Re: One year... and still standing!!! ;-)

[Guest guest]

Congratulations Tim!

(Consider writing an op ed piece for your local paper on finding your

ideal practice and avoiding burnout while providing excellent care, and

how good primary care will be the salvation of health care in the

U.S.).

G

At 06:42 AM 3/7/2007, you wrote:

Thank you everyone for your

wisdom and openness. You have all taught me

so much. Your help is immeasureable.

Partly because you all have been so instrumental in my office's success,

I

want to announce that as of yesterday I have been open for 1 year ...

and

I'm still standing!!!

The office has improved so much in one year, and I have a good many

ways

I'm still improving it. But most importantly, I'm loving medicine and

am

enjoying being a doctor again! That's paramount since it's the only

work

I ever imagined doing since I was about 4 years old, and as of about

two

years ago the flame was burning out and being squashed while

practicing

medicine in a large organization.

You all share in any success I have in my office. I very much

appreciate

and respect the real vanguard (Gordon, , Gwen, ,

Larry(s),

, ... and so many more of you) who were a couple years

ahead

of me and really challenged the " normal " to find something

better with IMP

concepts/models. You are all so fantastic!

Thank you, thank you, thank you!

Tim

PS -- I'm realizing I never did post photos of my office and have

never

posted stats ... I promise to try to do both one of these days!

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use

of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the

intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact

the

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original

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[Guest guest]

I would like to echo Tim's sentiments, but with a little spin.

I, too, have been open a year since January, but I am afraid to say that I am

barely making it as an solo/IMP practice. I do have other sources of income

which offsets the imbalance, but as a pure IMP, I have been very close to having

to jump ship, so to speak, to find a more conventional setting.

However...

As of late, the apparent slump seems to be lifting, and my practice is slowly

growing again. I am advertising again, an article came out on me in a Chamber

publication, and I have been getting more positive feedback than usual about my

newspaper articles, all of which have seemed to be synergistic with positive

changes lately.

Mostly, I am more aware of the regional differences we all experience, in terms

of demographics, ages, etc., but mostly in the mindset of our local populations.

Mine, apparently, is slow to accepting new ideas, and it prefers that their

doctor take insurance and Medicare.

Gordon has described the challenges of IMP’ers if you are male, rural and do not

take insurance. I am all three, and my reserves have depended on

y-in-Star-Trek-like maneuvers to make this thing survive. Unfortunately, my

lack of reserves has kept me from getting internet service at my office,

advertise more effectively, etc. And I accept all the responsibility, even if I

am more knowledgeable now, because I am the captain of this ship.

The punch line: yesterday, I was faxing a radiology report, updating my records,

in-putting notes and ticklers on my patients in my EMR, etc., and I felt a wave

of joy and pride. Where did this come from? I just stood there and thought to

myself how cool it was what I was doing, and how much fun it was all of the

sudden! Despite the recent struggles and discouragement, I felt very optimistic.

We all bring our own unique gifts to our practices and our patients. And I

suspect, like many of you, that I have yet to discover mine fully. But I am

convinced that an IMP is the “ideal” setting for this to occur. And now, as I am

trying to evolve my practice into a Robinhood/St. Luke’s model, I feel as if I

am setting challenge on top of challenge, perhaps prematurely. But I feel led

and compelled, since I will always have that internal struggle of wanting to

help the destitute while providing adequately for my family at the same time.

I am very grateful for this listserve and all of you who contribute to it. I

hope in the coming months to be able to post a more “successful” update.

Charlie Vargas

New Mountain Medicine

lin, NC

Date: 2007/03/07 Wed AM 05:42:43 CST

To:

Subject: One year... and still standing!!! ;-)

Thank you everyone for your wisdom and openness. You have all taught me

so much. Your help is immeasureable.

Partly because you all have been so instrumental in my office's success, I

want to announce that as of yesterday I have been open for 1 year ... and

I'm still standing!!!

The office has improved so much in one year, and I have a good many ways

I'm still improving it. But most importantly, I'm loving medicine and am

enjoying being a doctor again! That's paramount since it's the only work

I ever imagined doing since I was about 4 years old, and as of about two

years ago the flame was burning out and being squashed while practicing

medicine in a large organization.

