Milwaukee Community Acupuncture ~ Talkback Forum

Here’s the article.  The Talkback Forum (comments section) is getting interesting, as are the personal Facebook messages that I’m receiving.  I thought I’d move the venue from my Facebook in-box to a more participatory forum, ‘cuz I haven’t time to address them all by myself.  (And there was a 9-hour-lag-time in the OnMilwaukee.com forum between when my comments were submitted and when they were approved.)   Here are the comments:

flynnj7 wrote:
“I absolutely love the idea of meeting the needs of lower income patients. As the owner of a sliding scale acupuncture practice, I can tell you its been a huge benefit for many people who would not normally have been able to afford treatments.  However, I would like to offer some friendly criticisms regarding community acupuncture clinics. First, these clinics focus on 1/8 of what Eastern Medicine has to offer. Acupuncture is only 1 of 8 modalities offered in Eastern Medicine. This “treat’em and street’em” method of acupuncture is limiting the medicine’s full potential for healing. Each of my patients, regardless of their income level, receive complete care at my clinic which includes acupuncture, acu-pressure, moxa, cupping, gua sha, herbs, nutritional information, education relating to the practices of qi gong, tai chi, and meditation. Eastern Medicine has many tools available, so to limit your time available to use those tools with your patients is like trying to hang pictures with only nails and no hammer.  Finally, the idea that community acupuncture is somehow more traditional is just false. Community acupuncture and modern day acupuncture in China is based on a Western medical model. Talking to your patients is how Eastern medicine reaches differential diagnosis. That is the essence of Eastern medicine and it is what makes Eastern medicine distinctively different from Western. Go see a Tibetan doctor and let me know if the intake is only 5 minutes.”

I wrote back:
“Hi J. I disagree with your nail and hammer analogy. I think that Acupuncture is Like Noodles. We all need to eat when we are hungry. We might sit down to a quick and simple bowl of spaghetti prepared at Noodles & Co for under $10, and we could be back to the office in twenty minutes. Or we might choose a more elegant presentation of pasta at an exclusive restaurant like Bacchus, conversing for hours and spending a small car payment on our dinner. What we require is nutrition. A hearty bowl of noodles will fill our stomachs just as readily as dinner at an exclusive restaurant.  Acupuncture is like that. While many of the boutiquey-spa-like services (such as guasha, moxa, and tuina) offer a wonderful compliment to acupuncture (much like the fancy-schmanciness of exquisite pasta at an elite restaurant), they are not necessary to the fundamentals of acupuncture. Acupuncture is incredibly simple, and insanely effective medicine. All by itself.  How do I know this? I administer hundreds of patient treatments in my own Community Acupuncture clinic each month. Those patients feel better, their pain diminishes, and they tell their friends and family about it. Word-of-mouth about the success of frequent acupuncture treatments has spread like wildfire in our town and nationwide. It is estimated that a quarter-of-a-million acupuncture treatments will be administered at Community Acupuncture clinics this yearCare to hear from some patients in my Community Acupuncture clinic? Want to know more about the clinical outcomes of simple, frequent acupuncture in my Community clinic?  J, how do you decide which of your patients have access to the lower end of the sliding scale? Community Acupuncture clinics do not ask for any income verifications or hardship waivers. We don’t think that our patients should have to prove anything to receive affordable services. Everyone pays on the same sliding scale of $15 – $40, regardless of their personal circumstances.  J, how do you make a living for yourself if you spend so much time doing extensive intakes and lengthy treatments, while charging a nominal fee? I can’t imagine that you are able to treat very many patients in a day if you spend lengthy sessions with them. And if you aren’t charging a lot of money while not seeing a lot of patients, well, how does that work for you financially?   Community Acupuncture clinics are self-sustaining. The financial viability of our low-cost and high-volume clinics means that our patients can depend upon us to be here to serve them today, tomorrow, and for years to come.”

K” emailed this to me:It just makes me think about how when people read an article like that, they think acupuncturists are money grubbers, unless they do community style. It’s language which refers to regular acu’s as elitist or boutique – very holier than thou. And why USE that language? It doesnt educate people on acu or tcm. To me, it is language which is demeaning and more about marketing CA rather than helping people to find healthcare.  I just don’t get why it’s ok to market yourself while actually speaking down about others. I also find it misleading. I mean, if you knew nothing about acu and tcm and read about CA, it wouild seem like the only reason to see a non-ca practitioner is to be by yourself in a room and to get spoiled. as if ca is the foundation to tcm or acu. i love ca but hate this facet of the public side of it.”

And flynnJ7 emailed this to me:Yes, most Easter Medicine practitioners spend an initial visit of an hour attempting to reach diagnosis. That is the difference between a Western style of acupuncture and an Eastern style.  At my clinic I offer low cost treatments and I spend time with my patients. Cupping, gua sha, moxa, and acu-pressure are fluff now?  In China I believe the word acupuncture is better translated acu/moxa since they compliment each other and should be used together in treatment. Community Acupuncture doesn’t allow time for these additional modalities. So while your patients may sit for hours with needles, will it do any good if needles aren’t the best course of treatment?  I’ve had a number of patients tell me that acupuncture never worked for them in the past because they never experienced a combination of other modalities before. Like I said before, acupuncture is 1/8 of the medicine.  I also question the sanitation of these clinics. Community style acupuncture usually has people resting on a nice fabric chair. How do you clean that? In my clinic, I have a leather table that I can wipe clean and I always use clean sheets with each new patient. Acupuncture needles will cause patients to bleed, especially the commonly used community acupuncture hand and foot points. Even if you put a clean sheet on every chair, how do you clean the chair when the blood soaks through? Plus the human skin carries staph, now you add blood, even nervous sweating and you have a lazy boy full of germs.  In general, a low cost model of treatment is a great idea. CAN however needs more thought. Many acupuncturist do have enormous school loans to pay back. So please stop acting so elitist about your methods of treatment. The average cost of acupuncture is far less than conventional medicine. Acupuncturist charging $50-70 a treatment are making the choice to give quality care.  Where’s the spa-fluff chapter in the Su Wen?”

Anyone else care to weigh-in on the conversation? ______________________________________________________

More from flynnj7 last night: “I initially commented on this article because several comments were made that were somewhat disparaging of non-CA style acupuncture clinics. While I understand that this piece was mainly to introduce Milwaukee to this particular clinic, I felt the article did so at the expense of other acupuncturists in the area. My comments were meant to bring some balance to this article.  Apparently these comments were not well received by CA practitioners from across the U.S., as evidenced by people from Seattle, Racine and Maryland making comments here. The comments that referred to treatments as “spa like”, “boutique”, and “fluffy” were posted by these individuals, who were clearly demonstrating loyalty to only one treatment methodology (as espoused by CAN) at the expense of any other.  I’m sad to hear and see demonstrated that a network of TCM practitioners have extracted only one aspect of an entire medicine in order to be more profitable. Making $250 per hour doesn’t make you a community service.   Finally, to these people, I would say there are many of us TCM practitioners who offer excellent care to our patients using a variety of methodologies. That care is not some luxurious bowl of noodles, or an extravagance offered only to the wealthy and to characterize it as such is insulting.”

And this morning: “Boy, the Cult Acupuncture Network congregation is on the alert!  Jessica, herself, has made mention making up to $250 an hour. That again, is not a community service like you proclaim. Treating 10-15 patient in an hour is also very similar to most people’s GP. I personal went into the Eastern medicine field to provide a better quality of care. Feel free to question my intentions because I certainly question CAN’s.   Cheap marketing ploys which degrade and belittle other acupuncture clinics won’t gain you any support here in Milwaukee.  I see one patient an hour. I charge on a sliding scale fee, I provide acu-pressure, cupping, moxa, education and much more for my patients. What I don’t do is cut down other peoples practice and make claims that they’re some how not as worthy as my practice.  I realize I hit a nerve with regards to my sanitation concern. It is still a concern. Why not use massage chairs that are leather? At least you can disinfect them. I NEVER mentioned blood soaked clinics, but I’m not surprised CAN members would dramatize my statements.”
Jessica Feltz
Author: Jessica Feltz

<p> I learned about Community Acupuncture while studying at the Midwest College of Oriental Medicine (MCOM) in the Spring of 2006 when Lisa Rohleder's first article about her clinic appeared in Acupuncture Today. Coming from a middle-class background myself, I was the only student in my acupuncture class to have not experienced the healing benefits of this medicine prior to beginning studies at MCOM. I couldn't afford it. And my family couldn't understand what I was doing by investing in an education that they didn't perceive to be financially sustainable. </p> <p> The Community Acupuncture model is a perfect fit for me, balancing social justice and taoist simplicity with the patient's innate ability to heal him/herself (with a few gentle nudges from strategically placed needles). I am grateful every day to have found CAN and the love it brings into my life. I want to share that joy by spreading the message about how we can create a new health care experience in our communities through each of our very small efforts...and how those very small efforts can in turn change the world. </p> I enjoy my two sons, my 4 cats, and big stacks of books.  I own and operate...

Related Articles

Survey of CAN clinics

Skeptics in the acupuncture community say that CA clinics can’t be successful.  A variety of reasons are cited – prices too low, patients want one-on-one attention and wouldn’t like treatments in a room with other people, Dr.

Responses

Your email address will not be published. Required fields are marked *

  1. It is so awesome that now

    It is so awesome that now THEY are calling US elitist! THAT, ladies and gentlemen, is true comedy. As is the image of a gory, blood splattered acupuncture clinic. Jeez, what is she doing to people to be imagining blood soaked furniture?

    Too bad we can’t reply to the e-mails. I’d love to mention the patients who constantly tell us they’d tried acupuncture before with no results because they couldn’t afford them. 

     Kelly

  2. Critics of CA

    frequently seem to devolve to pulling the cards the person above did; “the ALL of Chinese Medicine” argument, and the “Ewwwwwww! Icky germs!” argument.

    1- As to the first argument, I would be very surprised to hear ANYONE on CAN make the argument that cupping, gua sha, herbs, qigong, or any of the other modalities within Chinese medicine are somehow lesser in their potential to heal than acupuncture. Chinese medicine, like Chinese culture generally, is rich beyond imagining, and hardly describes a monolithic entity.

    The term “Chinese Medicine” itself, once you push past the rather thin veneer of the post-1948 commiepuncture that forms the roots of the curricula that most of us were trained into, is a varied and multiplex critter that defies characterization as a single thing. And further, as I understand it, relatively few doctors in China “do it all”, and instead, tend to focus on one area or another.

    That’s why it’s so important that the class piece and the social justice piece be included in the discussion of why CA has developed the way it has. It isn’t about which treatments are perfect, or about preserving some pristine and mythical idea of “our medicine”. it’s about what most fully balances effectiveness, accessibility and affordability for the greatest number of people. BA practices have the capacity to do the first rather well, but with respect to the latter two, it fails miserably. It’s about what helps the most people, most often and most quickly, end of story.

    Skip’s recent post regarding his idea that the easy availability of relatively painless surgical steel needles has radically changed the traditional position in, and the potential contribution of acupuncture to, Chinese medicine is prescient. Treatment frequency, particularly in the initial stages DOES matter, no matter what modalities you’re using, but they won’t help at all if people can’t afford to get them. Frequency of treatment matters a great deal more than having the perfect point prescription or picking the perfect modality.

    There are too many people who need help in this society who aren’t getting it to sit around and argue the fine points of esoteric medicine. People need treatment, and acupuncture can be adapted in a cost-effective way to almost any condition and almost any person. It will be a wonderful day when the society values health enough to make it possible for people to come in and get hour long sessions and multiple modalities as often as they need them, but that day ain’t today, or tomorrow neither!

