Teaching CA in Schools

A few months back I was asked by Lisa to give a “guest lecture” for the CA class at OCOM.  Recently, in forums Tatyana brought up the fact that she was going to start teaching a class, asking for experiences/advice from people who had done it.  I was going to just post there, but I feel like there could be a lot of input from the Bloggosphere, so I’m making this my post. 

Also, a lot of this stuff has relavence not just for students, but fresh out acupunks and people who still might be curious as to “what’s this CA stuff all about anyway?”.  In lots of ways these are some fundamental issues that we all have to deal with in the “deprogramming” from school’s standard “Private Practice” model to the Commmunity Acupuncture model.  

I’m being lazy, so this will be in the same outline form that I used as the basis of my talk.  Many examples were specific to the Portland area, so bear that in mind.  Of course, not everyone will agree with these points, I welcome any discussion. 

Hybrids?  Herbs?  And  Private Practice?


1.  Tons of ideological reasons not to do it, probably covered already
a.  divides loyalty
i.  patients don’t often understand the differences in treatment or cost

ii.  Class issues
b.  very different modes of practice
i.  CA and PP are totally different approaches

2.  I am no zealot–even with CA–I’d love to be able to have a hybrid, but here’s the practical reasons that I can’t:
a.  You do not have the energy to practice full-time
i.  currently in clinic?  How do you feel after a shift? Could you take that 5 days a week?  8 hours a day?  Imagine pulling double shifts everyday all week long. . . 
ii.  Acu demands so much energy, you can really only do it “part-time”
A.  This Demands that you choose
B.  You have to make as much as you can within 20 treatment hours
D.  All this isn’t to say that you can’t have a Private Practice, but you can’t have both
b.  You probably don’t have the resources to make it work
i.  square footage is your largest expense, and the two types of clinic are, in fact, mutually exclusive as far as physical set-up. 
ii.  you’re second largest expense is payroll–ie reception, essential, in some form for CA, arguably you could do with-out it in a PP
c.  I’ve tried it, I have to tell you, bottom line was I made more on CA than I ever did on PP, when you’re no longer in school rent and food money are serious concerns
i.  Market reasons
ii.  cash flow reasons
iii.  you will prefer one to the other

Learn how to do acupuncture, learn it very well

1.  people will not come to you for herbs
a.  they know what acupuncture “is”, they come in for that
b.  a few very motivated people have probably already done herbs with someone else, to them you doing herbs is a “bonus” not the impetus
c.  trying to “push” herbs on patient’s new to them is a sure-fire way to make them uncomfortable, and maybe drive them away

2.  Acupuncture can treat 90% of what you see
a.  given enough time, acupuncture will take care of it
b.  acupuncture is cheaper
c.  of the remaining 10% that would find herbs very helpful
i.  ~5% are fairly easily dealt with
ii.  ~5% are extremely difficult cases that you will find frustratingly difficult, not fun challenges, often they are cases that have confounded many different practitioners of many different modalities

3.  Community Herbs are still an experiment
a.  doing it at WCA for ~3 months
b.  so far only a small fraction, actually around 5%, of 350-400 total pt’s
i.  that’s ~3 people a week, not sustainable
ii.  double that to my original 10% projections and it’s still not sustainable

4.  Herbs are a very dodgy source of income
a.  inventory = tons of overhead
b.  reasonable mark-up’s aim for break-even
i.  you make pennies on the dollar for herbal medicine
ii.  the charge for your time is the money-maker
iii.  Herbs take longer, so for the same amount of time you’re loosing potential income. 

5.  If you still want to do herbs, building a very strong acupuncture practice, CA or PP, is a prerequisite. 
a.  It is so unprofitable
i.  the goal with herbs are to break even
ii.  it is a service to your patients, but providing this service requires you are taken care of
iii.  this requires a Practice or JOB that can PAY the BILLS
b.  Naturopaths do use supplements to boost cash flow
i.  this model is profitable for a number of reasons I personally find offensive, and professionally are incongruent with the practice of Chinese Herbal Medicine
A.  often multiple supplements are given, thus the accumulated profit margins increase VS find the Formula for the patient, maybe with some modifications

B.  Often they are given continuously, ie no real plan to stop them, again consistent flow of inventory = more consistent cash flow VS very few Formulas are meant to be taken for weeks on end, let alone months
C.  Standard mark-up’s are 100%, that means, often patients are charged TWICE what the practitioner pays for the product, VS at WCA we do it with ~60% mark-up, and we have just started to turn a profit on inventory 
c.  Real-life examples of herb practitioners:
i.  Hiener Freuhoff–has a teaching/admin gig, and charges extremely high rates for his time
ii.  Guiho Liu–does acupuncture on most of his patients even if they’re there for herbs
iii.  Both have OTHER sources of income

Making it Work as a PP

1.  Make sure you have enough in savings to pay your total cost of living for at the VERY LEAST 6 months, more like a year
a.  all small businesses grow very slowly, 3 yr window
b.  many small businesses rely on loans to make it through the 3 yr window
i.  for a loan you need a business plan
A.  Market research, financial analysis, bank willing to listen
B.  A back-ground in business will help, but it will still take ~6 mo’s to get it done
c.  2 out of 3 small businesses fail

2.  Find an untapped upper class market, move there
a.  any left?
b.  do you want to be there?

3.  Take-on the insurance beast
a.  in the Portland area, even insurance gig’s are super competative
b.  the future of insurance coverage is shaky at best
i.  most people don’t have acupuncture covered
ii.  many plans will happily cut acupuncture from their benifits if they hit a rough patch
iii.  the possibility of a national health system will perforce exclude acupuncture
c.  This costs you money
i.  doing it yourself is such a waste of time=money, you might as well pack up and go home
ii.  paying some one to do it will increase your over head
iii.  getting a billing person will decrease your profit margin, usually ~5%

4.  bottom line, it can be done, but you’ll have to have the stuff to make a small business work, all the acupuncture skills in the world will make no difference in the face of that. 

