Community Acupuncture

March 3, 2010

Something about the community acupuncture concept is insulting to my common

sense. I ran into someone socially who told me that he had gone to 10 sessions

of PT and it was $1000 and he had a copay of $200; it didn't work and he decided

to go to community acupuncture and obtained 10 treatments for $100, had good

results and summed it all up by saying, " I don't know where there funding is

coming from, maybe a state grant, it sure was a great deal. " I decided to not

tell him that there was no funding, acupuncturists are actually delivering

effective treatments for 10% of what a PT with comparable education charges. I

felt embarrassed to actually say that outright. Why are we the first and only

profession that thinks we can gain something by going below rock bottom, bargain

basement. Ask yourself, " What else in the health care field is available for $

10? " Medicare pays chiros about 4x that much for the standard office visit,

regardless of whether this visit is in a group or individual, maybe we should

take a clue from that.

Regards,

Angela Pfaffenberger, Ph.D.

angelapfa

www.InnerhealthSalem.com

Phone: 503 364 3022

-

acudoc11

Chinese Medicine

Wednesday, March 03, 2010 11:06 AM

Re: Re: Community Acupuncture

Michael

There are ways to build proper SOAP note categories into a single form and

simply and quickly write the data fill-in in less than a few minutes. You

don't have to write an essay on each situation or category.

This can and is already being done.

It goes back to beating the proverbial " dead horse " .

This can be debated ad infinitum.

Practitioners might seek to improve where their time and energies are

unnecessarily expended....but only if they so choose.

Richard

In a message dated 3/3/2010 1:58:24 P.M. Eastern Standard Time,

naturaldoc1 writes:

Richard,

Good points but rules regarding documentation are much more stringent in

the US then in China. Not a fair comparison.

Michael W. Bowser, DC, LAc

March 3, 2010

Joe,

I replied to Mercurius.... it was difficult to gauge if his results were

that good.

My mom went to another practitioner who did moxa and took time with herbal

formulas.

She definitely saw improvements after that.

When it comes down to it, it was about getting to the root and not just

treating branches.

K

On Wed, Mar 3, 2010 at 6:47 AM, Joe Messey <joe.messey wrote:

>

> Rebekah:

>

> All patients fill out health history forms, informed consent forms and we

> keep SOAP notes on them all in individual files in a locked cabinet, just

> like any other acupuncturist.

>

> Joe sez:

> don't think anyone can criticize here...

>

> As long as HIPAA requirements are met and patients are informed when the

> limitations of this style make it insufficient for their particular needs,

> cant' see anything wrong with this.

>

> Rebekah:

>

> We are clear with our CA patients about what we can realistically treat

> given the CA model and its limitations. If we feel the patient would best

> be

> served with private acupuncture treatments (we cant do moxa, cupping, gua

> sha, e-stim in the community room) , need a more in-depth intake or herbal

> consult, or a DC, PT, ND, MD, what have you, we refer them out.

>

> Joe sez:

> Got that part covered

>

> K:

>

> He took the pulse in about 1 minute, asked 2 questions and put needles in

> as

> fast as I've ever seen.

> Maybe it's more about the individual practitioner's skills and

> attentiveness, even if it's focused for 5 minutes?

>

> Joe sez:

> a hallmark of a skilled and experienced practitioner is " getting to the

> point " (sorry, I just couldn't hold it back).

> K - you didn't say if the treatments worked. Did they?

>

> Tom:

>

> Besides, it is also the way (senior) acupuncturists practice in China.

>

> Zedbowls:

>

> The biggest threat to acupuncturists is acupuncture performed by those with

> little, ineffective, or no training.

>

> Joe sez:

> valid points, guys

>

> Rebekah - you have less than 4 years experience, your partner just 3 and

> your 2 assistants only have 2 years experience each.

> How do you (plural) diagnose at the pace you describe without the benefit

> of

> decades of experience?

> Are you able to triage your patients? Do you have certain conditions each

> of

> you focus and refer the others? How does that work?

>

> Joe wants to know

>

March 3, 2010

Richard,

I know that. My point was with less stringest reqs for note taking equals more

time to treat patients. Doing this for many years also allows them to be more

focused and still provide more services to the patient.

Michael W. Bowser, DC, LAc

Chinese Medicine

acudoc11

Wed, 3 Mar 2010 14:06:50 -0500

Re: Re: Community Acupuncture

Michael

There are ways to build proper SOAP note categories into a single form and

simply and quickly write the data fill-in in less than a few minutes. You

don't have to write an essay on each situation or category.

This can and is already being done.

It goes back to beating the proverbial " dead horse " .

This can be debated ad infinitum.

Practitioners might seek to improve where their time and energies are

unnecessarily expended....but only if they so choose.

Richard

In a message dated 3/3/2010 1:58:24 P.M. Eastern Standard Time,

naturaldoc1 writes:

Richard,

Good points but rules regarding documentation are much more stringent in

the US then in China. Not a fair comparison.

Michael W. Bowser, DC, LAc

March 3, 2010

Emily,

I can appreciate your concerns, I also have them. I would like to see more

acupuncture provided to patients. I think that there are many ways to do this

and seeing more patients per time period is one way to spread the financial

burden for the provider.

