How to manage time w/herbal practice

December 11, 2009

Laura,

I struggled with this issue for years. I don't think patients recognize how

little profit there is in the herbs, especially bulk herbs. If it was only

about money, it would be much more profitable to just treat with and charge for

acupuncture. I also have a small office but a busy practice. At least half of

my patients get bulk herbs weekly. I used to have one employee working at a

time, and she would be responsible for not only phones, scheduling, etc., but

for the pharmacy as well. Being without anyone for 2 years, I have had to

manage it myself.

I have 30 minutes of talk, pulse, etc. time before the treatment. If I am going

to give bulk herbs, I cut this time short so that I can weigh out the formula.

I also love to talk, but I find that I need it much less as the years go by. I

just have the patient get changed and on the table, and relax while I do the

herbs. It seems to work fine. I don't generally give out more than 8 bags at a

time, so I can easily do this in 10 minutes or so. I use a traditional qian

hand scale, as I think that is the fastest way. I also know who is getting

herbs, so I can schedule them accordingly and prevent myself from getting backed

up in my schedule. If I cannot get the herbs done for any reason, they simply

have to return later in the day or the following day. Everyone understands, and

it works out fine. I used to kill myself, coming in early and staying late to

weigh out all of the herbs. Now that I have a better system, I can kill myself

with other things instead.

I do not charge extra for both herbs and acupuncture. However, for people who

only get herbs, I charge a small fee for the evaluation time, and usually charge

an extra dollar per bag. I have seen others who do this as well.

I hope this helps. By the way, this is my first time posting, so hello

everyone.

Robert Keller

December 11, 2009

Hi Laura and all:

For all of those people struggling with this, as I do, it may be useful to

remember that " our " practice managment style exists, and it involves four very

important components:

1. Know your herbs and formulas well, brilliantly, so that no time is spent on

choosing and modifying.

2. Traditionally a doctor always had one or more apprentices who did the menial

work and became educated doing so. Time to bring this back.

3. Association with / ownership of a pharmacy where there are employees /

apprentices doing the menial work. This one is tricky w/ re to ethics, but can

be done. No different from the online pharmacies that we order from these days,

in some senses.

4. Know your CM so well that you can actually get to the root and treat with

ready-made (and " mildly-acting " ) classical formulas most of the time - this is

what one of my teachers does, apparently with great success. Although if he

mentions it too much I usually put a stopper in it by reminding him that there

are no high quality RCTs examining his claims in existence, and that there

likely never will be, so can he just be quiet about it.

A quick note on number 4. I read and heard so many times that the typical

patents that we commonly use are weak. And this may be so upon biochemical

analysis, but this IS NOT what our medicine is based on. In CM we use the same

axion that is used in Tai Ji: " four ounces to move a thousand pounds " . Anyone

who has even moderate skill in TaiJi knows how the most infintesimal force

applied (it's not even really " applied " ) in harmony with the opponent's

structure creates huge repercussions and effects. *This* is our medicine. It is

easy for us to slide into the biochemical model which is based on power and

concentration, but in my opinion, this is just one of the many attitudes which

will kill our profession.

A master physician can treat even serious cases with ready made classical

formulas most if not all of the time, resorting to raw herbs only when the

patient is sufficiently complex to warrant it.

Why don't we drag out our Tao Teh Chings (which should be at arm's length from

all of us) and see what the old guy had to say about weakness?

Chapter 41

...True power seems weak...

And interestingly, chapter 28:

The world is formed from the void,

like utensils from a block of wood.

The Master knows the utensils,

yet keeps to the the block:

thus she can use all things.

The last line has been variously rendered:

- Yes: A great carver does no cutting, a great ruler makes no rules.

- Thus great systems don't cut.

- He knows better than to divide

the whole.

- Hence, " a great tailor does little

cutting. "

- For

" The Master himself does not carve. "

I believe that one of Vursley's points regarding modification of formulas is to

keep changes to a minimum.

