Dr. Nell Smircina of PIQUE Health: 5 Things You Need To Know To Create a Highly Successful Private Practice

Always invest in your personal growth: We grossly underestimate the effect that personal growth will have on business growth. Investing in ourselves isn’t just about taking out a business loan for a larger space or build out and having the confidence it will work out; it’s about making sure we are growing as the visionary behind our practices.

As a part of our interview series with prominent medical professionals called “5 Things You Need To Know To Create a Highly Successful Private Practice” I had the pleasure of interviewing Dr. Nell Smircina.

Dr. Nell Smircina is a Licensed Acupuncturist and passionate healthcare advocate, specializing in the integration of Acupuncture into the Standard of Care. She is the Founder of PIQUE Health, a concierge integrative medical practice in Beverly Hills, CA. In addition to her work with PIQUE, Dr. Nell teaches in various master’s and doctoral programs, serves as the President of CSOMA, California’s State Association for Acupuncture, as well as on the Advocacy Committee for the American Society of Acupuncturists, and actively coaches students and practitioners looking to have flourishing practices.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you ended up where you are?

I originally knew nothing about integrative medicine, let alone acupuncture, which has since become a key part of my life mission: bringing acupuncture into the standard of care. I originally went to school on the path of becoming a surgeon. As I got through pre-med, I realized I would have a very difficult time balancing all the things I wanted in life with that career choice. I had done internships in Physical Therapy since I was about 15 and thought that would be a better fit to allow for more schedule/family flexibility while also allowing me to operate my own business. However, as I started working in entry level physical therapy, I was extremely frustrated with the limited scope of practice and had so many unanswered questions about inconsistencies in patient results.

Fortunately, at the time I was also on my own health journey, needing solutions for chronic pain from previous gymnastics injuries. I ended up trying acupuncture out of desperation, and to my surprise it was the one thing that worked for me. As I learned more, I found out that acupuncture is only one modality within a complete system of medicine; and learning more about that system even brought me answers about why certain patients heal differently than others. It also was a way for me to help patients more comprehensively and expand my scope of practice.

I am a person who is slightly obsessed with being as qualified and effective as possible, so I set out to complete my masters and then doctorate (a designation only 1% of acupuncturists have) in California, which was known to have rigorous education for this medicine. Moving to California from the east coast, I went all in, wanting to learn the ins and outs of this industry. I managed the teaching clinic at my school while I was completing my doctorate, started consulting for various herbal and supplement companies, and then got into advocacy, serving as the President of the California state acupuncture association and on the Advocacy Committee for the National Association.

I set out to not only have a private practice, but a successful one, which would provide a high touch, elevated patient care experience and demonstrate tremendous value for acupuncture and integrative medicine. I had every intention of staying involved with surgery patients, and did my doctoral research on acupuncture for post-surgical recovery. Post-surgical patients and men’s health are the two primary areas of focus for me as a clinician.

I’m a huge fan of mentorship throughout one’s career. None of us are able to achieve success without some help along the way. Who has been your biggest mentor? What was the most valuable lesson you learned from them?

Marilyn Allen. I have always called her the “queen of networking”. She is a force: such an advocate for acupuncture and the elevation of patient care. When I first got licensed, I asked her, “Marilyn, what is going to happen when you don’t feel like doing this anymore? Who is going to come in and speak for this amazing profession? How can I learn from you so we don’t lose momentum for this movement?” Five years later, I have been given this gift of working with her at American Acupuncture Council. She has taught me the power of manifesting and goal setting, the power of having a “why” and aligning your decisions with it. It is so important to surround yourself with people who will push you to reach your potential.

What made you want to start your own practice? Can you tell us the story of how you started it?

What made me not only want to have a practice, but a successful one, was seeing brilliant clinicians fail at business. I was seeing patients who needed help but had no idea what they needed to feel better. I wanted to see people value acupuncture and integrative medicine, rather than considering it “alternative” or “optional”. I wanted to disrupt the industry and rectify misconceptions, or stigmas and stereotypes, around my profession.

We have so many chronic diseases in this country that require a more comprehensive approach to care, and I saw that many of my colleagues were brilliant with treatment, but suffered with communicating value and running a business. I set out to conquer this area: show the value of this medicine by bringing meaningful results to patients in an environment that felt comfortable and high end, where patients truly understood the value of the service that was being provided.

Can you share the most interesting story that happened to you since you began your career?

When I was just starting my practice in Los Angeles, I was working full time as the Clinic Manager at the master’s program teaching clinic at Emperor’s College. I was also completing my doctorate and was seeing patients on a limited basis simply due to time constraints. I was offered an opportunity to meet with a Neurologist who ran an integrative medical suite in Beverly Hills, as he was looking for an acupuncturist. This opportunity was brought to me by one of the student interns at the clinic and I almost talked myself out of even going. I told myself unsubstantiated stories (I think we all are guilty of this time to time). I thought, “They probably want someone full time” or “I don’t really want to work for someone, and they probably are looking for an employee”. What stopped the story telling spiral was me refocusing on my why: bringing acupuncture into the standard of care. I realized the worst that could happen was that I’d meet some practitioners interested in integrative care and would have the opportunity to educate on the power of acupuncture as part of an integrative model. It was bigger than me.

