Cost of School, Capitalism

[Guest guest]

At the risk of being flamed (based on past experience) I would like to point

out that there seems to be a propensity towards eschewing many of the

principles of capitalism within the acupuncture profession.

 

Marketing is apparently anathema here, although it works well with many

other alternative professions.

 

Seeking to control clients is abhorrent to many on this list, even though if

you analyzed what happens in successful interactions with you and your

patients you would find that you indeed exercised control with the cases that

worked and failed to exercise control over many that did not. Client control is

a legitimate and accepted topic of conversation in the fields of finance,

accounting, medicine, law and chiropractic. Not so here.

 

Efficiency in delivery of care is another issue that seems heretical to

discuss. People who can afford to pay cash for things they want (acupuncture or

massage or personal training) which are not covered by health insurance are the

self same people who usually do not have 90 minutes twice a week to be at a

doctor's office. You actually can deliver a routine treatment in 15 minutes

if you have help, the facilities and a good algorithm for patient care. Does

it take a little longer for the patient? Absolutely. That's where the

doctor's self interest comes in.

 

I notice that many people here are trying to deliver healthcare to people

who cannot afford it. I would suggest that if at all possible you find a

location that has a large population of affluent people and tithe from your

successful (gross over 250K per year) practice. Don't martyr yourself. You will

do

more good as a wealthy individual who gives to charities than you will as a

starving artist.

 

I have spoken to people form this group both off and on the list for several

years. There are not even a handful who dare to apply standard, sound

practices to their businesses in order to make the profitable. Further, many

are

convinced that anyone who is actually successful and wealthy from the

healthcare industry must be a crook. That attitude is too provincial for words.

 

My experience in health care has a base in chiropractic, although

acupuncture and herbal remedies eventually constituted 65% of my practice.

Nevertheless, since acupuncture has a much broader scope of practice the

opportunity for

increased revenue should be at least proportionately greater, if not

geometrically.

 

I am a great believer in capitalism. If your practice (in the broader sense

of the word, to include any business) cannot prove itself in such a way as to

add enough benefit to the providers or owners as well as to the consumers or

patients, then it will and should go by the wayside.

 

With all that said, there are any number of courses you can take, even on

the Internet, that would allow savvy individuals to figure out how to market,

direct and make money from this great talent that you all have, given the

training available today.

 

Carpe Aurum.

 

Guy Porter

 

 

 

 

 

[Guest guest]

Mr. Porter can you tell us where you practice? I find your ideas provocative yet

I have no

idea where you are licensed or practicing.

Thanks,

Doug the Moderator

 

, DrGRPorter wrote:

>

> At the risk of being flamed (based on past experience) I would like to point

> out that there seems to be a propensity towards eschewing many of the

> principles of capitalism within the acupuncture profession.

>

> Marketing is apparently anathema here, although it works well with many

> other alternative professions.

>

> Seeking to control clients is abhorrent to many on this list, even though if

> you analyzed what happens in successful interactions with you and your

> patients you would find that you indeed exercised control with the cases that

> worked and failed to exercise control over many that did not. Client control

is

> a legitimate and accepted topic of conversation in the fields of finance,

> accounting, medicine, law and chiropractic. Not so here.

>

> Efficiency in delivery of care is another issue that seems heretical to

> discuss. People who can afford to pay cash for things they want (acupuncture

or

> massage or personal training) which are not covered by health insurance are

the

> self same people who usually do not have 90 minutes twice a week to be at a

> doctor's office. You actually can deliver a routine treatment in 15 minutes

> if you have help, the facilities and a good algorithm for patient care. Does

> it take a little longer for the patient? Absolutely. That's where the

> doctor's self interest comes in.

>

> I notice that many people here are trying to deliver healthcare to people

> who cannot afford it. I would suggest that if at all possible you find a

> location that has a large population of affluent people and tithe from your

> successful (gross over 250K per year) practice. Don't martyr yourself. You

will do

> more good as a wealthy individual who gives to charities than you will as a

> starving artist.

>

> I have spoken to people form this group both off and on the list for several

> years. There are not even a handful who dare to apply standard, sound

> practices to their businesses in order to make the profitable. Further, many

are

> convinced that anyone who is actually successful and wealthy from the

> healthcare industry must be a crook. That attitude is too provincial for

words.