What I do personally is anyone that needs herbal therapy I switch on to a

specific diet according to CM and patents. Only if truly necessary do I move to

granules, and from there to raw herbs. The three categories necessitating the

switch to granules or raw herbs for me are 1. the px is weak, 2. the px is on a

lot of pharmaceuticals, 3. I don't understand the patient well enough.

Hope this helps, Laura,

Hugo

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.middlemedicine.org

________________________________

heylaurag <heylaurag

Chinese Medicine

Fri, 11 December, 2009 5:44:28

How to manage time w/herbal practice

Hi, I'm wanting to get some ideas from others about how they manage their time

if they have a busy herbal practice. I am feeling really overwhelmed. Whenever

I've had a time when I haven't had very many patients taking herbs I've been so

happy and relaxed because when I get done at the end of the day I am done; I

don't have to stay and engage in the tedious process of making a bunch of

formulas (designing formulas=fun. making formulas=tedious boredom!).

But I do have a passion for practicing herbs and I've reached a point

where a large percentage of my patients are taking herbs. I really don't like

the idea of hiring someone to assist me. I have a very small office. It just

wouldn't work. I did recently buy a second pharmacy for home with the thought

that it would help to be able to make formulas from home. I " m glad I did it,

but so far it has only helped a little.

Part of my problem is that my patients and I talk a lot. Its hard to break that

habit because a lot of the time I enjoy talking (it feeds my former social

worker self).

Lately I have been avoiding taking new patients because i feel so overwhelmed.

The amount of money that I make from the herbs does not come close to making up

for seeing fewer patients. So I am doing extra work for less money. It sucks.

But my patients benefit...I sure am able to treat a lot of things that I

couldn't with acupuncture alone.

Do others charge extra for the office visit along with charging for the herbs

when you do both acupuncture and herbs7 Of course that's not an option when you

are billing insurance. I am considering doing simpler acupuncture treatments if

I am doing herbs--but I don't like the idea because I think the acupuncture is

so important (and I do have a passion for acupuncture too).

I guess part of my problem is that I am so deeply in debt with student loans

that a huge chunk of my income goes to my student loan payment--$1300 a month.

So I feel like I am doing this very challenging job working as a doctor and just

getting by financially, which really bites.

Any advice/ideas anyone?

Laura

December 11, 2009

Hi Laura-

I find that talking to patients while they are on the table really

speeds things up. I generally interview people in my office and then

have them go to the treatment room... but when I am short on time, I

have them go right in, ask a couple of basic questions, check their

tongues/ pulses and get started with acupuncture. If there are more

questions I need ask to determine the appropriate herbal formula, or if

the patient wants to chat, I do this while putting in the points. I can

usually get the needling/ interview done in about 10 minutes this way as

opposed to 20-25 minutes when talking in my office.

Ariel

Hugo Ramiro wrote:

>

> Hi Laura and all:

>

> For all of those people struggling with this, as I do, it may be

> useful to remember that " our " practice managment style exists, and it

> involves four very important components:

>

> 1. Know your herbs and formulas well, brilliantly, so that no time is

> spent on choosing and modifying.

> 2. Traditionally a doctor always had one or more apprentices who did

> the menial work and became educated doing so. Time to bring this back.

> 3. Association with / ownership of a pharmacy where there are

> employees / apprentices doing the menial work. This one is tricky w/

> re to ethics, but can be done. No different from the online pharmacies

> that we order from these days, in some senses.

> 4. Know your CM so well that you can actually get to the root and

> treat with ready-made (and " mildly-acting " ) classical formulas most of

> the time - this is what one of my teachers does, apparently with great

> success. Although if he mentions it too much I usually put a stopper

> in it by reminding him that there are no high quality RCTs examining

> his claims in existence, and that there likely never will be, so can

> he just be quiet about it.

>

> A quick note on number 4. I read and heard so many times that the

> typical patents that we commonly use are weak. And this may be so upon

> biochemical analysis, but this IS NOT what our medicine is based on.

