Thinking about a CAP? Go to Portland.

Please allow me to introduce myself, as this is my first ever blog on CAN. My name is Larry and I am a new practitioner out of Arizona. I was schooled back east at the Tri-State College of Acupuncture and graduated in 2007. I read “The Remedy” early in the last semester of school and felt that it addressed the bulk of my concerns as a student regarding patient accessability to acupuncture and East Asian medicine in general. On one hand I was set to graduate, having a very successful student career and enjoying the student clinic. On the other, I was casually indifferent to the whole thing and didn’t exactly know why. “The boards? No, I haven’t scheduled them yet?”. “Business cards? Wow, you’re really thinking ahead!”. When I read the Remedy, I was excited for the first time since year three began, feeling a sense of purpose that had been missing up to that point.

Anyways, I would like to write just a bit about having spent a few days in Portland to do site visits at local Community Acupuncture Practices (CAPs). After going, this is my recommendation to any one reading this, whether you like the CA business model and are considering it as a potential practice option, you have just read The Remedy, got back from a conference and have subsequently been transformed into a frothing, wild eyed CA-junky and have no other choice but to start a CAP, you already own and run a CAP, you are appalled at the very idea of CAPs and are here to justify your sense of disgust, you have a vague notion of CAPs but don’t think that you can practice that way or you are kind of wary, but also kind of curious to see what all the fuss is all about. Get your butt to Portland, Oregon, pronto.

My business partner Keith and I are in the process of opening a CAP in Tucson, the first of its kind here. We are both seasoned CAN veterans, having gone semi-blind and delirious staying up to ungodly hours online reading all things CAN. We thought we pretty much knew everything there was to know. We’ve even been to a WCA conference and got the Gospel Of Community Acupuncture from its most revered profits, the venerable Skip Van Meter and Lisa Rohleder. That was a powerful day and invalueable, indeed. However, nothing compares with the experience of just sitting in the waiting room of WCA and watching the ebb and flow of patients through its doors. If you have any questions about the CA model, I guarantee that the vast majority of them will be answered by just sitting in the reception area, watching and listening. What ever questions remain will most likely be answered in silence while reclining in the sacred temple that makes up their treatment space.

The main purpose of this post is to convey what is so hard to understand based on reading CAN or The Remedy. That is, how does a clinic that saw 431 appointments in a week feel and function? Logistically speaking, what is necessary and what is not? What are the myths that we as practitioners believe in and how do we animate and breathe life into these myths. How do the myths we believe in effect the way we physically set up our clinic, book appointments, manage tasks, communicate with patients and needle? Ultimately, how I came to view our trip was myth busting. We were myth busters, acu-style. And when myth is evicted, growth occurs.

Myth #1- The first myth that came crashing down for me was the belief that any clinic needs a seperate, sound proof intake area for first time patients. This one was so sturdy, as solid as Santa. My thoughts on this were something like, “No one wants to go into their health history in front of others so a seperate intake room is essential to the comfort of new patients.” Nope, not really. I don’t want to get into the why of it, rather just what I saw. New patients would check in and pay at reception. Then they would sit in a chair and read a magazine or something. Before long, an acupuncturist would greet them and talk in no great detail about their specific problem, their reason for coming in and trying acupuncture. This process, in all the newbies that I observed in four days, took as little as twenty seconds to as long as five minutes, maybe. The five minute one included massaging an herbal lotion into a gentlemens cervical musculature before being taken back to the treatment room. This blew my mind, I mean absolutley blew it. “What, there’s no Santa!?!” Seeing the ease in which this particular practitioner interacted with the patient, as if they were the only two in the room, while also respecting the fact that they were not, again, blew my mind. It happened over and over. I thought that it could only work because it was early, the clinic had just opened and the only other people in reception were myself, Keith, and the receptionist Connie. Wrong. Actually, the busier it got, the easier it was for the practitioner and patient to disappear. It was louder and more active. People were having side conversation, the phone was ringing and Connie was doing her thing. Basically, what I learned is that it is no big thing to just talk to someone in front of other people. The practitioners weren’t doing anything particularly special that needed to be hidden from others. The immediate gain in busting this myth is that it opens more room in a space for actual treatment. More room equals more chairs equals more appointments and more inflow of cash for a clinic. I must also say that I saw two intial intakes being done simultaneously, side by side on adjacet couches whose ends touched to form a right angle. Very close to one another and no percieved discomfort on anyones part. One of the practitioners was even palpating a womans paraspinal muscles to determine the precise location of her discomfort.

