Office Hours with Angelique and Toby, episode 20. Released February 18, 2026. 21 minutes.

About this episode

Toby Daly and Angelique Britt compare notes on the business side of a growing practice. Angelique explains why a simple two-price model left her herbal research and preparation unpaid, how she moved to separate tiers for acupuncture, herbs, and combined care, and how she handles herbs for insured patients. She also plans to expand from two treatment beds to four as new-patient waits stretch out, and the two discuss a staggered schedule with a buffer between patients and when it makes sense to hire.

The second half is a case discussion: a man in his sixties with heavy, sandy-feeling feet, night pain, occasional tingling and toe sores, slow-healing wounds, and urinary symptoms. Toby and Angelique weigh heaviness against dryness, how body type and skin inform channel choice, and how to ask about and palpate for temperature in the legs and feet.

Topics

Pricing tiers for acupuncture, herbs, and combined care
Herbs for insured patients
Growing from two treatment beds to four
Staggered scheduling with a 15-minute buffer
When to hire, and when to let a hire go
Case: heavy, sandy-feeling feet and slow-healing toe sores
Heaviness versus dryness; body type and channel choice
Asking about and palpating for temperature

Key terms

Saam acupuncture (舍岩): a Korean Buddhist monastic acupuncture tradition that treats imbalance on one channel system at a time, using combinations of the five transport points.

A note for listeners: this is a conversation between licensed practitioners, offered for education, not as medical advice. Patient details have been kept general to protect privacy.

Transcript

This transcript was generated automatically from the published audio and lightly edited for readability. It may contain errors in names and terms.

Welcome to Office Hours. Whether you're new to the acupuncture profession or have been at it for decades, this is the place where we discuss all things Chinese medicine and more. Join Toby Daly, a seasoned acupuncturist of the Saam tradition, and Angelique Britt, a nurse turned acupuncturist who is brand new to the field as they explore topics in and around the world of acupuncture and Chinese medicine. There's something for everyone here. Drop in anytime.

Toby: How cold is it there?

Angelique: How cold is it here? Forty degrees. So it's not bad.

Toby: Forty degrees. It was thirty seven here today. Yeah.

Angelique: Yeah. Wow. Cold drink. Not even a little bit, sorry. I have no compassion for that.

Toby: It seems fair. Everyone here is like, my God. You'd have been cracking up everyone here today is like scarf and hat and like and just all like curled over.

