Archive for the ‘Veteran’s Administration’ Category

Meeting the VA’s New Rheumatologist

January 11, 2017

I drove through the snow to Sioux Falls

The place with the old red brick walls

Where it seems it’s the norm

For the staff to be warm

To the vets who walk down those halls.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and assignments in western Iowa and southeast Alaska, I’m back home. Any identifiable patient information has been included with permission.

I heard this joke in 1982: You walk into the patient’s room in the VA and there are three glasses of orange juice on the bedside table.  What’s the diagnosis?

The punch line goes, “Patient died 3 days ago.”

Fast forward 20 years.  Having suffered for more than 30 years with chronic back pain from ankylosing spondylitis (much like rheumatoid arthritis but affecting the spine) I had started the miracle drug Enbrel a year prior, and finally got an appointment with the Veteran’s Administration rheumatologist in Sioux Falls, South Dakota.

Please do not judge the VA on the delay of care. I separated from the Public Health Service (along with National Oceanographic and Atmospheric Administration, the two uniformed services that no one knows) with such anger that I divested myself of certain papers. After the critical regeneration, booking a first-time rheumatology appointment took the same 6 months that it would in the private sector.

I came unprepared for the warmth and caring that flowed from everyone in the institution. I certainly did not expect two secretaries on their lunch break to help a clearly disoriented vet wandering the hallway, nor to do so with such kindness.

Since then I’ve driven once or twice a year back to Sioux Falls to meet with the rheumatologist. Every month or so I get a refrigerated container in the mail worth about $2,500.

The routine includes a lab appointment; if scheduled for 9:00 I can count on being done with the blood draw by 9:02. I have watched the system acquire bits and pieces of efficiency, until it happens as fast as possible without rushing the patient.

I’ve not had a morning doctor’s appointment previously. The blood test itself takes an hour to run, and I can only imagine the clockwork precision behind the scenes.

I sat down to wait. I napped.  I read a medical journal I’d brought from home.

I chatted with another vet, one of the moral giants who regularly walk the corridors there. I saw a lot of modified heroes.  In the last 15 years I’ve seen the number of women vets steadily increase.

A nurse came out to tell me of the doctor running behind schedule. I told her I understood patient flow, especially in a raging blizzard.

The doctor apologized to me for the delay, too, before anything else. I’d not met her before.  Young, energetic, and kind, she has a quiet competence about her along with the extraordinary intelligence that  permeates the subspecialty.

We both spoke well of the rheumatologist who preceded her during his semi-retirement, and I thanked her for coming to the VA. We agreed that telemedicine might be the future in a few specialties, but not in rheumatology.

Not until I explained my ankle problem in medicalese did she ask, and I told, of my status as a physician.  After that things went much faster.

I spoke briefly of how much I liked locum tenens. But I didn’t give details, so as not to make the next patient wait longer.

Where I’d walked into the building in low visibility, I walked out in bright sunshine. A fierce north wind which ruined gas mileage on the trip up sped me on my way home.

 

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Uncertainty usually strikes at least twice

November 2, 2016

Only a second was I left perplexed

And then with the changes I flexed

I know what to do

When the plans all fall through

I ask, What shall we do next?

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor.  Just back from a Canada moose hunt, I’ve worked a couple of days in northern Iowa, and I’m taking a few days off.  Any identifiable patient information has been included with permission.

I have been working on practicing in Canada for 20 months. Six weeks ago I thought I was within 2 months, then 3 weeks ago learned that my case would have to go through immigration because I have no plans to immigrate.  And that their review would take 6 months.

OK, I know how to deal with uncertainty. Bethany and I talked for about 10 minutes, with the unspeakable luxury of discussing, Where shall we go next?

If I had the chance to tell me as a teenager what life would look like 50 years in the future, I would not have believed me saying that such freedom could exist in the real world. We decided on interior Alaska for the winter.  And I decided I wanted to work for the Veterans’ Administration, because they have been so very good to me.

I got on the net, I plugged my headphones into my cell, and I started the process. VA facilities run shorthanded chronically, but the one in Fairbanks no longer works with agencies.  And they are willing to work with me directly.

Over the next couple of days I got emails from several people in the institution with a far warmer and friendlier tone than I expected.

Last week I started the credentialing process. I put in a mere 7 hours, finishing yesterday with a trip to FedEx.

Because I cut the agency out, I’ll have to arrange my own housing and vehicle.

Tonight I talked with a man who specializes in selling cars to seasonal Alaska workers and buying them back when the jobs are done. I’ll wait till things have firmed up till I start contacting real estate agents and other housing mavens.

Yesterday I learned that that my putative Canadian gig had found permanent recruits and wouldn’t need me.

Uncertainty, part of the human condition, runs rampant in the locum tenens business, and struck again in less than a week. Yet from experience I know if something falls through, I generally end up having a better time with my second, third or fourth choice than I would have with my first.

I got out my 3×5 cards and started making notes as I cruised Googlemaps and Wikipedia.

I read stuff to Bethany, and we talked. She doesn’t want to go anywhere reachable only by small plane or snow machine, or that has under 1000 people.  I, in turn, define my professional zone of comfort as less than 2 hours from the nearest surgeon.

We have to have indoor exercise facilities for both of us, internet access, and at least one grocery store. Nice options would include a cinema, indoor archery range, and recreational fishing.  I would like to walk to work, and Bethany would like to be able to get work as a teacher.

We’re looking forward to the next adventure.