You all share in any success I have in my office. I very much appreciate

and respect the real vanguard (Gordon, , Gwen, , Larry(s),

, ... and so many more of you) who were a couple years ahead

of me and really challenged the " normal " to find something better with IMP

concepts/models. You are all so fantastic!

Thank you, thank you, thank you!

Tim

PS -- I'm realizing I never did post photos of my office and have never

posted stats ... I promise to try to do both one of these days!

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.

[Guest guest]

Charlie--

Great to know you too get that wave of pride. It hits me from time to time

and I'll just stand there in my office, look around and just soak it in.

But for all the success of the year, I've also struggled a bit and

finances are not as good as I'd hoped. But they are improving and now

reaching my goals.And I admit I had the advantage of having 250-300

patients follow me from my former office -- I can't imagine truely

starting from scratch and I'm so impressed with all of you who make that

work. But until I catch up with the debt of year one, my family and I

will continue saving money in every way possible (like skipping IMP camp

and likely AAFP in Sept).

Most important to me however is the personal growth and working to improve

personal inadequacies which are glaringly obvious in this setting... I

actually love having no one to blame except myself for a problem or a job

not done well enough. The great part is that I can improve in a blink of

an eye!

Good luck with everything,

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.

> I would like to echo Tim's sentiments, but with a little spin.

>

> I, too, have been open a year since January, but I am afraid to say that

> I am barely making it as an solo/IMP practice. I do have other sources

> of income which offsets the imbalance, but as a pure IMP, I have been

> very close to having to jump ship, so to speak, to find a more

> conventional setting.

>

> However...

>

> As of late, the apparent slump seems to be lifting, and my practice is

> slowly growing again. I am advertising again, an article came out on me

> in a Chamber publication, and I have been getting more positive feedback

> than usual about my newspaper articles, all of which have seemed to be

> synergistic with positive changes lately.

>

> Mostly, I am more aware of the regional differences we all experience,

> in terms of demographics, ages, etc., but mostly in the mindset of our

> local populations. Mine, apparently, is slow to accepting new ideas, and

> it prefers that their doctor take insurance and Medicare.

>

> Gordon has described the challenges of IMP’ers if you are male, rural

> and do not take insurance. I am all three, and my reserves have depended

> on y-in-Star-Trek-like maneuvers to make this thing survive.

> Unfortunately, my lack of reserves has kept me from getting internet

> service at my office, advertise more effectively, etc. And I accept all

> the responsibility, even if I am more knowledgeable now, because I am

> the captain of this ship.

>

> The punch line: yesterday, I was faxing a radiology report, updating my

> records, in-putting notes and ticklers on my patients in my EMR, etc.,

> and I felt a wave of joy and pride. Where did this come from? I just

> stood there and thought to myself how cool it was what I was doing, and

> how much fun it was all of the sudden! Despite the recent struggles and

> discouragement, I felt very optimistic.

>

> We all bring our own unique gifts to our practices and our patients. And

> I suspect, like many of you, that I have yet to discover mine fully. But

> I am convinced that an IMP is the “ideal” setting for this to occur. And

> now, as I am trying to evolve my practice into a Robinhood/St. Luke’s

> model, I feel as if I am setting challenge on top of challenge, perhaps

> prematurely. But I feel led and compelled, since I will always have that

> internal struggle of wanting to help the destitute while providing

> adequately for my family at the same time.

>

> I am very grateful for this listserve and all of you who contribute to

> it. I hope in the coming months to be able to post a more “successful”

> update.

>

> Charlie Vargas

> New Mountain Medicine

> lin, NC

>

>

>

>

> Date: 2007/03/07 Wed AM 05:42:43 CST

> To:

> Subject: One year... and still standing!!! ;-)

>

>

> Thank you everyone for your wisdom and openness. You have all taught me

> so much. Your help is immeasureable.

>

> Partly because you all have been so instrumental in my office's success,

> I want to announce that as of yesterday I have been open for 1 year ...

> and I'm still standing!!!

>

> The office has improved so much in one year, and I have a good many ways

> I'm still improving it. But most importantly, I'm loving medicine and

> am enjoying being a doctor again! That's paramount since it's the only

> work I ever imagined doing since I was about 4 years old, and as of

> about two years ago the flame was burning out and being squashed while

> practicing medicine in a large organization.

