Friday, September 2, 2011

Commencement

This blog is primarily a narration of starting a private primary care clinic, from a physician standpoint, in real time.  It will subserve the core of a documentary, to be developed in the future.  Responses and discussion are welcome.

Background:  I am a 45 year old male physician trained in family medicine at the Baylor Department of Family and Community Medicine, a division of the Baylor College of Medicine, in Houston, Texas.  I actually started out in general surgery, but after 3+ years of residency training, I transferred to family medicine on philosophic and pragmatic grounds.  I graduated from the Baylor program in 1998 and started out working for a physician in south Texas, for $150,000/year for two years.  Because I did not have my contract carefully reviewed by an attorney, I ended up being paid only $270,000 for that time, however.  In those days, it was fairly typical for a physician graduating from a residency program to take a job for $120,000/year, or $150,000/year if the individual did obstetric work as well.  When that contract expired, I left the acrimony behind, and started my own clinic, de novo,  in a nearby larger city.  That office opened on 15 January 2001 in a 1,500 square foot office with two employees, completely paperless, with what was then Millbroook's Paradigm practice management system (handles demographics, accounts receivable, electronic transmissions, etc.) and Medicalogic's Logician, a comprehensive electronic medical record.  I had used the latter company's internet version of that product for a year or more prior.  Those were exciting and trying days, as I learned about the business of medicine, and the complex world of information technology (IT).  For almost nine years that practice grew and flourished, taking me from an income that necessitated filing earned income credit (EIC) in the first year, to almost $300,000/year in the end.  Personal changes, however, lead me leave that practice, and to move to The Woodlands, Texas, over 150 miles away.

The Woodlands is a beautiful and surreal world of affluence and expectation.  Residents refer to it as "The Bubble," suggesting an insular non-reality.  Think Stepford Wives, or perhaps utopian conformity.  The average income here at almost $120,000, but I did not move here for those reasons.  I moved here for the most common reason men move anywhere.

Initially I worked for a 15 member group of healthcare professionals locally, with an option to buy in later.  The work was demanding; the environment, oppressive.  While it was personally and professionally challenging, I persevered and offered suggestions about changes that would benefit the patients and practitioners alike.  Nonetheless, I was more than surprised to be suddenly and completely unexpectedly terminated after 20 months with the group, reason not given.  Later it was suggested to be a cost-cutting measure of some type, though I am am certain my average productivity was far from the least on the team.

Considering my transition from surgery to family medicine, my difficulty with my first employer and associated fiscal loss, my recent personal challenges, and this most recent job loss, I rationally must consider in what way I may be flawed that I do not maintain fluid relationships.  I am generally not bombastic or short tempered.  I am regarded by most as gentle, sensitive, and patient, perhaps too much so.  I believe that I have conditioned myself to believe that I can do a better job in a small work environment than in a larger one.  So here I am, jobless, capable, and searching for a better way to do medicine.  Commencement.  More to come.

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