Warnings over coffee

I warned the young doctor, the moaner

Striving to pay off his loaner

All of that debt

Just has to be met.

Please, never turn into an owner.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week.

Job offers cross my desk and invade my emails every day.  Most weeks include half a dozen calls from recruiters.  Just last week I got a flyer promising a strong six-figure base pay, with an available 66% upgrade for taking call.

I’m not in the market. Just trying to work reasonable hours takes up most of my time.  I forward some of the more interesting opportunities to a couple of colleagues who find themselves between jobs, a status that doesn’t last long for a doctor.

I sat down with one of them today, over coffee, to talk about an offer.  The email promised half the money a teacher makes, but would give the successful hire a chance to improve some skill sets. 

I informally counsel a good number of docs in the early phases of their careers.  If I talk about hanging up a shingle, I caution about the burdens of being an owner, and none of the cautions relate to the rapidly changing medical business climate.

The Affordable Health Care Act increases the regulatory burden on doctors.  With all the forms to fill out and reports to generate, few physicians can continue in small or solo practices unless they reject money from insurance and the government.  But that’s not what I warn the young docs about.

A medical business owner has to worry about overhead, and thus must be willing to fire less than stellar employees.  Few medicos have business training, even fewer have business sense, and most try to keep marginal staff in place, hoping they’ll improve.  If you’re kind enough to want to help people, you hate to fire a patient because they don’t pay bills.

I apply all these criticisms to myself.  Every day I go to work not worrying about management reminds me of how much emotional energy I spent on being a boss.

On the other hand, I finished med school with a mere $3,000 in debt (I had great poverty skills) and I didn’t face six figures of pay back.

More and more doctors marry other professionals and two good incomes decreases the drive to seek the highest paycheck.  At the same time, the physicians now coming out of training have had work hour limits, and hence have better leisure skills than my generation of doctors.

“Don’t get on the hamster wheel,” I cautioned my colleague.  “You’ll find it very difficult to get off before you burn out.”

Still the 40-hour work week, the ideal balance between home and work, eludes every doctor I know of, even the ones on salary.

Of leisure skills, Hospice, coq au vin, Barrett, Ellington, and drug reps

I sent patients from Hospice alive,

I visited my old clinic hive.

     So that I’m not alone

     I got a new phone,

And served dinner at fifty past five.

I started my day by getting a new phone.

I had to replace the old one with a smart phone that would let me use a drug database.  It can also function as a camcorder, take excellent pictures, act as a GPS, remember more music than I’ve had time to listen to in my life, and browse the net.  I rate it Pretty Miraculous, but I realize I’m starting at the bottom of the learning curve and that it can do a lot more.  I’ve missed every call I’ve gotten so far today because I changed my ringtone.

I did well at my saxophone lesson.  My teacher, Diane, and I played some pretty great music; we did a duet by Barrett and it came out well.  Then we jammed some Ellington.  I allowed my analytic hemisphere rest and I let the horn find the notes.

My teacher continues to be a beacon of life lessons.

I stopped by the Clinic Formerly Known As Mine, I got lots of hugs and told my tales.  I also ate the lunch the pharmaceutical manufacturers’ representative brought, but I didn’t talk to the rep, and as I walked away from the clinic I realized that in the last eight weeks, the amount of time I hadn’t spent talking to drug reps totaled forty hours.   On the other hand I know of four new drugs on the market that I need to learn about, possibly more.

I’m still the Medical Director at Care Initiatives Hospice; while on my epic road trip I attended meetings by Skype.  Today I enjoyed having a real meeting.  I feel we do a good job; we let another patient out of Hospice alive.  We cut dosage or eliminated a medication six times.  A Hospice meeting brings lessons in the human condition, eternal verities about drama and irony, and, as always, great stories.  I won’t write those stories because demented people cannot give their permission.

Back at home I cut up chicken hindquarters.  I poured tablespoons of garlic salt and black pepper into half a cup of flour.  After dredging the chicken in the flour, the pieces browned nicely in canola oil at the bottom of a Dutch over.  I took the pieces out and dumped in a pound of sliced Portobello mushrooms  and two chopped white onions.  After sautéing those till the onions were translucent I put the chicken back in, dumped in a bottle of white wine, and pressed in a dozen cloves of garlic. The covered pot went into a 350 degree oven.  Two hours later the house smelled lovely; by then I had two loaves of take-and-bake baguette bread ready, and the rice cooker had done its job.

Our friends, Dolf and Mercedes and their children came over for dinner.  They talked about the Florida adventure they’d just been on and I told about my 6000 mile, 7 week road trip.

Dolf has a strong work ethic but he also possesses an enviable set of leisure skills.  About a year ago I went to him for advice in that realm.  He said, “I got one word for you:  practice.”

I’m taking his advice.