Welcome Speech from POCAFest #1- patient-centered acupuncture

I must admit, I'm a bit wary of ever watching the speech I extemporized at POCAFest on Friday night. Looking out at all your faces, I found that I just couldn't tear my eyes away from the excitement I saw there, and so I put my printed speech down and spoke off the cuff on the ideas I've outlined below. Apparently, you can take the girl out of New York but you can't take the New York out of the girl- or at least, not her born-and-bred penchant for cursing her way through a conversation when she has a strong opinion. And I have a lot of strong opinions! Ah, well. 

For those of you who couldn't attend, or who would like to hear my opinions free from four-letter words, read on! 

WELCOME, PUNKS

I want to welcome all of you to the very first POCAfest. A lot of people worked very hard to make this event happen, so I want to thank them quickly, especially Skip, who organized this whole weekend; David, who scouted out this location with me, and worked to get this event technologically up to speed, with the assistance of Wade, Moses, Joseph, and Macey; thank you Cris for giving me the idea to look up this venue in the first place; Tatyana for spearheading the merch station and getting T-shirts printed up, and working the registration along with Nora, Kelly, Carmen, and Suzzanne; thanks to Cortney for getting all our CEU’s squared away; and to all the workshop and meeting leaders for being creative and awesome and dedicated; and thanks to Lisa for letting me preview her amazing keynote speech that helped me figure out what I want to say here.

The theme of our conference this weekend is patient-centered acupuncture. That is, acupuncture that has very little to do with the acupuncturist and their training and life path and various spiritual awakenings; but rather, acupuncture that everything to do with the patients! That is the work that we all do in our clinics; getting over ourselves and focusing instead on doing the best we can to create a sustainable means of bringing some relief to our communities. The “getting over ourselves” is actually the unofficial theme to this conference, which is: how to quit being an acupuncturist and become a PUNK.

To give us all a little context here, I’ll tell you that the first known use of the word punk was in 1596, so it’s a traditional term; it’s has a lineage, you might say. There are some not-so-great associations with the word- “inferior, rotten, worthless”- but as we know, words can be reclaimed and empowered. Anti-authoritarian young people took back the word punk in the 1970‘s and weknow it today as a word that describes “a member of a rebellious counterculture group.” Perhaps you can think of some people who fit this description.

But punk is also an action you can take against someone else. At least, that’s what it says on online slang dictionary dot com. If you “punk” someone, it means you’ve insulted them, you’ve criticized them, you’ve badly defeated them. Another definition of punk means to steal something of fairly low value, like: “Hey, that guy punked my bus transfer!” or “Hey, Skip totally punked my AAAOM membership card!” So punk is: a counter movement, proud rebels, humiliation of oppressive forces, stealing something worthless. With all those definitions in mind, I feel pretty confident in definitively stating that POCA has punked the acupuncture profession.

Now that we’ve gotten clear on who we are, I’d like to talk a bit about what we’re doing here this weekend, and what we’re doing going forward. I want to invite everyone here to think big, and get connected. These two things are related. The more connected that we become- to each other, to POCA, to our communities- the bigger the whole movement will get. Our clinics will get bigger, for one: they will provide treatments to hundreds of patients coming through our doors each week, they’ll provide salaries for several full-time punks and support staff, they’ll create a solid and reliable community center that will stay open even when one of the employees catches a cold, or has a baby, or takes a vacation. Our clinics will be real, functioning, sustainable businesses.

Another thing that will get bigger is awareness of community acupuncture: what it is, what it can do, how to find it and start getting it. Awareness creates demand, and POCA will be able to meet that demand by offering more trainings for punks, more support for clinics, more outreach to the public, and eventually, an alternative to overpriced acu-schools.

But a major way we need to think bigger is in terms of how community acupuncture can change the world. How far can we take this community acupuncture thing? How much can it really do to make a significant difference in the world we live in? I believe it has the power to solve a number of our most pressing problems in modern society. Let’s talk about that for a bit.

What are some of these issues? Community acupuncture is a form of healthcare, so let’s look at some of the biggest issues in healthcare today. Take, for example, the top medical expenses incurred by Americans in 2010. Going through the list, we see: Heart conditions; Traumatic accidents; Cancers; Mental health issues; Joint disorders; Respiratory conditions; High blood pressure; High cholesterol; Diabetes; Back pain. The drugs most commonly prescribed? Exactly what you would expect having heard the list of medical expenses: Painkillers; Statins; Blood pressure meds; Antacids; Antipsychotics; Asthma inhalers; Diabetes drugs.