I do think it is disingenuous to think that we should give it all away as

providers, we also need to make a living. CAN has been very outspoken

politically and tried to push an agenda through various media. I have no

problems with them staying focused upon sliding scale clinical training for

clinicians, just refrain from the politics.

Michael W. Bowser, DC, LAc

Chinese Traditional Medicine

emilylists

Wed, 3 Mar 2010 12:30:36 -0500

RE: Re: Community Acupuncture

This comment saddens and disturbs me.

CAN's " political agenda " is to promote the accessibility of acupuncture.

What " seeks more to divide us " are the comments from people who continually

disparage the competence and integrity of CAN practitioners.

Emily KonstanProud CAN Practitioner

> Chinese Traditional Medicine

> naturaldoc1

> Wed, 3 Mar 2010 15:30:30 +0000

> RE: Re: Community Acupuncture

>

> I am deeply concerned about the CAN political agenda that really seeks more to

divide us, as well as get us to take our eyes off the ball, as others are then

more easily able to take acupuncture as their own.

>

> Practice is one thing but the CAN politics is quite another.

>

> Michael W. Bowser, DC, LAc

>

Chinese Medicine

> anne.crowley

> Wed, 3 Mar 2010 15:12:04 +0000

> Re: Re: Community Acupuncture

>

> Mark:

> I always appreciate your posts. You have good business sense, and if we can't

stay in business, we can't help people. You tell it like it is. The model

doesn't make a difference. It is how we view ourselves as professionals.

> Anne

> Sent from my Verizon Wireless BlackBerry

>

> " zedbowls " <zaranski

> Wed, 03 Mar 2010 14:14:29

> <Chinese Medicine >

> Re: Community Acupuncture

>

> The biggest threat to acupuncturists is acupuncture performed by those with

little, ineffective, or no training.

>

> Physical therapists who have been shown " dry needling " , MDs/DOs/DCs who

trained one weekend in Florida and learned three strategies for pain, medical

doctors who read an interesting article and bought some neeedles.

>

> How about the MD who performs his best estimation of acupuncture (tho hes had

absolutely no formal training in chinese medicine foundations) and bills

insurance for " surgery " taking only co-pay from the patient.

>

> The threat comes when the treatments have limited success and the Px is told

(by someone they have been brainwashed from birth to trust and revere) that is

all they can expect from acupuncture!

>

> How about acu-hacks who graduated from accredited schools happy to take their

money and advance them even tho they had no real skills, yet somehow passed

their boards. Can't distinguish pulses, poor point location skills, treats by

trying to match symptoms to a suggested needling Rx from CAM, or simply follows

the pictures that accompany the needling RX their " acugraph III " suggests based

on " meridian flow analysis " ?

>

> It is clear that even " sham " acupuncture is effective to some extent,

according to most studies more effective than many " traditional " treatments

(drug therapy) for some conditions.

>

> Botox parties are popular in some portions of the country: amature enthusiatic

narcissists injecting ethanol-emboldened acquaintances with dangerous toxins in

hopes of recreational wrinkle-removal. Can trigger-point dry-needling parties

for desperate-but-frugal chronic pain suffers be next? Maybe Prolo-Parties??

>

> Even if we legislate that ACUPUNCTURE can only be performed by one fully

trained in TCM in approved programs at credentialed institutions, there are

plenty of other names for treatments that will not violate such laws. What about

someone who uses no needles, say only laser, or tuning fork, or only uses

" acupressure " ? They can say " its just like acupuncture, only it doesn't hurt! "

>

> CM students learn that many previous graduates a)never ended-up practicing or

b)many failed in practice from not making enough money to sustain or c) were

unable to attract enough patients (perhaps due to the high price of treatments

or general lack of understanding of the value of TCM in their community, or

because insurance does not cover acu in their State) and thus succombed to b)

above.

>

> Community acupuncture is a relatively new model with fervent backing by some

who are practicing it that would like to see others follow their footsteps. Many

schools are exposing current students to the model, and students tend to be an

impressionable bunch.

>

> We will see CA clinics start-up and fail at the same rate we see other model

(and even model-less) non CA clinics start-up and fail. No different from any

other business. 80% of all new restaurants (1st timers) fail within 6 months.

>

> Study continually. Cultivate your Qi. Develop your skills. Educate your

patients. Learn from others who are successfully changing their patients lives

by truly restoring proper health function. Honor the tradition by following the

advice in the Classics. Strive to be an exceptional practitioner. Be honest with

your patients and yourself. Help them understand the power and value of your

medicine thru education and results. Explain how they can get the best results

and do not be afraid to alter their lifestyle (thats what got them into trouble

in the forst place!).

>

> My words are not intended to offend. Your mileage may vary.

>

> Mark Zaranski

>

> Chinese Medicine , " Mercurius Trismegistus "

<magisterium_magnum wrote:

> >

> > Were the treatments effective?

> >

> > -

> > " " <johnkokko

> > <Chinese Medicine >

> > Wednesday, March 03, 2010 12:11 AM

> > Re: Re: Community Acupuncture

> >

> > > 15 years ago, I went to a well known acupuncturist in Denver who treated

> > > me

> > > and my mom in about 5 minutes each. He had a doctorate degree from China

> > > and was licensed in the US. He took the pulse in about 1 minute, asked 2

> > > questions and put needles in as fast as I've ever seen. That was it,

> > > didn't

> > > see him after those 5 minutes. His assistant took out the needles. His

> > > wife took the money and gave the herbs in home-made pills. That was it.