>

> You all share in any success I have in my office. I very much

> appreciate and respect the real vanguard (Gordon, , Gwen, ,

> Larry(s), , ... and so many more of you) who were a couple

> years ahead of me and really challenged the " normal " to find something

> better with IMP concepts/models. You are all so fantastic!

>

> Thank you, thank you, thank you!

> Tim

>

> PS -- I'm realizing I never did post photos of my office and have never

> posted stats ... I promise to try to do both one of these days!

>

> --

> Malia, MD

>

> Malia Family Medicine & Skin Sense Laser

> 6720 Pittsford-Palmyra Rd.

> Perinton Square Mall

> Fairport, NY 14450

>

> (phone / fax)

> www.relayhealth.com/doc/DrMalia

> www.SkinSenseLaser.com

>

> -- Confidentiality Notice --

> This email message, including all the attachments, is for the sole use

> of the intended recipient(s) and contains confidential information.

> Unauthorized use or disclosure is prohibited. If you are not the

> intended recipient, you may not use, disclose, copy or disseminate this

> information. If you are not the intended recipient, please contact the

> sender immediately by reply email and destroy all copies of the original

> message, including attachments.

>

>

>

>

>

>

>

>

[Guest guest]

Charlie

and Tim,

Next month, I will have my 4 year

anniversary. Unfortunately, although things are financially a little looser now

than they were during years 1-2, I find we are still going month to month. Although

the practice has remained solvent, I have had to take a (so far) permanent cut

in salary in order to keep the practice that way. Last year I was able to take

a salary of $112,000, but that salary is still less than I was making at the

big conglomerate, and although I don’t dwell on this, I figure I have “lost”

about $65,000 over the 4 years.

On the other hand, I too have found that I

have a lot of pride in being a small business owner; that I too stand at the

door of my office as I close up for the day with a smile on my face knowing

that for better or worse I have created this. It is my baby that has needed a

lot of nurturing and time for growth and will hopefully continue to give me

pleasure for years to come. I also realize that without having made the leap, I

would not have found this group, I would not have been able to be in an IMP

cohort, and I would not have had the joy(?) of having my

brain challenged continuously.

The financial stuff sucks (and Gordon and others

are working on this), but there is no question in my mind that by making the

leap, my life has been enriched in ways that would have been impossible in a

traditional medical system. For that, I am thankful. Good luck as your

practices continue to evolve and grow.

One year... and still standing!!! ;-)

Thank you everyone for your wisdom and openness. You have all taught me

so much. Your help is immeasureable.

Partly because you all have been so instrumental in my office's success, I

want to announce that as of yesterday I have been open for 1 year ... and

I'm still standing!!!

The office has improved so much in one year, and I have a good many ways

I'm still improving it. But most importantly, I'm loving medicine and am

enjoying being a doctor again! That's paramount since it's the only work

I ever imagined doing since I was about 4 years old, and as of about two

years ago the flame was burning out and being squashed while practicing

medicine in a large organization.

You all share in any success I have in my office. I very much appreciate

and respect the real vanguard (Gordon, , Gwen, , Larry(s),

, ... and so many more of you) who were a couple years ahead

of me and really challenged the " normal " to find something better

with IMP

concepts/models. You are all so fantastic!

Thank you, thank you, thank you!

Tim

PS -- I'm realizing I never did post photos of my office and have never

posted stats ... I promise to try to do both one of these days!

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.

[Guest guest]

BTW all of you please remember to get your NPI numbers and submit those to your BCBS, Medicare and Railroad Medicare carriers before May 1st so you dont experience delays in payment to your practices.

