Monday, September 29, 2003

Don't leave work without it

I mailed my application for disability insurance last Friday. Even though I have about 3 months to go before I lose my disability insurance through my current job, I figure I'd rather not take a chance of going without it for even a little while. Having needed it once before when an Achilles tendon rupture put me out of work for 3 months, I really understand how important this can be. As a solo practitioner, being disabled would mean no patients and no income without disability insurance. I applied for AAFP's disability insurance which pays you if you are not able to continue working as an FP. I guess some disability insurance plans won't pay if you are able to do some other kind of work.

The importance of having good disability insurance was driven home the week before when one of my friends, a Urologist, was shot 3 times by a disgruntled patient in the clinic. Luckily he survived and is now recovering, while his assailant later committed suicide. Apparently, he had been diagnosed with prostate cancer, but my friend said he had absolutely no warning that anything like that would happen with this person. And I believe it. My friend, unlike some busy specialists, is an easy-going, empathetic and patient physician who takes the time to explain things and listen to a patient's concerns. But he only gets 15 minutes per patient, like me, for returning patients. Some studies have found an association between patient satisfaction and the amount of time patients spend with their physicians. I wonder if things might have ended up differently if they could have had more time to talk. This is something that frightens me, as it should frighten us all. If this can happen to as nice a guy as him, then it certainly could happen to any of us.

As my friend said, "I don't know if I can go back and do things the way they've been done."

I know I won't.

Countdown: 98 days until target start date

Saturday, September 27, 2003

I decided to go home "early" last night (meaning 7:30PM) and finish charting today so that I could have some family time. I came in at 7:30 AM and have been plugging away ever since.

Like many physicians, I've found it hard to balance time between work (where I tend to be a perfectionist) and family. I could easily spend all day here catching up. But my daughter has a gymnastics meet from 1-5 PM today at a gym 45 minutes from here. Then I'm going to try to use my season tickets to catch the second half of the UCLA-San Diego State football game at the Rose Bowl (Go Bruins!)

The time in between work, family and personal time is the time I will get to work on getting my solo practice up and running. Fortunately, I am working half time now, so that gives me some free time to work on it. If I was working full-time, I don't think I could manage the daily grind AND starting a business, so I guess I am luckier than most.

I will also try not to spend too much time on this blog. Bye!

Countdown: 100 days until target start date

Friday, September 26, 2003

Bloody turnips

It's 5:38 PM. I just got done seeing my last patient for the day. I now have 22 charts piled on my desk that need progress notes (there were 2 no shows). I saw 7 physicals, 1 new patient, and the rest were returning patients with various problems ranging from something as easy as rechecking a high blood pressure to a laundry list of problems.

I've timed myself in the past. It takes me, on average, 4 minutes to chart and code a visit. I usually spend, on average, about 20 minutes of face to face time with a patient. So today's work will take me 8 hrs and 48 minutes to complete. I was given 6 hrs to do it in. Something doesn't seem right here.

Yesterday I decided that this situation is analogous to trying to perform phlebotomy on a member of the brassica rapa family:

"Here's another bushel o' turnips. I want 10 gallons of blood out of 'em."

"Uh, I've been squeezing and squeezing, but nothing's coming out."

"That's coz you're not squeezing hard enough."

"I think I'm squeezing as hard as I can. My hands are raw."

"C'mon, you can do better than that!"

"No, I mean it. Look, my skin is falling off."

"Squeeze HARDER! WIMP!"

"OWW! Look what you made me do. Hey, I'm bleeding!"

"See, what did I tell ya? You're getting a good gush of blood out of 'em now."

"What are you talking about? That's MY blood!"

"Look, as long as you meet your quota, we don't mind if you want to bleed on your own time."

OK. Time to chart. Although I'm starting to feel a little ........faint.......

Countdown: 101 days until target start date.

Thursday, September 25, 2003

Why is this here?

Practicing medicine in today's environment is hard enough and getting harder. Too much to do (empathetic listening to patient concerns, diagnosing their ailments, answering questions about herbal supplement XYZ, ordering tests, writing prescriptions, making sure preventive care guidelines are being met, charting a complete and defensible progress note, assigning the correct ICD-9 and CPT codes, making referrals, answering phone messages and e-mail, filling out insurance/disability/school forms, following up on test results, etc) and not enough time to do it in (15 minutes per patient).

Uh, right.

This site will chronicle my attempt to replicate what family practitioner Dr. Gordon Moore has pioneered in his "solo-solo practice" (Going Solo: Making the Leap) in the hopes of regaining some control and sanity in my professional (and personal) life. Hopefully, my experiences can help anyone else who might be attempting the same foolhardy stupid insane brave endeavor, and ease their transition while avoiding some of my pitfalls.

A very helpful resource is Dr. Moore's Practice Improvement website where other physicians share their thoughts and experiences on how to improve the practice of medicine.

Some background: I am currently a Family Physician with Kaiser Permanente in Pasadena, CA, and have been there for the past 13 years. Our clinic is very busy but the people there are very dedicated and hard-working, and Kaiser has consistently won awards for its quality of care. But quality medical care has its costs, not just financial, but emotional and psychological, too. Because of the conditions listed above, I submitted my resignation 2 weeks ago.

Kaiser is a closed self-sufficient system, so basically I'm starting out as if from residency. Others who are already in private practice will no doubt have an easier time of this than me.

So far, I've found that I can't apply for participation with private insurers until I have hospital privileges. Which I can't apply for without malpractice insurance. Which I can't get without a business location. I am narrowing my choices in office space, and hope to secure a business location in the next two weeks. And since it can take about 6 months to get approval for participation in health plans, I may be sitting in my shiny new office with no patients for the 1st 3 months of my fledgling practice.

Hmmm. Did I say this endeavor was brave? I think I was right the first time.

Countdown: 102 days until target start date.