> > > Less time than a community acupuncture clinic, but cost $80 for the

> > > needles

> > > and another $40 for the pills for the week. Still, he had this huge

> > > reputation and no one would even think that he was dangerous to the

> > > profession.

> > > Maybe it's more about the individual practitioner's skills and

> > > attentiveness, even if it's focused for 5 minutes?

> > >

> > > K

> > >

> > > On Tue, Mar 2, 2010 at 7:51 PM, Rebekah Sitty L.Ac.

> > > <rsittywrote:

> > >

> > >>

> > >> Hi There-

> > >> I just caught up on the recent flurry of opinions and concerns about

> > >> Community Acupuncture and, being an owner/practitioner at a CA style

> > >> clinic,

> > >> I wanted to throw my two cents into the discussion.

> > >>

> > >> First some details about how we run our practice: Our clinic is open 6

> > >> days/week, we have 5 acupuncturists who work there (two of us are the

> > >> owners). We see 4 existing patients each hour, or two new patients each

> > >> hour. All of our intakes are done in a private room with a table in case

> > >> we

> > >> need to perform an exam. Shifts are approximately 4.5 hours long and

> > >> contain

> > >> approx 15 patients. That seems to be the most number of patients we can

> > >> see

> > >> in a day without feeling burnt out. We charge $20-$40 for existing pts,

> > >> $40-$60 for new patients. We also offer private treatments out of the

> > >> same

> > >> office at $80 each.

> > >>

> > >> All patients fill out health history forms, informed consent forms and we

> > >> keep SOAP notes on them all in individual files in a locked cabinet, just

> > >> like any other acupuncturist.

> > >>

> > >> We are clear with our CA patients about what we can realistically treat

> > >> given the CA model and its limitations. If we feel the patient would best

> > >> be

> > >> served with private acupuncture treatments (we cant do moxa, cupping, gua

> > >> sha, e-stim in the community room) , need a more in-depth intake or

> > >> herbal

> > >> consult, or a DC, PT, ND, MD, what have you, we refer them out.

> > >>

> > >> We have many patients who come in monthly for private treatments and then

> > >> weekly for Community treatments.

> > >>

> > >> So why am I telling you all this? I guess to say: that it is working for

> > >> us. My partner and I love being able to treat first timers (about 40% of

> > >> our

> > >> new patients have never had acupuncture), or people who cant afford the

> > >> more

> > >> expensive treatments and watch them get better. Because of our rates,

> > >> many

> > >> people can afford to come weekly or bi-weekly and that frequency of

> > >> treatment can make a big difference in their healing,

> > >>

> > >> To Lee I would say: just as you may have had patients tell you they

> > >> haven't

> > >> gotten better by going to a CA clinic (or a MD or DC) , we hear similar

> > >> stories! I think every acupuncturist does. In our case, often the pt has

> > >> been getting private treatments but only going once a month because they

> > >> can't afford to go more often. And in our private treatments, we see

> > >> patients who didn't get better with one practitioner, but do well with

> > >> another. Just as we woudn't infer that this meant all private treatments

> > >> are

> > >> ineffective, I don't think it is fair to assume that CA treatments don't

> > >> work, either.

> > >>

> > >> As far as CA being a disservice to the practitioner because it is more

> > >> work

> > >> for the same amount of money- well, that is up to the practitioner. If I

> > >> gross an average of $95 seeing 4 pts in an hour, am I doing myself more

> > >> or

> > >> less of a disservice than the practitioner who charges $60 per visit and

> > >> sees one person per hour? Because practitioners with those rates exist,

> > >> too.

> > >> I am okay with that.

> > >>

> > >> I know of practitioners who don't call themselves community acupuncture

> > >> practitioners, yet they see similar numbers of people, often in rooms

> > >> with

> > >> curtains separating the tables from each other. I dont think this is much

> > >> different from what we do, except for the name or 'classification' of

> > >> type

> > >> of clinic. Do people who object to the CA model also object to

> > >> practitioners

> > >> who see 4 or more pts/hour? Because 'private' practitioners have been

> > >> doing

> > >> that for a long, long time. Perhaps the distinction in a case like this

> > >> is

> > >> in name only? I really think the CA model is not a new style of

> > >> practicing.

> > >> It may have a new name, but it is still acupuncture to me.

> > >>

> > >> Sorry for the long post. Looking forward to your comments!

> > >> -Rebekah

> > >>

> > >> ------------

> > >> Rebekah Sitty, MS, L.Ac.

> > >> San Francisco Community Acupuncture

> > >> 220 Valencia St.

> > >> San Francisco, CA 94103

> > >> 415.675.8973 rsitty <rsitty%40earthlink.net>

> > >> -------------

> > >>

> > >> The information contained in this electronic message may contain

> > >> protected

> > >> health information confidential under applicable law, and is intended

> > >> only

> > >> for the use of the individual or entity named above. If the recipient of

> > >> this copy is not the intended recipient, you are hereby notified that any

> > >> dissemination, copy or disclosure of this communication is strictly

> > >> prohibited. If you have received this communication in error, please

> > >> notify

> > >> the sender and purge the communication immediately without making any

> > >> copy

> > >> or distribution.

