On a sudden whim we packed our Toyota last October and headed south, taking the scenic route through South Park, Salida, Crestone, Alamosa on to New Mexico, and then through Santa Fe to Bernalillo and the Tamaya Resort. This resort takes its name and its architectural cues from the nearby Native American Pueblo of Santa Ana. The Pueblo's inhabitants, known as the Tamayame in their native language, have lived in the area since at least the early 1500s. Since the 1980s, the Santa Ana Pueblo has actively developed commercial enterprises to support the tribe. One of these is their partnership with Hyatt-Regency Hotels and the building and operation of the Tamaya Resort, which may be the nicest conference venue I have ever stayed at.
Our trip was inspired by curiosity. Emerson Ecologics, one of several large distributors of nutritional supplements to naturopathic and functional medicine practitioners, was holding their second Ignite Conference at the Tamaya, a conference for practitioners that focused on business and practice building or, as their website tagline read, "The business of better medicine."; Put simply, Emerson's strategy is that if they can help build their customers' businesses, they will build their own business as well. They made it sound like a win-win proposition for all involved, Emerson, their vendors, and the attendees.
As I said, I went more out of curiosity. At this point in my life and after 25 years in practice, I am in no rush to reinvent myself, change my business model, or even expand my business. If anything I'm thinking about the opposite, of quietly slipping out of the practice and transferring it to younger colleagues.
Yet, I remain active in planning conferences for the American Association of Naturopathic Physicians (AANP) and confess I was drawn to see this conference firsthand because the financial dynamics stood in such stark contrast to other conferences. The AANP, a non-profit professional association, runs the AANP Conferences to generate income for its operating expenses. The same is true of most other professional conferences, in particular our state and specialty association conferences. Our non-profit associations have a long tradition of leveraging our yearly legal requirements for continuing education to generate income. We are accustomed to this. The Ignite Conferences are the exception. Emerson Ecologics, a for-profit-corporation, ran this conference with no need to make a profit from attendees. In fact, because they are banking on long-term sales gains from the conference, they could even run the conference at a financial loss. There is likely a name to describe this pairing of opposites, this non-profit association running a for-profit conference versus a for-profit company running a no-profit conference, but the term escapes me at the moment; still it was something that I wanted to see and experience myself.
As I mentioned, the focus of the Ignite Conference was practice building; and this was clearly the primary agenda, with a handful of keynote speakers hitting general topics of broader interest thrown in. The majority of time was spent in small breakout sessions conducted by business trainers who brought a sharp, practiced eye to teaching three separate educational tracks: finance, operations, and marketing. The trainers covered topics such as 'scaling your business,' 'defining a clinical model to manage patients,' 'understanding and attracting your ideal client,' and so on. These three tracks each had multiple sequential sessions so that each track filled most of the day. The same lecture tracks were repeated two days in a row. Thus you could easily attend two out of the three tracks offered in their entirety. I confess that wanting to sample all the speakers, and being perpetually restless in lectures, I zigzagged my way through the schedule, hopping back and forth from track to track, speaker to speaker.
The business 'operations' track was led by Lorne Brown, a Canadian CPA and doctor of acupuncture from Vancouver with Leandra Fishman, who has decades of experience training Fortune 500 companies in sales and marketing and also aiding early stage start-ups. Dan Kalish, DC, led the 'patient process' tracks, and Julia Zaslow and Miriam Zacharias led the 'marketing' track. All five speakers were dynamic, skilled, sharp, at the top of their game, and clearly knew what they were talking about. I confess that I found the information Miriam Zacharias most useful for my own practice even though she threatened to send me to detention if I continued chattering in the back of the room with several newly-met friends.
A podcast by Dan Kalish will give you a sample of the content flavor: http://www.naturalmedicinejournal.com/journal/2016-10/how-effectively-build-successful-practice-advice-business-development-expert-daniel
Adam Car, Emerson's new CEO, hired to replace Fran Towey after he moved from Emerson to Natural Partners, opened the conference with some sobering statistics.
Nearly 70% of integrative healthcare practitioners see less than 25 patients per week – which wouldn't be a concern, however, only 3% of these practitioners are satisfied with their current salary. And, almost 50% of integrative healthcare practitioners operate solo, with no support staff – only 2% have management support….
Emerson's entire business can best be defined in six words: 'supporting the practice of healthy living.' And, supporting the practice of healthy living carries the responsibility of not only being a trusted source of dietary supplements but also… providing you with clinical education and business support education to help you thrive in your practice….
