“Money is in some respects life’s fire: it is a very excellent servant, but a terrible master.”
-PT Barnum
One of the most common issues we hear about from practitioners is not how to set their fees, but how to learn to feel comfortable with them. It’s one thing to say, “That’ll be X dollars, please,” but it’s another thing entirely to feel good about it.
Over the past few years we’ve made many pricing-related decisions, but the most important part has always been finding a way to embrace those decisions – to own the fees we set, regardless of whether they were high, low or somewhere in between.
Here are seven ways that you and your fees can start to comfortably co-habitate:
1. Remember How You Got Here
It’s been a long road.
In fact, I bet that even if you just opened your doors yesterday, it’s still been a long journey to get to the moment you put that “open” sign in your office window.
You’ve got a lot invested in getting to where you are now. Not just money, but time, risk, worry and a barrel full of other emotional twists that have likely ranged from thrilling to downright terrifying.
Does that mean you should set your prices high? No. But it does mean this: you have the right to set those prices wherever you choose. So do it. Wisely choose the best price for your service in your market, and know that you earned the right to do it.
2. Differentiate Between What You’re Worth, and What Your Services are Worth
Health care practitioners face a greater challenge in separating personal and service worth than many other professions. Because relationships can be so intimate in practice, it’s easy to confuse your own value as a human being with the value of what you do in the office each day.
Remember this: Charging less doesn’t make you a lesser person, and charging more doesn’t make you any better either.
You can set the fees for your services, but your clients will decide their worth. And they will decide, believe me. You can add as much value as you can, but in the end, they get to decide.
When it comes to your worth, however, it’s a different story, and it’s not about fees. Your clients and your pricing don’t get to dictate your worth. You do.
3. Distinguish Between Client Quality and Human Quality
To run a successful business, you need to be able to define people in terms of their customer attributes, without feeling like you’re commenting on their value as human beings.
If you are defining people that way, you should stop. But if you’re simply trying to decide how to run a viable clinic by setting prices that fit your chosen market and keep you in business, you’re doing fine, and you’re going to be fine.
If your business needs to have paying customers to survive, than someone who can’t pay is indeed a lousy customer. It doesn’t, however, make them a lousy person – don’t confuse the two, and don’t feel bad for trying to identify customers that fit your vision, and fees that match them.
4. Don’t Try To Include Everyone
You can set your fees at any level, and you still won’t reach everyone – every clinic excludes someone. Cheaper may mean more widely accessible, but it doesn’t mean accessible to everyone. To use acupuncture as an example, boutique/more expensive acupuncture excludes the less wealthy. Community acupuncture excludes the profoundly poor who can’t reach the bottom of the sliding scale. Free acupuncture excludes the bed-ridden and agoraphobic who can’t leave their homes. And yet, there’s nothing wrong with any of those pricing models.
You’ll always be excluding someone, somehow. Try to focus on the fact that you’re including a whole bunch of others. Building a successful practice is about narrowing the world down to a chunk you can effectively define, attract, and serve. Don’t let your attempts to run a good business make you feel like a bad person.
5. Remember to be Profitable
In the end, if your practice costs more than it makes for long enough, you’ll no longer be in practice. If your fees can’t cover your expenses in a reasonably busy clinic, then you’ll need to adjust one side of the equation somehow. Will increasing your fees make a difference, or will it drive people away? Would reducing them bring in significantly more patients? Can you cut costs? Should you be spending more in an effort to better attract and serve your market?
Remember that you need to make money so you can keep helping, and that your fees are an important part of that.
6. Understand That it Takes All Kinds
The CAM professions need different pricing models. The opportunity facing your practice is not how to scoop the patients from the “wellness” center next door and bring them to your “holistic” center, it’s how to get the huge chunk of the population that’s never even tried alternative care to consider you. Different fee structures – sliding scales, volume discounts, memberships, family pricing and dozens of other arrangements – are one way to make that possible. There’s more than one way, so don’t feel bad if you’re doing it differently. We need that.
7. Don’t Forget How Remarkable You Are
You made a choice to follow this path. You trained for it. You took a risk and opened your doors, or entered someone else’s. You invested in your practice. You’re pouring your heart and soul into running your show.
And you did all this to help people get better.
That’s remarkable. So don’t forget it. You can discount your fees. You can have a sliding scale. You can do pro bono work. You can do anything you want with your fees, as long as you’re not doing it because you feel unworthy.
Whatever prices you set, set them with confidence, and shout them from the rooftops, baby, because you’ve earned the right to do it.
A shout out to Lisa Rohleder at the Community Acupuncture Network, Burton Kent of Acupuncture Clinic Marketing, and all their readers. for their lively discussions on fees, classism and other money-related issues. It’s important stuff.
Dan, thanks for putting some more attention on this topic.
