Monday, April 11, 2011
"My Unexpected Career" by Pam Chang
We are sharing this piece that Pam wrote recently describing her personal journey of becoming a community acupuncturist:
In acupuncture school, I never knew how – or if – I'd ever practice Chinese medicine. In fact, all through my training, I never quite knew why I was studying Traditional Chinese Medicine (TCM). In August 2003, vaguely bored with my freelance architecture and civil engineering practice, I saw a notice of an acupuncture college open house in the local newspaper. I showed up on a whim. Throughout the presentation, I wondered why I was there while simultaneously recalling a play I'd just seen about the life of Alberta Hunter. Hunter was a jazz-age singer whose popularity faded in the 1950s when she was turning 60. Needing another career, she claimed to be 40, enrolled in nursing school, and worked as a nurse for 20 years before being forced to retire at age 80. She then returned to the stage for the last five years of her life. Inspired by Hunter, I could not come up with sufficient good reason for not enrolling in TCM school. True, the thought of sticking needles in people was not appealing, but I liked the idea of learning Chinese medicine theory and herb lore. I began studies for my masters degree in TCM that fall, just prior to my 48th birthday.
TCM school was a slog, a vast amount of rote memorization: Western medical concepts and terminology; Chinese medical concepts and terminology; acupuncture point names, locations, functions and combinations; and herb names, functions and combinations. Hardest was superimposing an Eastern mindset on a Western-trained mind. TCM entities were invisible functions rather than things. They were associated with certain symptoms but didn't necessarily cause those symptoms. And Chinese 'logic' seemed circular and slippery: a diagnosis was right if it led to beneficial treatment but a seemingly opposite diagnoses could also suggest beneficial treatment and therefore was right, too. Without supportive classmates and a driving thirst for soaking up knowledge, I would have dropped out – as did at least half of my starting class.
Despite not knowing why I was studying TCM, I benefited from my new-gained knowledge. Midway through my second year, I awoke one morning and noticed the indented imprint of my hand on my swollen left leg: pitting edema. By now, I'd completed enough anatomy and physiology classes to ask the right questions. After my Western MD ruled out deep vein thrombosis, I speculated on venous obstruction and began palpating my lower abdomen whereupon I felt an abnormal mass. Scans and surgery quickly followed and I was diagnosed with stage I ovarian cancer – my first major illness.
Becoming a patient changed my relationship to TCM. Before then, TCM was theory, something I studied out of curiosity and love of learning. Afterward, I opted for TCM over chemotherapy and experienced the process of gradually re-building my health by getting weekly acupuncture, boiling raw herb decoctions, taking powdered and pill-form herb extractions, renewing my qi-gong practice, altering my diet, and taking time for adequate rest. By the time I began my internship, I had received acupuncture from several competent clinicians and I had made many of the lifestyle changes that I would be recommending to my clients.
I can't determine how much of the confidence I was able to bring to the school clinic came from my experience of being a patient, how much of it was due to my age and having felt successful in prior careers, or how much of it derived from the comparatively quick point selection methods I'd learned in a meridian theory class. In any case, I enjoyed clinical practice and had several regular clients. Even so, up until my last trimester, I did not expect that I would continue to practice acupuncture except, perhaps, as a hobby.
The big stumbling block for me when I thought of opening a practice was cost, both mine and my clients'. Throughout school, the only practice model we saw was one that involved lots of time with individuals in a private room. We were trained to see at most one client per hour, asking the “ten questions”, feeling pulses and looking at tongues before inserting and manipulating needles, administering moxa or massage, and maybe prescribing herbs. I was afraid to run the numbers but I assumed that I would have to charge the standard $50-100 fee per visit to cover my rent, insurance, equipment, overhead, and profit. However, I wasn't comfortable paying $50+ per treatment myself. If I hadn't received deeply-discounted acupuncture at the school clinic, I wouldn't have been able to afford weekly treatments for very long. I didn't expect I'd be able to build up a practice at that fee among my friends, particularly those who earned, maybe, $25/hour, or who worked part-time, or were on fixed incomes. So I figured I'd keep on doing architecture for a livelihood and maybe do a few house calls per week, or be a substitute acupuncturist if my study-buddies ever wanted to take vacations.
Toward the end of my internship, eavesdropping on a conversation between a clinic supervisor and another intern, I learned about the community acupuncture (CA) practice model. In community clinics, one acupuncturist treats several clients, all seated in recliners together in one large room. Intakes are minimal and therapy mostly is limited to acupuncture at points on the head, neck, or lower arms and legs. Treating several clients per hour allows the acupuncturist to charge fees as low as $15/visit yet still earn $50 -100 per hour. Simultaneously, the low fees enable clients to afford more treatments – perhaps enough treatments for them to experience the often-gradual benefits of acupuncture. Community clinics typically offer sliding scale fees to all clients. They are for-profit businesses, supported by user fees, and they do not require the acupuncturist to spend time pursuing insurance monies or grants. Suddenly, I saw the possibility of acupuncture becoming my career.
