Monday, July 29, 2019

Exploring: One of the Pluses of Locum Tenens Urology


Brownsville NY 

Cape Vincent Lighthouse: where Lake Ontario becomes the st Lawrence River


Lake Ontario from Sacket's Harbor, site of War 1812 Naval battles


Finger Lake

The Black River


Grand Hotel, Clayton NY


Lake Ontario


Black River Trail, Watertown NY


Black River rafting, Watertown NY


Black River State Park


Night Skiing, Watertown NY


Typical winter evening, Watertown NY



Samuel Clemens, resident Elmira NY


Mohawk River Bridge, part of Erie Canal-way


Watkins Glen State Park


Finger Lake


Elmira College, 2019 Women's NCAA Hockey playoff


Chemung River, Elmira NY


Elmira NY


Street Fair, Elmira NY


Tribute to vets of the Spanish American War, Elmira NY



Wednesday, July 24, 2019

An excerpt from my newest book


An excerpt from my newest book coming out soon

Stream of Consciousness: A Tail of Male Infertility, Medicine, Life, & The New York Thruway  (A Real Cock & Ball Story)



I decided to drive.  I like a good road trip but what began with the excitement of a road adventure and good audio book soon gave way to increasing stress and tension with each passing mile.  The first 3 hours was pleasant enough but as I turned onto I-90 heading west from Albany, melancholy overcame my cheery disposition.  Interstate 90, which is known as the New York Thruway, traverses the state and passes some of the most important yet forgotten historic locations of our nation.  This is the region of the eastern edge of the Erie Canal, built in the early 19th century by Irish immigrants, at a tremendous cost in both dollars and lives.  The Erie Canal may well be one of the greatest construction achievements in US history and even world history, on par with the Panama Canal and maybe even the Pyramids at Giza yet as I was driving along the highway all I could see was economic despair.  I turned off the audio book, unable to concentrate.  The river was pretty but the towns along its banks looked destitute, slum-like.  I had to look up on the map to learn the name of the waterway; the Mohawk.   Old bridges and locks; a canal system.  I had to ask myself, “What is this canal?”  I don’t recall ever learning about it in school.  How is that possible?  I made a mental note to learn about the Erie Canal during any downtime I might have this upcoming weekend of locum tenens urology call, the mere thought of which making my throat dry.
The Erie Canal was built to connect the food production facilities of the Midwest via Chicago with New York City and then the world.  The Canal is what made New York City a world capital and had a great deal to do with our nation’s prosperity.  The canal’s slow death began with completion of the St Lawrence Seaway to the north with the final death blow occurring with completion of the Thruway in the 1970s.  The canal did make many of the cities along its path rich.  Towns like Amsterdam; Herkimer; Utica; Rome: these were once thriving industrial and manufacturing towns that to me, as I drove passed them, were in decay.  The recession of the early 1970s worsened things and the towns along this once prosperous corridor have withered on the vine.  Poverty in this region of NY is rampant with rates exceeding 30% in some cities.  
My mood worsened and dread crept into my head.  I no longer wanted to be here, on this depressing road, and when I got to Utica, a city with close to half its population living in or around poverty, I decided to get off the Thruway and take a local, rural highway, in search of some charm; some history.  I hopped onto NY12, a 220-or-so-mile rural highway that starts near Binghamton and ends along the St Lawrence River, skimming the western edge of Adirondack Park.   NY 12 skirts Adirondack Park but is not part of the preserve, with its pristine lakes, dense forests, remote wilderness and high peaks.  The Adirondack Mountains are old mountains, much older than the Appalachian Range or any other range for that matter, by 2 billion years or so.  In fact, the Adirondack Range is the oldest range in the world and was formed prior even to the period of Gondwana, the giant multi-continent land mass that preceded Pangea by more than a billion years.  Theodore Roosevelt successfully fought to preserve the Adirondacks from development, starting the conservation movement.  Adirondack Park is magnificent.  But NY 12 remains outside the park, a world away from magnificent, as it winds its way along the Black River passing town after town filled with decay, dilapidation, & despondency.  
I was going upriver into the heart of darkness.




Thursday, July 18, 2019

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.

Friday, April 05, 2019

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

Tuesday, December 18, 2018

The Downside of Locum

Zero job security

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

Time away from family

Loneliness & boredom


Saturday, December 15, 2018

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.  

Thursday, December 13, 2018

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. 

Thursday, November 29, 2018

Interview with NY State Assemblyman Raia

Thanks so much to Assemblyman Raia for your time.

Wednesday, November 28, 2018

Monday, November 26, 2018

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. 

Saturday, November 24, 2018

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

Saturday, October 14, 2017

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.

Tuesday, May 23, 2017

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.

Thursday, May 18, 2017

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.

Wednesday, May 17, 2017

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.  

urologist

Wednesday, May 10, 2017

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.

Tuesday, November 03, 2015

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.