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Love Your Microbusiness: Marketing for a community-based acupuncture practice
By: Lisa Rohleder, L.Ac.
Date Published: 03-09-2006

Love your microbusiness

Most acupuncturists are self-employed, sole proprietors running a microbusiness.  Not a small business, a microbusiness.  Definitions vary, but usually the legal definition of a small business is one which has under 100 employees.  A common definition of a microbusiness is a business with average annual gross receipts of $2,500,000 or less over the past three years.  Makes a microbusiness sound pretty good, doesn’t it!

Check out our free e-book, Love Your Micro business: Marketing a Community-Based Acupuncture Practice.

Many acupuncturists are intimidated by the business end of practice, and indeed by the idea of business itself.  Remembering that for most of us, the goal is to create a successful microbusiness can make it less intimidating.   For even more perspective and inspiration, it’s helpful to read about microbusinesses worldwide.  An excellent introduction is the book Banker to the Poor, by M Yunus, which describes the birth of the enormously powerful global micro-lending movement.  All over Bangladesh and Southeast Asia, women are lifting themselves out of the most grinding poverty by creating and running microbusinesses.    If they can do it there, surely we can do it here.

Being successful in business does not look only like Donald Trump or Martha Stewart on The Apprentice.   Being successful in business also looks like a Third World woman raising goats and selling goats’ milk so that her children can afford to go to school.  Being a successful acupuncturist doesn’t mean you have to dress up in a suit, drive a big car or engage in conspicuous consumption.  Part of our culture’s problem is that our images of success are so limited and so distorted.  The rewards of creating a successful microbusiness are not only financial.  Making your living by working for yourself can have a profound impact on your self-esteem.  Business success means not only economic self sufficiency but dignity, empowerment, integrity and creativity.

This EBook consists of marketing suggestions that have worked for an acupuncturist (me) who consistently sees around 70 patients a week.  I consider myself successful, and I haven’t sold my soul to do it.  You don’t have to sell yours either.  Creating a successful acupuncture practice has been one of the best things I ever did for myself, and I wish the same success for everyone who reads this book. Good luck!

Know who you are (and if you’re not sure, don’t worry, you’ll figure it out if you spend some time trying).  

Be able to answer the following questions:

  • What communities do I belong to?
  • What communities do I resonate with?
  • What kind of people do I like to be around?
The answers to these questions will describe your ideal patient base.

For example, if I respond to those questions, here are the answers I get:

I’m a white female acupuncturist, age 37, from a working class background, living in a working class neighborhood, over-educated ( a master’s degree in acupuncture, plus I can read classical Greek), a stepmother of three terrific teenagers, a serious meditator, an avid reader, a lousy knitter, a recovering Catholic who thinks a lot about social justice and social entrepreneurship, and the particular kind of eccentric who would keep chickens named Euphonia, Saraswati, and Claudia in her backyard.

Communities I belong to:  my neighborhood, working class people, Gen-Xers, educated feminists, parents, meditators, bookworms, knitters, ex-Catholics, activists, social entrepreneurs, self-employed people, acupuncturists, and urban chicken aficionados.

Communities I resonate with or empathize with, but don’t belong to:  single mothers, caregivers of people with serious illnesses, artists, bicyclists, veterans, and farmers.

I like being around creative people, stubborn people, feisty people, people who persevere through obstacles, people who are down to earth, people who pray, people who care a lot about their families, people who put energy into their communities, people from ethnic and cultural backgrounds different from mine,  people who are direct and who say what they think.  I don’t like to be around pretentious people, people who whine, or people who worry a lot about avian flu.

My patient base, not surprisingly, consists primarily of working class people as well as a few college professors, successful entrepreneurs, and other acupuncturists.  Although Portland is a very white town, my practice is much more ethnically diverse than most acupuncture practices.  I attract a lot of artists, parents, and activists of all varieties.

The point is that it’s easy to treat who you are and who you empathize with. The easiest kind of marketing is to identify target communities that fit those categories, and then focus on those communities.  You will know how to communicate to these people; you will understand their language. Their communities are places you either already spend time and know people, or you would enjoy doing so. It’s much, much harder to market yourself to people you can’t relate to -- and harder still to have a good connection with them as a practitioner.

Know what you like:  

Meaning, what kind of acupuncture you like to do.  Resolve to do that and only that.  Having fun doing acupuncture is not optional or frivolous, it’s absolutely vital.

