There’s No Money In Community Acupuncture

There’s a false idea being spread as a rumor in the local punk community. The rumor is that, “There is no money in Community Acupuncture.” This rumor came to me third hand from a local punk who has been looking into the CA business model and then again from someone who has contacts within the student community. Since I know the three punks that have been originating this rumor, I know about their experience in CA. It’s certainly not enough experience to be able to say whether or not a CA clinic can be profitable.
Rather then calling them to say, “Shut up. You don’t know what you’re talking about,” I wanted to, instead, give a little advice and direction to the rumor’s recipients. If you’ve heard that there’s no money in CA and you’re a student interested in the CA business model or a BA punk thinking about converting, ask the rumorist these two questions:

1. How much time did you give it?

An acupuncture clinic is a business. A business not only needs financial resources, it needs time. Time from you, the owner, and a whole lot of it. It’s a lot like having a baby. You have to participate fully in nourishing it if you expect it to thrive. If you neglect your responsibilities after conception, then face it, you’re a crappy parent and your business is probably going to die.
A business also needs time to grow capital. That’s the money in the bank that will protect your business during slow times then, eventually, pay you. To give you a real life example, our clinic was paying for itself within its first year and had three months worth of capital saved. By eighteen months we were able to pay back the partner’s initial investment. This was beyond my expectations. Which brings us to the next question.

2. What were you expecting? Really.

This question is meant to expose unrealistic expectations. I know of just a couple of CA clinics that have only had to open their doors to blow up. I think its fair to say that the conditions and timing were just right for them. The rest of us, the majority, have been subject to the norm. Which is that it takes time.
If you, the rumorist, opened a CA clinic and expected that patients are just going to flock to you, especially if your right out of school or if you don’t already have a strong patient base from your BA practice, odds are high that you’ve been deluding yourself. It takes more than fair treatment fees to attract enough patients to earn an income from your clinic.
Take connecting with your patients, for example. You are not going to connect with everyone. For whatever reason, there as some people that just won’t want treatments from you. For example, I have a patient that said he went to another CA clinic, but didn’t care for it because the practitioner seemed like a “used car sales[person]” to him. I know that I’ve lost patients because of characteristics of my personality didn’t vibe with a patient. That’s just the way it is. The goal is to find the patients that vibe with you, make them feel better, and encourage them to talk to everyone they know about their experience with you. Which, again, takes time!
If patients aren’t going to flock to you within the first year or two, then how do you expect to take home $50K while paying for operating expenses and building capital?  I’m not suggestion that you don’t have this as a goal or to not be optimistic and hopeful. You just shouldn’t expect it to happen within the first year. Or even within the first two years depending on expenses. It’s just not realistic.
So, don’t let this rumor cause you to dismiss the CA model. It’s just “spooky language” that’s either meant to deter competition (another blog topic fur sure) or it’s an excuse for not being committed enough to take care of the baby. Don’t let it scare you.     Talk to experienced CA clinic owners. Examine the “CAN Locate a Clinic Survey” data. Look at the demographics of your community. There are plenty of potential patients for you. You just have to be willing to do the work and put in the time.

SarasotaCA
Author: SarasotaCA

We all graduated from East West College of Natural Medicine, in Sarasota, Florida. We now have Sarasota Community Acupuncture in Sarasota, FLorida.

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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.

Responses

  1. One other question you may

    One other question you may need to ask is “what salary do you need from your practice and how soon do you need it?”. This alone may separate many CA prospects from BA prospects. Your $50,000 hypothetical figure is not that great for a 3-4 year master degree investment. Compare that to a nurse practitioner, who, with the same 3-4 years is getting an average $90,000 salary right out of school. Owning your own business is a whole different deal, of course, but for a mature LAc who needs to provide for a family, mortgage, college funds, and retirement, $50,000 is not going to cut it. Especially having to wait 2 years for it. You can easily net $50k after all business expenses from a BA practice in the first year if you are a go-getter (I did it myself this year in a new location). But to do this from a CA practice? It’s like winning the lottery- same odds. Maybe you’ll get there in 2 years, but by then a well-run BA clinic will be netting $80K. Some people just cannot afford the CA model. Please correct me if I’m wrong- and I hope I am- I love the CA idea and would love to do it- but don’t have a trust fund to provide for a philanthropic endeavor when I have bills to pay for my family.