Let’s use these statistics to forever let go of the belief that people need specialized, artisan- hand-crafted acupuncture treatments that require hours of personalized attention and complicated inquiry. It’s not true; people are not incurring billions of dollars in healthcare costs because they have specialized, rare, unusual, personal conditions, so let’s just get over that idea once and for all. The vast majority of people suffer from the same damn problems, which almost always come down to pain and/or stress. Pain and stress are the biggest root causes of mortality and morbidity in our society. Chronic stress is a major factor in heart disease, the number one cause of death for many years now here in the U.S. 

People who are stressed turn to addictive behaviors, like, smoking, drinking, and poor eating habits, as coping mechanisms; these habits in turn account for a large percentage of the second leading cause of death: cancers, complications of diabetes, the ninth leading cause of death. Accidents are the fourth leading cause of death; maybe you wonder, how can acupuncture prevent accidents? Well, studies show that the biggest factor in accidents is stress: people who are stressed are not paying attention. 

People experiencing pain and stress are naturally more likely to experience mental health problems; according to the CDC, 60 million Americans suffer from mental health issues, including depression and anxiety; and mental health problems are the number one cause of disability in the U.S. The tenth leading cause of death in this country is suicide. People who self-harm feel isolated, and according to a wide body of research, modern people are more socially isolated than ever before. People have far fewer close friends today than in previous years, and at any given time, 20 percent of all individuals are unhappy about being lonely.

Pain, stress, isolation: some of the biggest problems we face, and we punks have the means to address all of them. Community acupuncture is a simple and effective way of helping people with pain, stress, and isolation. An hour out of your day, once or twice a week; a place where you can look around the room and see your neighbor, your kid’s teacher, the guy from the hardware store, your co-worker, all resting together; where you can understand really deeply than you are not alone in your suffering, that everyone needs a chance to slow down and feel like themselves again; a place where there are absolutely no requirements beyond showing up; no beliefs necessary, nothing except a reasonable fee and some time. This is an incredible, beautiful, simple, effective solution to all of those problems I just listed. You all know this is true, if you’re a punk; or you’ll learn it for yourself, if you’re just getting started. A room full of chairs, some needles, some time. There is no other place where people can rest this way together, where people are not divided by occupation, economic status, race, religion, politics, or beliefs, but can cross all cultural spectrums and still be in the same peaceful space. Do not underestimate the power of that simple formula. We can literally change the world with it, if we could just get this service to more people.

Now here’s where I’m going to ask you to help out by thinking bigger, and getting more connected. In 2011, about 200 clinics gave about 300,000 community acupuncture treatments. That’s a great start. But in order for us to actually use community acupuncture to change the world, to give hundreds of millions of treatments each year, we have to think WAY bigger. In order for us to be in enough places to reach all the people that need us, we will need to reach out and clearly explain to the world at large what we do; we will all need our clinics to become much bigger and more stable; and we will need way more punks and clinics.

This simply doesn’t work if we try to do it by ourselves. We can’t do this alone, and why would we? Our movement has always been about collective leadership and collective action. DIY is a great punk ethic, but it’s not sustainable for the community acupuncture movement. Success in community acupuncture is WE, not I. Maybe one clinic here and there can survive with one dedicated punk and lots of volunteers. Maybe a few charismatic people can swing a few hundred treatments each week by themselves. But the reality is, the solo-punk clinic is far too fragile of a model on which to base a much bigger movement. All it takes is one simple life event to happen to that punk: a baby, a marriage, a move, an illness, a change of heart, and poof: it’s all gone. No more acupuncture for those people.

But you know, the solo CAP with one punk is not that much more fragile than the solo owner with a few employed punks. That model is not actually much more sustainable either. Let me quote here someone more experienced than myself, someone who has been in this movement since day one, someone revered among us, meaning, of course, Skip. And Skip commented recently on the subject of being a sole owner of a CAP, and I believe, to quote him exactly, his sensitive and wise and thoughtful opinion on the subject was, “It sucks to be you. Solo owner/ practitioners. It sucks being that. You have too many responsibilities on too many levels and no one is good enough to handle that balancing act by themselves.” This is the truth. It IS too much, and it is NOT sustainable. I don’t know any solo CAP owners who actually get paid for all the hours they put in running the place, who aren’t letting a dozen little things slip through the cracks every week through sheer overwhelm, who aren’t regularly pulling double shifts or having to close when flu season comes around. It’s not sustainable for punks who want to avoid burnout or for patients who want reliable access to consistent care.