5.  Find someone to hire you. 
a.  you might as well try to start a cash only private practice on NW 23rd (arguably the most “posh” of Portland’s commercial streets). 

Author: MattGulbransen

Born and bred in northern Indiana. Serious scholar. Dedicated acupuncturist. Employed at <a target="_blank" href="https://www.workingclassacupuncture.org/">Working Class Acupuncture</a>--the Mother Ship. Last of the red hot table top cloggers! Very interested in classically based acupuncture and herbology. Loner, out for justice! Currently working on ways to integrate herbal medicine into the CAN model. . . don't ask, still working on it!

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


  1. It’s about time

    It’s about time community acupuncture is taught in school side-by-side wtih the conventional models.  You’ve made some interesting points, Matt –  I would agree with you on much of it but I do disagree on the herb part.  Personally, I think herbs can be extremely valuable to many people’s conditions – I tried practicing acupuncture alone without herbs for awhile and did find myself frustrated with the lack of change in certain people, knowing very well that if they had herbs their progress could be substantially improved.  I think denying this fact is denying a patient more possibility to progress.  However, I think there is something to be said for acupuncture being the first line of treatment, particularly when obtained regularly and frequently, and not pushing herbs on people.  I think any acupuncturist trained in both would be smart to consider ways to incorporate herbs into their community practice, even in the simplest way (i.e. patents, mail-orders).  Personally, I have a pharmacy of powders and have been charging a sliding scale for herb formulas – this way it is still reasonable for people and I can offer them a stronger treatment – for particular patients such as those with infertility or more severe/chronic digestive/respiratory disorders, I would personally feel I was doing a disservice not offering/suggesting herbs to them in conjunction with the acupuncture.  

    Aside from this personal opinion of mine (I’m sure much more could be said by others to open a little “debate”) – it sounds to me like you’re going to offer great information to your future students! 

    Justine Deutsch, Lic. Ac.

    Acupuncture Together of Cambridge, MA


  2. private practice vs community acupuncture

    Hi Matt

    I have a unique situation but another take on this question. I work for an AMA community clinic. I worked there in the lab while I was going to Chinese medical school (got my degree in herbs and acupuncture). After I graduated, I did table acupuncture one day a week at this clinic for 4 years. Then I took the WCA seminar on CA and worked on a business model for a year. I presented it to the clinic board and they ok’d it. Many months later I am up and running. The main thing is that they pay me a salary no matter how many patients show up and they pay for the supplies and the malpractice insurance and other staffing needs. SWEET in many ways-there are other difficulties however.

    At the same time, my apartment has the perfect set up to see patients, so I do a small private practice and take insurance at home. I buy my own supplies and malpractice insurance, but can use a percentage of my rent as a tax write off. The private practice can wax and wane as they all do, without any stress on my part. 


    So, I suppose there are exceptions to everything and here is one of them. If folks can set themselves up with a private practice at home, and have the time and income to keep afloat, both can be done.

     By the way, I am really glad folks are getting out there and teaching the CA model.  Thanks for doing that.

  3. notes on diverget points of view from the above

    On hybrids: Claudia Voyles at Remedy here in Austin does a hybrid practice successfully and seemingly without ideological conflict or confusion to her patients. I really don’t think patients are as caught up in this stuff.

    On working only 20 hours a week: I think acupuncturists are prone to a slacker work ethic. I enjoy working five days a week, all day. Granted I only treat 70-80 people in a week, not 400. I also don’t have children. But my advice to people starting out would be to be open and be there ready to work as much as possible. There’s always something to do. The work I do now is easy compared to many things I’ve done in my life, and sure as hell is easier than picking cotton by hand like the generation before me had to do. So I don’t mind working hard. If you only want to work twenty hours a week, that’s cool, but my sense is that especially if you are opening a business from scratch you will become sustainable sooner if you work more. And yes, sometimes focusing your hours is a viable strategy too.

    On herbs: I disagree on almost every point. I have no experience doing sliding scale herbs formally, but I will lower prices here and there. I specifically try to buy reasonably priced products to begin with. I source from multiple vendors:

    Mayway, Crane (where I get KPC, Goldenflower, and some Asian patents), Qualiherb, Kamwo, BioEssence, SFC Trading, CAI , and Kwokshing primarily…

    We also have a sample bin we draw from to give people things, and Whole Foods dumps boxes of supplements on us from time to time, which we redistribute for free.

    I am no more pushing herbs than I am pushing acupuncture. I don’t find people know any more what acupunctue “is”over herbal medicine. It all seems pretty alien to the uninitiated from what I see. I always try to be prudent with herbs and factor in what the patient is willing or wants to do, and what they can afford. The cost of herbs is a concern, especially as they keep going up in price.

