Making Social Business Work

We say that we’re all about creating
jobs, and we are. Like a lot of other things, though, that sounds
easier and simpler than it actually is, and so there is a lot of room
for misunderstandings, especially between employers and employees.
There’s a learning curve for everyone about how to make a community
acupuncture clinic work. While a bunch of us are pretty far along the
success curve at this point, we haven’t made nearly as much progress
with describing that curve in words. Some of us can do it well, but
we’re still struggling to explain to other people how to do it well.
Teaching success requires articulating the physical and mental
demands of working in a community acupuncture clinic – and how to
meet those demands. I’m going to take a stab at that, or part of
that.

When I read Dr. Muhammad Yunus’ first
book, Banker to the Poor, almost 9 years ago, not long after I
opened my clinic, I cried. A lot. In between chapters, I alternately
cried and paced around my living room; I was overwhelmed, I didn’t
know quite what to do with myself. All I knew was that I wanted to do
a lot. And at the time I thought I was crying because I was so
moved by the book, this story of poor women in Bangladesh starting
their own businesses, becoming able to support themselves and their
families; I was moved by the radical idea that every person is
potentially an entrepreneur, and by the crazy beauty of some
economics professor deciding to start his own bank because he thought
that access to credit is a human right. That was all true, but I was
also crying because I had been set free. My tear ducts understood
that before the rest of me did.

It took a while for the ideas in
Banker to the Poor to fully sink in, and for me to grasp what
they meant for me as an acupuncturist, as a working class person, and
as a woman: that running a business wasn’t impossible for me because
of who I was; that I loved business, and it was OK to love business,
because business didn’t have to be about greed and domination; that
business could be a constructive response to injustice. By the time
Dr. Yunus came out with his second book, A World Without Poverty,
and defined the term “social business”, I didn’t burst into tears
when I read it; I was just happy that somebody had an actual name for
what I was trying to do. By then there were a handful of us trying to
use the business of acupuncture as a means to a social justice
end, and calling what we did “community acupuncture”.

That was 5 years ago. None of us
grasped then the full implications of what it means to be an owner,
an employer, or an employee within the social business model that is
community acupuncture. We probably still don’t, but we’ve learned a
lot in the interim. Mistakes, as they say, have been made. A lot of
those mistakes have to do with the process of getting our heads
around the profound reversals involved in working in a business that
is not designed to make a profit. An anti-capitalist capitalist
enterprise. A business whose purpose is only to be.
What does it mean to be successful at
that?
I’m not saying we’ve got it all figured out, but I want to take
inventory of a few things that have become clear in my mind over the
last few years.

Owners
and Equity

What
does it mean to be the owner of a community acupuncture clinic, and
how does that differ from being an employee?

In
your basic capitalist business, owners or shareholders make money off
the labor of other people, the business’ employees. Business
ownership represents the opportunity for passive income; that’s
what’s valuable about it, and ownership in a such a business is
valued in itself as equity. But in a business model whose goals are
social, the first priority becomes delivering those social dividends:
for us, acupuncture treatments that are financially accessible to
people of ordinary incomes (without involving charity), and living
wage jobs for the people who work in the clinics. Lo and behold, in
the community acupuncture model, that first priority leaves no room
for any other priorities. If you make acupuncture genuinely
affordable to people of ordinary incomes – in a country whose
median household income has slipped below $50K annually – and you
try to pay your employees a living wage, there is basically nothing
left over. The business spends what it makes in order to keep being
itself, which is what a social business is supposed to do. My equity
in WCA means that, after almost 10 years, I am the proud co-owner of
about 40 ancient recliners (and, OK, a couple of computers, some huge
filing cabinets, and a state of the art mop).

What
owning a community acupuncture clinic means, economically, is that
you have a job — a job that will pay you only when you are actually
doing it. If you decide to leave your clinic, and you are very, very
lucky, you may be able to get out the money that you originally put
in to start it up. Given that, it’s better for acupuncturists who
own a community clinic not to think of themselves as owners.
It’s
better for them to think of themselves as employees of the clinic,
whose first job is to create a decent job for themselves, and once
that’s achieved, if possible, to create a couple of other decent jobs
for other people.
If you
want more than that out of a business, this is the wrong business for
you. There’s a long post in the CAN forums that expands on this basic
theme and gets into the importance of everyone having job
descriptions, including and especially the owners. Because “owner”
all by itself, in the context of community acupuncture, means nothing
other than “more responsibility”.