In my own case, the room that this saves in the space that we are close to siging a lease for (fingers crossed) allows the addition of two to three more chairs for actual treatment.

Myth #2- Myth 2 involves talking to first time patients. My myth was that I need to talk to a new patient for at least ten minutes to get a feel for what was really going on as well as to explain the whole acupuncture process for the patient and recommend a course of treatment. Nope. I got to see how practitioners would either glance at the intake and/or just ask what was going on. Everything else can and did occur while the needles were being set in the treatment space. More than that, the pulses do most of the talking anyway. The practitioner just has to listen. A lot of this is covered in the Talking to patients thread in the Forum and need not be covered here. It is just important to emphasize that the needles and the patient do the work while they sit quietly in a recliner. Knowing the ins and outs of a patients medical history who has a wiry pulse does very little. A medical doctor may need to know the intimate details of someones medical history but we don’t. It’s in the pulse and on the tongue and adequately described with few words, one of which is usually stress. Being treated daily for four days at a CA clinic demonstrated this quite clearly.

So, when this myth is busted, where is the growth? There is more time for needling for us and more time for the patient to sit in stillness and experience the profound calm that occurs with treatment.

Myth #3- The third myth that got busted for me involved how far chairs should be spaced apart from one another and that people would want to sit in recliners away from one another. I naturally assumed that people want to be as far apart as possible as to not feel intruded upon, not to be annoyed by the conversations of others and to let any talking that need occur be private, as well as to give me ample room to navigate during treatment. This myth got shattered right quick. For starters, I was amazed at how quiet we can really be when we want to be. A few words, when whispered, are not intrusive when under the calm influence of the needles. This is one reason why it is so important to get to Portland, visit WCA and get treated every day you are there. So much of what can be learned is from the perspective of the patient, not the observing acupuncturist in town on business. Fans, white noise machines, heaters and outside noise eat up most of the room sound in even the busiest of treatment spaces. Soft background music takes care of the rest. But, beyond that, it was amazing to me how much I didn’t care that people were quietly or not so quietly talking. I just felt immensely grateful to be there, in a space where people were coming to feel better and were greeted with open arms. I felt happy to have people sit next to me and was eager to find a recliner next to others rather than away from them. I couldn’t help but think that CA taps into a primal human need for community, groups, sharing and communing. We want to be together and share our experiences. We are most definitely pack animals. We need each other. I felt comfort, not annoyance as the breeze created by an acupuncturist treating another patient brushed my foot. And when I awoke, I was amazed at just how many people were reclined quietly, adrift in acu-land.

How lovely to bust this myth. In not putting chairs far apart we gain functional space, more recliners. By not believing in the need for seperation we are affirmed with the fact that the human experience is collective, not isolated.

Myth #4- Charting. Some of the doubt that I have had in making CA work for me focuses around this issue. As I have started treating people more quickly in my one on one home treatment practice, getting ready for the eventual move into a clinic space, I have noticed that I can talk and get the needles in in under ten minutes usually with no problem. The problem arises when I chart what I did. What was under ten minutes can easily approach fifteen and beyond when I am done charting. Then, I noticed something peculiar at WCA. I never saw a practitioner with a chart in the treatment space. Even in reception, I never saw a practitioner looking at a chart unless it was for a first time patient. Even then, the chart did not follow them into the treatment room. When did they chart? I attended the WCA conference in Phoenix and learned how to chart more efficiently, but the myth I believed in was that you chart when you treat. Wrong. Not in CA. This is a time issue, plain and simple. I learned that you can review all of your daily patients charts before the shift begins and fill in your charts later. This is probably given the lowest priority of all tasks that the acupuncturists had. As Skip has said in a previous thread, you chart when you have absolutely nothing else to do. In the reality of CA, where treatment frequency can be much greater than once a week when necessary, how much of a treatment is actually going to change from one treatment to the next? Probably not much. I sat and watched as acupuncturists performed acupuncture and tended to the needs as patients as they arose without the unnecessary burden of charting. Of course, we want to chart accurately, but it became quite clear to me that charting can be the difference between thinking that I can book a patient every fifteen minutes or thinking that I am ready to book every ten minutes. No doubt, charting can take as long or longer than actually needling if I let it. Now I know that there is a time and a place for charting and that time and place is not in the treatment room.