    2- As to the second argument, of course sanitation is a leading issue, in any aspect of healthcare, and doubly so in a community setting, as the many threads devoted to it on this site will attest. And the management of needles and blood and cleanliness practices is clearly a major priority that must be regarded as a primary job in ANY clinic, community or otherwise. But the people who level that criticism at CA clinics are usually being extremely prissy about it.

    When was the last time you sat in the grimy seats of a waiting area at O’Hare on a January night with people coughing and dripping and snoring all around you and went home and wrote a letter to the airlines about how dangerous the environment was? The answer is, you didn’t. We navigate through community settings rife with the body fluids of others all the time and never give them a second thought. We sleep comfortably in hotel beds whose histories would probably scare the hell out of us if we knew them, eat in dirty fast food restaurants, and sit without thought in waiting rooms of all kinds, including very public places with lots of cloth seats (airplanes, buses, etc.) that are exposed to God knows what before you get there.

    And how about some of the conditions faced by those of us who’ve done acupuncture in detox or public health settings? And in addition to saving huge numbers of lives, the often almost obsessive sanitation practices in hospitals have given us, among other lovely new creatures, MRSA. Is that because hospitals are stupid and mistaken in being so careful about cleanliness? Of course not. It means only that sanitation is a difficult and by nature imperfect process.

    There is a constant tradeoff between the risks of exposure to pathogens and the fact that we, as creatures, are designed to live TOGETHER. Community acupuncture clinics face certain sanitation challenges that BA practices don’t to be sure, but think I can speak for most CA folks in saying that there is just as much or more damage created by isolating our suffering from that of others, and one aspect of the art of CA is finding that reasonable balance.

    To sum up, In reading so many criticisms of CA from our BA colleagues, and having done both now, it’s really strange to me that something as simple and straightforward as CA could be so threatening. Puts me in mind of a statement Kurt Vonnegut made about art critics in one of his essays to the effect that anyone who expresses contempt for a book or a play or a work of art had always seemed to him like someone who’s donned a suit of armor and attacked a hot fudge sundae.

    Please, folks! Are we, as acupuncturists and healthcare providers doing such a good job that we’re in danger of running out of sick people????????

  3. Republican scare tactics

    Flynn’s comments about sanitation have already been pretty well refuted and I have not much new to say on this except that it seems a pretty cheap shot to appeal to people’s fear of germs in an attempt to validate the unaffordable health care options in America – of which high priced acupuncture is most definitely a part of.  People sitting in a chair at a community clinic is not different from people sitting in a chair at the movie theater. Yes, one needs to be careful with blood, and it’s not too difficult to be standing by ready with a cotton ball to avoid staining the sheet. If the sheet gets stained, it can be thrown in a bucket of cold water and replaced by a clean sheet. Yes, staph is probably everywhere – do you want to live in a plastic bubble?

    As for K’s comment – it sounds like she is making a reactionary assumption in her mind. I don’t know what language she is referring to specifically. With my own writing and speech, I try to balance respect for other practitioners with the integrity of speaking the truth. Of course the term “boutique acupuncture” (BA)  is going to push some buttons.  Please take responsibility for Your buttons if you choose to take offense. I am clear on my intention and that is to lower economic barriers to receiving acupuncture. I do not bad mouth my friends – many of whom still choose to practice in a BA style. I hope they can make a good living at it, but fact is, I know that for most of them, it is a struggle.

  4. thank you

    Very well articulated. I like how you discuss the issue of sanitation – starting from a place of acknowledging it as an important issue, not dismissing it blithely, but then place that within the larger context of humanity and the practical aspects of how to help the most number of people. The other quick response I have to the germs-koodies fear grenade that critics of CA like to hurl is – “that’s what soap is for”.

  5. Easter Medicine practitioners

    “And flynnJ7 emailed this to me:Yes, most Easter Medicine practitioners…”

     

    on the third day after your practice fails, you rise from the dead…..and teach.

  6. You know, you should

    You know, you should represent the discussion you’ve had with J and K correctly. There were NOT personal emails. It was part of a facebook discussion that I, among others, became involved. You were NOT being personally singled out. You WERE involved in an online discussion between facebook friends that degenerated into name calling. It was acutally YOU who started the name calling. J was making comments on the business practice of CAN, you made specific comments about Js business. You even called her out by name in a public
    forum. Now you take the private part of this discussion (the discussion was occuring in public and private forums) and publish it on a blog?

  7. Privacy and the Internet

    Thank you Guest for your comment. Although I was not privy to the so-called private discussion on the internet (bit of an oxymoron in my mind – read on), I think the basic issue is whether or not Jessica misrepresented someone’s words (which I highly doubt), not her posting the discussion on this forum. 

    This forum exists so that we can discuss how to change the acupuncture profession in order to serve all citizens – not just a few.  It’s easy to see with your multiple all-caps wording that you are a bit riled up.  We see that happen a lot because Community Acupuncture pushes a lot of people’s buttons. Sorry that you feel that way. But maybe we have more in common than you think – though it’s difficult to have a very deep conversation with someone who remains anonymous.

    But in any case, back to the issue of privacy: Internet privacy with respect to email conversation is a very nebulous legal concept and thanks to you, I decided to do a little search on it and came across this article: https://www.netatty.com/privacy/privacy.html which is of some relevance.

    Unless J and K specifically stated “these words are in confidence and not to be shared with anyone”, I doubt any modern day ethicist, let alone a lawyer, would agree with your point of view that Jessica acted unethically or illegally to share this communication in a public forum.

    But please, let’s talk about the real issue (affordable acupuncture) instead of creating more smoke screens and hurled accusations in order to hide from them. 

     

     

     

  8. Quality care

    With respect, community acupuncturists are striving to give quality care as much as anyone. To give some validation to the private practitioner POV, it is true that other modalities can be helpful, and I can add my voice to the others who readily agree that acupuncture is one piece of the ancient medicine. Would it be nice to use cups? Sure. Direct moxa? Definitely. Are additional modalities necessary when people can afford to receive frequent acupuncture treatments? It’s arguable.

    Here’s a more telling point: it’s hard to be an expert in everything. IMO, some acupuncturists don’t  do acupuncture as well as they could because:

    1.) They are caught up in designing the best possible treatment for their patient…including all the pieces of a zang fu, 5 element, or whatever other diagnosis is needed for a personalized herbal formula, lifestyle recommendations, exercises, etc. This also includes the tie-in with the western medical training, and the need to sort all that out  in terms of the TCM diagnosis. There’s a lot to know, that’s for sure. The person who generalizes rather than specializes has a lot of distractions from designing the acupuncture treatment. I always wanted to be a really good acupuncturist, not so much a doctor. I don’t want to be a jack of all trades, but a master of one (even that will take lots and lots more practice).

    2.) They don’t stick as many needles into people. Full disclosure: I am only into my fourth month of prtacticing CA. My numbers are way below the veterans. But I am only in my clinic for 16 scheduled hours a week, and do well over 100 treatments a month. At some point next year, I alone will be at 350-400 treatments a month. And, those who haven’t, look at the other CA numbers. They will amaze you. I will admit ther are things I liked to do that I can’t do in a recliner. But my meridian diagnosis and therapy is getting really good. And I think it’s great that people who can benefit from acupuncture are getting really experienced acupuncturists when they go to community clinics.

    Correct me if I am wrong, CANers, but quality of care is at the top of the list. What also is true is that lots and lots of people coming to community clinics (sorry I don’t have numbers, but will estimate 70% at my place) have never had any acupuncture before, anywhere. Why? No access, too expensive. CA practitioners are not targeting patients already being treated at private practices. We are targeting patients who don’t have the luxury of considering acupuncture at private practices with price tags to match the one-on-one care.

    There’s a place for CA clinics. The people who get acupuncture in them feel better, and keep coming back.

    As for the sanitation, ditto our other posters. Clinic chairs (with frequently laundered covers) are way more sanitary than, say, headrests on a plane or bus. The solution to bleeding, sneezing, etc. is to change the cover. People are getting acupuncture, which  is slightly invasive, but there’s no big scary spillage of body fluids.

    Thanks for the discussion.

  9. Interesting Us vs. Them attitude

    I’m another person that was part of the initial Facebook thread and I find the response on this site to be very interesting.

    Several of the bloggers here at CAN (especially in this thread) seem to openly acknowledge cultivating some kind of “Us vs. Them” attitude between private practice and community practice. I would go so far as to say that its a point of pride. Pride that was wounded ever so slightly when this got started.

    Knowing all the people involved in this as well as I do I can help to burst several bubbles here.

    1) None of the private practice acupuncturists actually care if people practice CA or not. Their attitudes range from supportive to indifference due to being busy with their own clinics.

    2) Affordability is only one of the many reasons people have not tried acupuncture and is most likely the last obstacle that needs to be overcome to spread acupuncture.

    In the onmilwaukee.com article that Jessica linked to, there was already a comment denigrating acupuncture as an overcharged placebo — at any price.

    I can’t speak for the other people in the thread, but attacking private practice as expensive or a “boutique” is just not helping your cause, unless your cause is to build an “Us vs. Them” attitude. Why use these marketing methods where you actually admit to pushing buttons and then act surprised at the backlash? Many private practices work with both sliding scales or discounts in order to meet the needs of their patients which is a goal you both share in common.

    3) The biggest problem facing acupuncture is one of credibility, not affordability. Face it, for the average Joe here in the U.S. we’re all a bunch of hippie freaks or witch doctors. Fighting like this or even using marketing methods meant to be confrontational only makes people outside our community think we’re even less credible.

  10. I’m sure you are correct and

    I’m sure you are correct and that legally Jessica did nothing wrong. I’d counter though that by bringing J and Ks comments here, without specifically informing them, she broke some standard (n)etiquette rules and that by representing messages sent in a group discussion as private emails she shows a lack of integrity.

    You note that CA often pushes peoples buttons. I think this comes down to the language that seems to be commonly used. To describe non-CA as (to quote Jessica) boutique-y, spa-like and fancy-schmanzy seems to be deliberately designed to demean the non-CA practitioner. It’s certainly very disrespectful. I’m sure a common question that comes up is why CA can be so much cheaper than non-CA. Why not be more respectful:
    “CA practitioners believe that by treating communally and with a reduced set of services that they are able to provide patients with a higher healing value per dollar.”
    Vs
    “Oh we think it’s too expensive for you so we cut out the boutique-y fancy-schmanzy stuff.”

    Big difference right? Words have a lot of power and it seems that Jessica used words deliberately meant to inflame.

    How do you like this? “Sure CA is an effective treatment method; I also think that a beat-up Yugo is an effective way to get from A to B.”

    Childish? Disrespectful? Demeaning?

    It’s silly. You all want to make a living and make people healthy right? So why the need to belittle each other?

  11. sorry you are taking this personally

    I didn’t hear Jessica use any language that explicitly demeaned or disrespected a person. Her colorful language references a style of practice – which disregards the health care needs of the majority of Americans – are designed to make people think about this imbalance in the health care system. You are inferring that her comments are directed at people rather than a style of practice. I don’t see any name calling, and yet, in your last few sentences, I hear accusations of “childish, disrespectful, and demeaning”.  

    I’m sure Jessica can speak well for herself on this, but I don’t believe that her intent (or mine) is to disrespect anyone, but to speak up those who have traditionally not had a voice in the health care justice discussions.

    Please, let’s not keep derailing the discussion.  You can read about us and who we are because we stand behind our words with our real names. And yet, “unverified Guests” keep jumping in with meta-objections regarding the wording of a lively discussion that is focused on the well being of hundreds of millions of people.  

    Is your manner of participating in this discussion genuine, respectful, and open to a sincere dialogue? Or are you hiding something from us and/or yourself?