For instance, I like simplicity.  I enjoy doing a very simple kind of Japanese pulse diagnosis which results in very simple, streamlined treatments.  If I had to practice, say, NAET, with all those little bottles, not only would I do a terrible job at it but I would also want to shoot myself in the head.  I also don’t like billing insurance -- or, God forbid, tailoring my treatments to what I think insurance will cover.

Don’t ever give up what you like to do because you think a patient wants something different.  Patients who want something else can find it somewhere else; there are plenty of acupuncturists, and plenty of patients, for everybody.  It can be hard to promote yourself (more on that later); it is virtually impossible to promote yourself unless your enthusiasm for what you are doing is real and contagious.

Nothing is better for your business than you having fun.  I know that a lot of my patients come to me not only because I can relieve their pain but because I am always genuinely happy to see them.  I truly enjoy the process of treating them, and that’s obvious to them. We have a good time with each other.
 
Over eleven years of being an L.Ac., I’ve had time to think about what is fun for me and what isn’t in terms of treating patients.  Several years ago, I decided that if I didn’t want to burn out, I had to dispense with all the parts that weren’t fun.  It’s important to me not to burn out; acupuncture is an art form, developed over many years, and all the truly great acupuncturists have been practicing for decades.  Of course, I may never become truly great, but I would at least like to have the opportunity!


As it turned out, all the parts that weren’t fun for me also happened to be unnecessary.  My patients didn’t miss them at all.  I found patients who liked simple treatments (note: lots of men fall into this category). Most of my patients don’t have insurance that covers acupuncture, and the ones who did, who really wanted to see me, figured out ways to bill it themselves.

Take down the barriers

Are there barriers to your ideal patient base actually showing up in your clinic for acupuncture?
What are they? Are they geographical, psychological, cultural, financial?

All the marketing efforts in the world will accomplish nothing -- except to exhaust you -- if you don’t identify and take down these barriers. They are walls for you to bang your head against.

But before we talk about specific barriers, there’s one point that has to be addressed first.  No matter who you listed in your answers to the first three questions about communities, there is one barrier that will be virtually universal to all acupuncturists:  your ideal patients don’t know that you’re there.

Lots of acupuncturists are by nature introverts.  Nothing comes less naturally to us than standing up and shouting, “Hey!  Here I am!  Look at ME!!!”  Unfortunately, though, this is what it takes to get the people you want to help to realize that you’re available.  Hanging up your shingle is probably not going to be enough.  People are busy, distracted, have learned to tune out a lot just to get through their days.  Even after they notice you, they will probably forget about you right away.  Yes.  Even you.

Learn not to take this personally and do everything you can to get over your fear of rejection.  Successful marketing entails getting rejected over and over!  It’s not fun, but it won’t kill you.  Watch movies and read books about heroes and heroines.  You are going to need to be patient, persistent, and brave.  And like all the other heroes and heroines, eventually you will succeed.

But getting back to the other barriers...

In my case, if I look at my ideal patient base of working class people (plus the occasional over-educated feminist ex-Catholic who knits lumpy little scarves for her pet chickens), I notice several obvious barriers to them coming in to get acupuncture.  First, the price of acupuncture versus the amount that they are paid to do what they do for work.  The minimum wage in Oregon is $7.50 an hour, and the going rate for acupuncture is $65 per treatment. As barriers go, that’s a doozy.

What about insurance?  Well, unfortunately, a lot of working class patients don’t have any kind of health insurance, let alone the kind that covers acupuncture.  Another barrier!  And anyway, billing insurance doesn’t fall into the category of  “things I like”.

Many acupuncturists have a “financial hardship” policy; if people say they can’t afford it, they’ll temporarily reduce their fees or even give some treatments away.  What about that as a solution?  Actually, if you look closely, that kind of policy is yet another barrier!  I know working class people (because I am one) and I know that if I make them feel like a charity case, they will run in the other direction.  If they have to ask me about a sliding scale, they won’t get treated at all.  In fact, a barrier that I have no control over is that many working class patients have done some research, found out what acupuncture costs, and decided that, like health insurance, it’s one of the many things they’ll have to do without.

While we’re examining barriers, let’s check out the ones related to “professionalism”.  In conventional terms, “professionalism” in health care means wearing a white coat, having a spiffy, sterile-looking office, and a vaguely officious manner. Another thing I know about working class patients is that many of them do not have positive associations with that particular type of professionalism.  They have been put down by it too often.  A good way to prevent them from coming to see me would be to look and act like a conventional professional.  Which, of course, also wouldn’t exactly fit in the “things I like” box.