So
you’d better love your job. You need to feel that owning a community
acupuncture clinic is its own reward, because there aren’t going to
be any other rewards.

Owning
a community acupuncture clinic means having the opportunity to create
jobs, starting with your own. In reality, the lines between owners
and employees of a community acupuncture clinic are very, very
blurry. They get blurrier the bigger your business gets, the more
people you employ, and the more committed your employees are. But
they are quite blurry right from the start, because the nature of
community acupuncture is that you and your employees can never take
your jobs for granted. If you have a job in a community acupuncture
clinic, you have to create and re-create that job for yourself every
day, whether you own the clinic or not.

Employees
and Community Acupuncture

Being
an employee of a community acupuncture clinic is an enormous
responsibility. Because acupuncture represents, for most people in
America, a scary and unappealing unknown, the success of a clinic
that serves people of ordinary incomes depends entirely on its
employees’ ability to create and sustain relationships. I know, I
know, all businesses are ultimately about relationships, and their
success depends on the quality of their customer service, but you
have to admit that businesses with a product that doesn’t make people
go “Eww!” or “Eek!” or “Whaaat?” have a real advantage
over us acupuncturists. We may think that acupuncture is awesome, and
acupuncture may in fact BE awesome; nonetheless we still have to
prove it to almost everybody else. The burden is on us.

The
only way I have ever seen anybody successfully prove it is by putting
his or her entire self into his or her practice. That’s what patients
ultimately respond to. Not good intentions, not even good clinical
technique; they respond only to whole-hearted personal investment.
Maybe whole-hearted isn’t an adequate description. The successful
acupuncturists I know – some of whom are technically my employees –
give of themselves
profligately.
They pour themselves out like they don’t know how to measure. They
are all in.

And
given what you meet at work in a community acupuncture clinic, you’d
better be all in. The astonishing varieties of human pain that you
encounter are not the topic of this post, so I’m not going to go on
about it. The Buddha said, life is suffering. I’m a Christian but I
have to say: no shit. If you’re a community acupuncturist and you
disagree with the Buddha, you’re not working enough hours. You are
not going to be able to handle the work unless you are fully engaged,
because the emotional demands are enormous. A community acupuncture
clinic attracts people who don’t have the luxury of saying “Eww!”
or “Eek!” or “Whaaat?” to acupuncture; a lot of them are
desperate for any help they can get. As a community acupuncturist,
you can be up to your neck in other people’s suffering, or your
practice can be too slow to support you. There’s no middle ground.

Community
acupuncture is not something that you get paid to show up and do,
allowing you to leave and do something else that’s interesting. It
requires all of you. (See above, “other people’s suffering” and
“up to your neck”.) If you are going to do it full time, you
can’t do it as a way of also doing something else. This is hard for a
lot of acupuncturists to swallow. Part of the dream that a lot of
acupuncture students bought from acupuncture schools was the picture
of an endlessly fascinating, multi-faceted, stimulating life which
included practicing
acupuncture but wasn’t exclusively
about
practicing acupuncture. Community acupuncture is stimulating all
right, but as lives go, it’s not really multi-faceted. It looks more
like single-hearted devotion, as they say in the Bhagavad Gita. A lot
of acupuncturists thought that they were getting a career that would
interest and entertain them, no matter how much or how little they
committed to it; a career which magically would facilitate them being
interested and entertained by lots of other things. But community
acupuncture can’t fund your other interests, because it’s a social
business, and it only funds itself. You can’t do it on the side any
more than you can be married on the side.

It’s
not enough to love the idea of community acupuncture; it’s not enough
to be politically committed to the practice of it. You can’t be
abstract about it. You have to be passionate enough to give it your
undivided attention, which is a very concrete and immediate thing. If
you think of yourself as an activist, community acupuncture can’t be
the job you use to fund your activism. Community acupuncture has to
be your activism; it
has to be your passion. Just like there isn’t any extra money left
over from running the clinic, there won’t be any extra
you
left over from working in the clinic. Capitalism is all about having
a comfortable buffer, but this isn’t that kind of capitalism.