  12. Updated entry above

    I added some more of flynnj7’s comments above.  I’m not sure why she’s not posting on here, since she’s clearly reading everyone’s comments on this blog. 

    I appreciate Jordan helping to keep the conversation respectful.  I, personally, had to step away from it for a day and cool down, because I knew my responses would’ve been antagonistic. 

    “Name calling?”  I have no idea what you’re referencing here.  I’ve copied my posts in their entirety; nothing was edited out.  Is “boutique” the name-calling you’re referring to?  The word “boutique” refers to something which is specialized, one-of-a-kind, niche, small-volume/high-priced.  Isn’t that what you (private practitioners) keep espousing as the service which you are offering?  How is that demeaning?

    I suggested moving the discussion to the CAN blogs at 9:30 yesterday morning, and nobody objected.  I think it’s a discussion worth having publically.  However, when a Facebook thread has 18 individuals in it, and Fred & I are the only Community punks in the thread, I feel targeted. I don’t understand your huff.  None of your first or last names have been given.   My name and picture are attached to everything I’m saying here, publically.  I have nothing to hide. 

    I have to run now…will post more later.

  13. Well, this thread is on the verge

    of turning into a pissing contest. I will cop to having made a few intemperate comments in my last post, and I apologize for any offense given,  but I think if those of us who’ve made the jump to CA seem a bit touchy about criticism is because we get so much of it, and it’s never about the real issues. It’s always about germs or Wal-Mart acupuncture or destroying the value of the practice or some other issue that really doesn’t reflect the nature of the practice of community acupuncture by folks who know the systems and do it well. At the end of the day, health care is not a competition. It’s about how many people we help and how well we do it, no matter how it gets done, and that’s ALL it’s about. When we forget that, this crap happens.

    I was in standard private practice for many years, very successfully. I have also continuously worked in public health, for personal reasons much more than for financial ones. My entree CA was precipitated by the ever increasing dissonance between the walk and the talk in our profession, the constant noise about offering alternatives while bending over as hard as we could to get ourselves accepted by a system that even the doctors are now complaining is broken and corrupt. The majority of my friends in the profession are in more standard private practices and I think no less of them for doing so.

    I made the decision to switch formats, first because for me, meridian-style acupuncture is far more clinically effective and far more sound as far as my understanding of the medicine, and doing it in very spare and compressed public health situations for a long time has proven to me that the acupuncture I was taught in apprenticeship and at OCOM didn’t really come close to addressing the potential of the modality. I got interested in CAN because I found the philosophical and social critique at the base of the movement persuasive, and the clinical aspects provide a tremendously effective healing process to many more people than I could ever offer help to before.

    True, it’s not for everyone, nor do I think anyone could credibly state that there are not many other ways that Chinese medicine can legitimately be practiced. But you make a good point when you say that credibility is a huge concern and that infighting is not productive.

    The question I’m currently working with is whether we’re trying for credibility with the medical system, or credibility with the public. The medical system as currently constructed in this country…well, that’s an entirely different discussion. Credibility with the general public will come, as many of us have found, by how many people we help. Clients who get effective help don’t judge us by whether they got help in a recliner in a community room or on a massage table in a spa. They judge us by whether they got help.

    For me, community acupuncture has allowed me to offer genuine help to many more people than I was ever able to in years of private practice, and further, to offer it to people who would never have been able to afford it at all if I hadn’t gone to this format, and that for me, is a crucial issue. I’m going to keep doing it. I’m not really interested in fighting about it with people who do it differently, although I’m always interested in comparing notes and learning.  And for the record, the idea that I’m doing it because there’s some giant cash cow to be found in the community room?  HAH!

  14. Removed by moderator

    Moderator note: Content removed (spam commenter); 

    Comment left so as not to delete the comment below it.

     

  15. thanks Brent.

    thanks Brent.

    i also wanted to add a comment about credibility/affordability and the idea of acupuncture/AOM still seen as fringe medicine (aka ‘freaks, witch doctors’).

    IMHO, after being in a CA for over a year, I see that “credibility” is actually tied intrinsically to affordability.  (If by credibility we are talking about cultural acceptance and overall usage).

    How does a traditional medicine plucked from another culture only decades ago become mainstream in the new culture where it lands?

    Well, for one, greater usage by the culture where it lands, or normalization.  This has not happened to any really significant degree over the past two to three decades in our country. And, in the last 2.5 years, our profession has seen a significant change in the previous growth trends regarding practitioner numbers, attesting to this.  Many practitioners set their rates anywhere from $60-$150/ Tx, pretty much pricing out a huge segment of the population from ever trying it, let alone commiting to a series of 5-10 treatments ( $300 – $1500 for a series, give or take).  And we can have discussions about the “worth” of AOM all day long but it won’t change the fact that most people are less likely and less able to shell out $1000. 

    Doing CA, being CA, whatever we call it is less about any marketing method or any business sytem.  As Brent points out, it’s about helping as many people as possible.   The trends show that many CA’s offering acupuncture at a sliding scale rate are meeting a need that has gone unmet previously, except by a few practitioners who offer some kind of sliding scale or discounted treatments, which is great.  Thing is, these few practitioners offering their take on affordability has never happened on any scale large enough to make any significant impact regarding normaiization in the U.S.

    That’s the key in my mind.  High volume/affordable cost offered by enough practitioners around the country creates a cultural experience by sheer virtue of numbers.  It normalizes acupuncture/AOM for huge segments of the population who can’t afford to go to acupuncture at $65-75/pop.  No longer are we “witch doctors” or “freaks”, we are , well, “normal.”

     

  16. The updated entry from

    The updated entry from Jennifer seems to refer to my post, so I’ll clarify.

    I was joking about Jennifer’s concerns about there being so much blood that it actually soaks into the furniture and causes a sanitation problem. Her concerns struck me as so ridiculous that I found them funny.

    Sorry to respond in such an inflammatory manner to  infammatory statements. I recognize that it didn’t make Jennifer feel better about CA or the Cult Acupuncture Network, although that certainly wasn’t my goal. It just gave me a good laugh.

    I do find it exceptionally rude that she would post something so baseless and defaming in the comments section of an article about a new clinic that is read by people who are not in the profession. Poor form in my book. Although its apparent we read from different books.

    Cheers,

    Kelly

     

     

  17.  My CA clinic has been open

     My CA clinic has been open for 11 mos.  In that time we have given over 4000 treatments.  Based on our rate of growth, I predict we give well over double that next year. To be honest, I don’t have time to worry what BA practitioners think of us.

    BA Clinics (Boutique def. “a small company that offers highly specialized services or products”) serve one niche.  CA serves another — one could argue that the group it serves is much too large to be considered a niche.  Two different worlds, two different sets of concerns.  

    I suspect that much of the criticism directed toward CA is based in fear and competitive worries.  I haven’t had the need to worry about or see BA as competition.  I doubt I ever will.

    I run a CA clinic because it answers for me the question of how can I be of maximum benefit to the largest number of people.  That question became ethically imperative to me once I received my license.  The more people I treat, and the more people I see feeling better with acupuncture, the more I feel compelled toshare it with as many people as possible.

    I want acupuncture to be mainstreamed… normal.  The way that is going to happen is by it becomign widely available, and for people to see their friends and family receiving its benefits. The more people who get acupuncture, the more other people will want it.  Whenever I see a clinic with large numbers of patients (getting better) I am happy.  If anyone with a BA has a large patient load (150+ per week), well bully for you, you are doing the right thing by serving people.

    The heart of acupuncture is serving people.  CA lets me do that.

     

    David Lesseps

     

    Circle Community Acupuncture

    San Francisco

    http://www.circleca.com

  18. .

    ”Credibility with the general public will come, as many of us have found, by how many people we help.”

     that about sums it up perfectly.

  19. traditional chinese menacing

    hey all,
    i’ve been following as a spectator, and i’ve got to say i’m surprised that such a bunch of educated folks can let this rage on so long having ultimately resolved nothing. i expect to see this on foxsports.com, but not on a thread about different styles of treatment. ‘republican scare tactics?’ criticizing typos?

    my wife is a part of the group, and i’ve done a good bit of reading on TCM out of curiosity. while reading this dramedy, the central concept of yin and yang has come to mind, because it seems quite clear that there are practitioners and business models of every shape, color, and size. wasn’t that among the first topics in school? why can’t both exist harmoniously without criticism from the other? not good or bad, just different.
    what’s important, in my mind, is that you find a style that works for you and your patients.

    the initial article found at onmilwaukee.com was one-sided. somebody who felt insulted by the work of an uninformed journalist looking to publish an article, responded. and that led to stronger, more confrontational language.
    it’s great that there is passion on the subject, but perhaps it’s best to think about one’s tone when the goal is ultimately the same. everyone’s experience is unique, perspectives are unique, there is no reason your practices won’t reflect this reality.

    river jordan, i’m happy i don’t know you, because you seem very impressed with yourself and i’d find it awkward attempting to socialize with you.

  20. thanks joe not verified

    I sincerely appreciate the last sentence directed at me. It gives me an opportunity to cut down my delusional ego (yes, I have one). Really, this is true gold – the best words I’ve heard all week.

    THANK YOU!

    I regret that you aren’t interested in being my friend, but I guess there’s not much I can do about that other than to again offer a sincere apology if any words of mine seemed overly harsh or aimed at harming you or your friends. That wasn’t my intent.

    May all beings reconcile their quarrels and be at peace,

    Jordan Van Voast 

    206-860-5009

  21. Call a spade a spade, and why apples are not oranges.

    [Apologies for the double post. Didn’t realize I had to choose to have formatting…]

    Being a Milwaukee resident and Acupuncturist, I do have a vested interest in the article in question. I have a vested interest in growing and promoting Oriental Medicine in the Milwaukee region. I am happy Acupuncture got some published story time in Milwaukee journalism.

    I think the CAN business model and more standard Acupuncture clinic business model both have their place. There are absolutely tangible trade-offs to each type of business model.

    What has absolutely disgusted me about the Blog conversation is the insulting way both sides have referred to the model that differs from their own. It is absolutely without question intentionally negative to refer to CAN as Walmart-style Acupuncture, or some other derogatory comment. Period.

    It is just as intentionally negative to refer to the more standard model as “boutique”. Let’s be honest. Boutique conjures a very specific image in the American public, and it is not a positive one in the minds of most people. To claim otherwise is dishonest and disingenuous. Period.

    Those that use the any of the derogatory terms are doing so to intentionally denigrate their supposed “opposition”. It reminds me of negative ad campaigning in politics, and the backpedaling claims of innocent intent after the fact. This spade is a spade, and every single person here is adult enough to know it.

    The other comment that just completely caught me off guard was in regards to sanitation. Someone uses airport seating and other public places in an attempt to demonstrate something about sanitation in a comparison to the clinic setting. Seriously? There is a huge difference here. One is a professional medical practice setting where a medical procedure is being performed. The other is not. Apples are not oranges no matter how hard you try to make it so.

    In the end, we have Community Acupuncture business models (CABs), Standard Acupuncture business models (SABs), and the variations in between. There are some very significant differences between the two with significant limitations to both.

    Jamey Johnston, C.Ac

  22. Hey Jamey, thanks for

    Hey Jamey, thanks for weighing in.  I respectfully disagree with the idea that “boutique” is inherently and always negative – that’s why shoe shops, lingerie stores and dress shops catering to middle-to-upper-class ladies often call themselves boutiques – and acupuncture in the US has until recently largely been used by this same demographic.  I don’t think it’s disingenuous to say so. Of course, as you rightly point out, that demographic is not “most people.”

    Also, I won’t accept “Standard” or “SAB” as a substitute, because as Community Acupuncture clinics continue to grow in numbers and treatments given, we will soon be the “standard” in the US (I won’t claim that title for us quite yet).  Some people on this forum do use “private room acupuncture” (or PRA) as an alternative to “boutique acupuncture”; is that an acceptable alternative to you?

