Honing the Practice Model: Dynamics around Various Practice Approaches

By Jean-Paul Thuot, RAc

During my ten years of practice I have had my own clinic along with other acupuncturists, been a member of a large multi-disciplinary medical center, had a house-call only practice, and am now practicing in two chiropractic clinics that also offer massage therapy. In this article I am going to give my thoughts about each of these “styles” of practice and discuss the pros and cons of each.

Starting your own practice can be daunting and not a little expensive. The start up costs, lease payments, equipment purchase, and advertising can quickly add up, and if you are just starting out you can expect to make very little money until your patient base grows to a sufficient size. The general rule of thumb says that any small business loses money for the first two to five years, and I think that holds true of acupuncture practices as well. However, the freedom to design your own space and hold your own hours, not to mention brand yourself and your clinic in a way that really reflects you, is something that can not be undervalued. As well, you have the option of bringing other practitioners on board, which can go a long way to defraying the costs of operating your clinic.

Practicing with another acupuncturist—or indeed any other practitioner—can be an excellent way to grow your practice or it can be the kiss of death. It's important that whoever you practice with shares your ideals of patient care, and understands the importance of referrals. When I first graduated from college, I was very grateful to my friend and mentor, Arnie Lade RAc, RMT, for the space he offered in his clinic. The experience I gained from being in his clinic was immense as he has always been very generous with his instruction, offering me a lot of information that I had not gotten from school. Moreover, Arnie has been in practice for close to thirty years, so I also gained reputation and patients by becoming his associate.

The multi-disciplinary clinic was quite another story, however. This clinic had four medical doctors, two of whom practiced acupuncture, and a host of other complementary therapies, two acupuncturists, two massage therapists, a psychologist, a counselor, and two naturopathic physicians. With each of these practitioners doing their best to maintain and grow their practice, there were few referrals going in any direction. I found that once I referred one of my patients to the naturopath for nutritional guidance, they stopped coming to see me as the ND convinced them it was unnecessary. Only one MD ever referred me, as the others had their own CAM therapies and therefore didn't feel the need to refer to anyone else.

After the multi-disciplinary clinic closed, I was left without a clinic space. At that time I decided to take up a house-call only practice. This is perhaps one of the most challenging and rewarding types of practice that I have tried. It proved challenging because I had no space for walk-ins, and no store front of any kind, so getting patients meant I had to give talks at seniors’ homes and recreation centers as well as pass out my card to as many people and places as I could. Scheduling became quite a challenge as well, as I might find myself crisscrossing the city a couple of times throughout one day. The biggest rewards for me came from treating people who otherwise were not able to get out for treatment. I saw a lot of difficult cases during this time, and my abilities were certainly stretched with some patients.

The next few years I was in Taiwan, where I trained with a number of doctors, primarily Dr. Tseng of the Tzu Chi University Hospital in Hualien. There I got to see and participate in a busy hospital setting, where it was common to treat up to fifty people before lunch, and sometimes over one hundred and twenty patients in a day! With so many different cases coming through the door I learned a huge amount, and my diagnostic and treatment skills improved exponentially. Dr. Tseng was an excellent clinician with an almost photographic memory of his patients and their issues. He was also the fastest acupuncturist I've ever seen, with a system of treatment that had been honed to such a degree of efficiency that there was never a wasted moment in the clinic. As medical treatment in Taiwan is socialized, getting acupuncture cost the equivalent of about $3 or less. This meant that a patient could afford to come many times per week, and thus the success rate for the Chinese medical department was quite high. This, I think, is possibly the biggest advantage to this sort of clinic.

I am now practicing in two chiropractic offices, one near my home and one farther into the city. The set up is a little bit different in each, and both have good points and things that could use some improvement. In my downtown office I am paying a flat rent, and practice on the days when no one else is in. This has the advantage of giving me the space to myself, but on the flip side the only people I come in contact with are my own patients, so there isn't much opportunity for referrals or introductions to other possible clients. The other clinic has a fee-percentage structure, and I am sharing a room with a massage therapist. The one big advantage to this fee structure is that it behooves the others in the clinic to get everyone else busy, so referrals are common. Although the clinic itself is somewhat confined, the atmosphere lends itself to a camaraderie that is not available at my downtown clinic. I am finding that these factors combine nicely, and this practice is growing more quickly than at the office downtown.

I am sure that there are many other ways to run a practice, some of them quite attractive depending upon your personality. One school here in Victoria has a connection to a cruise ship company and offers to place their graduates on a cruise ship for six month contracts. Another clinic style that I am looking at closely is what is being called “Community Acupuncture” and shares some aspects with Dr. Tseng's hospital ward: one open space with multiple treatment tables, a lower fee charged to patients, and a walk-in style where appointments aren't always necessary. No matter the style, however, I think it is good and normal to try different approaches to discover what works best for you and your personality. The connection between patient and practitioner is what matters the most, and I think no matter where I have been, that has always been my focus.