Let's catch up

It has been a while since I wrote about independent practice.  What can I say?  I've been busy.  Very busy.  That is a good thing. 

It has been 13 years and a few months and I enjoy solo practice as much as I did on day one, even more so. 

The early years were tough.

Lean.

Now is good.

Phone rings non-stop.  I had added 13,000 plus patients to my practice and I am really appreciated.

I have built the practice I have always wanted but never thought I could have.

I have a solid sub-specialty practice in male infertility, have a vasectomy center, do vasectomy reversals in-office and I have client depositor sperm bank. 

How many other urologists have that in Suffolk County?  Zero.  Nassau County? Zero.  New York State?  Zero.

Am I proud of this?  Hell yeah!

I have a strong referral base of independent docs, like me, who have resisted acquisition for all these years.  They ain't going anywhere.

The majority of my patients come from professional referral, word of mouth referral & web.

I do advocacy work for https://nysurologicalsociety.org/  on their exec committee and I am the President of the http://www.scms-sam.org/index3.html

It is all good.

Lov'in it.

The IU.

The New SCMS President Speaking

Sperm Talk Radio with Dr Doug Stein

Medicine Unplugged

Listen to this episode of my podcast, Medicine Unplugged, Medicine Unplugged: An interview with Dr William Spencer MD, Suffolk County Legislator https://anchor.fm/saluspopuli/episodes/Medicine-Unplugged-An-interview-with-Dr-William-Spencer-MD--Suffolk-County-Legislator-e3l2ch

The Downside of Locum

Zero job security

Control over schedule?  Not as much as you'd think

Time away from family

Loneliness & boredom

Dip a toe in the water!

You can jump in the water and hope it is a suitable temperature

OR

You can put your toe in the water

THEN

Your ankle...calf...knee..thigh...

You get the point. 

Maybe hospital based practice is a fit,maybe not

Maybe rural locales work for you, maybe not

Maybe the diamond is already in your own backyard

Perhaps before totally giving up what you love, try a temporary assignment.  

The locum gig

Everyone who does locum, it seems to me, has a story.  A good story. One that speaks to me and my independent streak.  

The full time locum who refuses conform

The mom who wants to spend more time at home by being away

The harried independent combatting burnout

The retirement plan

The mid-career "what's next?"

Is truly amazing, this option.  This locum tenens option. 

Interview with NY State Assemblyman Raia

Thanks so much to Assemblyman Raia for your time.

Interview with medical liability insurance expert

 Thanks so much for Scott Palde from Cornerstone Consultants for the incredible interview.

A discussion with a health care attorney about practice acquisition

Thanks so much to Gary Herschman of Epstein Becker Green for his terrific wisdom on private equity acquisition of medical practices. 

An interview with Dr John Phillips

Dr John Phillips: For more information on Dr Phillips.

In this interview we discuss:

1. prostate cancer screening
2. advocacy
3. medical education
4. life

1: Control.  One must have control of day to day, week to week and have decision making ability.  We all have constraints, but within their confines we need to be able to make meaningful decisions to be happy

2: Meaning: whether one lays brick, cleans floors, or does surgery, one must have the feeling that what they do has meaning and importance in the broader sense of life, to feel as though you will have left a positive mark, and that one's time here on Earth was not wasted.  One must feel as if their work is critical to the success of their organization's mission, whatever that role maybe.  

3: Respect: one must feel as though peers feel positively about your career and skills and that such skills are valued above and beyond a paycheck.  One must feel that their patients respect them as well.  Skills ought to cultivated and nourished.  

4: Academics: medicine demands a decades long learning process.   When a physician no longer finds learning fun, professional and personal happiness will suffer. 

5: Compensation: once basic needs are met, happiness is not increased by absolute W2 income levels.  While important, W2 is not everything.  Compensation ought to be linked to effort but without the other 4 elements to satisfaction, professional satisfaction and happiness will always remain elusive.

Remaining Solo: 5 Strategies

1: Go micro: go super small.  One doc.  One staff or no staff.   EHR, patient portal, no phones.  No insurance.   Good option for family doc. 

2: Go concierge: charge extra fees.  No insurance.  Good option for family doc

3: Go super special: cosmetic, anti aging, infertility.  Easier said that done. Good for plastic surgeon and derm.

4: Go non par: take no insurance.  Bill at crazy out of network rates.   Good for neurosurgery, Ortho, general surgery

5: Go stupid busy: how the rest of us do it. Take everything.  See everything.  Work everyday, everywhere.   Not sustainable. 

