic I hope you realize) time $20/patient gives one $2000/week gross. More realistically you tend to top out at 80 patients/week (80% efficiency) or $1600 gross. That’s tops and it will take you some time to get there.

    But here’s the thing. Doing this week in and week out really wears on you. Its a lonely existence. You’ll want a partner in the long run (which I think you know can be tough to find- I’ll get to that later). Another partner means you need more chairs because you will overlap some. That probably means a new space for your clinic.

    Also you will hopefully get up to speed on four patients/hour and see that you could do six patients/hour. That also means more chairs. For instance Lisa and I were doing six patients/hour and we would In rare circumstances fill two rooms that have 23 chairs all told.  Even on an average night working together we would peak at 18 or so chairs filled. And the thing is you always want extra chairs to give your patients some choice on where to sit. Patients get their favorite chairs and its best to give them a shot at those chairs.

    So can you see how if you are doing well the energy will be going towards bigger. Your margins get easier. You aren’t so tired. You are happier. A happier Acupuncturist leads to happier patients. A vicious cycle.  Wink

    You don’t have to start out big. From what you’ve said, your size clinic seems right for you.  In the long run though… 

    One final thing, which is the other thing I think your query brought up and that’s understanding, really understanding CA. A lot of practitioners who are attempting CA are not understanding it and are not doing so well. Why and what can they do?  That’s the subject of my next blog post, Conceiving Community Acupuncture.

    Oh- is that a cockatiel on your shoulder? 

  5. I have 7 chairs

    Sure you can make a living with a 6-11 chair clinic.  You just have to think out of the WCA boxSmile.  The survey showed that clinics with 6-11 chairs are providing a living for some of the owners.  The range of salaries is modest.

     Here’s how I run my clinic. 

     I work 21 hrs a week of pt contact.  I schedule 6 per hour (10 minute slots) with 2 slots for a new pt.  M, W, F I schedule pts 9-12.  Tu, Th I schedule them 2:30 – 6.  That’s a total of 96 slots.  80% is 76 slots.  My clinic averages $21 per visit (both new and return – $15-35 sliding fee scale).  

    I have to get people up by 1 hour.  Some are ready before that.  Dr. Tan says he has them sit 30-45 minutes.  People get better in my clinic and refer their friends.  I keep a sticky in my office with times they need to get up.  

    I agree that reception is a plus.  However, if you prioritize and keep the patients in mind, you can do it without reception.  Process the payments at the end of the shift.  Chart CC and points either at the chair or right after you see them and finish charting later.  Focus on your pts, giving them your full attention.  Get volunteer reception as soon as you can and progress from there.

    I envision taking on a partner to work the opposite hours I do when I have the demand.  We can overlap in the office but not with treatment.  Some will be lonely in a solo practice, some will not be.  As Skip said, finding a partner is an adventure in itself and doesn’t always work out.

    I bought the notion that I had to have a large clinic to succeed.  I tried twice to move to a larger space and it didn’t work out for a variety of reasons.  That caused me to rethink my space and to ask myself if I wanted to run a huge business like WCA has become.  Time will tell if a 6-11 chair clinic will work.  I certainly think it is a viable option to start with.  If you sign a 3 year lease you can get started, build up your pt base, take on reception, see how things are going and decide if you want to move to a larger space.  Check out large and small spaces to begin with as you won’t want to move very far from your first location or you will lose your pt base. 

    Rents for larger spaces in the suburbs of MPLS are pretty high.  Not so much in the urban areas.  It certainly seems that urban clinics that start with 12 or more chairs and 2 practitioners get up to speed much quicker than the 6-11 chair clinics.  We had one clinic in the suburbs start with 16 chairs – new practice – and when they downsized to 8 chairs in the same building, did better.  There were 2 practitioners in this clinic.

    My conclusions are that this model is still new; there are variations on the WCA theme that are working; hybrids usually don’t make it; you have to have your heart  in it; and keeping the pts first will lead you to what works for you.

     

     

  6. Thanks Ann!  

    It is so helpful to hear how others are making it work.  The reason I asked others to respond is that it can be too overwhelming for people to have to imagine a huge clinic right off the bat, or ever for some.  If it seems there are no other options than WCA we can lose a lot of people who do understand and want to do community acupuncture, but can’t or won’t take on a huge clinic.  

    I have very modest needs and a working partner so I could reasonably keep doing what I am doing and earn an acceptable (to me) income, pay my loans and live just fine with my 6 “chairs” I may want my own big space someday, but it would be sad if I never thought of a way to make CA work for me right now.  If it were “huge or nothing” I would be in some business office downtown in front of a computer dreaming of the day I would get to practice acupuncture again.  