> In CM we use the same axion that is used in Tai Ji: " four ounces to

> move a thousand pounds " . Anyone who has even moderate skill in TaiJi

> knows how the most infintesimal force applied (it's not even really

> " applied " ) in harmony with the opponent's structure creates huge

> repercussions and effects. *This* is our medicine. It is easy for us

> to slide into the biochemical model which is based on power and

> concentration, but in my opinion, this is just one of the many

> attitudes which will kill our profession.

> A master physician can treat even serious cases with ready made

> classical formulas most if not all of the time, resorting to raw herbs

> only when the patient is sufficiently complex to warrant it.

>

> Why don't we drag out our Tao Teh Chings (which should be at arm's

> length from all of us) and see what the old guy had to say about weakness?

> Chapter 41

> ...True power seems weak...

>

> And interestingly, chapter 28:

>

> The world is formed from the void,

> like utensils from a block of wood.

> The Master knows the utensils,

> yet keeps to the the block:

> thus she can use all things.

>

> The last line has been variously rendered:

> - Yes: A great carver does no cutting, a great ruler makes no rules.

> - Thus great systems don't cut.

> - He knows better than to divide

> the whole.

> - Hence, " a great tailor does little

> cutting. "

> - For

> " The Master himself does not carve. "

>

> I believe that one of Vursley's points regarding modification of

> formulas is to keep changes to a minimum.

>

> What I do personally is anyone that needs herbal therapy I switch on

> to a specific diet according to CM and patents. Only if truly

> necessary do I move to granules, and from there to raw herbs. The

> three categories necessitating the switch to granules or raw herbs for

> me are 1. the px is weak, 2. the px is on a lot of pharmaceuticals, 3.

> I don't understand the patient well enough.

>

> Hope this helps, Laura,

>

> Hugo

>

> ________________________________

> Hugo Ramiro

> http://middlemedicine.wordpress.com <http://middlemedicine.wordpress.com>

> http://www.middlemedicine.org <http://www.middlemedicine.org>

>

> ________________________________

> heylaurag <heylaurag <heylaurag%40hotmail.com>>

> Chinese Medicine

> <Chinese Medicine%40>

> Fri, 11 December, 2009 5:44:28

> How to manage time w/herbal practice

>

> Hi, I'm wanting to get some ideas from others about how they manage

> their time if they have a busy herbal practice. I am feeling really

> overwhelmed. Whenever I've had a time when I haven't had very many

> patients taking herbs I've been so happy and relaxed because when I

> get done at the end of the day I am done; I don't have to stay and

> engage in the tedious process of making a bunch of formulas (designing

> formulas=fun. making formulas=tedious boredom!).

>

> But I do have a passion for practicing herbs and I've reached a point

> where a large percentage of my patients are taking herbs. I really

> don't like the idea of hiring someone to assist me. I have a very

> small office. It just wouldn't work. I did recently buy a second

> pharmacy for home with the thought that it would help to be able to

> make formulas from home. I " m glad I did it, but so far it has only

> helped a little.

>

> Part of my problem is that my patients and I talk a lot. Its hard to

> break that habit because a lot of the time I enjoy talking (it feeds

> my former social worker self).

>

> Lately I have been avoiding taking new patients because i feel so

> overwhelmed. The amount of money that I make from the herbs does not

> come close to making up for seeing fewer patients. So I am doing extra

> work for less money. It sucks. But my patients benefit...I sure am

> able to treat a lot of things that I couldn't with acupuncture alone.

>

> Do others charge extra for the office visit along with charging for

> the herbs when you do both acupuncture and herbs7 Of course that's not

> an option when you are billing insurance. I am considering doing

> simpler acupuncture treatments if I am doing herbs--but I don't like

> the idea because I think the acupuncture is so important (and I do

> have a passion for acupuncture too).

>

> I guess part of my problem is that I am so deeply in debt with student

> loans that a huge chunk of my income goes to my student loan

> payment--$1300 a month. So I feel like I am doing this very

> challenging job working as a doctor and just getting by financially,

> which really bites.

>

> Any advice/ideas anyone?

>

> Laura

>

December 11, 2009

Hi Laura:

I sympathize with your situation. Managing growth is not easy, but it is a

GREAT problem to have so keep your head up.

