Your Comments: Heated Debate on Hourly Pay for an Acupuncturist in a Community Setting
Written by John Weeks
Your Comments: Heated Debate on the Hourly Pay for an Acupuncturist in a Community Setting
Summary: The recent
column on the Working Class Acupuncture (WCA) model of delivering low
cost acupuncture in a community room provoked a response that the
$15-$20 rate for hiring an acupuncturist does not reflect rates
elsewhere and was "shameful." The Integrator contacted the WCA co-founders for their response, and then contacted Subhuti Dharmananda, PhD, a
clinic operator who also offers a national perspective. The discussion
jumps between what acupuncturists get paid in various markets, and what
they may "deserve" to get paid. Your comments ...
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The recent Integrator article on delivering low cost acupuncture in a community room ("Working Class Acupuncture (WCA): Revolutionary Model Creates Access, Fosters Business Potential,"
November 25, 2006) was picked up by the E-Forum of the AOM Alliance. The article included a statement that WCA sometimes hires
acupuncturists at $15-$20 per hour. Lisa Rohleder, LAc, co-founder,
states that this is the going rate, in Portland, for addiction-focused and group-delivered
acupuncture services.
This prompted an outraged comment from
Seattle-area acupuncturist Nancy Sherman, MAc, LAc. The Integrator then contacted Subhuti Dharmananda, PhD, a not-for-profit clinic operator whose other business dealings have given him a national perspective. Rohleder and her
partner, Skip Van Meter, LAc, each responded. This discussion jumps
between what acupuncturists get paid in various markets, and what they
may deserve to get paid, regardless of whether or not they do.
1. Seattle LAc Says Going Rates are $35-$45/Hour
After seeing the AOM Alliance article, Nancy
Paine Sherman, MAc, LAc, responded with shock at the hourly rates paid,
based on her experience in the Seattle area with national,
not-for-profit addiction services provider Therapeutic Health Services (THS). Sherman delivers care in four THS clinics.
"I am addressing these comments to you and the AOM E-Forum about the article in the recent Forum.
"I
work regularly weekly in addiction and mental health services in a
group setting and am employed as an independent contractor by various
clinics. This article is very interesting as a business model, however
I was shocked by Rohleder's statement about the hourly rate of pay for
acupuncturists.
"Perhaps
pay scales are a little different in Portland than in Western
Washington, but I doubt they would or should be. I can assure you the
'going rate' here is $35 - $45 per hour for practitioners in this
setting. She is suggesting less that 50% of that is appropriate! With
our education, skills, etc. acupuncturists in any setting should be
paid no less than $30 per hour. The way I calculate this in my own
business model is I should be making about 50% per hour of what my
standard per treatment rate is because for those hours I do not have
the overhead/supply expenses of my private practice, nor do I have the
cost of marketing to bring those patients/clients to my practice.
"My
concern about this statement is that it could diminish and downgrade
our value to clinics already offering acupuncture and potential
employers/clinics. I am very sorry to know that Rohleder may be
employing acupuncturists for her 'overflow' at $15 - $20 an hour. Shame on her."
2. Follow-up: Hourly Payment Will Be Less for Clinics Hiring Interns
Comment writer's employer
I contacted Sherman and she offered the following comments which noted
that hourly costs may be significantly lower in some facilities with
interns.
"...
While I would rather not specify what I earn there, I will say it is
within the range I gave you in the previous email. I am not the
only acupuncturist employed with them and while I can only speak for myself, I
believe all of us are paid within that same compensation range.
"Evergreen Treatment Services is the
other major methadone treatment clinic in Seattle. They have had
an extensive acupuncture clinic there for many years and most
acupuncturists here who are NADA-certified (National Acupuncture Detoxification Association) do some training there. Because
of the interns' work there they obviously have some low cost practitioners
helping out as part of their internship. However, the employed
acupuncturists there - I am certain - are not working for $20/hour!
"Anyone with a high school diploma or GED who
isn't a convicted felon can work here as a transit operator for $15 - $20
an hour. We have a minimum 3- year graduate level professional degree in
our medicine in WA! "There are other
clinics in this area who employ acupuncturists by the hour to
work in group settings. Again, I can only speak definitively for myself
and my employer, but I am 99.9% sure no practitioner here is being
paid as little as $20/hour. This, of course, precludes any volunteer
work we do, meaning donated services. I volunteer services once a
month at a clinic and in that setting, I do not expect to be
paid. We do this as a service to the community and an
underserved population - an entirely different situation. That work is to
nourish our hearts, not our practices."