    We mostly do patents, then powders, and last raw. I also try to factor in what format of herbs is best suited to a given situation…for instance I generally wouldn’t want to give someone with a cold or flu a formula in powder or raw because the toxin clearing, anti-viral herbs are going to taste quite nasty – and who wants to deal with herbal preparation when they don’t feel good anyway?

    Jan-June’08 we’ve sold in herbs about half the amount we made doing acupuncture, and yes the cost of the herbs was about half that amount we made selling them. Herbs are profitable. You just buy them and sell them as you go. It’s not like we made a huge front end outlay. You could start a small patent pharmacy with a few things you think might be of most importance for a few hundred dollars, or less if you wanted to.

    So, herbs don’t = tons of overhead, and you don’t make pennies on the dollar, but most importantly you can do a lot with herbs – and not necessarilly more slowly. For example, I can give someone a $6.00 bottle of Zhi Bai Di Huang Wan for their hot flashes, and chances are they will come back in a week and say their hot flashes are either gone or substantially diminished. Can I do that with an acupuncture treatment? I can’t. I can think of many other examples where herbs are just going to work more effectively and more quickly: sore throat, sinus infections, coughs, vaginal discharge, diarrhea, excessive bleeding…and so on.

    I’m not saying acupuncture can’t treat 90% of what you see, but will it do on it’s own what acupuncture and herbs would do? It’s just not my experience that it will, but that’s just my experience – others may have different experiences. And maybe my experience will change as I go along.

    I’ve been licensed since Dec of ’04, and doing this full on only since opening my clinic in Nov ’06. My experience since opening my shop has essentially been one of exploring the possibilities and the limits of acupuncture, and communicating my understanding of this realistically to patients in coordinating a course of treatment.

    My sense is that acupuncture essentially doesn’t add anything to the equation. It works with what is there, and moves things. It downloads stress fairly immediately, and boosts function generally more gradually. Herbs are slow when you are nourishing the deeper substances, but I don’t know that acupuncture can even do this.

    It is a shame if people are emerging out of acupuncture curricullums that teach herbal medicine and then not using it.

    My big concern about Chinese medicine is sustainability. Bioregionalism it ain’t. I’m not to the point just yet of taking this on though.

    On class: it’s an issue for you if you choose to make it one in relation to practicing acupuncture. I personally do not move through the world focusing on issues of class, and I treat all kinds of people from all kinds of cultural, socio-economic, educational, and occupational experiences. I personally suspect the working class people I treat aren’t spending their time looking at web sites like classmatters.org… Yes, acupuncture should be available to more than just wealthy people, and there are more people that are not wealthy than are, whatever their “class”. And there is surely a need to serve an entire population that is beyond even the low end of the sliding scale, but I would suspect this gets into the realm of non-profits.

    On insurance: pure evil.

    Thanks for posting, and thanks for indulging my reply. Clearly, you’ve given me a lot to thank about.

    A class at AOMA is in the works.





  4. Hybrid practices

    I know the general idea is that hybrid practices don’t work, but I’ve been practicing this way for almost a year and it’s been a good experience. I’ve had a private practice (I like this term much better than the term “boutique practice”) in Kingston, Washington for almost 8 years. Last fall I started offering low cost treatments two mornings a week — $35 the first visit, $25 thereafter and $20 for subsequent visits in a week. It’s been working very well, and I’ve hired another acupuncturist to handle Saturdays. I have two tables set up in two rooms, so it’s a bit of a different model than a lot of the community clinics. I’ve had a lot of people start coming for treatments regularly who never would have been able to afford it if not for the community sessions. People with not much money at all, and people who appear to have lots of money, but who feel more comfortable with the lower prices. It doesn’t matter to me if they come to the clinic by bus, or drive up in their sportscar. One woman, a doctor’s wife, drives up in her Lexus, and she’s one of our biggest fans — tells everyone who will listen about us. Sometimes we reduce the price if someone has a problem paying our fees, but most people are thrilled with our prices. It’s been really rewarding doing this because people are so appreciative. I find that my community clinic clients are very considerate about keeping their appointments and being on time. I don’t generally charge for missed appointments, but sometimes people will insist on paying if they’ve had to cancel at the last minute.

    As much as I enjoy the community clinic, I still have clients with insurance who prefer to use up their insurance visits, or some cash clients will alternate back and forth between the private sessions and community clinic. Sometimes it works well to have someone come in first for a private session and then switch to the community clinic. It’s nice to have the options available for people to choose.

    The private sessions still provide the majority of my income, but the community clinic income is growing and we’ll expand the hours as it grows. Right now I work long days on Tuesday and Thursday, since I do the community clinic in the morning and then switch to private sessions in the afternoon, half a day of private sessions on Wednesday, and a full day of private sessions on Friday. I find three and a half days a week is just right for me. It’s interesting because quite often it seems when the community clinic is down, my private sessions will be busy, and when I’m really full in the community clinic it can often be lighter in the private sessions. I don’t know why, but it’s nice to be tapping into both markets.

    One unexpected source of referrals for the community clinic has been massage therapists in the area. We now have six therapists coming regularly to the clinic. They love the low cost treatments, and are telling all their clients about it. One massage therapist even got one of her clients up off her table and brought her hobbling into the clinic for a treatment.