  2. Dear Guest, unverified,
    I

    Dear Guest, unverified,

    I think it’s great that you are a go-getter and have been successful, and that you feel $80K is attainable for a BA after two years.  I myself managed that in my BA.  However, I know of only one other acupuncturist in my entire state that was able to do that.  I know many (dozens) of acupuncturists who are not able to do it, no matter how “go getter”-ish they are. 

    If a potential student would like to earn what a nurse practitioner earns right out of school, maybe they should become…a nurse practitioner? 

    I truly believe that percentage-wise, just as many CA’s fail as do BA’s.  But that’s just from my personal experience – it would be great to see some data.

    Yes, I hear you about $50K not being a great return on a four year graduate program that cost $60K or more.  Point well taken.  Any schools listening?  I don’t think so.

    Let’s all quit blaming CA or BA, shall we?  The reality is that acupuncturists are being brainwashed into believing they should be making tons of money if they are “doing it right”.  When are we going to get the point that for the vast majority of us, it would be great to make a living, forget about a killing.

    That’s a topic for another post…coming soon.

  3. thank you, guest

    for again reminding me and us working class folks that working within our communities is philanthropy.  And also by defining CA as a “philanthropic endeavor”, I thank you for highlighting a key factor in why you made the right decision in BA and would fail miserably as a CA punk. How can you love what you don’t understand?

    And we all have bills/debt.  Some of us have allegiance to our communities as well.  And while charging less may sound like a good idea, doing so when it means sacrificing class privilege is an entirely different matter, no? It’s why I don’t charge $0 and you don’t charge $15.  

     

     

  4. Where are you getting your numbers from?

    The best part of CAN really is that we’re honest with each other. It’s no fun to not be seeing the patient numbers you want or making the $$ you want, but at least we’re honest with each other.

    With the other acupuncturists we don’t talk about REAL patient number or REAL income numbers, because you know what it’s not very pretty. 

    Let’s be honest with ourselves here. Acupuncture is a difficult industry to succeed in no matter who you are. We have to convince people it’s worth it to spend $60+ per treatment when in reality sometimes it takes a couple of treatments to get well. 

    I’ve worked with people in very successful BA clinic and see their actual accounting numbers.  And you know what, it took them a long time to get there. 

    Just ask any small business advisor how long it takes any small business to break even. Sometimes it takes 2-3 years. Netting $50k in a BA practice is just not really a viable business model for people in this economy. And $80K in 2 years, I think this is the same fairy tales we’ve been hearing from our business classes at school again. 

    So what if someone makes $100k gross if their expenses are $50k, We have to look at some REAL numbers here. And the real ones just don’t look good. 

    Yes, please go back to school for nursing and make that $90K!

  5. I doubt any Nurse

    I doubt any Nurse practitioner makes 90K for 20-30 hrs per week… just saying.  Even if your making 50K in a CAP… that’s great for only a 20-25 hr work week.

    I’d rather enjoy my free time and make 50K than make 90 and work 40 hrs… urgh!

    Ben 

    The People’s Acupuncture Clinic

    “health for the people… by the people.”

    http://www.thepeoplesacupunctureclinic.com

  6. like!

    “And we all have bills/debt.  Some of us have allegiance to our communities as well.”

     

    Personally speaking–  I dont want to be rich.  I dont want to be a doctor.  I want to treat the people in my community and make a living wage at a job I love.  I want to be my own boss.  I want to be a fair employer.  — Debt is just imaginary numbers– I was born in debt, raised in debt and will die in debt– welcome to the american working class!! there are a lot of us!!  My american dream does not involve a white colar, a big house or a new car!

