RE: Back to overhead vs streamlined living, what else can we do -- a rant, beware

May 21, 2007

Excellent post. If

you watch or read “The Secret” that Pam mentions, then you can

maybe start to see where she is coming from: “If I imagine great

reimbursement, patients, etc so vividly in my mind then it will eventually

happen one day.” I think that is part of it, as is the fact that

she is simply the eternal optimist whereas I’m more a realist. Basically,

her practice is motivating but can not be duplicated for the most part.

Back to overhead vs streamlined living, what else can we do -- a rant, beware

RE Contrarian point of view.

OK, I've started over the weekend

digging into Pam's " mission statement. "

First pass, there are some MAJOR

DIFFERENCES with my style of practice, indeed, even if I cut ALL my staff, I

see major dissimilarities here.

Indeed, Pam, I don't see how viable

your model is in most areas.

Several points:

1) Malpractice " discounting. "

While you take NO Medicare or other major insurances, I CANNOT GET ANY DISCOUNT

unless I cut my hours down from " standard " hours. Must have

office availability. Thus my insurance rate STAYS AT $14K, MUCH HIGHER

than your UNDER $2000 per year.

2) Rent. While I applaud your

$300/month rent, I'm just not seeing it. I have a nice rent place with

small footprint, but it's still 4x yours. This is a nonstarter for me.

3) Health insurance and other

high-deductable issues. Here's an issue I have with this -- if you don't

use the insurance, fine. But if you do -- instant disaster unless you

have the cash reserves.

4) Cost of hardware/software.

You do NOT include the ORIGINAL COST of your laptop, NOR replacement and back

up hardware. This is an ERROR in calculating overhead. By the way,

backup in a paperless system is a disaster that WILL happen.

5) Hospital privileges. Some

of us have 'em; some MUST have 'em. If you have them, then often you MUST

take call for uncompensated care for people without insurance. While

you'd feel that seeing pts and not being paid is your personal choice, I see it

is impossible for me to do this long-term. Even Medicaid in my area pays

ONLY $30/visit, no matter what. Hospitals get PAID BY THE STATE and

FEDERAL GOV'T some reimbursement, if only nonprofit.

6) As you point out, most if not all

of us doing this HAVE SECOND JOBS. This is not a possibility for most of

us.

OK, so in addition to real LIFE

discussions below, why am I shouting at all of you:

1) If you want to be a NON-PROFIT,

just do it. Pam, I'm sorry, but I'm just not a martyr. If you are,

good for you.

2) This plan is NOT VIABLE in this

environment, at least in an area like mine (and many many others, you too Jean)

where Medicare IS a prevailing insurer (and reimburses well too).

I'm trying to be somewhat realistic

here, to see if " your model " is transferable to most areas.

Sadly, I don't think so.

A fine minimalist practice, but 4

hours of practice, 3 days a week will NEVER NEVER NEVER work in most places,

perhaps in Eugene (which seems a reflection of a certain tv show in Alaska with

Janine ) but not in my area of the Northeast.

Rather than working into the side

areas of solar energy self-sufficiency and biodiesel (don't own a Diesel, but

do have a Subaru), I'd rather discuss the following:

1) Software mainstream that

works: Appointment Quest for appts ($23/month), Relay Health with free

website ($25/month x 24 months quote, they're following up with me today).

2) Affordable scanners: $300 Xerox

option for 10 pages a minute conversion to PDF file format. Can all be

paperless TOMORROW with a reasonable filing system of names and dates of

service.

Finally, we ALL must TAKE STOCK ON

WHAT WE WANT TO DO:

1) Be a minimalist overheader -- how

much do you really need to live.

2) Can you do this for the long haul

-- delayed gratification is NOT for everyone.

3) Finally, we need to make the BIG

decision, each of us, if Health Insurance as it is structured NOW with payment

to providers is worth it. If you don't believe health insurance can pay

your way, then BAIL and make your practice NON-insurance. But before you

do, you need to survey your populations to see if they can AFFORD YOU.

I'm saying all of these things as

I'm concerned with the viability of ALL of us-- conservation is fine in an area

of doc need, but now that the IRS has relaxed the rules to give ANY PROVIDER

FULL COMPUTER support, there is the potential to SHUT OUT ALL nonparticipators,

gathering up most practices.

This is a REAL possibility.

Also a real opportunity... you

can do your job and take insurances, and listen to patients but you must " do

the math " to be sure that you know, as Pam writes, how much money it takes

to keep you going.

Perhaps I should just be a

" contrarian " and speak on the other side of the podium with Pam.

Regards to all ... We can probably

do this, each of us, but beware and be careful.

Dr Matt Levin

Family Medicine

Pittsburgh Pa

Dr_Levincomcast (DOT) net

Office

Fax.

More about me--

Using SOAPware since 1997

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

Part-time practice management and technology consultant

RE: Dumpster Diving

> >

> > Now Pamela,

> >

> > I don't even bring my husband to the recycling dump anymore because

he

> > was pulling out more stuff then we were getting rid of. His thing is

> > books, perfectly good books. Books he will never read by the way.

> >

> > Kathy Saradarian, MD

> >

> > Branchville, NJ

> >

> > Solo low-staff practice since 4/03

> >

> > In practice since 9/90

> >

> > Practice Partner User since 5/03

> >

>

May 21, 2007

I am not sure what subject to put this next item under. It has to do with the

reduced reimbursement and increase in time in the office that at least my

practice has to start with, personal choices regarding starting a practice so

that we can spend more time with patients.

My partner in the office is getting divorced. Right now she is making similar

to what I am making and the other Kathy, $40,000 tops. Her husband, who is a

high producing OB-GYN and makes 250-300,000 yearly doesn't want to pay any

alimony as he says that there are FPs in our area that make 160,000.

exampleThis would be a male physician who sees patients every 5-10 minutes and

does hospital work and likely has someone at home taking care of the home

fulltime. This would also be a practice that is sponsored by the hospital, so

he is likely still losing money, but sending referrals to the hospital, so still

worthwhile for them to support.

Her husband thinks that she should be able to make this amount and if she can't

she is just incompetent. They have 4 kids, 3 of whom were born during medical

school and residency, which we all know isn't a walk in the park. He has always

told her she could stay home full time, but she wanted to continue practicing as

she did spend all that time in school and further training...and likes

practicing medicine to boot. I guess cuz she wasn't home enough, cleaning the

house, decorating, with the kids lined up so that he could pat them on the head,

he got a girlfriend and then decided to get divorced after 16 years of marriage.

I wonder what would have happened if she had stayed home? My guess is that he

still would have found a girlfriend and then she would have to gear up to

working from ground zero. The money that he makes has always been " his " money

which he would then let her spend with his approval.

How does she present this micropractice as a viable choice that will likely

begin to bring in more money, thus making it a sensible business and work

choice? They will be going to court in about a month, and a judge will be

deciding the alimony issue.

She would basically like some alimony while we gear up our own practice to

include aesthetics with the hope that it will increase our reimbursement. We

had previously both worked part time.

She has moved to a smaller house, so that she can afford the mortgage and still

have room for the kids-they will share custody. She has always been the one in

the house to try to recycle, not over spend, while he is always making big

purchases. Iowa is a 50-50 state regarding assests, but likely there aren't may

assets as he really likes to spend money, guns, cigars, travel. Obviously there

are some major philosophical differences and that is likely the crux of split

and not that she should have stayed home.

Kathy Broman

Mason City, IA

On Monday, May 21, 2007, at 08:09AM, " Brock DO "

wrote:

>Excellent post. If you watch or read " The Secret " that Pam mentions, then

>you can maybe start to see where she is coming from: " If I imagine great

>reimbursement, patients, etc so vividly in my mind then it will eventually

>happen one day. " I think that is part of it, as is the fact that she is

>simply the eternal optimist whereas I'm more a realist. Basically, her

>practice is motivating but can not be duplicated for the most part.