>

> My experience in health care has a base in chiropractic, although

> acupuncture and herbal remedies eventually constituted 65% of my practice.

> Nevertheless, since acupuncture has a much broader scope of practice the

opportunity

for

> increased revenue should be at least proportionately greater, if not

> geometrically.

>

> I am a great believer in capitalism. If your practice (in the broader sense

> of the word, to include any business) cannot prove itself in such a way as to

> add enough benefit to the providers or owners as well as to the consumers or

> patients, then it will and should go by the wayside.

>

> With all that said, there are any number of courses you can take, even on

> the Internet, that would allow savvy individuals to figure out how to market,

> direct and make money from this great talent that you all have, given the

> training available today.

>

> Carpe Aurum.

>

> Guy Porter

>

>

>

>

>

[Guest guest]

Dear Doug:

 

I don't often talk about myself, but do so at your express request.

 

I practiced for 18 years in St. Louis, MO. I have a DC degree and somewhat

over 1,200 hours in CM courses. My library includes about several shelves of

well worn CM books as well. My undergraduate degree is in neurobiology and

philosophy from Washington University in St. Louis.

 

I taught clinical biomechanics, research methodologies and was Logan

College's first Director of Clinical Research. I spent three years doing

acupuncture

in a psychiatric outpatient facility, as well as various adventures into

hospitals in the St. Louis area well before acupuncture was accepted as much as

it is.

 

My private practice saw 50 - 100 patient visits per week. At times I

marketed my practice as catering to " chronic and difficult cases, " " optimal

health, "

and " Head and Facial Pain. " The latter was the most profitable, the first

was the most spiritual. I sold herbs, supplements and various other health

care devices from my practice. I made sure that I gave away at least 10K of

services per year to people who would not otherwise afford them.

 

In 2001, I was stricken by a combination of psoriatic arthritis and gout and

I am no longer able to use my hands. I have been available as a marketing

consultant to a few doctors, but now I make my living in the field of finance.

 

In the almost six years it took to get a correct diagnosis for my problem, I

have seen over 30 different physicians of all stripes. I have been to many

offices where I was depersonalized, treated like a piece of meat and billed

about $1,000 per hour for the ten minutes of time I spent with the physician who

ignored my most pressing symptoms and told me to lose weight and take

NSAID's. For the value of what is delivered, most of the people on this list

should

definitely be making an annual gross of 250K per year. The alternative to CM

is often times very ineffective. On the other hand, the medicine that saved

my life (figuratively) costs $1750 per month and is worth every penny. I

would not like to see pharmaceutical companies hindered or penalized for their

profits when it takes literally billions of dollars to develop the type of

medicines they have been making in the last 30 years.

 

I don't think that anything I said in my part of this discussion was

disrespectful, unfounded or any other adjective which would justify your holding

it

for review for several days.

 

I look forward to being allowed into the discussion just like everyone else

is.

 

Guy Porter

 

PS You're welcome to call me Guy. If you want to be formal, you should

address me as " Dr. "

 

 

 

[Guest guest]

Guy et al.,

 

According to my wife, Honora Wolfe, so many of her students feel that

making money by providing health care is somehow tainted that she

actually has to teach a module on assessing and potentially correcting

one's deepest assumptions about money and success. (I would call these

" assumptions " neuroses or hang-ups.) Money is simply a form of qi and,

as such, is neither good or bad in and of itself. It's how you make

and use it that endows it with value, including moral value.

 

Honora would also agree that many of her students think of capitalism

as something negative and are adverse to the concept of business in

general. I think she would say that it is exactly these students who

are least likely to succeed long-term. I agree with you that there is

no reason whatsoever for someone to be unable to a make a good living

doing this medicine as long as they are willing to do what it takes to

be successful and have the right business plan. By " doing what it

takes, " I do not mean anything unethical or even dubiously ethical.

What I mean is taking one's services where they are needed, putting in

the hours necessary (possibly evenings and weekends), taking the

financial risk of opening a professional clinic, and doing or hiring

someone else to do all the peripheral things necessary to run a

successful business.