     

     

     

     

  7. Interesting topic

    Community Acupuncturists can make anywhere from very little money to quite a bit in their individual practices. See here.

    I would imagine this can also be said for private room LAc’s as well.

    Ultimately what constitutes ‘enough’ money is highly subjective. As others have eloquently written above, factors other than gross receipts tend to hold greater importance to CA punks.  This is why we choose this model to employ.

     Speaking for myself, I need – and earn – ~ $43,000/year to pay my bills, debt and living expenses – including a new car payment (farewell ’01 Civic whom I loved!).  So do the 2 full-timers who run our shop with me (full-timers work ~ 30 hrs/wk).

     Do the math – that’s $129,000 for just our 3 full-timers.  Never mind our part-time admin. staff of 5 others. And our shop savings account.

    My heavy-handed point: CA clinics can make money.  

    To suggest anything else is simply false.

     

  8. Thanks andy

    Im with you on that one.  43k sounds pretty nice.  Im finding that the more I like my job the more I like my life.  And the less is spent on crap I dont need.  That was a big drain on me before.

     

     

  9. Also..

    SOME nurse practitioners could be making 90-100k.  If they get a “sweet
    gig” with a cardiologist or something.  There are many that make 60k. 
    They are almost all salaried and work not 40hrs per week but more like
    50+.

  10. i love how…

    folks are so quick to make this sweeping generalization about CA, but are unwilling (or unable, due to the appalling lack of actual data by the schools)  to make any attempt at the same critical analysis of the BA side of things. because in real life, THERE’S MOSTLY NO MONEY IN BA EITHER and that myth’s been doing damage for 20 plus years.

    the myth is perpetuated by schools and acu professional orgs that just wish this whole CA thing would go away–which it isn’t, thankfully!

    and thanks for aknowledging the more nuanced picture, which is equally true of BA practices and all small businesses: that some take off quickly, others like a rocket but all require lots and lots of time and attention.

    as to guest’s comments, wow! first let me say a sincere congratulations on being able to create a successful practice  so quickly. and especially since you are in the tiny minority of acupuncturists (8.7% according to the NCCAOM’s own job task analysis) who are actually doing this.

    Guest claims that a “well-run BA practiice will be netting $80,000 in 2 years” really? where are the stats to support this? this is the usual figure thrown around by acu schools and why is it that no one–not schools or alumni or the alphabet org–can show any real numbers to back this up??? if they actually had the data, wouldn’t they want to publish it everywhere?

    please, everyone, students and prospective clinic owners especially, i urge you to look past the
    empty promises at the cold hard numbers on success
    rates in BA practice. the NCCAOM itself has them here: esp the lovely graph on page 19

    https://nccaom.org/exams/pdfdocs/jta/Append/NCCAOM%202008%20JTA%20Report%20to%20the%20AOM%20Community%20%28s%29.pdf

    Key points, again:

    70% GROSS less than $60,000 per year. So cut that $60,000 in half after taxes,
    business expenses, etc. and you will probably be taking home right
    around $30,000 (minus income taxes) per year if you are grossing at the TOP of the range of
    this respondent group.

    If you aren’t at the top range of this respondent group, you can expect to be
    living on even less than $30,000 per year.

    we all know anecdotally, that many, if not most, BA practitioners also have other jobs (or trust funds or spouses to support them), often teaching other prospective punks, ironically . and this is especially true in the first several years of practice, while it is building. it’s the reality with owning most small businesses.

    and you’re right, guest, that nurses and other medical professionals can walk right into a large pool of available jobs that pay well enough to repay their educational investment. unfortunately, most acupcuncturists have no hope of doing this, despite the myth.

    don’t even get me started on the letters to DOE from schools and professional orgs, admitting that this is the truth and how it just isn’t their fault if students are misled (by them).

    i take the mirror position: if i had a trust fund, i might have the luxury of dabbling in the boutique acu hobby, but i don’t. and i wouldn’t give up the joy of CA for anything!!

    and if having a sustainable practice doing CA is the same odds as the lottery, then i’m going to start playing the lottery every day!!!

