Open Sourcing Modern Acupuncture: Part Four, Stamina

Recently I had an interesting conversation with a prospective POCA Tech student, who described to me his efforts to research acupuncture schools. He told me that he spoke with a current student at a Classical Chinese Medicine program, who reacted with horror when he heard that the prospective student was considering POCA Tech. Apparently the CCM student exclaimed, “I would never allow anyone from THAT SCHOOL to give me acupuncture!”

The prospective student looked at me — the Director of That School — expectantly.

“Well,” I said, “in terms of patients, he’s not exactly our target demographic.”

I remembered this conversation when I was thinking about Modern Acupuncture, and about target demographics, and what ordinary people (as opposed to Classical Chinese Medicine students) want from acupuncture.

Something that POCA and Modern Acupuncture agree on is that people who want to get acupuncture don’t like to be surprised. Acupuncture treatment plans for any condition, but particularly for chronic conditions, are not best executed in a chaotic environment, or even just one where the hours and the location change frequently.  Important things that acupuncture clinics can provide to patients are consistency, stability, and predictability. Before I was a community acupuncturist, when I was doing what a lot of acupuncturists do and changing my practice location and my hours every 6 months or so, I was lucky enough to have a small group of loyal regulars who followed me around. That was kind of them, but not particularly good for them. (Or for me, but that’s a different story.) And it was a small group of patients who were loyal to me, personally, not a big patient base that had deep confidence that a clinic would be there for them and their loved ones. As I said, I wasn’t a community acupuncturist then.

Something we tell POCA Tech students regularly is that, to be a successful community acupuncturist, you need to be OK with being boring (and bored) in a certain way. You need to like routines; you need to like doing some of the same things over and over. Because people show up to a community clinic with the same problems, over and over. Back pain, neck pain, sinus congestion, anxiety; you have to be prepared to address them over and over, because even though they’re old hat to you after awhile, for any given patient, any one of those boring-to-you problems might be what’s standing between them and a decent quality of life. And if you know what works, that’s what they’ll want you to use, no matter how many times you’ve used it before and how unexciting it is to you at that point. Fortunately multiple strategies work for acupuncture, and you can mix up your approaches to keep them interesting to you while still being effective for your patient. But if you are expecting every treatment to be a transcendental revelation of the beauty of Classical Chinese Medicine, you should not be working in a community acupuncture clinic.

And here’s the thing about working in and/or managing an acupuncture clinic that has grown into being a collective resource for its surrounding community: you can expect ongoing waves of patients who are just now discovering the effectiveness of acupuncture, because one of their family or friends got good results. So here they are, prepared to be astonished by your most routine treatments when they get relief for something that’s been bothering them forever. It’s same-old same-old for you, but new and wonderful to them. So, beyond being boring and consistent on an individual patient level, you get to be boring and consistent for ever-expanding networks of patients. For generations. For decades. If you’re really good at this, your reward is to be fractally boring.

You’d better like people at least as much as, and probably way more than, you like acupuncture theory.

Also, punking is a long game. From the perspective of the community surrounding any given clinic, one of the most valuable attributes a punk can bring to work is stamina.  Stamina is right up there with empathy in terms of punk virtues. Physical, mental, and emotional staying power; endurance, determination, perseverance, grit.

Related to this: unless #letstingle turns out to be a game changer, what’s true about marketing community acupuncture is: you can’t. You have to be prepared to sit tight and wait for the right patients to find you and your clinic. The only marketing that really works, long term, is relationship-building. And you need stamina for that, too, for showing up day after day, ready to build the next relationship.

If you’re a clinic owner, or manager of a nonprofit, you also need stamina to maintain the clinic structure itself. Or as Cris described it in a prior comment, “the joyful personnel- bookkeeping- schedule-writing-supply-chain-learning-curve-IT-headache-parking-nightmare.” Like punking itself, there’s a lot of repetition involved. The same things need to be done over and over, and familiarity doesn’t necessarily make them more interesting.

As we get accustomed to having our own acupuncture school, we’re realizing that stamina is something we need to talk about more with our students, along with its corollary, learning how to manage your own energy so you can save as much of it as possible for the long haul. Meaning, knowing what not to waste your energy on; seizing opportunities for tiny hacks that add up to long-term savings, so that your clinic will be there in 5 or 10 years for the person who needs it then. For example, finding ways to do the things that have to be done in ways that you enjoy, or at least don’t hate, as opposed to “the right way”. Because you just can’t make yourself do too many things you hate when you’re running a business — not if you want to stay in business. It doesn’t matter if you’re doing your social media “the right way” if the right way wears you out; you won’t be able to keep it up and then it won’t matter.