Angelique: Meanwhile, all the New Englanders were like So I have an update. I decided to make some changes to business practices. I'm getting more and more used to just going with the flow and trying things and seeing what happens and then pivoting. I noticed that I was starting to feel a little resentful in some ways. And I was like, Why am I feeling resentful? And I recognized that I was basically doing a lot of work for free. And not realizing how much work I was doing for free. And so how that was manifesting is I was trying to keep things simple. And by virtue of keeping things simple, I made things more complicated for myself. Isn't that the way things go? And so I had just two prices. I had my initial visit price and a follow up visit price. And I just it didn't matter if you're just gonna have accu acupuncture, if you're gonna get acupuncture and herbs, but just it was one stop shopping, one price, easy peasy. That's what I thought. And then I started taking insurance and insurance reimburses on Various levels and scales and there is no insurance reimbursement for any of the herbs. And so no matter if they people were private paying or people were using insurance, the cost of herbs was always extra. And because of how I've chosen to do herbs, which is the raw ground method, Sharon Weizenbaum does this. And there's actually a really great video in White Pine Circle about the thermos method of using raw ground herbs. I think the acupuncturist name and I'd have to double check it. It's Evan Aaron. I think if that sounds familiar. Yeah. It's a great it's a great, it's like an hour and a half course. Really, it's cool to listen to, if anyone's curious. But be by doing that, you can make herbs really low cost, which so far for me has increased compliance. And because I'm a new provider and you know, I don't have all of the confidence of I'm gonna knock it out of the park with the herbal medicine. It's nicer for me to be able to offer a lower cost both for accessibility and for the ability to have a little freedom with Experimentation is not the right word, but with learning, I guess, the trade on my own. And so I was putting so much time into figuring out the formulas and researching the formulas and grinding the formulas. And so it just I realized I was doing a lot of extra hours, particularly with the herbal patients, that just wasn't being reflected in anything. I was just there is just it was everywhere. And so I decided to make things a little more complex in terms of what I offer with the hopes of making things simpler and to compensate myself for my time. In a more fair way. And so I now have three different tiers of offerings. So you can get just acupuncture, you can have just herbs or acupuncture and herbs. And I'm gonna see how that this goes. And this has different pricing options. And then I decided that if you're going to use insurance to pay for your treatment and you're interested in herbs, that there'll be an extra like processing and preparation fee that I'll add on, which is I checked with my biller who we will eventually talk to on here. That's okay to do. Like you're not going to get in trouble with the insurance company if you do this because it's not something that insurance reimburses for anyway. And so that just felt better overall. And so I have rolled that out this month and we're going to see what's happening. And although I can't share the identity yet of this person, I'm going to have another acupuncturist joining me. Great. So I've been working on doing like physical updates in the space that I currently have to make space for us to be there. So I will be able to. Double my treatment space with yeah, which is great. So I'll go from having two beds to four and I'll start using, I haven't done this yet. We're in process. I've got all of the materials. We just have to have my very handy husband install some of the things that are required. And then I'll start using some of the space for overflow people or the last minute folks that I'm actually starting to have trouble fitting in a timely manner, which I guess might have to have. I mean, I'm not fully booked forever for months, but it's I'm I, you know, for new patients for that block of time that I established for a new visit, I have a couple weeks out that before I can fit someone in. So that's been that's been neat to experience. So yeah, those are those are my little updates and I shared for both transparency and just because I'm why not? I'm sure I'm not the only one that's trying to make it on their own. Out there in the world in our profession.

Toby: Yeah, I remember that. Especially like researching herbal formulas, right? You could spend hours on just selecting a formula. So you have to get some kind of compensation for that. So especially that you weren't compensating yourself at all. I think that's that's really reasonable to bring that back in. Yeah. I think you're gonna really enjoy having more than two rooms. You're seeing two patients an hour, is that right?

Angelique: Yeah, I kind of I have a sort of hybridization of that. I so my hybridization is so if I have an hour's block of time, I will see one patient and then the next one the half an hour. But at the end of that second patient, I leave a gap of fifteen minutes before the next hour starts. And that's because I'm by myself. And so I have to break to have to, you know, change the table linens and make sure the trash is picked up. And if there's an herbo formula that has to be actually physically made, I have time to do that. Someone needs a little bit extra time. I'm not feeling so stressed that there's someone waiting in the waiting room for the space that I'm currently occupying. So it allows a little bit more breathing room and is easier on my nervous system to have it this way.

Toby: I think that's really reasonable. I think it might be nice if well, depending on if the other practitioners are using it, though it's really nice to have a third room because every once in a while you need that. You need to squeeze someone in some emergent thing or someone just needs extra time. It's really nice to have that third room. So I think I told you I used to do five rooms. That was insane. But three rooms is nice because two rooms is pretty anyways, especially I just see two patients an hour now at this point. And that's really easy, but it's nice to have a third room every once in a while when You know, always stuff comes up. So again, you have to you have to squeeze someone in, someone needs extra time or something like that. It's really nice to have that third room.

Angelique: Mm-hmm. And the scheduling pattern, I'll give credit to my friend Nina, who's also an acupuncturist in the Jamaica Plain area, because she showed me and I was like, This works. I was had my I had my thoughts were in knots over how to figure out the whole scheduling thing. And this has been really nice. I did try doing the every thirty minutes seeing a patient and especially with two just two rooms available that I did not like how that felt for me. I felt stressed all the time and I was like, I am not working in nursing for a reason anymore. I don't wanna fight like this. It felt too reminiscent of like the pressure I would feel, you know, working in the hospital. So

Toby: Yeah, but especially when you get at some point when you get help at your clinic, right, you'll find that's just really that's really comfortable. You know, two patients an hour is really comfortable with someone else taking care of everything, you know, it's it's just really nice.