>

> Back to overhead vs streamlined living, what

>else can we do -- a rant, beware

>

>RE Contrarian point of view.

>

>OK, I've started over the weekend digging into Pam's " mission statement. "

>

>First pass, there are some MAJOR DIFFERENCES with my style of practice,

>indeed, even if I cut ALL my staff, I see major dissimilarities here.

>

>Indeed, Pam, I don't see how viable your model is in most areas.

>

>Several points:

>

>1) Malpractice " discounting. " While you take NO Medicare or other major

>insurances, I CANNOT GET ANY DISCOUNT unless I cut my hours down from

> " standard " hours. Must have office availability. Thus my insurance rate

>STAYS AT $14K, MUCH HIGHER than your UNDER $2000 per year.

>

>2) Rent. While I applaud your $300/month rent, I'm just not seeing it. I

>have a nice rent place with small footprint, but it's still 4x yours. This

>is a nonstarter for me.

>

>3) Health insurance and other high-deductable issues. Here's an issue I

>have with this -- if you don't use the insurance, fine. But if you do --

>instant disaster unless you have the cash reserves.

>

>4) Cost of hardware/software. You do NOT include the ORIGINAL COST of your

>laptop, NOR replacement and back up hardware. This is an ERROR in

>calculating overhead. By the way, backup in a paperless system is a

>disaster that WILL happen.

>

>5) Hospital privileges. Some of us have 'em; some MUST have 'em. If you

>have them, then often you MUST take call for uncompensated care for people

>without insurance. While you'd feel that seeing pts and not being paid is

>your personal choice, I see it is impossible for me to do this long-term.

>Even Medicaid in my area pays ONLY $30/visit, no matter what. Hospitals get

>PAID BY THE STATE and FEDERAL GOV'T some reimbursement, if only nonprofit.

>

>6) As you point out, most if not all of us doing this HAVE SECOND JOBS.

>This is not a possibility for most of us.

>

>OK, so in addition to real LIFE discussions below, why am I shouting at all

>of you:

>

>1) If you want to be a NON-PROFIT, just do it. Pam, I'm sorry, but I'm just

>not a martyr. If you are, good for you.

>

>2) This plan is NOT VIABLE in this environment, at least in an area like

>mine (and many many others, you too Jean) where Medicare IS a prevailing

>insurer (and reimburses well too).

>

>I'm trying to be somewhat realistic here, to see if " your model " is

>transferable to most areas.

>

>Sadly, I don't think so.

>

>A fine minimalist practice, but 4 hours of practice, 3 days a week will

>NEVER NEVER NEVER work in most places, perhaps in Eugene (which seems a

>reflection of a certain tv show in Alaska with Janine ) but not in my

>area of the Northeast.

>

>Rather than working into the side areas of solar energy self-sufficiency and

>biodiesel (don't own a Diesel, but do have a Subaru), I'd rather discuss the

>following:

>

>1) Software mainstream that works: Appointment Quest for appts ($23/month),

>Relay Health with free website ($25/month x 24 months quote, they're

>following up with me today).

>

>2) Affordable scanners: $300 Xerox option for 10 pages a minute conversion

>to PDF file format. Can all be paperless TOMORROW with a reasonable filing

>system of names and dates of service.

>

>Finally, we ALL must TAKE STOCK ON WHAT WE WANT TO DO:

>

>1) Be a minimalist overheader -- how much do you really need to live.

>

>2) Can you do this for the long haul -- delayed gratification is NOT for

>everyone.

>

>3) Finally, we need to make the BIG decision, each of us, if Health

>Insurance as it is structured NOW with payment to providers is worth it. If

>you don't believe health insurance can pay your way, then BAIL and make your

>practice NON-insurance. But before you do, you need to survey your

>populations to see if they can AFFORD YOU.

>

>I'm saying all of these things as I'm concerned with the viability of ALL of

>us-- conservation is fine in an area of doc need, but now that the IRS has

>relaxed the rules to give ANY PROVIDER FULL COMPUTER support, there is the

>potential to SHUT OUT ALL nonparticipators, gathering up most practices.

>

>This is a REAL possibility.

>

>Also a real opportunity... you can do your job and take insurances, and

>listen to patients but you must " do the math " to be sure that you know, as

>Pam writes, how much money it takes to keep you going.

>

>Perhaps I should just be a " contrarian " and speak on the other side of the

>podium with Pam.

>

>Regards to all ... We can probably do this, each of us, but beware and be

>careful.

>

>Dr Matt Levin

>Family Medicine

>Pittsburgh Pa

>Dr_Levincomcast (DOT) net

>Office

>Fax.

>

>More about me--

>Using SOAPware since 1997

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

>Part-time practice management and technology consultant

>

> RE: Dumpster Diving

>> >

>> > Now Pamela,

>> >

>> > I don't even bring my husband to the recycling dump anymore because he

>> > was pulling out more stuff then we were getting rid of. His thing is

>> > books, perfectly good books. Books he will never read by the way.

>> >

>> > Kathy Saradarian, MD

>> >

>> > Branchville, NJ

>> >

>> > Solo low-staff practice since 4/03

>> >

>> > In practice since 9/90

>> >

>> > Practice Partner User since 5/03

>> >

>>

>

May 21, 2007

Matt,

Could you explain this from your post:

" but now that the IRS has relaxed the rules to give ANY PROVIDER

FULL COMPUTER support, there is the potential to SHUT OUT ALL

nonparticipators, gathering up most practices. "

Thanks,

Sharon

At 04:27 AM 5/21/2007, you wrote:

RE Contrarian point of

view.

OK, I've started over the weekend digging into Pam's " mission

statement. "

First pass, there are some MAJOR DIFFERENCES with my style of practice,

indeed, even if I cut ALL my staff, I see major dissimilarities

here.

Indeed, Pam, I don't see how viable your model is in most areas.

Several points:

1) Malpractice " discounting. " While you take NO Medicare

or other major insurances, I CANNOT GET ANY DISCOUNT unless I cut my

hours down from " standard " hours. Must have office

availability. Thus my insurance rate STAYS AT $14K, MUCH HIGHER

than your UNDER $2000 per year.

2) Rent. While I applaud your $300/month rent, I'm just not seeing

it. I have a nice rent place with small footprint, but it's still

4x yours. This is a nonstarter for me.

3) Health insurance and other high-deductable issues. Here's an

issue I have with this -- if you don't use the insurance, fine. But

if you do -- instant disaster unless you have the cash reserves.

4) Cost of hardware/software. You do NOT include the ORIGINAL COST

of your laptop, NOR replacement and back up hardware. This is an

ERROR in calculating overhead. By the way, backup in a paperless

system is a disaster that WILL happen.

5) Hospital privileges. Some of us have 'em; some MUST have

'em. If you have them, then often you MUST take call for

uncompensated care for people without insurance. While you'd feel

that seeing pts and not being paid is your personal choice, I see it is

impossible for me to do this long-term. Even Medicaid in my area

pays ONLY $30/visit, no matter what. Hospitals get PAID BY THE

STATE and FEDERAL GOV'T some reimbursement, if only nonprofit.

6) As you point out, most if not all of us doing this HAVE SECOND

JOBS. This is not a possibility for most of us.

OK, so in addition to real LIFE discussions below, why am I shouting at

all of you:

1) If you want to be a NON-PROFIT, just do it. Pam, I'm sorry, but

I'm just not a martyr. If you are, good for you.

2) This plan is NOT VIABLE in this environment, at least in an area like

mine (and many many others, you too Jean) where Medicare IS a prevailing

insurer (and reimburses well too).

I'm trying to be somewhat realistic here, to see if " your

model " is transferable to most areas.

Sadly, I don't think so.

A fine minimalist practice, but 4 hours of practice, 3 days a week will

NEVER NEVER NEVER work in most places, perhaps in Eugene (which seems a

reflection of a certain tv show in Alaska with Janine ) but not in

my area of the Northeast.