    I’m open to different possibilities for the future. I’d like to expand the community clinic to a larger space, with no stairs. I’m checking into grant possibilities. I want to be less reliant on insurance companies, and I’ll see how that goes in the future. I expect that I’ll always do at least some private sessions, but I do think I’ll cut them down as the community clinic grows.

    The whole issue of class doesn’t concern me much, maybe because I’ve been able to move between classes fairly easily in my adult life. My clients are such a mix of classes and I enjoy them all. I find it’s wonderful to have a variety of types of people to work with, and the community clinic has definitely added more variety to my practice.

  5. I also think hybrids are

    I also think hybrids are fine.  I have some patients who simply want to be alone for various reasons from cultural or religious dress practices to patients who just can’t relax being needled in a group.  No one cares, I’m very close to my working class roots so I don’t feel that I am missing any ideological problems.  I don’t think people with less money need to be protected by not having other options available.  I make it clear that the treatment is the same, they are paying more for privacy only, not special treatment, and I still do short intakes.

  6. OK, so this is probably the

    OK, so this is probably the largest volume of responses to one of my posts, so I’m going to reply to as much as I can:
    1.  Timing
    I DID get through most of this material in a 2 hour class session, but I was keeping the discussion pretty well on track, and remember, they had already been in this class for several weeks at this point, so a lot of this material wasn’t brand new.  I think you would be better served teaching 1-2 topics per class, there were still a lot of unanswered questions by the time I was done.
    2.  Hybrids, rates/set-up/what is CA?
    Wally, don’t use anecdotes!  My sister’s brother’s cousin’s aunt, twice removed has an electric car that runs on AAA batteries, has a top speed of 80 mph and unlimited range.  I don’t care if you’re in the same clinic, unless you come to me with your OWN experience, or hard NUMBERS about this person’s situation, it is less than useless!  
    Charging $25 per treatment is WAY different then $15.  If the “going rate” (whatever the hell that’s supposed to mean) in your area is $60, then $15 is a much deeper discount, and not to knock your set-up, but 2 tables in 2 different rooms is also WAY different than 3 rooms filled with 8-12 recliners.  I can see how your patients don’t get confused.  To me there are 2 defining features of CA:
    a.  Ridiculously cheap
    b.  In recliners, in a room that could have potentially 4-8 other people in it, 2 people is a couple, not a community.    
    Like I said, not trying to knock what you’ve got:  to stay strong, we need people out there working on new and different ways of doing this that work for them, but the goal of the class was not to think creatively about set-ups, is was about teaching a model that is tested and works in the real world, and has worked for multiple people.  Creative new solutions will naturally come to those who have them, like yourself.  
    The Hybrid issue is less about CLASS, more about not confusing the student or patients about what it is that you do at that crazy acupuncture place of yours.  So I can pay $60 dollars to lie on a table by myself in a room or $15 to sit in a recliner in an open room with other patients?  The big question:  What’s the difference in treatment?  And then the inevitable kicker:  Which one is better?  The choices don’t hurt patients, they hurt YOU the practitioner, because people are wary enough about this acupuncture business, adding another layer of information/choice about something they probably know nothing about doesn’t help.  
    3.  Herbs
    HEY PEOLPE I LOVE HERBS!!!  I’m THE herbalist at WCA!!!  The idea is to disabuse the students of the notion that if they do CA, they can also have their dream bulk dispensary and have to time to mix custom formulas for every patient!  They won’t!  
    WCA makes money on herbs, but it’s NOT ENOUGH TO KEEP THE CLINIC AFLOAT, we’re talking about bottom line here.  Can you jack-up your prices to make it more profitable?  Of freaking course!  I even outlined how one could do that.  Just because YOU might not have a problem with it doesn’t mean I don’t find it unethical.  
    WCA patients have had wonderful turn-arounds in their conditions that the acupuncture didn’t seem to touch, but in many cases the acupuncture does just fine.  These are STUDENTS we’re talking to here, many of them lack confidence in acupuncture’s efficacy and they immediately run to herbs as an adjunct.  You have to let them in on the secret of acupuncture’s efficacy:  patience–give it a few weeks of regular treatment, then add in herbs if they aren’t progressing like you want them to.  (And yes, hot-flashes can be resolved with acupuncture, about half of the time:  Kd07, bilaterally).  
    Pushing herbs:  again these are STUDENTS at OCOM, they are expected to give an acupuncture treatment and a CUSTOM formula to EVERY patient that they see, in many cases this IS pushing herbs on people!  On the first treatment I don’t even discuss herbs, even if I know that they could help, just to let the patient get used to the needles–of course there are exceptions!  If they are in serious trouble, they get both straight out of the gate, but those people are usually coming to us out of desperation, no need to worry about scaring them away.  
    4.  “Work Ethic”
    I graduated in Sept ’06 and have been doing this full time since Nov ’06, so for some hitting the ground running is not only what we want–it’s necessary to SURVIVE.  If you had two years to piddle around and figure things out, great!  I didn’t.  This was my attempt to give these students a hard dose of reality for those (apparently few of us) who take this seriously as a CAREER (as in sole source of income), and will have to quit doing it if it can’t pay the bills.  
    I said 20 TREATMENT hours.  Of course running the day to day of a clinic requires more time than that!  I work 5 days a week and of those only 21 are filled with appointment slots, and I see a solid 60-65 patients a week in that time.  But that’s not all I do–WCA wouldn’t survive if that’s all any of us did!!!  The point is not to justify “them lazy-ass acupunks”, it’s about not SPREADING YOURSELF THIN.  Focusing hours is almost a must:  you have to make it clear when you’re “open for business” and when you’re not.  Counter-intuitively this is what makes you busier.  In starting a business you probably need to work 60 hours a week, but my point was to not expect to be ABLE to do much more than 20 TREATMENT HOURS in a week.  Students especially, have the notion that they can fill 40 hours worth of appointments and WOW look at all that mooola!!!  That’s not going to happen, and even if it did, I don’t think they could even sustain it.  I challenge ANYONE to do that much ACUPUNCTURE, not book-keeping, not marketing, not inventory, etc and still be a sane, healthy, well rested person.  If you can, good on you, but most of us can’t.  (And don’t tell me about this guy you studied with in China, blah blah blah, this ain’t China, I’m talking about people these students have a snow-ball’s chance in hell of emulating.)

