You’ll find this throughout the CAM/holistic professional community, particularly early in practice: the massage therapist trades a session for an adjustment from the chiropractor. The acupuncturist swaps time with the naturopath, who in turn trades a visit with a web designer. The homeopath exchanges treatments with the landscaping guy who cuts the grass in front of her office.

At first blush there’s nothing inherently wrong with this beyond the obvious tax-dodging implications. And for the practitioners just starting out who are time-rich and cash-poor, it allows them to get their hands on things they need.

The reality is that it’s not as sweet as it looks, particularly if you continue the swapping when your practice reaches a decent size. Let’s take a closer look at some of the drawbacks to exchanging services:

It’s Not Fair
We already have an exchange system in place. It’s called cash. It allows everyone to value their products or services using the same standard. It provides enormous flexibility to describe the value of what you offer down to the cent, with no ceiling. Exchanging services, however, tends to become one-offs: one treatment for one treatment. One haircut for one adjustment. One brochure layout for one massage. As a result, one of services in question is usually being undervalued, and over time, that person gets the short end of the stick. Unless you’re trading an adjustment for an adjustment, someone’s likely getting screwed.

The problem is that you’re a health care professional, and it may just be you getting shorted. You’ve likely got a lot invested in your education and practice, and your time may just be worth more, on average, than many other people. If you’re swapping your health care services for haircuts, you may be selling yourself short. There’s nothing wrong with haircuts, it’s just that you’re trading apples for oranges and it’s hard to strike a balance.

It Makes You “Buy” What You Don’t Need
If you’re starting out and have an abundance of time on your hands, this seems like a great way to get what you need. The truth is, you also ending up buying either a)things you don’t really need; b)more quantity of something than you need; or c)things you need, but from vendors you wouldn’t choose if you were using cash from your pocket.

It Sets a Precedent
It can be difficult to get off the trade train. As you grow, you may find yourself wishing you were billing for that service, and spending the cash on what you need, as opposed to trading.

It Affects Referrals and Outcomes
I can’t back this one up with data – although if anyone can, please let us know – but my suspicion is that the people you exchange with don’t refer as well as people who pay out of pocket. And, as I’ve mentioned before, it’s possible people who don’t pay don’t have the same success from a health perspective.

The bottom line? Trade if you want, trade if you must. But as your practice grows, be conscious of what your time is worth, and whether the trade is a sensible choice.

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Pro-Bono Work and Discounts: What’s CAM Practitioner To Do?

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2 Responses to “Exchanging Services: The Practice Downside”

  1. Dan Fleishman, D.C, says:

    You bring up some very good points.I think it is a topic that is very close to many of us at one time or another.

  2. Dan says:

    I agree – it’s remarkably common. Thanks for stopping by, Dan!

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