Rather than working into the side areas of solar energy self-sufficiency

and biodiesel (don't own a Diesel, but do have a Subaru), I'd rather

discuss the following:

1) Software mainstream that works: Appointment Quest for appts

($23/month), Relay Health with free website ($25/month x 24 months quote,

they're following up with me today).

2) Affordable scanners: $300 Xerox option for 10 pages a minute

conversion to PDF file format. Can all be paperless TOMORROW with a

reasonable filing system of names and dates of service.

Finally, we ALL must TAKE STOCK ON WHAT WE WANT TO DO:

1) Be a minimalist overheader -- how much do you really need to

live.

2) Can you do this for the long haul -- delayed gratification is NOT for

everyone.

3) Finally, we need to make the BIG decision, each of us, if Health

Insurance as it is structured NOW with payment to providers is worth

it. If you don't believe health insurance can pay your way, then

BAIL and make your practice NON-insurance. But before you do, you

need to survey your populations to see if they can AFFORD YOU.

I'm saying all of these things as I'm concerned with the viability of ALL

of us-- conservation is fine in an area of doc need, but now that the IRS

has relaxed the rules to give ANY PROVIDER FULL COMPUTER support, there

is the potential to SHUT OUT ALL nonparticipators, gathering up most

practices.

This is a REAL possibility.

Also a real opportunity... you can do your job and take insurances, and

listen to patients but you must " do the math " to be sure that

you know, as Pam writes, how much money it takes to keep you going.

Perhaps I should just be a " contrarian " and speak on the other

side of the podium with Pam.

Regards to all ... We can probably do this, each of us, but beware and be

careful.

Dr Matt Levin

Family Medicine

Pittsburgh Pa

Dr_Levin@...

Office

Fax.

More about me--

Using SOAPware since 1997

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

Pittsburgh

Part-time practice management and technology consultant

RE: Dumpster Diving

> >

> > Now Pamela,

> >

> > I don't even bring my husband to the recycling dump anymore

because he

> > was pulling out more stuff then we were getting rid of. His

thing is

> > books, perfectly good books. Books he will never read by

the way.

> >

> > Kathy Saradarian, MD

> >

> > Branchville, NJ

> >

> > Solo low-staff practice since 4/03

> >

> > In practice since 9/90

> >

> > Practice Partner User since 5/03

> >

>

May 21, 2007

--

There's more to The Secret than just positive thinking. And it ain't a new

concept either. Most of us more successful people have been using it from

time to time and throughout our lives for a long time, but we are

implementing it consistently.

This whole financial viability discussion is quite valuable. Due to

little baseball coaching about 15 hours per week (we are 4-5), I'm not

keeping up with posts and won't put much time into explaining all my

thoughts on the issues at hand. But basically, I for one was worried

about financial viability when I did my math before starting the practice.

At the SF AAFP in 2005 I was able to tie together the concept of my

hybrid of IMP/solo-solo with aesthetics during a 4-hour walk all over the

city on a beautiful Saturday evening.

But if I didn't " take on the demons " of the financing of this, then I'd be

taking on the demons of working in my old office, or the demons of

staffing, etc. These are all personal choices.

And each of our offices will have different designs and capabilities. I'm

sure Matt's office and 's offices are different in their own ways

even though they both feel Pam's model wouldn't work in most any other

place. But consistently saying anyone else's ideas/models won't work in a

certain area limits the potential that they could succeed -- no one can

possibly know until it's attempted!

In a way I can relate this to colonial USA when fully 1/3 of the

population were royalists and didn't want to be independent, 1/3 wanted to

break away and 1/3 didn't care. Somehow I would expect the royalists were

saying much the same as many doubters of IMP about how the ideas simply

won't work. But reality is that after a few rocky years and changes in

government and tweaking of philosophy and some luck, this great USA

experiment is working well (not perfectly , but really, really well) even

though the concept of a democracy was crazy 230 years ago.

Perhaps the IMP model/concept is like that too -- that is, are we in the

rough early years and we need to continue adjusting and improving while

the doubters keep saying, " this can't work in the end. "

.... don't know the answer but I'm going down to the harbor and throw in a

teabag!!!

Live free or die -- Give me liberty or give me death -- one by land or two

by sea (or vice versa?)... E Pluribus Unum and all that jazz!!!!

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.

> Excellent post. If you watch or read " The Secret " that Pam mentions,

> then you can maybe start to see where she is coming from: " If I imagine

> great reimbursement, patients, etc so vividly in my mind then it will

> eventually happen one day. " I think that is part of it, as is the fact

> that she is simply the eternal optimist whereas I'm more a realist.

> Basically, her practice is motivating but can not be duplicated for the

> most part.

>

> Back to overhead vs streamlined living,

> what else can we do -- a rant, beware

>

> RE Contrarian point of view.

>

> OK, I've started over the weekend digging into Pam's " mission

> statement. "

>

> First pass, there are some MAJOR DIFFERENCES with my style of practice,

> indeed, even if I cut ALL my staff, I see major dissimilarities here.

>

> Indeed, Pam, I don't see how viable your model is in most areas.

>

> Several points:

>

> 1) Malpractice " discounting. " While you take NO Medicare or other major

> insurances, I CANNOT GET ANY DISCOUNT unless I cut my hours down from

> " standard " hours. Must have office availability. Thus my insurance

> rate STAYS AT $14K, MUCH HIGHER than your UNDER $2000 per year.

>

> 2) Rent. While I applaud your $300/month rent, I'm just not seeing it.

> I have a nice rent place with small footprint, but it's still 4x yours.

> This is a nonstarter for me.

>

> 3) Health insurance and other high-deductable issues. Here's an issue I

> have with this -- if you don't use the insurance, fine. But if you do

> -- instant disaster unless you have the cash reserves.

>

> 4) Cost of hardware/software. You do NOT include the ORIGINAL COST of

> your laptop, NOR replacement and back up hardware. This is an ERROR in

> calculating overhead. By the way, backup in a paperless system is a

> disaster that WILL happen.

>

> 5) Hospital privileges. Some of us have 'em; some MUST have 'em. If

> you have them, then often you MUST take call for uncompensated care for

> people without insurance. While you'd feel that seeing pts and not

> being paid is your personal choice, I see it is impossible for me to do

> this long-term. Even Medicaid in my area pays ONLY $30/visit, no matter

> what. Hospitals get PAID BY THE STATE and FEDERAL GOV'T some

> reimbursement, if only nonprofit.

>

> 6) As you point out, most if not all of us doing this HAVE SECOND JOBS.

> This is not a possibility for most of us.

>

> OK, so in addition to real LIFE discussions below, why am I shouting at

> all of you:

>

> 1) If you want to be a NON-PROFIT, just do it. Pam, I'm sorry, but I'm

> just not a martyr. If you are, good for you.

>

> 2) This plan is NOT VIABLE in this environment, at least in an area like

> mine (and many many others, you too Jean) where Medicare IS a prevailing

> insurer (and reimburses well too).

>

> I'm trying to be somewhat realistic here, to see if " your model " is

> transferable to most areas.

>

> Sadly, I don't think so.

>

> A fine minimalist practice, but 4 hours of practice, 3 days a week will

> NEVER NEVER NEVER work in most places, perhaps in Eugene (which seems a

> reflection of a certain tv show in Alaska with Janine ) but not in

> my area of the Northeast.

>

> Rather than working into the side areas of solar energy self-sufficiency

> and biodiesel (don't own a Diesel, but do have a Subaru), I'd rather

> discuss the following:

>

> 1) Software mainstream that works: Appointment Quest for appts

> ($23/month), Relay Health with free website ($25/month x 24 months

> quote, they're following up with me today).

>

> 2) Affordable scanners: $300 Xerox option for 10 pages a minute

> conversion to PDF file format. Can all be paperless TOMORROW with a

> reasonable filing system of names and dates of service.

>

> Finally, we ALL must TAKE STOCK ON WHAT WE WANT TO DO:

>

> 1) Be a minimalist overheader -- how much do you really need to live.

