Sunday, July 13, 2008

Dare I Return?: Part I

April 19th, 2007 was my last post. What happened after that was a tornado of chaotic, but somehow organized activity to manifest the new space where my practice would boom. My philosophy has always been more patient-centered, than doctor-centered -- thus, my dislike for sterile, white surroundings which seem to have become the norm in the doctor world. When did doctors become so boring? It seems that doctors were at war with their patients, rather than in the consciousness of making them feel comfortable and healed. Well, I'm not sure how I developed a sensibility for the patient's side, but perhaps it came from my very love-hate relationship with this career. Now that I have created the holistic, earthy and inviting venue from which healthcare is administered in my office, however, I realize that it was not medicine that I disliked, it was the way it was delivered, from staff attitude to environment, that I hated. I despised my time at the hospital and working for a thankless multi-specialty group, with all the politics and territoriality it involved, but now I love getting up and going to work everyday. Being a solo practitioner, a doctor under my own terms, is where I have found my fulfillment in this challenging profession, especially in its forgotten step-sister -- primary care.

So, I stopped writing last year because suddenly the daily tasks to accomplish this move the way I wanted it to happen, while still running what felt like a full-time schedule at the time, overtook me. I am no Donald Trump, but I sure felt like one: weekly meetings with real estate broker to find the space, weekly meetings with the architect once I chose a space working on the details of the layout, figuring out how I was going to do the billing once I left my sheltered shared services lease (which in retrospect I realize was more detrimental than helpful), and finally, the hiring of my own staff for the very first time.

Standing on the Edge of the Cliff

I was watching Donny Deutsch's "The Big Idea," a great show for any up and coming entrepreneur (which any solo doc running his or her own business should think themselves as), and he talked about the moment in an entrepreneur's life when you've got all the bases loaded, and it's time to take that big risk. He called it "that edge of the cliff moment" when you look down and you know you have to throw yourself off the edge to get to your goals, but it's scary. Well, my edge of the cliff moment was when I hired the architect to draw up plans on a space I would totally demolish and rebuild into a doctor's office. I had searched and searched for a space for months, and nothing I saw satisfied me, until I found a space with a very desirable layout in a building I knew to have good management I could work with. So I decided to move into my own space, and for a business decision I will explain later, take on space greater in size than what I needed, which has turned out to be the best decision I made, and build it out from scratch. If I had taken a space that only fit the needs of the small practice I was running at the time, I would have outgrown it overnight. After all, I knew my practice would grow. So I stood at the edge of the cliff, and began writing checks for the demolition and build-out that followed. Of course, somewhere in there I projected what my expenses would be, obtained a business loan, then started making the payments when work commenced -- probably the greatest risk I have taken in my medical career to date. As they say, innocence is bliss. Once the money starting flowing out, the feeling is of a free-fall off the edge of the business cliff. Well, that for sure is the point of no return.

Beyond the Point of No Return

Things got sticky. In any project, Murphy's Law always makes its facetious face known, I feel only to test the doer's commitment and resolve. When building anything from scratch in an old building whose use has probably been modified several times, watch out for the traps. A bathroom absolutely had to built within the space, because I would not have patients walking down the hall to the community bathrooms with urine specimens in hand. You never know who your neighbors will be, and it's always best to keep biohazards under control. Anyway, only 4 weeks into the project, and 4 weeks away from opening day, a minor glitch with the bathroom. They couldn't get the pipes through for the toilet. The walls, the connections, etc... something didn't fit. This is where one is tested. I had absolute faith that a solution could be found, so I stood by that commitment and as team leader for this project, I urged the contractor to find a solution "ASAP," since I was beyond the point of no return. It had to work! No ifs, ands or buts!!! Well, it finally did, but other glitches soon made the craggy face known. The main one was problems with the contractor's ability to stick to their own proposed schedule. Well, if you've ever worked with a contractor you'll know that that's just par for the course. It didn't matter to me, because the job had to get done, and I didn't have another 3 months for it to finish. I had left my old lease behind, taking the dive off of the cliff head first, and was headed towards my future at an accelerating pace. We had solved the toilet problem and conquered the NYC building department, what else could be harder?

A Detour for the Parents

Well, now the ball was rolling in New York City. The location had been chosen. After multiple revisions, the plans had been set with 3 treatment rooms, and 2 consult rooms, a big enough waiting area and an expansive reception desk to meet the future needs of the practice. Any wrenches had been removed from the construction engine, and now I had to leave New York to help my parents move out of the house I grew up in. My fellow doctors thought I was crazy. "You're gonna what?" "I'm going to take a month off to get all affairs in order for the move, and spend 2 weeks of that month in Florida helping my parents move out of 30+ years of memories and pack-ratting." They retorted, "What's going to happen to your patients?" I arranged for a doctor to cover for my practice for the month, and off I was. I had ended my lease with the doctor I was sharing space with so I wouldn't have to pay rent for that month off. He agreed, graciously, to allow me to continue to receive mail at the old location and have the in-house biller continue to follow-up on claims from the prior few months. I was a free man. They thought my patients wouldn't return to me, but they all did. I knew they would -- when you offer a good service others are not offering, you know your clients will return.

Anyway, back to Florida, parents now moved to new apartment, and the house is a residual mess of memories and junk. My task: to separate the memories from the trash. Thankfully, my aunt flew in from California to assist, as both my father and mother could not due to ongoing health problems. I really needed to do this. This was the house I was brought home to from the Hospital when I was born. I was attached to it. 2 weeks was just the right amount of time to say goodbye, as I enjoyed it for the last time. Everyday we took bags upon bags of donations to the Salvation Army. At the very least good would come from the dissolution of the house I grew up in. I enjoyed the pool for the last few times, and said my goodbyes. As I saw my parents grow old in front of me, a chapter in our lives was ending simultaneously. Draw what parallels you may from these two moves -- it was a cleansing, a rebirth out of old stagnant stuff. We cannot sit in the past forever, no matter how scary venturing into the future unknown may seem or feel.

Cloudy Skies ahead....

Upon my return to New York, I found the project at a stand-still. Apparently, in my absence, the contractor diverted most of his workforce towards other projects, knowing that I wouldn't be there to monitor its progress. For anyone doing any sort of renovation or construction, remember, never look the other way. As great as it was to make peace with the changes at home, I returned to a mess here in New York City. Now with opening day only 2 1/2 weeks away, I could not see how everything would be done by then. I was furious!!! I called the architect and arranged an emergency meeting with the contractor. A lot of stuff needed to get done, and since no one (including the contractor) was taking a leadership role, I grabbed this runaway bull by the horns and became the project manager. I had to be tough. I had to be shrewd. I had to go to the Brooklyn shipyards looking for cimstone for the counter-tops. [All part of the vision, my friends.] But most importantly, I had to not take no for an answer! Good thing I had watched a few seasons of The Apprentice -- perhaps it helped me take the reins with confidence. As a doctor, I work to be a compassionate healer, but as a project manager, one has to be a tough and ruthless SOB or they'll walk all over you. It was a crash course in Hard Knocks 101. Doctoring makes us organized and detailed and those skills came in handy while directing how this project would be completed in as close to schedule as possible. But, it didn't happen without a few more glitches, and with a few angels to let me know I was on the right track.

To be continued....


Blogger Doctor S. said...

Welcome back Doctor! I'm glad to see how far you have come! I look forward to future updates. thanks for visiting my at

9:47 AM EDT  
Blogger Medicine Man said...

I'm glad to be back. Thanks for your comment on the last post. It inspired me to write again, even though it had been more than a year.

10:58 PM EDT  

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