At Emerson, we strongly believe ….. to change healthcare and patient health, you not only need to be effective clinicians, but effective business people and IGNITE is here for that.
Adam and Emerson clearly see how this equation might work; by supporting the practitioners to care for more patients, they will help their own bottom line. I can't fault them on that; in fact, I can see an attractive bottom line for everyone as the net result should be that more people are living healthier lives.
Joe Pizzorno, ND, gave the opening keynote address, an updated version of the lecture he gave at the Utah AANP conference last summer. Dr. Pizzorno continues to research the links between toxin exposure and chronic disease. In Dr. Pizzorno's assessment, toxicity is now the primary cause of chronic disease. While few of us might choose to argue with this idea, Dr. Pizzorno now has the data to argue his theory with the most myopic of mainstream practitioners. This is an important topic, and I enjoyed sitting through it a second time. Dr. Pizzorno has turned this lecture into a book scheduled for publication early in 2017. He also let it be known that a second part to this lecture, a "how to treat toxicity in the modern world"; presentation is in the works. We are hoping to hear it at the AANP conference at the Biltmore in the summer of 2017. For a good summary of the current Pizzorno lecture: http://anhinternational.org/2016/04/13/toxicity-new-normal-says-natural-medicine-expert-pizzorno/
Mimi Guarneri, MD, opened the second day of the conference with a morning keynote that tracked her evolution from an interventional cardiologist at the Scripps Institute to founding the Scripps Institute of Integrative Medicine and then to her current group practice, where she offers a concierge version of functional medicine in La Jolla, California. She works in close collaboration with several naturopathic physicians including Moira Fitzpatrick, ND, and Erica Oberg, ND. Dr. Guarneri employs a model of integrative medicine practice that it would be nice to see emulated more often by other medical doctors; don't attempt to be the expert in all things alternative, simply hire a smart naturopathic doctor who already is the expert in natural medicine to complement your own skill set and knowledge base. Listening to her rant against standard approaches to health care, I couldn't help but think, "she isn't just preaching to the choir, she's singing to the choir."; She was an exceptionally captivating speaker. For more about Dr Guarneri's clinic, see http://pacificpearllajolla.com/.
Jaclyn Chasse, ND, is the driving force behind Emerson's Ignite Conference, a role she is made for. It seemed to be quite a stretch, though, to both organize this Ignite conference while serving as president of the AANP and in theory overseeing the planning of the AANP conference as well. Never one to be tactful, I asked her about this first thing upon my arrival: "Won't this conference compete with the AANP's conference?"; With her perpetual enthusiasm, Dr. Chasse immediately assured me it wouldn't be a problem as the two conferences have such different agendas; the AANP conference is all about continuing education and expanding professional knowledge and skills while Ignite is about growing your business. I understood the idea; and after surviving the conference, I pretty much agree, but not for the same reasons. Rebecca Takemoto of Sync-opate, the conference organizer behind the scenes, pointed out to me straight away that I hardly knew anyone at the Ignite conference; only a few of the attendees were naturopathic doctors. Most were other types of providers, mostly DCs and MDs, hoping to learn how to market themselves and make money selling supplements. Ignite does not draw from the same pool of practitioners that the AANP does. So in the end, there is little competition. Yet, Ignite does draw on naturopathic doctors as speakers and experts in natural medicine; Drs. Dick Thom, Paul Anderson, Lise Alschuler, and Tina Kaczor all spoke at the conference.
Left to right: Tina Kaczor, ND, Jaclyn Chasse, ND (AANP President),
Joseph Pizzorno, ND, and Jacob Schor, ND
Many of my colleagues are aware that I regularly question the ethics of selling supplements at a profit, so you can imagine that at times I found myself questioning the ethics of looking at patients only as potential sources of income. When one of the speakers explained that "a practice's current customer base is the lowest hanging fruit"; from which to draw a profit, I imagined duct tape covering my mouth least I blurt out something about caring for the ill. Some of the lectures were, indeed, a bit heavily focused on turning a profit for my own comfort.
Truth is that many of our colleagues do need help financing their good works, and these ideas provided necessary balance to our heartfelt but not always profitable efforts. I found the marketing speakers useful to hear from; on the drive home I found myself contemplating a new website, one designed to attract the sort of patients that I can do the most good in helping. Our current website has not seen significant change made since 2001; it is amazing it still works, come to think of it.
My concerns, or shall we say qualms, about the conference's business focus were put to rest on the last day of the conference by the final speakers I listened to, Tina Kaczor, ND, and Tieraona Low Dog, MD.