  7. A vote for civility

    hey CANners,

    I appreciate all the passion, and disagreements, it’s all great fodder for conversation, but i feel like I’ve been suddenly transported to the recent nastiness in the acupuncture marketing blog. Let’s respect that each of us is having our own experience and we’re here to help each other, not tear each other down. How we say our words can be as or more important as the words themselves, esp in cyber where you only have the words and not the in person delivery.

    and Guest, if you want to use special pronouns, at least use your name. It’s too easy to take shots from the cloak of invisibility. I’m personally so over the whole anonymity thing. How can there be a conversation when you don’t know who it is that you are speaking with?



  8. A strong reminder….

    about what CAN is hoping to accomplish.  This quote taken from our membership page:

    “Members of the Community Acupuncture Network (CAN) are, first and foremost, participants in a community of individuals and organizations dedicated to promoting access to acupuncture for more people through community practice…..

    The forums are moderated so exercise restraint and good manners.”

    Thank you.

  9. I clearly have no place here.

    Hi Matt,

    I think your reply to me puts on display for all to see one of CAN’s biggest problems. It seems that if one does not agree with all things Working Class Acupuncture then one runs the risk of being publicly lambasted for daring to think for oneself and say what one thinks. I don’t quite get what this is about, but it’s disheartening and fairly pointless in my opinion.

    Regarding my “anectdote” about Claudia’s “hybrid” clinic being “less than useless”: Uh, dude, Chinese medicine is very largely anectdotal, as is the bulk of your reply to me.

    To clarify further, just in case you are confused (I can’t tell if you are responding to me throughout or just in parts).

    1. I know Claudia Voyles, I don’t work with her at Remedy. I own and operate South Austin Community Acupuncture.

    2. You say, “not to knock your set-up, but 2 tables in 2 different rooms is also WAY
    different than 3 rooms filled with 8-12 recliners. I can see how your
    patients don’t get confused.”

    My clinic has 7 recliners in one room, a table and two chairs in another, and a couple out in common areas. We use our entire space.

    3. You say, ” the goal of the class was not to think creatively about set-ups, is was
    about teaching a model that is tested and works in the real world, and
    has worked for multiple people.” (anecdotal?)

    That’s fine, but where do you draw the line? The parameters of a CAN clinic are clearly stated. Beyond those three key points I think it’s fairly wide open though – and there are many, many variables that are going to shape each persons practice.

    While I understand this was not the point of your class, I think people should be encouraged to think creatively about their set ups, but even more importantly to consider how they are going to create a practice that is how they want to practice. That, to me, is way more important than insisting everyone immulate WCA as closely as possible.

    There is this attitude that creeps into the discussion that to deviate from what you espouse makes one somehow less righteous. I have issue with this.

    4. You say, “The idea is to disabuse the students of the notion that if they do
    CA, they can also have their dream bulk dispensary and have to time to
    mix custom formulas for every patient! They won’t!”

    True enough.

    I very carefully thought about what I wrote on how we dispense herbs in my community acupuncture clinic (something Skip’s been wanting me to post on for a long while now), with the hope that it would actually be informative. I hope somebody got something out of it. I certainly wasn’t recommending bulk pharmacies.

    5. You say, “WCA makes money on herbs, but it’s NOT ENOUGH TO KEEP THE CLINIC AFLOAT…”

    Did you misconstrue what I was saying as ‘selling herbs keeps my clinic afloat’, because I never said that? However, I will share that so far in 2008 I’ve done nearly $48K in acupuncture, and $24K in herbs. Draw whatever conclusions you will.

    6. Regarding the pricing of herbs you say, “Just because YOU might not have a problem with it doesn’t mean I don’t find it unethical.”

    Matt, I’m in business. I’m not so radical as to deem buying products at wholesale and selling them at retail as morally corrupt. I don’t think there are any ethical issues in how I mark up my herbs. I tried to make very clear that I always try to keep things reasonable and flexible.

    7. You say, “If you had two years to piddle around and figure things out, great! I didn’t.”

    I have to concur with the guest’s reply on this point. You don’t know me, or what I do. One thing I was doing during this time, in addition to trying to figure out how the hell I was going to survive doing acupuncture, was dealing with the family crisis of coming to grips with my elderly mother’s sudden decline.