Angelique: Yeah, I yeah, also I'm checking people in and checking people out and money and I do hate taking the money. It's the worst. I've actually started to s to say to people like my least favorite part is taking your money, but unfortunately it's something I have to do. And so this is how much it is for the day, or adding some little joke or something along with it. 'Cause I really it's I feel very supermarket checkout. Yeah. You know, at the end and being like, That'll be X amount of dollars today.

Toby: I really I really feel like you have to split this between two different people, right? That the high level clinical work, you're just you're trying to people get their best possible state of health and then someone else to do to manage that financial part of that, the just cleaning the lindens part of it, just all that kind of stuff. It's really nice to split that between two different people rather than one person going from that really high level clinical work to other thing, you know, d again, like more mundane kind of things. Yeah. Again, I never figured out how to do that myself. And that's that's why I hired somebody because I just couldn't I just never felt comfortable doing that, switching those roles.

Angelique: Once I get to a place where the volume feels pretty steady and I have, you know, like I've got pretty right now I'm almost fully booked this week. Like I had I had like one I think open visit. And next week it's like I'll usually have one or two, sometimes three visits still open, but up to three weeks, like three weeks out, I'm half full from now. Do you know what I mean? So that's pretty cool.

Toby: This is this is that this is that new problem I was telling you about. Then when people just again, it's it's nice too, you're not jam packed too, because again, emergent patients. I always do this when my patient when my schedule is all the way full, but something emergent, they really need help, I just put them in. And so if you're not jam crazy packed already at that point, then that's really helpful. But even when I'm pretty full, I still see those kind of patients when they just really need.

Angelique: Yeah, I've had that happen where I've tacked them on at the end of the day because that's the time I've had the space. And I it's I don't have the problem of like being booked forever and ever. I know I have no space for you yet. I don't have that problem yet. But when I get to that point of being, you know, I don't even know what the threshold would be, but enough predictable volume that I can substantiate another person that I can pay on a regular basis that's not piecemeal that I can train and like have. Yes, I absolutely want to be able to do that. I just don't feel like I'm at that. Financial stability place yeah where I can do that and pay them well. Right. I don't wanna I don't want to not pay someone well. So if I take someone on, I wanna make sure that I can give them a good wage, not just a fair wage.

Toby: Yeah. And especially I've had all kinds of people help me and then especially people that sometimes people that came to help me made everything worse. So you have to be really careful. So you have to get the right person and then compensate them well. I just can't recommend that highly enough. So if something again, just in case anyone's hearing this, right? Somebody that's not that's there to help you and is not working out. Use me as an example and let them go sooner rather than later because I just always went too long for those kind of things. And then and then you get somebody amazing, which I have somebody amazing with me right now. And then yeah, you compensate well and then just appreciate, you know, that it's so great to be able to do those. Again, because it's it's really two different jobs. And so it's really nice to have a second person doing that the other part of that job rather than all for you.

Angelique: Yes, I look forward to that day. It's coming.

Toby: It is really it's coming pretty quickly. Just a little past a year in. So congratulations. You I'm really glad everything's going so well. Again, there's so much healing that needs to be done in this world. So it's nice. It's nice people recognize that and coming to see you. So congratulations.

Angelique: Yeah, I don't I don't feel like I should be throwing myself a party just yet, but you know, things are moving in the right direction.

Toby: There's no guarantee of that, right? And you get you got you got your training and you open your door and then and then yeah, that's nice. You pray and you hope, right? And then it's n it's nice. Again, if you can help somebody, they're they're gonna tell twenty people. So that tends to go well. Yeah. Okay, anything else for today you want to discuss?

Angelique: Well, I actually this just actually I remembered this suddenly. There's so I kind of wimped out on the system. I have definitely have been carrying Phillips and your words with me around trusting the system, trusting the system. And I totally wimped out. But I wanna return to it with there's a there's a patient that has a really interesting issue. So I'll tell you about it from memory. So forgive me if I don't have all of them.