 

I agree with you that many of the people who complain about not being

able to make a financial go of this medicine are using an unworkable

business plan (whether consciously or unconsciously). For instance,

IMHO, if it takes more than 15 minutes to make a CM pattern

discrimination on a new patient, that is going to make it difficult to

make a living doing this medicine. (I routinely teach this skill, both

live and through Distance Learning.) Further, all the advice-giving

about diet, lifestyle, stress, etc. should be automated in some way,

such as by computerized print-outs, use of books sold for a profit,

the selling or " renting " of " tapes " (audio or DVD), or counseling

given by a trained employee who only makes a fraction of what you

(should) make per hour. As for time-efficient acupuncture protocols,

look at Golden Needle Wang Le-ting or Miriam Lee. Wang Le-ting

literally treated 50 or more patients per day. At $20 per patient, are

you gonna say you couldn't live on that? By the way, he was called

Golden Needle because his treatments were so clinically effective.

 

Lastly, " if you keep doing what you're doing, you'll keep getting what

you're getting. "

 

Bob

[Guest guest]

Bob et al,

 

I fully agree with you that money is neither good nor bad, but that the moral

value behind

it comes from how we make and use it.

 

I remember a story that my teacher Anni kelsang Delek used to say at the

Tibetan

Dharma centre where I lived for close to three years. She told us of a layman

Buddhist

pracitioner who realized the value of spreading the dharma, so that others may

gain

benifit. This layman was very good in business and so decided to use his gift

in making

money for the benifit of others, in fact every time he amounted a certain sized

fortune he

would have a temple built with his resources. He would then go back to

amounting

fortune again and then have another temple built and so on. Anni Kelsang Delek

always

stressed the importance of remaining natural in the world, but changing our

mind, ie. it is

the intention behind what we do that makes the difference.

 

Anyways I indebted especially to you, Bob, for all your dedicated work of

trying to turn

out good Chinese Medical practitioners. Your efforts over the years have

influenced me

and many others greatly. To me you have set a good example of some one who has

dedicated their life to a cause that many have benifited from and through that

pursuit has

been able to raise a family. Such a good balance. Obviously your intentions

have been

good.

 

Cheers,

Trevor

 

, " Bob Flaws " <pemachophel2001

wrote:

>

> Guy et al.,

>

> According to my wife, Honora Wolfe, so many of her students feel that

> making money by providing health care is somehow tainted that she

> actually has to teach a module on assessing and potentially correcting

> one's deepest assumptions about money and success. (I would call these

> " assumptions " neuroses or hang-ups.) Money is simply a form of qi and,

> as such, is neither good or bad in and of itself. It's how you make

> and use it that endows it with value, including moral value.

>

> Honora would also agree that many of her students think of capitalism

> as something negative and are adverse to the concept of business in

> general. I think she would say that it is exactly these students who

> are least likely to succeed long-term. I agree with you that there is

> no reason whatsoever for someone to be unable to a make a good living

> doing this medicine as long as they are willing to do what it takes to

> be successful and have the right business plan. By " doing what it

> takes, " I do not mean anything unethical or even dubiously ethical.

> What I mean is taking one's services where they are needed, putting in

> the hours necessary (possibly evenings and weekends), taking the

> financial risk of opening a professional clinic, and doing or hiring

> someone else to do all the peripheral things necessary to run a

> successful business.

>

> I agree with you that many of the people who complain about not being

> able to make a financial go of this medicine are using an unworkable

> business plan (whether consciously or unconsciously). For instance,

> IMHO, if it takes more than 15 minutes to make a CM pattern

> discrimination on a new patient, that is going to make it difficult to

> make a living doing this medicine. (I routinely teach this skill, both

> live and through Distance Learning.) Further, all the advice-giving

> about diet, lifestyle, stress, etc. should be automated in some way,

> such as by computerized print-outs, use of books sold for a profit,

> the selling or " renting " of " tapes " (audio or DVD), or counseling

> given by a trained employee who only makes a fraction of what you

> (should) make per hour. As for time-efficient acupuncture protocols,

> look at Golden Needle Wang Le-ting or Miriam Lee. Wang Le-ting

> literally treated 50 or more patients per day. At $20 per patient, are

> you gonna say you couldn't live on that? By the way, he was called

> Golden Needle because his treatments were so clinically effective.

>

> Lastly, " if you keep doing what you're doing, you'll keep getting what

> you're getting. "

>

> Bob

>

[Guest guest]

Guy, I'm sorry that I indeed hold your post so I could ponder it a little. There

was

something about it that struck me as odd and the fact that your presence on the

web

otherwise is minimal. Now that I see your history and background I understand

more as to

my response. Now that I see your letter I am re-assured there was no need for

concern. I

apologize and this correspondence was probably best done off list but here we

are.

