POCA Clinic Member Changes

Recently I saw a bumper sticker for a local food co-op that said, “I own a grocery store with some friends” and I thought of POCA. Back in 2011, when we made the transition from the Community Acupuncture Network (which was a 501c6 nonprofit) to POCA, one of the reasons was that we didn’t want to be just another acupuncture organization — we wanted to own a business together. We wanted to be producers, not just consumers. (Occupy, Resist, Produce!) So now we collectively own a  pile of intellectual property (otherwise known as a knowledge commons) and because we’re so into open-sourcing, that pile keeps getting bigger. Which is cool. But what’s cooler, I think, is how we use that intellectual property to make things.

Things that we need — and things that don’t suck. Conferences that don’t suck, CEUs that don’t suck, an EHR that doesn’t suck, an acupuncture school that doesn’t suck.

If you’re not excited about things that don’t suck, possibly you haven’t been involved with the acupuncture profession long enough.

Part of the momentum behind the transition to a co-op was that CAN had some attributes of a club, which don’t get me wrong, were often really fun. I don’t know about anybody else but I’d never previously had the opportunity to go to a party (ahem, professional conference) where my friends were jello wrestling in costume, or the opportunity to participate in a filthy haiku contest on the internet, and also I didn’t have any idea what a merkin was, and oh yeah the absinthe hangovers after BOD meetings were a revelation too, so — thank you CAN, I had no idea what I was missing! Some of those clubby attributes, though, seemed to have outlived their usefulness. We were pretty clear that POCA wasn’t meant to be a club, and also: memberships should pay for themselves with tangible, practical benefits; you shouldn’t have to love or like or even agree with everybody in the co-op in order to become a member; and you shouldn’t have to be a fan of everything that each self-organizing circle does. (Like, you shouldn’t have to jello wrestle in a merkin. An early pass at trauma-informed practices.)

We wanted to focus on creating mutually beneficial economic relationships. With the perspective that: if you want to use the stuff that POCA makes, and/or you want to participate in making it, you should think about joining; and if you want to make or do something that the co-op isn’t currently making or doing, you should think about self-organizing with other likeminded members, to make a circle devoted to that thing. (Oh, you want to jello wrestle in a merkin? That’s totally fine! If other POCA members want that too, find them and make a circle for yourselves! The non-fans of your circle don’t have to watch, but if you can make it pay for itself, the Finance Circle will probably have no objections.) That was the foundation for becoming a co-op. And the mission of the new organization was pretty simple: to get affordable and accessible group acupuncture to places where there wasn’t any.

I think it’s helpful to consider the recent changes to the clinic membership guidelines in light of that particular part of our history.

For most of POCA’s life, it’s run on a budget of about $100K a year, give or take, and it’s more or less broken even. The co-op brings in about $100K and spends about $100K. That hasn’t changed. In 2018 we made $101,607 and we spent $102,801. Also, POCA’s had about 2000 members, give or take, for years — while CAN had maybe 600? The member count shot up after the 2011 transition and has stayed in the same neighborhood ever since. What has changed in the last few years is that the number of member clinics has declined noticeably, and the Membership Circle started talking about that back in the fall of 2017. Our overall member numbers are down about 10% but the clinic membership is down more than 25%. Also, these days, we have more and more ideas about how to spend our revenue, so we’re not satisfied with that $100K in revenue. In other words, something has to change with this business we own together.

Coincidentally, many of the core volunteers of POCA also happen to own or manage small businesses, so we have experience with how these things work. If the co-op were a clinic, we’d say we’d hit a plateau, or a slump. Most of us have experienced these slumps with our clinics. After a period of hard work and exciting growth, things somehow get stagnant and our numbers go down, and we’re like, OK, what’s going on and how do we fix it?

If the co-op were a clinic, we would start out by asking ourselves, well, have we been distracted by anything recently? Does the stagnation coincide with our attention being consumed by something other than running our business?

Oh, you mean that 501c3  accredited acupuncture school that we put together in record time? Yeah, that would qualify as a distraction. A good distraction, but a distraction nonetheless. A good investment in the future of the co-op, but a serious detour away from keeping an eye on the day to day running of our small business. We’re only human and we only have so much energy so yeah, POCA Tech is definitely part of the slump.

But as we know, since a lot of us have been small business owners for a decade or more, life is distracting. Things happen, and then they settle down; now that we’re accredited, the school should take less of that kind of urgent attention. Is there anything else going on with our clinic, uh, co-op, that might be affecting our numbers? Perhaps we should take a look at our systems.

We all know we need a new website, and we’re working on it. But we also know that even though our website has seen better days, so have the physical facilities of many of our clinics, and those don’t have to be shiny and new in order to serve a lot of people. (WCA Cully and its 600 tx/week is living proof.) What might be stopping us from doing more business? Hey, is there anything needlessly complicated with our intake processes? Anything that’s tying up our energy and creating a barrier to doing business, meaning — people showing up, giving us their money and using our services like we want them to? That’s always the first thing we look at with a clinic. Anything wonky with our front desk, so to speak?

It seems like patient members are joining just fine, no obstacles there (which is interesting since that’s the category where back in 2011 a lot of people laughed and said, no patients will ever join as members) but clinic members are the opposite.

Wait — HOW complicated is it for clinics to join POCA? HOW many criteria are there? Sixteen, you say? Taking up a full page on the website, with increasingly intricate caveats due to the shenanigans of past would-be clinic members?

Oh.

Yeah, that sure looks like a barrier to doing business. Which is what the Membership Circle has been talking about, and why they created the new clinic membership guidelines.

