Open Sourcing Modern Acupuncture, Part Two: Trouble

After I read this article in the Franchise Times, a multiple choice question popped into my mind. (Yeah, that happens. More about that in a minute.) What do you get if you cross the People’s Organization of Community Acupuncture with Massage Envy?

a) Modern Acupuncture
b) $$$$$ !!!!!
c) trouble
d) a & c
e) a & b

The founders of Modern Acupuncture seem to think the correct answer is e. But I think it’s d.

Why? Check out this instagram post, dated Nov 27, 2017:

ma_modernacupuncture Each year, thousands of acupuncturists graduate from college and seek employment. This means you'll have no trouble finding licensed acupuncturists to staff your Modern Acupuncture location.

My reaction:

hahahahahahahahaha

*sob*

You know why multiple choice questions regularly pop into my mind? Because POCA had SO much trouble finding L.Acs to work in its clinics that we had to start our own acupuncture school to supply them (please read this post if you haven’t) and now a not-insignificant portion of my brain is devoted to tasks like generating multiple choice questions. (I can’t seem to turn it off.)

In the previous post in this series, I wrote that Modern Acupuncture is running a staggeringly expensive experiment on behalf of our knowledge commons, whether they intended it that way or not. One of the questions their experiment will answer is, how troubled is the acupuncture industry, really? There’s pretty significant disagreement about that. On one hand, you’ve got articles like this, that suggest there are more than 37,000 L.Acs in the US and that number is growing. On the other, you’ve got POCA’s experience, and lots of anecdotal reports, that suggest however many acupuncturists are out there, an alarming proportion aren’t working, or are barely working, in the field that they spent so much money and time to get into.

Shouldn’t all those unemployed acupuncturists be an element in Modern Acupuncture’s favor, though? Doesn’t that constitute a workforce-in-waiting?

Not in POCA’s experience, or we wouldn’t have bothered to start our own school. One POCA clinic owner wrote, “That Instagram post is truly hysterical.  Hiring and managing a staff is by far the hardest thing we do.  And really the managing is better than the hiring.”

Modern Acupuncture is paying employees more than many POCA clinics pay (or, offering more work at similar compensation), so won’t they attract more candidates? Plus they look more legitimate; you all are a bunch of dirty communists and nobody takes you seriously. (Whoops, channeling Acupuncture Today there.)

Modern Acupuncture is also charging more for treatments, and paying higher rent, and on top of all the overhead, there’s supposed to be money left over for the investors, and for the franchise itself.  Or, as this article put it, “overlaying an expensive franchise model over a relatively simple business tends to layer high costs on businesses with limited capacity to generate the required sales and margins to meet those costs.”

Alas, even if Modern Acupuncture can attract more potential employees,  I predict those employees won’t be any better at building and maintaining a patient base than POCA’s failures were. If it were easy to train people to succeed in a community acupuncture setting, we wouldn’t have had to start our own school. Let’s talk about Robert Doane for a minute. As in, “World renowned acupuncturist and educator Robert (Bob) Doane has joined Modern Acupuncture™…In his role as Co-founder and Clinical Director at Modern Acupuncture, Doane is creating the new hire training for the licensed acupuncturist.” That’s impressive, right? And reassuring?

Well no, not really. Because teaching people to practice distal acupuncture isn’t the same as teaching them to build and maintain a patient base, and while Doane’s biography describes how he’s done a lot of different things in business, including building a busy acupuncture clinic,  one thing he apparently hasn’t done? Is to own a busy acupuncture clinic where he’s not onsite as an owner-operator. His established clinic model has only one location. And that’s a big deal.

Imagine, for a moment, owning a (supposedly) high-volume clinic, staffed by acupuncturists who graduated from conventional acupuncture schools where they likely got 1) zero experience with a high volume clinic and 2) negative programming about how inferior high volume clinics are — and imagine those were the people responsible for attracting and retaining patients. Wouldn’t you expect the clinic to struggle? The vast majority of POCA clinics, including the ones that Modern Acupuncture reps visited and copied from (check out the layout of Beach Community Acupuncture and compare it with the MA template) have owner-operators onsite, plus maybe one or two other amazing, trusted employees (or maybe not).