 

 

Now to my disagreements! :-)

 

What struck me odd in your post was that your approach was so different from the

experience of most practitioners I see. I do disagree with not just you but many

others

that believe a chiropractic model can be applied to the acupuncture business. I

haven't

figured out why but I just don't see it working successfully for us.

 

One issue is the degree of specialization. I think you would agree that people

visiting

chiropractors have specific needs in terms of musco-skeletal or views of the use

of

supplements. You found head and facial pain to be successful for you at many

levels. I do

believe that some degree of specialization is needed for a successful practice.

The fact is

that our schools are so generalized that it takes many years once out of school

to find

what that is. For the most part we have a Chinese model without the

post-graduate job

placement that they had up until the recent past.

 

I'm going to segue into Bob's post about business since it seems relevant.

 

1- taking one's services where they are needed,

2- putting in the hours necessary

3- taking the financial risk of opening a professional clinic

4-someone else to do all the peripheral things necessary to run a successful

business.

 

The first might include what Bill has written about, the second I can also see

as " hanging

in there, it may not happen overnight, don't expect your patients from your

student clinic

to come see you. The third and fourth I don't know about. I would say that one

should

practice in your chosen location before opening your own clinic. I've seen

plenty of just

graduated who have taken on big financial committments before establishing a

base.

Begin by working in a place where there is alot of traffic. I would say keep a

low overhead

until you have everything in place including more patients than you can handle

who will

see you personally at a new location.

 

I'm a firm believer in communism. And by that I mean serving the community you

are in.

When you market, you market for the person who is going to refer you more

patients.

Marketing one patient at a time is a waste of time. Market to people have access

and

influence over a number of people. The obvious choice is doctors but it can be

persons in

a church or a business. But the problem is you often don't know who that person

is going

to be. It's like the dictum of praying on the last day of your life... you just

can't predict

when it's going to be. The best referrals have come from people who unbeknowest

to me

are influential in their own big or little groups.

 

If you look like a punk or a cheerleader or a hippie (like me) your patients are

only going

to refer their friends, associates, family, bosses who think that they can deal

with your

image. I can accept that. Conversly if you maintain a sharp doctoral effeciency

you may get

more but turn off some. I've talked to some former students who dress very badly

and

treat basically out of their bedrooms. That's fine for a few of their friends

but who is going

to refer their boss or mother to that kind of situation? I've also seen

practitioners who have

professional offices that turn people off. They say about them: this guy is a

businessman

not a healer. All scenerios are pretty extreme but we are all somewhere on that

line.

 

What I don't think new practitioners realize is that patients just come just

because they

were number one in their class or has a great bedside manner or that the

practitioner feels

him or herself to have an enlightened consciousness. Similarily I don't expect

patients to

see me just because I'm good at this or that. You are going to have to let

people know that

(and suffer the consequences if you aren't).

 

Despite having alot to say about all this I'm one of those who are kind of

disinterested in

the money issue. I feel lucky to have what I have. I can't complain... although

I do. I guess

I'm saying this on a good day... more about that later.

 

 

doug

 

 

 

 

 

 

, DrGRPorter wrote:

>

> Dear Doug:

>

> I don't often talk about myself, but do so at your express request.

>

> I practiced for 18 years in St. Louis, MO. I have a DC degree and somewhat

> over 1,200 hours in CM courses. My library includes about several shelves of

> well worn CM books as well. My undergraduate degree is in neurobiology and

> philosophy from Washington University in St. Louis.

>

[Guest guest]

 OK I am just about to graduate (should be studying for finals) and wanted to

chime in here. This is going to be free flow and I am dyslexic so forgive any

errors. I and my patients know that I will be very successful. What I have

patients? Yes I started treating in the student clinic in January 2004 almost 3

years ago. I am often booked 6-8 weeks in advance even in the semesters that I

see 15 patients a week. Are they the same people? No because I tend to be

booked. I should say that I come from a sales back ground and am a capitalist.

Sales is relationship building. Even a doctor has to sell a patient on taking

their medication or getting a surgery. I always recommend the book “Points for

profit” to the new students and tell them to buy it their first year, read it

again their second year and then again during their third year. For myself, the

book “Points for profit” has a lot of “Duh!!!” stuff in it but then again my

background is the reason why.