    You hit the ground running working in a clinic someone else already put the hard work into establishing. I’ve been out of school since Dec of ’04/licensed Feb of ’05. Months of preperation went into making my clinic happen before we signed a lease in July of ’06, or opened our doors in Nov of ’06. So, what you are calling “piddling around for two years”, I experienced as a time when I worked harder than I ever have in my entire life to make someting happen – and I made it happen. I find your condescending tone highly offensive as you are touching on much of what is near and dear to me.

    You don’t know this, but running your own business is a lot different than working for someone. It will test your mettle in ways previously unimaginable. Get back with me when you open your own place.

    9. I’ve never been to China.

    In closing, if I seem offended, I am. So far, I have gotten similar rebuffs from Skip, and Lisa, and now you Matt.

    In the forums I have been blasted over the doctoral initiative; called painfully naive, and told pointedly that the folks at AOMA by default are without conscience and don’t give a damn about us (These people are my acupuncture community). We can now add to that list my unethical practice of selling herbs.

    As well, I have endured snide remarks from Skip about what WCA gave us “for free”… Before there were WCA workshops, we visited WCA: we bought air fare, payed for hotel rooms, paid for treatments at WCA, bought merch and books from WCA, and bought Skip and Lisa dinner. Skip, thanks for letting us visit and sharing your business model “for free”.

    Seriously, thanks. We’re grateful. But I think I’m done here.




  10. how unfortunate


    i think you do have a place here. i am sorry to hear about the snide remarks you experienced from the
    above mentioned people, but i want to remind you that there are many
    more of us that are part of CAN that appreciate and respect each other. as CAN grows in numbers, it is natural that many of us will disagree, hopefully in respectful way, but maybe not always – we are all human. i agree with a lot of what you expressed in your posts here and appreciate the stuff i may not necessarily agree with.

    i love using herbs and do it as much as i can in my clinic. i am still figuring out a good way to pace herbs into the flow of the clinic, but i have no intention of stopping to use them. i sell herbs for what i feel is a fair price and haven’t had any complaints.

    from the beginning of joining CAN, i felt and expressed that there has to be room for people to be creative with the community acu model and to make it their own and adapt it to the community they are serving. this is the beauty of it. i think that as long as we are sticking to the main priciples of CA –
    lower fees, simplify treatments and build community (and have some
    understanding on HOW to do the above 3 things) – we can be creative
    with it, so it expresses who we are and addresses the needs of our
    community. we are planning to add another massage table in our clinic
    because the one table we currently have is really popular – many clients (myself
    included) find it really comfortable. does that mean we are a “lesser”
    CA clinic because of it? that’s ridiculous.

    i am getting ready to teach
    a class on CA in the Fall and i plan to encourage creative thinking around set up,
    while sharing the information about what has worked for others. i would
    not have it any other way. i think the main point in teaching CA is to
    give students /new acupuncturists options in how they practice and
    how many people can access their care.

    having gone through the incredibly labor-intensive process of setting up my own clinic (with an awesome partner, thank god), i can appreciate what you are saying about that whole journey and i think it is pretty hard to understand for someone who did not go through that process and just walked into a job with all the structure set up for them.

    i feel a greta deal of gratitude and affection for Skip and Lisa and i also don’t expect to agree with them at every turn, nor do i expect them to be perfect in their comunication. i like having flawed teachers – keeps meon my toes. so i hope they get a chance to mend things with you, because you deserve it. i hope all involved in this conversation learn something useful from it.

    as far as the teaching goes, i think it might be more appropriate to share the details / discussion on the forum thread i started at Lisa’s request rather than the public blog, but it is only my opinion.


  11. .

    for the last few days, each time i’ve checked the forums and seen this blog and its comments i’ve started to write something in response and then stopped myself. mostly because i’m not interested in adding fuel to a really crappy “conversation”. im not sure if other than the few who have said anything, no one else has for this same reason either. but at this point i think that it is important to say that i feel that matt’s response was obnoxious, unhelpful, and quite unwarranted. wally’s response to the original blog was well thought out and elaborated, and most of all respectful and open to reciprocal conversation. our community is small enough as it is and i think it really sucks when people begin to feel attacked or isolated for bringing ideas from their own experience to the table.


    wally, i really hope that this doesnt discourage you from staying involved with this forum. speaking for myself,  i have really appreciated and enjoyed your input here over the last little while. you have offered a lot of really great first hand experience and practical help that has added to the expansion and building of this community, it would be a shame to loose you.