For option 5: rethink contracts.  Get in with IPA. 

Any other options? PM me.

5 Threats to Independent Care

Independent practice is under inexorable assault.  Here are the 5 latest threats.

• MACRA/MIPS  This is a very complex endeavor.  No one who I have spoken to really knows precisely how to proceed.  It is also a zero sum gain: the bonus payments from successful practices come from the deductions from the unsuccessful ones.  
• Cyber security  If you use any electronic resources, which includes electronic claims submittal, you are at risk for malicious cyber attack.  Protection in the form of best practice IT solutions and insurance cost $$$
• Cost sharing/deductibles  Even for patients with insurance, the dollar amounts of deductibles have risen dramatically over the past 10 years, far outpacing wage increases.  This translates to fewer patient visits and more expensive collection efforts
• Consolidation   Health care has become consolidated over the past 15 or so years.  In some markets there is only one payer. On the provider side there has been a major shift to employed models into larger and larger entities.  This means drying up referral networks combined with declining reimbursements to offices and increased premiums for employee health insurance.
• Income inequality  The majority of increases in wealth, income, and standard of living have gone to the top 1%.  Most doctor practices cater to the lower 99%, who struggle to pay bills and as such, put off health care as long as possible.  

Sorry for the doom and gloom but it is what it is.  Solutions in next post.

Thanks for listening.

The IU.

The latest and greatest tools

Always important to have the latest and greatest tools. You know the saying: with the right tools any job is easy.  

Dr Schoor

urologist

I am back!

I could find my login for this blog but just remembered it. I am back. Sorry for the delay. I have nothing else to say.

Hiking the AT

Left today for my 50 mile AT trek.  As I lay here tonight in my tent, wide awake, I reflect on the day.   

My partners and I left the hotel at 8 or so to drop off one of the cars at the end point, a trekker hostle in TN.  

Then we returned to the start point to begin the hike, which started at 12:06 pm.   We were joined by 3 others, Jeff, Elena (husband and wife) and John, age 75, and the most experienced of us all.  

The hike began with a 1500 or so foot scent up to the ridge line.  Some of the views were amazing, see below:

but most of the day was spent in thick forest.  

We got to the campsite, the No Business Shelter, at about 4pm.  We had to locate water.  The stream was 0.3 miles away.  

Not so easy but I had the right equipment to get the job done.  

Through the rest of daylight, more hikers passed through and set up shop.  Everyone has been quite nice and an interesting mix: professionals, ex-military, a retired Reverend, a finance guy etc.  

This is bear country so we had to take precautions to protect ourselves and our food.  All food gets hung in the air far from the camp.  

I am sleeping in a tent.  I am warm and comfy.   Unfortunately, the ground here is slanted so I am having difficulty sleeping. Oh well.  Could be worse.   

Tomorrow we do 10 miles to Big Bald Shelter.  Should be fun. 

Am I glad I went: not so sure yet.   Will let you know.   

AT Day 4

16 + miles.  Too much.  Exhausted. Tomorrow last day.   Here are 2 pictures. 

AT DAY 5

Today is the last day.  As I write this, I am in a shelter 2/3rd of the way from last nights shelter and THE END.

We calculated yesterday's walk to be 17 miles.  Very tough indeed.   

I feel good today though have no appetite.  Zero.   Wonder if I have a parasite?   

Is raining today.   Pouring in fact.  I am dry. 

Already did 6.8 miles.  I have another 4 miles until comfort and safety.   

All in all did I enjoy it?  At the time of this writing: no.   I feel a sense of great accomplishment but who friggin cares.  

Day 3 AT

Too bad I only post at night, when I am cold and tired.  Today was nothing short of spectacular.  The day began with a hike to the top of Bald Mountain where we had amazing views.

There was even a couple that braved the winds to camp on the peak.   

Then we descended a couple thousand feet through forest of several varieties. 

Ultimately we hit Sam's Gap, which bisects I 26.   I saw a cab.  I can't say I was not tempted to haiil it and head to Asheville, given my exhaustion and the change in weather for the worse.   

Now it is raining lightly but we have a nice fire.  

Tomorrow we do a 14.7 miler.  I am nervous but have been assured it is not too hard.   Yeh right.  The remaining 2.5 miles to tonight's area was very tough.   Of course, it was up hill for ~1000 feet.   

On balance, has been great.   As we stand here this minute, I'd like to be home.  Miss my family.   Oh well.  Tuesday it is.