 

 

 

Sales is also education. Educate the people you meet about you what you are

doing and what acupuncture is about. I am a Honora Wolf and Bob Flaws fanboi

even though they do not know me (please forgive me if spelled you name

incorrectly). Take every opportunity to market yourself and you are doing.

Location is king? Heck no. I have no doubt that I could start a clinic next to

the most famous TCM practitioner in any town and make a lot of money. Why? It is

about networking and educating, which is also sales. Having said that, when I

graduate I am moving to an area that has 1.8 million people and only 5-7

acupuncturists most of whom do not do herbs. I already have people talking about

me and waiting for me to set up shop. There is a high end hair salon that has 2

rooms they want me to start my practice in. How was I able to achieve this?

Networking (once again I refer you to “points for profit” or Honora Wolf ). The

next part is to disclose my dirty little secrets, which are re!

ally not secret.

 

 

 

I have to pay my students loans oh no I can not survive! BS, there is a thing

called deferment. You can put a school loan into eternal deferment. I would

recommend that you at least pay the interest. However, having said that you do

not have to start paying your loans after graduation just tell them you are

having troubles and can not afford to pay. I had a $2,000 school loan I deferred

for over 10 years and a few of those years my household was making far more than

100k a year. They do not ask you how much you make.

 

 

 

Leverage other peoples money and assets. When I start out like I said I found a

place that is going to pay for overhead and is already a business. I forgot to

mention the person who owns the place is going to have an open house where he

invites all of his clients and the people who are interested in me doing TCM.

The best part, the owner is going to pay for the open house.  (The financial

advisor in me is coming out… a house is not an investment you do not own it and

it does not give you income. Miss three payments and it will be taken from you.

It is not liquid and if you need to sell the market may be down. Do not buy a

house to work out of!!!!!)

 

 

 

Have a specialty? Yes I am specializing in women’s health care, fertility issues

in particular. Have I received a “certificate” in this area? No why do I need

to. This is the area I am interested in and have been studying it on my own. In

addition, I have learned facial acupuncture. Why? My patients in the student

clinic requested it so I took a course. If I add only 2 new facial acupuncture

patients a month it will add around $56,000 a year to my income per year.

 

 

 

What if my patients can not afford treatments over time? There are many

companies that will give your patients a credit card that can only be used at

your location. The plus side is you do not have to worry about collections, for

that is between the loan company and the patient leaving you out of the

equation.  Ok I have to stop this now before I give away my best kept secrets.

 

 

 

I will stop by saying this. Although I give kudos to those that want to give

cheap treatments to those in need, I will do far more good for those in need by

making money so that I can afford to do good rather than worrying about keeping

a roof over my head.

 

 

 

Michael Slayton, AOMA student body president

 

Sorry about the formatting couldnt get it right.

 

 

 

 

 

[Guest guest]

Thanks for the good words Trevor.

 

Sincerely,

 

Bob

 

, " Trevor Erikson "

<trevor_erikson wrote:

>

> Bob et al,

>

> I fully agree with you that money is neither good nor bad, but that

the moral value behind

> it comes from how we make and use it.

>

> I remember a story that my teacher Anni kelsang Delek used to say

at the Tibetan

> Dharma centre where I lived for close to three years. She told us

of a layman Buddhist

> pracitioner who realized the value of spreading the dharma, so that

others may gain

> benifit. This layman was very good in business and so decided to

use his gift in making

> money for the benifit of others, in fact every time he amounted a

certain sized fortune he

> would have a temple built with his resources. He would then go back

to amounting

> fortune again and then have another temple built and so on. Anni

Kelsang Delek always

> stressed the importance of remaining natural in the world, but

changing our mind, ie. it is

> the intention behind what we do that makes the difference.

>

> Anyways I indebted especially to you, Bob, for all your dedicated

work of trying to turn

> out good Chinese Medical practitioners. Your efforts over the years

have influenced me

> and many others greatly. To me you have set a good example of some

one who has

> dedicated their life to a cause that many have benifited from and

through that pursuit has

> been able to raise a family. Such a good balance. Obviously your

intentions have been

> good.

