It’s time to discuss some “secrets in plain sight” that I believe will help acupuncturists increase their profitability. These observations were made while working in multidisciplinary clinics for over two decades in Long Island, New York, and four of the five boroughs of New York City.
Hold the Lease, Hold the Power
The lease-holding acupuncturist who is able to sublease or rent space to other clinicians holds considerable power. Renting to judiciously selected medical providers allows for a steady income through rent. An optimal combination of specialties has a synergistic effect to increase patient volume and profit for all. And if profit decreases, disputes occur, or more profitable opportunities arise, then the acupuncturist may exercise their rights as a landlord to terminate the relationship. The landlord-tenant roles supplant clinical hierarchy.
States may prohibit hiring clinicians from different specialties, but subleasing or renting space to one is a pragmatic alternative. If an acupuncturist is practicing in a state that requires a referral, then renting space to a clinician who is able to provide those referrals is convenient. A complacent clinician who is dependent on a steady flow of “office” patients will learn who is “boss” when that flow is interrupted, collections are reduced and rent is due.
Nexus of Care, Nexus of Power
An observation from personal-injury clinics is that patients receiving multiple medical services want conveniently coordinated services. In New York, this role is often occupied by a chiropractor. All medical services are under the chiropractor's purview. The care-coordinating role is a modified form of “networking” with other clinicians.
By referring patients to other clinicians and gathering the resulting reports, the chiropractor gains a comprehensive understanding of the patient's health. This makes the chiropractor a valuable resource of information to the patient and a powerful referral source to other medical providers. The patient depends on the chiropractor for both clinical services and information. The chiropractor is a case manager.
Acupuncturists may take this central role, even in a “stand-alone” clinic. This requires rejecting an isolationist and team approach alike. The role to take is akin to a coach; all other clinicians – regardless of degree and training – are your players. Make a comprehensive care plan, give referrals, get reports and pass information to the patient. Become the center of your own network.
A simple demonstration of this position is when presenting the patient with a referral. A request written on an office referral pad requesting specific services with a physician’s business card is more authoritative than giving their card alone.
Communicating with other clinicians, requesting medical reports and explaining progress to the patient is work. Potential referrals from clinicians and positive patient rapport with reputation makes the effort worthwhile.
Give Patients, Get Patients
A patient is a valuable commodity. An acupuncturist who refers patients to other clinicians may also receive referrals from them latter. One way to encourage this exchange is to refer patients who are most appropriate and will benefit from the service. Successful exchanges of patients between clinicians require a mutual knowledge of specialty and preferred patient. Discussing mutual patients is a means to directly contact a clinician and develop rapport.
Patient's Right to Remain
A custom among multidisciplinary practices seems to be that the referring clinician retains “possession” of the patient. A patient referred to tenant clinicians by the acupuncturist lease holder is an “office patient”; in contrast to a “private patient,” who is brought to the clinic by renting clinicians. Patients are shared for the benefit of the patient and clinicians.
This distinction becomes relevant when the tenant-clinician leaves the clinic. Office patients are expected to remain, whereas private patients are expected to follow the leaving clinician.
In practice, patients receiving multiple services at the same location tend to become loyal to the clinic instead of individual clinicians. When the tenant-clinician becomes “a face in the crowd,” there is little motivation for the patient to follow them, especially if they are replaced by clinician of same specialty. Consequently, private patients are more likely to become office patients than vice versa.
Offer Convenience to Gain Control
Certain conveniences encourage dependence from tenant-clinicians. Staff services, patients and file storage for tenant-clinicians allow them to focus their attention of providing a service. They may become exceptionally busy, thus risking forgetting efforts to obtain “private patients.” They may unwittingly relegate themselves to the role of an employee due to a devolving clinical dynamic as they pay rent. In this situation, evicting a clinician is equivalent to termination, but without paying unemployment.
One example of control is in the distribution of patients. In the absence of scheduling, a system of priorities emerges. First priority are office patients receiving multiple services that day, followed by office patients receiving single services, followed by private patients.
Concern: Centralization Brings Instability
Occupying several vital roles – without any successors – creates a situation whereby any absence adversely impacts the business. At a certain point in business development, it is wise to delegate vital responsibilities to others to ensure unimpeded function. The business mission statement and goals may serve as resources when making decisions and as guiding ideology.
Concern: Time Is Profit
As one assumes these and other roles, managing time becomes essential. These roles may consume so much time that one has few opportunities to enjoy one's profit. As “Flogging Molly” sings, “The summer that was lost now is gone”1 – a reminder that time is a profit which is irreplaceable.
Maximize Your “Power Plays” for Profit
I can comfortably say from observation that adopting the trifecta of roles above (case manager, clinician and networker) will improve an acupuncturist's chances for generous profit. Each role ascribes a certain degree power and complexity in an aspect of the business of medicine: giving, receiving and treating patients. These roles require one to have or develop confidence, communication skills, assertiveness and a curiosity of other clinicians. In the meantime, one suggestion is to find and experience the “play” in one's power plays for profit.
Reference
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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