Classism and Marketing Conversation (Part Two): the Ravings of a Self-Righteous Hippie, or Cautionary Tales about Doing Good

So for anyone who hasn't been following the conversation over at Burton Kent's blog (http://www.acupunctureclinicmarketing.com/sanborn-maxim/#comments), it's gotten, um, "animated". Which I think is a good thing.

There is potentially a lot to say about all of it, but I want to use this post to focus on responding to a specific set of comments, and to reflect back on some of the issues that started this conversation in the first place.

First, to Jared: I'm sincerely glad you figured out what works for you in your practice. I think it's great that you love your patients and that you listened to them. The more people who get acupuncture, in whatever setting they get it, the better. And thank you for saying that you tried the community acupuncture model and it didn't work for you. People need to hear that.

Second, to Burton: the exchange I had with Jared is a perfect example of why we need to have this conversation. Jared wrote that he read my book and he likes the idea of community acupuncture. Just like you, just like lots of people. And yet I bit his head off, in public, and I've done my best to pick a fight with you, also in public. I just want to clarify why.

Nobody in CAN wants to encourage acupuncturists to adopt the community acupuncture model when there's no way in hell it's going to work for them. There's no way in hell it's going to work for them if they are adopting it for idealistic reasons, if they are trying to do good. There's no room in community acupuncture for idealism. Community acupuncture only works when it's about reality. Reality means that acupuncturists who want to practice community acupuncture, if they want to make a living at it, have got to deal with their issues about class. The comments on your blog should be required reading for anybody contemplating a community acupuncture practice.

And about those comments...

I'm not trying to be Gandhi. Suggesting that I am is a great example of the classist dynamic that will undermine a well-meaning acupuncturist's community practice. And I have to add, Jared, that I've gotten the Gandhi treatment before (or, alternately, the Mother Theresa treatment) from a lot of acupuncturists, and I'd much rather get it in the context of a full frontal attack like yours than as an actual compliment. Either way, though, the implication is the same: that if I want to serve working class people, I must be some kind of wanna-be saint, because who else would get down in the gutter like that? Only a really extraordinary person would willingly devote herself to all those losers, who as we know are lazy, dirty, ignorant, and gleefully spending their healthcare dollars on cable TV.

And although I love the phrase "the ravings of a self-righteous hippie", and I can't wait to add it as a tagline to my new book, I'm going to quibble with the "self-righteous" part. Is it really self righteous to get mad when somebody insults you? Irritable, yes; bitchy, probably; unsaintly, definitely; but "self-righteous" implies a kind of abstract moralism that I have to tell you, I don't feel. My clinic's success depends on me not feeling that. What I do feel is a very concrete, very personal kind of rage. Is it being "holier than thou" when your true desire is not to be holy but to give the "thou" a hard slap upside the head? I bet Gandhi didn't talk like that.

Acupuncturists, and acupuncture business coaches, keep saying insulting classist things about people I really care about. I care about them not in some abstract, humanitarian way, but in the concrete, personal way you care about your friends, neighbors, and family. I don't have a problem with an acupuncturist deciding he only wants to serve upper middle class people. That's his choice, his business, none of mine. Sweeping generalizations about acupuncture, fees, and patients -- my patients! -- are my business, however. For instance:

"When I meet (an) acupuncturist that is charging far too low a rate it has nothing to do with trying to help people out but everything to do with a lack of confidence in ones self and (one's) clinical skills. I choose to serve my community by volunteering every week not by devaluing (my) professional service".

"The value and importance we place on something is heavily influenced by price. By underpricing your services, you make your patients undervalue your services. They'll comply less, complain more, and actually be worse patients because of the price you set. Don't cheapen yourself, your skills, or your profession."

"...it is well known that your personal income will be the same as that of your average patient. If your patients all make $25,000 to $40,000 a year, that's what your income will be as well...It may be wise to pick a town or area in which the median annual income is $75,000 to $100,000 a year... it is a proven fact that people who are not charged at all, or who are charged very low fees, rarely get well as quickly and completely as people who are charged more."

Everybody get the message? Don't treat people who can't afford market rates, because they won't get better anyway! And they'll be disrespectful jerks! And if you are even thinking about cheapening yourself by taking care of people who make $25-$40K a year, it's because you have no clinical confidence and no self-esteem! Because people who can't afford market rates aren't really worth anything anyway...

If that message doesn't make you mad, please don't even think about practicing community acupuncture. (Or using a sliding scale for any other purpose.) You can't have it both ways. You can't admire me, like my book, like the concept of community acupuncture, and simultaneously buy into the idea that you can "devalue" your professional services by charging "too little". Well, you can, but the cognitive dissonance is gonna get you (and your business) in the end. The impulse to have it both ways is an idealistic impulse, I think, and I'm not an idealist. I'm driven by my commitment to specific, actual people who need a specific, actual service. If you insult them, I will do my best to be a specific, actual bitch to you, because it's part of how I stay sane in the midst of people simultaneously telling me how much they admire me and how little self-esteem I must have to do what I do. You can't say I didn't warn you.