My Readiness Manifesto

An interesting thing happened at the clinic last week.A thunderstorm knocked out our phone lines for the better part of three days, and even though we checked voicemail hourly, returned calls from our cell phones, and changed our outgoing voicemail directing patients to call my cell if they needed someone, our business still took a nosedive.We went from seeing 45-50 patients on a weekday to around 30.

It was interesting to realize just how much our clinic operations rely on a simple working phone.The week reminded me of the old days, back when I first opened, back when we were only open four days a week, back when it was just me doing everything.I was a compulsive phone-answerer.At the end of each shift I’d forward the office phone to my cell phone so I wouldn’t miss any calls, then I’d double-check to make sure I had forwarded it.On days off I’d answer the phone EVERY time it rang, no matter where I was or what I was doing.I was phone-crazy.Maybe I went a bit overboard, but I think this was crucial to getting a lot of patients in the door from the very beginning.I was super-available;  I wanted to make it as easy as possible for patients: no frustrating phone tag, no menu of options, just a live person every time they called.

I only tell this story as an example of how utterly ridiculous the job of a business owner can sometimes be.I’d seriously schedule appointments while standing in line at the grocery store.But this blog isn’t about me and my phone obsession.It’s about you as a potential CAP owner, a new CAP owner, or a seasoned one.First of all, for a few minutes I want you to stop thinking of yourself as an acupuncturist.Forget about your education and your tens of thousands of dollars in student loan debt; forget about qi and blood and yin and yang; forget about Skip and Lisa and WCA and CAN and POCA.You’re just a small business owner.Has anything in your life prepared you to do this?Are you ready to do this?Do you even want to do this?If you haven’t opened your clinic yet, you need to answer these questions before you look at commercial property or pick up that first yard-sale recliner. If you already a CAP owner, you need to explore these questions anyway.The answers may surprise you.

First of all, has anything in your life up until this point prepared you to run a business?

 

Most of us, myself included, have never run a business before.It’s okay; it doesn’t mean you’re not prepared.Think of what you’ve learned at other jobs.My various retail jobs taught me how to provide good customer service and simple systems for daily accounting and money tracking.Being a summer camp counselor taught me not to take myself too seriously and the power of group energy. Being a karaoke hostess taught me how to encourage people when they’re about to do something they’re a little afraid of.My job as a refugee resettlement case manager taught me a whole lot about classism, racism and xenophobia.My job as a fundraising account coordinator taught me how to work an Excel spreadsheet and basic marketing concepts.What are the jobs you’ve done in your lifetime and what translatable skills have you learned from them?I’m serious.Sit there and write them down.You’ll learn two things: 1) what you do know, and 2) what you don’t know.There will be gaps in your experience; we all have them.But you have to get comfortable with them.Don’t shy away from the things you don’t know; embrace them. A huge gap for me was that I had no experience being the boss of other people, and it’s turned out to be my biggest challenge as a business owner.I wish I had known this 18 months ago; I could have invested more time up-front learning how to be a good employer, being proactive instead of reactive.It probably would have saved me and my employees a lot of stress.

Secondly, are you ready to do this?

There’s the stuff that we preach on here all the time: go to a workshop, read CA-101, visit other CAPs, read Noodles, etc.And there’s a reason why we preach it – you have to understand and trust the basics of CA if you’re going to make this work.Then there’s the stuff we don’ tpreach as much but is equally important: if there are gaps in your business experience, get some help!Educate yourself.There are countless books out there on how to run a small business.One that has been a huge help to me is The E-Myth Revisited by Michael Gerber.Actually someone here on CAN recommended it; I don’t remember who.Thank you, comrade, whoever you are.I’m not saying you have to read the E-Myth; just read something.Go to your library and check out some books about small business; there are thousands.Find what resonates with you.Talk to people; talk to business owners in your community.They will want you to succeed.

Are you ready to do not one but three jobs? THREE jobs. Michael Gerber talks about this in his book.A small business owner is three people in one: an Entrepreneur, a Manager, and a Technician.The Technician is responsible for actually delivering the service; in our case we put on the Technician hat when we’re in the treatment room with patients.The Manager is responsible for everything operational and non-technical: buying office supplies, making sure there are enough needles, balancing the books, paying taxes, getting a business license, cleaning the bathrooms, hiring staff, answering phones, updating the facebook page, etc.Then there’s the Entrepreneur – the visionary, the long-range strategic planner, the one who thinks beyond day-to-day operations.Any one of these jobs is a lot for one person to do; as a business owner you have to do all three.Don’t lure yourself into thinking that just because you’re a good acupuncturist, you’ll be a good business owner.That’s the “Entrepreneurial Myth”that Gerber writes about.You can’t do only the things you like to do; if you focus on only one aspect you will fail.

