If you know any millionaires or philanthropists...

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AJMD429
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If you know any millionaires or philanthropists...

Post by AJMD429 »

This year has nearly killed the practice. I've been ok working for free because I've got an employed wife, live a very hillbilly life-style, and have a strange and probably irrational sense of what I do being a 'calling' of sorts. Not sure why, but I was young and impressionable when I got edgikated, and when I took that durned Hippocratic Oath. Kind of like marrying young; you don't really understand what you're getting into... :D Anyhow, it is what it is. There is something strangely addicting about helping people, even when it is unpleasant - my 'lunch' break today consisted of going to an empty exam room so nobody would hear me tearing up as I told a woman whose been my patient 33 years - since she was a young kid - that she has metastatic breast cancer...Merry Christmas. But we will help her deal with it emotionally, and keep the rest of her body healthy, while the specialists do their magic.

After moving away from a cohabitation-arrangement with two other doctors that didn't work out, in an over-priced rental space, and then the space we were moving in to wasn't ready because covid delayed all the remodeling and inspections and so on, we just got hammered.

Then our "eight day" shutdown for most of the remodeling turned into three weeks, and on top of that the postal service thought we were one of the many practices that permanently closed, so put all our mail on 'return to sender' status during the construction. I doubt we will ever recapture that revenue, as it comes in hundreds upon hundreds of small checks from insurance companies, and they have no incentive to just spontaneously re-issue and re-send the checks, so we will have to pay someone to figure out what we are owed (in health care we never know what the insurance will actually pay, or even if they will pay, and it often takes at least 90 days before we can find out), then if we are owed the $17.28, our employee will likely have to sit on hold 30 minutes and explain why the insurer should reissue the check. End-of-year means many patients won't even be in their system after year-end, having changed plans, so I'm sure that will be another excuse to delay reimbursement.

My employees are SO dedicated that they are literally working for IOU's and we just divvy up whatever co-pays we get on a given day and give the neediest employee enough so they can get groceries and gas. They have faith in me that I will eventually pay them even if I don't get paid, but more importantly, they have a sense of devotion to our patients. Many patients can't even get in to any 'primary care' doctors now due to covid, and we feel we need to be there for our patients. I am so humbled by the employees I have, who live paycheck-to-paycheck, and are willing to sacrifice like that; most people wouldn't work an hour over-time without demanding time and a half on the very next paycheck, yet these people are working many, many hours for a promise. It isn't fun for me to work without pay, but at least I have an employed wife, and years of building up some reserve. I've been able to sell a few guns when needed to pay bills; these are young people who have no reserve, and some have to hitch rides to work because they can't afford a vehicle.

God is with us though - when the photocopier needed servicing and we owed a month on the contract so they wouldn't come out, it happened that same day that a patient took up a collection at church, and handed me an envelope that was almost enough to pay the balance and get the copier going again. Another started a GoFundMe page.

So.....if you know any bored philanthropists searching for a decent 'cause' I'd volunteer ours. We aren't doing missionary work or anything that exotic, just trying to keep ordinary middle-class Americans as healthy as they can be, but I think it is a good cause.

Our GoFundMe Page... :| :oops:

Pretty humbling as I said, and makes me feel like a failure in many ways, but I guess God wanted me to make a fool out of myself in the business world, and save my 'expertise' for the clinical realm.
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Re: If you know any millionaires or philanthropists...

Post by piller »

I wish I knew someone who could help.
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Re: If you know any millionaires or philanthropists...

Post by Sixgun »

Doc,
I'm at a loss for words reading that. I don't get it......there are so many hands in the pot nowadays that the original maker of the money (you) cannot collect. I do beieve socialism is well entrenched into this nation.

I'm so disgusted after this last election I've about shut down. I just don't see an incentive anymore to try to make things betters.....when hope goes out the window, our society will crash....the left has won.

I'm sorry to hear that....
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Re: If you know any millionaires or philanthropists...

Post by gamekeeper »

Sorry to hear things are so dire Doc but I guess you are not alone in these weird times. I'll send what I can wish it was more. I hope you and your staff have a very merry Christmas and a more prosperous new year.
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Re: If you know any millionaires or philanthropists...

Post by rossim92 »

with a little luck drawing tonight is for 320 million, maybe i will hit!
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Re: If you know any millionaires or philanthropists...

Post by AJMD429 »

It sucks sometimes, but there are so many whose every-dsy problems dwarf my worst day.
We are all in the same boat; we just get assigned different oars to pull.