In the months that followed, I attended a workshop on “the nuts and bolts of community acupuncture” sponsored by Working Class Acupuncture, the Portland, Oregon clinic that pioneered the community acupuncture model. I finished school, passed my licensing exam, and realized that if I wanted to be a community-style acupuncturist, I would have to open my own clinic. In September 2007, I started talking to Tatyana Ryevzina, the clinic supervisor from whom I had first learned of CA, about starting our own clinic. Six months later, we opened Sarana Community Acupuncture in an 800 square-foot storefront in a strip-mall in Albany, California. Furnished with one (later two) massage tables, three La-Z-boy armchair recliners, four folding recliners, and an assortment of used tables, lamps, shelves, rugs, wall-hangings, etc., the space looked more like a living room than a medical clinic.
From opening day onward, we attracted enough clients to cover our monthly expenses. Our first month in business, we were open twelve hours per week and typically saw 20-30 clients per week. Some of our clients came from Tatyana's prior practice where she'd been offering community-style treatment two days per week for several months. Other clients came through contacts I'd accumulated from having lived in the neighborhood for 28 years or because they'd seen the notices we'd posted around town. After two months, we increased our open hours to 18 per week and were scheduling about 40 appointments per week. In ten months, we had earned back all of our start-up costs. This month (March 2011), Sarana will celebrate its third birthday. We are now open 40 hours per week with four acupuncturists and we see 140-150 clients per week. Our clients are referred to us by other acupuncturists, non-acupuncture therapists, word of mouth, and Internet list-serves or web-searches. Not all CA clinics are this successful – some more so and others less – but based on the Community Acupuncture Network's (www.communityacupuncturenetwork.org) current listing of 160 clinics –up from 80 in 2007– this model of practice is clearly spreading.
As a new acupuncturist, one of the things that was hardest for me was developing speed. For my first two months, I scheduled appointments at 20-minute intervals, then at 15-minute intervals for the next year. In May 2009, I started scheduling five clients per hour and since October 2009, I've been scheduling six per hour. The slow transition to six clients per hour was a mistake. It allowed me to be far too chatty with my clients. Chatting more, I've since learned, just means that it takes longer for a client to settle into the deep relaxation of acupuncture treatment. Moreover, working slower encouraged my tendency to spend too long selecting the 'perfect' point prescription. As my schedule sped up, I had to choose points without thinking about them so much – and learned that my 'on-the-fly' points worked as well or better than the TCM-diagnosis – based selections. My most recent colleague at Sarana began scheduling six clients per hour immediately. By this time, of course, we had trained our clients to need little chatter and we had created lists of point protocols for the most common ailments.
The other thing that was hard for me was becoming comfortable as a clinician. During my first several months, I felt that I was doing performance art, playing the role of acupuncturist, “faking it until I could make it”. I didn't feel that I was a healer. I didn't feel that I had the “magic fingers” that one of my classmates seemed to have in her instant ability to find ashi (sensitive) points. But one day, after I'd been practicing for 6-12 months, one of my clients burst into tears during her intake. In silence, I passed her the box of tissues, stepped back while she recomposed herself, then inserted her needles. She slept during her treatment, awoke in better spirits, went home and wrote me a thank-you note. She's still a regular client. I realized then that my gift for healing is in holding a space where people can feel safe and acknowledged. I can listen to them and bear witness of their struggles. What happens with the acupuncture needles, I think, is that people heal themselves but to do so, they must allow themselves to relax. I don't have “magic fingers” but it doesn't matter. My job is to be as trustworthy and caring a person as I can be and then to step aside and let people heal themselves.
So, having stumbled cluelessly into TCM and fortuitously onto the CA scene, I feel incredibly lucky. I thought I liked what I was doing when I worked as an architect, but now I feel I've found my proper life work providing a useful and widely-appreciated service to my community. Sarana provides my business partner and me a very modest income but it enables us to live well-enough and earn, probably, about as much as most of our clients. Our clinic also provides partial incomes and lots of practice to two other acupuncturists – a job option that was rarely available when I finished school. And we provide lots of acupuncture to lots of people. Last month, one of my clients told me that losing her health insurance may have been a blessing – relying only on weekly acupuncture and traditional medicines, she now feels less pain than when she was taking prescription pain-killers. When I was in school, one of my instructors said that he taught because school gave him the social interaction that he could not have in his doctor/patient relationships. I disagree. I give some 40-50 treatments per week and, even though I may share only five minutes of conversation per visit, I've come to feel very connected to my clients. They come in – regularly or sporadically – and bring their friends and family members, share news of major and minor events of their lives, offer us gifts and garden produce, and thank us again and again. But I am equally grateful – for having clients who support us and our version of affordable health care.