Toby: Yeah. That's fine.

Angelique: So as a patient in their 60s, a male patient, thin and wiry, I can't, I can't quite I think he's more of a large intestine body than stomach excess body, like more large intestine. But could be a little stomach excess. His behavior, he's very busy, has to be busy all the time. He's retired, but volunteers five days a week, really enjoys it. And his main complaint is that he has this feeling of that his feet are full of sand. They're just sandy feet. He has full sensation, but his feet are full of sand. And at nighttime, especially after a day of activity, they'll really hurt. And he'll have to get up and walk around. And he also has the most curious of the symptoms is that periodically, unpredictably, he will get these red spots on one or two of his toes on each foot that start to tingle. Like he'll get a tingling and the spots will become red. And they'll open up and become sores. And so when he first started, he came, he started coming a few weeks ago. So we're good, we're on our second, third treatment, maybe. Didn't have any of these spots or sores. And between the last time I saw him and this time, he mentioned he had a tingle and then he has these red spots like on the tips, just under the tip, the toe tip. Like if I can't remember what the is it The sh I can never say the Chinese word, but the tip the tips of the fingers, if you had the tips of the toe points, you know, they're just below those points. So on the second and third toes. So like stomach channel, maybe. And they're blanchable because I check, you know, as a nursing thing, if tissue's blanchable, it means there's circulation that's still coming to the area. And if it's not blanchable, it usually means that the tissue's gonna die. It's like a pressure sore. And I'm like, are these pressure sores? Very curious, not tender to touch. Okay, so I treated him with traditional Chinese medicine style, acupuncture, moved the needle on zero things. Okay. He came back. And so when he was talking about sand, and I already know this was this was not correct that I shouldn't have done this, but I did this anyway. I was like, well, it's a deep, like, could sand be numbness? Is it a deep numbness? So despite that he Has a more of a large intestine constitution. I did supplement the large intestine and he was fine on the table. Didn't do anything. Like and like nothing. One of these patients where like nothing is moving. I was like, are you sleeping any better? Is your update any better? And in terms of like other constitutional things, he tends to run on the cooler side. Skin is normal. It's kind of like kind of dry, like not super dry, but not super moist. But like on the drier side, digestion's fine, appetite's fine. Energy is pretty good. He has some kidney qi deficiency stuff. So he's got, you know, he has frequent clear urination, has some incontinence, multiple voids at nighttime. So that sort of thing. So maybe he needs heart. I don't know. So I went back to traditional Chinese medicine style acupuncture and I did ba feng. And he felt very much of the energy going to his feet as one does with ba feng. I don't ever lead with ba feng, just like I lead with. Saam a lot of the time just because of the intensity of the needling. And so I don't know what the I don't know what the effect of this will be, but this is one of those patients like the needle is not moving at all. And so I abandoned ship with large intestine because I realized I realized after that visit, I was like, I probably should have done something different. Like maybe he needed spleen. And then I was like, what could I do? Spleen?

Toby: No, but maybe even spleen, especially the sand sensation with dry on the inside and slightly dry on the outside, then I would consider spleening better for that. Yeah, I don't think about sand as being like a numbness.

Angelique: Think it literally as dry sand.

Toby: Be I mean, especially if they say it like that ever can

Angelique: And like heavy, but there's like a heavy sand. It was like heavy, like these feet are full of sand. So I was like heaviness, that dampness

Toby: That would yeah, would they pull me away from spleen there, but I definitely wouldn't go to large intestine for that kind of presentation. Yeah. While you were talking about it, I again, except for the fact that he is he's having a little bit of incondance, I like small intestine for that kind of thing. Right? Kidney channel going right through the bottom of the foot and then getting a lot of movement for that sand. That's reasonable. Any varicosities or anything like that on

Angelique: No, no.

Toby: I'm hesitant with heart because of the red spot. The red spa on the toes. You know, that's a that's a reason not to do it, right?

