Social entrepreneurship is one of the most exciting concepts to emerge in the last decade, especially for self-employed people and small business owners. Closely related to the sustainable business movement, social entrepreneurship reflects the belief that not only does a healthy business have a triple bottom line of "people, planet and profit" instead of profit alone, but that business actually can be used to solve social problems. Social entrepreneurship is not charity; it has nothing to do with giving services away. To a social entrepreneur, problems represent opportunities - business opportunities - in disguise.
Few of us who work in health care would deny we are hip-deep in problems. The cost of health insurance continues to spiral upward, while at last estimate, 45 million Americans did not have any health insurance coverage at all. This does not include those who are underinsured, or those who go bankrupt due to medical bills despite having what they thought was good coverage. In the world of Oriental medicine, many acupuncturists are frustrated by the increasingly onerous process of seeking third-party reimbursement, but at the same time find the idea of building a cash practice too daunting. Simultaneously, public health jobs for acupuncturists are disappearing at a frightening rate, along with government funding for many other human services.
It's time for us to get creative.
The purpose of this column is to discuss social entrepreneurship in the acupuncture arena, beginning with the example I know best: my own practice. My business was set up to solve a set of problems that could certainly be described as social, but which I experienced as very personal. Four years ago, these were my problems: I loved acupuncture, but my public health job wouldn't support my family. I wanted to pay my student loans. I wanted to be able to practice acupuncture the way I've learned it works best - with frequent, simple treatments. I didn't want my treatments to be dictated by what insurance would pay for. I feel loyal to the community I live in, and the community I come from, and that's who I wanted to treat. I live in a working-class neighborhood, and I come from a working-class background. People like me cannot possibly afford acupuncture at the going rate, and they're lucky if they have any health insurance at all, let alone the kind that covers acupuncture. On the other hand, they're not poor enough to qualify for free health care. Anyway, I didn't want to rely on grants or donations to provide care for people; I knew too well from working in public health what an unstable foundation those things can be.
The unifying solution to all of my problems was to quit my public health job, embrace being self-employed, and let go of the conventional business model for an acupuncture practice in order to come up with one that would make acupuncture accessible - not only financially, but psychologically - to the community I live in. I stopped thinking of "treatment" as a singular experience, consisting of one patient, one table, one medical-looking cubicle, one hour with lots of one-on-one attention from me, and one financial unit of $65. Instead, I decided that "treatment" means having acupuncture available frequently and regularly, with four to six patients an hour receiving care in the same quite, soothing space, sitting in recliners, relaxing with distal points, each paying what they felt they could afford on a sliding scale of $15 to $35 per person. There would be no involvement with third-party payers in any form; no depending on grants or government money; and no interaction with any system outside my little community of patients. I rapidly found out that not only could I make more money with this business model than I could with the conventional $65 per treatment model, but that something unique and beautiful arose from the process of treating patients in the same energetic space - something which, for lack of a better description, I call "the qi of community."
I believe the heart of acupuncture is radical, elegant simplicity. Because of this, acupuncture is extraordinarily flexible. It can adapt to any treatment setting, any practitioner and any culture, while remaining remarkably effective. As years passed and my practice flourished, as I reflected on how all of my problems with earning a living had been solved by focusing on acupuncture's simplicity, I became possessed by a vision of what acupuncture could do for the problems of our health care system as a whole. Imagine what could happen if acupuncture were widely available to everyone in America, regardless of whether they had insurance or not. Imagine the impact of a clinic in every neighborhood: patients getting off expensive pain medication they can't afford, uninsured asthma patients no longer needing to go to the ER, overwhelmed working parents no longer yelling at their kids or drinking to escape from the stress of their lives - because they have an alternative. Imagine acupuncturists being integral to every community, and acupuncture being the medicine everyone uses and values.
That's what social entrepreneurship is all about: transforming a vision of justice and hope into reality through the power of business. It's not about providing charity or becoming a martyr. It doesn't mean that you need to turn your practice into a nonprofit. It only means understanding that capitalism is a good servant and a terrible master. Succeeding in business does not have to mean selling your soul.
Social entrepreneurship is perfectly compatible with prosperity, creativity and freedom - all of the things many of us long for in our practices. The current health care crisis is a tremendous opportunity for us. It's time for acupuncturists to embrace the role of social entrepreneurs. Acupuncture can change the world.
