I've got some good news and some bad news. The good news is that acupuncture is enjoying a remarkable degree of acceptance as a viable from of therapy all around the world from both the general public and modern medicine practitioners; the bad news is that many acupuncturists are struggling and failing to earn a living providing this therapy.
I began to seriously ponder those two questions after the wake-up call provided by the National Certification Commission for Acupuncture and Oriental Medicine's 2008 Job Training Analysis of NCCAOM Diplomats. The 2008 JTA found that 91 percent of those who responded to that survey were in solo private practice and their average annual gross incomes were between $41,000 and $60,000 per year. These gross income figures were before subtracting practice overhead expenses that typically run from 35 percent to 50 percent. Only 9 percent of all respondents reported grossing over $120,000 per year.
I was shocked and saddened by these statistics because I believe most people graduating from our schools should be able to build to a gross income in the $100,000-$120,000 per year range within a few years of opening their practices. It is unacceptable that only 1 out of 10 are making this income when you consider the tens of thousands of dollars and years of time it takes to become a licensed acupuncturist. Even more troubling is the fact that when acupuncturists struggle and fail in their practices, this represents a lost opportunity to help the public with this form of safe, natural therapy.
I opened my practice in 1986 right out of school as the sole source of income for my family of four. It was sink or swim. I managed to build a very steady practice that has continued to support my family over those years. I am now busier than ever seeing about 100 patients a week in my solo private practice with just one support staff. Once my practice was well established after my initial few years, I have never had a slow period despite the ups and downs of the economy. How was it that I came to be in and stay in that top 10 percent? It wasn't luck or some special healing ability, it was figuring out how to make the services I was offering worthwhile for both my patients and myself.
In addition to managing my practice, I spent many of those years working with various institutions involved with the growth of the AOM field including membership organizations, licensing and regulatory bodies, and the insurance industry. I also wrote two books: one that explained acupuncture for the general public and one on practice building for acupuncturists. My experiences with all of these endeavors led me to believe there are specific reasons why many fail to build successful practices despite acupuncture's growing acceptance. I will try to identify and offer advice on some of those reasons in a series of articles. Much of what I have to say will require some outside the box thinking but it should be clear that the current "box" is not working so well for 90 percent of us.
Cook, Chef, or Restaurateur?
One of the biggest mistakes I see being made in the AOM field is the idea that if you become really good at diagnosis and treatment, your practice will automatically become financially successful. This is seen by how much emphasis is placed on increasing training and finding the "best" method for diagnosing and treating such and such conditions. While you must of course become competent in diagnosis and treatment, the idea that your practice success is proportional to your clinic skill is just plain naive. That is like believing that if you are a good cook, or better yet a great chef, your restaurant will automatically be successful. There is much more to building a successful restaurant than being a good chef and there is much more to building a successful AOM practice than being good at diagnosis and treatment.
When I say you need more than diagnosis/treatment skill, I am not just referring to slapping-on business skills like marketing. That is another common misconception I have seen promoted over the years. Yes, you do need ability in diagnosis/treatment and in basic business and marketing skills, but - like yin and yang - these two categories should not be considered as separate. They are the different sides of the interconnected skills you need and their total is much more than the sum of those two parts. People need to stop thinking of these two as separate and start looking for how each factor influences and is influenced by the other.
An example of the overlap between these two is the issue of treatment frequency with acupuncture. It amazes me that most those teaching diagnosis/treatment techniques rarely mention just how many treatments should be needed over what period of time. How you space your treatments is every bit as important as what points you chose. When learning about herbs and herbal formulas, you must learn about appropriate dosages. The number and frequency of acupuncture treatments is to acupuncture what dosages are to herbal medicine. Many acupuncturists are under-treating their patients and their success rates suffer. Learn how to space your treatments and how long it should take to produce results and your success rates will increase.
The problem, of course, is that the issue of treatment frequency is related to the issue of treatment charges and treatment charges are related to what your particular market will bear. The best treatment frequency may not be practical for your patients especially if your treatment charges are higher. The question of treatment charges would seem to be more of a business/practice management issue than a clinical one. But, since your treatment charges will have a big impact on how you manage the number and spacing of your treatments, this now becomes a clinical issue too. There are business ramifications within the clinical and clinical ramifications within the business.
In pointing this out, I am not trying to criticize those teaching diagnosis/treatment techniques, but rather to point out that the AOM field is undergoing tremendous growing pains and we need to adjust the focus of our training. When you realize how poorly most of those entering practice are doing, it is clear we need to place more emphasis on practice success - on being a successful restaurateur rather than a great chef. With 9 out of 10 ending up in solo private practice, more focus is needed on understanding just what it takes to make private practice work.
I never had the goal to be in our profession's top 10 percent income-wise. I only wanted to support my family while helping as many people as I could. I now want to help other AOM practitioners achieve the same thing and look forward to being knocked down in those rankings. In the upcoming articles, I will try to boil things down to their basics and highlight more of the common misconceptions I believe are holding so many back from building successful practices.
Click here for previous articles by Matthew Bauer, LAc.