I have found a couple of different things effective for handling this problem. I

think you absolutely need to separate out the two therapies and have a specific

charge for an acupuncture session and a separate visit/charge for an herbal

consulation. The insurance codes don't cover the herbs or herbal consult anyway

so you are shorting yourself if you are squeezing this into an acupuncture

session. I just explain to them that I don't want to cut their appointment

short and need a certain amount of time to compile an effective herbal formula.

No one has complained about this and are mostly happy that I am taking the time

to do it right.

The other thing that I do in my clinic, is to utilize an intern. I seem to get

a lot of people wandering into my clinic expressing a strong interest in

studying . These people are usually more than willing to take

advantage of an opportunity to work with the herbal medicine. After some

training, I write prescriptions and have them fill them for me. They in turn

get full access to my library and I introduce them to the basic theory with " The

Web that has No Weaver " and Foundations by Maciocia. This way they get a better

idea about what we do and how we do it and can make a more informed decision

about whether to pursue a formal education,etc. All my interns started working

with no pay. The ones that stayed on for some time eventually were compensated

financially, but it is a good way to get some help without putting up alot of

capital.

I hope this is helpful. Good luck!

Chinese Medicine , " heylaurag " <heylaurag

wrote:

>

> Hi, I'm wanting to get some ideas from others about how they manage their time

if they have a busy herbal practice. I am feeling really overwhelmed. Whenever

I've had a time when I haven't had very many patients taking herbs I've been so

happy and relaxed because when I get done at the end of the day I am done; I

don't have to stay and engage in the tedious process of making a bunch of

formulas (designing formulas=fun. making formulas=tedious boredom!).

>

> But I do have a passion for practicing herbs and I've reached a point

> where a large percentage of my patients are taking herbs. I really don't like

the idea of hiring someone to assist me. I have a very small office. It just

wouldn't work. I did recently buy a second pharmacy for home with the thought

that it would help to be able to make formulas from home. I " m glad I did it,

but so far it has only helped a little.

>

> Part of my problem is that my patients and I talk a lot. Its hard to break

that habit because a lot of the time I enjoy talking (it feeds my former social

worker self).

>

> Lately I have been avoiding taking new patients because i feel so overwhelmed.

The amount of money that I make from the herbs does not come close to making up

for seeing fewer patients. So I am doing extra work for less money. It sucks.

But my patients benefit...I sure am able to treat a lot of things that I

couldn't with acupuncture alone.

>

> Do others charge extra for the office visit along with charging for the herbs

when you do both acupuncture and herbs7 Of course that's not an option when you

are billing insurance. I am considering doing simpler acupuncture treatments if

I am doing herbs--but I don't like the idea because I think the acupuncture is

so important (and I do have a passion for acupuncture too).

>

> I guess part of my problem is that I am so deeply in debt with student loans

that a huge chunk of my income goes to my student loan payment--$1300 a month.

So I feel like I am doing this very challenging job working as a doctor and just

getting by financially, which really bites.

>

> Any advice/ideas anyone?

>

> Laura

>

December 11, 2009

I love all the suggestions already provided and have used many myself with great

success. The other idea that has not been mentioned yet is to raise your

rates.Â If youÂ are turning away new patients to take better care by providing

life coaching/counseling you should charge a higher rate. So often I see great

APs undervalueing themselves...providing discounts for patients driving nice new

car or smoking and eating out. Our services are of great value and certainly the

growing rare skill of being able to customize herbal formulas deserves a higher

rate of compensation that the person doing more basic care. Don't be afraid to

set your rates at what you deserve, pay your loans and other bills because you

are just that good....

Be well,

Bob

Robert Linde, AP, RH

Professional Herbalists Training Program

Acupuncture & Herbal Therapies

901 Central Ave

St. Petersburg, FL 33705

www.acuherbals.com

727-551-0857

--- On Fri, 12/11/09, heylaurag <heylaurag wrote:

heylaurag <heylaurag

How to manage time w/herbal practice

Chinese Medicine

Friday, December 11, 2009, 5:44 AM

Â