A few years ago, at the end of that year, I sat down and did the math.
I’d been seeing seven to nine patients a day, four days a week. I didn’t have admin support because I couldn’t afford it. I had been practicing under a membership model I’d designed to make care consistent and accessible. My highest tier was $250 a month for unlimited visits. I was barely paying myself $2,000 a month.
When I calculated what I would have made if I’d just charged my regular rate for each appointment I actually had, the difference was $50,000. Fifty thousand dollars I’d left on the table. And my regular rate was still way too low. Looking back now, with a clearer sense of what appropriate pricing actually looks like, the real cost was probably well into six figures.
That was sobering.
But it also made how I was feeling make a lot more sense.
That year, I regularly browsed nonprofit job boards. I daydreamed about qualifying for public service loan forgiveness. I seriously considered surrendering my naturopathic license and just doing acupuncture. There are parts of delivering naturopathic care that are logistically heavy, and it didn’t feel worth it for what I was making. The energy exchange was not working.
I realized that do not have the internal makeup to work a regular job. I am not a good employee unless I am working for myself. So I didn’t take the plunge. But I was close.
The Mismatch I Couldn’t See
What I didn’t understand at the time was that I was trying to optimize for two things that directly conflict with each other.
I wanted high touch. Meaningful therapeutic relationships. Time to really understand what was going on with someone. The kind of care that actually moves the needle.
And I wanted low cost. I wanted people to be able to access good care without it being a financial stretch. I thought that was what being a good practitioner meant.
So I built a model that tried to do both. Unlimited visits for $250 a month. I’d modeled it on direct primary care without realizing a crucial difference: most people don’t want to see their PCP every week. But people love getting acupuncture regularly. So I ended up seeing the same patients over and over, week after week.
I also offered a menu of appointment lengths. $75 for 30 minutes, $112 for 45, $150 for an hour. Patients could choose. Not only was the per-hour rate too low, having multiple visit options created its own problems. People would often choose the shorter visit even when they needed the longer one. A 30-minute visit isn’t that much less work than a 60-minute visit. You still have to chart. But it pays half as much. And a 30-minute appointment in the wrong time slot could make the surrounding slots unusable for anything else. My schedule was constantly a mess.
I also had a tendency to round down. If someone booked for an hour but the visit only took 45 minutes, I’d charge them the 45-minute rate. It felt like the right thing to do. It was not.
And some of those weekly patients weren’t actually getting better. They were essentially borrowing my qi. Using our sessions to let my nervous system regulate theirs instead of learning how to do it themselves. I wasn’t setting them up for success. I was creating dependency.
In my mind, success in healthcare means someone doesn’t need me that much anymore. It’s good to have access to a practitioner who knows you. That doesn’t mean you need to see them every week forever.
I was optimizing for high touch and low cost, and the result was that I delivered neither. Not real depth, because I was too exhausted and financially strained to show up fully. Not real affordability, because the model wasn’t sustainable enough to survive.
Why We Get This So Wrong
I don’t think I’m unusual in this. I think most of us skip this step entirely.
We’re not taught about this in school. We learn to be clinicians, which is what we’re there for, but we absorb all kinds of unexamined messages about what a “good” practice looks like. And the people we learn from, the brilliant clinicians we admire, are often not business people. Many of them are teaching precisely because their clinical work alone isn’t paying the bills. So the models we inherit are already shaped by scarcity.
We focus so much on figuring out our clinical specialty that we don’t think about what kind of business would actually support that work. And if you’re not clear on what you’re optimizing for, or if you’re optimizing for two things that directly conflict with each other, there’s a tension that runs through the entire experience of running your practice. Either you pay the price with burnout, your patients pay the price with dropped balls or confusing models, or both.
There’s also something deeper. A lot of us carry complicated feelings about money and self worth. I thought that charging more meant I was greedy and extractive and transactional. That if I were really good at this, I wouldn’t need to charge much. That high touch and low cost should be able to coexist if I just tried hard enough.
But they can’t. Not in the same model. Not without something giving way. You can optimize for high touch. You can optimize for low cost. You usually can’t do both unless you have an unusually high capacity for volume, a very efficient multi-practitioner clinic, or a model that doesn’t rely on one-on-one time. Group programs. Content. Something.
That’s not a moral failing. It’s just math.
What It Cost Me to Change
When I finally worked with a coach and she recommended my prices should be at least $250 an hour, I could not sleep all night. My body was in a panic. Guilt, fear, shame, uncertainty. All of it.
Another piece of sobering math: it cost me about $130 per available patient hour just to be operational. I’d been charging $150. The margin I was surviving on was almost nothing.
I had a maternity leave coming up, which gave me a natural transition point. I raised my prices. I braced for the fallout.
And people just… paid.
One person scoffed. He was one of the qi borrowers. Coming in every week, asking for lots of administrative extras, not actually getting better because he wasn’t doing the work. Everyone else either spaced out their visits (which was healthier for both of us), gradually and naturally dropped off the schedule, or kept coming at the new rate. New people started finding me. People who were more aligned with the kind of care I actually wanted to provide.
All that fear. All that panic. And then it was just fine.
A Different Kind of Clarity
I want to be clear: optimizing for low cost isn’t wrong. It’s just a different choice with different tradeoffs.
Community acupuncture is a good example. Practitioners see four to six patients at a time in a shared room. Sliding scale pricing. High volume. It works because they’ve made a structural choice. Less privacy, less one-on-one time, in exchange for genuine affordability. They’re not trying to deliver high touch at a low price point. They’ve chosen what they’re giving up.
That’s the difference. Not high touch versus low cost as a moral question, but as a design question. What are you actually building for? And does your model support that, or work against it?
When I got clear that I was optimizing for high touch, everything else got simpler. Pricing decisions. Scheduling decisions. Which opportunities to say yes to. Even now, when I accommodate extra appointments in my schedule for a week or two, it makes me question my life choices. That’s good information. It tells me I’m still optimizing for the right thing.
It’s okay to refine what you’re optimizing for over time. But the first question to get honest about is this one: high touch or low cost? Because most of the painful tangles I see, in my own practice and in conversations with other practitioners, come from trying to do both without realizing they’re in tension.
You can’t build a sustainable practice on a foundation you haven’t chosen.