Then there’s the Clinyons, Obama’s, and Bidens, whose job seems to be to sneak around and drill holes in the hull... :|
Doctors for Sensible Gun Laws
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Re: If you know any millionaires or philanthropists...

Post by hfcable »

i hear you and know quite welll what you mean. sold my interest in my practice and closed that deal a little earlier this year [ price was a fire sale....what i expected in this election year and covid year ]

[ the last 3 years have done about 40% more work each year, in order to make 60% less money each of those years !!! ]

but now i am free of most of the worries and just working half time for the new group. and i am not yet over the feelings of guilt for not being there all the time to do the injections etc that folks need, though i am helping coach/teach the new docs

i know you will hang in there and i believe times will improve.

you have my best wishes and prayers.

and i did contribute ... and will keep abreast of this and try to help more.

God bless you and your staff and family.
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Re: If you know any millionaires or philanthropists...

Post by AJMD429 »

I'm convinced God has more work for me to do...

I guess I'm flattered that He considers I do a good enough job to warrant the support. Sometimes I wish he'd make it a bit easier, when I compare 'lifestyles' with other docs who do the four-minute-99214 style thing. I guess you only get/stay good at something when you are stressed and pushed.

"....come on, Coach, give me a break...." :D
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"first do no harm" - gun control LAWS lead to far more deaths than 'easy access' ever could.


Want REAL change? . . . . . "Boortz/Nugent in 2012 . . . ! "
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If I could go back in time and change careers, I would go with something easier and more respected---like being a cop in Chicago or Detroit.
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Re: If you know any millionaires or philanthropists...

Post by hfcable »

i would probably still go to medical school, though, i might stay with the MD/PhD program i was starting in, and just do research.... ibut i would miss doing the hands on work with patients.... so maybe i would not change much after all
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Re: If you know any millionaires or philanthropists...

Post by OldWin »

Sorry you have to deal with this Doc. My hat is off to you guys who are in the medical field. It doesn't need to be like that, and wouldn't be, if we were allowed to have the free republic we are supposed to have.
Insurance is one of the world's evils.
I wish you the best. If I hit the lottery I will send you some cash. Unfortunately, machinists aren't rolling in dough either! :D
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hfcable wrote:
Wed Dec 23, 2020 9:02 pm
i would probably still go to medical school, though, i might stay with the MD/PhD program i was starting in, and just do research.... ibut i would miss doing the hands on work with patients.... so maybe i would not change much after all
Yeah, I've of course thought about the "would I do it again" question many times.

At age 30, finishing up my debt-acquiring 13 years of education, "the world was at my fingertips" and I had "unlimited potential". That is an energizing feeling I'll always remember. I had been fortunate enough to do well enough academically that there never was a moment I had to choose a 'lesser' path unless it was truly my choice. I chose Family Practice because it 'spoke to me' and I felt there was an opportunity there to use all my diverse skills (pharmacology, medicine, and 'people' skills) to their best advantage. Of course in hindsight, the incomes of the 'scope-based' specialties changed so dramatically, and the technology in pharmacies meant a single pharmacist could fill several times as many prescriptions as before, so those incomes soared, and the primary care stagnated. I could have gone into any number of other specialties and earned enough to retire by age 40-45 given my lifestyle, but I just loved Family Practice.

On the other hand, if you spend your life doing something only for the money, and you don't enjoy it, that can set you up for disaster. A few manage to retire early, leave the rat-race, then go on to live another three decades 'playing'. Others have their first heart-attack or cancer a year into their early retirement.

I just figure I'll do what I enjoy, and let God handle the rest. So far I've bought crappier food than I'd like, but never gone hungry, and I've only owned one new vehicle, but never been without transportation, and I've lived in a house that more resembles "deer camp" than a normal house, but I've managed to keep a wife reasonably happy and raise some good kids, so not much else matters in the big picture.

Life goes on - all our boats are going down the river regardless of what we do, so we'd best enjoy the trip, and help each other while we can. Eventually all our boats sink, and we feed the fishes.
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Re: If you know any millionaires or philanthropists...

Post by mickbr »

Im no financial advisor but cant you guys just do locum work or shifts at hospitals for extra cash? I thought you guys could just make a few calls and line up an extra shift for a thousand bucks? Honestly asking as I used to have doctor friends whilst I was in the military. They floated about doing casual work for half the hours I did, but 2x the money.
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In my situation I’m already putting in 75-85 hours a week so not doable. Can’t do less due to number of patients we have is so high. Once we drop insurance there will be attrition and we can actually make a profit.
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Want REAL change? . . . . . "Boortz/Nugent in 2012 . . . ! "
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Post by gamekeeper »

Got a thank you note from Christy, I said will do more in the new year, glad to see the fund has now been shared so that should help.
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Re: If you know any millionaires or philanthropists...