When Sherman learned of some of the WCA perspectives, below, she sent this additional note:
"It is possible that a major difference in the cost of living
between Portland and the Seattle area could mean her figure is appropriate
there, and I am not familiar with the averages in Portland or any of
Oregon. If the range had been qualified as a 'local' going rate maybe the
probability of giving the wrong impression could have been avoided. If that is
the case, then I'm happy if acupuncturists there are earning per hour what is a
good wage there.
"We all realize that for the cost and time spent on our education,
acupuncturists are generally underpaid but we choose the profession because of
our love of the medicine and our work. $15 - $20 here would be considered worse
than just underpaid. I would consider it exploitive."
3 . Dharmananda: Half the Prevailing Private Practice Rate is Maximum Pay
Subhuti Dharmananda, PhD
Subhuti Dharmananda, PhD, has
been a national presence in natural healthcare and AOM for decades as
writer, consultant, product formulator and as manager of not-for profit
clinics in Portland, Oregon. The perspective offered here is shaped by
his national connections through his Institute for Traditional Medicine and his own clinics, including the Immune Enhancement Program and the An Hao natural health Care Clinic. experience with his .
"There are actually relatively few
situations in the entire country where a licensed acupuncturist is hired for an
hourly wage. So, the data is sparse. There is variation, of course, by city:
San Francisco clinics will pay higher than Portland because of the higher cost
of living there.
"Many practitioners
do not have enough patients to get by.
"So, they are happy to get an hourly
wage."
- Subhuti Dharmananda, PhD
"I am happy to share with you the pay scale
we use, and I think we are in the typical range (hospitals probably pay more if
they hire someone to work there). We pay from $18-$25/hour (the lower pay is
starting wage, the higher pay for someone who has been with us for years). Our
experience is that practitioners like having the steady hourly pay for part of
their income, rather than relying solely on patients filling individual slots in
their practices, even though they charge more than double to see patients in
that setting. If you take the case of Portland, where we have two schools
pouring out TCM practitioners (the tendency is to stay here), many practitioners
do not have enough patients to get by. So, they are happy to get an hourly
wage.
"There is a difference, I think, between
working at an acupuncture services clinic (like working class or the 'general
setting' you are talking about) and working at the ITM facility, as we have a
focus on difficult to treat diseases and the patients have access to a lot of
herbs (subsidized by ITM). Thus, there is a certain extra attraction for
working at our facilities even if the pay is inadequate.
"In sum, I would say that if you take the
prevailing rate for an acupuncture visit (return visits) in the city of concern
and divide it by two, that should be the maximum hourly rate and the beginning
rate can be something below that." (bold added)
4. Rohleder and Van Meter Clarify, Respond
Van Meter, left, and Rohleder, right, with WCA co-founder Lupine Hudson
The WCA founders, Rohleder and Van
Meter, suggested I contact Dharmananda in the midst of a handful of
follow-up emails with them. These selected comments clarify their
perspectives.
"I find this comment
by Nancy Paine Sherman rather odd. Does she think Lisa is lying? Maybe
the pay rate for acupuncturists in Portland and Seattle is different
... But here are some facts from what I know with some possible
explanations:
Lisa and I both worked for several years in public health at the Portland Alternative Health Center (PAHC), which is part of Central City Concern
(CCC). CCC is the primary agency around Portland dealing with homeless
and addiction services. For my last two years I was the lead
acupuncturist there. When we started we got $15/hour and when we left
seven years later we got $20/hour. Now the longer we stayed there the
more hours we got and thus eventually were eligible for a decent
benefit package but that didn't kick in for a couple of years and as
almost every acupuncturists then was employed halftime at most (I had
32 hours) they only got a percentage of benefits.
"Before I worked at PAHC, I worked at InAct,
which is the agency in town that handles the 'drug court' contract. Do
you know about drug courts? Several cities have them. What they are
is when a person is picked up for the first time on possession they are
offered either jail time or counseling with acupuncture. At InAct I
worked just a year for $16/hour. No benefit package.
For additional comparison, Van Meter notes that clinical supervisor pay at the Oregon College of Oriental Medicine
was $22-$25/hour a few years ago, and that by state law, acupuncturists
need to have 5 years of practice before supervising. He adds that
instructor rates at OCOM, where Rohleder has taught, are roughly
$40/hour, but include no prep time "so it worked out to $20/hour." He then sent me to Dharmananda for more information.
I suggested to Rohleder that they might want to respond to Sherman's
comments, which were scheduled to run in this week's AOM Alliance E-Forum. She responded:
"I am not all that interested in defending
what we are paying our acupuncturists, because it seems sort of beside
the point. We're not a large employer, and we have a file stuffed full
of resumes from acupuncturists who would like to work for us. We never
advertise that we're hiring because we know we would get swamped."