This
isn’t about being a consumer of ideology or interesting experiences
or fascinating theories. This is about being consumed.

Some
of us, employers and employees, love this. It doesn’t matter so much
to us whose name is on the incorporation papers of the clinic. We
come to work because we want to be consumed. We want to give it
everything we’ve got. And, as far as I can tell, that is the only
way to make the jobs within a social business work. You can’t pay
anyone enough to do this, neither owners nor employees; everyone has
to want it for its own sake, and want it badly.


Employees
and Management

Community
acupuncture clinics also don’t make enough money to pay people to
manage other people. If you work in a community acupuncture clinic,
you have to want to manage yourself; otherwise we can’t afford you.
You can’t be half-hearted, ambivalent, or difficult; it’s not
sustainable for us to nag you or cajole you or clean up after you in
any way. Because those of us who are not ambivalent about our jobs
are being consumed by our patients, one way or another, and we don’t
have anything left over for you. The only way this works is if you
want to be consumed alongside us. We like to mingle our smoke and
ashes; it’s cozy and social.

In
order to continue to survive as social businesses, as entities that
exist to take care of people without much money, community
acupuncture clinics can’t fuck around and they can’t employ people
who fuck around. Because, let me tell you, there is not a lot of
social support in America for taking care of people of ordinary
incomes, people without much money. If you are a community
acupuncture clinic, there’s nobody to catch you if you fall – and
anyway, you ought to be too busy picking up everyone else to have
time to fall.

So
what community acupuncture clinics require in their employees and
their owners is
motivated adults.
Both of those words are important. We can’t have motivated
children
(or adolescents) or
unmotivated
adults. Sometimes I despair that motivated adults are in short supply
in the acupuncture world. Somehow the movement has found enough of
them to survive, even to thrive, but like any fire, it always wants
more fuel.

Most
of us are not done with the process of growing up; that’s OK. If
you’re committed to becoming a grown up, working in a community
acupuncture clinic will help you. But you have to arrive with the
desire to grow already in place, otherwise you and the people you
work with are going to have a hard time.

It’s
not just individuals that need to grow; our movement as a whole is
growing and evolving into something much bigger and much more mature.
My hope for POCA is that it will support more of us in giving even
more of ourselves. In social business as in life, what you get is
what you give. Community acupuncture has made us rich, and POCA will
make us richer.

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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. Thank you so much for this post!

    Thank you so much. This is wonderful. I am hiring an employee and I have been explaining to her how really we are colleagues and we’re in this together. Thank you Lisa!-Jade

  2. hiring too

    Ill be hiring soon as well and already employ reception.  Maybe if I can communicate the nature of a social business then they can “get it” faster.  Then the clinic can have some good employees and Ad Astra can reach 300 treatments a week.  BDC!

    Today I got an email from AAAOM (and read it for some reason) and was shocked that in the second line it stated their mission as “defend,
    enhance, and advance the profession.” (as if the profession actually exsisted in a meaningful way!)

    This seems to back up the charge that the acu-establishment is primarily focused on themselves (and a commitment to turf warfare).  Their mission statement says nothing about patients or healing!

    It stands in pretty stark contrast to the blog by Lisa above.  CAN and POCA are clearly patient oriented above all else.  Everything exists the way it does to meet those ends.  To run a successful CAP one needs above all else a burning desire to see lots of people and to help lots of people.  

    If our “profession” was oriented around cultivating systems and punks to see as many people as possible then we would get more of the respect that the AAAOM is so thirsty for.  

    Nick

  3. ‘oh, right-o, the Patient!”

     Nick writes: “Their mission statement says nothing about patients or healing!”

     

    Reminds me of the Monty Python sketch in “The Meaning of Life” where the doctors are so fascinated with the Machine that Goes BING that they do not at first realize they are missing the actual patient.  But you know, they DO have the Machine that Goes BING.  Who cares about the patient when you have a Machine that Goes BING.

  4. It sounds like social

    It sounds like social businesses are looking to hire co-workers rather than looking to hire employees.  That is what I got from Jade’s response.