  12. You’re Right Where You Need to Be

    Everything that was directed at you was clearly prefaced with your name.  You took much of my response much too personally, as I did with your original reply (which I found confrontational in tone).  Many of the comments were definitely not directed at you, quit projecting everything onto yourself.  
    The fact is, you are much more important to CAN than I am.  I have nothing but respect for true dissent.  However, I am NOT Skip or Lisa, if you have had previous issues with them don’t drag me into it.  I’m no more hard-line WCA than you are hard-line anti-WCA (sounds to me like your clinic is quite similar to ours).   And neither are Skip and Lisa CAN, they are important members of CAN, but this is not a dictatorship.   I won’t respond to your allegations towards Skip, I have nothing to do with them, quit projecting onto me.  
    As for lambasting?  Imply that I’m a lazy slacker and that LAc’s are failing because they are, as a rule, lazy slackers, BE PREPARED FOR A FIGHT!  Them’s fightin’ words!  You pick a fight, then get all upset when you get one, what’s that?  
    Chinese medicine is NOT ANECDOTAL, “dude”!  It has a vast written record of people’s individual EMPIRICAL EXPERIENCE, which is what I was writing about, in fact, I even said “your own personal experience” what you know from your own life is not an anecdote!!!  Zhang Ji did not write the Shang Han Lun about what his teacher/friend/whatever said worked, he wrote about those prescriptions that were able (and in many cases unable) to save members of his clan from sickness.  Dr Tan doesn’t teach a system he picked up somewhere, he teaches a system he has developed out of the ideas that worked for him!  
    As for the content of the class, they had access to 3 members of the WCA crew, all of whom can personally testify to it’s efficacy.  Look, creativity is fine and good, but again, this is about giving students CONCRETE things to work with, not just vague outlines with the encouragement to “be creative”.  That’s largely how “practice management” classes are taught now and I think is a huge contributing factor to the failure of so many people in this field.  These are acupuncture students, many really need hand-holding to get through the “business stuff” and get down to what it is that they really want to do!  
    Once again: herbs can make money, that’s obvious.  However, the larger point I was trying to make was that they should not be the focus of your practice, as your numbers show, acupuncture alone would fare better than herbs alone.  Again, the point was about focusing intent, get the herbs situated later, don’t delay getting needles in people until you’ve worked out your herbs system.  PLEASE make a separate blog about how you do your herbal practice!!!  (I’ll eventually do this for WCA too, but it’s still really in it’s infancy, and you obviously already have a system worked out–share it, contribute.)
    Pricing is personal, if our ethics differ, I do no more than disagree with you.  We do ~67% and that suits us.  Do whatever suits you.  This is the same for insurance, I disagree with it vehemently, but I DO NOT distain those who deal with it, they’re doing what they can to get by and I understand that.  
    I am sorry for your loss.  I don’t mean to demean that.  But guess what Wally, you don’t know me either!  I struggled for about a year trying to make my private practice work, I was only on at WCA for 1-2 shifts a week at that time.  I was effectively trying to run a hybrid.  This is one reason Lisa asked me to speak–a first hand account of what it was like to try and FAIL at a hybrid practice.  It hasn’t been that long since I became a “salaried acupuncturist” and thus am making enough to begin to pay off the $10,000 worth of debt from trying to live, start a private practice and work in a Community Acupuncture setting for a year.  Add to that the fact that I still have $68, 000 that I owe Uncle Sam for my lack-luster “education”.  The change in my status was largely because I had run out of credit:  it basically came down to either I get this job or I quit the profession, so don’t lecture me about how hard you had it while I was on easy street.  Again, you want to take swipes and don’t seem to want to take the backlash.  Here I am Wally, coming back at ya’ having run my own business and failed.  Yet, where are you?  Succeeding, using the very model I was simply trying to promote, trying to give students my reality tested reasons for certain alternatives not working.  
    This DOES point to bigger issues, not so much with CAN:  I AM mad as hell, and I don’t want to take it anymore.  A while back there was a big discussion about anger: is it good?  bad?  productive?  counter?  Well, I guess it’s obvious where I stand.  
    I am mad about what’s going on in this “profession” of ours:  SCHOOLS ARE ROBBING STUDENTS BLIND.  Giving them platitudes about practice management, then lying about how abysmally they fail.  Maybe I was naive and stupid to take what I was told at face value, I’ll grant you that, but I give no quarter to those who knowingly perpetuate the same bulls**t.  
    I have seen most of my classmates struggle to survive.  The few who have anything to show for their debt are ones who:  a. were established practitioners of another modality before school  b. sold-out to insurance  c. took on the CAN model, and of those, guess who’s doing the best?  People that adhere most closely to the WCA model.  Don’t tell me such and such works if you’re not doing it yourself!  Don’t tell me I’m a bum and got what I have handed to me!  Don’t you even begin to imply that the first professional Doctorate is anything more than a piece of crap proposal, at worst just for the money at best a weak-kneed capitulation to a system that still doesn’t even take us seriously.  Fact is, Wally, I don’t give a good godd**n about you, it’s the STUDENTS that I care about.  If that makes you mad, good!  Fire away!  Just bring something real to the fray, and make sure you STAY in the kitchen if it gets hot.  If a few tough words are all it takes for you to leave the table, we are in serious trouble.  True dissent is welcome, weak support for an ideology you yourself do not practice is not.  
    Am I a big dumb jerk?  Sure, but I’ve got a fistful of reasons for it.  

  13. over the top


    There’s no justification for verbal abuse. You have information to share and points to make, but mixing these in with personal attacks — “Fact is, Wally, I don’t give a good godd**n about you” (one of your last statements of the post)– is at best unprofessional, and there is just no way to justify treating another in this manner in this or any forum.



  14. Leaving the table

    Look Matt, in your initial blog you asked for input:

    “Of course, not everyone will agree with these points, I welcome any discussion. Hybrids? Herbs? And Private Practice?”….

    I tried to very thoughtfully and thoroughly respond because I think the topic is important. Upon re-reading what I wrote initially, it is difficult for me to see how my tone came across as confrontational to you. Was it because I said I disagree? Because I used the word ‘slacker’?