> > >>

> > >

> > > --

> > >

> > > ""

> > >

> > > www.tcmreview.com

> > >

March 4, 2010

Hi John,

I am sorry for my late reply in this discussion. I posted my community

acupuncture post sometime near January 25th, and it only got posted now. If not

for Z'ev I would not know it had been posted at all.

" People with the resources will still pay premium price to go for the people

with reputations and specific skill-sets. "

I agree with you that people with resources still want to be seen, but on the

other hand people didn't accumulate their resources by just spending to be seen.

They often are some of the most notorious bargain hunters, and will often try to

talk practitioners down in their fees. I have quite a few " wealthy " patients

that come to my community clinic, because they can. They save some times $50.00

per visit by seeing me in a community clinic. And they still get a skilled

practitioner, so I don't think your argument completely sticks.

Secondly you said:

" Someone told me something that stuck with me... if you start seeing people as

numbers, then you're more of a business person than medicine person.

If it's a numbers game, your light might burn out faster.

K "

If you don't run the numbers, ever, then you are in academia or work in a

hospital. The problem with our profession is that we our educated to think that

we will see patients at $60.00+ an hour, and as students we do the math on that,

and say " Yeah, this will work if I can even see 6 patients a day, 5 days a week.

I can make it. " The reality is that for the first 5 years, unless you are in a

place with no other practitioners, it is hand to mouth. Most of the

practitioners I know work two to three other jobs, besides running their

practice.

Perhaps what needs to be done is to teach more students about the realities of

what it costs to run a practice, and the real salary of an acupuncturist in the

USA. Most of my colleagues who only do acupuncture make between $25,000 -

$40,000 per year gross. This is not much money. I think if people crunched the

numbers a bit more, there would be less people interested in our profession,

because for most people that are between 1 - 5 years out of school it is so

hard. If I remember right, we have an 80% attrition rate from people who

graduate to the people who are still in practice 5 years out. That is a huge

brain drain, and worse those people often go on to do whatever they are going to

do next with anywhere between $30,000 and $100,000 worth in debt. No offense,

but when you take this into account, I think it is naive to not calculate the

numbers, and come up with a sound business plan, about just how you are going to

succeed in this business.

Sincerely,

L.Ac.

The Database

March 4, 2010

Hi Richard,

The Database translated the Biao You Fu as annotated by Yang Ji

Zhou a while ago. We have it in Chinese and English. Maybe you would be

interested in coming over and comparing your translation ....

Sincerely,

L.Ac.

The Database

>

> I can't imagine what kind of limitations some might be referring to.

>

> I just finished a many year process with Dr Wu, Boping OMD MD PhD of

> transcribing a discussion-translation of BIAO YOU FU.

>

> This is a high level book for acupuncturists who have read such basic works

> as YU LONG GE etc. and are now ready for a more advanced level.

>

> It is not the usual word-for-word Chinese to English translation but a

> sentence by sentence discussion of high level use of acupuncture.

>

> It is not meant for publication in book form (at this moment if at all) -

> more for a lengthy magazine article.

>

> I'll advise when it's available in English with the Chinese.

>

> Richard

>

March 4, 2010

hey Anne,

What do you like about serins? They spend the most on advertizing, certainly

that gets passed along to buyers. Do you ever see Px's with sensitivity to the

silicone coating on their needles?

Do you tube needle or free needle? Do you recycle the tubes?

We inserted over 120,000 needles in 2009; with DBC spring tens thats still >12k

insertion tubes that we recycled! The only thing that tube does for us is

provide rigidity for the package. We pull that tubeand pocket it when we open

the pack. DBCs are uncoated stainless, easily as smooth as the serins due to

polishing. Nice and stiff for their gauge so your qi is easily tranfered into

penetration rather than bending needles and hurting Pxs. SOOO much less

packaging per 1000 needles.

Mark Z

Chinese Medicine , anne.crowley wrote:

>

> Wow, I could go on vacation with the difference. I am pretty hooked on serins.

> Anne

> Sent from my Verizon Wireless BlackBerry

>

> <johnkokko

> Wed, 3 Mar 2010 08:30:34

> <Chinese Medicine >

> Re: Re: Community Acupuncture

>

> Here's a correction on my needle $ comparison:

>

> Seirins = $10 / pack of 100 = 10 cents / each

> DBC = $22.50 for pack of 1000 = 2.25 cents/ each

>

> 40 treatments / week = Seirins $40/ week $160/ month about $1760/

> year (4 weeks off for vacation)

> = DBC $9/ week $36 / month

> about $396 / year (4 weeks off for vacation)

>

> The difference is $1760 - 396 = *$1364 / year* if you see 40 patients/

> week.

>

> So cost of needles do make a difference.

>

> K

>

> On Wed, Mar 3, 2010 at 8:08 AM, <johnkokko wrote:

>

> > Our market value depends on a few things...