Interestingly enough, our state medical board recently wrote an article on the characteristics necessary to professionalism in medicine, and at the very top of their list was, of all things, altruism.  They defined altruism as the practitioner putting their patients’ needs ahead of the practitioner’s own.  So, let’s see, I  do like that definition of professionalism, and if I apply it to the needs of my ideal patient base, it would actually require me to ditch the attitude and the outfit which function as psychological and cultural barriers to my patients’ access to care, and to adopt practices which make them feel comfortable and welcome.

Just about the only barrier I don’t have to grapple with here is geography; my clinic is two blocks down the street from my house, in a working class neighborhood, on two bus lines and a bike route.  Whew.

To make a long story very short, the way to take down all these barriers -- all of them at once, actually, it was surprisingly efficient -- was to jettison the conventional business model for acupuncture and to create a better one, which suited the needs of my target patients.  That is not what this particular book is about, but if you want to know more about that business model, please visit our website at www.workingclassacupuncture.org.


Strive to be useful

Think in terms of service.  The idea of “selling yourself” is not only scary but vaguely nauseating to many of us, myself included.  And providing health care is not like selling aluminum siding -- or at least, it shouldn’t be!  

Try thinking about it this way:  there are people out there who need what you have to offer. Your job is to find them, so that you can make their lives better.  Not only is this an uplifting thought, it is absolutely true.  No matter who you are, there is somebody out there who needs you, who would really benefit by coming to see you.  If your practice makes you feel the opposite way, you are probably targeting the wrong people.

Spend some time consciously putting the issue of money aside (imagine that you’re independently wealthy, and doing this just for fun). Concentrate on what a pleasure it is to be useful to someone. Think about how that feels. ( If there’s no pleasure for you in being useful to someone, you need to get out of health care immediately.)  To whom do you want to be useful?  How might you do that?  Now go find those people. Remember that they don’t know to come looking for you.

This point is actually a subset of the first one:  know who you are.  You belong to certain communities, and you are a resource to those communities.  You are the person who can bring Chinese medicine to those people whom you identify with or empathize with.  They can receive it from you because you understand them.  Focus on your function as a useful person, not on your fears about money.

In my case, caregivers and single mothers are people I like being useful to, because they are already giving so much to others.  Nurturing them feels like bringing some balance back to an imbalanced place.  It’s satisfying in a way that has nothing to do with getting paid.

Enjoy your own marketing

Find ways to get yourself out there that you actually enjoy doing.

A new acupuncturist whom I mentored was a serious skateboarder; in fact, he went to acupuncture school primarily in order to be able to treat his own knees so that he could continue skating.  Although he was intimidated by marketing his acupuncture practice, with some encouragement he willingly designed a flier, “Acupuncture for Skateboarders” with a collage of cool images.  He enjoyed making the flier; it was creative and it involved paging through lots of skating magazines.  Then he took the flier and began hanging around skate parks, looking for people to talk to.  It gave him an excuse to skate, a reason to attend skating competitions, and an opportunity to have animated conversations with people who shared his passion.  Talking about his practice to strangers was still a little scary, but the discomfort of that was offset by the pleasure of being in a community he knew he belonged to.

I think of myself as an entrepreneur, and I like going into other self-employed people’s businesses and having conversations about what they’re doing, how they got started, what obstacles they encountered; it’s very interesting to me. I like other entrepreneurs.  I like talking to them about business -- theirs, mine, anybody’s.  Whether or not they ever come and see me for acupuncture, at the end of our conversation,  I will have had a good time. I don’t think of this as “networking” because that sounds like a chore, and talking to these people is fun.  I don’t have to force myself to go out and have these conversations, I look forward to it.

If you enjoy your own marketing, other people will too.  Just as important, however, is that if you enjoy it you will DO it.  

Have energy for your practice

You MUST have energy to put into your practice.  Where do you get it?

Meditate.  Whatever this looks like for you -- whether it’s a formal practice like Vipassana, prayer, qi gong, or just sitting still.   This is very important, because being an acupuncturist entails moving in and out of a lot of different energy fields -- some of which are very imbalanced and full of pain.  You need a daily practice in which you center and replenish yourself.  You will have much more energy to offer to your patients.  You will attract more patients because you can handle the increased volume.