    Finally, we do have a higher standard of sanitation than your average bus station, movie theater or waiting room, but there’s no need to have OR levels of sanitation; there just isn’t (and I would argue that you are being disingenuous here).  Perhaps there is a fruit that is in-between an apple and an orange?

  23. I agree with most of what my

    I agree with most of what my colleagues here on CAN have said.  The way acupuncture becomes mainstream is to have lots and lots and lots of people getting acupuncture.  Simple.  

    I am not sure what the objections to this article are about.  I don’t see anything derogatory being said.  Sure, it wasn’t discussing Oriental medicine and all it’s modalities because the article was about a Community acupuncture clinic.  If you want an article about your clinic and what you offer, submit a press release, give talks, educate the public.  But, don’t go onto a media site and start disrespecting the people that the article was written about. Acupuncture in the media is a good thing for everyone.  

    I just want to add a little to the discussion on the word boutique.

    Before I became an acupuncturist, I was an innkeeper for a short time.  I worked at 2 small inns that referred to themselves as *boutique* hotels. Boutique in that sense meant a very small hotel and more specialized, personal attention, and because of this people paid more for it.  Referring to themselves as boutique set them apart and the owners thought it conveyed an “elegant” feel.  People who could afford to stay there did, and enjoyed having a small staff at their disposal.  While those who could not afford it, or didn’t care about that extra personal time and “elegant” feel, stayed at the many, many other hotels/motels in the area. 

    I also worked at a clothing *boutique* that hand made the clothes and offered lots of personal service. People paid more for the clothing there than some other shops, because the clothing took time to make, and lots of personal attention was given to the customers.  People who could afford and wanted to buy clothes there did, while the majority of people that I knew (in my community) went to other, more affordable places. Not to mention, i prefer to NOT be helped personally when I am shopping.  Just my preference. (My preference is the same for acupuncture: not a lot of talking and a lot of time with the needles.)  

    While working at these places, I could not afford the stay in a boutique hotel or buy boutique clothing.  That didn’t mean that I went without shelter or clothing.  I simply went to places that I could afford.  Never once did a customer take offense to the term boutique and the owners prided themselves on this term. I haven’t heard of anything negative being “conjured up” by the term boutique.  Am I the only one?   I suppose a person could assume that they can’t afford boutique prices, which may very well be true.  But, affordability and simplicity is not what I think of when I think Boutique.  Is that what the problem is with the name boutique?  

    As long as people have choices, they will choose what they are comfortable with and can afford.  Let the patients choose their clinics.  That is why CAN is here: to offer an alternative to higher priced, more personal attention acupuncture.   One of the reasons that we here on CAN get so fired up is that prior to CAN there was NO ALTERNATIVE and no one seemed to care about this fact.  People who couldn’t afford it, simply did not have a choice.  

    Everyone deserves quality, accessible healthcare, and aside from some name calling and fear based assumptions, I am sure that is what all of us want to provide.   Who you make your clinic accessible to is your choice.  I have chosen to make my clinic accessible to the majority of my community, rather than the minority.  Like Jessica, I am really glad there are other LAcs out there who want to provide the private room acupuncture, because I really don’t.  I want the simplicity of powerful acupuncture to speak for itself, rather than spending time discussing it.  I want people to refer their friends, family, and co-workers because of their experiences and know that they can afford this kind of relief on a regular basis.   

  24. First, I really can

    First, I really can appreciate Private Room Acupuncture/Model. That is a honest and *neutral* description comparable to the neutral and honest Community Acupuncture/Model. “Standard” was sticking for me quite a bit, and I did use it absent a better descriptor. PRA is great!

    I’m not arguing that ’boutique’ is always negative, but it does paint very specific picture in the minds of our society. “Boutique” takes on a less than positive tone and is frankly negatively connotative when used with “Acupuncture”.

    I defy anyone to name one other medical profession that is referred to as “Boutique” in a positive manner?

    Now, I am going to rebut your last argument by simply pointing out I never stated, nor was it my intent to imply, Operating Room level sanitation. You are putting words in my mouth on that point. ….and… Crimney-on-a-cracker, we’d all be out of business!

    What I was pointing out is that there is a level of sanitation in a medical office (MD, DO, Chiro, Dentist, Acupuncturist, etc, etc) that is far and away above that of an airport terminal. You simply cannot not compare the two as the usage of those spaces is so vastly different.

    Whether it is getting acupuncture needles insert, blood drawn, teeth pulled, or what have you these are medical procedures, and, as you pointed out, requires a higher standard than an airport terminal.

    Jamey Johnston, C.Ac

  25. I simply challenge you to

    I simply challenge you to provide one other *medical profession* that is referred to in a positive manner using the word “boutique”.

  26. Google boutique medicine and

    Google boutique medicine and a lot of different things come up.  Like Women’s Health Boutique, Health Haven Boutique, etc.  The only argument against boutique that came up under that search was that not everyone can afford it.  Affordability is a fact that cannot really be disputed.  By charging high rates, you are automatically reducing the number of people that can afford it.  I still don’t see anything wrong with the name boutique.

  27. Since I’m the person who brought airports into it

    let me clarify. This thread has gone a lot of places, and some stuff has gotten lost in the translation. Thanks for pointing out the the great difference between sanitation in a public space like an airport and the necessary sanitation of any kind of healthcare venue. You are absolutely correct. My point was made in order to answer the way in which those criticisms get levelled at me and others who run community clinics. So often, it’s a statement or an implication that it isn’t possible to provide a clean, safe environment in a community room, just because there are more people being treated, and it’s often followed by some statement or story about how the person can’t stand touching anything anyone else has touched with their hair or something like that. We have a great fear of each other, and it goes far beyond any legitimate issue of cleanliness and proper sanitary maintenance. The rules for maintaining a clean environment in a community room are exactly the same as for a private room, there are just more steps involved. My point was about the illogic of that particular style of argument, and you are correct to point out the inconsistency from a more general perspective.

    A quick comment about the “boutique” term. I had a successful “boutique” practice for many years, and during that time, I did everything I could to niche it, differentiate it, and make it appeal to a very specific clientele. I succeeded because of that. I’m not at all regretful of those years, because they taught me what I needed to know to get here, which is ultimately where I always wanted to be. I helped a lot of people, developed some wonderful relationships, and I’m not at all ashamed to call what I did “boutique”, because I was trying as hard as I could to be special and different than what else was out there. Over time, I changed my direction and my thinking about wanting to do that, but I don’t disavow the fact that I gave myself heart and soul to the process for a long time and it gave me the skills that are allowing me to do this now. And further, I think we’re all getting a little wrapped up around what we call stuff. Let’s agree to call one Fred and the other Ginger and get on with taking care of folks!

  28. see above. It’s not much of

    see above. It’s not much of a challenge.  Google reveals that many other health care providers use boutique or concierge, though it is a relatively new term.  Though there are some arguments with boutique medicine (BM), the only one I can find is that boutique medicine is only available to higher income population.  No argument here. I don’t think the doctors who practice BM are referring to themselves in a negative manner or take offense when people use the term.

    Just because acupuncture has not been referred to as boutique in the past doesn’t mean that it is invalid or has some sort of negative meaning.  The times are a changing, especially now that there are several business models to choose from.

    Here is an article about the recession and boutique medicine still thriving.   In another article (not this one), they even mention that BM is not just for the wealthy because they will provide scholarships, and fee waivers for those who cannot afford their services (for up to 10 percent of their patients).  Sounds like private room acupuncturists who offer “discounts” to people of lower incomes. 

    https://tinyurl.com/ms9vwy

     

     

  29. MEDICAL PROFESSIONAL!!!

    Of course!  (*slaps palm to forehead*) This argument isn’t about the word “boutique”…it’s about being a medical professional.  Many of us here at CAN don’t really care if we’re thought of as medical professionals or not.  There have been many arguments for lowering the educational standards, reducing the regulatory requirements, and opening-up the practice of acupuncture to many, many more NON-MEDICAL professionals.

    What I am now hearing, is that the word “boutique” is offensive because it is not generally associated with a “respectable medical practice”.  The reason that many of us (CAN’ers) might not find the word “boutique” to be offensive, is that (many of us) don’t put that much stock in being a “medical professional.” 

    Here’s an article about “boutique medicine”:   https://www.cnn.com/2008/HEALTH/09/18/ep.concierge.medicine/index.html

    I’m sure I have more to say, but it will have to wait.  We’re running out the door to a school function.  In the meantime, another acronym I considered using was for Private Practitioner (PP)…but my young boys quickly turned “PP” into many bathroom-humored-jokey-comments…  (Insert your own 8 to 10-year-old little boy humor here.)  Wink

  30. Note in many of those search returns…

    Outside of a dictionary definition, the term is not used in a positive manner. There are specific negative connotations.

  31. “Boutique” boiled down.

    Let’s just boil it down.

    Do CA clinic owners find references to “Walmart style” Acupuncture offensive?

    Why?

    Walmart brings large volumes of people products and services in an inexpensive manner. It describes what CA is doing.

    If I operated a CA clinic I would find the term offensive. I have never used the term in marketing. I haven’t used the term in a public or professional settings, outside of an example such as this.

    Boutique Acupuncture is negatively connotative in the way that term for CA is negatively connotative.

    Nora informed me earlier of a more honest term used here. Private Room Acupuncture. It accurately describes the business model without the negative connotations associated with “boutique”. Community Acupuncture honestly describes your business model without the negative connotations.

    I cannot tell CA clinic owners that “Walmart-style Acupuncture” is non-offensive.

    CA clinic owners cannot tell PRA owners that “Boutique Acupuncture” is non-offensive.

    I’m making a case for mutual respect, and I’m surprised at the amount of denial and resistance. Thank you guys for your time.

    Jamey Johnston, C.Ac

  32. ” What I am now hearing, is

    ” What I am now hearing, is that the word “boutique” is offensive because it is not generally associated with a “respectable medical practice”. The reason that many of us (CAN’ers) might not find the word “boutique” to be offensive, is that (many of us) don’t put that much stock in being a “medical professional.” ”

    This is one part of the reason why the term is offensive Jessica because like it or not Acupuncturists are medical professionals. I’m not implying that we are doctors, or surgeons, but we are a professionals in a medical field. That is not the only connotation to the word that offends.

    Just because you personally do not care if you are considered a respectable medical professional does not mean all Acupuncturists should follow your lead.

    It doesn’t give you license to be rude and sarcastic towards any idea that does not dove-tail with your own, and I want you to think real carefully about who is making this statement specifically to you (Jessica and I attended school together).

    I’ve been very respectful in my tone and temperament both here and at OnMilwaukee.com. I do not appreciate your derision.

    Jamey Johnston, C.Ac

  33. I am not being sarcastic…

    …the problem is that you can’t hear me giggling in cyberspace.  The Self-Righteous-Hippie is right; this has all been said before:

    We’ve already called ourselves Wal-Mart and again Wal-Mart and yet again Wal-Mart, so you won’t hurt (m)any feelings here by throwing that name around.  I think most of us have a sense of humor about our chosen profession.  (This was meant to be comedic relief; it made me laugh, just like “Bobbie’s” Haiku did.)  We’d rather be the Subaru-Guy than the Mercedes mechanic.  We don’t, however, want to be “Malibu Barbie” or  “holier-than-thou“.  And while I’m digging-up old blogs, here’s a great discussion of CAN’s motives

    On demysitfying/de-professionalizing acupuncture, I love this quote: “Michael Smith, the founder of NADA, once pointed out that you can teach anyone (anyone!) to do acupuncture in about 45 minutes.  ‘There’s the sharp end, and there’s the dull end.  You put the sharp end in the patient…’  I laughed really hard at that, and not because he was joking.  Mystifying acupuncture doesn’t help anybody.  Complicating what we do doesn’t make us professionals.  This is what an acupuncturist needs to do: be present, be respectful, communicate the treatment plan clearly, hold the space, give a fuck, put the sharp end in the patient, and get out of the way.

