What Makes For A Busy Clinic? Looking At The Annual CAN Clinic Survey
Yea! The annual CAN survey of clinics is out! Time to see if we can glean any information from it that could help our clinics get busier. Before I do that though I need to say every year I'm relieved when this comes out because since we (Lisa and I at Working Class Acupuncture) first started reaching out to other punks about practicing acupuncture like this-Community Acupuncture that is-we always had in the back of our mind a tiny worry that we were giving our colleagues wacky advice. People kept telling us that for whatever reason the circumstances that allowed WCA to be a viable clinic wouldn't work anywhere else, and sometimes we were afraid they might be right. Honestly I am not sure what I would have done if that were the case.
But you know what? Other clinics can do as well as WCA! Yay! So let's tear into the survey.
The first thing to see is that 41% of the clinics that were on Locate-A-Clinic at the time of the survey, late April-mid-May responded, or 95 of 215. Meh. Such is to be expected when you depend on people to fill out on their own an on-line survey. So some things we can't figure out very well and some things we have to take into consideration:
– With such a survey you have to figure that the clinics that respond are more positive than the group as a whole. How much? I have no idea. However as I look at the raw data I see that a bunch of the clinics that I know are doing well did not respond so I feel I can say that it's not at all like the busiest clinics responded and the non-busy clinics didn't. But until we have a full census, we can't say we have a completely true picture of POCA LOC CA clinics.
– The survey notes that most of the clinics (80 or 84%) first opened their doors in 2008 or later. My educated guess is that if more clinics had responded then that percentage would be even higher. I say “educated” because in one way or another I think I am aware of a healthy 95-98% of the CA clinics in North America, including a score or more that aren't on LOC or even a part of POCA. And the important thing about this is something I'd eventually really like to know but is beyond this survey:
How long does it take a newly opened clinic to 1) break even financially, 2) financially support at least the clinic owner, and 3) how many treatments a week does it take to do 1 & 2? If we could tell prospective clinic owners and punks what they need to do and how long it will take to be able to make a living from this, that would be great! But we’re not there yet. In a year or two I'd really like to make that push. My guess right now is that you should expect to take two years to really get going. It takes most newly hired punks a good year to get used to the faster pace of CA and develop a patient base. If you find yourself say three to four years in and still aren’t seeing by yourself say 80 patients/week then I think something is off. Possibly you have distractions that keep you from building your practice like say family needs or perhaps there's something you are doing in the clinic that's a turn-off: poor space, going too slow, not open enough hours, etc. If that is true then you should get in touch with POCA Clinic Success and speak to us about your issues. We'd love to help!
With those big caveats there are still a few things that we can see. In the six years since CAN started, a variety of clinics have opened up and even with this survey we can possibly discern things that successful clinics share. That's what I want to talk about with the rest of this blog post.
strong>How busy is busy and how many clinics are busy
From the raw data where 95 clinics answered, I see that 24 of them reported seeing at least 100 patients/week. In addition, from my talking to several of the others who were close to that mark, I am pretty certain that a further 15 clinics have since crossed that 100 patients/week barrier for a total of 39. That's 41% of the responding clinics are up above the 100 patients/week line now. (Remember the survey is reporting 2011 numbers so I am trying to make it current.) I can also think of off the top of my head a further 10 clinics that are definitely above that line but didn't respond to the survey. There are probably more.
-10 of the responding clinics were seeing greater than 200 patients/week. (12%)
-2 clinics were over 300 patients/week. I am also sure that a further three clinics passed that line since.
– 5 solo practitioner clinics are included in those 39 clinics over 100 patients/week (and two of them have just hired a punk. The rest of the clinics have at least two practitioners.) It seems like the outer limit for the number of patients a solo practitioner can treat in a week sustainably is around 120-140. The highest total reported was 135/week. Notice that I say “sustainably” as there are reports of individuals treating 160 or more on selected weeks.
– Price. I looked into what was the cheapest price clinics charged for a second appointment. From the survey all the clinics reported charging either $15 or $20 for second appointments. That's notable in that I am aware of several clinics charging at least $25 for return appointments but none of them answered the survey. Oh well.
But of the responders, 25 of 95 or 26.3% charged $20 for second appointments. The rest (73.7%) charged at least $15.
For all 39 clinics that see at least 100 patients/week, 7 of them charged $20. That's 18% for $20 return appointments, 80% for $15 return appointments.
Get this: the top nine busiest clinics all charged just $15 for second appointments. That's all but one of the 10 clinics that reported seeing more than 200 patients/week. One of the things that I tend to believe is that those clinics charging $15 rather than $20 more than make up for the $5 less per return patients they get in greater volume. Now having the nine busiest clinics all charging $15 as opposed to $20 or $25 is not definitive proof but it does tend to point in that direction. And to be fair the 10th clinic is not only doing fine but has a help wanted sign out as I type.
