What's the one thing that acupuncturists seem to obsess over the most? (Besides student loan payments.)? I think it would be some form of the question, "Does ~~ work?", Insert whatever you like there, from the big picture, "Does acupuncture work?", down to the more minute "Do the 'three emperors' points work for non-hodgkin's lymphoma?" This is a HUGE stumbling block for any acupuncturist. However, the startling possibilities that I will propose are insights that maybe somewhat unique to community acupuncturists.
Now, the acupuncture establishment is based on the idea that there is a more or less fixed spectrum of therapeutic response to treatment, like this:
At one end the treatment is a "failure" and the other end, the treatment is "perfect". This way of thinking implies that the practitioner is solely responsible for the efficacy of the treatment. We can then replace the "therapeutic effect" with a measure of the "correctness" of the treatment.
Much like boutique acupuncture itself, the focus is taken off of the patient and put back on the practitioner. It becomes a game of "you're no good at acupuncture" or "my style is the best". My hypothesis is this: there is no correlation of "correctness" of treatment with therapeutic response. It's all about WHO you are treating not WHAT you are doing.
I have literally done thousands of treatments over the last three years here at WCA, and I've noticed something: Sometimes no matter what you do a patient will have miraculous results. Sometimes no matter what you do the patient will get no results what so ever. Usually, whatever you do, patients get some results.
Yes, you can have a perfectly "correct" treatment that does nothing, and a totally "incorrect" treatment that seems miraculous. Most of the time, you're in the gray middle.
Unfortunately, we do not have the funding and I really don't have the patience to go through and quantitatively measure these outcomes. But, I believe that the sample size I'm dealing with here, which keeps on growing and growing, lends itself to qualitative analysis that's not just wild speculation. (Much like the process that I believe lead from a combination of massage and blood-letting to acupuncture as we now know it.)
Here's the continuation of my earlier hypothesis: in any given population of people, a small percentage will be "ultra-responders", a small percentage will be "zero-responders" and the vast majority will fall somewhere along that spectrum. This is irregardless of what the practitioner is doing. That is to say, that the style of acupuncture is the LEAST important part, as long as they are getting acupuncture, the particulars are unimportant. Let's try and visualize what I'm getting at here:
Yup, it's a bell-curve, the dreaded instrument of statisticians everywhere (y=1/sqrt2Pi*e^-(x^2/2)). Why the bell-curve, you ask? Well, it is one of the most statistically sound formulas to describe a random distribution. Imagine, if you will, that in your clinic you settle on a single protocol. Oh I don't know, let's say: Du20, Lu07, LI04, 11, St36, Sp06, GB34, 40, LR03 all at ~4 fen of insertion depth and with an "even" stimulation technique. Now, let's say you do this protocol on each and every one of your patients, anybody that walks into the treatment area gets these and only these points. What do you think the results would look like? I think it will be the bell curve. Doing the same protocol is a simple way of controlling the "what points did you do?" variable. What emerges is the natural and random distribution of the "hyper" and "zero" responders and everyone in between.
What about the effect of different treatment styles? Well, to be honest I think that being particularly proficient in certain style will only nudge the curve slightly to the right. When I say "nudge" I mean barely. The longer I'm in practice, the more I become convinced that styles and systems are a fall-back strategy to support you through the actual time needed to learn by experience and intuition. Humans are always seeking meaning in everything, style provides a convenient shelf to put everything on, but after a while you realize that many of the places you've been pigeonholing things into aren't all that congruent with reality.
I'm NOT saying that theory is useless, quite the contrary. People who adhere to one and only one orthodox strategy get the advantage of not having to over analyze everything and can just work from a single perspective. It helps if your system is more simple and internally consistent, like Japanese Meridian Therapy or Tung/Tan or even "Five Element". TCM being eclectic and byzantine tends to *require* over analyzation. These simple styles with simple rules allow you to work in a consistent manner, thus exposing their flaws over time. Staying true to a system allows you to just gloss over these shortfalls until you have the confidence to try something different. Ok, so what's all this have to do with Community Acupuncture?