    “PRA”: Well, I’m glad that we’ve at least agreed on an acronym.

    I’m all for respect.  Let’s just take a deep breath and have a good laugh and move along with it now…

  34. Haiku & Other Stuff

    Sorry that I didn’t get the Haiku posted here this afternoon, Bobby. (I was busy treating patients.) I did appreciate your humor: “An online discussion/Has spiraled out of control./Does this count as spam?” I think it only counts as spam if it’s in your inbox…

    Thoughts on this discussion:

    “Why not use massage chairs that are leather?” Several reasons:

    While I won’t try to speak on behalf of all CAN members, I think that many members here object to the use of animal products for fashion, furniture, and/or food. As such, you will be hard-pressed to find leather or other animal skins in our clinics.
    Many of us are trying to lower the carbon footprint of our medicine. Here’s a story about CommuniChi on NPR’s The Environment Report.  That is, by reusing recliner chairs which would otherwise have gone to landfills, we can reduce the emissions of the manufacturing plants (for said furniture) and diminish our dependence upon fossil fuels for transportation (of chairs) to retail stores. Chinese Medicine teaches us that we are inadvertently linked to our environments; by caring for our planet, we care for ourselves and our patients.
    When we establish a community acupuncture clinic and teach our neighbors about how beneficial acupuncture is for their health, we are making a commitment to remaining in business for them for decades to come. Overextending ourselves financially by purchasing extravagant furniture (like leather chairs), does not ensure the fiscal solvency of our low-cost clinics.

    “Please stop acting so elitist about your methods of treatment.”

         Elitist? Please. Call me Acu-Mart or McPuncture. Suggest that I’m cheap and easy. My methods are nothing fancy: just a handful of nickle-needles and a cookbook of tried-and-true recipes that any first-year-student could follow…actually, I think an acu-tech could manage just fine.  But don’t call me elitist. There is nothing special about my acupuncture treatments.

    “To me, it is language which is demeaning and more about marketing CA… also (I) find it misleading. I mean, if you knew nothing about acu and tcm and read about CA, it would seem like the only reason to see a non-ca practitioner is to be by yourself in a room and to get spoiled.”

         I don’t think there is anything derogatory about the term “Boutique” or “BA”. I think it’s an apt description for somebody who offers a specialized, one-of-a-kind, niche, small-volume/high-priced treatment. Isn’t that your whole argument here: you spend lots of time designing an individualized treatment and offer lots of extra modalities which make it extra special? If I was spending that much time and energy on my unique product, I would want people to know about it, and I would be honored to call it an acu-boutique.

         If your buttons are being pushed around the word “boutique”, that is Your issue. It is not my intention to degrade your services. I think this word helps convey to listeners the difference between what a patient might encounter at your clinic vs. what they might find in mine. I WANT patients to understand that at my clinic they won’t have to endure lifestyle coaching, disrobing, nutritional advice, or other services which might make them feel uncomfortable. Acupuncture is weird enough without fire cups and squirrel dung and a practitioner’s elbow digging into a patient’s GB30. People walking into the door of a CA clinic in San Francisco or Tucscon or Manchester or MILWAUKEE will all receive the exact same product: needles in a chair for $15 – $35 (or $40). There is nothing special or unique or boutique about any of us.

    “Why USE that language? It doesn’t educate people on acu or tcm. To me, it is language which is demeaning and more about marketing CA rather than helping people to find healthcare.”

         It sounds like you wish that we would spend our marketing resources by educating patients about the modalities which you offer. Perhaps you could talk to the AAAAAAAOM about how much (or little) they’re helping to market the services of Oriental Medicine. We are teaching our communities to get lots and lots of affordable ACUPUNCTURE. That’s why we are the Community ACUPUNCTURE Network. We don’t intend to teach our neighborhoods about the other Oriental Medicine modalities…but maybe the AAAAAAAAAAAOM could help you with that.

    “Even if you put a clean sheet on every chair, how do you clean the chair when the blood soaks through?”

         Seriously? We use needles here, not ice picks. Blood gets on a blanket about once every three months. *A single drop of blood.* We do have extra blankets available, so that a soiled one can be taken off and a clean one can replace it. Ditto to the rest of bottley’s sanitation comments.

    “As the owner of a sliding scale acupuncture practice…”

         If you have found a way to provide low-cost healthcare, one which will support your practice for the next 10-20 years (as more people hear about the low end of your sliding scale and want to receive services for $15 per treatment at your clinic), I am thrilled for you and your patients. Really, I am. Maybe you can create a website and teach other punks about the financial viability of a low-volume/low-cost clinic like yours.

    “Jessica, herself, has made mention making up to $250 an hour.”

         First of all, I never said that; the upper limit of the sliding scale at our clinic is $35 per treatment, which means the most we could make is $210 per hour. Second of all, $35 is *far more* than our patient average, which means we don’t even come close to that hourly potential. And that’s just fine with us. We established the bottom of our sliding scale with the intention that even if everybody only paid $15, our clinic could still stand on its own. And do you know what the busy clinics with lots of patients and a surplus of money do? They hire employees. That’s right: in this recession, CA clinics are *creating* new jobs for receptionists and acupuncturists.

    “Acupuncturist charging $50-70 a treatment are making the choice to give quality care.”

         None of the 100-or-so CAN clinics would be in business for long if our patients didn’t find our treatments effective. Our clinic, The Turning Point, has been open for less than two years, and we have over 1600 patients… mostly from our existing patients’ word-of-mouth-marketing-machine. I think it is safe to assume that our patients–who referred the newbies to us–feel that we “give quality care.”

    On a final note: Fred and I have had tea with many of the private-room acupuncturists in our town. We all refer back and forth as appropriate. Some of our patients want more attention than we have to offer; some of their patients cannot afford full-price treatments. We like them, and they like us. Just because I don’t want to give a boutique-style treatment doesn’t mean that I think there’s anything wrong with you choosing to do so. I still like (most of) my classmates who have chosen to create a private room practice. I am grateful to them, because they fill a need in the healthcare spectrum that I have no interest in serving.

  35. sarcasm detector functional

    sorry Jordan Van Voast,
    but you don’t get to play victim nor do you get to be the ‘bigger man’. you ever-so-sneakily insulted good friends of mine (yes, intentionally) when they came to play on your court and attempted to poo-poo their opinions. i was simply letting you know that you were being a lousy host. if i pushed Your Buttons, perhaps you need to take responsibility for Your Fingers and not insult strangers with whom you disagree.

    i do not care for your phony apology and will not be calling you.

    best of luck.

  36. Exclusive or Exceptional

    I have several beefs with the “movement” CAN. It uses elitist language throughout the philosophy. I see a wolf hiding in sheep’s clothing, and I felt the need to confront it.

    The On Milwaukee article was incredibly one sided, and so I said something.
    I don’t serve a single “Malibu Barbie”, and its sad that Jessica and others have posted that they are happy PRA exists to serve the patients they don’t want to treat. Who do you think my patients are exactly? Why are you so sure my patients are upper middle class? Why is CAN so incredibly judgmental? This issue has not really been resolved and I’m not sure it ever will.

    CAN has something to gain from the demeaning language. They inflate their own worth by making themselves “different from the rest”, and do it at the expense of harming the credibility of other practitioners and acupuncture as a whole.
    I have never referred to CA clinics as Acu-mart or any other demeaning language (aside from cult…I’m only human and my buttons where pushed). I have certainly never insulted your patients, or called you a bag of ramen noodles.

    As a matter of fact, and Jessica knows this to be true, I worked with a non-profit organization to help them set up a CA clinic. At the time I was unaware of how degrading CAN is to other PRA clinics.
    I’m guessing many CA practitioners are unaware of how hurtful the CAN marketing “movement” is as well. I only hope some of you branch off to start a new movement that is less demeaning and more outside the box.

    The notion that seeing volumes of people will some how increase the credibility of TCM seems like a contradiction to everything alternative medicine stands to represent. We are an alternative medicine even if you want to pretend we are not. Even the yellow pages agree.
    Exceptional care is very different from exclusive. Actually, I don’t believe most systems of medicine aim to be exclusive. I do believe most systems of medicine aim to be exceptional.
    I know many PRA clinics which provide low-cost care and/or discounts in order to better serve middle to low income levels. At the same time these clinics do not compromise the complete system of Eastern medicine by restricting their face time with their patients.

    What is the most common complaint patients have with their doctor? At my clinic patients share horror stories about how their meds didn’t combine well, how their doctor missed the initial signs pointing towards the patient having a serious disease, or how their doctor consistently dismisses most of their symptoms because they only spend 10-15 minutes per patient.
    Yesterday I saw a GP that spent 60 minutes with me, in my working class neighborhood in South Milwaukee. He did a full, almost TCM like intake with me. His treatment course is to see all of his patients every other week for 6 sessions of cranial sacral care. He believes this helps the body recover and heal. He spends 45 minutes per follow up session of one on one care. Can you believe a GP (at a major Milwaukee medical clinic) is spending that kind of time with each patient? I applaud him from moving away from the idea that volume is more important than time spent with his patients. Thanks to his face time with me, I think I will have the most healing relationship I have ever had with a Western doctor.
    If treating volume becomes the standard for Eastern medicine, I hope there are a few of us who remain passionate enough to continue to provide exceptional care.

    Take care,
    Jennifer Flynn

  37. I am not acupuncturist

    But I work in a community acupunture clinic at the front desk. I don’t now jack about acupuncture theory, differential diagnosis, or the 10 questions. I know that our acupuncturists see lots of people (about 200 treatments/week at the clinic currently), do short intakes, and get really great results. Daily I hear stories from people who have relief from long standing, painful conditions. Many people have shared with us that the acupuncture at our clinic has saved their lives.

     

    Many people also share with me that they had positive acupuncture experiences with other (PRA) practioners, but they could only afford to go once a month and didn’t get results. These people are very happy about a sliding scale where they don’t have to ask for discounts or feel guilty about being a charity case. I’m happy that some PRA pracitioners will lower their prices, but understand many people will never ask for this.

     

    I’m not saying that the acupuncture that people do in private rooms for more money is not valuable. But the thing I don’t get is why, WHY if there is a way for many, many people to get acupuncture in an effective way that will help them at a price they could afford, WHY wouldn’t everyone want to do it? It frustrates me personally in the same way that the fact that there is enough food in the world yet people still go hungry does.

     

    I realize that some of the people arguing on here think that CA is leaving stuff out and couldn’t possibly being helping people so well. Our patients don’t feel like they are just a number or getting the short shrift at an HMO. They are getting frequent, effective treatments and their health is improving vastly. According to a recent patient survey we did and my conversations with these patients nearly all would rate our care as exceptional. 

     

    Call it Acu-mart, or McAcupuncture or whatever the hell you want (although I recognize that Jennifer is not doing this). I don’t think the woman who is headache-free for the first time in 10 years gives a rat’s ass that she is only getting 1/8 of some ancient, special medicine or that someone didn’t talk to for her an hour to figure out how to help her condition. 

     

    So Jennifer you can have whatever “beefs” with the movement you want. But seriously, if you knew you could effectively treat more people CA-style at an affordable price and still make a living yourself, would you not opt for helping more people? Wouldn’t you at least want to try it out? Would you like to come explain to some of our patients why not?