"But actually my first thought was, Woo-hoo! Seattle here I come! If acupuncturists can make that
kind of money in Seattle, I think that's great. I also think it's great
that we are having an actual conversation about real numbers, which is
darn hard to do in the acu world."
5. Classism, Pay, Challenges in Successful Practice, and WCA as Business Training
Rohleder then brings the discussion back to a core issue in the philosophy of WCA and hte Community Acupuncture Network.
"So here is this other thing I would like to
get into, but I'm not sure if you want to include all this. It has less
to do with integration and more to do with the woeful state of
professional development among acupuncturists. Even though my pay as an
acupuncturist at PAHC was, God forbid, comparable to a lowly TRANSIT
OPERATOR (do I detect a smidgin of classism there?), I was and am very
grateful for that job, because it gave me the opportunity to actually
practice, and greatly contributed to my long-term survival as an
acupuncturist. It gave me experience and it gave me confidence.
"Our goal (at WCA) is not to create long-term employees, but to support other entrepreneurs in opening more accessible clinics."
- Lisa Rohleder, LAc
"Part of the reason that I think so many
acupuncturists fail long-term is that they start right out of school
trying to charge high prices, which makes it hard for them to attract
and retain patients (since they are understandably not sure yet what
they are doing) -- in the long run they lose rather than gain
confidence in their skills, and they quit. I was saved from that fate
by my job.
"There are very few public health jobs left in Portland and I worry
about the ultimate impact on acupuncturists as a result. What my public
health job did not give me were the skills to make a living in private
practice, because the work I was doing was with patients who would
never be able to pay me themselves. The government was paying for
their treatment, and their counselors or their parole officers made
sure that they came to acupuncture. Not exactly the dynamic you see
with patients in a private practice.
"When we started hiring acupuncturists a little over a year ago, we
deliberately chose practitioners who already had private practices of
their own. We deliberately limited their hours to under 10 per week, so
that they would have energy to give to their private practices, and we
deliberately set our pay rate at $17/hour so that they would never
forget that they could be earning more money out on their own. We did
this because we wanted practitioners to gain experience and confidence
at WCA and then go out and create successful clinics using our business
model. Our goal was not to create long-term employees, but to support
other entrepreneurs in opening more accessible clinics. We also gave
them lots of tips and coaching and pep talks.
"It worked. One of our acupuncturists was seeing 2 patients a week in
her private practice when she started working for us, and now she's
seeing 30 or so. The other was seeing 15, and now she's seeing 50. (She
actually left us so that she could concentrate on her own clinic). We
do joint marketing whenever possible with these practitioners, and we
all refer to each other, since we are located in different parts of
town. We don't want employees who feel dependent on us, we want
comrades. If you want to interview any of these people I'll get them in
touch with you. Unless they all move to Seattle once they find out how
much I'm exploiting them.
"The point to all this is -- how can we create
structures so that more acupuncturists can actually make a living doing
acupuncture?
"If someone else came up with a better plan, I would be genuinely happy."
- Lisa Rohleder, LAc
I don't have any better ideas than what I'm doing, and
I don't know anyone else who is having even the small success that we
are having on this issue. If someone else came up with a better plan, I
would be genuinely happy and I would support the heck out of them,
whoever they were.
"Based on my own experience, I don't think that acupuncturists have
much security working full-time in public health; funding is way too
vulnerable. Most public health acupuncturists in Portland lost their
jobs a while ago. I think that giving acupuncturists hands-on
experience with a replicable business model offers them more stability
in the long run, even if the initial pay is low. But like I said, this
is the best I can do. WCA doesn't get any state or federal funds,
unlike a methadone clinic. If someone can do better, hurray for them. If they'll share their business model, I'll take notes. Thanks again for
hosting this conversation."
Comment: As a person who has worked closely with
a number of the CAM professions, this conversation about income
stimulates the guilty feeling of giving away a club handshake which one was sworn to never share outside the fold. These issues are not about
acupuncture, but cut across the CAM fields and into MD-centric integrative
medicine. I recall the awkwardness a decade ago as
pioneering integrative clinic directors began to acknowledge that their numbers
weren't adding up. The cash-paying patients simply weren't there.
I suspect that the darkest shadow lurking here, for some, is a concern
that poor business success implies poor medicine. But the business of medicine doesn't follow typical business rules. Having
more services available in conventional medicine drives up costs.
Having more surgeries and high tech services available, in conventional
medicine, is frequently shown to worsen outcomes. (Seethis Integrator article for background.) The macro relationship between US medical investment and our lousy health outcomes, compared to other nations which spend less, further underscores the loco nature of medical economics.
I agree with Rohleder that we need to experiment, even revolutionize our delivery to create breakthroughs and reach more people with health-promoting services. To do so, the economics of our practices need to be an open, shame-less discussion.
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