Friday, April 10, 2009

Sea-Change in the Acupuncture World

a map of Community Acupuncture clinics in North America

When I finished my acupuncture clinical internship in 2007, the only way I learned to practice involved “10-Question” intakes, one patient per treatment room, and about an hour per patient. We heard stories of famous practitioners with lots of assistants treating ten people per hour, but all the practicing acupuncturists I knew scheduled 1-2, maybe 3 clients per hour in 1-3 treatment rooms. In the year since I’ve become a community acupuncturist, the acupuncture world has changed radically. My guess is that in another 5 or so years, community acupuncture will be as common as private-room treatments and Americans will consider acupuncture as ordinary as, say, physical therapy or flu shots. Granted, living in the over-enlightened San Francisco Bay Area, I may just be out of touch with reality, nevertheless, here’s why I think Community Acupuncture (CA) is about to go mainstream.

In late 2006, when my business partner, Tatyana Ryevzina, started her CA practice one afternoon per week, most of her clients were used to private-room treatments and had never heard of community-style acupuncture. Nevertheless, few had difficulty transitioning to lower-cost treatments in a group setting. Within months, her community-treatment appointment slots were fully booked. Within a year, she had added a second half-day shift for community-style appointments and she was earning more from community treatments than from private-room treatments. In March 2008, when Tatyana and I opened Sarana Community Acupuncture, we treated about 25 clients weekly while open for 4 shifts (13 hours) per week. A year later, in a recession economy, we are treating about 70 clients/week while open 6 shifts (19.5 hours). This month, we’ve just added 2 more shifts (for a total of 26 open hours per week). I don’t know how our growth rate compares to conventional private-room acupuncture clinic start-ups or even to other CA clinics, but I see the success of our clinic and the emergence of over 80 Community Acupuncture Network (CAN) clinics in the past 3 years as proof that the CA model is viable and replicable.

Beyond viability, what persuades me that CA is here to stay are our clients. Our first clients were mostly people from Tatyana’s prior practice, personal friends, or people who had seen our posted advertisements. Now most of our clients have been recommended to come to us by other clients. Some of the new clients have heard of us from 2-3 different sources, possibly including on-line rating services such as or one of the local Parents’ Network Groups. Many of our clients are fiercely loyal. They actively recruit their friends and family members, classmates from exercise class, or fellow support-group members to become our clients. And they loudly defend us against skeptics who suggest that we are less effective than private-room clinics or that CA is merely a passing fad.

We also have more and more clients who find us because they are specifically looking for either CA clinics or inexpensive acupuncture. One young woman booked an appointment because, although she’d never had acupuncture, she’d read The Remedy and thought she wanted to be a community acupuncturist. Others have been to CAN-affiliated clinics elsewhere and want to continue their CA-style treatments. This type of feedback, along with the weekly outpourings of gratitude for $15-40 sliding-scale acupuncture treatments, shows me that lots of people want CA clinics to survive, grow, and be an ordinary part of their lives.

But, have our supporters reached sufficient critical-mass to shift CA from an emerging trend to a cultural norm? Malcolm Gladwell in The Tipping Point says that after about 5% of a population adopts a new idea, that idea becomes mainstream. The idea of CA may not have reached 5% of the general population or even 5% of the acupuncturist population, but in at least one of the 4 San Francisco Bay Area Traditional Chinese Medicine (TCM) colleges, it is reaching 100% of the most recent graduating classes. Since Fall 2008, AIMC in Berkeley has offered a community acupuncture seminar and a CA clinical internship. ACTCM in San Francisco invited local CA clinics to participate in a TCM health fair this past winter, and ACCHS in Oakland will include a guest lecture on CA in their spring 2009 Practice Management class. In Northern California, I am one of 8 CA practitioners I know who received their licenses within the past 2 years. While the majority of acupuncturists may remain oblivious to CA, our success is surely being monitored by our former classmates.

And our progress is being monitored by more than our classmates. Every month, it seems, we get inquiries from acupuncturists or TCM students who want to know how a CA clinic is run. Some come for a tour or a treatment. Others become volunteers. Currently at Sarana CA, we have 3 TCM students and 3 acupuncturists who help us with reception in exchange for learning the nuts and bolts of CA. More established CA clinics, Working Class Acupuncture in Portland, OR, for example, can hire acupuncturists and support staff, giving them the opportunity to work alongside more experienced practitioners without first having to buy into a practice. What this shows me is that CA clinics are likely to become a significant post-graduate training venue for acupuncturists who don’t feel ready to open their own practices. And because CA is a comparatively low-risk, low start-up cost business – unlike cruise ships, spas, HMOs, subsidized nonprofits, or even many conventional private-room acupuncture clinics where new graduates might find work – more and more new acupuncturists will be inspired to work in or open more and more new CA clinics.

So this is how the acupuncture world has changed. When I started TCM school, for-profit community acupuncture barely existed in the US. When I graduated, it offered hope as a way for me to practice acupuncture at a price my friends could afford. Now CA has proven itself to be viable, replicable, desirable, and inspiring – an idea whose time has come. It’s an idea that is spreading from Portland, OR to Manchester, NH, Minneapolis, MN to Austin, TX; into the halls of TCM schools and into the minds of new TCM graduates. I think that CA is on a roll now, a roll that will continue until the CA market is saturated, when CA clinics are as common as dentist offices –and a whole lot cheaper! And for all this, I want to express thanks – to my mentors and their lineages, to CA compatriots, to Sarana Community Acupuncture clients and colleagues – it’s a wonderful life, living the change I want to create.

Pamela O. Chang

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