If we have more patient members, wouldn’t it be nice if we had more places where they could use their member coupons? And what about all those places where there are just no POCA clinics at all? Or as Cait said, how can we be FOR community acupuncture in a wide sense so more and more and more folks can benefit from it?

Let’s take Sunny Valley Acupuncture (SVA) as an example (that’s not its real name). SVA is owned by a sole proprietor L.Ac. and is an hour away from one POCA clinic and an hour and a half away from another, in an area of the country that has been hit hard by the opioid epidemic. Sunny Valley itself is a tiny little town in a rural area. SVA considerately lists all its services and prices on its website (these are real): $65 for “basic” acupuncture, $90 for a first visit, $30 for an herbal consult — and community acupuncture at $15 to $35 a treatment, sliding scale, on Friday evenings.

True confession: if we treated a patient at WCA who was visiting Portland from Sunny Valley (or even the neighboring tiny towns of Cloudy Valley and Windy Valley), I would totally refer them to SVA in the hopes that they could get there on Friday evenings. Do I wish the proprietor would offer community acupuncture more than once a week? Of course I do. Am I glad our one-time WCA patient can maybe get acupuncture that they can afford at least sometimes? You bet I am. If SVA were a POCA member, that patient would have a reason to join too (they seemed awfully excited about their treatment at WCA) and then maybe use a coupon to take their mom, who also really needs acupuncture. If SVA’s community acupuncture hours on Fridays filled up, maybe the owner would consider opening some more hours, or maybe she wouldn’t. Maybe she would take a bunch of POCA online CEUs and get inspired, or maybe not. But does it really make sense for POCA as a business to not to even try to do business with SVA, when it’s the only option for fifty+ miles? What are we really gaining here?

Another true confession: I’ve never been really involved with Locate a Clinic. I’m not detail-oriented enough to do Membership work and I’m super-grateful other people are. But, FWIW, I think our prior version of Locate A Clinic, whether or not it was perfect, served the co-op well. I’m honestly glad that the proprietor of SVA, who seems like a genuinely nice person, wasn’t in the mix when we were building all the stuff we have now. But I think at this point she'll be fine, and judging by how she wrote about community acupuncture on her website it doesn’t look like she’s treating it as some kind of deceptive loss leader. For her own inscrutable reasons, she only wants to do it once a week; she doesn’t look like a scammer to me, just somebody with regrettably limited hours. But if she did somehow turn into a scammer, I trust our patients to figure that out for themselves (and let us know). At this point in time, I don’t think we have to protect them.

Or to put it another way: if we had been open for doing business with clinics like SVA back in 2011, I don’t think we could have handled it. But I think we can handle it now. Just like clinics have to build up their capacity over time to treat more people, POCA as a business has had to build up its capacity to do more complex stuff. If we can create an accredited acupuncture school, I think we can navigate the complexities of a different kind of clinic membership.

Some people are unhappy with the Locate a Clinic changes and say they won’t renew their POCA memberships. In 2011, some people who were involved in CAN refused to join POCA. Those of us who own or manage or work in clinics know, that any time you change your systems, there will be somebody who doesn’t like it. And in fact, no matter how you run your clinic, there will be some people who don’t like it, who try it out but never come back. An effective way to ruin your morale — and your clinic along with it — is to chase after the people who don’t like you, as opposed to looking at the structure of your business to make sure it’s open to serving as many people as possible who do like you, or who might if you gave them the opportunity.

If you’re going to successfully use this model, you have to believe that there are a lot of people out there who want and need what you have to offer in exactly the way that you have to offer it; and for everybody who says, no thanks (politely or otherwise) there are plenty more people who would get SO much good out of what you’re offering — IF you could just figure out how to get out of your own way enough to be ready for them. Part of getting out of your own way is not agonizing about the one-and-dones, or the people you tried to help but couldn’t, or in general, all the ways you’re not perfect. You just have to show up, over and over, and do your job.

I was talking to another POCA volunteer recently who described a phenomenon we’ve both noticed in different situations (like, really different — CCAOM meetings for me and Facebook groups for them): sometimes people seem to believe that POCA is either much, much bigger and more powerful than it actually is, or much, much smaller and sort of miserable, and also sometimes they seem to believe these things simultaneously.*  You can generate a lot of drama around either huge & powerful or tiny & wretched, but generating drama is, let’s just say, more characteristic of CAN and our historically famous/infamous parties than it is of POCA’s relatively sober and pragmatic present — and future. The truth is that POCA’s a small business, doing its thing, making stuff for people to use.

The clinic membership changes are, in some ways, the beginning of a new phase, but they’re also a reaffirmation of what we’ve been doing all along — small business. Having a cooperative is an expression of faith in small business. Having a cooperative that’s sociocratically organized is an expression of faith that members who care enough to volunteer for Circles like Membership and Finance will make good decisions about those things. The beauty of our knowledge commons is that we share what works and what doesn’t work in all our different small businesses, and that’s the basis for making acupuncture accessible to hundreds of thousands of people who otherwise would never had had it. We just have to keep our heads on straight, keep our focus on our business (the one we own together and all the ones we own separately) and keep doing our thing. Thank you, Membership, and thank you, Finance. Onward!

p.s. If you want to discuss the clinic membership changes further, here’s a thread where you can do that: https://www.pocacoop.com/forums/viewthread/9146/

*I have a theory that this is part of what happened with Modern Acupuncture, they had two thoughts simultaneously: on the one hand, the community acupuncture model is BRILLIANT, it’s gonna be HUUUGE; and they also thought, those stupid communists don’t even know what they have!  They didn’t really look at what we were actually doing, and its relative challenges and rewards. Yeah, we’ll see how all that turns out.

Author: lisafer