    I think timing treatments is fine for effectiveness, my patients do well.  Those of us who have to time treatments probably lose some of the “community napping” spirit, which is really cool, but not necessary for effective acupuncture IMO.   

    I don’t disagree with anything Skip is saying, WCA has created a successful business model to follow.  I just want people to know that there are other options to at least start with for those of us who want to offer accessible acupuncture, but don’t want the huge clinic.  I have previously posted a blog on my set up.

    I’m getting a kiss from my cockatiel Luna in my latest pic.  I have four feather kids support so I’m making my clinic work. 

  7. mid size clinic

    We are doing modestly well with our ten chair, two practitioner clinic.  Our numbers continue to grow after 20 months in business, albeit less rapidly than our first year. I’m not going to dissect this issue in great detail now, as I think there are so many unique aspects to each practice – metropolitan locality, neighborhood dynamics, number of practitioners, CA-only, or hybrid, years in practice.

    I think Skip really hit the nail on the head when he talked about the importance of self-confidence, believing in the medicine, and really being able to project that in a way that is neither coldly authoritative, nor wimpishly reserved.

    I also think it would be a lot more challenging to do alone, but I know there are those who don’t let that stop their determination and I offer a deep bow to them.

    On a related note, we just sent out a survey to 648 collected email addresses….will discuss this more in the practitioner forum.

     

    All true religions seek to gain access to that level of consciousness which is not ego-bound.</

  8. It’s also about INTENTION.

    Ann, I’m glad you responded, because I was thinking about you, and Lumiel, in reference to this issue.  Somewhere in here there’s a CAN math problem:  when does 7 chairs not equal 7 chairs? And your comment on this thread was a good example.

    For years acupuncturists have been saying to me in one form or another (with disbelief or disgust or horror or awe) OMG WCA IS SO BIG! Recently in fact John Weeks of the Integrator Blog mentioned that he thinks WCA is the largest free-standing acupuncture clinic in the US. (I’m working on another blog post about what that means if it’s true.) Anyway, it’s taken me a couple of years to formulate some clear thoughts about why that is. So here goes: WCA is so big, relative to other acupuncture clinics, because those of us who work at WCA want to treat a lot of patients — as opposed to most other acupuncturists, who don’t.

    Yeah, seriously, that’s it. Even when we describe what we do as a low-cost, high-volume practice, I notice that very often acupuncturists love the low-cost part, but treat the high-volume part with some distaste. For a lot of people, the high-volume part is just the necessary evil that allows the low-cost part. If I were to think about that in terms of classism, I would think that from the typical upper-middle class conventional acupuncture perspective, “low cost” is OK, because that fits in with a nice top-down philanthropic perspective, but “high volume” reeks of Walmart — meaning, dealing with LOTS of low-class people with their low-class tastes. From another angle, you could say that the acupuncture world is distinctly lacking in a populist perspective — a lot of acupuncturists genuinely can’t imagine being anything else other than elitist in terms of medicine. That’s why they got into ALTERNATIVE medicine, because they can’t stomach the idea of being part of the mainstream. 

    The reason WCA is so big is that we really are populists. We really think it’s great to treat as many people as possible, and to come up with more and more systems so that we can continually increase the number of people we treat. We really want acupuncture to belong to everyone — that is a meaningful goal to us even apart from the success of our own business.

    However, you can have a populist perspective with 7 chairs (or 3 chairs and a table in a 250 sq foot space, like Lumiel, though as we know Lumiel did outgrow her space recently). One of the things I noticed about your post, Ann, is that you talked a lot about your systems. You have a lot of systems because unlike most acupuncturists, you are not thinking about each individual treatment as the point of what you are doing. You are thinking about how to deliver care to the  largest number of people possible in the space that you have, and that is the difference.

    To go back to the example that started this conversation —  the acupuncturist who said “If this doesn’t work for you, we can try a private room next time” is not primarily interested in treating as many people as possible; she’s too focused on individuals, at the expense of the whole picture. Community acupuncture is more than a bunch of individual treatments stacked on top of each other. A lot of acupuncturists don’t get that, and if they don’t get that, they won’t make it. The acupuncturists who do get it will do fine no matter how many chairs they have.  

  9. That’s an excellent point.

    That’s an excellent point.  I agree we have to be committed to treating A LOT of patients, but it seems like it can be done on a smaller scale.  Are the numbers of patients that Lumiel and Ann treat that different than someone who works at WCA? Each individual can only treat so many people.

