Chinese Medicine Notes

Interview with Lisa Rohleder- Community Acupuncture

Posted on June 29, 2009 by Yael

The concept of Community Acupuncture (CA) has been introduced to me by Roy Green Pach at the beginning of the year.
Roy wrote a wonderful article for my website in Hebrew, and the reaction to it was overwhelming. It’s amazing to me that little ol’ Israel can be a part of a great movement in real time and not in a delay of a number of years! And it’s true- we have a growing number of practitioners that practice CA, and more and more people are interested in the model, and the proof is that that particulare article was probably one of the most popular in my website.

Roy approached me and together we set up a blog for CA, all in Hebrew, and people are interested- asking questions, enjoying his thoughts- and yeah, it helps that he’s a great writer. Recently Roy interviewed Lisa Rohleder, the practitioner from Portland who started it all, for his blog. Lisa felt she needed a change, as you will soon read, and she made that change: She started out with 12 patients back in 2002, and experimented a lot with the model she created.
Years later, Lisa is now seeing about 400 patients a week, charging about $15-$40 per treatment, and along with her husband Skip, she has one of the biggest clinics in the USA. I thought that it would be wonderful if that interview would be posted on CMNotes as well, as I know that CA is gaining more and more popularity around the world.  I also think it’s important to let practitioners know that they have an option. Things can be different for them. Things are changing in our world, including marketing strategies and our clinics and how we run them are no exception. So I’m really happy to be part of this spirit of change, and I hope that it will strike a chord with you too! Enjoy.

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When was your first encounter with Chinese medicine?
After I graduated from college, I was planning to go to medical school. I took a year off to be a full time volunteer in an AIDS service organization. That was back in 1989, before there were any effective AIDS drugs, so people were trying all sorts of alternatives, including acupuncture. One of my goals in volunteering was to make sure that I was OK being around sick people before I committed myself to becoming a doctor. What I found out was that I was fine with sick people, but that I really didn’t like hospitals.  A lot of the people I knew were having very positive experiences with acupuncture, so I decided to study acupuncture instead.

When did you first realize that you needed to change the way you practice?
It was kind of a slow process; I had to spend quite a while, seven years or so, attempting to practice the conventional way before it became clear to me that it was never going to 1) allow me to treat the people I wanted to treat, and 2) allow me to make a living. I had all of these different people that I was treating, many of them my neighbors, none of whom could afford to pay the rates I was officially charging. I had all of these “special arrangements”, all of these people paying me $5 or $10 or $20, at the same time I claimed that I was charging $60. It was ridiculous. And some of these people needed acupuncture really badly, and they were getting a lot out of it, and they were genuinely paying me the absolute limit of what they could afford, even if that was only $5. Some of them were very, very ill with conditions that Western medicine could do nothing about. So it finally occurred to me that I needed a business model that reflected my reality, and my neighbors’ reality. It was the right thing to do to charge less; it just meant that I needed to see a LOT more people.

Was the transition to the CA model difficult in any way?
Only in that I didn’t really know what I was doing. It wasn’t “the CA model” at that time; it was me flailing around, trying to figure out how to run my business in a way that made sense. Other than that, it was the most enormous relief. I was so happy to be able to present acupuncture enthusiastically to everyone I knew, once I felt like they could afford it.

WCA seems to offer patients a different medical experience - more casual and warm, less “professional-medicinal”. Do you think that this is an essential part of the CA model?
Yes, I do. I think there are lots of subtle problems with the way that acupuncturists try to identify themselves as “professionals”. Some of those problems have to do with classism, and the ways that classism dis-empowers patients; and some of those problems have to do with acupuncturists trying to make acupuncture more like Western medicine, and that’s bad for everybody: patients, practitioners, and acupuncture itself. The CA model is not about trying to make acupuncture a respectable, upper middle class occupation; it’s about making acupuncture available to everyone who needs it. Which goes along with acupuncturists actually being able to make a living doing acupuncture. Most acupuncturists describe feeling hugely liberated by no longer having to pretend to be a doctor; it makes relationships with patients much easier, much more natural, much more rewarding. Everyone, both patients and practitioner, gets to relax. I think the mutual warmth that is possible in this model is a major reason why so many acupuncturists who practice community acupuncture are so happy. It’s a lot more fun this way.

 Some practitioners say that there is nothing wrong with charging $200 per treatment, as long as there is someone who’s willing to pay such an amount. What would you say to that?
Besides something unprintable?   Well, “ there is nothing wrong with charging $200 per treatment, as long as there is someone who’s willing to pay such an amount” assumes that charging rates that make acupuncture inaccessible to the majority of people isn’t hurting anyone, when obviously it is. It’s hurting the people who need acupuncture who can’t afford it, and it’s hurting the reputation of the medicine by making it into this irrelevant luxury item. The idea that there is no moral dimension to what you charge for health care is absurd. That ’s like asking, why shouldn’t I be selfish and greedy as long as I can get away with it?

Some practitioners are interested in offering CA a few days a week, while continuing private treatments on other days. Do you think they can be successful in doing so?
I doubt it. It’s hard to get to a really high volume of patients when you have what amounts to a confusing fee structure. Why would the same service cost so much more? However, lots of people are determined to do it this way, and I have given up trying to talk them out of it. The truth is, there is nothing you can accomplish in the private setting that you can’t accomplish in the community setting, except talk too much. Some people are not ready to give up talking too much.

Do you think community acupuncture can suit fresh new students?
I think it’s the best thing possible for new students. It gives them lots of clinical experience right away, which is very important. It allows them access to a much wider range of patients, so that they have a chance to be acupuncturists. One of the worst things about the conventional model is the way it sets up a self-defeating cycle for new practitioners: they charge too much, so that patients can’t afford to come often enough, so that patients don’t get good results, so that patients don’t come back, so that the new practitioners lose confidence in acupuncture and in themselves, so that they don’t attract more patients, so that they lose more confidence, etc. The community model works in reverse: if the new practitioner can see patients often enough, regardless of whether or not their treatments are perfect, they will get good clinical results from acupuncture. And then patients come back, and refer more patients, and the new practitioner gains more confidence, and attracts more patients, and develops better and better clinical skills, and on and on like that.

What advice can you give practitioners who want to start practicing CA?
Join the Community Acupuncture Network and read everything! And get together locally with other like-minded acupuncturists. It’s important to get support. Oh, and read our new book, “Acupuncture Is Like Noodles”.

What is the next step for the Community Acupuncture Revolution?
You know, I don’t really know. We’re all making this up as we go along – we’ll just have to see what happens next.

Thank you!
Thank you, Roy

Over to you
What do you think about CA? Like it ? Hate it? I am interested in your thoughts, please leave a comment.