Recently in the forums Whitney from Oakland Acupuncture Project posted this gem: “Especially in the beginning any owner must have a big presence at the clinic.  If you are not doing the bulk of treatments and setting the tone with new patient communication you are seriously jeopardizing the possibility that any of your well thought out systems will actually work….for you or for patients. In our first 8 mos the only person who ever spoke to a patient was an owner.  We were clear with each other about systems, treatment plans, clear about our mission.  This enabled us to communicate clearly and in a similar way with patients.  We were WAY invested and we grew quickly.”This is a perfect example of someone who’s thinking as a Technician, a Manager and an Entrepreneur, and is committed to doing all three jobs.

What emotions are working against you?For many of us it’s fear.In acupuncture school we’re taught a set of beliefs, a worldview, and a way of doing things that actually translates very little into the real world treating real patients.It’s scary to discard that protective mantle built up through years of training.If you do have fears about being a business owner, congratulations, you’re normal.Take some time to explore those fears, where they’re coming from, and how they may hold you back.What are you really afraid of?That you won’t make enough money?That you won’t be able to treat back pain without putting needles in the back?That you won’t have enough time for a comprehensive intake?That you’ll be too overwhelmed seeing 100 patients a week?That you’re not good enough?What’s holding you back?If you have serious doubts or fears about doing CA, your patient numbers will reflect that.

Most of all, are you committed?Are you willing to take a huge risk and leap of faith?You have to invest financially, emotionally and energetically.Do you still have your foot halfway in another door?Halfway in another door is one foot out of your clinic.Are you still holding onto something as a safety net?Because your safety net may actually be a snare, keeping you from fully committing to you rbusiness.And if you’re not fully committed, your patients won’t be either.

And finally, do you want to do this?

Don’t judge yourself here; be honest.Many business owners go into business because they’re good at something and they’re tired of working for someone else.As acupuncturists, that’s often the case, but sometimes we go into business for ourselves simply because we have no other options.It’s not like there are tons of jobs to apply for (oh wait, except for all of these).I don’t think Lisa has given away any toasters yet.But do you really want to be a business owner?

In her keynote address at the CANference, Lisa talked about how if you have interests outside of your practice that are seriously competing for your attention, you’ll have trouble attracting large numbers of patients.Community acupuncture can’t just be one interesting thing you do; it really can be the only interesting thing you do.It’s true.Here’s an example of how this translates for me.Sunday is my day off.What did I do last Sunday?Well, I skipped my morning yoga class to drive 6 miles to the nearest office supply store to buy yellow ink.Our printer won’t print without yellow ink, even if you’re just printing black and white.Go figure.Since we were running low on forms the day before I knew the Sunday crew would probably need to make some copies, so yellow ink was a must.I bought the yellow ink, dropped it off at the clinic, then came home.Then I spent a couple of hours dealing with an employee issue.Then I went to the clinic for the second time on my day off to wrap up things regarding said employee issue.Then I returned some patient emails.Then I worked on the schedule for the coming week, which I thought had already been worked out before the aforementioned employee issue came up.Then I changed the outgoing voice message at the clinic to say that we’d be closed for Memorial Day.I forgot to put a sign on the clinic door saying we’re closed for Memorial Day but oh well.I wasn’t going back there for a third time on my day off.Things I had planned to do on Sunday: go to yoga class, do several loads of laundry, finish packing up my winter clothes, vacuum, call my friend Susan, practice the piano, and take my dog for a walk.The dog walk was the only one that happened.Now, it isn’t like this every day off.But as a business owner, you have to be okay with having days like this.You need to understand that even if you’re not physically at the clinic, you will probably be engaged in some type o fbusiness-related activity every single day.And if you have a significant other in your life, they have to be okay with this too.

Here’s the thing.Sadly we’re not at a point yet where CAPs are in every neighborhood providing thousands of jobs to acupunks (but we are providing actual jobs!).Maybe there’s no CAP in your town yet, so your only option is to open your own.It’s okay!You just have to stop thinking like an acupuncturist and start thinking like a business owner.Many business skills are just that – skills that can be learned.There are scores of small business resources out there, many of which are free.Prepare yourself mentally and emotionally – being a business owner tends to magnify one’s insecurities, imperfections, and emotiona lscars.But it will also bring out strengths you didn’t know you had.Owning a CAP will challenge you, exhaust you, invigorate you, wear you down, build you up, make you laugh, make you cry, keep you up at night, and cause your heart to feel like it’s going to burst through your chest.And that’s just on a slow day.

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.

Responses

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  1. thanks, alexa!

    so much helpful information here! thanks for being willing to burst through some of the uncertainty, programming and illusion about what it actually means to be a CA business owner.

    and just one added thought to your last question. if it turns out that you really aren’t in the position to run your own CA clinic (emotionally, financially, energetically, with unlimited commitment and willingness to devote yourself FULL-TIME for at least a few to four years to this endeavor), it doesn’t mean that there are no options for doing CA.

    Because, although there are almost no other available acu jobs–and certainly almost NONE of the illusionary jobs you were taught to expect in acu-fantasy school land (the ubiquitous $60-80,000 right out of school just for being your special self. really just a way for schools to keep their student loan debt repayment scam going)–there are CA clinics all over the country that are desperately looking to hire CA punks. yup, real, actual jobs doing acupuncture and learning CA from the inside out! generous punks that will actually mentor you! a way to see the miracle of simple, frequent acupuncture treatments helping patients and creating sustainable jobs. so keep your eye on this forum and maybe find your place there. there is plenty of need for all of us, and our varied talents and readiness.