    I feel that the original thought of trying a private room if CA doesn’t work is a different issue than having a huge clinic.  Clearly that practitioner just isn’t sure about CA, opening a huge clinic would only make things much worse for him.  I don’t think a hybrid is a good idea, I have only defended it for certain privacy or cultural/religious situations.  I decided to move my screens around for a couple people who need privacy for those reasons, and I charge them the same scale.

  10. I guess this is a good time for me to join in.

    Sept. 2,  I moved from a 242 sf space to a 305 sf space with additional sf in storage, and a  bathroom.  This allowed me to have two very important things I was hankering for, for ages: 2 more chairs and free parking, for just about the same price!

    I was clearly uncomfortable in the first space for at least 6 months.  Even though I didn’t have the numbers as high as I wanted, I felt like I was bursting at the seams.  I suspected that this contributed to limited numbers in patients, as well. I’m sure you remember my comment earlier about not making as much money as I wanted to, either (ie: a decent “living”).  I was making more money than I had before for most of my career, but I still wasn’t able to claim a high enough income to compare with other modest professions.  Besides, I kept having this feeling that there are tons of other people out there who need to know about this clinic.  Moving to a more visible and accessible space is part of my strategy to expand my practice.

    As Skip mentioned, CA is a low fee/high volume business model.  I don’t really consider myself “high volume” yet, as many standard practice punks treat as many in a week in their rotating private rooms.  I have 21 on the books for tomorrow.  I lick my chops when I see that.  I love it when they come in and fill those chairs.  The other day I had seven, and I hadn’t closed down the last hour soon enough to stop two people from signing on at the end, so I was there for an interminable time, emptying wastebaskets, studying, returning calls, fluffing chairs, running out to the copy shop during a lull, getting the mail, and gnashing my teeth, vowing now to let it happen again. Those things did need to get done, but there was a lot of time I was just itching to treat someone.

    You see, I was so happy two years ago when I switched to a CAP.  Two years later, I have plans to expand.  After doing the numbers, as SKip has laid out for us above, I know that I need to pull in lots more people.  Even if I end up leaving this practice and starting over in Escondido, I’m in expansion mode here.  My space doesn’t allow more than 6 treatment stations.  Some of them afford a small degree of privacy, but the chairs and tables are still pretty close together.  When a snorer really gets going into the high decibel range, some of the adjacent chairs are tempted to reach out and jiggle his table or chair.  But the curtains and screens make them feel that they have privacy, and this lets them relax right away in the beginning.  Later on, they don’t care at all about the privacy issue.

    I’ve already thought that if I expand really fast (depends on how much traffic our new road sign brings in) I might try to rent the space next to me and open a door in that wall.  I’m pouring everything I have into this little clinic, partly because it’s so much fun, and partly because I still want to sell it.  And this time the signage is going with it, too.

    I’m still scheduling 15 minute slots, but on a day like, say, tomorrow, when I already had 18 packed solid, I don’t say No to others who want to come in that day.  I just slip them in between others, at equal intervals, as if I did schedule 10-minute slots.  Next month I will bring out a 10-minute schedule for patients to fill out.  It was several months ago that I realized that I could do six in an hour, and that the shortage of chairs was preventing this.  I ended up treating people in the waiting room, sometimes.  They wanted to get in so badly, they said they didn’t mind at all being upright in a chair in the waiting room.

    So yes, I can echo both Ann and Skip.  A small size (minimum 6 stations) can do well for a while, but larger will definitely be better for both practitioner and the public.  Tiny (3-4 stations) is do-able, but only on a temporary basis.  Just long enough to be able to afford rent in a larger space.

    I’d like to offer more details later, in a larger posting detailing my first clinic space, to encourage small budgets to go ahead and jump in (the water’s fine!), with the warning that you want to do this only to get started.  I think that anyone with the CA spirit would suffocate in a space like that if left there more than a year. 

    And partners?  Well, I am so looking forward to getting my first paid receptionist because I am no longer thrilled to be wearing the 20+ hats around here.  It’s like having 6 small children.  After that happens, I look forward to hiring my first  paid punk.