> > 1. how much it cost (money, time and energy) to learn what we learned (in

> > school, outside of school, in clinical practice etc)

> > 2. how much it costs to maintain a practice in the location we have our

> > clinic situated (high end rent/ parking versus)

> > 3. how saturated the area we practice is with competitive forces

> > 4. the specific modality we practice (facial acupuncture vs pain management

> > vs fertility etc)

> > 5. the model we practice (community style vs 1 patient/ hour vs 2/ hour

> > etc.)

> >

> > A 10 cents/ needle Seirin vs 2.25 cents / needle DBC is not so important

> > from a money point of view (about 80 cents/ treatment difference), but I

> > guess that could add up.... 40 treatments/ week = $32 or $300/ year.

> > The worst part of the Seirins is all of the wasted paper and plastic (one

> > needle/ guide tube/ package).

> >

> > This is just a generalization, but I've found that women like to pay more

> > for treatments than men.

> > Students of all types usually can't afford more than $50/ treatment (once/

> > week)

> > Middle aged patients generally will pay more than elderly patients (who

> > have a high insurance cost / month as well)

> > and finally... lawyers don't like to pay very much for their treatments,

> > even though they need the care more than most.

> >

> > K

> >

> > On Wed, Mar 3, 2010 at 7:02 AM, Sean Doherty <seanwrote:

> >

> >>

> >> On Mar 2, 2010, at 3:28 PM, wrote:

> >>

> >> > first what cost? needles are pennies on the dollar.

> >>

> >> I have seen this argument a number of times and am always surprised by it.

> >> Are we charging like plumbers and carpenters? Our fee being equal to the

> >> cost of materials (if you are lucky)? Obviously, needles are only a very

> >> small fraction of the cost of running a practice. Paper is cheap, too, and

> >> that is all lawyers push around.

> >>

> >> Sean

> >>

March 4, 2010

Hey Joe! (and Mike)

Of course decades of experience will make anyone a better practitioner. If you

are saying that you feel I am not experienced enough to see 4 patients each hour

for part of my practice, well, that is an opinion you are certainly entitled to.

I dare to say that my patients feel otherwise. Would a practitioner with

decades of experience be more effective than I? I would hope so! But they

would be more effective in whatever style they chose to practice in.

I actually think seeing patients in this style provided a HUGE learning curve

for me, accelerated my learning process far faster than if I had stuck to only

seeing one person each hour. Just the sheer quantity of patients and pulses and

tongues I see, and the fact that most patients come weekly lets me quickly gauge

the effectiveness of my treatments. And I really enjoy having other

practitioners in the clinic to consult with (we often see the same patients).

So, yes, in the beginning I was fumbling, as we all do in the beginning, but the

amount of experience I gained in a short time was invaluable.

And Mike, I understand your concern in regards to CAN's politics. I know they

really can put alot of people off - people who otherwise might support the CA

model. That makes me sad, because I think their intentions are good. But it is

important to recognize the distinction between CAN and Community Acupuncture

clinics. Not all of us who run these clinics are CAN members and some of us

don't always agree with CAN's politics or positions on the FPD, for example. I

guess the best way to say this is that CAN does not speak for every

acupuncturist who practices CA style acupuncture.

-Rebekah

------------

Rebekah Sitty, MS, L.Ac.

San Francisco Community Acupuncture

220 Valencia St.

San Francisco, CA 94103

415.675.8973 rsitty

-------------

The information contained in this electronic message may contain protected

health information confidential under applicable law, and is intended only for

the use of the individual or entity named above. If the recipient of this copy

is not the intended recipient, you are hereby notified that any dissemination,

copy or disclosure of this communication is strictly prohibited. If you have

received this communication in error, please notify the sender and purge the

communication immediately without making any copy or distribution.

March 4, 2010

Hi Rebekah

Nah - I don't know you, so I'm not *saying* anything.

Experience and pace are a legitimate concern, so I just asked you what

systems and methods you are employing to work that pace with unseasoned

practitioners.

I ask because I am interested in how you are accomplishing it. Teamwork is a

good part of working with others. Still wonder how things work

Joe

March 4, 2010

Rebekah, More treatments delivered, more pulses palpated, more tongues

examined, more results reviewed = more experienced practitioner and hopefully

more effective.

One does not need to use the CA model to achieve this.

A 28 yo Bastyr grad joined our Clinic in the middle of 2009, and has experienced

only one (4-day, M-Th) work week where she needled less than 100 people. She

began taking on some re-eval duties (after being trained) after a few months,

and is training and shadowing the Clinic Director on initial exams now (and has

done a few solo). Her previous experience was in a not too busy private

practice and then on cruise ship (gained lots of valuable experience in public

speaking and attracting patients!). In our practice, practitioners are

supported by assistants who perform moxibustion, remove needles, perform

cupping(still & /or sliding) and guasha when indicated (assts also turnover rooms

between Clients and do laundry). Practitioners concentrate on diagnosis,

treatment strategy, herbal therapy, and dietary advice; teach class(es?) monthly

and participate in screenings, etc.

I see huge value in new practitioners honing clinical skills at busy clinics

(and gaining insight into successful business practices). School Clinics are

rarely (never?) a good model for success in private practice. Unfortunately the

only " official " residency programs are associated with the same schools w/poor

example student clinics.

