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. Tan’s methods don’t produce lasting results, using second hand furniture means the clinics aren’t pleasant and no one will come and more.  

 I decided to see how the clinics are doing.  I did a survey of the clinics on Locate a Clinic in May of this year.  The results are below.  

Overall Conclusions:

The only correlations I could see from the data are that:

1) Acupuncture (Acu) income per week is larger if there are more than 1 L. Ac working at the clinic.

2) Acu income per week is larger if there is a person doing reception, not just the Invisible Receptionist (IR).There are a few exceptions to this, but these are the general trends.

3) In the entire sample, salary of owners did correlate with # of months being open, with those open longer paying higher salaries.This correlation did not hold in the medium sized clinic sample.

Other outstanding results:

1) Large urban clinics (4) provided a living to the owners between opening and 12 months with 4 out of 5 reporting making a living between 0 and 5 months.

2) In the mid sized clinics (29), the range of months to making a living for the owners ranges from always to 36 months.Of the 14 reporting on this parameter, all but 3 of them (or 21%) were making a living from the CAP (Community Acupuncture Practice) in 14 months.

3) Of the small clinics (3) one owner expects to make a living at 6 months.The other two, open 13 and 22 months have not made a living at the CAP yet.

4) Success of a clinic did not correlate with # of years in practice before starting a CAP.

5) Acu income per week did not depend on the size of the clinic with the exception of Working Class Acupuncture.

Summary of LOC survey dataMay 2008

By Ann Mongeau L. Ac., RN

Survey Request andquestions:At the end of this report.

Methods:At the end of this report

Sample:

37 out of 60 LOC clinics responded for a 62% response rate.

The sample was divided into 3 categories – small, mid and large sized clinics (see methods for the reasoning behind this grouping):

Small (5 or less chairs/tables) 3

Large(12 or more chairs/tables) 5

Mid(6-11 chairs/tables) 29

One clinic has been open since 2002, another since September of 2004 and the rest have been open 2.5 years or less.

Size of clinics range from 242 Square Feet (SF) to 4000 SF with the average of the mid sized clinics ranging from 700-950 SF

20 or 54% of the sample have 2 or more L. Acs working at the clinic.

One clinic is rural, 11 suburban and 27 either urban or urban/suburban.

4 out of 5 of the large clinics are urban, one suburban.The rest of the sample is mixed between urban, suburban and rural with 1 clinic rural and 1 clinic rural/suburban.

The type of building and layout of the clinics vary with no pattern except that the larger clinics tend to have one or several large treatment rooms.Clinics in office buildings predictably tend to have several small treatment rooms.

Location

West (California,Colorado, Arizona) – 10

NW (Oregon,Washington, Canada) – 8

  NE(Maine, CT, RI, MA, NH, NY) – 9

MW (MN, TX, WI, IL)– 10

Rent

Small = $695 – $1000

Large = $991- $4000

Mid = $655 – $2150 Average =$966

Sliding scale, # days open

All clinics fit the following CAN LOC criteria:They feature group treatment spaces (no private acupuncture treatments), a sliding scale somewhere between $15 and 40 with no greater than a $15 surcharge for the initial treatment. If a flat rate is charged, it’s $30 or less. No proof of income is required or requested. Herbal consults are charged at the same rate as the community acupuncture rates above. The clinic must be open at least three days a week.

Operating expenses annually

Vary from $9K to$115K.The average of all clinics with these outliers removed is $28.9K.

Most medium clinics are ranging from $20K to 40K.

Start up costs

Vary widely from 0 -$40K.I didn’t ask for details so no conclusions can be drawn.The average was $11,500.

Results:

# Months until making aliving

The large clinics (5 in the sample) report owners making a living from 0-5 months after opening.4 are Urban and one is Suburban.

Of the small clinics (3) one owner expects to make a living at 6 months. The other two, open 13 and 22 months have not made a living at the CAP yet.

In the mid sized clinics, owners of several were making a living right away; another group at 4-6 months; a group at 10-14 months and one at 20 months.

