Many Offices, Many Lessons

This past September marked my 13th anniversary of being a New York State licensed acupuncturist. I have seen and learned much since the first day I inserted an acupuncture needle for pay.

After graduation and in debt, I was not willing to borrow vast sums of money to take a chance establishing an office. Instead, I found employment in the multidisciplinary office model. This type of office consisted of practitioners of several disciplines treating patients at the same location. Some patients were shared, others were not. I have worked or covered in more than two dozen of these offices, mostly as an employee and sometimes self-employed. I have seen offices rise and fall and would like to share with you some of the lessons I learned.

One of the first things I learned was that office appearance has little relation to success. I have worked in one office where the wallpaper was falling off the wall and the staff wore jeans and the waiting room was full of patients. I have also worked in an office with beautiful new slate floors where the staff wore lab coats and we all sat and stared at the pretty flowers.

When a successful office changes management and makes radical changes quickly, it is likely to fail soon after. Patients abhor change. It is essential that a new management company or owner continues to function in the same or similar manner as the established office. New management needs to realize they are not just buying access to a space and a patient base; they are buying all business relations from referring doctor to each patient. If a new manager seeks change it must be implemented slowly in order to build a new clientele, transition the present clientele and compensate for lost clientele.

An office dependant on a single referral source of patients is inherently unstable. There are no guarantees that a referral source will continue to refer indefinitely. A referral source may no longer have patients to refer or decide to refer them to someone else. A significant or gradual decline in referrals from a reliable source is an indicator that something is amiss. Therefore, it is wise to have several referral sources to ensure stability and take care that each relationship is mutually beneficial.

Complacency will ultimately lead to downfall. Offices that become "comfortable" or over confident tend to become lazy and not notice subtle indicators of decline. Signs include: losing touch with the business market, diminished contact with referral sources, decline in referrals, decline in payment and decline in patient visits to name a few factors. A prolonged presence of any combination or degree of these signs is comparable to watching a car accident in slow motion.

Overspecialization poses a potential long-term risk. Consider the panda bear - the animal that lives almost exclusively on bamboo. Widespread disease or other loss of edible bamboo endangers the species. Similar to the panda, an office that "lives" on a certain type of clientele or specialization of pathology is equally at risk. Changes in demographics, laws, or development of better techniques can empty a waiting room in a matter of months. At the first hint of said changes it is essential to expand the specialty, client base and/or shift to other specialties or clientele type.

Most but not all employers pay on time. When working as an "independent contractor," particularly if working as a substitute, some bosses do not pay in a timely manner. Some employers require months of reminding before a check is mailed.

Office staff dynamic and attitude greatly affect success. A harmonious, happy and sincere staff creates a welcoming environment that patients enjoy and remember. I worked in one office where the receptionists were particularly attractive and the male patients appeared for treatment regularly. Another office briefly had a receptionist with multiple ear piercings- including a "bar" through her cheek- and her presence intimidated the majority of patients and even prompted a few to consider transferring to another office.

Better health is not always a sufficient motivation for treatment. Some patients are motivated by financial gain (building a lawsuit), others by vanity (facelifts, facial rejuvenation), others by being able to maintain their unhealthy lifestyle (repetitive movement injury), and still others due to court mandated treatment (drug detox). Others choose acupuncture and Oriental Medicine out of desperation because their western treatment was not successful or is prohibitively expensive, such as infertility.

Not every patient is interested in full recovery from treatment. Some patients reach what I like to call "acceptable discomfort" and then self-terminate care.

Patients seek results first. Treatments that produce profound results and are memorable will encourage referrals. Examples include: pregnancy when western diagnosis was not promising, remarkable improvement of severe conditions as increased recovery from stroke and rapid improvement of skin after facial rejuvenation at a fraction of the price of a facelift.

Finances affect patient treatment goals and frequency. Patients who have insurance are more likely to continue treatment until their condition is fully resolved but patients who pay cash are more likely to "self discharge." Cash-paying patients seem to have an "illness-to-cost ratio"- the patient places a dollar value on their condition, and continues treatment as long as the value of their discomfort is greater than the cost of treatment. Through patient education, the practitioner encourages the patient to raise the dollar value they assign to their discomfort.

Fees may predict success. Sometimes fees correlate to patient success. High fees attract only the most committed patients and consequently have the highest chance of success, and thus referrals. This is especially true where patient involvement is necessary. For example, a patient who is willing to pay $300 for a "stop smoking" treatment is likely more committed to stopping than one who pays $10 for the same treatment.

People will pay more to "feel good" than to actually get better. In the spa setting, service is not necessarily better than the clinical setting but the presentation, staff attitude and attention given to the patient/client keep them returning for more.

There are many ways and office can fail. Some are due to poor or ill maintained relationships, lack of awareness, not satisfying patient expectations and not adapting to a changing marketplace.

Take these lessons and determine if any will help you. If you pause and reflect on your practice and personality then you already have an advantage over the likes of those I have worked for or with. Self-awareness is vital to success in work and in life. After all, how can you improve that which you do not know needs improving? And that is probably the biggest lesson of all.