Angelique: And then I was I was wondering about stomach because he has some congestion, like he kinda has a chronic runny nose situation. That happens worse in winter. And so because the toes affected are the second and third toes, I was like, could we supplement the stomach? Yeah. So it's one of those things where it's like, I think if I'm gonna do it, I'm gonna commit and we're gonna just stick and trust the system.

Toby: Maybe supplement a lung, right? Because it's better for body type. If he's definitely dry on the inside and

Angelique: No, he but he's n the noy at the I the runniness of the nose, I was thinking of wet on the inside. How the digestion doesn't

Toby: Is that in the inside is that in the inside in the nose? Is that definitely inside?

Angelique: I mean it's coming from sinuses which are this is what messes me up. So you think of you think of running nose is outside wet? So of course. It depends.

Toby: Sometimes I do. Right. No, no, frustratingly, frustratingly, but that's what I do, right? And but especially the body type has much more weight for me than is that is that runny nose inside or outside, right? The body type definitely is inside. Okay. And the skin's definitely outside. So I can see especially if he's really skinny, then that's I know, but so I'm I'm just much more likely to supplement lung for that kind of case.

Angelique: Okay. Okay. This is why we're talking 'cause it's yeah, if I'm gonna commit, we're gonna commit. Yeah. I don't think there's any I don't think there's any other details that I've left out or missed that are significant. Other than like he's he's got kind of a liver excess complexion.

Toby: What does that mean?

Angelique: He's he's like s like it's it's like a dark sallow. He's just like dark. Like it's just there's a darkness. Not in his energy per se, but like in his in his face. If I were thinking of it in like the four humours, he'd be melancholic. You know, it's just like he's got that sort of look.

Toby: Yeah, that's great to recognize it. And then maybe the lightness of Sanjiao might help with that heaviness in the feet. And that you especially we could say that might be heat below with the red spots down below. You know, so again, I'm just always trying to w what's the body trying to tell us it needs? So especially, you know, persistent red spots, we could we could say that's a heap below.

Angelique: Well it's not it's intermittent. It's very random. It just so happens.

Toby: Less weight less weight on that then. Okay. But it definitely the heaviness, right? It definitely has that heaviness in the feet. Okay.

Angelique: Okay. So that gives me some options I hadn't considered before. Okay. All right. Yeah, that was my it's like, wow, because I was looking at that, I'm like, how do I even interpret this? So that makes a lot of sense. I somehow forgot that like, yeah, red spots mean heat.

Toby: But they like you're saying they're intermittent, so I'm hesitant to jump on that.

Angelique: They're they're intermittent in appearance. It's like once they appear, it seems that they're there and they get worse and they open and then the wounds are slow to heal. That's been his history. And so I'm I'm seeing the beginning of a cycle for him. So it's not like they come and go throughout the course of like a month or something. It's they're cyclical over like a year, year and a half. I think the eighteen months was the last time he had these.

Toby: Ask him if there's a temperature component to his feet.

Angelique: Sensation wise.

Toby: Yeah, 'cause he'll tell you don't don't lead him hot or cold, right? Just ask him, Is there a temperature con component to your feet?

Angelique: Okay. That's a good way to ask it. In general, is there temperature component to your hands?

Toby: Yeah. That's it. Again, it just keeps it open. And then and then feel yourself too, right? That's that you know, especially if you palpate the leg and it gets hotter as you get down. That's the that's a supplement Sanjiao idea for me. Okay.

Angelique: That's not something I mean, I palpate, but I it's j like th if they feel warm, they feel cold. I did not consider doing it on a gradient.

Toby: Yeah, especially as you as you go down the leg.

Angelique: Okay, that's helpful. Thanks.

Toby: Okay. Good. Yeah. Anyways, th this it's nice as we discuss stuff, then we can talk about more and more nuanced things. So th thanks a lot for bringing it up. Sure. Anything else? Go ahead.

Angelique: No, I was gonna say that's that's all at the top of my mind for this moment. How about

Toby: Great. I always have tons of stuff to talk about, but let's stop it here and then let's pick it up next time, okay?

Angelique: All right. That sounds good to me. We'll see you next time.

Toby: Yeah, good talking to you. Take care, everybody.

Angelique: Bye.