# Months until making aliving – Mid sized clinics

# months		1	2	3	4	5	12	14	20	36
	# clinics	3	1	1	2	1	2	1	1	1

This parameter is hard to evaluate since “making a living” varies from individual to individual.Only one clinic in a rural area has been open two years and the owner is not making a living.There is only one clinic classified as totally rural in the survey.

Comparisons of categories:

In the entire data set(large, medium and small clinics)

There was no correlationbetween:

Acupuncture(acu) income per week and

location (area of North America)

U/S/R (Urban/Suburban/Rural)

U/S/R and location

U/S/R and # months open

years of private practice before CAP

#pt spaces except in the case of WCA

#months open

#months until seeing 50-60 a week

open on Saturday or Sunday     

Acu income per week does rise with more L. Acs working in the space.

Invisible Receptionist:In general, if a person does reception,the clinic income is greater but there are exceptions in the medium sized clinics.

No correlation between:

# months until seeing 50-60 a week

U/S/R

Location

#L. Acs

Large clinics (12 or more spaces) were seeing 50-60 per month in 2 – 5.5 months

Mid clinics (6-11 spaces) were seeing 50-60 per month in 1-16 months.The mathematical average is 7 months.There are clusters between 1 and 7 months and again between 9 and 12 months and between 14 and 16 months.

The two small clinics reporting took 9 and 18 months respectively to see 50-60/wk.

Data in the Medium sizedclinics only:

Is consistent with the comparison data from the entire sample except salary of the owners did not correlate with # months open.

Overall Conclusions:

The only correlations I could see from the data are that:

1) Acu income per week is larger if there are more than 1 L. Ac working at the clinic.

2) Acu income per week is larger if there is a person doing reception, not just the IR.There are a few exceptions to this, but these are the general trends.

3) In the entire sample,salary of owners did correlate with # of months being open, with those open longer paying higher salaries.This correlation did not hold in the medium sized clinic sample.

Other outstanding results:

1) Large urban clinics (4) provided a living to the owners between opening and 12 months with 4 out of 5 reporting making a living between 0 and 5 months.

2) In the mid sized clinics (29), the range of months to making a living for the owners ranges from always to 36 months.Of the 14 reporting on this parameter, all but 3 of them (or 21%) were making a living from the CAP in 14 months.

3) Of the small clinics (3) one owner expects to make a living at 6 months.The other two, open 13 and 22 months have not made a living at the CAP yet.

4) Success of a clinic did not correlate with # of years in practice before starting a CAP.

5) Acu income per week did not depend on the size of the clinic with the exception of Working Class Acupuncture.

There are many factors that go into the making of a successful clinic that can’t be measured in a survey.Some of these are: empathy, sincere desire to help, organizational ability, people skills, charisma, drive to succeed, the drive to improve skills, confidence (in all skills), amount of attention that is able to be paid to the business, business skills, location of the clinic, ease of accessibility of the clinic– and probably many more.

It is my hope that this survey will give those considering a CAP some information on the history of some of the North American CAPs so far.

I would love to see a similar (and better) study done on the private practice of acupuncture in North America and a study done on the fate of graduates from acupuncture colleges.That awaits someone with the interest and money to do the study.

I anticipate repeating this survey or a better one periodically.

SurveyRequest

        CAN has been in existence nearly 2 years.  There are now 60 clinics listed on LOC.  As a teacher of the model, I often get questions about how clinics are doing.  People want to know if clinics are successful (i.e.making a living for the practitioners), how long it took them to be successful and what financial picture to expect.  I think it is our responsibility as promoters of the model to have some facts/history to give to people instead of asking them to take the model on faith.  We now have enough history to begin.  I also note that even though Skip posted the infamous “Make NoSmall Plans” post advocating for a “Big Damn Clinic”, the vast majority of clinics have from 6-11 chairs/tables. 

        I would greatly appreciate as much of the following information as you are able and willing to provide.  I will compile it in an excel spreadsheet and make it available on CAN.  I will identify each clinic by the area of the country (NW, SW, MW, E, etc) in which they are located, rather than the name of the clinic.  If you don’t have the data that I’m requesting but can give me some data that I can use to figure out what I’m asking, I’ll gladly do the math.  Of course, I’ll go with what I have but I would really appreciate a complete response from every clinic within a month.