Bob Doane out Tacoma way does take on new-grad needlers as residents and teaches

them alot about high-volume-practice pain-reduction/relief care (tan style

needler). He does alot of Lotus CEU stuff mostly west coast.

We are presently expanding (due to area needs for alternatives to drugs &

surgery)and have opportunites for 2 hard-working needlers (much more TCM &

meridian style) who want to gain valuable experience in corrective care (focus

on root cause) and sucessful business practice exposure.

Mark Zaranski

East Wind Acupuncture, Inc.

Chesterton, Indiana

www.ewacupuncture.com

Chinese Medicine , " Rebekah Sitty L.Ac. "

<rsitty wrote:

>

> Hey Joe! (and Mike)

>

> Of course decades of experience will make anyone a better practitioner. If

you are saying that you feel I am not experienced enough to see 4 patients each

hour for part of my practice, well, that is an opinion you are certainly

entitled to. I dare to say that my patients feel otherwise. Would a

practitioner with decades of experience be more effective than I? I would hope

so! But they would be more effective in whatever style they chose to practice

in.

>

> I actually think seeing patients in this style provided a HUGE learning curve

for me, accelerated my learning process far faster than if I had stuck to only

seeing one person each hour. Just the sheer quantity of patients and pulses and

tongues I see, and the fact that most patients come weekly lets me quickly gauge

the effectiveness of my treatments. And I really enjoy having other

practitioners in the clinic to consult with (we often see the same patients).

So, yes, in the beginning I was fumbling, as we all do in the beginning, but the

amount of experience I gained in a short time was invaluable.

>

> And Mike, I understand your concern in regards to CAN's politics. I know they

really can put alot of people off - people who otherwise might support the CA

model. That makes me sad, because I think their intentions are good. But it is

important to recognize the distinction between CAN and Community Acupuncture

clinics. Not all of us who run these clinics are CAN members and some of us

don't always agree with CAN's politics or positions on the FPD, for example. I

guess the best way to say this is that CAN does not speak for every

acupuncturist who practices CA style acupuncture.

>

> -Rebekah

> ------------

> Rebekah Sitty, MS, L.Ac.

> San Francisco Community Acupuncture

> 220 Valencia St.

> San Francisco, CA 94103

> 415.675.8973 rsitty

> -------------

>

> The information contained in this electronic message may contain protected

health information confidential under applicable law, and is intended only for

the use of the individual or entity named above. If the recipient of this copy

is not the intended recipient, you are hereby notified that any dissemination,

copy or disclosure of this communication is strictly prohibited. If you have

received this communication in error, please notify the sender and purge the

communication immediately without making any copy or distribution.

>

March 4, 2010

I always considered CA to be some sort of weird communist gimmick. Alot of

my fellow students are communists. It's very popular.

If someone wants to be a communist, that's fine with me I guess. If someone

wants to do CA, that's cool too. Doesn't bother me. I think there's a

demand for that sort of thing.

Makes the hippies feel warm and fuzzy.

-

" " <johnkokko

Thursday, March 04, 2010 8:23 AM

Re: Re: Community Acupuncture

> Politics and Economics seem to go hand-in-hand.

>

> On Thu, Mar 4, 2010 at 8:09 AM, mike Bowser <naturaldoc1

> wrote:

>

>>

>> Rebekah,

>>

>> So why not just use the model and leave along the politics?

>>

>> Michael W. Bowser, DC, LAc

March 4, 2010

Michael

600 or so Asians is definitely not consensus especially when there are at

least 20,000 licensees in the US.

And a majority of those Asians you speak about were MDs in China and

yes....they want to get back to their doctor status. I don't blame them.....I

would also if I were them.

Florida laws and rules did not come from being liberal.

They were hard fought for by activists who did not sit around the

round-table chewing the fat.

Bottom line.....you can wish all you want but the profession is a LONG way

off from CONSENSUS.

Richard

<<Let us not forget that moving towards the mainstream is what got us many

of ops we have today. That would also include your liberal Florida laws

for the profession. Let us remind ourselves that the FPD is not likely to

change any of our practices, it is looking towards the future of this

medicine. Let us not forget the many Asians that are not usually part of our

discussions, are overwhelmingly in support of it. The non-Asian practitioners

are pretty much split but when adding in the Asian community it is a

majority in favor of doing this and the trend line continues. Interesting that

students seem to favor it largely as well.>>

Michael W. Bowser, DC, LAc

March 4, 2010

Michael

The point being that none of these modalities are absolutely necessary for

the majority of cases if the practitioner is a capable needle

practitioner.

That was the point.

One can use all these other modalities...such as me......primarily using Ba

Gua Fa and Chinese herbs but then I have no interest in seeing hundreds of

people per day. That's where I conserve my energy.

Richard

In a message dated 3/4/2010 11:43:41 A.M. Eastern Standard Time,

naturaldoc1 writes:

Richard,

Moxa, cupping, estim, herbs, tui na, nutrition, etc. In Chinese clinics

they do use these routinely, no?

Michael W. Bowser, DC, LAc

March 4, 2010

Anne,

As a fellow TAI grad I was stuck on serins too!! I recently switched

to DBC spring tens and they are great!! I love not having silicone on

the needle, they are excellent quality and love not filling up my

trash can with all the packaging. Definitely give them a try.