     

    8000 treatments and counting…

     

    Shoshana

    TCA Front Desk jockey

     

     

     

     

  38. Bully-pulpit

    Regardless of the present discussion about practice management styles (to which I am mostly impartial beyond the CA community’s insistence upon degrading practices that do not share their philosophy), this whole bully-pulpit thing is kind of ridiculous.

    “A more participatory forum” = “someplace where I know that people share my opinions and will back them up” in this instance.

    Pretty classless honestly.

  39. Joe ~

    Your sarcasm detector is malfunctioning.  You do not know Jordan.  He sincerely meant that apology.  Jordan is my personal peaceful, Buddhist hero.  I don’t think there is a person on this site who is less likely to inflame than he…

  40. It’s not that I don’t want

    It’s not that I don’t want to treat middle and upper class people, because I have quite a few of these patients.  They don’t come to me because they can’t afford PRA, they come because they like the community room and love the idea of CA.

     And, Jennifer, I don’t know who your patients are.  I do know that they prefer the PRA or they would find another alternative.  I would prefer not to treat people who are looking for something other than affordable acupuncture on a regular basis.  So, that is why I am glad that there are other acupuncturists to refer people to.  Simple as that.  I am not insulting you or your patients. I just recognize that there are different practitioners that meet different needs.  I don’t fear others practices or worry how it will affect my practice, because I believe in what I am doing and I know that acupuncture is a powerful medicine all on its own.  

    The point I was trying to make is that I don’t want to use the PRA model to treat people, whoever those people might be.   My patients don’t want to spend time talking.   They come for acupuncture, peace, and community.  And that is what they get.  

  41. I don’t fit the definition of boutique.

    My patients don’t ask for a discount. I disclose my sliding scale fee during the initial visit and advertise it. So I don’t fit your rationale for referring to PRA clinics as boutique. What would you call my clinic?

  42. Jennifer, apparently you

    Jennifer, apparently you didn’t even read the “Malibu Barbie” link, because that term was in reference to practitioners, not patients.  Also, if some of us are snippy, it’s because we’re tired of other practitioners making specious arguments like “we need to spend lots of time talking to patients, because MDs don’t spend enough time with their patients.”  

  43. I’ve been asking people

    I’ve been asking people around me about the word boutique. It seems that a commonly held connotation is of “frivolous excess”. I think that’s pretty negative to most of the PRA folks around here.

  44. Why?

    Why should she do anything different? She helps people, a lot of people, in the way that best suits her. There clearly are different models, they work for different practitioners and for different patients. We don’t have to all be the same and offer the same package.

  45. you got it right, phil

    this site is not just floating in a vacuum – it exsits to support and promote the community acupuncture practice model and movement, so that more people can afford regular acupuncture in this world (read our mission statement lately?). there is room for folks to disagree and discuss IF it is helpful in fulfilling our mission. -tatyana

  46. My Boutique Sliding-Scale Fees

    My patients pay anywhere from $0-70. Its based on income level and family size. Any unique names you want to call my clinic?

  47. I don’t see the PRA

    I don’t see the PRA practices are any threat to you fulfilling your mission. I also don’t see why you would think that every practitioner has to follow your model. What are you the Third Reich of Acupuncture?

    If PRA people tell you that boutique is offensive to them, and some CAN people admit that they know it pushes buttons, why not just suck it up and stop using the word? It’s not brain surgery people.

  48. yikes

    I seriously would not go there…comparing CAN to Nazi Germany. Off limits and completely inappropriate. 

    Remember, this is a group of people who are trying to make healthcare accessible to everyone, regardless of differences, end of story. 

    Also, I don’t think anyone is telling anyone how to practice. CA is obviously not for you, good luck in your practice.  

    Blythe 

  49. Blythe, you are absolutely

    Blythe, you are absolutely 100% correct. My comment should be deleted immediately. It didn’t further the discussion, it was offensive, it used nflammatory concepts, it was childish, it made a lnk between entirely unrelated subjects.

    Are there any other comments here that match those criteria?

  50. I’m sorry folks…

    CAN and non-CAN alike, but violence, rhetorical or otherwise, is still violence, and I have a very hard time imagining that the ever-increasingly bellicose tone this discussion has taken on is productive of anything but more inflammation. I will admit to contributing to some of it early on, but it’s become ridiculous on both sides, and it seems the everyone stopped listening quite a while ago. We ALL owe each other better than this. Whatever our differences, we ALL have vastly more in common with each other than we do with insurance companies and the forces in the society that are working around the clock to maintain the status quo. The disinformationists who are currently in the process of scuttling healthcare reform, if they were watching, would be settling back on their fat asses licking their chops and laughing about now. Let’s not do their work for them. We have people to take care of. It isn’t abou who started it. It’s about who has the balls to stop it. If we’re ready to walk our talk, and it really is about the patients, then we can ALL do better. Anyone care to join me?

  51. you are all free

    Of course you are all free to practice how you want. But Jennifer is the one bringing her “beefs” about CA into various arenas. My practical experiene working with patients at our clinic directly opposes her intimation that CA compromises “the complete system of Eastern medicine by restricting their face time with their patients.” Or even it it is somehow a compromise (whatever that would mean), the patient outcomes are still great.

    But I am still curious, why if someone’s goal is to help people, why they wouldn’t be interested in using a model that could allow them to help even more people. Or why they would want to tear down someone who is working to do that (with claims of unsanitary practices, incomplete medicine, etc…) The original article that started all this seemed rather benign to a lay person. And of course all PRAs are also welcome to write press releases and try for media coverage based on their own unique models and styles. So far the critiques have come across as a lot of defensive posturing.  

  52. If you are determining what

    If you are determining what the fee is (based on an equation?) for the patient, then I would call it Paternalistic Acupuncture.

    Main Entry: pa·ter·nal·ism
    Pronunciation: pə-ˈtər-nə-ˌli-zəm
    Function: noun
    Date: 1881
    1 : a system under which an authority undertakes to supply needs or regulate conduct of those under its control in matters affecting them as individuals as well as in their relations to authority and to each other
    2 : a policy or practice based on or characteristic of paternalism

    https://www.merriam-webster.com/dictionary/paternalism

     

    cheers,

    David 

     

    Circle Community Acupuncture

    San Francisco

    http://www.circleca.com

  53. “Any other unique names for my clinic?” Humiliating.

         I’m sorry, Jen. I know that you have good intentions, but I would feel humiliated, embarrassed, and ashamed if I had to provide proof of income and family verification in order to have access to the sliding scale. After a patient has given you this information, who decides what level they pay? Do you actually say to them, “OK, you only have to pay $5” or “$40”or “Sorry, but you’re paying full-fare today”?

         And in fact, I *have* had to beg for such help: when I was in WI, receiving no child support, going to school, and trying to keep my family together. It was the most demeaning experience of my life. I felt judged. I waited until I absolutely had no other choice than to pull my financial records together and go begging for help. If Xander hadn’t had seizures and landed in the ER while we were uninsured, I would never have sought Medicaid. I had no desire to beg for charitable services, even though there were programs which could have helped us long before we were in crisis.

          Is that what you want for your patients? For them to wait until an emergency forces them to pull together their records and come begging for a hand-out? Or do you want to teach everybody—regardless of their financial situation—to seek acupuncture as a first line of defense against the common cold, stress headaches, or a poor night’s sleep?

         I am grateful to have found a system in which all of my patients—the doctors and professors, the artists and students, the elderly and the children—pay within the same $20 range ($15 – $35). They can all sit in the room together, knowing that they have all contributed equally to sustaining the clinic. Furthermore, everybody retains their dignity, because nobody has to disclose to me what their bank records look like.

         Nobody is telling you to practice like the Community Acupuncture Clinics. Nobody is saying that one way is better than another. The fact that we’ve chosen to establish CA clinics is indicative of the fact that we like our way best; just as the fact that you’ve chosen to establish your own unique clinic is indicative of the fact that you like your way best.

         There are reasons we (at CAN) do things the way we do, and we’re really excited to talk about them with people who ask questions. We can tell you about all the horrors associated with trying to run a hybrid clinic (a clinic which mixes both private treatments and community treatments, or one in which the sliding scale stretches from accessible to expensive) because we’ve seen the disastrous outcomes from others who have tried to do this. We’ve seen them fail, and we want to help so that others don’t make the same mistakes. We want hundreds—nay thousands—more clinics like ours springing-up across the country, because our patients ask us for referrals for their far-away friends and family. We want them to be able to say to their loved ones, “Go to this clinic in your town, because it’s just like my clinic in my town.” I refer my patients’ loved ones to CA clinics across the country each and every week, with increasing frequency.

         I understand that you didn’t like the tone of the OnMilwaukee article. But as eleaton pointed-out, it was a business article about one local clinic opening-up. It was not an article about Oriental Medicine, or alternative therapies, or accessory modalities. It explained what Milwaukee Community Acupuncture will be doing and why they will operate a bit differently. If you want an article that talks about why you practice the way you do, I’m sure you can find a journalist to share your story too.

  54. wow, that’s a lot of stuff i didn’t say

    didn’t say private room-boutique-expensive-whatever-you-want-to-call-it practitioners are a threat to the mission – they are catering to a very small segment of the population anyway. didn’t say everyone should do community acupuncture, although i must admit, i believe in the vision of CAN model becoming predominant in this country (just watch us). i know from experience of teaching this model that NOT all practtitioners are suited for this type of practice. some of it is due to their personality and a lot of it is due to the faulty acupuncture education in tihs country.

    this type of discourse just silly and boring and useless. suck it up? or how about you create your own blog / website (PRA.com?) and tell everybody how things should really be done. i actually rarely use boutique as a term, but i don’t mind if others use it, because i understand what they mean by it. it sure is provocative and that’s a good thing in this sleepy complacent and self-centered profession.-tatyana

  55. Imagine you are someone

    Imagine you are someone working 40 hours per week for $14.50 (twice the minimum wage).   If you got one acupuncture treatment per week at $65 it would be like spending 1/2 of one days wages (more really since this doesn’t account for what you would pay in taxes, ssi, etc.) or 12.5% of your weekly income on acupuncture.  If the acupuncture really helped you you might try to sustain this for a while.  

    Now imagine you are making minimum wage.  That same $65 acupuncture treatment is now a full days wage each week, or 20% of your income. 

     In the first case weekly treatments if they were really helping would be something that an individual might be able to budget for a short while, in the second scenario acupuncture would seem like a “frivolous excess”, even if it were working, since that is what  many people budget for their housing expenses monthly.  

    To imagine that our potential patients just need to prioritize their health over some other expense like housing is ludicrous. When people find themselves in having to choose healthcare over things like food or housing , or having to work at jobs that are hurting them so that they can afford health insurance and still put food on the table, can we really expect them to prioritize something like acupuncture?  Maybe if acupuncture were more mainstream, and more affordable to more people they would be able to see and experience the simple, essential benefit of it. 

     

    I know that many PRA, BA, non-CA practitioners offer sliding scales, but aside from the humiliation and paternalistic implications pointed out by david and jessica, I would really like to know how many patients or what percentage of a private practice can sustain patients at a “discounted” rate.  If you are trying to attract patients that can pay your full rate of $65 on up you will be setting up your practice to attract those people.  

    CA practices aren’t “better” than other types of practices, they are just more clear about who they want to be able to help– a much wider range of incomes, classes, races, ages, etc. and they are set up to accomplish that goal as much as possible.

     Calling your practice standard, normal, private room, etc. doesn’t communicate the subtleties of economics and class, that calling a practice boutique  might.  Is it the term that offends, or the truth that it points to?  I think that acupuncturists feel piqued by the term because ostensibly we all went into this to help others.  It’s hard to discover that much of what we think about how our profession should look, be practiced, what to charge, etc. is actually a barrier to many people, and not just financially.  