I went to the meeting and it turned out to be an ideal situation. They were not looking for an employee- they were looking for a Licensed Acupuncturist who wanted to have their own practice in an integrative medical suite. Hours were flexible and because it was a collection of practitioners, it was the perfect setting for me. I was able to afford renting two days per week, while working in an awesome collective of practitioners in Beverly Hills. This was really my foot in the door to building a Beverly Hills practice. I started small and learned so much from others around me before moving into my own space. I got to truly integrate myself into the Beverly Hills community without doing the typical business loan for a medical suite build out and then growing. I eventually (and intentionally) outgrew where I was and felt more than ready when I got my own space, thanks to something as simple as staying focused on why I’m doing what I’m doing. This was just a confirmation that you can’t go wrong by letting your “why” guide every decision you make.

Because it is a “helping profession”, some healthcare providers struggle with the idea of “monetization.” How do you address the business aspect of running a medical practice? Can you share a story or example?

Previously, I was the Clinic Manager at a master’s program teaching clinic, and every quarter would lead an intern meeting. This meeting was for students who were going through their intern years, treating patients, but under supervision for clinical hours. They always were issued business cards, and quarter after quarter, they would have many left over, and felt hesitant about handing them out. Self-promotion and marketing felt uncomfortable, or even wrong, as if by promoting what they do, they were somehow not as invested in the “giving” aspect of providing care.

My message to them was simple. You should never feel badly about promoting what you do when you are coming from a genuine place and have the ability to help someone. If you see someone who needs help and you stay silent, that’s what you should feel terrible about. You spend so much time and money on your education to be in a position to effectively help people, and there are many ways to feel like you have a good balance. I personally do pro-bono work with veterans or low-income populations, but the majority of my time in practice is monetized at what my experience and care is worth. If I could not care first for myself and my family, the energy and experience I bring every day to my patients would be unsustainable, and there is no way I’d have the luxury of doing pro-bono or philanthropic work.

Managing being a provider and a business owner is a constant balancing act. How do you manage both roles?

I’m still learning every day! I think constant self-assessment to see what you like, don’t like, are good at, or need improvement with, all factor in. The practitioner/business owner role is one that requires you to be brutally honest with yourself about what you are truly meant to be doing with your time and passion. It’s easy to fall into the “I have to…” during the day to day. But I have realized how passionate I am about business and how effective I am at articulating value; and I’ve started hiring more practitioners who have zero business interest but are phenomenal doctors. I also have no business running my own books or doing taxes! We have to be humble enough to let someone else help with the juggling if that’s what is best for the patients and the business. You can never be everything to everyone.

From completing your degree to opening a practice and becoming a business owner, your path was most likely challenging. Can you share a story about one of your greatest struggles? Can you share what you did to overcome it?

The biggest challenge for me has been doing everything possible to dispel the stereotypes associated with my industry, while also battling the more obvious challenges of being a young female doctor. Educating people on my credentials, the validity and efficacy of the complete system of medicine I practice and working to stay above the fray is a constant. Every industry needs role modeling, and as a leader, educator, and coach as well as a practitioner, holding myself to a high standard of professionalism is a necessary responsibility but can be a struggle. Sometimes it would be great to go to a business meeting in jeans and a t-shirt, but not only is that not on brand for my business, I also want to constantly portray a better image for my profession as a whole. My solution to overcoming this has always been consistently staying focused on my why: bringing acupuncture into the standard of care and reminding myself of the role I play in that goal.

Ok, thank you. Here is the main question of our interview. What are the 5 things you need to know to create a thriving practice, and why? (Please share a story or example for each.)

