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Guest Column: Acupuncturist Rohleder on Massage Envy, Group Visits, Business Models and Access PDF Print E-mail
Written by John Weeks   

Guest Column: Rohleder Says Meeting Patient Needs Links Successful Models of Massage Envy, Group Visit and Community Acupuncture

Summary: Is the growth of the $90-million Massage Envy due to the same principle as that of group visits and community room acupuncture - meeting patient needs? Lisa Rohleder, LAc, co-founder of Community Acupuncture Network, offers a provocative perspective in response to two recent Integrator articles. She uses author Paul Hawken, in his influential new book, Blessed Unrest as a reference.  Then Rohleder presents the struggle to create successful business models in complementary healthcare as "a function of two classic attributes of adolescence: an unstable identity and extreme self-centeredness." Might deeper connection with a service mission help integrative and natural healthcare models to thrive?  
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group visits, shared medical appointments, CAM,
Working Class Acupuncture

Two recent Integrator articles - one on group visits and holistic practice and the other on $90-million Massage Envy - led me to comment on similarities with the radical reform acupuncture business model promoted by the Community Acupuncture Network (CAN). Lisa Rohleder, LAc, CAN co-founder, and co-owner of Working Class Acupuncture, sent the Integrator a very thoughtful analysis. Does the immaturity of integrative medicine, acupuncture and other complementary and alternative healthcare professions keep them adopting practices which might better connect them to both success and what Rohleder calls "real service to patients?"

Is Immaturity Keeping
the Complementary and Integrative Healthcare Professions

from Seizing Opportunities?

- Lisa Rohleder, LAc
Working Class Acupuncture
Community Acupuncture Network

Thank you for posting the two recent pieces that addressed low-cost, high volume business models for massage and the resonance of group visits with holistic healthcare. I’m most interested, as you know, in combining those two concepts to create greater access to acupuncture for as many people as possible.

It’s very exciting to receive news that these approaches are gaining traction in other areas of medicine.

Lisa Rohleder, LAc, WCA, ciommunity room acupuncture
Rohleder( rt) with CAN colleagues
You commented that it’s "interesting how the venture capitalism of Massage Envy and the collective consciousness/socialism of WCA find their way to similar models." Paul Hawken in his new book, Blessed Unrest, suggests that humanity is creating new forms of organization as a biological response to our ecological crisis.

The hope is that we are evolving toward creating structures that better serve humanity as a whole. Whether we call them venture capitalism or communism is less important that what those structures can actually accomplish.

In terms of complementary/alternative medicine, I believe that we are experiencing our own form of evolution as well. We are past the infancy of CAM in this country and unmistakably into its adolescence. Our current struggles are adolescent struggles that will be resolved, I hope, by maturation. "The struggle to create successful business models in complementary healthcare” is a function of two classic
"Whether we call them
venture capitalism or
communism is less
important than what
those structures can
actually accomplish."

attributes of adolescence: an unstable identity and extreme self-centeredness. I feel I can state this with confidence with regards to my own discipline, acupuncture, but I think it applies to a number of other CAM disciplines as well. We don’t really know who we are, so we try to be what we’re not -- usually MDs, though we’ll settle for being spa therapists as well, if that niche appears to be open. We worry a lot about titles, turf, and what other people think about us.

We don’t, honestly, have very much interest in patients, not the selfless kind of interest which is supposed to characterize medicine.

What Massage Envy and Working Class Acupuncture have in common is a willingness to adapt the delivery of care to what the patient actually needs and can actually use in real life, which is why both businesses are successful, even though they come from different ideologies. It’s also what distinguishes them from other CAM business models. A lot of CAM disciplines can’t get past the issue of whether insurance will pay for our services ( a subset of “what other people think of us”) even though it ought to be clear that insurance is not responsive to us or to an increasing number of patients who are uninsured or underinsured. CAM in general sees no problem with abdicating our responsibility to be financially accessible to patients to a lot of huge, third-party, for profit corporations -- and then we wonder why things are going so badly.

Adolescents tend to be naive, too.

"CAM in general will
be interested in
the benefits
of group
visits until we
our current self-

centeredness and get
interested in real
to real patients."

Dr. Gmeiner comments that, “If you have an educational or patient empowerment focus, group visits are it.” The problem is that CAM does not have a patient empowerment focus, not yet -- we are far too insecure for that. Group visits do have better outcomes, in part because there is less room for practitioner egos. CAM in general will not be interested in the benefits of group visits until we outgrow our current self-centeredness and get interested in real service to real patients -- the vast majority of whom cannot afford boutique medicine.

Comment: Gmeiner spoke clearly in her Integrator interview about the fit of group visits - or shared clinical appointments - with the patient empowerment mission of holistic and whole person practice. Why are naturopathic doctors, integrative medical doctors, and most acupuncturists not actively exploring this model? Why don't massage therapists and chiropractors get smart about the value of classes and the known success of group contexts for adult learning? Are the integrative and complementary professions so hellbent on realizing MD-like entitlement that they are missing their own destiny? Rohleder poses strong challenges. One sign that she may be right on the money is how many visionaries in the integrative care field wonder aloud at how they and their fellows are struggling to gain acceptance and integration into a failing system. Isn't that what your 'integration' is all about, Weeks? The ugly image comes to mind of rats trying frantically to scamper aboard a sinking ship. Maybe, to stop that backwards flow, it's time to take a lead in real innovation.

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for inclusion in a future Your Comments forum.

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