By Lawrence Howard, L.Ac., MS.Ac.
Toward the final semesters of school acupuncture students take the
“practice management” class where they are introduced to creating an
office. They learn about topics such as leases, tax forms, and how to
write a business plan - with the intention of getting a business loan.
These are the components of what one may call the basic “free-standing”
business office model. It may be the most common business model among
practitioners but it is not the only one.
Each business model has its strengths and weaknesses, and it is for the
oriental medical practitioner to decide which is most appealing to them
and their potential patient base. Practice style is as important as the
business model for it will affect income as well as reflect some of the
practitioner’s goals. Treatment style sets the practitioner with or
apart from other practitioners in the area. It may reflect the
professional interests of the practitioner and determine the type of
patients that are attracted to the office. Keeping these in mind, a new
practitioner can get a better sense of what to expect and veteran
practitioner something to think about when they evaluate their practice.
Free-standing office - The practitioner finds and rents office
space, “puts out a shingle,” and hopes for the best. The office could be
a store-front, medical building, or a home’s basement or even
living-room. Advertising, coupons, free evaluations/treatments, and word
of mouth are a few methods patients are obtained; the practitioner
essentially run a grass-roots campaign to attract patients. They may
have staff but probably not at the beginning. The practitioner is
independent but alone.
Shared-space - Practitioners of the same specialty share an
office space. Practitioners may share the rent or one practitioner may
rent (sublet) from the other. In the latter case, expenses as utilities
and staff are often included in the rent. The primary owning
practitioner may have the option to rent a treatment room by the day or
even the hour. The dynamic between/among practitioners may be
cooperative or more competitive. This is essentially a free-standing
office but with less expense.
Cross-referral - The practitioner refers patients to nearby
practitioners of another specialty. These practitioners might include
medical doctors, dentists, accountants, soccer coaches, or just about
anyone else. There is the stated or implied intention to refer patients
to one another. This system works best if there is a mutual exchange of
patients and there is more than one source. It is recommended that the
practitioner is familiar with the specialty they are referring the
patient and that the referral is legitimate.
One may call this “networking” with other practitioners. This is
cooperative relationship because each person increases their indirect
potential patient/client base…word of mouth.
Multi-disciplinary - The patient sees several practitioners in
the same office space. Modalities may be administered consecutively or
simultaneously as long as they do not compromise the effectiveness of
each other. These practitioners may include chiropractors and physical
therapists. There are many management variations to this model but they
are clinically similar.
Housecalls - This allows the practitioner to escape the humdrum
office routine entirely. The benefits include little overhead, limited
travel - if one can limit their “range” to a neighborhood, the ability
to charge less due to lower expense or more due to it being a housecall.
There is the additional benefit of flexible hours, guarantee to see
patients unless prior cancellation; there are no “no shows.” There is
the disadvantage of little control over the treatment setting (ex. small
dogs, cats wanting attention). Bringing a treatment table or chair is
Coverage - Substituting for other practitioners. The practitioner
covers for fellow practitioners who are vacationing or are ill. This
income is especially unstable, however, a large base of practitioners
may be able to compensate.
Purchasing an office (free-standing probably) - Practitioners
moving to another location or retiring want to sell their successful
practice. They choose to sell their practice instead of dissolving the
practice or referring patients to other practitioners. The prospective
owner may buy the practice “lock, stock and barrel.” The purchaser
should be well “transitioned” to the office in order to retain the
patient base. They probably should avoid making dramatic changes
immediately - following the adage “if it ain’t broke don’t fix it.”
Patients in an established office are accustomed to a routine and don’t
always adapt to change easily.
A new owner should use their preferred treatment style or techniques on
new patients. They should pay close attention to the rate of retention
or referrals compared to the established patients. This will help the
practitioner adapt to their style to what works best.
In addition to having a place to practice there is the issue of how the
treatment is conducted and the immediate surroundings to consider.