Best,

Lisa

On Mar 3, 2010, at 11:45 PM, zedbowls wrote:

> hey Anne,

>

> What do you like about serins? They spend the most on advertizing,

> certainly that gets passed along to buyers. Do you ever see Px's

> with sensitivity to the silicone coating on their needles?

>

> Do you tube needle or free needle? Do you recycle the tubes?

>

> We inserted over 120,000 needles in 2009; with DBC spring tens thats

> still >12k insertion tubes that we recycled! The only thing that

> tube does for us is provide rigidity for the package. We pull that

> tubeand pocket it when we open the pack. DBCs are uncoated

> stainless, easily as smooth as the serins due to polishing. Nice and

> stiff for their gauge so your qi is easily tranfered into

> penetration rather than bending needles and hurting Pxs. SOOO much

> less packaging per 1000 needles.

>

> Mark Z

>

> Chinese Medicine ,

> anne.crowley wrote:

> >

> > Wow, I could go on vacation with the difference. I am pretty

> hooked on serins.

> > Anne

> > Sent from my Verizon Wireless BlackBerry

> >

> > <johnkokko

> > Wed, 3 Mar 2010 08:30:34

> > <Chinese Medicine >

> > Re: Re: Community Acupuncture

> >

> > Here's a correction on my needle $ comparison:

> >

> > Seirins = $10 / pack of 100 = 10 cents / each

> > DBC = $22.50 for pack of 1000 = 2.25 cents/ each

> >

> > 40 treatments / week = Seirins $40/ week $160/ month about $1760/

> > year (4 weeks off for vacation)

> > = DBC $9/ week $36 / month

> > about $396 / year (4 weeks off for vacation)

> >

> > The difference is $1760 - 396 = *$1364 / year* if you see 40

> patients/

> > week.

> >

> > So cost of needles do make a difference.

> >

> > K

> >

> > On Wed, Mar 3, 2010 at 8:08 AM, <johnkokko wrote:

> >

> > > Our market value depends on a few things...

> > > 1. how much it cost (money, time and energy) to learn what we

> learned (in

> > > school, outside of school, in clinical practice etc)

> > > 2. how much it costs to maintain a practice in the location we

> have our

> > > clinic situated (high end rent/ parking versus)

> > > 3. how saturated the area we practice is with competitive forces

> > > 4. the specific modality we practice (facial acupuncture vs pain

> management

> > > vs fertility etc)

> > > 5. the model we practice (community style vs 1 patient/ hour vs

> 2/ hour

> > > etc.)

> > >

> > > A 10 cents/ needle Seirin vs 2.25 cents / needle DBC is not so

> important

> > > from a money point of view (about 80 cents/ treatment

> difference), but I

> > > guess that could add up.... 40 treatments/ week = $32 or $300/

> year.

> > > The worst part of the Seirins is all of the wasted paper and

> plastic (one

> > > needle/ guide tube/ package).

> > >

> > > This is just a generalization, but I've found that women like to

> pay more

> > > for treatments than men.

> > > Students of all types usually can't afford more than $50/

> treatment (once/

> > > week)

> > > Middle aged patients generally will pay more than elderly

> patients (who

> > > have a high insurance cost / month as well)

> > > and finally... lawyers don't like to pay very much for their

> treatments,

> > > even though they need the care more than most.

> > >

> > > K

> > >

> > > On Wed, Mar 3, 2010 at 7:02 AM, Sean Doherty <seanwrote:

> > >

> > >>

> > >> On Mar 2, 2010, at 3:28 PM, wrote:

> > >>

> > >> > first what cost? needles are pennies on the dollar.

> > >>

> > >> I have seen this argument a number of times and am always

> surprised by it.

> > >> Are we charging like plumbers and carpenters? Our fee being

> equal to the

> > >> cost of materials (if you are lucky)? Obviously, needles are

> only a very

> > >> small fraction of the cost of running a practice. Paper is

> cheap, too, and

> > >> that is all lawyers push around.

> > >>

> > >> Sean

> > >>

March 4, 2010

Michael

Of course....eventually ALL things must change.

Not something I wish to see in the way it will happen and the results

thereof.

Richard

In a message dated 3/4/2010 12:43:33 P.M. Eastern Standard Time,

naturaldoc1 writes:

Richard,

It will happen and then we can all talk about the ways things used to be.

Michael W. Bowser, DC, LAc

March 4, 2010

Mark:

What do I like about Serins?Â Probably the best answer is " familiarity " .Â My

acupuncturist used them, and still does.Â I like knowing when I look at a green

needle, red needle, yellow needle, and metal shaft needle - I know exactly what

it does.Â I use a lot of needles and move quickly when I am needling - so it

all flows.Â

I tried the DBC - once, because given a free packet.Â Now when using guide

tube, you have to keep reinserting the needle.Â That was a stumbling block.

Also when I free handed with it on my patient's knee he said, " Wow those needles

are hurting more today for some reason. " Just ancedotal evidence.

I guess I could get the smaller guage on the DBC.Â Reinserting for the guide

tube might be tough.Â I don't always use it. Most of the time I am using free

hand.

