“What Every AOM Student Should Be Taught About Earning a Living.”

Hi all  – this is the first in a series of topics that I plan to post in the hopes of getting people talking and thinking about the biggest stumbling blocks to successful practices. I start with the topic of what every AOM student should be taught about earning a living because an ounce of prevention is worth a pound of cure. By teaching students the realities of what it takes to earn a living in this field, they can be much better prepared when they get licensed rather than making mistakes that only digs them into a deeper hole. I want to do all I can to help those who have been practicing for some time to improve their situation, but it is far easier and makes the most sense to emphasize what needs to be taught to get people off on the right foot.   

First and foremost, AOM students need to be taught that solo private practice offers them the greatest degree of control over their own financial futures. This is an irrefutable fact that needs be acknowledged. No other path affords practitioners more personal control. Every other possible career path – renting office space or partnering with another practitioner, being hired either as an independent contractor or as a employee within establish practices or integrative medical settings – all of these rely on factors beyond one’s control.

 I am not saying none of these paths will ever work for anyone, sometimes they do. But far too often these scenarios do not work and practitioners waste valuable time in their first few years that they could have spent building their patient base and learning how to manage a practice while building their income – if they were taught the right way to do this. And that is the second part of what every AOM student should be taught. They first need to understand solo private practice gives them the most control over their financial futures and then they need to be taught just how to build their practices over their first 2-3 years. That is what my book “Making Acupuncture Pay” was designed to do and what many people have told me it is doing for them.      

When I give talks at AOM schools, I always ask what those students plan to do once they get licensed. Virtually every student I asked this of replied that that are looking to work out of someone else’s office or within some sort of existing facility.  I have yet to hear that a new licensee plans to open their own practice right away.   While I agree working within an established practice or facility would be an easier way to get one’s feet wet, what is far more likely is that recent graduates fumble around for 2-3 years not earning enough to sustain themselves and then eventually try opening their own practices. By this time they are that much more desperate to make something happen quickly and they have not yet learned the right way to run their own practices and they struggle. Many then drop practicing altogether 5-6 years after licensing or continue to see a few people a week out of their homes.

I fully understand that it costs money to open a practice and students come out of school already hurting financially including those with high student loans. To that I say all the more reason to be taught from the very beginning just what the real world prospects are instead of being fed some vague list of different options graduates could pursue. Student loan debt is about the most serious debt one could ever undertake. There is virtually no bankruptcy protection option if you default and your credit can be ruined, any tax refund you may be due will be lost and your wages can be garnished by 15%. Coming out of school with high student loan debt and then pursuing a dead-end career path because you don’t have any more money to spend in the one path that could pull you out of debt is terrible planning. 

The beauty of practicing AOM is that you can run a practice on a shoestring budget. The tools of our trade are very inexpensive. The public is starved for affordable natural therapy that works and AOM practitioners have the best chance of providing that service once they learn how to make their services work financially for both patient and practitioner. When I opened my practice, I had moved to a new town and did not know a single sole there. I had no practice building training but I made rent my first month and all expenses by the third month. Within 2 years, I was supporting my family of 4 even though I made many mistakes and had no one to advise me. I firmly believe that with the right education and HARD WORK, most AOM practitioners should be making a solid income within 2-3 years.

My book is based on what I learned over 25 years of practice and the involvement I have had over those years in many other aspects of the AOM profession. I am also committing myself to personally help those who have read my book and seek further advice. Please help me help others by passing this posting along to any students, recent graduates or AOM school staff/administrators you may know. I not only want to help students and graduates, I also want to get the schools to think more critically about the opportunity they have to help their graduates turn  their educations into a career worthy of the time and money students invest.  I hope to encourage and support schools to broaden their focus to include career development as well as licensing exam pass rates. AOM represents the greatest body of natural healing knowledge the world has ever known. Most schools do a reasonably good job teaching those skills and the public wants and needs those services. We just need to seriously consider what knowledge is missing that prevents graduates from making a solid living. So – students, graduates, practitioners, and school educators/administrators – what say you?             

Matthew Bauer

The general consensus among many of my classmates was that we would rent space. However, ever since I read your book and through several conversations I’ve had on the topic, I think the “jumping in with both feet” concept is the way to go. I have one graduate friend who followed this method and within a couple of months had a full schedule.  In the next couple of months I plan to put this plan into action, once I have my license.

Please do me (and the rest of us) a favor and see if you can get that friend/classmate of yours who did so well right off the bat to join in the conversation here and share their experience. I wonder if it is the one student that told me they were going to take the plunge after my encouragement. If renting rooms was the answer, the current success rate would be much higher.

Matthew Bauer

I agree with your thoughts on private practice, Matt. When I first graduated, I considered myself very lucky that I found a part-time employee position with an established practice that I really respected. At the same time, I was looking for space to rent from someone in a different town. Renting from someone didn’t turn out to be very easy, so I ended up opening my own little clinic, while at the same time still working at the other one. That only lasted about six months before I left the other place and went full-time in my own practice, though not because I was overly busy.

The biggest thing I learned is that no matter where you work, you are essentially self-employed. Just because there is an established practice, it doesn’t mean you will instantly be flooded with patients. I had to work just as hard at getting new patients in and maintaining patient flow at both clinics. I didn’t get paid very much, and some weeks, I barely made gas money. I realized that I had to do a lot more on my own to bring in new patients, that I wouldn’t always be handed patients from my employer. So it finally hit me that if I’m going to spend precious energy on networking and marketing, then it should be solely for my own clinic. That’s when I decided to go solo full-time.  Those next few months were a little rocky but I’m still here! I’ve made my expenses since the first month with occasional paychecks home, I was able to take a small regular salary about 9 months in, and this past year I was able to give myself a raise. Zero regrets.

