In the first part of this series, I described the personal and professional factors that have led me to transition to herbs-only practice of Chinese medicine. In the next few articles, I will describe my process in more detail.
But first, full disclosure…
Before I go further, I want to mention that it is a privilege for me to be contemplating herbs-only practice. Of the half-dozen people I initially told about my decision, most said something like, “Your must be doing very well financially to make this decision!” The implication being that, since acupuncture is the cash cow of American EAM practice, one can only make that switch when finances are abundant. While I’m not sure that’s a perfect assumption in my circumstances, these responses got me thinking.
In what ways have my particular circumstances set me up so that this change is an option?
One of the most annoying things about acupuncture business & practice management teaching is the attempt to universalize one individual’s experience.
There are many successful practices all over the world. Some people, enthused by their own success, believe they have “cracked the code to effortless clinic income,” and become motivated to teach others their methods. A wonderful impulse, particularly when not entirely motivated by profit, but ultimately problematic in many cases. If a person does nothing but universalize their particular efforts and outcomes, not researching widely or thinking fully about their own success, they end up teaching people something that is only actually useful in their particular set of circumstances.
So, in the spirit of anti-universalism, I offer a brief description of some of my particular circumstances that have made this possible.
- No analysis of Watershed Wellness’ success would be complete without considering my wife and business partner, Amanda Barp. Not everyone has such an ideal partner – many Chinese medicine practitioners are doing their work solo. While doubtless there are pros and cons to having a business partner, even more when that business partner is your life partner, in our case the negatives are almost non-existent. If it wasn’t for her and our partnership, this wouldn’t be happening, period.
- Peculiarities of the coastal Oregon market for Chinese medicine services. When we moved to Astoria, OR, we did not know how underserved it was. There are a few great practitioners trying to serve a significant rural population not just in NW Oregon but also SW Washington. On the peninsula, a beloved practitioner recently retired and they have nobody serving those communities directly. Few of the practitioners from Long Beach to Manzanita, and as far inland as Longview, have herbal expertise. With my training, even if there were other herbalists here, I’d have a strong standing in the market. This is quite helpful in increasing my available pool of potential patients.
- Experience and lineage. To build on that last sentiment – in any situation I’d be likely to have a little edge in terms of market position as a Chinese herbalist. I have specialized and advanced training, I have teaching background, and the energy of my lineage to buoy me. And as I’ve been chiefly focusing on herbalism this last ten years, I have built clinical experience that helps me get positive results in most cases. Word of mouth marketing is powerful!
- The business is bigger than me. It’s been 10+ years of intense work, but we’ve finally built a resilient business that wasn’t phased much by the COVID-19 related closures, nor the many adjustments we’ve need to make. We have an excellent group of practitioners, and a rock solid office support team. Amanda and I have given uncountable hours and dollars to this thing, and it is finally paying us back for all of that hard work. Because of that, I can make changes and do experiments without threatening the clinic, or my personal finances, too much. That’s a hell of a gift.
So, the more closely somebody’s circumstances match mine, the more likely they are to find something instructive in what I have to say here. If your situation differs greatly from mine, you’ll still likely find things to learn from my account. Just be aware of what might limit the applicability of the information.
Considering the pitfalls and challenges of herbs-only practice
In considering this change, I first tried to identify as many potential problems as I could. I’ll describe the problems briefly below. There are doubtless other concerns that you might have as you contemplate a similar move – this felt like a complete list to me. I’ve since addressed each of these items. How, and what the results have been, will occupy the rest of this series.
My initial brainstormed list:
- Lack of interest in herbal practice / shrinking market. The first three of these all relate to the concern already discussed – acupuncture is more well known and accepted in the United States. Here I am pointing to a concern about the size of the market of people who are interested in herbal practice. I am in a sparsely populated rural part of Oregon. We have actually been surprised at how strong the demand has been for what our clinic offers! But, any deviation from what we’re already doing introduces an element of uncertainty that is uncomfortable. Will people want standalone Chinese herbal practice?
- Insurance billing discrepancies. Related to the previous concern, here I was worried mostly about whether, and how well, insurance companies compensate for treatments that do not involve acupuncture. The medical services at our clinic are about 50% primary health insurance oriented – so a loss of that income source, even just with one practitioner, could be significant.
- Messaging herbal practice. So, with a potentially smaller pool of interested people in my area, and the likelihood of having to go cash-only for at least some patients due to insurance billing problems, what does one do? It comes down to marketing of one type or another. My next questions, then, revolved around how to talk about herbs-only practice to a population more used to acupuncture being part of the equation?
- Maintaining continuity of care with existing patients. One of my most important goals in the transition is to minimize the disruption for existing patients. How best to deal with patients for whom acupuncture is a vital part of their treatment? And, more broadly, how do I talk to my existing patients about the changes that I’m making in a way that honors the relationships we’ve forged so far?
- Making appropriate internal business adjustments. I had a variety of concerns about the logistics of this switch and how they might impact the clinic’s functioning. When do I stop taking new patients for acupuncture? How should I structure my herbs-only appointments, and how will that work in Unified Practice, our EHR? How will I price things, and will that allow me to fulfill my revenue responsibilities in the business? Should I offer discounted herbal appointments to other Watershed Wellness patients? If so, how?
- All eggs in one basket syndrome. I have always been a proponent of maintaining multiple streams of revenue in my business, and multiple streams of interest in my brain. Is it a dramatic financial mistake to simplify my professional orientation? And what of the sustainability of herbal practice? If I invest the rest of my life into Chinese herbs, and then we lose access to Chinese herbs (or they become unsustainably expensive) then what? Is there something I’m going to miss about acupuncture practice?
That’s a lot to think about!
The complexity and importance of many of these questions is likely part of what kept me from moving on this earlier. I’ll admit that I haven’t fully resolved every aspect of these questions, or the questions buried underneath them, but I’d like to talk about what I have figured out – and what I see coming.
In the next article, I’ll look specifically at how the structure of my appointments and the rest of my clinical container are changing to suit the new reality.