We all know what a personal and profound issue money can be. After all, it makes the world go round. As many people have stated, money is really a symbol of value. Its power is only in the perception and value that we give it. It has no intrinsic value in and of itself. Throughout the world, money is accepted as a means of exchange and a way to measure the value of goods and services. It is not the only way to measure something, but it is the most commonly used system of business relationship.

On a personal level, money reflects our own sense of personal value, a measure of how we see ourselves and the value we put on what we do. Many authors speak about this relationship and ways to overcome negative, "poverty consciousness" attitudes that reflect a negative self-image. Suze Orman is one of the most popular exponents of this thinking, with books such as "The 9 Steps to Financial Freedom" challenging us to take financial responsibility both practically and "spiritually" by exploring our deepest beliefs.

Even though the question may be an extremely personal one, the implications of the answer are much broader, involving our relationship with other individuals and within the culture as a whole. It is a reflection of our political and moral conclusions. As money is a means of exchange, there is an inevitable comparison and contrast between the value of my services to those of other people. This comparison is not just between others in the same field or profession but more importantly within society as a whole. Therefore, the question of defining ones personal worth and value has a social consequence.

However, how does that affect us as homeopaths? Many peoples experience in this country is that it is hard to make a decent living doing homeopathy. This is mainly due to the lack of acceptance of homeopathy. It is not that popular and is not recognized as a licensed profession and is therefore harder to get insurance cover. This is most difficult for those homeopaths that are not licensed in any way, the so-called "professional homeopaths". Although the number of homeopaths practicing is constantly growing, the number that make their living solely from homeopathy is relatively few. Another factor is that we spend a long time in our consultations and then see patients infrequently. This makes it harder to bill people according to time. One can go to see a conventional physician privately and be charged over $200 for a visit that takes 10-15 minutes. If we were to charge on a similar scale, the first appointment would be around $1500, not a realistic amount for most to pay. Other alternative therapies, such as Chiropractic, Acupuncture and forms of Therapy get around this by seeing patients more frequently. This is more necessary for those therapies, although there is some justified criticism that their motives for people to come frequently is as much financial as it is for health reasons.

So, given all these factors, how much should a homeopath charge in order to make a reasonable living comparable to other health professionals, and that can support him/her and family? This is again somewhat relative and depends on some external factors such as the standard of living in the area one lives in and the type of person the homeopath is treating or wants to treat. A homeopath in New York or San Francisco can generally charge more than in the central valley of California or in most mid-western states. Lets take the example of a homeopath that works 4 days a week seeing patients and sees a patient for 1 1/2 - 2 hours for the initial visit and 30 45 minutes for a second visit, charging $200 for the initial fee and $60 for follow up visits. If he/she saw 4 new patients per week and 7 follow-ups a day, this would average out to $121,520 per year, for working 49 weeks of the year. After expenses of say $40,000 a year, this would still come out to about $80,000, well above the national average and enough to live even in New York and San Francisco, although perhaps not enough to buy a house there!

So, what can be the justifications for charging significantly more than the amounts above? Some people would say that those with more experience should charge more money. There is obvious logic in this, but even then, is there a ceiling or should the market be the sole determinate for this decision? Another argument is that if a homeopath chooses to see fewer patients, or needs more time for the interviews and also the research involved in finding the remedy, then more can be charged. As we know, homeopathy is a time consuming business and our work is often not finished once we have taken the case. Hours of study can often be involved. However, this time needs to be considered in the consultation fee and cannot realistically be assessed on an hourly basis. Is it reasonable therefore to expect to make a living working two days a week when the majority of average working people need to work 5 days to make enough to survive? When deciding how much to charge, how much should we compare ourselves to other therapists, physicians and professional people in general? Why should we make less money than say a real estate agent? Most would agree that, given the level of skill and responsibility involved, we should be able to make a reasonable living, equitable with other professional people and that allows us to live relatively well.

However, given the lack of acceptance of homeopathy and for those of us without a license the lack of recognition in a society where medical licensure is the norm, it is challenging to make a living and to charge the fees necessary and comparable to other professionals. The issue of insurance coverage is another factor. For those professions that can charge insurance companies, there is always the tendency to charge the maximum fee possible, with the consequence now of exorbitant insurance premiums and millions with no insurance. However, it has generally served both wealthy people and those professionals serving this community. For those of us working outside of this system, we have to accept that people will have to pay out of pocket and are only generally willing to part with so much money. The amount that we can charge depends as much on external factors as it does our own "inner" sense of value.