    Melissa

    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  11. This is an issue many people

    This is an issue many people don’t understand or remember.  At some point (after setting up the business, when you work all day every day) this becomes a PART TIME JOB.  I don’t work as much as friends who have regular 9 to 5 jobs.  If I wanted to earn more I could schedule more shifts or hours for myself.  I’d be exhausted, but then many people are exhausted after their work day.  I like my 25 or 30 hours that I work.  I can do ad design and book keeping and whatnot from home in the evening after my child goes to bed.  I have the exact work schedule I want in order to be with my girl as much as possible.  I even have a half day off in the middle of the week for sleeping in and having breakfast with friends.  If I want a vacation or need to go out of town I have total control of the schedule book.  To me that’s worth a lot more than dollars.

    Plus, the actual work is the best job ever.  For me it’s win-win!

     

  12. About the big bucks…

    They are out there for some people,not many, who really want them. When I went to the Tan conference in San Diego last March I met an acupuncturist with a BA practice in  — brain fart — what’s that place outside Phoenix ? — Scottsdale! He charges $125.00 a treatment and believed he had every right to and that he should earn as much as an MD.It seemed to be an integral part of his self-esteem. Not my style or political leanings, but there you go, We talked about CA and he told me every time he had raised his fees his numbers had gone up. I told him when I dropped my my numbers went way up.So, I thought some people really need to feel special and can afford to pay to announce it that way.I love the poeple I see in my CA clinic and they are much sicker than the ones I used to see in my BA clinic so the work is much more exciting. But that’s not entirely the point. A small number of punks will have both the will and the good luck, be in the right place at the right time to make big bucks in their BA practices. I believe the NCCAOM stats show that the higher earning BA punks had been in practice for up to 20 years. That’s a lot of work and scrambling to make big bucks, a lot of community building. And a few CA clinics also hit the ground running due to the same factors. Andy, for instance, could double his salry easily if he didn’t provide as many jobs and worked more hours. But that’s not what Andy’s about.

    There are a lot of punks who graduate with student loans, mortgages, kids and cars who can’t afford to wait a year or two to make $80,000. I’d be willing to bet a lot of them lose those homes and cars if they don’t get other jobs to make ends meet. It’s not a simple thing to have a successful business. So many factors have to fall into place, along with the entrepreneurial genes in the practitioner.

    It’s rare for any business to open it’s doors to a stampede of customers. Those who do are rare, and very, very lucky, and I wish them all the best. After all that’s the American dream, isn’t it? HOLY SHIT__ I just realized we don’t have a Canadian Dream. Jeez…..what the….

    Just my CDN $0.0197 worth.

    Pauline

  13. what we know about LAc income

    Hope I am not too late for anyone who posted here to read this. Data on LAc income is hard to come by. There are a handful (like 5 or 6 for those with an extra finger) of published studies on the acupuncture workforce. And there has NEVER been a survey devoted to the workforce: how much income, average fees, hours worked, total patients per month, etc. The absence of a workforce survey is one very important reason why acupuncture is not listed in the Bureau of Labor & Statistics. To digress a moment…one must wonder how it is a profession has neglected to survey and decribe its workforce for 40 years. My colleagues and I were asked to analyze surveys from three communities of acupuncturists including CAN which we hope to publish sometime in the first half of 2011. Summing it all up here are the findings in brief.Keep in mind these are not randomly sampled surveys so they are just reports from communities and should not be construed to represent the large profession. However, they do help fill a 40 y.o. gap.

    CAN clinics average the most patients…by far. New graduates carry the largest debt. CAN did not collect debt data. However, the Old Guard community did and their debt was also substantial but only 70% of the new grads at the OGs graduation. More importantly, nobody is paying off their debt. Presumably because they cannot afford to. Old Guard claims the highest fees, more than triple CAN and about 40% greater than new grads.