    About individual patients vs. the whole group of patients.  I had an interesting experience last week with a patient who left in a huff because she could hear us whispering. She was the only one in a recliner, and I was counseling another patient in the reception area.  The huffy patient was someone who had come in many times (often very late) for insomnia, anxiety, stress, etc.  When she left she was really angry, and said so! The other patient (the whisperee) and I talked it out and soothed each other and cleared the clinic so that when I got home that night, I decided to let that angry patient go.  she called back 2 days later to apologize and explain.  But it was too late.  I suggested that she look up another clinic that is now advertising once-a-week discount acu txs, and said that I didn’t think she could be comfortable in my new space, now that we have no private intake room.  She really begged to be let back in, but I said that she should give it a rest for a couple of weeks, take some B vitamins, look into the other clinic, and maybe we could talk again.  But to me the door is closed.  She isn’t what we call “A Good Fit” for CA, at least not this space.  I doubt she’d fit comfortably into other CA clinics, either.

    This experience seemed to clarify for myself who I want to serve, and how.  I remember one of our members once expressing that he wanted to help “boatloads” of people.  I loved that expression, and feel that way, too.

  11. Lisa, you once asked me

    if I could imagine myself seeing 80-90 visits a week.  Completely!  I showed in my post above how I could see 75 in 21 hrs of pt contact.  I could see 80-90 in 25 if they would come in the door!

     The thing that is most fun about CA is getting the experience to do even better treatments.  It’s just so awesome to see people get better using little tiny needles instead of high tech, expensive, scary stuff.  Great medicine and I sure didn’t realize that seeing 8-12 a week doing private acupuncture – even with herbs.

  12. I’m wondering, If treatments

    I’m wondering, If treatments are timed and a practitioner has no problem with doing that, why would one person need more than six stations?  I could fit eight if I squished a little, right now my patients have a lot of elbow room which I prefer.    

  13. Come again?

    Sure, in practice one starts out either by yourself or with one partner and slowly builds up your practice to where, if you are working say 20 hours, you are treating hopefully 70-100 patients. (You can do more than 100 patients but at that point you need to change your treatment style again- very few needles each time among other things.  That’s another topic but doable.) Yes, most successful individual CA practitioners treat from 70-100 patients a week in about 20-25 hours. That is true for individual practitioners at WCA too. We just have more practitioners.

    But successfully building up your practice to those numbers leads to a fork in the road for the practitioner. When a solo practitioner gets to that 70-100 size, a problem happens.The practitioner thinks, “I’m full.” The Universe says, “No you’re not.” In other words its not natural to cap your numbers at 70-100 because there a ton of people out there who need your help. In addition, there’s a financial incentive to grow further because you are trying to make a living beyond just a week to week existence. (Here is where it would be good for Ann and others to not just say how many people they are seeing but what their net profit is.) Economy of scale kicks in.

    But its hard to go much beyond 100 patients as a lone practitioner so the urge to get another practitioner either as a partner or an employee is very strong. That’s how WCA grew. And as Lisa states, CA is populist, meaning that treating a lot of people is desirable.To try to keep your numbers low (“manageable”) is an insistence that the practitioner’s needs are different than the patients’. 

    Now you can try to keep your numbers low enough for just you but like with hybrids that’s easier said than done. To limit your numbers means that the energy you are radiating is repellent to patients. (This is also true with practitioners who never get to the 70-100 range.) Attracting and repelling at the same time is quite a feat. Its tiring in the long run and because of that and how new most CA clinics are, I am leery about saying you can make a living with a 4-7 chair clinic. I want to see more time elapse first. The interest in the forum I recently started about hiring Acupuncturists (especially from the more established CA clinics) reinforces my thoughts. 

    WCA is often put on a pedestal and we hate that. But we did not start out to be mega-sized. We just allow room for patients to see us. Its no different than being small to us.

  14. Time will give us the

    Time will give us the answers, but I don’t think it’s fair or good to the cause to criticize people who refuse to become WCA overnight, as has been said CAN is not WCA.  We can read your story and learn from it, but in life we all have to go through out own experience step by step.  

  15. I don’t see the conflict you are seeing Linda.

    “I don’t think it’s fair or good to the cause to criticize people who refuse to become WCA overnight.”

     

    I am not doing that. I am commenting on how various CA clinics have evolved and the decisions and conflicts that they run into. Decisions and conflicts that you are wrestling with and will continue to wrestle with in the future. We all continue to wrestle with and rework our decisions. WCA in fact has made many wrong decisions that we had to revisit and redo. I’ve said the stupidest things…Oi.

  16. Criticism isn’t really the

    Criticism isn’t really the right word.  There have been a few of your posts I have read that seem to imply anyone who doesn’t go huge is not smart or a wimp, it rubs me the wrong way that’s all.  