Myth Busting! What joy! What is gained by busting the myth of charting is more time to focus on treating and the ability to book every ten minutes, if charting is what pushes you over that magic threshold.

Myth #5- Here was a big myth for me. Things need to run perfectly. Well, guess what? They don’t and they certainly don’t at WCA either. Like the old saying goes, “We make plans so that God can laugh.”, this seems to be the rule for a CAP. While I was at WCA, people were late. A lot. People showed up early. It’s all good. I watched as practitioners just went with the flow, and that place knows how to flow. Keith and I dragged a friend from breakfast to get treated and hoped Skip could fit him in. When we got there, he was totally booked, but no worries. Skip briefly reviewed his chart, asked what he could do for him and the took all three of us back and needled. This was also the first time he was seeing Keith and I. And he did a first patient intake before taking us back. The four of us were needled in under fifteen minutes. Of course, Skip is a rock star, but the point is that in not getting bogged down in unnecessary crap, we are allowed the time to adjust to lifes surprises. I watched how when you book every ten minutes, chaos is the rule. However, as CA practitioners we can adjust as necessary and not stress the small things.

Busting the myth of expected perfection allows me to feel into the natural chaos that surrounds us, that we are a part of. Stress can only result if we fight it. This doesn’t have to happen. It all works out at the end of the day.

Myth #6- Now that I’ve spent all this time preaching WCA, this myth is just in time. WCA = Community Acupuncture. This is so not true. What Skip and Lisa have given us is the map. It is up to us to study the map, but eventually we have to put it down and feel the terrain under our feet for ourselves. After spending the first two days of our visit observing and being treated at WCA, we set out to go to as many other clinics that we could in old Stumptown. We hit BCA, Pins and Needles and Acupuncture For Wellness. We wanted to go to more, including Open Hands and Pine Street, but time constraints dictated otherwise. Regardless, of the CAs that we did see, they were all awesome, all vibrant and alive, all unique. They all share the CA business model. However, they had their own touches, their own idiosyncrasies. Each space was a colorful interaction between the personalities of the owners and the physical space in which they were set. They were not cookie cutter copies of WCA, nor did they want to be. The were beautifully themselves, while providing a common service…affordable, accessable, high-quality acupuncture.

Busting this myth gives Keith and I the freedom and joy to create a space that reflects who we are, what we like to see, hear and feel, what speaks to us and through us. It gives us room to just be ourselves.

OK, time to wrap this up. In closing, let me just say that I think it is important that we understand how what we learn in school can screw up our application of community acupuncture and, in the end, hurt us as business owners. When we discover CA and feel a strong desire to manifest it as our practice, we often bring a lot of underlying assumptions into the process. These are our myths. We believe in them because they have served us well up until this point. These myths function and operate as laws in a low volume practice, the practice model that is taught in school. When we unknowingly take these laws into a high volume practice, they slow it down, they impede it. To use an computer analogy, CA has a different operating system than the school taught practice model, or “Boutique Acupuncture”. If we write these codes into the CA system, we will get errors, efficiency and output will be effected and the system will at least underperform and at worst may actually crash. Going to Portland and doing a WCA site visit can help to expose your myths. It can help expose aspects of practice that are unnecessary and harmful to the CA business model. The thing about myths is that they are so believed in, so taken as givens, that weneed to personally experience their illusory and imaginary nature in order to transcend them. Going to P-town can help that process.

And for the critics, get in a chair three days in a row for $55 and then we’ll talk.

Much love and thanks to Skip, Lisa, Moses, Christine, Connie, Lupine, Ilse, John, Matt, Joe, Maria, Kelly, Diane, Sarah and everyone else who helped us on our trip.

Author: LarryG

CA punk for 12 years. AZ License #600