The magic of being an owner-operator is the magic of hands-on; you can step in and work if you need to, you can connect with patients yourself if your employees aren’t as good at it, you’re personally invested in a way nobody else is. If you think these aren’t important factors, I’m sorry, you don’t understand small business. And in situations where staffing is questionable, owner-operators are even more important. Heck, 17 years after WCA’s start, when I haven’t had any  scheduled punking shifts since 2015, I still punk from time to time because I’m still the sub of last resort! And some patients still remember me as the first person they got acupuncture from. I held WCA’s patient base energetically until I had punks I trusted to take over; imagine what would happen if you just dumped your fledgling clinic’s patient base into the hands of L.Acs with no track record, and if they proved to be clueless (odds are high), there’d be nobody to hold it at all. That’s the risk everyone who owns a Modern Acupuncture franchise is taking, unless they’re an experienced high-volume acupuncturist themselves. (Highly unlikely, based on how many acupuncturists have that kind of disposable income.)

What I’m getting at is that in conventional acupuncture schools, students don’t learn the energetics of building and maintaining a patient base for a high volume clinic. At POCA Tech, we spend a huge amount of time on this, and we still feel like we can’t talk about it enough. Cohort 3 students told me that last weekend, one of our faculty members, Cortney — who is also a WCA superpunk — skewered them with her eyes and warned, “Never forget that to be able to treat a lot of people, consistently, you really have to want it.” How many L.Acs who are employed by Modern Acupuncture are going to want it, or even understand what that means? (And no, I’m not talking about financial incentives.) Successful POCA clinics that have employees  also generally have an owner-operator who can at least model how to want it.

OK, getting back to the question of, how troubled is the acupuncture industry?

Well, two acupuncture schools lost their accreditation last weekend. Also, based on ACAOM data, claiming that “thousands” of acupuncturists graduate every year is a stretch; it looks like it’s under 2000 each year, and falling steadily.

Cruising around the web, you can find these figures about alternative medicine utilization in the US:
chiropractic utilization is about 9%
massage utilization is about 19%
while acupuncture utilization is about 1.5% .

Utilization is a chicken and egg problem, I get that, I really do. People can’t use acupuncture if there are too few acupuncturists actually working, and too many of the ones that are have weird hours and no systems to run their offices. In theory, lots of locations and really good systems should help solve the utilization problem. POCA and Modern Acupuncture clearly agree on that.

The major difference, though, is that Modern Acupuncture isn’t trying to solve the utilization problem incrementally, it’s trying to solve it really fast, and they’re powering their solution with the promise of profits for investors. Modern Acupuncture is obviously counting on utilization rising to meet their costs. That’s such a big risk — particularly in light of the owner-operator issue — that thinking about it makes me feel sort of sick, actually. I guess it’s empathy, because I know what it feels like to put a ton of time and energy into making a clinic, and then hold your breath while you wait for acupuncture utilization in your community rise to meet your clinic’s needs.

Based on past experience, I find it hard to believe that Marilyn Allen started crying when Modern Acupuncture called her because she’s moved by the masses having access to acupuncture. I think it’s more likely that she was crying because she understands more than anybody how troubled the industry really is, and she hoped Modern Acupuncture might be a solution. I think the odds are that our troubled industry just got itself an equally troubled franchise.

p.s. An alert comrade drew my attention to the fact that all MA locations are now offering unlimited acupuncture in 2019 for $995. Given that this apparently undercuts their membership model, it looks pretty desperate. Even if it's a short term offer, and designed to get people to use their FSA/HSA money…I remember people trying similar things in the early days of CAN — basically, before we collectively knew what we were doing — and I never remember it working.

Author: lisafer