1. Always invest in your personal growth: We grossly underestimate the effect that personal growth will have on business growth. Investing in ourselves isn’t just about taking out a business loan for a larger space or build out and having the confidence it will work out; it’s about making sure we are growing as the visionary behind our practices. Any time I’ve taken a slightly uncomfortable jump to invest in myself, has always paid off in one way or another: through a lesson, a connection, or actionable tools I can use for business growth. If you look at my books, the largest financial investment is my growth: seminars, one on one coaching, masterminds, classes, etc.
2. Know your brand and do not stray: If your brand is genuine and is actually the right fit for you and your business, then who you attract as patients are the right ones for you. Staying consistent with your brand allows you to continue to help the right people. Pretending to be something you are not will not only affect your happiness, but also the results for your patients. Your “why” dictates your brand, or it should at least. It should feel like an extension of your mission, so it’s easy to stick to with a little practice.
3. Everything is always your fault: get comfortable with being accountable: I know this is a tough one! As a practitioner and business owner, it’s tempting to say “I’ve never done X before” or “How was I supposed to know Y?”, but with these roles, you don’t have the luxury of a victim mentality. If something in your practice isn’t going how you want it to go (Not enough patients? Staff not motivated? Patients aren’t referring people?) you have to first look at yourself and your accountability. What could you have done differently? What should you do more of because it’s working? Who could you enlist in this process who knows more than you? Learning accountability is such a freeing experience because it allows you to maintain control over your practice in a positive way. You’ll never stop growing if you have a structure for holding yourself accountable and making changes when necessary.
4. Other providers are not your competition, they are on your care team: Yes, owning a practice is a business, but having qualified people on your team (inside and/or outside of your office) boosts your credibility big time, and brings more value to your patients. Knowing who to enlist in a patient’s care, or potentially who to refer to if you’re not the best fit for the patient is so important. For example, in my practice I work primarily with recovery like post-surgical care or injuries, and also Andropause, or middle-aged men’s health. I treat male fertility effectively, but I know some amazing specialists in female fertility and often refer patients. We cannot be everything to everyone, and I’d much rather refer a patient to the practitioner who will help them the most than keep them just for the sake of having another patient. Many patients who I have referred to other providers have then turned around and referred me a patient who is a perfect fit for my practice. Which leads into my last thing to know…
5. Remember every little thing is about the patient experience: Every business and clinical decision we make needs to first check the box of being best for the patient and their experience. A silly example, since I gave a patient referral example previously: I was obsessed with these chairs for my consultation room. They were beautiful, on brand, and easy to clean, and I was so proud of the fact that I had the capital to redecorate my office without feeling stressed about it. The downside? They were in no way comfortable for the patient to sit in for 45 minutes! So regardless of my emotional attachment and excitement about them, they got nixed. It can be something this simple. You have to make sure everything is about the patient first. I’ve also moved out of an office building which had 7 floors of medical professions (and easy referrals) because the walls were so thin and patients could not relax hearing the noise from the ultrasound machine next door. That’s a bigger leap than office chairs, but I was not going to knowingly stay in a situation which would not get any better for my patients. It’s about them.

As a business owner you spend most of your time working IN your practice, seeing patients. When and how do you shift to working ON your practice? (Marketing, upgrading systems, growing your practice, etc.) How much time do you spend on the business elements?

Historically, I have spent too much time on things that just “had to be done”. I have recently started a new practice of evaluating tasks. I see how much time the task requires and ask myself if I would pay someone my hourly rate to do that task. If I wouldn’t, I look for another solution and someone who can do that task more efficiently and effectively than I can. It’s hard to imagine as an incredibly passionate person that someone could do something better than you in your own business, but this is a reality. Some business owners are absolutely meant to stay primarily in the provider role, while some, like myself, are really interested in growing the business and should have additional providers to help with patient care. Some practitioners need an office or business manager. It’s important to know yourself and constantly evaluate why you’re doing what you are doing.

I understand that the healthcare industry has unique stresses and hazards that other industries don’t have. What specific practices would you recommend to other healthcare leaders to improve their physical or mental wellness? Can you share a story or example?

To see what’s right for you, constantly ask yourself if you’re demanding the same things from yourself that you would expect from your patients. If I’m telling patients that acupuncture once per week is something to do even if you have no chief complaint and are just looking to maintain good health, decrease stress and boost immunity, then I better be doing that as well. We give these simple hints to patients like no screen time right before bed or increasing hydration, and often as providers we get “too busy” to do the basics ourselves. I’d recommend starting there because there is a reason we give certain guidance to patients: we believe these are things that will give them the biggest bang for their buck, and that should work with us too.

So think about the five non-negotiable things you’d ask a patient to do and make sure you’re doing them yourself. For me, it’s acupuncture once per week even if I’m just stressed and nothing else, a weighted blanket for deeper sleep and nervous system regulation, room temperature or warm water rather than iced or cold water, no screens a half hour before bed and moving every single day even if it’s a 10-minute spin class or 20 minute walk with my dog. These are all super-efficient, effective, and not overwhelming things to implement.

Can you please give us your favorite “Life Lesson Quote”? Can you share a story about how that was relevant in your own life?

“Don’t stumble over something behind you”. I have this as canvas art in my living room, so I look at it every day. We are often held back by things in our past, things that no longer serve us (or maybe never did) and the only way to grow is to learn from those valuable lessons and do things differently moving forward. This is such a guiding principle for me.

How can our readers further follow your work online?

My practice’s website is piquebh.com and my most comprehensive social is my LinkedIn: Dr. Nell Smircina.

Thank you for these great insights! We wish you continued success and good health!