Do things that make you feel creative.  Good marketing is about creativity. (So is good acupuncture.)  Cultivate yours, whether it’s painting, cooking, dancing, playing music, writing, knitting, gardening, or making mud pies with your kids.  This kind of play also helps replenish you so that you have something to offer your patients when they come in exhausted and discouraged.

Rest.  All acupuncturists who have been in practice for any substantial amount of time know that when they are tired or overwhelmed, their practice will slow way down.   It’s like magic, but not the kind of magic you want.  No energy= no patients.

Have patience.  Then have some more.

Patience, patience, patience.  All marketing strategies take time to work.  Almost five months ago our clinic was on TV.  I thought at the time, “Wow, I can see why people want to be on TV; it works faster than everything else” because the phone started to ring before the cameras had left the building, and indeed, we probably got twenty new patients in the next two weeks from that particular exposure.  However, five months later, we are still getting calls from people who found out about us from that 3 minutes of airtime.  It took them that long to make the phone call!   It seems that especially with acupuncture, people tend to think about it for a while before acting.   They may be waiting until they are sure that they need you. Don’t evaluate the success of any particular marketing effort until at least 6 months after you’ve completed it.

Word of mouth is by far the best advertising:  better than websites, better than being featured in the newspaper, better than going out and giving talks, better than TV,  better than any form of advertising known to man. The thing is, word of mouth takes time.

An exercise that was very useful to me was “the patient genealogy” exercise:  drawing a diagram of where all my current patients came from, designed to show how the flow of referrals happened.  When I was finished, what I had was not a straight line of one person refers one person who refers one person, and so on, but a repeated pattern of a wheel with a center and spokes coming out of it.  Out of a practice of a more than a hundred active patients, I had only  seven or eight wheels. Each hub of a wheel represented one patient, and the spokes represented t all the patients that person had referred.  Some of those spokes in turn became the center of their own wheels.  One of the wheels had nineteen spokes:  one single patient had referred (not only referred, in his case, but actually paid for) nineteen other people to come to our clinic -- most of his large family, many of his friends, a few of his employees. There are certain people in any community who have a lot of influence; you often can’t tell who these people are just by looking.  You recognize them by the ripples they cause.

This is why the idea of communities is so important.  Communities will do your marketing for you.  You just have to keep patiently putting yourself out there -- in the right communities -- until you encounter enough of these influential patients.  And that takes some time, because they are unusual, definitely not in the majority --but that’s OK, because you only need a few of them to fill up your practice!

In my experience asking for referrals doesn’t work.  Not because patients don’t want to give them to you, but because most patients don’t have the power to make the referral actually happen.   A lot of my patients have said wistfully to me, “You know, I’ve told everyone I know to come and see you.  But they just won’t.”  The ones who do have the power to send people to you don’t need to be asked.  If you are useful to them, they will very naturally and probably without thinking much about it cause their family and friends to show up in your office.  It’s just a function of who they are.

A note on Scarcity and Competition:  they are not real
    
But they are nasty persistent illusions, and they can make you miserable. Resist them with true stories like this one:

Our clinic,  Working Class Acupuncture (which uses a sliding scale for treatment that goes down much farther than people would think possible), takes up a lot of space in a huge old building in NE Portland.  Part of that space we sublet to two other acupuncturists who have private practices separate from ours.  Both of them charge market rates (meaning, two to four times more than we do). Both of them are busy.  One is so busy that new patients have to wait a month to see her. The reason all the acupuncturists in our building are  so successful, despite the large and obvious disparity in our prices, is that we all like doing acupuncture and we are all clear on who we really want to work with.

There are plenty of patients for everybody.

Remember also the research that showed that restaurants that are all lined up in a row all do better economically than restaurants that are far away from other restaurants.  People like to have choices.  Similar principles operate with acupuncture practices.  Never waste energy worrying about competition; it takes away energy you need in order to treat patients.

About the Author:

Lisa Rohleder, LAc. is the Founder of Working Class Acupuncture in Portland, Oregon.
From a working class background near Baltimore, MD, she currently lives in a working class house with her working class partner and she works in the same working class neighborhood in her working class clinic, in Portland, OR.  She labels herself an over-educated (master’s degree in acupuncture, plus she reads classical Greek), a stepmother of three terrific teenagers, a serious meditator, an avid reader, a lousy knitter, a recovering Catholic who thinks a lot about social justice and social entrepreneurship, and the particular kind of eccentric who would keep chickens named Euphonia, Saraswati, and Claudia in her backyard.

Please visit her website:  WorkingClassAcupuncture.org

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