     

    Melissa

    Good health is not a measure of adapting to a sick society.

    When the power of love outshines the love of power, the world will know peace.

  2. Thank you!

    What a brilliantly helpful blog post.  It is great to see the day-to-day ups and downs spelled out like this.  I just signed my lease this past week and will be opening some time in July, and I’m so freaking psyched I cannot believe it.  It feels like Christmas Eve to me, every single day.  I keep seeing people as I drive down the street walking along, or riding a bike, or waiting for the bus, in my neighborhood, and I wonder with each one – will I get to meet them?  Know their name? Will they come to find if acupuncture can help them?  And I hope I get to meet them all, and treat them all, and I hope that acupuncture can help them all.  And, I’m also excited to answer phones and sweep the floor and paint the walls and market the living crap out of it.  I can’t remember the last time I felt so devoted to and excited about anything.  Your blog entry is a great and encouraging light for the road ahead of me, I really appreciate it!

  3. Thanks, Melissa

    Of course!  Yes, fortunately there is another option for doing CA if you’re not in a position to be a business owner – thanks for the reminder that CA clinics offer real jobs with many real patients who need simple acupuncture.  I just edited my original post so we can have even more hyperlinks to the jobs page!

  4. well said, alexa.  and this

    well said, alexa.  and this blog pretty much applies to any acu-grad no matter the economic delivery model each person chooses to pursue.  it’s a lot of work to get a practice going and keep it going.

  5. Congrats, Kim!

    How exciting that you just signed your lease!  You’ll be amazed and humbled by your new patient community – all those people riding their bikes or waiting for the bus in your neighborhood, yes, they will become your patients but more than that they will become a part of your life and pretty soon you won’t be able to imagine living without them.  And then there are all the people you haven’t thought of yet – the ones who will show up because you’re there and available and possibly able to help.  Your heart will just break and burst at the same time.

    It’s so crazy – today was my first actual day off in over a month.  For weeks I’ve fantasized about this day and all the wonderful carefree things I would do.  Believe me, I’ve thoroughly enjoyed some time away from the clinic, but I’ve spent the better part of the day missing my patients and eagerly anticipating my next clinic shift.  I can’t help it, I am completely in love with my patients.  I think most of our comrades probably know exactly what I’m talking about.

  6. Willingness, Motivation and Overcoming Fears

    Thanks for a great post and much food for thought, Alexa-

    Until you own a clinic (and in many ways it owns you), you truly have no idea what you are getting yourself into.  At least that’s how I feel about it now.

    One thing I’ve come to realize myself over the course of being a CAP owner is just how much willingness and motivation is needed and how important it is to overcome fears.  I am with you 100% in saying that I was never prepared to be a boss and, quite frankly, I find it to be the most uncomfortable and difficult part of my job.  I am sure I will get used to it at some point and it is getting easier the more I do it, but it was one of the many parts I just hadn’t really given much thought to until it happened.  Earlier on there were other challenges which since then have become much more comfortable.  I also can totally relate with working outside of the job hours – that’s just something that has to be done – but it can definitely be tiresome.  I find that I really need to make it essential to take breaks and not get too involved in clinic stuff on my days off or it can be really draining.  But ultimately the more willingness we have as owners to do all the things we need to do, including doing whatever we can to help our patients get in for treatment as simply and conveniently and with few barriers as possible, the better our successes are and the happier we’ll be – and of course the more people who will have access to our medicine.  Not always easy in practice even though the concept is simple.  Anyway, great points on the biz running/owning part. 

    Justine Deutsch, Acupuncture Together of Cambridge, MA

  7. Thank you Alexa

    For another awesomely helpful post.  I love that someone as organized as you still sometimes runs out of yellow ink (and I know, why can’t you print black without ALL the inks? so annoying)!  I have two “days off” – Wednesday and Sunday, and my Wendesdays usually look like your recent Sunday: it’s my day away from the clinic to do clinic stuff (in addition to the household stuff that you have to hang around the house to do: laundry, making bread, etc.)   I got a little burned out there for awhile so started drawing a firmer boundary around Sundays, and trying to make that the day that I really prioritize spiritual stuff and hanging out with family and friends; but it’s not a hard boundary.  Whenever I leave the house I’m the neighborhood acupuncturist, and I love that.  As soon as I started feeling less burned out and more energetic I wanted to put that energy into the clinic, and that feels right.  I still have to pay attention to self-care so I don’t cross over from “rested and focused” to “obsessive but unproductive.”  But I still can’t imagine doing *anything* else.

  8. A beautiful, honest kick in

    A beautiful, honest kick in the tush. I love it. Thanks!
    Dana @ Skagit Community Acupuncture

  9. DON’T sell it to acupuncture

    DON’T sell it to acupuncture students second-hand.

    Hey, maybe we can make art from them and have a contest?