>

> 2) Can you do this for the long haul -- delayed gratification is NOT for

> everyone.

>

> 3) Finally, we need to make the BIG decision, each of us, if Health

> Insurance as it is structured NOW with payment to providers is worth it.

> If you don't believe health insurance can pay your way, then BAIL and

> make your practice NON-insurance. But before you do, you need to survey

> your populations to see if they can AFFORD YOU.

>

> I'm saying all of these things as I'm concerned with the viability of

> ALL of us-- conservation is fine in an area of doc need, but now that

> the IRS has relaxed the rules to give ANY PROVIDER FULL COMPUTER

> support, there is the potential to SHUT OUT ALL nonparticipators,

> gathering up most practices.

>

> This is a REAL possibility.

>

> Also a real opportunity... you can do your job and take insurances, and

> listen to patients but you must " do the math " to be sure that you know,

> as Pam writes, how much money it takes to keep you going.

>

> Perhaps I should just be a " contrarian " and speak on the other side of

> the podium with Pam.

>

> Regards to all ... We can probably do this, each of us, but beware and

> be careful.

>

> Dr Matt Levin

> Family Medicine

> Pittsburgh Pa

> Dr_Levincomcast (DOT) net

> Office

> Fax.

>

> More about me--

> Using SOAPware since 1997

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

> Part-time practice management and technology consultant

>

> RE: Dumpster Diving

>> >

>> > Now Pamela,

>> >

>> > I don't even bring my husband to the recycling dump anymore because

>> he was pulling out more stuff then we were getting rid of. His thing

>> is books, perfectly good books. Books he will never read by the way.

>> >

>> > Kathy Saradarian, MD

>> >

>> > Branchville, NJ

>> >

>> > Solo low-staff practice since 4/03

>> >

>> > In practice since 9/90

>> >

>> > Practice Partner User since 5/03

>> >

>>

>

May 21, 2007

Just saw my own post and wish to clarify the first paragraph regarding The

Secret ...

I mean " most of us more successful people " as in basically anyone who is

on this list and who has been successful in school and career, etc. There

are aspects of the secret that we each are likely using in our own way.

Also, I meant to write that we have NOT been implementing it consistently

(original was mis-typed).

Sorry about that.

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.

> --

> There's more to The Secret than just positive thinking. And it ain't a

> new concept either. Most of us more successful people have been using

> it from time to time and throughout our lives for a long time, but we

> are

> implementing it consistently.

>

> This whole financial viability discussion is quite valuable. Due to

> little baseball coaching about 15 hours per week (we are 4-5), I'm not

> keeping up with posts and won't put much time into explaining all my

> thoughts on the issues at hand. But basically, I for one was worried

> about financial viability when I did my math before starting the

> practice.

> At the SF AAFP in 2005 I was able to tie together the concept of my

> hybrid of IMP/solo-solo with aesthetics during a 4-hour walk all over

> the city on a beautiful Saturday evening.

> But if I didn't " take on the demons " of the financing of this, then I'd

> be taking on the demons of working in my old office, or the demons of

> staffing, etc. These are all personal choices.

>

> And each of our offices will have different designs and capabilities.

> I'm sure Matt's office and 's offices are different in their own

> ways even though they both feel Pam's model wouldn't work in most any

> other place. But consistently saying anyone else's ideas/models won't

> work in a certain area limits the potential that they could succeed --

> no one can possibly know until it's attempted!

>

> In a way I can relate this to colonial USA when fully 1/3 of the

> population were royalists and didn't want to be independent, 1/3 wanted

> to break away and 1/3 didn't care. Somehow I would expect the royalists

> were saying much the same as many doubters of IMP about how the ideas

> simply won't work. But reality is that after a few rocky years and

> changes in government and tweaking of philosophy and some luck, this

> great USA experiment is working well (not perfectly , but really, really

> well) even though the concept of a democracy was crazy 230 years ago.

> Perhaps the IMP model/concept is like that too -- that is, are we in the

> rough early years and we need to continue adjusting and improving while

> the doubters keep saying, " this can't work in the end. "

>

> .... don't know the answer but I'm going down to the harbor and throw in

> a teabag!!!

>

> Live free or die -- Give me liberty or give me death -- one by land or

> two by sea (or vice versa?)... E Pluribus Unum and all that jazz!!!!

>

> 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.

>

>> Excellent post. If you watch or read " The Secret " that Pam mentions,

>> then you can maybe start to see where she is coming from: " If I

>> imagine great reimbursement, patients, etc so vividly in my mind then

>> it will eventually happen one day. " I think that is part of it, as is

>> the fact that she is simply the eternal optimist whereas I'm more a

>> realist. Basically, her practice is motivating but can not be

>> duplicated for the most part.

>>

>> Back to overhead vs streamlined

>> living, what else can we do -- a rant, beware

>>

>> RE Contrarian point of view.

>>

>> OK, I've started over the weekend digging into Pam's " mission

>> statement. "

>>

>> First pass, there are some MAJOR DIFFERENCES with my style of

>> practice, indeed, even if I cut ALL my staff, I see major

>> dissimilarities here.

>>

>> Indeed, Pam, I don't see how viable your model is in most areas.

>>

>> Several points:

>>

>> 1) Malpractice " discounting. " While you take NO Medicare or other

>> major insurances, I CANNOT GET ANY DISCOUNT unless I cut my hours down

>> from " standard " hours. Must have office availability. Thus my

>> insurance rate STAYS AT $14K, MUCH HIGHER than your UNDER $2000 per

>> year.

>>

>> 2) Rent. While I applaud your $300/month rent, I'm just not seeing

>> it. I have a nice rent place with small footprint, but it's still 4x

>> yours. This is a nonstarter for me.

>>

>> 3) Health insurance and other high-deductable issues. Here's an issue

>> I have with this -- if you don't use the insurance, fine. But if you

>> do -- instant disaster unless you have the cash reserves.

>>

>> 4) Cost of hardware/software. You do NOT include the ORIGINAL COST of

>> your laptop, NOR replacement and back up hardware. This is an ERROR

>> in calculating overhead. By the way, backup in a paperless system is

>> a disaster that WILL happen.

>>

>> 5) Hospital privileges. Some of us have 'em; some MUST have 'em. If

>> you have them, then often you MUST take call for uncompensated care

>> for people without insurance. While you'd feel that seeing pts and

>> not being paid is your personal choice, I see it is impossible for me

>> to do this long-term. Even Medicaid in my area pays ONLY $30/visit, no

>> matter what. Hospitals get PAID BY THE STATE and FEDERAL GOV'T some

>> reimbursement, if only nonprofit.

>>

>> 6) As you point out, most if not all of us doing this HAVE SECOND

>> JOBS. This is not a possibility for most of us.

>>

>> OK, so in addition to real LIFE discussions below, why am I shouting

>> at all of you:

>>

>> 1) If you want to be a NON-PROFIT, just do it. Pam, I'm sorry, but

>> I'm just not a martyr. If you are, good for you.

>>

>> 2) This plan is NOT VIABLE in this environment, at least in an area

>> like mine (and many many others, you too Jean) where Medicare IS a

>> prevailing insurer (and reimburses well too).

>>

>> I'm trying to be somewhat realistic here, to see if " your model " is

>> transferable to most areas.

>>

>> Sadly, I don't think so.

>>

>> A fine minimalist practice, but 4 hours of practice, 3 days a week

>> will NEVER NEVER NEVER work in most places, perhaps in Eugene (which

>> seems a reflection of a certain tv show in Alaska with Janine )

>> but not in my area of the Northeast.

>>

>> Rather than working into the side areas of solar energy

>> self-sufficiency and biodiesel (don't own a Diesel, but do have a

>> Subaru), I'd rather discuss the following:

>>

>> 1) Software mainstream that works: Appointment Quest for appts

>> ($23/month), Relay Health with free website ($25/month x 24 months

>> quote, they're following up with me today).