WCA will be 17 years old this spring. Over the course of its life, I’ve made any number of regrettable mistakes and learned all sort of things through trial and error. At this point I’ve also accumulated plenty of critics, people with higher standards than WCA’s. It’s always interesting to find out that the people with the higher standards are no longer practicing acupuncture. WCA might not be doing things the right way, but 17 years out we’re still doing them. Guess what’s more valuable to the person who woke up this morning with terrible neck pain, the right way or the way that’s still available when they need it?

You have to factor in stamina when you’re setting up your systems. Which gets us back to Modern Acupuncture.

In the POCAverse, punks need stamina; so do clinic owners/managers. If the punks and the owners/managers are the same people, they need even more stamina. What feeds our stamina and keeps us going? I think it’s relationships. Everybody has days when they want to quit their job, when they realize that they could probably make a living by doing something easier than tackling our society’s lack of access to safe, affordable pain management. For everyone I know in the POCAverse, what keeps us in the game is relationships: primarily with our patients, but also with our communities, our coworkers and our comrades. And the longer we can stay in it, the more we can leverage the advantages of our long-term relationships: bigger patient bases, ever-expanding word-of-mouth, being not just a known quantity but an institution in our communities. Eventually, the waiting pays off.

A great limitation, for POCA clinics, is that creating and maintaining the structure for a big, stable clinic doesn’t pay any better than being a solo punk. Sometimes it pays less well, especially in the short term. Modern Acupuncture is counting on its clinics being so successful and long-lived that they can pay back enormous initial investments in the structure, not to mention, make the franchise itself profitable by means of ongoing royalty streams from clinics. Modern Acupuncture is also playing a long game, so Modern Acupuncture should also be concerned with cultivating stamina. (And if #letstingle isn’t as powerful as they hope, they’re really going to have to dig in and wait for their clinics to fill up.)

Stamina is utterly different from initial excitement, from marketing “buzz”, and from getting people to “invest in a concept”.  Stamina is doing the work, day after day for years, when it’s no longer a concept and especially when it’s not particularly intellectually exciting to the acupuncturist. The problem is, nothing in the structure of the acupuncture profession, particularly not conventional acupuncture education, supports the kind of stamina Modern Acupuncture is going to need to cultivate. (No conventional acupuncture school teaches students to treat high volumes of patients, let alone sustainably.) The acupuncture profession as a whole, being in love with unattainable expectations for itself, is a case study in how to burn people out.

Individual Modern Acupuncture clinics aren’t just weird mirrors of individual POCA clinics (I’ll just put this and this here, again); all of Modern Acupuncture is a weird mirror of POCA itself. They’re hoping to have hundreds of clinics up and running within a few years, collectively building a patient base for the franchise; they’re hoping to create almost instantly what we’ve built incrementally. Which means they can expect to have all the problems that we have, but on a larger scale, and probably showing up faster. I think this is great news for POCA. Something big that has the same problems as we do, but something that “leaders in the acupuncture profession” actually claim to care about and support?

How can we not benefit from this experiment? I just hope Modern Acupuncture can hang in there long enough to try to solve our, I mean its, problems. Here’s hoping for stamina.

Author: lisafer

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  1. I think maybe implied in your blog about cultivating relationships is also the relationship we have with ourselves, the acupunk, because we need to show up day after fucking day and do the work in clinic, and whatever else we need to do to keep the place running. You and Skip called this the “Glacial Grind” at one point. We need to take care of ourselves however we can to maintain the stamina over the years. This need to take care for the long haul really hit home for me in the past couple years due in part to injury. Days off, exercise, doing other things we love to stay sane and moderate any compassion fatigue/burnout we encounter bc of the nature of our work.

    Another thing I would like to add is that we have seen over the years that there is a ramp-up time for new punks for their caseload so their stamina can be built up over time to be superpunks.

    As for the getting bored part, I like that. I like being bored. I get inspired. Doing acupuncture for me is like a walking meditation, active but quiet. I get ideas. Because I am a good technician after ten years and confident in my needling skills, I can also devote more energy to the personal relationship transactions of each encounter, and try more and more to sprinkle in some humor and jokes and puns, and learn more about my patients and try to engage with them whereever they are at on any particular day or session.

  2. Stamina has been more on my mind lately as well. I find that I’m having to much more self-care with more days off the busier I get. So of course it affects the “consistency, stability, and predictability” needed to be part of the community. It’s a hard balance. Almost 10 years after I opened, I’m working on figuring out how or even if I can do another 10. Like you said Lisa, here’s hoping for stamina!

  3. Yes, stamina…. at 55 and 2 yrs into a clinic, the 2nd time around, doing it all on my own, again, stamina is necessary. I think, hell, I know, I need a younger partner or 2. Great post.