I also saw some harrowing picture of the needles under a microscope and some are

not as sharp.Â I know we have had this discussion before here about needles.Â

So, I am willing to try some different guages and see how it works.Â I like the

vacation idea.

Also, yes, I hate the waste in packaging.Â I live in a more rural area - the

word is they are not going to recycle that type of plastic.

I don't see 100 patients in 2 days, either, but still don't like the waste.

Now silicon reaction.Â I have some patients (and it is rare) get the bump

(forget the name)Â near a capillary.Â WhatÂ does a silicone reaction look like?

I am not firing on all cylinders as I just returned from a 12 hr train trip last

night (from upstate NY - yeah, Syracuse) to Maryland.Â Have to refocus for my

10 patients today.

Anne

Anne C. Crowley, L.Ac., Dipl.Ac.

www.LaPlataAcupuncture.com

-

" zedbowls " <zaranski

" Traditional "

Wednesday, March 3, 2010 11:45:49 PM GMT -05:00 US/Canada Eastern

Re: Community Acupuncture

Â

hey Anne,

What do you like about serins? They spend the most on advertizing, certainly

that gets passed along to buyers. Do you ever see Px's with sensitivity to the

silicone coating on their needles?

Do you tube needle or free needle? Do you recycle the tubes?

We inserted over 120,000 needles in 2009; with DBC spring tens thats still >12k

insertion tubes that we recycled! The only thing that tube does for us is

provide rigidity for the package. We pull that tubeand pocket it when we open

the pack. DBCs are uncoated stainless, easily as smooth as the serins due to

polishing. Nice and stiff for their gauge so your qi is easily tranfered into

penetration rather than bending needles and hurting Pxs. SOOO much less

packaging per 1000 needles.

Mark Z

Chinese Medicine , anne.crowley wrote:

>

> Wow, I could go on vacation with the difference. I am pretty hooked on serins.

> Anne

> Sent from my Verizon Wireless BlackBerry

>

> <johnkokko

> Wed, 3 Mar 2010 08:30:34

> < Chinese Medicine >

> Re: Re: Community Acupuncture

>

> Here's a correction on my needle $ comparison:

>

> Seirins = $10 / pack of 100 = 10 cents / each

> DBC = $22.50 for pack of 1000 = 2.25 cents/ each

>

> 40 treatments / week = Seirins $40/ week $160/ month about $1760/

> year (4 weeks off for vacation)

> = DBC $9/ week $36 / month

> about $396 / year (4 weeks off for vacation)

>

> The difference is $1760 - 396 = *$1364 / year* if you see 40 patients/

> week.

>

> So cost of needles do make a difference.

>

> K

>

> On Wed, Mar 3, 2010 at 8:08 AM, <johnkokko wrote:

>

> > Our market value depends on a few things...

> > 1. how much it cost (money, time and energy) to learn what we learned (in

> > school, outside of school, in clinical practice etc)

> > 2. how much it costs to maintain a practice in the location we have our

> > clinic situated (high end rent/ parking versus)

> > 3. how saturated the area we practice is with competitive forces

> > 4. the specific modality we practice (facial acupuncture vs pain management

> > vs fertility etc)

> > 5. the model we practice (community style vs 1 patient/ hour vs 2/ hour

> > etc.)

> >

> > A 10 cents/ needle Seirin vs 2.25 cents / needle DBC is not so important

> > from a money point of view (about 80 cents/ treatment difference), but I

> > guess that could add up.... 40 treatments/ week = $32 or $300/ year.

> > The worst part of the Seirins is all of the wasted paper and plastic (one

> > needle/ guide tube/ package).

> >

> > This is just a generalization, but I've found that women like to pay more

> > for treatments than men.

> > Students of all types usually can't afford more than $50/ treatment (once/

> > week)

> > Middle aged patients generally will pay more than elderly patients (who

> > have a high insurance cost / month as well)

> > and finally... lawyers don't like to pay very much for their treatments,

> > even though they need the care more than most.

> >

> > K

> >

> > On Wed, Mar 3, 2010 at 7:02 AM, Sean Doherty <seanwrote:

> >

> >>

> >> On Mar 2, 2010, at 3:28 PM, wrote:

> >>

> >> > first what cost? needles are pennies on the dollar.

> >>

> >> I have seen this argument a number of times and am always surprised by it.

> >> Are we charging like plumbers and carpenters? Our fee being equal to the

> >> cost of materials (if you are lucky)? Obviously, needles are only a very

> >> small fraction of the cost of running a practice. Paper is cheap, too, and

> >> that is all lawyers push around.

> >>

> >> Sean

> >>

March 4, 2010

Rebekah,

So why not just use the model and leave along the politics?

Michael W. Bowser, DC, LAc

Chinese Medicine

rsitty

Wed, 3 Mar 2010 21:19:20 -0800

Re: Community Acupuncture

Hey Joe! (and Mike)

Of course decades of experience will make anyone a better practitioner. If you

are saying that you feel I am not experienced enough to see 4 patients each hour

for part of my practice, well, that is an opinion you are certainly entitled to.

I dare to say that my patients feel otherwise. Would a practitioner with decades

of experience be more effective than I? I would hope so! But they would be more

effective in whatever style they chose to practice in.