      I don’t just use boutique pejoratively to get a rise out of someone for a thrill.  The term is used to get people, acupuncturists, patients, to think about the way things are.  

     Why do so many acupuncturists get themselves knotted up about this term and it’s potential for negativity.  Why not spend that energy trying to figure out how to offer acupuncture/gua sha/cupping/herbs/ etc to folks at an affordable price while making a sustainable living, and then launch a movement/ network to support it; something we here at CAN have failed to do.

     Yet despite our failure to do the above we all seem to be pretty damn happy just doing acupuncture and making a living at it too.   

     

  56. Wow. Lots of comments here.

    I am the person who first coined the term Boutique Acupuncture. (Thank you, thank you very much. I’ll be here the rest of the week.)

    I first coined the term to describe the state of acupuncture in this country: primarily catering to rich and upper middle class people. It still does that today. Which is what Boutiques do. Nothing wrong with that. Boutiques are smart small shops that spend a lot of time with their relatively few clients who pay a good deal for whatever it is they are buying.  Which is what the traditional business model for acupuncture in this country does. 

    Say again why you don’t like the term? Realise that I have skimmed the comments and I’m not gonna touch some of those comments…

  57. You can’t PROVE it is a negative term

    There are problems with the term boutique, but really, can anyone empirically prove that a word is negative? But should you have to? The community acupuncturists have defined what they mean by Community Acupuncture, and have expressed dissatisfaction with anyone using the term Community Acupuncture to describe their clinic if they are not following that criteria. Fair enough. But from the way I see it, they are also trying to put a label, Boutique Acupuncture, on everybody else in the profession, except maybe the hybrids (whom are to just be pitied). It seems like most people don’t like having that name applied to them, so why insist on using it? If you want to define yourself, that is fine and necessary. Why not let others do the same? You might not object to Wal Mart acupuncture, but someday somebody might try to stick a label on CA that you really won’t like. In a way this, is a stupid argument, but it is also kind of a microcosm of the larger world. How many problems have we had in our world from one group trying to define another one? Actually, it kind of reminds me of how the Republicans insist on calling the Democratic Party the DEMOCRAT party. Anyway, I have never seen a debate on an internet forum where anyone has ever changed their position. I support CAN 100%, but on this I disagree. So maybe 99%.

  58. Just curious, honestly

    Just curious, honestly really not trying to inflame, but how many acupuncturists out there can afford to pay, will pay, and do pay $65 Tx to their colleagues on any regular basis to get acupuncture?

  59. Seems like the following is the essence of what you are saying:

    It seems like most people don’t like having that name applied to them, so why insist on using it?

     

    There are several ways I can answer this.  First of all, there must be a reason why some people don’t like the term Boutique Acupuncture- but those reasons are never stated and I’m not gonna just back down when someone cries. I mean if every clinic was doing gangbusters then no one would bother with a term like Boutique Acupuncture, would they?  As I say above I think it accurately describes the type of practice that is standard (so far) in this country and in that it is not perjorative in the least. that someone takes it as perjorative, well, that’s their problem, especially if they don’t look into their feelings of why they are upset. 

     

    I tend to think that the underlying emotions behind being upset has to do with fear of not being successful and if they are labeled in any way they amight well not succeed. That most acupuncturists don’t succeed- and the fact that the failure rate is barely every talked about in the profession only bolsters this quite fear that so many acupuncturists have. So I am naming something, much like saying the Emperor has no clothes. In that story it would be wrong for the child to keep their mouth shut, just like it was wrong for all the adults to pretend the Emperor was wearing clothes. In our profession I am calling out the bad business model that is stifiling the growth of acupuncture.

     

    Damn straight I am mad at what the schools teach their students about how to set up their practices. There are only so many upper middle and rich people in this country and the schools are pumping out way more acupuncturists than that Boutique business model needs. There needs to be some serious soul searching in our profession about how to really grow it so it becomes a standard part of the medical infrastructure in the US, Canada, Australia, Europe, etc. But there is a huge resistance to doing that talk. So I prod, prick, and provoke people into really looking at what they are doing, how they are limiting themselves in their practices. Sometimes it actually works.

    So basically calling something Boutique acupuncture, plus talking a lot about Class Divisions in this country and how different Classes do things differently is part of my calling. For it I (we) have been called Walmart Acupuncture and far worse in the last several years. I guess if people have to get upset first then so be it. Some of them will get past it even if they keep their practice Boutique-y. More power to ’em.

    But we have to get past that fear and no way will I shut up about it. I hate seeing Acupuncturists go out of business.

  60. Someone just a couple of

    Someone just a couple of posts above asked me specifically what I find offensive about the term boutique. I asked the following question on a couple of non-acupuncture forums to get a small, but random, public sampling.

    “When you hear the word ‘Boutique’ what adjectives come to mind?”

    Here are the negative connotations to the word and why it is demeaning to your fellow practitioners:

    pretentious
    some place to avoid (okay, this isn’t an adjective…)
    over priced
    snobbish
    frou-frou
    optional
    fluff (as in “something of little substance or consequence”)

    I find these connotations of the word as offensive as terms used against CA that imply it is low quality.

    Now, crismonteiro asks us to imagine being someone earning $14.50 and paying $65.00 per treatment and then to imagine minimum wage. Cris, I don’t have to imagine. In 2000-2001, I was earning $12.50/hr and had a personal financial obligation that adjusted my discretionary income down to around the same as if I were earning $8.00/hr.

    I was paying $60.00 for acupuncture treatment. I completed a course of 10 treatments for knee pain, and returned 4 months later for work-related tendonitis in my wrists. It was worth every penny. I was so incredibly impressed with the recovery ( for pain that a neurologist condemned me to have for life) I became an acupuncturist.

    No one is denying that CA avails itself to a much lower income bracket, as well as, larger income brackets. I have no issues with anyone who wishes to operate a high volume-low cost model.

    I operate a Private Room clinic (I still have to thank Nora for turning me on to that term) at the rate I paid 10 years ago. The majority of my patients consist of lower-middle to middle-middle class. I have one. One, patient who is independently wealthy. I’m not sure how that makes me pretentious, or snobbish.

    Colleagues do not need to insult me, demean my practice, by using a word with connotations of being pretentious, snobbish, frou-frou, etc. because I choose not too operate my clinic in the way they operate theirs for very specific reasons.

    Just as CA folks get fired up if someone implies they are offering sub-par service (ie- Walmart Acupuncture) because CA clinics operate differently.

    Now folks can be as obtuse as they choose to be, and claim they do not understand the term “boutique’s” offense, but it is simply disingenuous B.S. It is beneath Acupuncturists to demean other Acupuncturists.

  61. “It isn’t about who started

    “It isn’t about who started it. It’s about who has the balls to stop it. If we’re ready to walk our talk, and it really is about the patients, then we can ALL do better. Anyone care to join me?”

    Bottley, I’m already there with ya.

    Jamey Johnston

  62. Skip,

    The vast majority of

    Skip,

    The vast majority of my PRA patients are not rich, nor upper-middle class. For you to imply that through the use of the term “boutique” (which you just admitted you are doing) is insulting, inflammatory, and offensive. You assume… and we all know what that does, right?

    I do not have the time to re-type my complete response found above, but my name is in the tag line.

    Jamey Johnston, C.Ac

  63. Skip,

    In reference to the

    Skip,

    In reference to the negative connotations to the “boutique” I posted earlier….

    If you “*hate* seeing Acupuncturists go out of business” so much, then why not accept that the term can be detrimental to your fellow acupuncturists?

    If there is a term, such as, Private Room Acupuncture, that accurately and honestly highlights the difference from CA without demeaning your fellow Acupuncturists, then why not use it?

    Why do you feel the need to make my success more difficult by labeling my practice negatively?

    Jamey Johnston, C.Ac

  64. David,

    My response is

    David,

    My response is offered in the same tone as yours.

    I find it interesting that you had to search for a label to apply to something that does not fit into your preconceived notions. I made no mention of a formula and your definition makes no mention of a formula. But, by any reasonable interpretation, your definition applies to any CAN clinic.

    A CAN clinic has already decided what treatments are available to its patients. What treatments they are allowed and a formula for how much time a practitioner must spend with their patients.

    I’m beginning to suspect that a CAN clinic is different from a CA clinic.

  65. Labeling

    Thanks for sharing that with me, Jessica. But, as you seem to have forgotten, as a friend for nine years, I know exactly what you went through. You also know what I, and the rest of our friends, have gone through.

    I’m surprised, since I’m pretty sure I told you this already, that you would accuse me of humiliating my patients. Once again, CANers have made incorrect assumptions about how I treat my patients. I do NOT request income verification and, until this year, only had a donation box for payment. I created the guidelines because my patients requested it. Whatever my patients pay is between me and my patient. No one feels awkward that they are paying less or more because it is private. Do you want everyone to know how much you spend on everything you do?

    It really sounds like you don’t know what my intentions are, or ever did, if you think I would humiliate someone. I feel compassion for you. I feel compassion for every member of CAN because you cling to labels and a compulsion towards conformity.

    To those on this website that are Buddhist, you have created one big illusion and one enormous label. Keep clinging to “Boutique Acupuncture”, it won’t bother me any more. I can tell you your label does not exist in my clinic. I hope you are able to eventually overcome your attachment to your “movement” and to your labels.

  66. Do you really think

    that the name “boutique acupuncture” has anything to do with the high failure rate of acupuncturists? That seems a bit like standing in a nuclear wasteland and blaming someone holding a sign that says “kaboom”,  instead of the perpetrators who dropped the bomb.

    Skip has hits the nail on the head in that there is a rampant of fear of failure in our profession, although it is heavily denied from the schools and the Acupuncture Today people because the status quo is good for them…why should they care about students? Are there any meaningful studies which actually look into the long term failure/success rate of acupuncture graduates? From what little I’ve read, I’ve heard this type of research is woefully inadequate. 

    The widespread denial of failure trickles down and affects everyone in the profession. It breeds competition and fear, and a very prickly persona which resents any sort of challenge to our view of the world.

    I believe the BA term is an accurate label and it isn’t inherently condescending. It highlights the class exclusion that occurs with that model in a powerful way that “private room acupuncture” does not. 

    I believe debate can be vigorous, with intense discussion of ideas, and still exist within a container of mutual love and respect.  

     

     

     

     

  67. Nothing I say affects your business.

    Seriously.  I am just another acupuncturist. I am not a patient. Your business lives or dies depending on how many patients come through your door. I do not affect how many people come through your door. Your business does not depend on what another acupuncturist calls your business. 

    You have to realize that this isn’t about you. I (we) did not coin the term “Boutique” to talk about you personally and anyone personally. We coined it because when you compare the going rate for acupuncture to what the majority of the population in the US earns, it becomes very clear that 80% of the population cannot afford to pay for enough acupuncture to do any good (i.e. frequent and regular acuopuncture) and that bears any resemblence to the kind of treatment plans that you see in China. Not all private room treaters are Boutiquers. (The overwhelming majority are one and the same but still there are exceptions.) You are making something personal that isn’t personal, We are trying to talk about a pattern in the acupuncture profession. If you don’t fit that pattern then why do you care? The fact is most acupuncturists do fit it and most acupuncturists fail.

    The sad thing about the overwhelming majority of acupuncturists in the US is that they are so caught up in themselves: how they present themselves, how they decorate their clinics, how other acupuncturists regard them, what techniques they know or who they studied with, etc. that they fail to connect with enough patients. And, yes, that includes some Community Acupuncturists I know as well. Most acupuncturists never see clearly their goal (treating patients) because they are too caught up in details, like this silly broo ha ha over the phrase Boutique Acupuncture. Instead they should be worrying about connecting with enough people to make a living and that includes looking at the barriers one is putting up that might drive potential patients away.