>

> Cheers,

> Trevor

>

> , " Bob Flaws "

<pemachophel2001@>

> wrote:

> >

> > Guy et al.,

> >

> > According to my wife, Honora Wolfe, so many of her students feel that

> > making money by providing health care is somehow tainted that she

> > actually has to teach a module on assessing and potentially correcting

> > one's deepest assumptions about money and success. (I would call these

> > " assumptions " neuroses or hang-ups.) Money is simply a form of qi and,

> > as such, is neither good or bad in and of itself. It's how you make

> > and use it that endows it with value, including moral value.

> >

> > Honora would also agree that many of her students think of capitalism

> > as something negative and are adverse to the concept of business in

> > general. I think she would say that it is exactly these students who

> > are least likely to succeed long-term. I agree with you that there is

> > no reason whatsoever for someone to be unable to a make a good living

> > doing this medicine as long as they are willing to do what it takes to

> > be successful and have the right business plan. By " doing what it

> > takes, " I do not mean anything unethical or even dubiously ethical.

> > What I mean is taking one's services where they are needed, putting in

> > the hours necessary (possibly evenings and weekends), taking the

> > financial risk of opening a professional clinic, and doing or hiring

> > someone else to do all the peripheral things necessary to run a

> > successful business.

> >

> > I agree with you that many of the people who complain about not being

> > able to make a financial go of this medicine are using an unworkable

> > business plan (whether consciously or unconsciously). For instance,

> > IMHO, if it takes more than 15 minutes to make a CM pattern

> > discrimination on a new patient, that is going to make it difficult to

> > make a living doing this medicine. (I routinely teach this skill, both

> > live and through Distance Learning.) Further, all the advice-giving

> > about diet, lifestyle, stress, etc. should be automated in some way,

> > such as by computerized print-outs, use of books sold for a profit,

> > the selling or " renting " of " tapes " (audio or DVD), or counseling

> > given by a trained employee who only makes a fraction of what you

> > (should) make per hour. As for time-efficient acupuncture protocols,

> > look at Golden Needle Wang Le-ting or Miriam Lee. Wang Le-ting

> > literally treated 50 or more patients per day. At $20 per patient, are

> > you gonna say you couldn't live on that? By the way, he was called

> > Golden Needle because his treatments were so clinically effective.

> >

> > Lastly, " if you keep doing what you're doing, you'll keep getting what

> > you're getting. "

> >

> > Bob

> >

>

[Guest guest]

Every now and then I have the urge to add my two cents. The most useful

thought I have is a critique of the practice-management courses in the

schools. I graduated in 1995 and I stopped teaching (not practice

management)about 3 years ago. Upon entering school I had the reasonable

expectation of having a taxable income (after paying the employers'

side of workman's compensation and social security) of $100,000 or

more. If I have to work 70+ hours a week at a job that demands an

expensive education, constantly high creativity and precise work with

high liability, I deserve it.

 

My practice management course consisted of two items. 1) A lesson on

how to properly fill out a Dome Expense Record and a One-Write receipt

system. 2) Being told that the most important element of building a

practice is networking. I paid somewhere around $500 in tuition for

those kernels of wisdom. And to my eye, things hadn't changed much by

the time I taught except that one of those schools had the grace to

expand the bookkeeping lessons so the lack of useful content was much

less discernible.

 

Things I would put in a practice-mangement course:

-At least one class period on supply/demand theory with assigned

10 page paper on how it manifests in health care.

-The basics of researching a market.

-The basics of branding and packaging service businesses.

-An introduction to demographics, pyschographics and their

interpretation.

-Competitive strategies

-How to judge the effectivenes of your individual marketing

techniques.

-The 50/30/20 rule. 50% of your time is billable, 30% of your

time you spend on marketing, 20% of your time you spend on

bookkeeping/collateral contact/sweeping the floor.

-Two thoughts from a wealthy relative.

-If they won't put it writing they aren't going to do it.

-Never make a deal you can't be a little ashamed of.

-THIS MEDICINE IS A TREASURE. ITS EASILY WORTH $90 - $125 PER

HOUR. TAKE A LOT OF PRIDE IN IT AND DEMAND THAT OTHERS RESPECT IT TOO.

 

Another course I would require: A survey of general business law.

 

My first disillusionment after graduation was that I was going to

acquire a degree in business the hard way. There was no way around it.

 

" Damn it Jim! I'm a clinician, not a marketer! "

Dr. McCoy, USS Enterprise

 

Joe