Thank you for sharing your experience and hang in there – it really does get easier over time. I am trying to raise awareness of the problem with this idea that renting space or otherwise working within someone else’s practice is a better way to start off. If you think about this scenario critically, you see the flaws especially for someone just starting-out. I wrote about this in my chapter “Making the Case for Private Practice” available in my “Free Chapters” selection on this site but I want to expand of it here.

When you first start out after licensing, you won’t likely have an established patient base to bring with you. You then either need the incredible luck to find a situation where an established practice (solo or group practice) is looking for a novice acupuncturist to send their patients to or you need to start from scratch and build your own patient base from within someone else’s practice.  While you may be able to find some “Integrative “ centers open to the idea of adding an acupuncturist to the list of their available different practitioners, there is the issue of who gets to decide just which practitioner any given patient is sent to. You, as the newest member of this “team” and freshly licensed will be the low person on that totem pole. And while it is true in theory that adding acupuncture to chiropractic or massage therapy could benefit a patient, it is rarely cost effective to add mutable therapies to treat the same problem.

As for trying to build your patient base from within someone else’s practice, that will prove much more difficult than doing so from your own practice. Instead of promoting yourself and your practice, you will be trying to promote yourself as “the acupuncturists within so-and-so’s practice.” Remember, it usually takes a good 2-3 years to build a sustainable patient base and working within someone else’s practice not only make this more difficult, you become dependent on everything staying stable over those years within a practice you do not control.  

Life is full of trade-offs. The trade-off here is working within someone else’s practice gives you the advantage of not having to spend as much money or make as big a commitment as when you open your own practice. There is also the chance and hope that the established practice you work within will send some patients your way. The downside to this is that you are now subject to so many factors you cannot control and you will still need to work at promoting yourself and building a patient base but will now be trying to do this at a tremendous disadvantage compared to doing so in your own practice. My work is about trying to raise awareness about this trade-off and giving a lot of information on how to make the solo private practice route have the best chance of success.

Matthew Bauer

Matthew, thank you for your work.  I recently taught Practice Management at my local Acupuncture college, and Making Acupuncture Pay was required reading for my students.  At the end of the class, they produced a set of decent business plans though many grossly overestimated the number of patients they would see in the first year.  Next year I hope to do a better job (with your help) with the idea of graduating at least some successful acupuncturists.. I feel that if I can help the students become successful, we will all benefit.

AER

Thank you for you post here and for the work you do! Let me know how I can help in any way.  Other than teach 2 classes at two different schools 26 years ago, I have not worked with current schools and don’t pretend to know the dynamics of how things go within and between our schools. One thing I would love to see happen though is for those who teach practice management in our AOM schools to have a forum to communicate with each other. EVERYONE will benefit from our graduates going on to earn a reasonable living – especially the public. Every failed practice is a lost opportunity that individual had to help thousands of people with a safe, natural therapy. I wish school administrators and our professional associations would recognize this and make graduate success more of a priority.

Please let your students know I want to offer as much support as I can once they take the plunge and make a go of it. At this stage of my career, I feel I can best contribute and give back in this fashion and thanks so much for making my book part of your classes.  

Matthew Bauer

Thanks everyone for so much great insight.  I am graduating soon and plan to open a private practice.  One disparity that is confusing me is that it seems like some people are able to be relatively successful soon after starting a practice, and yet M. Bauer is saying it takes 2-3 yrs to build a practice.   Can I plan on making any money in the first few years or should I assume no net profit?  I am financially planning now and trying to be realistic about my earning potential right out of school….

Great question and welcome to the Forum! I have the habit of being very conservative in the way I state things. It is surely possible to start making money in less than 2-3 years but I still believe it takes 2-3 years to build a firm foundation of a sustainable practice. In my Making Acupuncture Pay book, I have a section on “Getting off to a fast start” where I offer advice on how to hit the ground running. Some of those who have busy practices within a few months usually have some element of luck or some kind of unusually fortunate circumstance that allowed that to happen. The main message I am trying to get out is that people should not count on it being easy or happening fast but plan and be ready for a gradual building-up of a patient base.

I hope others will offer their experiences but if you keep your overhead down, you can be in the black within a few months even if you don’t get lucky. 

 
Matthew Bauer

I was licensed one week after I had my daughter, then opened up my clinic 2 months later.  It’s been an interesting journey, but you can definitely have kids and keep up with a successful practice.  My daughter is almost 2, so I’ve only been in practice for about 18 months.  There are definitely times when I feel like all I do is work to pay for daycare & student loans, but I am thankful for the opportunity to work for myself and am able to spend as much time as needed with my family.  It’s stressful at times, but it’s so rewarding, so don’t feel discouraged about having kids while working on your practice.  

Thanks for sharing your experiences and offering encouragement. For your circumstances, I would just remind you that if you structure things right in your practice, things actually get easier in years 3-4 even as you get busier. You should then start to make much more than covering daycare and student loans.  

Matthew Bauer

Thank YOU for your advice and encouragement, Matt.  Your book has been such a great tool for me and while my practice is successful and steady, your book has given me so much encouragement on how to continue growing.  Several acupuncturists who have been in the business for 25+ years have told me that they wish your book had been available when they were starting out.