>>

>> 2) Affordable scanners: $300 Xerox option for 10 pages a minute

>> conversion to PDF file format. Can all be paperless TOMORROW with a

>> reasonable filing system of names and dates of service.

>>

>> Finally, we ALL must TAKE STOCK ON WHAT WE WANT TO DO:

>>

>> 1) Be a minimalist overheader -- how much do you really need to live.

>>

>> 2) Can you do this for the long haul -- delayed gratification is NOT

>> for everyone.

>>

>> 3) Finally, we need to make the BIG decision, each of us, if Health

>> Insurance as it is structured NOW with payment to providers is worth

>> it.

>> If you don't believe health insurance can pay your way, then BAIL and

>> make your practice NON-insurance. But before you do, you need to

>> survey your populations to see if they can AFFORD YOU.

>>

>> I'm saying all of these things as I'm concerned with the viability of

>> ALL of us-- conservation is fine in an area of doc need, but now that

>> the IRS has relaxed the rules to give ANY PROVIDER FULL COMPUTER

>> support, there is the potential to SHUT OUT ALL nonparticipators,

>> gathering up most practices.

>>

>> This is a REAL possibility.

>>

>> Also a real opportunity... you can do your job and take insurances,

>> and listen to patients but you must " do the math " to be sure that you

>> know, as Pam writes, how much money it takes to keep you going.

>>

>> Perhaps I should just be a " contrarian " and speak on the other side of

>> the podium with Pam.

>>

>> Regards to all ... We can probably do this, each of us, but beware and

>> be careful.

>>

>> Dr Matt Levin

>> Family Medicine

>> Pittsburgh Pa

>> Dr_Levincomcast (DOT) net

>> Office

>> Fax.

>>

>> More about me--

>> Using SOAPware since 1997

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

>> Pittsburgh Part-time practice management and technology consultant

>>

>> RE: Dumpster Diving

>>> >

>>> > Now Pamela,

>>> >

>>> > I don't even bring my husband to the recycling dump anymore because

>>> he was pulling out more stuff then we were getting rid of. His thing

>>> is books, perfectly good books. Books he will never read by the way.

>>> >

>>> > Kathy Saradarian, MD

>>> >

>>> > Branchville, NJ

>>> >

>>> > Solo low-staff practice since 4/03

>>> >

>>> > In practice since 9/90

>>> >

>>> > Practice Partner User since 5/03

>>> >

>>>

>>

>

May 21, 2007

Sounds like she is listening too much to his opinion and evaluation of her circumstances. Her future earning potential isn't as much a consideration as her current financial situation. If she is seeking child support, her expenses are very relevant. So, downsizing and being extra frugal doesn't actually get you more money usually. The idea is that the lifestyle of the kids should not be radically changed, and they should continue to live in much the same way as before the divorce. Money earned during the marriage is marriage money..not his. She may or may not get alimony, I do not know your state laws nor did I practice family law, but she sounds too defensive and willing to give up too much. I am not saying being hostile. What I am saying is do not let his opinion as to what she desrves control her thinking. Clearly, he has already demonstrated what he thinks she deserves, and it aint much. The kids situation can

always be revisited, but once the property has been divided and alimony determined, it is usually final. Tell her to remember that conceding all of their joint property is final. She will not get it back nor will this be pretty either way. Her worrying about offending him will cost her and her kids for the rest of their lives. I am not saying fight or be vindictive, but do not settle for less than you are entitled to receive. Do not go without a lawyer. Yes, you can go alone, and you can also regret it.Kathy Broman wrote: I am not sure what subject to put this next item under. It has to do with the reduced reimbursement and increase in time in the office that at least my practice has to start with, personal choices regarding starting a practice so that we can spend more time with patients. My partner in the office is getting divorced. Right now she is making similar to what I am making and the other Kathy, $40,000 tops. Her husband, who is a high producing OB-GYN and makes 250-300,000 yearly doesn't want to pay any alimony as he says that there are FPs in our area that make 160,000. exampleThis would be a male physician who sees patients every 5-10 minutes and does hospital work and likely has someone at home taking care of the home fulltime. This would also be a practice that is sponsored by the hospital, so he is likely still losing money, but sending referrals to the hospital, so still worthwhile for them to support.

Her husband thinks that she should be able to make this amount and if she can't she is just incompetent. They have 4 kids, 3 of whom were born during medical school and residency, which we all know isn't a walk in the park. He has always told her she could stay home full time, but she wanted to continue practicing as she did spend all that time in school and further training...and likes practicing medicine to boot. I guess cuz she wasn't home enough, cleaning the house, decorating, with the kids lined up so that he could pat them on the head, he got a girlfriend and then decided to get divorced after 16 years of marriage. I wonder what would have happened if she had stayed home? My guess is that he still would have found a girlfriend and then she would have to gear up to working from ground zero. The money that he makes has always been "his" money which he would then let her spend with his approval.How does she present this micropractice as a viable choice that

will likely begin to bring in more money, thus making it a sensible business and work choice? They will be going to court in about a month, and a judge will be deciding the alimony issue.She would basically like some alimony while we gear up our own practice to include aesthetics with the hope that it will increase our reimbursement. We had previously both worked part time.She has moved to a smaller house, so that she can afford the mortgage and still have room for the kids-they will share custody. She has always been the one in the house to try to recycle, not over spend, while he is always making big purchases. Iowa is a 50-50 state regarding assests, but likely there aren't may assets as he really likes to spend money, guns, cigars, travel. Obviously there are some major philosophical differences and that is likely the crux of split and not that she should have stayed home.Kathy Broman Mason City, IAOn Monday, May 21, 2007, at 08:09AM, " Brock

DO" <drbrockrrohio> wrote:>Excellent post. If you watch or read "The Secret" that Pam mentions, then>you can maybe start to see where she is coming from: "If I imagine great>reimbursement, patients, etc so vividly in my mind then it will eventually>happen one day." I think that is part of it, as is the fact that she is>simply the eternal optimist whereas I'm more a realist. Basically, her>practice is motivating but can not be duplicated for the most part.>> >>>> >> Back to overhead vs streamlined living, what>else can we do -- a rant, beware>> >>RE Contrarian point of view.>> >>OK, I've started over the weekend digging into Pam's "mission statement.">> >>First pass, there are some MAJOR DIFFERENCES with my style of practice,>indeed, even if I cut ALL my staff, I see major dissimilarities here.>> >>Indeed, Pam, I don't see how viable your model is in most areas.>> >>Several points:>> >>1) Malpractice "discounting." While you take NO Medicare or other major>insurances, I CANNOT GET ANY DISCOUNT unless I cut my hours down from>"standard" hours. Must have office

availability. Thus my insurance rate>STAYS AT $14K, MUCH HIGHER than your UNDER $2000 per year.>> >>2) Rent. While I applaud your $300/month rent, I'm just not seeing it. I>have a nice rent place with small footprint, but it's still 4x yours. This>is a nonstarter for me.>> >>3) Health insurance and other high-deductable issues. Here's an issue I>have with this -- if you don't use the insurance, fine. But if you do -->instant disaster unless you have the cash reserves.>> >>4) Cost of hardware/software. You do NOT include the ORIGINAL COST of your>laptop, NOR replacement and back up hardware. This is an ERROR in>calculating overhead. By the way, backup in a paperless system is a>disaster that WILL happen.>> >>5) Hospital privileges. Some of us have 'em; some MUST have 'em. If you>have them, then often

you MUST take call for uncompensated care for people>without insurance. While you'd feel that seeing pts and not being paid is>your personal choice, I see it is impossible for me to do this long-term.>Even Medicaid in my area pays ONLY $30/visit, no matter what. Hospitals get>PAID BY THE STATE and FEDERAL GOV'T some reimbursement, if only nonprofit.>> >>6) As you point out, most if not all of us doing this HAVE SECOND JOBS.>This is not a possibility for most of us.>> >>OK, so in addition to real LIFE discussions below, why am I shouting at all>of you:>> >>1) If you want to be a NON-PROFIT, just do it. Pam, I'm sorry, but I'm just>not a martyr. If you are, good for you.>> >>2) This plan is NOT VIABLE in this environment, at least in an area like>mine (and many many others, you too Jean) where Medicare IS a

prevailing>insurer (and reimburses well too).>> >>I'm trying to be somewhat realistic here, to see if "your model" is>transferable to most areas.>> >>Sadly, I don't think so.>> >>A fine minimalist practice, but 4 hours of practice, 3 days a week will>NEVER NEVER NEVER work in most places, perhaps in Eugene (which seems a>reflection of a certain tv show in Alaska with Janine ) but not in my>area of the Northeast.>> >>Rather than working into the side areas of solar energy self-sufficiency and>biodiesel (don't own a Diesel, but do have a Subaru), I'd rather discuss the>following:>> >>1) Software mainstream that works: Appointment Quest for appts ($23/month),>Relay Health with free website ($25/month x 24 months quote, they're>following up with me today).>>