Spa style - This is where the patient is not just treated but
pampered. This can be found particularly in offices that specialize in
“facial rejuvenation.” There are simple amenities as perfumed facial
pillows, soft lighting or “dimmer” lights, soft new age bamboo music, or
nature music and glasses of water (not paper cups). Attention is given
to the smallest detail - office ambiance, letterhead, signage, body
language, and speech. The practitioner is the patient’s humble servant…
and practitioner too.
Standard - This style is called standard because it is learned as
an intern in school and serves as a good reference point. A complete
history is taken and the patient is treated in their entirety – about an
hour is spent on each patient. The treatment strategy is probably
ultimately multi-branched/rooted. The main complaint is taken into
consideration, but also as part of the larger “clinical picture.”
Successful treatment and patient attention are the highest priority.
Medical clinic style - This is where the practitioner focuses
treatment on the main complaint. Patterns are identified and standard
protocols are used which the practitioner may modify. This is often a
fast-paced office where there is less interaction. This office may
streamline time by limiting point selection to readily accessible
“Microsystems” as the ear and hand. Successful treatment, speed, and
patient volume are the highest priorities in this style.
Any office may focus on a particular ailment. They include pain
management, stop smoking, weight loss, stress reduction, drug/alcohol
detoxification. Specializing has the benefit of focusing on a particular
population and building a reputation on this specialty but the challenge
is choosing a specialty that will attract a sufficient number of
patients. Additionally, limiting to one specialty can become boring
after a few years.
It’s fair to consider that a practitioner’s opinion and understanding of
Oriental Medicine may affect their treatment tendencies. For example, a
practitioner who believes qi is just a theory may focus on needling
trigger points, whereas a practitioner at the opposite end of the
spectrum may integrate “emitted qi gong” techniques into their
“Traditional” or “Old school” - These practitioners strive to
practice Oriental Medicine in its purest energetic form. They may use
raw herbs, qi gong, and possibly cross-over into other similar energetic
“Modern” or “New School” - These practitioners embrace the latest
technology. They may use spray-on moxa, point locators, lasers,
electrical stimulation, herbal injection, meridian diagnosing machines
“Medical” - Discarding the energetic foundations in favor of
needling nerves, trigger points and other physical structures.
A practitioner should know their general tendencies because it will
affect how they interact with their patients. It’s easy to see which
kind of practitioner an avid yoga instructor, computer technician, and
orthopedist would prefer and refer their friends. A practitioner who is
aware of their patient tendencies can adapt their interactions to their
patient or market to a patient type.
Putting it Together
The great challenge for each practitioner is to match business model,
practice style, and treatment style to patient expectations and the
neighborhood demographic in order to earn a good income. Although this
is ultimately a personal matter, there are two simple concepts to keep
in mind when making these decisions - time and space. The patient is
paying for your time and you have office space - both of which are
limited. It is also good to keep in mind that one of the most severe
pains a patient can experience is that of opening their wallet to pay.
Here are two simplistic scenarios generating the same income:
1. Spa style/Standard- 5 patients treated at a rate of 1-2 patients per
hour (two tables) at $100 resulting in about a 5-hour work day.
2. Clinic style- 25 patients treated at a rate of 5 patients per hour
(five tables) $20 per patient resulting in a 5-hour work day.
It is easy to see how time and space greatly affect all other factors
considered. A patient accustomed to a “clinical” style treatment will
likely feel a spa style treatment is too long and preventing them from
doing other things. A patient expecting a “traditional” practitioner but
is getting treated in a “standard” style would feel neglected and
slighted in a “clinical” style office with a “medical” type
For any new office there are some unsaid, uncelebrated landmarks that
are noteworthy. The landmarks are: earning enough to pay for lunch,
paying for gas to the office, paying the office rent, paying the home
mortgage/rent, putting away for retirement.
We are fortunate to be in a business with so much flexibility. We are
able to adapt to our location yet attract those we seek. Our future is
in our hands and we can change it anytime.
Lawrence Howard, LAc, MSAc is a New York State licensed
acupuncturist and has worked or covered in over twenty offices in the
five boroughs of NYC and two counties of Long Island as an employee,
independent contractor or owner since 1998.