So what’s the solution here? We know we want there to be WAY more clinics and yet we also know that doing it the way a lot of us have been doing it is not going to work in the long-term. I had a big idea last spring about what I came to discover is called social franchising, and though at the time I thought I had made it up, because I had never heard of it before, it does exist, primarily for delivery of health services in developing nations. Social franchising is when you take concepts of franchising and apply them to social businesses to help them scale up. Social businesses exist to provide services or products that aim to effect social change, while offering stable employment for the people working in them- community acupuncture aim to be social businesses. Franchising involves standardizing all of a business’ systems- the services offered, the prices, how staff gets paid, how the rooms are laid out, what vendors you use for supplies, how regularly you order inventory, everything- in order to make it user-friendly for both the people working there and the people coming in. If you’ve worked in one franchise location, you can easily step into another. And if you’ve gone to one location as a patient or customer, you will know what to expect from any other location. Franchise locations can differ a bit from each other, depending on the nature of the places in which they’re located or the personalities of the people working in them, but ultimately the things that matter- services and systems- are standardized. This kind of standardization could really help stabilize CAPs. For example, on Wednesday I had a sick punk, another punk who couldn’t cover because she couldn’t get childcare, and me, who had already worked four shifts in three days. But I couldn’t call my friends at Circle or Community Acupuncture Works or anyone in the East Bay for help, because having to show them around my particular systems, talk about all the random ways we differ in things like charting, where the cotton balls are stored, what kinds of treatments we do, how I would pay them- it’s pretty complicated to just add someone else into the picture. Standardizing systems would solve that problem.

Unfortunately, franchising requires a lot of things that we don’t have in POCA, including a management structure, legal agreements, financial agreements, and all sorts of scary and complicated stuff that we frankly know nothing about. But the idea of social franchising led me to think about other options, like developing a model by which clinics in a geographical region, like the Bay Area for example, or a part of New England, could be collectively operated by a team of people, using a model of standardized best practices for services and systems. I was inspired by the way that WCA uses modules to divide up the work of operating a clinic. Now if you’re not familiar with modules, let me sum them up by saying modules are a means of taking the work of operating a clinic- things like inventory management, HR, bookkeeping, marketing- and dividing them up between the punks at a clinic. So instead of one clinic owner who works clinic shifts, hires punks to come in and work other shifts, and then does all the admin/cleaning/financial planning/inventory/HR/etc. in their “free time,” a clinic using modules would employ several punks who worked needling shifts and took on a module or two. A full-time punk’s work week would include about 25 hours of so of needling and charting and being with patients, and on average another 5-7 hours doing HR, or marketing, or whatever their module is. So the idea with collective operations is to develop a pilot program wherein all systems and services across several clinics are standardized, and modules are split between them. Another way to spread out the work involved in operating clinics would be to have multiple local clinics who have standardized their services collectively hire one clinic manager to do all of the modules all of their clinics; developing a marketing plan for one clinic is really not that much less work that doing one for five; nor is overseeing HR. So then the punks could just be punks, and leave clinic operations to a professional.

Now, developing these new ideas will take a lot of eyes. I invite anyone who has thoughts about this to contact me, at director@pocacoop.com. We need a lot of experienced input from big clinics as well as fresh insight and ideas from newer folks, because part of developing best practices includes solving some of the lingering problems we have within the CAP model. One major problem that clinics continue to struggle with is long-term financial sustainability, by which I mean, having a cushion for operations to pull a clinic through a slow period, having income that supports employee health and retirement benefits, and basically operating on margins that are a little less precipice-like. You don’t build big buildings on precipices. Okay, I guess it’s absurd for me to stand here in Northern California earthquake country and say that, so I’ll say rather, you don’t build something *lasting* on a precipice; all it takes is one little shake and the whole thing comes tumbling down. We need more solid ground for this movement.

Developing a collective operations model is one way of building more solid ground. Another is to envision more broadly where and how we can see CAPs being built and sustained. I am asking for your ideas here as well. How can we envision CAPs that can be replicated more easily? Can we develop different kinds of CAPs that could be attached to existing structures and systems?