>>2) Affordable scanners: $300 Xerox option for 10 pages a minute conversion>to PDF file format. Can all be paperless TOMORROW with a reasonable filing>system of names and dates of service.>> >>Finally, we ALL must TAKE STOCK ON WHAT WE WANT TO DO:>> >>1) Be a minimalist overheader -- how much do you really need to live.>> >>2) Can you do this for the long haul -- delayed gratification is NOT for>everyone.>> >>3) Finally, we need to make the BIG decision, each of us, if Health>Insurance as it is structured NOW with payment to providers is worth it. If>you don't believe health insurance can pay your way, then BAIL and make your>practice NON-insurance. But before you do, you need to survey your>populations to see if they can AFFORD YOU.>> >>I'm saying all of these things as

I'm concerned with the viability of ALL of>us-- conservation is fine in an area of doc need, but now that the IRS has>relaxed the rules to give ANY PROVIDER FULL COMPUTER support, there is the>potential to SHUT OUT ALL nonparticipators, gathering up most practices.>> >>This is a REAL possibility.>> >>Also a real opportunity... you can do your job and take insurances, and>listen to patients but you must "do the math" to be sure that you know, as>Pam writes, how much money it takes to keep you going.>> >>Perhaps I should just be a "contrarian" and speak on the other side of the>podium with Pam.>> >>Regards to all ... We can probably do this, each of us, but beware and be>careful.>> >>Dr Matt Levin>Family Medicine>Pittsburgh Pa>Dr_Levincomcast (DOT) <mailto:Dr_Levincomcast (DOT) net> net >Office >Fax. >> >>More about me-->Using SOAPware since 1997>Solo Practice started Dec 1st 2004 in Greensburg PA, east of Pittsburgh>Part-time practice management and technology consultant>> RE: Dumpster Diving>> > >> > >> > >> > Now Pamela,>> > >> > >> > >> > I don't even bring my husband

to the recycling dump anymore because he>> > was pulling out more stuff then we were getting rid of. His thing is>> > books, perfectly good books. Books he will never read by the way.>> > >> > >> > >> > >> > >> > >> > >> > Kathy Saradarian, MD>> > >> > Branchville, NJ>> > >> > Solo low-staff practice since 4/03>> > >> > In practice since 9/90>> > >> > Practice Partner User since 5/03>> >>>>> >>

May 22, 2007

Dear Kathy, What your friend's husband is saying is what angry divorcing people usually say about each other and about their previous partner's needs, only with an MD twist to it. She needs to not make any personal attempt to mediate this issue, get a great lawyer, and let him get her what she ought to get out of their divorce. She did a lot to get the GYN Hotshot into the place where he could make twice what she makes, and she is due a portion of that. This is a typical divorce scenario. Her explanation about the IMP should not relate to money but to quality of life for her family and the need to have a flexible enough schedule to care for her children as a single parent. With an IMP she can get time off as she needs to care for the children when they are sick. As the owner of her own practice

she can bring them to work when they are off early at school or when the school has a day off for teacher education, As the controller of her own schedule, she can take a break to be at home when the children come home from school to supervise their homework assignment setup before she cuts back to work to see another patient. None of these things would be available in a busy, high producing practice. With both parents in a high producing practice, her children would spend only a little more time with their parents than the average orphan. The fact that her husband didn't know that or take it into account probably has something to do with the divorce. She could just stop work entirely. We all know women who have done that to care for their children. He would have to support that also. I repeat, she should not feel any need to buy into

his description of her appropriate future. They have decided by the divorce process that he has no right to decision-making about her future, only obligations about their children. The state laws vary in their application on that issue. I had a very good friend who was a family judge for years and I learned: judges go to continued education to learn the standard judgments in their state about child support and alimony. Testimony doesn't have a lot to do with changing this. There is usually a variable way that they make their decisions depending on the number of the children, variable income, so on. If the parties agree on something, even if it is totally unfair, the Judge will go along with it, with no demur. So, just let the lawyers talk to the Judge. She is unlikely to get her husband to agree to more than the state allows, and she should

get at least all that the state allows, whatever that is. Dr Joanne, the Physician in Drain, Oregon Kathy Broman wrote: I am not sure what subject to put this next item under. It has to do with the reduced reimbursement and increase in time in the office that at least my practice has to start with, personal choices regarding

starting a practice so that we can spend more time with patients. My partner in the office is getting divorced. Right now she is making similar to what I am making and the other Kathy, $40,000 tops. Her husband, who is a high producing OB-GYN and makes 250-300,000 yearly doesn't want to pay any alimony as he says that there are FPs in our area that make 160,000. exampleThis would be a male physician who sees patients every 5-10 minutes and does hospital work and likely has someone at home taking care of the home fulltime. This would also be a practice that is sponsored by the hospital, so he is likely still losing money, but sending referrals to the hospital, so still worthwhile for them to support. Her husband thinks that she should be able to make this amount and if she can't she is just incompetent. They have 4 kids, 3 of whom were born during medical school and residency, which we all know isn't a walk in the park. He has always told her she could stay home

full time, but she wanted to continue practicing as she did spend all that time in school and further training...and likes practicing medicine to boot. I guess cuz she wasn't home enough, cleaning the house, decorating, with the kids lined up so that he could pat them on the head, he got a girlfriend and then decided to get divorced after 16 years of marriage. I wonder what would have happened if she had stayed home? My guess is that he still would have found a girlfriend and then she would have to gear up to working from ground zero. The money that he makes has always been "his" money which he would then let her spend with his approval.How does she present this micropractice as a viable choice that will likely begin to bring in more money, thus making it a sensible business and work choice? They will be going to court in about a month, and a judge will be deciding the alimony issue.She would basically like some alimony while we gear up our own practice to include

aesthetics with the hope that it will increase our reimbursement. We had previously both worked part time.She has moved to a smaller house, so that she can afford the mortgage and still have room for the kids-they will share custody. She has always been the one in the house to try to recycle, not over spend, while he is always making big purchases. Iowa is a 50-50 state regarding assests, but likely there aren't may assets as he really likes to spend money, guns, cigars, travel. Obviously there are some major philosophical differences and that is likely the crux of split and not that she should have stayed home.Kathy Broman Mason City, IAOn Monday, May 21, 2007, at 08:09AM, " Brock DO" <drbrockrrohio> wrote:>Excellent post. If you watch or read "The Secret" that Pam mentions, then>you can maybe start to see where she is coming from: "If I imagine great>reimbursement,

patients, etc so vividly in my mind then it will eventually>happen one day." I think that is part of it, as is the fact that she is>simply the eternal optimist whereas I'm more a realist. Basically, her>practice is motivating but can not be duplicated for the most part.>> >>>> >> Back to overhead vs streamlined living, what>else can we do -- a rant, beware>>