[Practiceimprovemen t1] One year... and still standing!!! ;-)>>> Thank you everyone for your wisdom and openness. You have all taught me> so much. Your help is immeasureable.>> Partly because you all have been so instrumental in my office's success,> I want to announce that as of yesterday I have been open for 1 year ...> and I'm still standing!!!>> The office has improved so much in one year, and I have a good many ways> I'm still improving it. But most importantly, I'm loving medicine and> am enjoying being a doctor again! That's paramount since it's the only> work I ever imagined doing since I was about 4

years old, and as of> about two years ago the flame was burning out and being squashed while> practicing medicine in a large organization.>> You all share in any success I have in my office. I very much> appreciate and respect the real vanguard (Gordon, , Gwen, ,> Larry(s), , ... and so many more of you) who were a couple> years ahead of me and really challenged the "normal" to find something> better with IMP concepts/models. You are all so fantastic!>> Thank you, thank you, thank you!> Tim>> PS -- I'm realizing I never did post photos of my office and have never> posted stats ... I promise to try to do both one of these days!>> --> Malia, MD>> Malia Family Medicine & Skin Sense Laser> 6720 Pittsford-Palmyra Rd.> Perinton Square Mall> Fairport, NY 14450>>

(phone / fax)> www.relayhealth. com/doc/DrMalia> www.SkinSenseLaser. com>> -- Confidentiality Notice --> This email message, including all the attachments, is for the sole use> of the intended recipient(s) and contains confidential information.> Unauthorized use or disclosure is prohibited. If you are not the> intended recipient, you may not use, disclose, copy or disseminate this> information. If you are not the intended recipient, please contact the> sender immediately by reply email and destroy all copies of the original> message, including attachments.>>>>>>>>

[Guest guest]

Congrats! It is a milestone. Bob Forester" Malia, MD" wrote: Thank you everyone for your wisdom and openness. You have all taught meso much. Your help is immeasureable.Partly because you all have been so instrumental in my office's success, Iwant to announce that as of yesterday I have been open for 1 year ... andI'm still standing!!!The office has improved so much in one year, and I have a good many waysI'm still improving it. But most importantly,

I'm loving medicine and amenjoying being a doctor again! That's paramount since it's the only workI ever imagined doing since I was about 4 years old, and as of about twoyears ago the flame was burning out and being squashed while practicingmedicine in a large organization.You all share in any success I have in my office. I very much appreciateand respect the real vanguard (Gordon, , Gwen, , Larry(s),, ... and so many more of you) who were a couple years aheadof me and really challenged the "normal" to find something better with IMPconcepts/models. You are all so fantastic!Thank you, thank you, thank you!TimPS -- I'm realizing I never did post photos of my office and have neverposted stats ... I promise to try to do both one of these days!-- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport,

NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com-- Confidentiality Notice --This email message, including all the attachments, is for the sole use ofthe intended recipient(s) and contains confidential information.Unauthorized use or disclosure is prohibited. If you are not the intendedrecipient, you may not use, disclose, copy or disseminate thisinformation. If you are not the intended recipient, please contact thesender immediately by reply email and destroy all copies of the originalmessage, including attachments.

Looking for earth-friendly autos? Browse Top Cars by "Green Rating" at Yahoo! Autos' Green Center.

[Guest guest]