  5. .

    I’ve read this post several times now, and I’m really excited to be part of this movement.  I think it’s a shame we live in the age of the mega-corp, which gives business such a bad name.  I’ve known and worked for many small business owners, who did not run social businesses, and who treated everyone who worked for them fairly, nicely, like they were part of a family, who often rearranged their own lives and plans for the sake of something happening with their employee’s lives.  I hope that people who see this movement who are not necessarily a  part of it will see another option besides the greed and domination model of the mega-corp world.

  6. We’re all in this together….

     We need COMMITTED practitioners, who want to serve while also making a modest living. I had a friend in the 1980’s who was dying of AIDS, and yet devoted all his ‘free time’ working on the CA Water Board to try and re-write the Western States Water agreements so that they would match our limited resources. When I asked him why he chose to work on such a futile project (meaning that the players involved would not give an inch of ‘their water’ until Hell froze over), and he replied thus:
    “You know your basic ham & egg breakfast? The chicken was involved, but that pig was committed. If we were all equally committed, things would change, instantly!”
    It has given me much food for thought over the years, I gave money to environmental groups, got ‘involved’ but on this issue, I am committed!

     

    Allyndreth 

  7. As a practitioner in a

    As a practitioner in a Community Acupuncture Clinic, I feel obliged to voice my concerns with this post. I find this post to be conservative and short sighted when it comes to labor and its exploitation and it gives employers potential license to ill. First, the post underestimates the success of the CAN model. Perhaps in an rural setting the success of the model is difficult, but in an urban area, even when the clinic is poorly managed, the model is successful. I know of more than one CAN clinic where the owner treats very seldom (and some owners open multiple clinics) and the employees sustain the clinic. There is equity to be had in these clinics and owners are making money off of the labor of others. Crying poverty is the age old adage of the capitalist and this post promotes the very same message. One of the classical ways to manipulate employees is to encourage them to see the owner as a fellow coworker and comrade. This confuses roles, blur lines and sets the employees up to be taken advantage of. This post, at least in its interpretation as the comment below reflects, is encouraging employers to create this sort of false illusion. Many of us practitioners that work for CAN clinics are motivated adults and sometimes we are working for egotistical children. It is very concerning that the post outlines that owners do not have time for the their employees and that they can’t allow for difficult employees. It is easy to see how a shortsighted employer can have a field day with this. The post creates an archetype for the CAN employee—to be seen and not heard. This is anthesis of a social business model. It is the employers obligation to make time for their employees and historically, those employees that have been labeled difficult and outspoken are the ones fighting for labor rights and reform. I find that those within CAN have a tendency to to quickly toot their own horn and not see the short comings of their own model. In his analysis of capitalism, Marx clearly identified that its success was based specifically on the exploitation of labor. You can’t present yourself as a social business without adequately addressing labor, however CAN continues to do so. Through CAN, jobs are being creating, but the question is what sort of jobs are they?

  8. minus the typos, sorry posted the wrong version!

    As a practitioner in a Community Acupuncture Clinic, I feel obliged to voice my concerns with this post. I find this post to be conservative and short sighted when it comes to labor and its exploitation and it gives employers potential license to ill. First, the post underestimates the success of the CAN model. Perhaps in an rural setting the success of the model is difficult, but in an urban area, even when the clinic is poorly managed, the model is successful. I know of more than one CAN clinic where the owner treats very seldom (and some owners open multiple clinics) and the employees sustain the clinic. There is equity to be had in these clinics and owners are making money off of the labor of others. Crying poverty is the age old adage of the capitalist and this post promotes the very same message. One of the classical ways to manipulate employees is to encourage them to see the owner as a fellow coworker and comrade. This confuses roles, blurs lines and sets the employees up to be taken advantage of. This post, at least in its interpretation as the comment above reflects, is encouraging employers to create this sort of false illusion. Many of us practitioners that work for CAN clinics are motivated adults and sometimes we are working for egotistical children. It is very concerning that the post outlines that owners do not have time for their employees and that they can’t allow for difficult employees. It is easy to see how a shortsighted employer can have a field day with this. The post creates an archetype for the CAN employee—to be seen and not heard. This is the antithesis of a social business model. It is the employers obligation to make time for their employees and historically, those employees that have been labeled difficult and outspoken are the ones fighting for labor rights and reform. I find that those within CAN have a tendency to too quickly toot their own horn and not see the short comings of their own model. In his analysis of capitalism, Marx clearly identified that its success was based specifically on the exploitation of labor. You can’t present yourself as a social business without adequately addressing labor, however CAN continues to do so. Through CAN, jobs are being creating, but the question is what sort of jobs are they?