>>RE Contrarian point of view.>> >>OK, I've started over the weekend digging into Pam's "mission statement.">> >>First pass, there are some MAJOR DIFFERENCES with my style of practice,>indeed, even if I cut ALL my staff, I see major dissimilarities here.>> >>Indeed, Pam, I don't see how viable your model is in most areas.>> >>Several points:>> >>1) Malpractice "discounting." While you take NO Medicare or other major>insurances, I CANNOT GET ANY DISCOUNT unless I cut my hours down from>"standard" hours. Must have office availability. Thus my insurance rate>STAYS AT $14K, MUCH HIGHER than your UNDER $2000 per year.>> >>2) Rent. While I applaud your $300/month rent, I'm just not seeing it. I>have a nice rent place with small footprint, but it's still 4x

yours. This>is a nonstarter for me.>> >>3) Health insurance and other high-deductable issues. Here's an issue I>have with this -- if you don't use the insurance, fine. But if you do -->instant disaster unless you have the cash reserves.>> >>4) Cost of hardware/software. You do NOT include the ORIGINAL COST of your>laptop, NOR replacement and back up hardware. This is an ERROR in>calculating overhead. By the way, backup in a paperless system is a>disaster that WILL happen.>> >>5) Hospital privileges. Some of us have 'em; some MUST have 'em. If you>have them, then often you MUST take call for uncompensated care for people>without insurance. While you'd feel that seeing pts and not being paid is>your personal choice, I see it is impossible for me to do this long-term.>Even Medicaid in my area pays ONLY $30/visit, no matter

what. Hospitals get>PAID BY THE STATE and FEDERAL GOV'T some reimbursement, if only nonprofit.>> >>6) As you point out, most if not all of us doing this HAVE SECOND JOBS.>This is not a possibility for most of us.>> >>OK, so in addition to real LIFE discussions below, why am I shouting at all>of you:>> >>1) If you want to be a NON-PROFIT, just do it. Pam, I'm sorry, but I'm just>not a martyr. If you are, good for you.>> >>2) This plan is NOT VIABLE in this environment, at least in an area like>mine (and many many others, you too Jean) where Medicare IS a prevailing>insurer (and reimburses well too).>> >>I'm trying to be somewhat realistic here, to see if "your model" is>transferable to most areas.>> >>Sadly, I don't think so.>> >>A

fine minimalist practice, but 4 hours of practice, 3 days a week will>NEVER NEVER NEVER work in most places, perhaps in Eugene (which seems a>reflection of a certain tv show in Alaska with Janine ) but not in my>area of the Northeast.>> >>Rather than working into the side areas of solar energy self-sufficiency and>biodiesel (don't own a Diesel, but do have a Subaru), I'd rather discuss the>following:>> >>1) Software mainstream that works: Appointment Quest for appts ($23/month),>Relay Health with free website ($25/month x 24 months quote, they're>following up with me today).>> >>2) Affordable scanners: $300 Xerox option for 10 pages a minute conversion>to PDF file format. Can all be paperless TOMORROW with a reasonable filing>system of names and dates of service.>> >>Finally, we ALL must TAKE

STOCK ON WHAT WE WANT TO DO:>> >>1) Be a minimalist overheader -- how much do you really need to live.>> >>2) Can you do this for the long haul -- delayed gratification is NOT for>everyone.>> >>3) Finally, we need to make the BIG decision, each of us, if Health>Insurance as it is structured NOW with payment to providers is worth it. If>you don't believe health insurance can pay your way, then BAIL and make your>practice NON-insurance. But before you do, you need to survey your>populations to see if they can AFFORD YOU.>> >>I'm saying all of these things as I'm concerned with the viability of ALL of>us-- conservation is fine in an area of doc need, but now that the IRS has>relaxed the rules to give ANY PROVIDER FULL COMPUTER support, there is the>potential to SHUT OUT ALL nonparticipators, gathering up most

practices.>> >>This is a REAL possibility.>> >>Also a real opportunity... you can do your job and take insurances, and>listen to patients but you must "do the math" to be sure that you know, as>Pam writes, how much money it takes to keep you going.>> >>Perhaps I should just be a "contrarian" and speak on the other side of the>podium with Pam.>> >>Regards to all ... We can probably do this, each of us, but beware and be>careful.>> >>Dr Matt Levin>Family Medicine>Pittsburgh Pa>Dr_Levincomcast (DOT) <mailto:Dr_Levincomcast (DOT) net> net >Office >Fax. >> >>More about me-->Using SOAPware since 1997>Solo Practice started Dec 1st 2004 in Greensburg PA, east of

Pittsburgh>Part-time practice management and technology consultant>> RE: Dumpster Diving>> > >> > >> > >> > Now Pamela,>> > >> > >> > >> > I don't even bring my husband to the recycling dump anymore because he>> > was pulling out more stuff then we were getting rid of. His thing is>> > books, perfectly good books. Books he will never read by the way.>> > >> > >>

> >> > >> > >> > >> > >> > Kathy Saradarian, MD>> > >> > Branchville, NJ>> > >> > Solo low-staff practice since 4/03>> > >> > In practice since 9/90>> > >> > Practice Partner User since 5/03>> >>>>> >>

No need to miss a message. Get email on-the-go with Yahoo! Mail for Mobile. Get started.

May 22, 2007

Agreed, she should stop trying to "take care of everything", and let the highly educated divorce lawyer do his/her stuff. Had she chosen to take the highpaying, time consuming job, he might ask for complete custody, on the basis of her not being a good mother. My biller recently got divorced after 3 yr of amiable separation. Even then things became nasty, and back stabbing. Better to let the lawyer advise you what you are entitled to, take it and let the lawyer make the case for her alimony, etc. I also say in a 50-50 state you are entitled to your half, especially if you sacrified income/education to let the other spouse get ahead. There are calculations for this, and any retirement money's he has put away, she also is entitled to a portion of, depending on her income, whether she worked at all, part time, full time. It doens't matter what she could make, only what she does make.

Cote

--------- RE: Dumpster Diving>> > >> > >> > >> > Now Pamela,>> > >> > >> > >> > I don't even bring my husband to the recycling dump anymore because he>> > was pulling out more stuff then we were getting rid of. His thing is>> > books, perfectly good books. Books he will never read by the way.>> > >> > >> > >> > >> > >> > >> > >> > Kathy Saradarian, MD>> > >&g

t; > Branchville, NJ>> > >> > Solo low-staff practice since 4/03>> > >> > In practice since 9/90>> > >> > Practice Partner User since 5/03>> >>>>> >>

No need to miss a message. Get email on-the-go with Yahoo! Mail for Mobile. Get started.

May 23, 2007

Sorry Joanne, but I disagree. Doing the court thing with children involved only makes them the losers. Sorry to say that I have done both the court thing and mediation, and I'll take mediation 110-1. In my state, the child support guidelines are quite clear 29% of net income, you can do the math. Alimony would be out of the question for someone with a professional degree. Remember that alimony income is taxed; child support is not. Why do men do these things?? "There is not in all America a more dangerous trait than the deification of mere smartness unaccompanied by any sense of moral responsibility." Theodore Roosevelt Certainly there is no hunting like the hunting of man and those who have hunted armed men long enough and liked it, never really

care for anything else thereafter. Ernest Hemingway, "On the Blue Water," Esquire, April 1936US author & journalist (1899 - 1961) "You never change things by fighting the existing reality. To change something build a new model that makes the existing model obsolete"- Buckminster Fuller RE: [Practiceimprovemen t1] Dumpster Diving>> > >> > >> > >> > Now Pamela,>> > >> > >> > >> > I don't even bring my husband to the recycling dump anymore because he>> > was pulling out more stuff then we were getting rid of. His thing is>> > books, perfectly good books. Books he will never read by the way.>> > >> > >>

> >> > >> > >> > >> > >> > Kathy Saradarian, MD>> > >> > Branchville, NJ>> > >> > Solo low-staff practice since 4/03>> > >> > In practice since 9/90>> > >> > Practice Partner User since 5/03>> >>>>> >> No need to miss a message. Get email on-the-go with Yahoo! Mail for Mobile. Get started.

