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Your Comments: Heated Debate on Hourly Pay for an Acupuncturist in a Community Setting PDF Print E-mail
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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ImageThe 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,

"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. (See this 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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