How could CAPs be integrated into public systems, like CAPs in libraries? Attached to post offices? At every town’s city hall? On every military base? Associated with every school district? What about CAPs on community college campuses? Or associated with a national or regional network of non-profits? Can we attach a CAP to existing retail models? Coffee shop CAPs? Craft brewery CAPs? Salvation Army or Goodwill CAPs? Oil change CAPs?

What else can we figure out? Well, people keep asking about an affordable acu-school. Believe me when I say some of our best minds are on task for that, but before we can start graduating punks to work in our clinics, we need to ask, how can we make it easier everywhere for punks to practice? What if everyone here committed to attending a meeting with all the other punks in their region to brainstorm how to ease legislative barriers to practice in their states or provinces? Can we collectively research licensing laws and protocols for changing existing standards, start getting to know local lawmakers and board members, start gathering information about the processes and people involved in licensing in places and then sharing what we learn on the forums? Having friendly licensing laws in place and having access to exams are key factors for POCA to provide education that will lead to licensure and the ability for punks to practice. What can we do to ensure that we can graduate effective and competent punks who have the right to practice and aren’t in enormous amounts of debt?

I am asking you to all participate in bringing us to the next level. I want to hear from you. I want to hear your ideas, your brainstorms, and your thoughts, no matter how unlikely they may seem. There is a fantasy in our culture that genius and innovation is due to individual efforts. That is not true. Great change happens because lots of people contribute their ideas and build upon them together. Maybe you’ve heard of this remarkable invention called the lightbulb generally attributed to a guy named Thomas Edison. So, Edison had this set up where lightbulbs had to be placed carefully into an opening in a piece of wood with a few metal strips; the lightbulb had to be set standing straight up and would fall to the ground if moved about- which totally sucked, because one of the first industries that wanted lightbulbs was the shipping industry, and obviously you couldn’t keep the lightbulb steady on a ship. So Edison was struggling with this major problem, and one day in the lab while he was screwing a cap onto a tin bottle of turpentine, a lab assistant nearby was watching him and had the brilliant idea of creating a screw-in base for lightbulbs that could be mounted anywhere. Think of the jokes this world would lack if you couldn’t screw in a lightbulb. But the reason I tell you this story is to point out that Edison’s work, which incidentally was based on the work of various other developers over the previous seventy-five years, might not have gone anywhere without that lab assistant. And why did he have such an observant and participatory lab assistant? Because Edison’s greatest innovation was applying the principles of large-scale teamwork to the process of invention. he knew nothing really gets done by yourself.

That’s what I mean when I say that POCA needs to operate collectively as we grow. There’s a great book called “Group Genius” that I just finished reading which provides tons of research in support of the fact that real innovation comes when we put our heads together. Together, we can create a sustainable scaleable model for clinics; we can create an affordable acupuncture school, we can change legislation to allow simple and legal entry into the community acupuncture profession, we can change the course of healthcare practice and well-being in the world- IF we think big, and work together. We can’t do this as individuals; we must do it as collaborators. We have to lead together. So I am asking you, get involved this weekend and from now on. Don’t look to Lisa or Skip or Cris or myself or any individual to tell you where we’re going- let’s ALL determine the destination and draw up the map. 

Get involved in POCA. Get connected to other clinics and punks in your region. Get involved in Circles- come to the circle meetings and find out what we’re working on, what our long-term plans are, and how you can help. Get on the forums. Talk to each other and share your ideas. Email me or any of the circle leaders if you have ideas or need direction about how to get more involved, but ask yourself what you might have to offer- don’t wait for someone to ask. Let’s plan together to make it easier for punks to be able to be punks and have clinics without getting burned out. Let’s work together to make community acupuncture an everyday part of people’s lives. Let’s enjoy this beautiful Northern California coast. I invite you to draw on the local Ken Kesey and Merry Prankster-qi to inspire us all to take it FURTHER. Thank you for being here and thank you for listening. Have a great weekend.

Author: Demetra

I live in San Francisco but I'm from New York, and apparently it shows. I come from a family with some members who have had very troubling illnesses, and I found my way to acupuncture in trying to figure out how to help. My father's illness cost him his small business, his savings, his house, and ultimately his life. I viscerally believe that healthcare should never, ever be limited to those few with money to spare. I see every day how the practice of affordable, community acupuncture can honestly heal the world. I feel a moral and ethical responsibility to do everything I can to make this gentle, powerful community medicine available to everyone.