  9. Can you give me some data

    to back this up: ” I know of more than one CAN clinic where the owner treats very seldom
    (and some owners open multiple clinics) and the employees sustain the
    clinic. There is equity to be had in these clinics and owners are making
    money off of the labor of others.”  If someone has figured out how to create equity in the CA model, there are a lot of us who would really like to know how they did that. Details, please. 

    Also — do these scenarios involve “employees” who are not really employees — independent contractors, etc?

  10. To the guest practitioner in a CA clinic

    I am surprised that as a practitioner in a CA clinic you wouldn’t be a member of CAN or if so have chosen to comment without  your name.

    I would love to see the numbers from the clinic where you work to see how much profit the owner takes in and how high of a salary they make without seeing very many patients.

    Having just opened my second clinic last week (it cost me $2,300 cash which led me to not pay myself on the last payroll), I would love to know how another clinic owner can afford to pay acupuncturists a decent wage, pay themselves a decent wage, have receptionists, pay payroll taxes, in Minnesota we also have to pay 2% of all sales to the state for low income health care, pay 3% on all credit card sales, worker’s comp, malpractice insurance and all supplies without treating very many patients themselves. 

    As Lisa’s article states as soon as we get busier and need to hire another practitioner the money goes to them and the support needed for them to do their job. I personally do the job of 2-3 people as well as being an acupuncturist.  That’s because I cannot afford to hire people to do that work.

    It’s easy for you to say as an employee that Lisa is wrong, but if you’re not the owner then I don’t think that you can accurately enter into the discussion of whether we are making money.  If business slows down I pay everyone else and do not take a paycheck.  Will you volunteer to give up your paycheck the next time the clinic is slow?

    We’re not complaining because we feel that what we’re doing is worthwhile, and I love helping my patients, but please don’t try to refute anonymously the facts of this model.

    Again I ask, please let me know which clinic owners you are referring to that are making money for themselves without really seeing patients because I want to speak to them and find out how I can improve and thereby make more money while working less.

    Kerri Casey L.Ac.

    MN Community Acupuncture

  11. Ex-employee of CA clinic

    I want to start off by saying that I am fully supportive of the CA model and CAN. I believe in making acupuncture affordable to everyone and also in making the profession fair to everyone. As an ex-employee, I’d like to share my experience in working for a CA clinic.

    I interviewed for  an independent contractor position for a clinic in a different state to where I ended up moving. A week prior to my moving I was informed that I would be an employee instead of an independent contractor and because this was to my “benefit” I would be taking a pay cut. I accepted due to being eager to start a new job in a new place doing what I love best…acupuncture!

    Upon my arrival, additional unpaid hours were added to my shifts due to the fact that I was now an employee. I had to come in for “observation hours” and weekly meetings, all of which I was not compensated for due to my “commission” status in the clinic.,VS, being paid hourly. 

    On top of the additional hours I was expected to show up for, I was also responsible for marketing myself and getting my own clientele.  I have no problem with building a practice, however when I’m working 5 days a week with extended hours, I draw the line at working on my days off.

    I approached the owner about my concerns and I was met with “I’m sorry, we should just go our separate ways.” (BTW, this response was given to me a week later after I was mislead to belive she was going to look into what would be better: working 3 shorter days or two longer days a week).

    I was not given any explanation, however, realizing her unrealistic expecations, I welcomed this  suggestion. The reality of the situation being an employee of this kind of clinic was more than I bargained for. I spoke with several employees from different clinics in different states and they all agreed that this was not a fair set up.

    My hope is that this forum will aid current and future employees in making wise decisions for themselves and not only serve as a support network for employers. Acupuncture employees are people too, and we are also the future clinic owners who will hopefully fairly employ future acupuncturists as well.