  17. criticism?

    of course interpretations vary from person to person, but what i got from skip’s posts here are pragmatism and encouragement to broaden our vision. he is not advocating that we all should have clinic that are carbon copies of wca – i am not getting that. wca is what he knows and he is sharing what he knows and i appreciate it a lot. i also can see the process of how their vision grew, that it was gradual adjustments, this makes sense to me.

    i think there is a relationship between deciding to cap the number of patients who will get treated at one’s clinic and the issue of practice self-sabotage. i think there is an energetic connection there. when i am tired or burned out, i sometimes think that i wish to have a mellow shift, not too many people – i think that makes my numbers drop overall. i have to really watch that one. i have a fantastic business partner, but she is a pretty new practtioner and she sometimes gets overwhelmed if she has more than 10 patients in a row. we are going to talk about this because i think this issue will affect how quickly our practice grows, so we need to pay attention to these things.

    this stuff is really good food for thought.

    by the way, skip, you said that “its not natural to cap your numbers at
    70-100”, so i wonder: is there a “natural” numbers cap that just
    happens? or are all c.a. clinics destined to expand until they are as big as wca? what do you think? how does one know when they are there?

    -tatyana

  18. Ditto Tatyana’s comment on the website.

    Skip is only trying to save us months (no, years) of floundering in waters navigated long ago by WCA.  He doesn’t bother to step in and hold your hand first so that your feelings don’t get hurt; he just states his thoughts.  Those of us who are sensitive get a little stung sometimes.  I’m not pointing any fingers at anyone, as I myself went through this.  I’m sensitive, yes.  But somehow I managed to push my ego aside and look for the truth in his advice.  Almost all the time I realize how helpful it is!  And it’s a valuable mirror that I could find in other places.

    Remember, in one year you will look back at how you were practicing this year, and you will be astounded at the change you have gone through.  I can’t even recognize who I was 2 years ago.  And, like the kids who were teenagers who thought their parents were ignorant and suddenly towers of wisdom when the kids turned 28?  WCA has years and years of experience on us and I think we should take advantage of their gift of time and effort to help us come up to speed ASAP.

  19. Some ideas and numbers

    I  have netted $18,448 in 8 months this year.  If the trend continues, my net for the year should be $27,672.  I have been averaging about 45-50 visits a week which is down from previously.   Summer in MN is vacation time so business slows.  It’s picked up since school started.

     Recall from the survey that most owner income is in the $20-30K range.  Not great, but these clinics are at most 3 yrs old.  Some owners have other sources of support so don’t mind this salary.

     Skip has asked what to do when you get to 70-100 in a 7 chair clinic.  For me, getting close to that will mean hiring someone to work the opposite shifts from me along with reception.  That would make hours available all day 5 days a week.  My building isn’t open on the weekends.  I also see this as a limit of this space.

     When a mid sized clinic “fills up” I see some options.  You could open up another location. You could move to a larger location.  You could recruit others to set up a community clinic in a nearby neighborhood.  

    I don’t know if 6-11 chair clinics are going to wear well long term.  It seems that they could if the owners don’t want to expand.  If the owners want to expand, they can if they keep their leases 2-3 years long.  The survey with 29 mid sized clinics (6-11 chairs), showed 79% of them supporting their owners in 14 months.  Two of them were converts from private practice and were supporting owners at the start.  Given limited resources and sometimes limited options for space, a mid sized clinic might be the best someone can swing.

     Time will tell.  One thing is for sure.  79% of private practices aren’t supporting their owners within 14 months or we’d be hearing about it.

  20. My feelings aren’t hurt,

    My feelings aren’t hurt, that’s not what my posts have been about.  I enjoy Skip’s posts tremendously, I would never ask him to change a thing about how he posts even when it irritates me.  I know his goal is to help people succeed, but no one has all the answers.  I wanted people like Ann to give their experiences, and show the readers of this blog other opinions and options.  Isn’t the purpose of this blog to get everyone sharing and even disagreeing?  

    Skip and Lisa have said they don’t want to be on a pedestal so I, and I hope others will continue to question things they say.  Many call them parents, it’s a joke of course, but in truth that puts a lot of power in what they say and that can be dangerous.  I deeply respect them and everyone at WCA, but nobody knows everything.  WCA is still a young business, we are all learning together.

    I guess I am the rebellious child who questions everything.  

  21. Ann, thank you for

    Ann, thank you for generously sharing your info.  That helps me and will likely help many others.  Way to go girl!  I know you have issues with your set up, but your ability to make it work is inspiring.