On the other hand some homeopaths do charge significantly more than these "averages", ranging from $400 all the way up to around $1,000 for an initial consult. What impression does that give of homeopathy and for the person charging this amount? Is it acceptable for those who have given themselves to a "healing" profession to charge such large amounts of money that only the very rich can afford? Does it create an image of homeopathy being only the domain of the exclusive few, a privilege instead of a need? Also, what is the impact of this on the dynamic of the relationship between homeopath and patient? Does it create a sense of preciousness; a kind of collusion that what is being experienced is somehow more significant because of the amount of money involved? If money is the arbiter of value, then surely this can be the consequence of the amount charged.

What does it say about the homeopath in relation to other homeopaths? Does it state that because one homeopath charges $500 it makes him/her twice as good as someone who charges $250. Is this the impression intended? It is commonly stated that people respect things more when they have to pay for them, so therefore, by that deduction, the more you pay, the more you respect it. There is no doubt that when you do things for free, there is a tendency not to get the respect and appreciation that is due, but is there a limit to this? Is one of the motives of those homeopaths that charge large amounts to gain the respect for their work and profession that is generally not given to homeopaths in society as a whole? Whatever the reason, charging large amounts of money makes a distinct political statement. In the United States this option is open mainly but not exclusively to licensed homeopathic physicians who are able to have some fees covered by insurance and where physicians as a rule are able to charge what seems to many ordinary people to be exorbitant amounts of money.

One other factor is that for licensed physicians who choose to accept Medicare, the only nationalized fee for service medical insurance system, in San Francisco, a routine 30 minute visit can be billed at $80, whilst a 90 minute visit can be billed at $240. However, by accepting Medicare, all patients have to be billed at this rate, whether they are using Medicare or not. By opting out of Medicare, a licensed doctor can charge any rate they want, but this prevents some people from having access to their services.

When deciding how much money to charge for a consultation, I had to think carefully as to whom I wanted to be able to treat and the impression that I would create within the community. I didnt feel comfortable making a decision independent of the social climate I live in and the political realities of the financial class system in the United States. I chose to charge $225.00 for an initial 2-hour consultation and $75.00 for follow-ups that last between 30-45 minutes. Living in the San Francisco Bay Area, that is not considered a high rate although for many people is already prohibitive but considering I have been practicing for 20 years, people have said I should charge more. However, I felt that I wanted homeopathy to be available to as many people as possible and not to give the impression that homeopathy is only a medicine for the wealthy. It had to reflect my own political and social conscience. I also often do brief phone calls for free and I dont have a clock by the phone, ticking off every second. I do try and keep a tally of phone calls that take more than 5 minutes and may charge a $35-$50 fee for these consultations, depending on the time taken. It is easy to be on the phone a lot and not charge anything, in the midst of a busy day. I also bring people to student clinics that are charged on a sliding scale with a $75.00 maximum charge for an initial consultation. I chose not to offer a formal sliding scale in my practice as I do a lot of student clinics where people dont have to pay much, although if someone shows a real interest in wanting homeopathy and cannot afford the fees, I will accommodate them. Whilst it may appear that I am wallowing in my own sense of socialist nobility, I have also seen how I have been willing to do things for free and not respect the time Im spending A certain degree of "poverty consciousness" prevalent in many homeopaths has been alive and well within me and as said, I have had to become more aware of the amount of time spent calling back patients and charge for my services appropriately. One of the most important lessons Ive learnt to be aware of the time I spend doing homeopathy and the number of hours that can go unrewarded unless Im careful.

As homeopaths we are used to feeling somewhat inferior and it is easy not to respect the work we do, the skill involved and if I may say so, the amazing benefits that homeopathy can give. Also, in comparison to other therapies and the amount of money people often spend on them, homeopathy is usually quite a cheap option, and even if it doesnt work, it generally doesnt set people back thousands of dollars.

In conclusion, we have to explore all options that can help make homeopathy a viable profession that can support homeopaths and their families. This will only really happen when homeopathy is recognized as an independent, legal and accepted form of medicine. In the meantime, we are all rather on our own, relying on our wits, wisdom and courage. We have to have the confidence to charge a fee that fairly represents the work we do and that is comparable to others in society. It should be a reflection of the value we have in ourselves. At the same time, we have to be aware of the temptations to want to charge larger amounts of money based on a need for acceptance and recognition. At that point, the "ego" satisfaction of the homeopath is at play and this can affect the dynamic of the relationship between homeopath and patient and also have a wider impact on homeopathy as a whole. As homeopaths, we are no different than any other people, and obviously some degree of recognition and respect is important, personally and socially. However, we are also motivated primarily by our mission to heal the sick and if the desire to make money and if the power and recognition this gives becomes too much the focus, it compromises us individually and also homeopathy as a whole.

Therefore, when deciding how much to charge patients, it is important to deeply question our motives and to look inside ourselves honestly when deciding how much money we want to ask from our patients.