Moody friends. Drama queens. Your life? Nope! - their life, your story. Play Sims Stories at Yahoo! Games.

May 23, 2007

I thought I'd give the rant some thought before responding. OK here

goes...

About the major differences. I can see that. I am practicing medicine

with my own twist, infusing my personality. I am not suggesting

that everyone practice like me. I am suggesting that everyone find

what makes them happy. It is a different recipe for us all. I have a

pet peeve about people steeping too long in " victim mode " because

it seems counterproductive after a point. If IMPing isn't for you

then don't do it. If the factory lifestyle isn't for you then by all

means quit your job. Find what you love. Maybe it's not medicine.

I think it was Kathy who said if she practiced like me in NJ she'd

scare all her patients. Well, we don't want that now!

People need docs. Docs need work. My husband keeps reminding

me that unemployed doctor is an oxymoron. He tells me I'll be

the LAST ONE to be out of work in a depression or a societal meltdown.

He tells me if doctors can't figure out how to stay in business something

is very wrong. (implying - something is wrong with the docs)

OK that's the intro...

1) Malpractice Discounts. I've checked all over the country and

*most* insurers offer LOTS of discounts (no claims, board cert,

risk redxn CME, part time, yada,yada.) That sucks if you are with

an insurer that doesn't offer ANY discounts. You are in the

minority here I'd say.

2) Cheap rent. I keep thinking I'd be happy working in a broom

closet. I really do not need as much space as I have. Can you

share your space with more docs? sublet if you have too

much space? just thinking...

3) Yep, instant 10K if I need medical care with high deductible

insurance. It is a risk. I guess I'm more of a risk taker than I thought.

I'm not as bad as " Lawnchair Larry " and you've simply GOT to google

that for a good laugh...

4) Hardware/Software - OK I owned my apple prior to ever thinking

about opening my practice. It was $1200 and I bought it a year

before I ever opened the practice. That IS my hardware. Software?

What software? Apple comes pre-loaded with software that I am

using for my primitive EMR which workd great for me. I did buy

a $40 external hard drive for back up so throw that into the

hardware mix I guess. I did buy a $99 HCFA fill n print program

which I haven't used in 8 months since starting ebilling on the

free clearinghouse. I calculate my yearly overhead based on

recurring expenses as I paid 3-4K ish up front to open my

practice (rent, decor, goodwill wicker chair, add in the pre-owned

laptop) I don't count this stuff as a recurring yearly expense to

run my business. If you want me to break it down over 10 years I

guess add $300-400 per year for start-up costs. My start up costs

are so piddly and paid off before the first person walked through the

door that I have trouble thinking of these expenses as part of my

yearly expense. Thats how my brain works..I think I'm rambling. Sorry.

5) Hospital priviledges. Yes. I take my share of unassigned patients

but half of them have great insurance so I wish they'd send um to

someone who is accepting new pts. It is really an extra complication

for them to see me once or twice and then be sent to someone else.

I tried to fx this with the ED but they see where I'm coming from

and can't change " the system " I get uninsured patients too and they

all pay at the time of service. I have not had anyone NOT pay. I've

had many never call for appts and a few who No show. I do get

what you're saying Matt. When you are in survival mode and they

send another uninsured nonpaying/lowpaying pt your way it does

add insult to injury...

6) I don't remember pointing out that people had second jobs.

The goal as I see it is to have one fun job that you simply

can't wait to get to in the morning. OK. Here's my opening

line of my keynote. Contemplate this....

" What if the thought of going into work filled you with joy? "

7) I don't want to be a NON-PROFIT! Too much paperwork for my

lifestyle. I am happy doing what I am doing. Martyr? How am I

a martyr?

OK. So...in summary. This is not about everyone running a

hippie doc martry pameland model. Its about

physicians defining themselves, finding their happiness, and

networking with their communities to create primary care

practices that work.

Be happy.

Low overhead will be less stressful. See how low you can go.

Get your community on board. Network with your community. really!!

Remember: Everyone needs a doctor.

We will be the last group to be unemployed!

OK, back to studying for the board exam....

Pamela

> > >

> > > yes we are apparently all married to the same man

> > > did I post my answer to just Kathy off l ist?

> > > But I f we have any more books here in this house, then I have to go

> > >

> > > OF COURSE we have the undergrad books Annie Jeez ! You do not get rid

> > of

> > > books. 12 th commandmanet.(11th is I will see you today and i will see

> > you

> > > on time)

> > >

> > > RE: Dumpster Diving

> > >

> > > Now Pamela,

> > >

> > > I don't even bring my husband to the recycling dump anymore because he

> > > was pulling out more stuff then we were getting rid of. His thing is

> > > books, perfectly good books. Books he will never read by the way.

> > >

> > > Kathy Saradarian, MD

> > >

> > > Branchville, NJ

> > >

> > > Solo low-staff practice since 4/03

> > >

> > > In practice since 9/90

> > >

> > > Practice Partner User since 5/03

> > >

> >

>

May 23, 2007

From Drain, Like I said, the system varies from state to state. In this state, everything he earned and bought during their marriage is jointly owned and she can get half of it. The material he personally inherited is sometimes included as well, which can be an onerous thing if this includes lots of land. I did not say "don't mediate", I said, "let the lawyers work out how to get what is best for her and the family". The most important thing is, do not go into mediation and give away the children's future comfort or let him take most of their assets and give it to his next wife and their children. Can't say how often I have seen it happen. In this town alone, there are several families in which the first wife's children are living in abject poverty, while the second wife's children are worth

multimillions of dollars because the first wife "gave him a divorce." without protecting her children's futures by getting their share of the property the husband took. You should see what happens later, between the grandchildren, in those cases... ..in this valley there have been some mysterious deaths and some severe abuse cases that were settled (with money of course) out of court. This is serious stuff but beyond the venu of this listserve, and I don't think we should continue it here. Joanne Holland, DVM/MD Drain, OregonRamon Parrish wrote: Sorry Joanne, but I disagree. Doing the court thing with children involved only makes them the losers. Sorry to say that I have done both the court thing and mediation, and I'll take mediation 110-1. In my state, the child support guidelines are quite clear 29% of net income, you can do the math. Alimony would be out of the question for someone with a professional degree. Remember that alimony income is taxed; child support is not. Why do men do these things?? "There is not in all America a more dangerous trait than the deification of mere smartness unaccompanied by any sense of moral responsibility." Theodore

Roosevelt Certainly there is no hunting like the hunting of man and those who have hunted armed men long enough and liked it, never really care for anything else thereafter. Ernest Hemingway, "On the Blue Water," Esquire, April 1936US author & journalist (1899 - 1961) "You never change things by fighting the existing reality. To change something build a new model that makes the existing model obsolete"- Buckminster Fuller RE: [Practiceimprovemen t1] Dumpster Diving>> > >> > >> > >> > Now Pamela,>> > >> > >> > >> > I don't even bring my husband to the recycling dump anymore because he>> > was pulling out more stuff then we were getting rid of. His thing is>> > books, perfectly good books. Books he will never read by the way.>> > >> > >> > >> > >> > >> >

>> > >> > Kathy Saradarian, MD>> > >> > Branchville, NJ>> > >> > Solo low-staff practice since 4/03>> > >> > In practice since 9/90>> > >> > Practice Partner User since 5/03>> >>>>> >> No need to miss a message. Get email on-the-go with Yahoo! Mail for Mobile. Get started. Moody friends. Drama queens. Your life? Nope! - their life, your story.Play Sims Stories at Yahoo! Games.

Bored stiff? Loosen up...Download and play hundreds of games for free on Yahoo! Games.

Sign In

RE: Back to overhead vs streamlined living, what else can we do -- a rant, beware

Recommended Posts

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Join the conversation

Activity