I have renamed my blog to what was always my dream title, and is also the fantasy post-graduate lecture series for other acupuncturists.
F
rom the trenches? Is this a war, you may ask?
Yes I think it is.
A war of hearts and minds being wrested away from the dependency fostered by an unscrupulous and for-profit medical system.
A war away from the misinformation generated by direct marketing to consumers from the drug industry, creating a generation of patients who think that everything can be cured instantly by one little pill without any effort on their part to change things.
A war of beleaguered and often impoverished practitioners who dearly love their clients, but are drowning under the weight of oppressive student loans and the energetic demands of trying to support their clients while averaging $40 for an office visit.
A war against for-profit acupuncture schools who think nothing of raising their tuition to the maximum allowed under federal law every time the federal government raises the lending limits available to students, but refuse to teach them how to successfully run their businesses.
A war against our own resistance to running professional practices including insurance and workers compensation because no one has stepped forward to show you how it can be done.
From The Trenches has been simmering on the back burner for years, and is nearly ready for being launched in a bigger way. Stay tuned!
I had a conversation with a neighbor last night that left me so angry I couldn’t sleep and got me thinking about the nature of compassion in the health profession. My neighbor said that practitioner A was more compassionate that practitioner B because they charged less money. Unfortunately for my neighbor, I went bananas (apologized later) but it really hit a sore spot with me.
I found myself on the soapbox about the difficulties of practice, and defending my colleagues even though his comments really had nothing to do with me, and they didn't need defending. And since we are never angry for the reasons we think we are, it got me thinking about WHY I reacted so strongly to his assertion that a doctor’s compassion could be measure by the difference in charging $15 and $30 dollars.
Why IS compassion in our society is measured by how much someone charges? And why is it the expectation that the serving professions such as doctors, nurses, clergy and teachers, to name a few, are expected to do this at the cost of their own financial well-being? As if wanting to serve and help others also implies that we must do this at our own expense? Where did service and poverty become linked?
As a long term clinician who has gone through multiple levels of transformation regarding my practice and those I serve, this is something I have given a good deal of attention to. Being in private practice is hard and expensive, and in my experience those who are able to stick it out for more than the first 5 years seem to be able to continue by beginning to put limits on how much they give away, or perhaps to recognize their own depth and knowledge. In the beginning, I wanted to be one stop shopping – a place where patients could get a lot of what they needed or at least be directed to other practitioners who could serve them as needed. And in order to further develop that expertise, most of us continue with post-graduate work, advanced degrees, and trips abroad to study with learned scholars, all of it unpaid or without compensation. After a decade or so, many of us have a depth of training that far exceeds anything we learned in school, in whatever modality – MD, chiropractic, massage, energy healer, therapist.
After about 15,000 patients visits, I realized that the need, the suffering was unending –the well was deep; it will never be done, no matter how much of myself or my personal life I sacrifice, so I better find a way to create a vision for my practice that was more sustaining, that does not burn me out, and that allows my inner child to have the freedom to do other things besides practice medicine (such as go to Italy or study opera).
Master Usui of the Reiki path in Japan found this out painfully after several years of trying to give away his energy work for free. He found that unless there was an energetic exchange on some level between the patient and the practitioner, many of his clients did not get better. And although it was a difficult change for him, he began to charge for his services. The question of how much to charge and what to include for that charge is a personal one, and a doctor’s compassion cannot be measured by that alone. But I think it is impossible to work at a deficit forever – you cannot constantly give and give without having being replenished in some way, or you will burn out. I find it heartbreaking that so many of my colleagues are leaving the practice of medicine forever in search of greener pastures. This is a tremendous loss – it means we have younger, less trained clinicians available to serve both patients or as mentors to younger practitioners.
While I feel guilty that my neighbor got the full force of my feelings on the subject, he also did not realize how truly expensive it is to practice medicine, or the amount of sacrifice involved. I don't think compassion can be measured by something so trivial as what we charge for our work, especially in light of an HMO culture that has become accustomed to a $10 co-pay. Do you realize the fee schedules for ancillary services such as chiro and acupuncture have not gone up at ALL in the last 22 years and in fact have been reduced in most cases. Many of us stagger under the weight of 6-figure student loans. Mental health and massage are now not even covered benefits for many insurance holders.
In some ways, charging what you are worth is perhaps more a measure of learning to have compassion for yourself in addition to your patients.