Post by mickbr »

AJMD429 wrote:
Sun Dec 27, 2020 11:34 am
In my situation I’m already putting in 75-85 hours a week so not doable. Can’t do less due to number of patients we have is so high. Once we drop insurance there will be attrition and we can actually make a profit.
75-85 hous is a big week doc, I see where you are coming from.
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Yeah it is strange, but when you deal with insurance, a given amount patients causes a given overhead, because it will mean a certain number of test results coming, in, ER and specialist notes to review, prescriptions refills to approve or get 'prior authorization' for, and so on. That has nothing to do with how may patients you see, and none of those services are reimbursed by insurance. So you have say 2,000 patients, and there will be enough work to keep five employees busy full-time. Zero revenue though. Then of course that many patients will generate say 40 visits per day on average with things they actually need seen for due to the need to examine a body part, or do more in-depth communication than is easy over the telephone. Those are the only things that insurance pays for. Sadly, what that means in the 'real world' is that the doctor demands face-to-face visits for every little thing, is unwilling to do much over the phone, and and will typically make the patient have a separate visit for each one or two 'problems' instead of doing a bunch at one visit (since reimbursement is the same essentially for a 4-minute 99214 visit as a 45-minute 99214). You can literally have 'too many patients' because unless you have the ability yourself to see them for enough face-to-face visits you are just taking care of them for free.

Direct Pay practices do it differently - they charge a monthly fee for all the stuff you anticipate doing, and all the stuff you can do over the phone or internet, and a sort of 'token' fee for actual face-to-face visits when they are needed. It more accurately reflects the work done, and the staff needed, and resources used, so it gets away from all the face-to-face visits that aren't always that necessary. Sure, we need to do an actual face-to-face appointment when you're needing examined for belly pain or skin cancer screening or a pap smear, but when discussing cholesterol often no need to make the patient come in.
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Want REAL change? . . . . . "Boortz/Nugent in 2012 . . . ! "
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Re: If you know any millionaires or philanthropists...

Post by jfwlb »

I rarely post here but lurk a lot. I helped with what I could. I feel you are a very important part of this site and I have learned quite a lot from you. I will pray that you and your employees will come out ahead and prosper. God Bless.

John
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Post by JimT »

If what you are doing ain't "missionary" work I don't know what is.
Our guiding "philosophy" is "STOP FOR THE ONE IN FRONT OF YOU" ... and you have one in front of you quite a few times a day!
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amen to that
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Thanks for both the prayers and the pesos.

Some employees out sick but I’m putting any who wants it on the ivermectin.

My biggest fear is still that the Democrats will destroy this country, whether or not I go broke or die of CoVid... :|
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Re: If you know any millionaires or philanthropists...

Post by CowboyTutt »

Doc, made a donation, not huge, but something. This is the time of year where I have to go 5-6 weeks off of one monthly paycheck. Will donate again January 31st after getting paid again. Thank you for your service Doc! -Tutt
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Post by Sixgun »

Doc still has long hair...I like the picture. :D
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Sixgun wrote:
Wed Jan 06, 2021 11:50 pm
Doc still has long hair...I like the picture. :D
LOL - a long time ago I decided to just be me; my family is stuck with me unless they can figure out how to kill me and make it look accidental, God would see through any fake stuff I'd try, and my patients judge me by how I treat them, not whether I look like Marcus Welby... Plus I'm too lazy to cut my own hair, and too cheap to pay anyone else to do it, so every spring I cut enough off to donate to Locks of Love, and that's about it.

Autoclave and phones broke at the office, and postal service still says some local covid thing shut down their sorting center so that's their excuse for not delivering our mail again (after we were closed for construction), so revenues out there in space at a bad time of year.

Oh well....we will survive. We're in much better shape than our nation is, for sure.

Tony Katz has a good show on it this morning on WIBC (available streaming - https://www.wibc.com/listen-to-wibc/). Cowards on the Republican side evidently decided not to object to fraud, because some protesters (likely Antifa agent provocateurs) were violent.
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"first do no harm" - gun control LAWS lead to far more deaths than 'easy access' ever could.


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Doc, Good Luck with it.
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Advanced is being able to do the basics while your leg is on fire---Bill Jeans
Don't ever take a fence down until you know why it was put up---Robert Frost
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