Do acupuncturists ever get acupuncture done on themselves? "Like most healthcare professionals, I’m terrible about getting my own treatment," David LeGar, a private practitioner in Phoenix, Ariz., told ValuePenguin. "They always say doctors are the worst patients — I’m not a doctor, I only have a master’s — but I really should be better about following my own advice." LeGar, whose wife is also trained in the traditional albeit *alternative* Chinese medicine, put up with our other unknowing questions about his career and his path toward it. After all, the Bureau of Labor Statistics has yet to classify the profession even though three million Americans receive the treatment each year.
Why acupuncture in the first place?
It didn’t start out that way. Originally, I wanted to be a chemist, and I wanted to help people. I wanted to be a scientist, win the Nobel Peace Prize, make cold fusion, that kind of thing. Throughout life, it changes, your path changes. In my early 20s, I started wanting to learn more about the concept of chi or qi, the Asian mysticism, like acupuncture, and I started a tai chi and yoga class. I started as a student there. And I went from a student, to a student-teacher, to a teacher. It was a Korean-run program. Acupuncture comes from China, but Japan and Korea and most of east Asia have had a long history with acupuncture and oriental medicine anyway. I had learned some of those theories and felt chi was the basis of oriental medicine through this practice. My wife -- we met from working at the same job at the tai chi and yoga center together -- said, "We’ve had experience with this chi, but we don’t know how it works, or why it works. We don’t know the science behind it. How about we go to acupuncture school?"
At the time, the company I worked for had us assigned to the Sedona center, and we were working there. The closest school was in Phoenix. The two-and-a-half hour drive was a little bit daunting; I don’t think I could have made it. A few months later, they moved us to the Mesa center, and suddenly a two-and-a-half-hour drive became a 20-minute drive. This was in 2005. By May of 2005, I was enrolled in classes at the Phoenix Institute of Herbal Medicine and Acupuncture. Five years later -- after 3,000 hours and a thesis -- I got my master’s of science in oriental medicine. Three of the four national exams later — because you only needed three to get licensed in this state — I was able to get my acupuncture license. I’m still going to get that last test to be nationally certified, but I wanted to start practicing.
What was being an acupuncture student like?
I had been familiar, a little bit, with the theories of oriental medicine and acupuncture, so I was excited to be involved. PIHMA is a unique school in that it was designed for working adults. A lot of acupuncture schools you have to go to during the day, and PIHMA set it up for us weekends and nights. It was kind of daunting. I had to work full-time and go to school full-time. I was going, taking four classes a semester: fall, spring and summer. For five years, there was only a two-week break between Christmas and New Year’s where I didn’t have class. Because the moment you took finals, the very next day the next semester began.
Because the school specialized, they’d say, “Here’s what you need to do. Take these classes and you’re done.” The pathway is pretty well set out for you. You just start taking classes as they appear. The first semester’s all about location, and theory one, and just getting introduced to it and running the basics. I didn’t over-do it: I kept it to four classes a semester, because I was trying not to burn out.
What was the greatest challenge of the education itself?
The thesis. Not every master’s actually has to do that, and we did have to. Thankfully it didn’t have to be an original thesis. The thesis was in addition to all other classes. We would have to sit down and spend a lot of extra time writing a paper, citing sources. It’s a research paper, and for some people, it’s very easy; for some people, it’s difficult. Mine was on gout, and how oriental medicine and western medicine treated gout.
What was top of mind as you neared receiving your degree?
Unfortunately -- and I’ll be honest -- we only really had one semester of practice management, of actually being a business owner. So a lot of people, when we’re getting ready to graduate, were excited, all ready to use our degree, but were unprepared. The practice of acupuncture -- and the medicine itself -- that’s a lifelong practice. That’s why they always call medicine work "practice"; you’re never mastering it. You’re always going to learn more every year, and it’s good to find a mentor for things like that to be clinically better. But we’re good enough to get out into the world, not hurt anybody, and get good results. As you learn more and more, you get better at craft.
But preparing to open my own business, and have my own practice, that was daunting. I didn’t have an MBA; I had a master’s in oriental medicine. I didn’t know about best practices to have an accounting system, or how to advertise and market appropriately, or even how to deal with insurance companies at the time. I’d taken some extra training courses on that, but I would say that was the biggest deficiency as far as our education. There was very limited opportunity to work for somebody else, so you pretty much had to go through the create-your-own-clinic route. There was a lot of risk in that, like “How do I do this?” without really knowing how. We made some mistakes, but I’m still here, still chugging away.
Running your own business, what is a day in your work life like?
I set my own schedule, and I have help with that, with electronic scheduling. I may run errands in the morning, or I may come straight here, depending on whether a patient is booked in the earliest hour or not. If there is one, I’ll be here, startup the computer, get the file ready. The patient comes in. I only have one room, so I see one patient at a time. As I grow, I will have multiple rooms and see more people, and then I will also expand to have a front desk person to help patients check in and out. But right now it’s still one.