Dr. Kaczor described the story of how she and her partner Teresa Silliman, ND, created the Clinic of Natural Medicine in Eugene, Oregon, in terms that I found so congruent to my own sensibilities that I found my eyes tearing as I listened to her heartfelt presentation. I do know Dr. Kaczor well as we have served together on various volunteer boards over the years; it was a relief to hear that one can be successful in practice by emphasizing key principles like integrity, honesty, and a focus on quality care and customer service. Granted these ideas are a bit old fashioned, but so was Dr. Kaczor's bottom line: "Success isn't defined by how much money you make, it is defined by the life you live."
One particular analogy Dr. Kaczor used stuck. She described mountain biking on a narrow trail between tight trees. She explained that over time, and perhaps the hard way, she had learned to focus on the space between the trees rather than the trees themselves, to "look at where you want to get to,"; the gap between the trees rather than the obstacles that stand in your path. "If you stare at the trees, you can't help but hit them."; Once I translated her analogy into tree skiing, it worked well for me. Focus on where you want to end up, not at the obstacles in the way.
Tieraona Low Dog, MD, grabbed the bull by the horns, so to speak, and took on the ethical questions that had been weighing heavily in my mind and looked at them directly and put them to rest. Can we, should we, make a profit off of supplements? Should we even be selling supplements in our offices? She elegantly contrasted the business of disease versus the business of medicine versus the business of healing. All of us have to dance between these competing paradigms, and the art is to do so successfully. She contrasted the modern shift in medicine away from paternalism to patient-centered care and patient autonomy. In fact, she may have given the most comprehensive lecture on medical ethics I can remember. For those naturopathic doctors with Oregon licenses that require yearly CE in ethics, this would be a great lecture to watch online. Film crews were all over the place during the conference so I assume the resultant recordings will be both available and excellent. You'll actually learn something useful. Perhaps we can convince Emerson to post Low Dog's lecture online for free as it will be good for their business? [hint, hint]
The elephant in the room, omnipresent at all times at the conference though not mentioned during the lectures, was the ongoing promotion of Emerson's direct-to-customer supplement purchasing program. In this new modern world of clinical practice and supplement sales, they would prefer that your patients purchase products directly from their website through an online service called Wellevate. They are, after all, far better at packing and mailing packages than you or I will ever be and are happy to do so for a small percentage of the sales cost. Their system allows the practitioner to set the sale price to collect from zero up to 35% profit on each sale. The money Emerson sends to the practitioner is not legally a commission or kickback, as doing so is illegal in some locales. You'll have to get the Emerson people to explain how this works to you. There is a certain attraction to having a practice that doesn't have money tied up in maintaining an in-house pharmacy. Products sitting on the shelf getting older by the day, getting closer to their expiration dates, cost us money.
Emerson isn't alone in promoting this sort of program. Natural Partners, of course, offers a similar 'service' called 'np script' as do other smaller companies. The practitioner has full control of the markup of the products a patient purchases and these services even allow us the option out of profiting from supplement sales. In the past, one of the oft-repeated rationales for marking up costs to retail was the cost of maintaining an in-office pharmacy. These services put the kibosh on that argument.
Colleagues are already asking me about the conference: Did I like it? Should they go next year? What's not to like? The conference was, as expected, impeccably organized as are other Sync-opate meetings. As the budget only required that the conference try to break even, the food was over the top, the open bars hard to say no to, and the schedule filled to the max with skilled and practiced presenters. To my pleasure, Glen Nagel, ND, was squeezed into the schedule last second to lead a chilly early morning herb walk through the cottonwood forest that separates the resort proper from the Rio Grande River.
What's not to like about being well fed at a beautiful resort? I enjoyed myself. So did my wife and so did my dog, who is quite the extrovert and loves to meet people (the dog that is).
Whether or not you should attend is a different question. Sitting through lectures that focus on smart business practices will likely increase your income. Given the scant business training that most of us receive during our medical training, attending these Ignite Conferences does make financial sense. Granted that I found the mindset of some of the presenters incongruent with my personal approach to practice, or shall we say my personal sense of ethics. To me patients are not clients that we milk our income from. But that's me…. Yet, the majority of ideas presented made good sense and were not offensive. Perhaps we need to play Robin Hood now and then, shifting resources from more affluent patients so that we can afford to see our less affluent ones?
As mentioned, Emerson had all the lectures filmed, and they have promised to post useful snippets onto their website at a future date as well as have full lectures available for purchase. It makes sense to sample these lectures before committing to the full conference, to see if you find this sort of thing useful or not. The lectures will be posted at eeignite.com.
Jacob Schor, ND, FABNO