    CAN reported average income ~$65K. Old Guard close ~$80K. New grads closer to ~$45K. However, these are average figures. The median is a better measure of the midpoint, where half fall above and below a certain number. The median for new grads was $15K, while the median for CAN and Old Guard were almost the same at ~$60K.

    A couple other points. The Old Guard numbers do not “pencil out”; i.e., when you multiply hours per week by pts by fee the reported average income is too high. The CAN numbers pencil out. One of the co-authors suggested how this could be. Maybe his explanation is familiar to readers.

    “I received those surveys. When things were going well, I reported. When things weren’t, I
    didn’t. I didn’t want to acknowledge that I wasn’t succeeding. Additionally there is a culture of “positive (and magical) thinking” which says: If you say it, it’s
    true. I can just see people reporting the income they want to make in a month, rather than the income they actually make. I’m telling you, the sickness runs deep.”

     

  14. Thanks Steven.

    Are those incomes gross?

    Can you explain how you are defining “Old Guard,” please?  Are these school administrators?  CEU Circuit Lecturers?  Did you include their income if they owned acupuncture supply companies?  Or is their income *strictly* acupuncture treatments?

    How are you defining “new grads”?  How new is new? 

    Look forward to your publication…

  15. Good questions, Jessica

    and thanks Steven for the preliminary report; very interesting stuff.  Also, I’m still waking up today, but I think the second half of this sentence might be missing a verb? “However, the Old Guard community did and their debt was also substantial but only 70% of the new grads at the OGs graduation.”

  16. question

    Steven,

    Thanks for the summary.

    I’m curious about your distinctions — Old Guard, New Grad, and CAN.  The first two seem to be distinctions of length of time in practice while the third group is a business model approach.  The CAN group is made up of a mix of both long-time practitioners (old farts like Skip) and newbies (myself).  Should I presume the OG and NG numbers reflect only boutique/private room practices?

    David L f’ing Ac (my earned title)

  17. clarifications to questions and reading the NCCAOM JTA report

    Old Guard is a term I am using here (on this blog) to
    describe a community (I like Lisa’s term and am trying to use it whenever
    possible) that conducted their own survey and sent me the data. I presume they
    are practitioners. They averaged the most years in practice (~7) and reported
    the highest incomes. They did include quite a few questions in their own survey
    (as did the other two communities) that addressed business practices. Some sell
    herbs but did not specify whether it was out of their practice or a factory. In
    the paper the OG community is named.

     

    The new grads are from an AOM training program. They are very new. The
    school is not identified in the paper. Seems prudent.

    I do not want to name the groups here because I think I have a responsibility to the
    informants and my co-authors not to identify the communities by name before
    the paper comes out.

    Sorry
    for the kind of garbled prose on comparable debt. The point is that at
    graduation the OGs debt was 70% that of the NGs. It looks like debt loads are
    getting higher. Anyone who is following the Title IV debate will not find this
    surprising. The other point is that neither community is paying these debts
    off; also consistent with the Title IV hearings and viewed as a major problem
    with how student loans have been exploited.

    David
    – Only the CAN folks acknowledge group needling. I presume the other two
    communities are boutique/private.

    Regarding
    info in the 2008 NCCAOM JTA (noted elsewehere in this colum), one of the
    problems is the decision to define full-time work as >30 hrs appears arbitrary. It also softens the findings. The report separated out the LAcs
    who worked less than 30 hours. The problem is almost 60% of LAcs responding to
    the NCCAOM survey work less than 30 hours. In fact, working less than 30 hours
    could be the norm for LAcs. Graph 11 shows this clearly. The stat that was reported was 70% earn $60,000or less. Sounds OK however it is only for the 40% of respondents who work more than
    30 hours. In September the NCCAOM released new data and made the statement that
    if you included the “part time” LAcs the average income (which has never
    been revealed) would be “much less.”