I come into the room, I grab the file, I talk to the patient. If it’s a repeat patient, someone who’s seen me before, I ask simple questions about their chief complaints. In my clinic, I specialize in pain management, which is what acupuncture is best known for. I love to help people in pain. Lower back pain -- that’s probably the most common thing that comes to my clinic. I love working on headaches and migraines — that’s my favorite thing — but let’s say low back pain. I'll ask the patient, "How is your low back pain? Is it better, is it worse? Has it changed since last time we had a treatment?" I do a tongue diagnosis and a pulse diagnosis; those are very important. They’re part of oriental medicine to know the diagnosis with the person themself.
Then I get them on the table, put the needles in, give them the treatment. They rest between 20 and 30 minutes; the needles are retained between 20 and 30 minutes. Then I come back in, I remove the needles. If necessary I will give the patient electrical stimulation. We use what’s known as an e-stim device, or electrical stimulation device, that is similar to a TENS unit, only instead of using suction cups, and you put them directly on the skin, I use the needles themselves as a grounding point. I use alligator clips, so I can go from one point to another and create a line of where I want the electrical stimulation to flow. I also may use an infrared lamp as a way of helping.
At the end of a treatment, I may show a patient exercises, if they're appropriate and necessary for their condition. Obviously for headaches, there’s no exercise to make a headache go away, but there are for low back pain. There are some great exercises for things like that. I may also use other parts of my practice, like cupping or gua sha, if necessary. After the needling, we settle up; if they have insurance, if they have co-pays. We make another appointment, if necessary. Usually, a repeat patient's appointment takes about an hour.
And if you're seeing a new patient?
It’s usually a two-hour treatment, because we talk for the first hour. That’s what also gives me an idea of the diagnosis. I converse with the patient,, and I get a lot of info about their life. I ask them about their eating habits, their bowel movements, menstrual cycle if the patient is a female, sleeping habits. If they tend to sweat easily, if they get hot or cold; whether they have headaches, or how their eyes are, ears are. It’s a very thorough diagnosis on all these different parts; energy level, their emotional state. Because all those things put together, plus understanding the tongue and pulse diagnosis, tell me what’s the problem with the patient.
If the patient has lower back pain, it may be because of a trauma: “Hey, I was playing football with no pads, and I hurt myself.” Or: “I just bend over a lot, that’s part of my job, and I injured it over many years of that damage.” But it may be, “I just have back pain. I don’t know what happened. It just started coming on.” Let’s look to the root of the problem. And that’s what that initial interview does for me. It lets me find out what the root of the problem is. We can treat the branch, we can treat the symptom, and get the place to feel better, because they don’t want back pain. But we also don’t want the pain to just come back the moment the treatment is over. It’s the root of the problem, so the pain doesn’t come back, your body heals itself, and you can move on without any issues. And that’s what that first hour is for the new patient.
The second hour is same as it is for repeat patients: They get on the table, I put the needles in, do any extra treatments and then get them moving on their way.
Aside from treatment, what else could be on your plate during the day?
Of course I wear many hats. I’m my own CFO, I’m my own CIO. So I have to do accounting work. I use QuickBooks, but I make sure all my invoices are put in: what’s paid, what’s open, things like that. And I usually use double or triple redundancy to make sure I don’t miss anything. I call insurances. I do take insurance, and all major insurances at least have some acupuncture coverage; not all plans do: Blue Cross Blue Shield, United Healthcare, Aetna, and Cigna. Those are the big four, I would say, and they all cover acupuncture in some way. It’s just that not every plan has coverage. And then, if I have new patients who are calling in and wondering about it, I would make calls to the individual insurance to find out, if necessary. Some insurances will have me access a website, which is always nice. But I have to call and either get a yes or a no, and then find out the details if it’s a yes. What are the limits? Things like that. I have to then bill the insurance company. We have some programs to help with that.
While the patient is resting on the table for 20 to 30 minutes, I check on them every so often to make sure they’re OK, and they’re feeling good. During that time, I make my chart notes: where I put the needles, the depth, the angle, why I did it, the timeline for insurance purposes. Make notes of everything that I’m going to be doing. I usually also bill insurance during that little time break so that I can keep on top of things and keep it moving.
That would be a lot of my day. If I have extra time, I try to market myself. Find places on the internet where I can put up a profile for free, like a yellow pages or Healthgrades or something like that. I try to use my social network systems to put out an article about acupuncture to inform more people. “Hey, there’s a new article on exercises that are good for you.” Or, “There’s recently a study that says neck and shoulder pain, acupuncture really helps with that.” Let people know about it, so I can not only raise awareness for the general public, but also raise awareness for my clinic.
How do you find new patients?
As of late, the bulk of my patients probably come from internet service. I have search optimization person. If you are in my zip code, so to speak, or nearby, and you type in “acupuncture,” I pop up. It’s how Google runs things now.
I also get a lot of patients through being in-network. In the state of Arizona, only UnitedHealthcare, Aetna and Health Net will really put me in network. Cigna and Blue Cross Blue Shield Arizona will not hire any acupuncturists in that work, it’s their policy. So I have no access to them. But the others, they will go online, maybe people will go, “I want to try acupuncture,” and they’ll go to United Health Care’s website and type it in, and I pop up.
