Riffing on the CAN survey

The Community Acupuncture Network recently released their 4th annual clinic survey. I highly recommend checking it out. They did an awesome job looking into CA clinics in great detail. Their effort compares very favorably to NCCAOM's survey released last year, critiqued here by the always eloquent Lisafer. The NCCAOM survey seems to have been taken off their website.

For some reason, I have a bachelor's degree in math, which has not made me a cent since graduation but does mean I get excited when I see big amounts of numbers. I couldn't resist doing a little digging around in CAN's data and came up with a few comments of my own. I put some of the CAN data into my own spreadsheet. To make things easier, I did away with CAN's ranges and used the middle value (so I input $15,000 instead of the $10,000-$19,999 CAN had). Since the averages I got are not much different than those CAN lists, this seems like an acceptable move.

Here are a few thoughts on CAN's clinic survey:

4th annual (young) clinic survey
The worst thing about the data is that it is heavily weighted toward newer clinics. Nearly 60% of respondents opened in 2009 or later, and 77% opened in 2008 or later. This should be expected since community acupuncture (CA) is a relatively new thing and is only now taking off. One would assume in coming years the number of mature clinics in the survey will increase. But for now it means most of the data in the survey applies to newer clinics, making it tough to make any solid long-term conclusions. Graphing clinics and years open, we get a big ski slope (click to see bigger version). Remember this shape, as the large number of young clinics will heavily influence all the data.

Treatments per week
If we graph clinics against treatments per week, we see a similar shape, although it is starting to show a bell curve. CAN concluded CA clinics treated an average of 66.5 patients per week. However, if you only include entries with 3 or more respondents, the number is 48 per week; if you only include entries with 5 or more respondents, it is 43 per week. If you eliminate the two biggest clinics, the number is 60 per week. By eliminating outliers, it seems like a more representative "average" CA clinic sees 45-55 patients a week.

Owner income
Ok, now we're getting down to the juicy stuff. How much did people make?? In my opinion, CAN's dual goals -- providing patients with affordable treatments and helping practitioners make stable incomes -- are fantastic. Very practical and crucial to the survival of our field. According to CAN, the average owner made about $16,000 in a year. Even if you only include entries with 9 or more respondents, the average is still $15,000, so CAN's figure seems pretty solid. But looking at the graph we see a major spike toward the end.

Income disparity or income immaturity?
The 46 bottom-earning owners, 37% of the total, made an average of $1,300 a year, or about $110 a month. The bottom 50% made an average of $3,500, or about $300 a month. On the other hand, the top 50% earners made an average of $30,300, or about $2,500 a month; while the top 8% of earners made an average of $48,000, or about $4,000 a month.

Looking at it this way, CA doesn't look very lucrative, or even sustainable. However, as CAN points out, the 62 owners earning less than 20K are heavily weighted toward clinics that opened in 2009-2010 (47 clinics), while the 20 owners making 35-70K are more weighted toward clinics that opened in 2008 or earlier (14 clinics). That leaves another 42 owners I assume are earning between 20-35K.

So is the picture bright or dim? Well, it seems that half the owners made more than $20,000. While this isn't quite a living wage, it's not awful. And the longer a clinic stays open, the more stable incomes get. Remember, more than half the clinics surveyed opened in 2009 or 2010, so seeing half of the owners report very low incomes isn't very unusual. Unfortunately, without more data on mature clinics, it's not possible to make any strong conclusions.

Tell me more
There are a few things I wish CAN would have included as part of their survey. Hopefully, they will do so next year.

The first thing I wondered about was comparisons to last year's survey. How did the clinics that answered both this year and last change? More or fewer patients? Income growth? Did they hire any acupuncturists?

Also, I was very curious if any of the clinics surveyed last year have gone out of business. Does the data give any clues as to why CA clinics fail, or what percentage fail in what time frame?

Finally, I wondered about concentration of CA clinics. This might be tough to tell from the small data set, but was there any relationship between success and number of other CA clinics in the area (on a per capita basis)? Maybe newer clinics trying to get going in more saturated areas (Portland, Seattle) are having a tougher time than those that open in isolated areas. Or maybe starting a business in a place that is already familiar with CA is easier than being the first.

All in all, a great survey with heaps of good information. Thanks to CAN for being an example of transparency and for its dedication to figuring out how acupuncturists can both treat patients and put food on the table!