The acupuncture establishment argues that a perfect treatment exists. (Which anyone who's been in practice long enough knows to be false, whether you agree with my above hypothesis or not). How do we place a value on that?
First off, I don't think that there is any such thing as a completely worthless treatment, so I'm going to arbitrarily set the starting value at $1.
Next, I'm going to assume that the value we place on a treatment grows geometrically (y=1.75^x). Which is to say that a treatment that is 99 times as effective is worth closer to $200 than simply $99. Think about it, if you got a "perfect" treatment whose effects last months, maybe even years, wouldn't you be willing to invest that kind of money in it?
If treatments were consistently worth $200, don't you think everybody would know about it? You know, like everybody knows about antibiotics and aspirin, airplanes etc? The acupuncture establishment has two different strategies for dealing with questions about this:
A. The fault is in the practitioner for not knowing enough--why not sign-up for a doctoral program and learn more about how to give more perfect treatments.
B. People just don't value their health/know how valuable these treatments can be--you need to give lectures to the public about how great it is, to "educate" them (they're so stooopid).
The first statement, we dealt with above. The second statement gets to the heart of the matter. If a patient's response potential is what dictates the efficacy of treatment, then only to a very small percentage of patients is any treatment actually worth $200. Take a look at this chart:
Take your time with this one, there's a lot going on.
Notice where the bulk of patients are--only half-way up the value curve. I've marked the midpoint of the response curve with the midpoint of the value curve. This I have dubbed the "whatever" point. It's the point where a patient's response is most closely matched to the perceived value of the treatment. Guess what? It's $16. See where most of the people fall? Yeah, it roughly approximates our sliding scale here at WCA. You can also infer from this that some people who come in are over paying! They get treatments that are worth only $7-$8, but they have to pay us a minimum of $15. There are also people who are taking WCA for a ride, they get $150 treatments for a measly $35 (maybe they pay at the higher end because they like us so much).
All of this has serious implications for how to build a practice. Human behavior is hard to predict, but I think it's safe to say that the patients who are spending too much for the effects that they receive will simply stop coming in. These are people I dub "tourists" mostly because they're just trying it out, and find it's nothing special, in this case it's literally "not worth it". Some people will get effects that are just shy of what they're paying. In my observation, they come in randomly. They know something is happening, but it's just not quite enough to justify the recurring expense. Then there's the "regulars" they get what they pay for and pay for what they get. They get consistently adequate results for the amount they're putting in. They are the bread and butter of Community Acupuncture, WCA would not exist without these people. Then, something ironic happens at the far end of the curve. People that get awesome results will only come in intermittently, not because they don't seimge the value, but because they simply don't need to.
The insight here is that time does the work, not a certain style or practitioner, it's just statistical averages. As more and more people move through the clinic, the practitioner merely "accumulates" larger and larger numbers of "regulars", with a lot of turn around with "tourists" and variations with patients who come in randomly/intermittently. If you can just stay in business long enough, you will see your "regulars" start crowding out the other types of responders, there simply won't be room for anyone else on the schedule.
The sliding scale allows patients to pay what their treatments are worth most of the time. It lets the practitioner off the hook too, as they don't have to keep chasing $200 treatment patients, continually grasping for responders to whom an acupuncture treatment is actually worth that much. This evens out the cash flow more, keeping a budding business afloat just a little longer, moving it closer and closer to the "break even" point.
Community Acupuncture simply slows the failure rate down enough that one can actually begin to succeed. Debt loads and wrong assumptions about "correct" treatments contribute to the very rapid failure we see in most of the "field". The secret of how to "retain" patients isn't about "good" treatments, it has to do with how patients relate to their treatments, in terms of value and efficacy. Once again, "It's not about YOU, it's about the patient." Stick around long enough and enough of them will find you valuable enough to support you in your endeavor. Now, if we could only do something about those pesky student loan payments. . .