        I will not list salary or expenses per year minus salaries by clinic but report them in the aggregate i.e. in the MW, L. Ac salaries range from X to Y. Yearly clinic expenses ranged from X to Y.   I will also sort the data and make some tables that draw conclusions.  I intend to group the clinics in 3 groups – those with less than 6 chairs/tables, those with 6-11 chairs/tables and those with 12 chairs or more.  My reasoning is that the max an L. Ac can see is 6 pts an hour.  Therefore one L. Ac needs at least 6 chairs/tables and 2 working on the same shift need at least 12 chairs/tables.

This should be a very interesting view of where we are at this point!

        Please add your responses and e-mail this back to me at amongeau@mm.com

Many thanks, Ann Mongeau

ClinicSize:

# chairs

# tables

# couches (will count as 2 chairs unless you indicate otherwise)

# Square feet of your clinic

How many treatment spaces (i.e. one large room, two smaller rooms, etc)

Location:

Town, State/Province

Urban/Suburban/Rural

Store front/officebuilding/ industrial or warehouse  Other (describe)

Finances:

Rent/month

Yearly expenses minus salaries (not reported by clinic)

Sliding scale

Start up costs if new business

# Years in pvt. practice before CAP

Conversion costs if established pvt. practice

# acu visits per week

acu income per week (include new and return visits)

herb income per week (sale of herbs)

# L. Acs full time/part time including owner(s)

Office manager: Hired/volunteer

Reception status: IR/#Hired/#Volunteer

The following information will be reported in the aggregate i.e. salaries in the NE ranged from X to Y.  If there are only a few clinics in the area, I will lump the salaries in a larger area so that individual clinic salaries aren’t discernible. 

Officemanager         pay/hr

Reception                pay/hr

L.Acs                     pay/hr orsalary

Owner                     salary

History:

Year-month opened

Days and hours open i.e. 6 days 28 hrs

Open Saturday

# months until seeing 50-60 acu visits per week

# months until the owner(s) made a living from the CAP

How long (mo) owner(s) have 2^nd job while CAP

Methods:

I got permission to do the survey. 

I printed the LOC list on May10, 2008 and this list served as the basis for recruitment of participants.I e-mailed the survey to those 60 clinics on May 10, 2008. I requested the data within a month.I resent the survey to most of those who didn’t respond between May 26 and June 1, 2008.Another request was made of two of the larger clinics on June 21.Those surveyed were contacted through the CAN web site or their own web sites published on CAN.

For analysis I placed clinics in one of three groups assuming one L. Ac can see a maximum of 6 pts per hour and the patients would stay a maximum of one hour.Small clinics have 5 or less chairs/tables (pt spaces) and can accommodate one L. Ac per shift seeing 5 or less pts per hour. Mid sized clinics have 6-11 chairs which can accommodate one L. Ac seeing 6 per hour but not 2 L. Acs per shift working at maximum capacity.Large clinics have 12 or more chairs so that two L. Acs seeing 6 per hour could work the same shift and see their maximum number of patients.Clinics with enough capacity can and do allow patients to stay until they are ready to get up.

I used Micorsoft Excel for data entry and analysis.

If a cell is empty, the parameter wasn’t reported.

When a range was given for a parameter, I occasionally averaged the number (i.e. income per week from X to Y) or multiplied out the number (owner income X per month times 12) so that the sorting function would work.

I created parameters that weren’t asked for in the survey to enable sorting (i.e. # chairs and tables was added and put in a category “# pt spaces” and the # of months open were counted from the opening date to May 08).

If the type of reception wasn’t specified, I assumed the use of the IR.

I compared data using an excel spreadsheet, the data sort functions available on excel, eyeballing the results and sometimes hand calculating averages.No other statistical measures/methods were used.

I compared parameters in the entire data set and then created a spreadsheet with just the medium sized clinics and compared the same parameters.

As surveys go, this is a small sample so finding trends in the data is suspect.The mid sized clinic sample is the only one large enough to draw conclusions and those results were the same as the results from the entire sample.