Charlie, I had the same feeling often but you need 3-5 years to succeed and be comfortable. It all depends on where you started. I call the first two years the "prozac years". I would like to echo Tim's sentiments, but with a little spin.I, too, have been open a year since January, but I am afraid to say that I am barely making it as an solo/IMP practice. I do have other sources of income which offsets the imbalance, but as a pure IMP, I have been very close to having to jump ship, so to speak, to find a more conventional setting.However...As of late, the apparent slump seems to be lifting, and my practice is slowly growing again. I am advertising again, an article came out on me in a Chamber publication, and I have been getting more positive feedback than usual about my newspaper articles, all of which have seemed to be synergistic with positive changes lately.Mostly, I am more aware of the regional differences we all experience, in terms of demographics, ages, etc., but mostly in the mindset of our local populations. Mine, apparently, is slow to accepting new ideas, and it prefers that their doctor take insurance and Medicare.Gordon has described the challenges of IMP’ers if you are male, rural and do not take insurance. I am all three, and my reserves have depended on y-in-Star-Trek-like maneuvers to make this thing survive. Unfortunately, my lack of reserves has kept me from getting internet service at my office, advertise more effectively, etc. And I accept all the responsibility, even if I am more knowledgeable now, because I am the captain of this ship.The punch line: yesterday, I was faxing a radiology report, updating my records, in-putting notes and ticklers on my patients in my EMR, etc., and I felt a wave of joy and pride. Where did this come from? I just stood there and thought to myself how cool it was what I was doing, and how much fun it was all of the sudden! Despite the recent struggles and discouragement, I felt very optimistic.We all bring our own unique gifts to our practices and our patients. And I suspect, like many of you, that I have yet to discover mine fully. But I am convinced that an IMP is the “ideal” setting for this to occur. And now, as I am trying to evolve my practice into a Robinhood/St. Luke’s model, I feel as if I am setting challenge on top of challenge, perhaps prematurely. But I feel led and compelled, since I will always have that internal struggle of wanting to help the destitute while providing adequately for my family at the same time.I am very grateful for this listserve and all of you who contribute to it. I hope in the coming months to be able to post a more “successful” update.Charlie VargasNew Mountain Medicinelin, NCDate: 2007/03/07 Wed AM 05:42:43 CSTTo: Subject: One year... and still standing!!! ;-)Thank you everyone for your wisdom and openness. You have all taught meso much. Your help is immeasureable.Partly because you all have been so instrumental in my office's success, Iwant to announce that as of yesterday I have been open for 1 year ... andI'm still standing!!!The office has improved so much in one year, and I have a good many waysI'm still improving it. But most importantly, I'm loving medicine and amenjoying being a doctor again! That's paramount since it's the only workI ever imagined doing since I was about 4 years old, and as of about twoyears ago the flame was burning out and being squashed while practicingmedicine in a large organization.You all share in any success I have in my office. I very much appreciateand respect the real vanguard (Gordon, , Gwen, , Larry(s),, ... and so many more of you) who were a couple years aheadof me and really challenged the "normal" to find something better with IMPconcepts/models. You are all so fantastic!Thank you, thank you, thank you!TimPS -- I'm realizing I never did post photos of my office and have neverposted stats ... I promise to try to do both one of these days!-- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com-- Confidentiality Notice --This email message, including all the attachments, is for the sole use ofthe intended recipient(s) and contains confidential information.Unauthorized use or disclosure is prohibited. If you are not the intendedrecipient, you may not use, disclose, copy or disseminate thisinformation. If you are not the intended recipient, please contact thesender immediately by reply email and destroy all copies of the originalmessage, including attachments.

[Guest guest]

Re break even and making money

I'm at the 26 month point and am just now seeing alittle light here

Unlike the “true” IMP, I have a 2.5 full time equivalent in stff (1 fte is my

wife, front desk, and financial keeper. I know if I had less outlay for staff,

I'd be doing much better but would be less sane!!

Unlike traditional models, where you should be making “normal” income at 18-24

months, the solo primary model appears to take up to 4 years

I'm also planning to share expenses with another solo at a new location, which

is actually old to both of us, but we feel the pts would be very happy to have

us back, so expect to build up this newer location while sharing future expenses

and automating more-- 2 locations makes me feel Appointmentquest.com is a good

way to go, as well as tackling chart scanning

Keep the faith-- I have NO intention of going back to some admin bossing me

around!!

Dr Matt Levin

Family Medicine

Pittsburgh Pa

DrLevin@...

Office

Fax.

More about me--

Using SOAPware since 1997

In active medical practice since 1988

Solo Practice started Dec 1st 2004 in Greensburg PA, east of Pittsburgh, ongoing

EMR consultancy started 2005

Sent from my Verizon Wireless BlackBerry

One year... and still standing!!! ;-)

Thank you everyone for your wisdom and openness. You have all taught me

so much. Your help is immeasureable.

Partly because you all have been so instrumental in my office's success, I

want to announce that as of yesterday I have been open for 1 year ... and

I'm still standing!!!

The office has improved so much in one year, and I have a good many ways

I'm still improving it. But most importantly, I'm loving medicine and am

enjoying being a doctor again! That's paramount since it's the only work

I ever imagined doing since I was about 4 years old, and as of about two

years ago the flame was burning out and being squashed while practicing

medicine in a large organization.

You all share in any success I have in my office. I very much appreciate

and respect the real vanguard (Gordon, , Gwen, , Larry(s),

, ... and so many more of you) who were a couple years ahead

of me and really challenged the " normal " to find something better with IMP

concepts/models. You are all so fantastic!

Thank you, thank you, thank you!

Tim

PS -- I'm realizing I never did post photos of my office and have never

posted stats ... I promise to try to do both one of these days!

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.