Are new patients generally reticent or open-minded about acupuncture?
Some people, they’re always scared of the needles themselves, is usually what they say. The needles don’t hurt, but they’re always just worried about them. Now, I have had a couple people who have been sent by their — generally, it’s a guy sent by his girlfriend or wife — and he doesn’t really want to come in, but they are insisting... In Arizona, people do not need a referral from an MP to see an acupuncturist, so they usually don’t have one, they just come in. Probably a good marketing strategy for me is to build up a better relationship with the MPs in the area.
Beyond the needle, what are some other misconceptions about acupuncture that need to be dispelled?
Obviously, the needles don’t hurt. I have a bit of a sense of humor about it. Some of it is the way acupuncture is displayed comically sometimes, and I laugh. But there’s not as many needles as most people think. It’s not like you look like a pincushion and every inch of you is covered. Kung-Fu Panda did that: His entire back is covered with acupuncture. Or there’s a commercial about it, an insurance agent, where the guy goes in and literally every inch of him is just covered with needles as he’s sitting in the chair. It’s really not that many. In fact, we generally strive to utilize the concept of less is more.
I’d also like people to know that there’s a lot of research behind it, especially over the last few years; it’s an exciting time. Back in the day, 2,000 years ago or so, acupuncture was the only medicine in East Asia, so they had to treat everything. And it came up with protocols for everything. But not everything was as effective as it needed to be, because they had to work with what they had. There are a lot of studies that have shown that it’s beneficial; the World Health Organization recognizes a lot of different diseases that acupuncture successfully treats. They’re a large organization — they’re the biggest health organization in the world — and they have a lot of faith in acupuncture.
Have you had a skeptical patient become a believer after their treatment?
One woman had had migraines one week before her menses for about 27 years straight. Since that moment, she’d had a horrible migraine for about three days to one week before her period. I say that because it’s a lot time. She comes in to the clinic -– actually, this is when I was still a student -- and she had a migraine that day. We just put in, I want to say, six needles. And while the needles were in, she didn’t have any migraines at all. So that was her moment of, “Hey, there’s something to this.” She came back for the next four weeks, so five treatments total. And on the fifth treatment, when she should have had the migraine again, she didn’t have a migraine. We broke a 27-year cycle.
That’s a very common case for a lot of migraines. I’ve had a lot of people come in with migraines — had them for months, weeks, always had them — and just in a few sessions, usually five or less, they’re gone. And there’s no more migraines, no more chronic tension headaches. They’re either reduced to almost nothing or they’re gone. And those are some of my favorites, because those are great success stories.
What separates a great acupuncturist from an average one? Anything innate?
Certain things are just technique, like learning to put the needle in. It may sound simple, but over time you do get better at it, and the only way you can do that is by practicing over and over again. Some of it is being exposed to the same conditions over and over again. You get used to the subtle differences of the diagnoses, and really that just takes experience.
But really what separates a great acupuncturist from somebody who just kind of phones it in is the desire to get better and learn. Really, I could teach people just protocols: “Use these five points for shoulder pain. Use these ten points for back pain.” And a lot of practitioners who aren’t licensed acupuncturists, but are allowed to do it, that’s what they learn, that’s how they learn it. They only take a couple hundred hours of extra training, and they learn something clinical, and that’s how they do it. They don’t understand the why or the how it works. They just learn how to do these things and, let’s say, 80% of the time it’ll be effective. And if that’s as far as they want to take it out, that’s great; these people can have a positive, 80% of the time, can have a positive response to the medicine. But a great practitioner is always wanting to learn more.
And more importantly, they listen to their patients. It’s subtle, but the patient’s body, the way they talk, they’re telling you what they need, and you have to just pay attention to it.
What advice would you offer to someone considering a career as an acupuncturist?
Start learning more about practice management. You will come out of school knowing how to be a decent acupuncturist, and your clinical skills are going to grow with time. But the only way they grow is if your clinic continues to run and grow as well. I’ve often wanted to go back to school and teach practice management, to teach them how to utilize insurance, how to utilize marketing, how to be a business owner — because we’re woefully deficient, we’re woefully unprepared for that. A lot of acupuncturists don’t work full-time in their field. They have to work a day job because they can’t get their clinic up and running in a way that they need to so they can focus on their art, their passion, full-time. And that’s because we don’t know how to run a business.
I love to help people, but if I don’t have a clinic, I can’t help anybody. So I have to learn how to run that business to keep my doors open, to heal and help as many people as possible.
LeGar's Reading List for Acupuncture
- The Yellow Emperor’s Classic of Internal Medicine, by Ilza Veith -- "That one’s just a classic. It’s the oldest written acupuncture book, so that one’s always fun to look at the classics and how it was done."
- The Web that Has No Weaver, by Ted J. Kaptchuk -- "I recommend this one to my patients because it's a great way to learn about oriental medicine without going to school."
- Foundations of Chinese Medicine, by Giovanni Maciocia -- "This is for remembering the basics. Once you know the building blocks, the basics, you can develop all the advanced stuff from there."