What to charge patients

Since my formative years coincided with the birth of the NHS and free medical care for all, I feel deep in my bones that at some level all medical care, including what I offer my patients, should be free.  This has always made me feel uneasy about charging my patients, making it all the more difficult for me throughout my long practice life to know at what level to pitch my fees.  I am, after all, a freelance acupuncturist dependent on my practice income for my financial survival, unlike those working in the NHS who are employed by the state, so charge I must, but how much?  Do I add into this figure the number of years I have been treating, and do I have a standard rate for everybody? But what about those people who can quite understandably not afford the weekly fee needed for treatment?  Hidden within this, to me, vexed question of the level of fees to charge, too, is the conviction that it would be wrong to deny treatment to somebody I could help simply because they cannot afford it.

This problem has bedevilled all the years of my practice, and seems to have grown if anything more acute since my move first from my home practice to the SOFEA clinic in Camden Town, and finally on to Harley Street, of all places, to what is considered to be the pinnacle of medical practice, where I now work amongst those who are happy to charge the most exorbitant fees that I would be ashamed to charge anybody.

My arrival in Harley Street was the result of one of those chance encounters which seem to punctuate my life, and had nothing to do with a desire to work from the very heart of London’s private medical world.  If anything, I would have preferred to move my practice somewhere else, but this clinic just fell into my lap, a chance too good to miss.  I was walking along Harley Street and passed a handwritten notice in a window saying that there was a clinic room for hire.  It turned out to be an ideal place for me and for others from SOFEA, its greatest advantage being our freedom to use moxibustion without other practitioners complaining of the smell, and access to surprisingly large storage areas for the many SOFEA files which needed to be kept for the requisite minimum of seven years.  It also happened, luckily, to be only a few minutes’ walk from my new home.  But as I walk to Harley Street each day, I am aware that I am walking past many medical practices where what I have decided to charge my patients would be viewed as ridiculously low.  What would those working in these very luxurious clinics say, I think, were they to know that I continue to charge some of my longstanding patients the very reduced rates I have offered them over the years, with the occasional free treatment thrown in for good measure?

One of the reasons why the whole issue of fees has proved such a problem for me is because it has a lot to do with my assessment of my own worth, something I am unclear about.  How do I value what I do, and do I put a monetary value on this, and, if so, at what level?  What fee to charge therefore still remains a sensitive subject for me, particularly as a few days ago I happened to note from the web that a former student of mine is charging three times the rate I now charge.  Is she right to do this, and am I therefore being unprofessional not to do the same?  Or is there still some value in retaining the idea that the vocation I have chosen represents my desire to help others, rather than doing it for financial reward?

I realise I have ended up after all these years doing what a tutor during my original training told us not to do, which was to charge different levels of fees for different patients.  He said that this only led to confusion, and he was right.  “Stick to one fee and let the patients decide whether they can afford to pay it.  Don’t make their financial circumstances your concern,” he told us.  And this is what I have always found difficult.   

I have come to the conclusion that my problem with working out how much to charge touches on my dislike of meanness, and its counterweight, my desire to be generous.  I regard treating as a gift I am offering my patients.  To ask them to pay for this is in some senses much like giving somebody a present and then holding out my hand for them to pay for it.  Even though I recognise the need to make a living, to charge the high fees which some would definitely consider appropriate for my many years of practice and my level of expertise represents not the gift I would like to bestow on my patients, but smacks of meanness.  For somebody who would always prefer to give than to receive, this inevitably causes problems, still unresolved within me to this day, after so many years of practice.