– Of the 39 clinics with 100+ patients/week, they reported as opening in the following years. Remember they are reporting 2011 numbers:
- 2002: 1 clinic (This is WCA)
- 2006: 1 clinic (and that one in December)
- 2007: 6 clinics
- 2008: 9 clinics
- 2009: 6 clinics
- 2010: 10 clinics
- 2011: 2 clinics (Youngest clinic opened last September)
Of the 10 clinics that reported over 200 patients/week, 1 had opened the year before (January of 2010 to be exact so really they had two years), 2 had opened in 2009, 3 in 2008, 2 in 2007, 1 in 2006, and 1 in 2002. One thing to do is go back to past surveys to see how fast these clinics got to 200.
Of the 300 club, 1 had opened in 2002, and the other in 2007. And I said that three more clinics are undoubtedly over 300 now: 1 had opened in 2008, 1 in 2009, and 1 in 2010.
– Number of chairs in these 39 clinics.
- 2 reported at “4 or less” chairs.
- 17 reported “between 5-9” chairs
- 11 reported “between 10-14” chairs
- 4 reported “between 15-19” chairs
- 5 reported “over 20 chairs” with the biggest being 30 chairs
8 of these clinics either moved to a new location which allowed them to have more chairs or were able to expand on site. That number is from my memories of conversations past and is probably low. The takeaway message here is that if you hope to get big and start off with less than 10 chairs/tables, you will probably have to expand or move. And yes it's a PITA.
Okay, I'm running out of steam here. Anything you see that you want clarification on? Anything else you want me to look into? Post in the comments!
P.S. Do you love talking and thinking about busy clinics? Come to our Big Damn Clinic workshop! The price for registration goes up on Aug 15 and as I write this we are just about 2/3 full. Register here!
“The takeaway message here is that if you hope to get big and start off with less than 10 chairs/tables, you will probably have to expand or move. And yes it’s a PITA. ”
I can second that. We started out with 8 chairs with no reception room or office space then expanded to 11 chairs with a separate office and reception room. Recently, we squeezed in 2 more chairs so we are up to 13. Now… we are looking to move when the lease is up next year to a space for 25-30 chairs (in a lower rent neighborhood).
BDC in Kansas? Yes please!
love this, thank you Skip! I can see our history of coming in line with these trends and reaping the benefits: –moving after 6 months to location that allows 12 chairs (went form 8, prob add a few more soon),
–doubling our hours and making them consistent across the week (ie. easier to remember for patients), –lowering our scale from $20 to $15 (our numbers doubled within a month).
–we also took your advice and got clear on our job descriptions using the module system and worked to clear any other emotional/outside issues that might be stopping the flow.
for your question:
1)we are a slow to medium grower. we paid our bills from the first month in jan 2009 (even with a $1600/mo rent). we broke even at about 14-16 months if I recall correctly. but until we made the above changes, our numbers stayed stuck at different points.
2)We paid ourselves in line with the majority of practicing acupuncturists the second year (ie. $20,000ish each) and we have increased by 50%+ each year since.
3)It takes about 165 txs/week to do all of the above (including a budget that includes everything! all our insurance, CEUs, licenses, clinic savings, and as of Jan, health insurance for us and our receptionist). As soon as we are back stable in the 180-200 range (where we were before summer slow down), we’ll have full-time paid reception.
within the next year, we’ll have another punk and possibly another location, perhaps in a nearby city. hello BDC!!!
I know BDC will address again/more the employee/when/ how much questions, so looking forward to that!
so, yeah, following the recipe as closely as possible: scale, size, hours, systems plus hard work and perseverence = dream come true (and that’s way more than the money part, of course, WAY more.)
* in the spirit of full disclosure, we also had an angel donor at six months in. A patient that loved the clinic so much, she just wanted to drop some cash on us! We set it aside in its own account and called it an advertising/operating budget and we only used to for things we wouldn’t otherwise be able to do: occasional newspaper ads, health fair entrance stuff, recliners when they broke at times we didn’t have anything in the budget, accounting costs the first year (we budget for that now!), office break-in expenses, travel to CANference and POCAfest. We never put it towards our regular monthly expenses or pay, so we could really see what was sustainable. (Believe me, there were some early months this would have increased the food budget!)We went through it after 32 months, so it averaged maybe a few hundred per month, but what a testament and a gift, and we were floored with gratitude.
anyway just wanted to throw that out there as a testimonial to believing in the trends you point out.
Just heard from a clinic that didn’t participate in the survey and so is not listed here:
The Acupuncture Studio in Glens Falls NY. moved earlier this year from a place where they had I think 5 chairs? Not sure there-to a place that has 11 chairs. Their numbers have gone up from 133 at the old place to 150 on average. A week. A couple weeks have been 175. Oh-and this is a solo punk, Kevin Campopiano.
Kevin is a beast.
Too busy to respond to the survey, sounds like! Go Kevin!