    Regarding my use of the word ‘slacker’ – which seems to have offended you based on the above, I never called you a slacker, or lazy, or even used the word lazy. The intention was
    a general statement about acupuncturists who work very part time and
    then wonder why they can’t grow a practice. That’s all. Any meaning beyond that is yours.

    I’m sorry to dredge up previous encounters I’ve had in the forum with Skip and Lisa, but when you began by addressing my anecdotal report on a hybrid that works by calling it ‘less than worthless’ my buttons were pushed, and so on from there.

    I’m not projecting or confusing you with them, I’m just noticing that the only people who have been attacking towards me with their language in CAN are all WCA – and fairly harshly so. I’m not into that. I get that we are all human here, but over and over I see that if one does not agree precisely with what WCA espouses then you risk angry confrontation.

    You say you have nothing but respect for true dissent, then demonstrate it.

    You can’t insult me over and over, and simultaneously say how important I am to CAN and how I should contribute. Well, um, obviously you can. I just think the two are not congruent, and it’s an abusive and disfunctional way to communicate.

    I am consciously choosing to leave the table because I don’t think CAN is a culture that fosters thinking for ones self, or thinking critically on multiple levels. While the business model is good, I think a lot of the sentiment that has gotten glommed onto it since the inception of CAN is pointless, and pretty unappealing to many people.

    I am not mad.

    You might be a big dumb jerk with a fistfull of reasons, but you’re probably a pretty lovable one underneath it all.

    Take care,


    ps: I am not anti-CAN, or WCA. I’ve just got to distance myself for matters of my own personal integrity. I am still a huge proponent of CA (obviously) and am willing to be of assistance in any way I can to anyone who asks. Y’all know where to find me.






  15. You belong here!


    I agreed with just about everything you said in the initial response and thought some of the responses that came after it were rude and uncalled for.  WCA is doing great things, but if everyone is expected to practice exactly as they do we can say goodbye to community acupuncture right now, people have to have the freedom to create their practice in a way that benefits themselves and their particular community.  I would be an idiot to try and mimic something that works in Portland here in Detroit.  There are things I must do differently and I am proud of how I am making things work for me and my patients.

    BTW, I actually agree with the slacker comment.  I used to work a 40 hour workweek doing acupuncture and found it perfectly fine.  Was I tired at the end of the day, heck yes, but everyone I know is tired at the end of their workday, that’s just life.  The idea that we are only capable of working 15-20 hours is weird to me.

    Stick around Wally, I am sure there are many people who appreciated your comments and benefitted from them.  We do need dissent or CA will just be a fad that disappears for all but a few who fit the WCA mold, and that would be tragic. 

  16. The Great Satan Responds

    I don’t think you should leave.  Despite my earlier fire spitting outbursts, I really really do think you are more valuable than I am to the CAN community.   I should have said what I said in a better way.  I still vehemently disagree that it is a lack of work ethic that causes acupunks to fail, I think many simply do not know how to make it work (or maybe are unwilling to change notions about it that they were taught).  Anyway, I can understand wanting distance, but how about a truce:
    I can only speak for myself, but I won’t comment on a Wally post and maybe you could avoid commenting on mine.  Like I said, I can only speak for myself, but maybe other WCAer’s could reach a similar truce with you.  This way, all of CAN benefits from having Wally AND WCA, without any of the attendant drama when the twain meet. (I mean, we’re only talking about 4 people here!)
    I actually do not like either/or type thinking, this shouldn’t be either you stay or we stay, we should both stay, but make sure that we stay out of each other’s way.  I do value dissent, but I see value in the conflict as well, even if I’m not the most productive participant (I obviously could never be a lawyer or politician, thank heaven!).  Not that I know all the in’s and out’s of CAN, but maybe there could be a semi-formal way of initiating these types of “conflict free” arrangements.  That way people that enjoy the fray can beat one another over the head and those who don’t don’t have to get dragged in.  
    Ok, that’s my last 2 cents on this.  Wally, you should stay because we are richer for having you present.  If you decide not to, I get that too.  It is unfortunate that I had to precipitate this, but that’s the way the cookie crumbles.  Take care, and keep your clinic going strong, THAT’s way more important than any ideological discussion on CAN.  

  17. Matt,

    You stated, “I mean,


    You stated, “I mean, we’re only talking about 4 people here!”

    Matt, it’s about a lot more than 4 people. I have been very offended by all of your abusive and toxic responses. (Is this how you treat your patients?) And, like Wally, I too, as well as many others, have had to deal with unprofessional responses from both Skip and Lisa.

    Matt, your unprofessionalism doesn’t serve CAN well.

    Wally, if you are reading this, thank you for your posts! I agree with you that if one does not agree precisely with what WCA espouses then you risk angry confrontation.


  18. Wow, thank you…

    Nancy, where have you been all my life?? Since I found out about and got on CAN, I’ve been disturbed by the animosity and fighting between the PP’ers and the CA’ers. I do both, I like doing both, and was thrilled to read your post about someone else happily doing the same.

     Thank you again for your contribution to this site and for making me feel a bit more at home here.

  19. As more people hear about pocatech, more are asking…but what about hybrid and herbs and lifestyle advice. Thank you for outlining this so succintly, now i can just point the potential interviewers to this post!