The one thing you didn’t add, which I’m not sure where I would put in your list, is that I have noticed that it’s very hard for practitioners to truly make peace with their fees when they cannot afford their own services, and when no one they have relationships with (family, friends, neighbors, etc.) can afford them either. There’s something about pricing yourself out of your natural community which is very problematic in the long run, both for marketing and networking, and for job satisfaction. I’ve met a lot of very unhappy acupuncturists who don’t know anyone who can afford to pay them what they are asking, and that undercuts their success in every possible way. It’s a stressful situation to be in, and I only know two solutions: make a conscious decision to change your social circle, which is a huge amount of work, or lower your fees to the point that people you already know will be happy to help promote your business for you.
Great point, Lisa. I think you nailed the dilemma that’s at the root of all this. I should have called you before I wrote this one… 🙂
I’ve often heard it said that “your income is likely to be the average of the five people you spend the most time with.” It’s a statement that used to drive me crazy because it felt like this predetermined outcome that I could only change by leaving my social circle, which I wasn’t about to consider.
You’re absolutely right about the challenges of pricing yourself out of your natural community. It IS hard. But I think there are two kinds of hard in there. The first is the difficulty you face when you price yourself for a market that doesn’t exist, is too small, or is saturated. That’s BUSINESS hard.
The second is when you set your fees outside of your personal comfort zone (which is likely determined by your natural community). That’s MENTAL hard.
I like to believe that practitioners who want to run businesses in markets outside of their natural community (love that term, BTW) can learn to deal with that second kind of hard – it just takes some mental ju-jitsu to get there. In other words, you may have a natural predisposition for a certain market, but you really can succeed in any viable market.
It may be hard to move outside of what you know, but I have to believe it’s possible for those who want to.
Thanks Lisa!
Dan, I think this conversation is going someplace really interesting, so I hope you don’t mind me linking to the CAN blog.
Here’s my question for you: can you describe that “mental ju-jitsu” in more detail? The reason I’m asking — this is another issue that came up repeatedly in the class I taught at OCOM ( one of the two acupuncture colleges in Portland). Lots of students said in the course of the class that what they hoped to do when they graduated was to have two different practices to serve two different markets: a community clinic where they could see their friends and neighbors, and a conventional clinic where they could use all the techniques they were taught in school, to help the only people who could afford those kinds of services — upper middle class and upper class people. I found myself saying to them over and over that this wasn’t realistic.
My experience of practicing acupuncture is that it is infinitely more demanding than I expected it to be when I was in school — demanding in a good way, not in a bad way, but demanding all the same. It requires all of my internal resources; it has changed many other seemingly unrelated aspects of my life. To be consistently effective, happy, and energized in my work with patients, I find that I need a very high level of integrity in my life. I need to meditate regularly, I need to get enough sleep, I can’t have any drama in my personal life, I can’t be distracted or divided or ambivalent. I can’t be different people at different times. I’m very grateful that my work forces me to have a stable, peaceful, focused existence; it’s a great benefit. However. Every acupuncturist I know who is in practice long term says basically the same thing — that doing acupuncture, no matter how good your boundaries are, takes more out of you than you think it will. People who maintain two practice locations or two different business models rarely keep that up long term, because it’s just too tiring. Eventually they have to choose, one or the other, not both.
It’s been my experience that the success of my practice has largely depended on my personal integrity. First, people like integrity; it’s magnetic, and it attracts patients like crazy. Second, integrity is EASY. It’s comfortable. It’s simple, it’s uncomplicated, and it saves a lot of energy — energy which is freed up for my practice. I’m all for challenging my comfort zone, and I would say nothing in my life has ever expanded that comfort zone the way running a business has, and I’m unendingly grateful for that. But I think there is a blurry place where stretching your comfort zone, moving outside of what you know, is potentially the place where you lose your connection to who you really are. If you lose that, you have nothing real to give to anyone else.
So this is why I am interested in your “mental ju-jitsu”. I’m pretty sure I could be successful as an acupuncturist in any viable market. The problem is, though, that I can’t imagine having the energy to do it long term anywhere except within my natural community. Being successful as an acupuncturist represents an enormous commitment and a huge outlay of energy, no matter where you do it. I’m trying to imagine that commitment and that outlay added to the energy it would take to break away — and stay away — from your natural community. And I can’t see it. There’s enormous comfort and nourishment for me in serving the community I live in, the people I know, and I can’t imagine going to work day in, day out, for years, without that nourishment.
So can you explain how you could do that mental ju-jitsu without compromising your integrity and cutting yourself off from what sustains you?
Obviously he won’t respond to something that’s already set up to be a no win question. He’s too smart and successful to fall for that one.
If you are not going to move and grow or find ways to push yourself you will fail in business of any kind, period.
The marketplace does not care if you are tired, demanded upon, or anything else. In fact it is dependant upon you dropping out if you truly do not want to make this happen. It’s that simple in the end.
Mental martial arts is overcoming your comfort zone AND retaining who you are and growing. That’s why it’s couched in the form of martial arts. It’s strength, yes, it’s hard. Sorry.