  68. Classic

    This is classic, true gold.

    Paragraph one “… high failure rate of acupuncturists.” Paragraph two “Are there any meaningful studies that look into the… success rate of acupuncturists?”

    I love how in a single post you make a statement, then question your own statement without batting an eyelid. Classic double-think, buddy!

    I wonder who told you about the high failure rate, I assume it was a Level 5 CAN Thetan, maybe it was Tom Cruise?

  69. Skip,

    Nice of you to actually read this post. I know you couldn’t be bothered to read some of the others before posting.

  70. To the Skipper

    Take some time out before responding any further and go back to read the posts. This way you are fully informed.

    Just review the assumptions made about my clinic. I’m sure I’m not the minority, but then again I really don’t have any data on that. Do you?

  71. .

    jennifer, you are missing the point, which is: asking patients to PROVE they deserve to pay less for treatment is demeaning and humiliating. if you have ever been on the receiving end of that type of policy (i have, lots), you would know how it feels. it is not the kind of relationship we choose to have in a “CAN clinic”. our systems are in place to support our patients, not conrol or demean them . there are reasons why a really wide sliding scale (like $0-70) is just as problematic as asking for proff of income). we cling to our systems because they work well, and we know this because lots of folks come back again and again and bring their friends and families with them to be treated. if you don’t understand this, please read Acupuncture is Like Noodles, and (if you haven’t) go and receive a treatment in a “CAN clinic”. otheriwse you are just here to argue and waste our time picking a fight (iow – trolling). 

    -tatyana

  72. Please don’t thank me.

    I was just trying to get folks to calm down; unfortunately now some folks are belligerently insisting we use the term “PRA” – which, while descriptive of the physical setup of many acupuncture practices in the US, does not, as Cris so aptly says: “communicate the subtleties of economics and class, that calling a
    practice boutique might.”  Calling attention to class differences – yea, even calling for the abolition of inequalities – is *not the same* as being derrogatory or demeaning.  I also don’t care what you call your clinic setup, and I don’t care about your unscientific survey. 

  73. Please READ T

    Wow, I was trolling this blog before I even gave consent. Interesting.

    T, You need to read my response to Jessica. I don’t request income verification. Thanks for making my point more clear. CAN only exists to assume things that benefit themselves. Your assumptions are not reality.

  74. Skip,

    I’ve respectfully

    Skip,

    I’ve respectfully explained how you are denigrating your fellow acupuncturists, just as “Acu-mart”, or Walmart-style, denigrates CA. It is just as personal to me, as it is to you, when someone make unjust, unfounded, and untruthful attacks on your business, your livelihood.

    My position here is that neither is right.

    I’ve pointed out how using that term in a public medium only serves to *help* further tear down your fellow acupuncturists, and please note that I never said the term alone was responsible for failure rates. You are trying to put words in my mouth that were never said; trying to take it to the absolute extreme.

    You stated emphatically that you *hate* to see your fellow acupuncturists fail, but are more than willing to add fuel to the fire by using a hostile term.

    Holding onto the position that the term is innocuous is facetious. You go ahead and do what you gotta do, but I hope you can see your way through to respecting that PRA clinics find it offensive.

    Thank you all again for your time.

    Jamey Johnston, C.Ac

  75. [Apologies again for the

    [Apologies again for the double post. This having to select formatting is tiresome.]

    Skip,

    I’ve respectfully explained how you are denigrating your fellow acupuncturists, just as “Acu-mart”, or Walmart-style, denigrates CA. It is just as personal to me, as it is to you, when someone make unjust, unfounded, and untruthful attacks on your business, your livelihood.

    My position here is that neither is right.

    I’ve pointed out how using that term in a public medium only serves to *help* further tear down your fellow acupuncturists, and please note that I never said the term alone was responsible for failure rates. You are trying to put words in my mouth that were never said; trying to take it to the absolute extreme.

    You stated emphatically that you *hate* to see your fellow acupuncturists fail, but are more than willing to add fuel to the fire by using a hostile term.

    Holding onto the position that the term is innocuous is facetious. You go ahead and do what you gotta do, but I hope you can see your way through to respecting that PRA clinics find it offensive.

    Thank you all again for your time.

    Jamey Johnston, C.Ac

  76. read?

    yes, i read your response to jessica before i posted the above comment – seems like you did not read all of my comment before you posted your response. actually, you were trolling on the forum attached to the OnMilwakee article that jessica quoted in the original blog before you came over to troll here. you posted really insulting comments to an article that was in no way critical of you, it was just announcing a new business in your area and explaining how they do things. i think it threatens you somehow, but i do not know you, do not do therapy and simply do not care. i stand by my assessment that you are here to pick a fight that is not useful. i have work to do, so best of luck to you. if you ever want to have a real conversation about this practice model, then join CAN and get informed and then we can talk.

    -tatyana

  77. T and J how is my clinic Humiliating?

    You said it, now explain yourself please.

    On Milwaukee is an article online open to the FREE SPEECH opinions of everyone. Does CAN still believe in FREE SPEECH? Clearly its okay for you to insult, but I can’t make a reasonable comment on a one sided article. Interesting.

    Its also interesting that we are some how trolling, even though we we’re posted on the blog without permission. Then I was hassled by Jessica to make comments on here and to “stop hiding”. I have nothing to hide. Just sharing my truth, sorry it upsets you. If you were really a punk, I don’t think you’d care.

    I’m not sorry, however, to point out that all of you exclaimed that the entire point behind CAN was to provide affordable care. I’m doing it, but because I’m not apart of your “movement” it seems you will still find fault. Very, very, very interesting.

  78. Humiliation

    I get that you don’t require your patients to bring-in documentation.  That’s not how your original post sounded, but now I understand. 

    HOWEVER, if *I* had to give you a payment based on *your* income/family size chart, and I knew that you could then guesstimate my financial situation based upon how much money I paid you, and *if* I fell into the lower-end of your predetermined payment chart: I would feel humiliated. 

    Jennifer, I think it has been said several different times in several different ways by several different people, that if you’ve found a way to provide affordable care to your community, that’s great!  I hope it’s self-sustaining.  I (personally) have concerns about the viability of a low-volume, low-cost clinic which uses household size/income charts.  But if it really works for you, GO FOR IT!  People had doubts about Lisa’s model too, but she’s proven them wrong with a model that can be replicated in dozens of different marketplaces across the country.  Write a book, start a website, start your own Revolution…

  79. One of the dirty little

    One of the dirty little secrets of our profession that the schools don’t like to discuss is how many of their graduates are still practicing 5 years after graduation. Some of my CAN colleagues have tried to find out if there is research on this and what little there is doesn’t say much. For example, the number of people who continue to maintain a license doesn’t really say whether they are actually making a living at it, or simply like to keep letters after their name for reasons of ego security or failure to do life housekeeping or whatever. I do a lot of double thinking – and triple quadruple thinking. It’s called questioning the status quo. 

     

  80. Actually…

    This whole thing was only a matter of simply presenting a differing opinion to a somewhat one-sided article at first before a number of CA practitioners from all over the country chimed in with overly defensive responses and the situation escalated. You were the ones who decided to move this to this CA forum, so settle down about trolling. It’s ridiculous to complain about people arguing differing opinions in your house when you invited them here to do it. By my assessment, there are only a near handful of PRA practitioners here trying to argue a position against a much larger group of CA practitioners due to the fact that the discussion was brought here for that exact reason, ie. bully pulpit. So, I’m a little confused about why you’re throwing around terms like trolling.

  81. Double-Think

    Doublethink is the power to hold two contradictory beliefs in ones mind simultaneously while accepting both. Example:
    1) There are massive numbers of failing acupuncture clinics.
    2) I don’t know how many failing acupuncture clinics there are.

    A conspiracy theory alleges that events are secretly influenced by a premeditated group:
    The schools don’t know how many graduates are still practising after 5 years, it must be a dirty little secret.

    The numbers would indeed be interesting. If they existed it would be interesting to compare fall out rates for acupuncture to any other small business. Interesting to know at 5 years how many people are still practising and compare that to how many people are still in any other occupation that they spent 10’s of thousands of dollars being educated for.

    These are good questions, I’m all for knowing the answers to those questions. I have another, I’d bet that CA or PRA, not many of you are making the income that they sell people at MCOM.

    Keep up with the critical thinking. Maybe try applying some to your own doublethinking.

  82. Ok…

     Okay, Jennifer I went back and read what you said on the OnMilwaukee blog and here.

    I think what is the telling remark that you say in a comment on that OnMilwaukee piece:

    I felt the article did so at the expense of other acupuncturists
    in the area. My comments were meant to bring some balance to this
    article.

    So you feel threatened and chose to fight back. (I particularly laughed out loud at the “treat em and street em” phrase. That’s what we do! Make em better and let them go.) It’s only natural that if you feel threatened that you fight back.

    I wish you could experience our clinic, or hear Lisa talk (she will be in St Paul on the 29th BTW. Yes! A plug!) or at any rate realize that you and this new CA clinic are not in competition. 

     You and that new clinic are seeing a different clientele and your success or failure will have nothing to do with how that other CA clinic does. Now from our experience if that CA clinic succeeds they wil be getting a bunch of patients who first experienced acupuncture elsewhere but couldn’t afford to go back but what are you gonna do about that? Lower your rates? If someone can’t afford you they can’t afford you, simple as that and if that CA clinic wasn’t there for them to turn to then they wouldn’t get treated at all. That would be a bad thing.Of course they will get a lot more patients than you as people will risk trying acupuncture if the price is cheaper. No problem with that IMO. 

     So in looking at what else you said, particularly with the pieces in the first post where Jessica quotes you… again I wish you could see us first hand or at least hear Lisa talk as I think you would get a different idea of what CA is about. Unfortunately this blog is not the best avenue for understanding in that regard, nor is an article in OnMilwaukee.

    I will say this: none of your arguments are original. I don’t mean that in a disrespectful way. It’s just that your arguments have been made over the years by other acupuncturists. And yet we (CA practitioners) are not only still here but we are growing at a terrific rate despite those arguments. In light of that fact that the majority of new practitioners don’t succeed in business tell me that we (CA folks) are onto something good with our business model.

    Why might that be? Because patients don’t give a crap about what acupuncturists think about each other. They only care about getting better. If they do get better they tell their family and friends and the clinic in question stays open. So your arguements are honestly pretty meaningless becauwse you aren’t our main audience. Patients are. Oh well.

     Here’s a story. In my town (Portland) there are two acupuncture schools. One, OCOM, is your basic TCM school. IMO its pretty boring, dull. (And I went there!) The other, NCNM promotes itself directly against  OCOM by saying they don’t teach TCM but “Classical Chinese Medicine”. They say it is better than TCM. OCOM does not respond in kind.  Does it help NCNM to do this? Well, OCOM is much more financially viable than NCNM, has many more students too.

    Got it? What you say is not important. It’s what your clients say.

    That’s all I have to say right now because the details of what you say are not important to me. I have enough experience to know I do a good job and my patients appreciate me and my efforts. Just some advice I guess: drop the fight. It doesn’t help you. That’s my experience from the Other Side.

  83. Jamey, you are missing the point

    I’ll keep it simple: I and no one on CAN is tearing down your clinic. No acupuncturist can do that. You are giving us too much credit, too much power. Its you who are deciding the term is hostile.  Take responsibility for yourself and how you feel threatened by us.

  84. Closing Comments On This Thread

    Hoping any readers of this conversation would also be interested in other topics related to community acupuncture posted on these public blog pages. Check the link to the right for past blog posts, and expect new writing throughout each week.

    Andy @ CAN