Well, my trip to the past is almost over.  The practice continued to grow.  Growth cycles were directly related to season of the year and how busy we were. The longer the wait time, the slower the growth.  As the growth slowed, wait times diminished; and, as wait time diminished, growth again accelerated.

It made sense.  When wait time was low, I could spend more time with the patient.  The more time I spent with a patient, the more referrals I received from that patient.  During the early years of the practice, I would freak when wait times diminished (growth slowed or reversed).  I drove Renee crazy.  I thought I did something wrong and didn’t know it.  Renee started charting numbers of patient seen monthly to show me the natural flow of the practice.  I finally relaxed.

The insurance companies and our government finally killed the practice.  Overhead continued to rise.  Maintaining the EMR was expensive.  Office staffing was expensive.  Replacing aging equipment was expensive. Taxes, snow removal, electricity and water were expensive.  Reimbursements from Medicare and the insurers decreased significantly.  Insurance company interference in patient care increased.  No matter how many patients I could see in a day, income per patient finally fell low enough to make it impossible to stay independent.

I swore I would never sell my practice.  I swore the big hospital-owned corporations buying private practices would be the end of medicine as I knew it.  I was right!  I also had no choice.  I sold to Amita.  Working for Amita was better than I expected.  They gave me plenty of time to see patients.  The other big hospital corporations would have given me 10 minutes per patient.  Amita gave me 30 minutes per patient.  I was actually having fun.

Unfortunately, my back worsened requiring extensive surgery.  My recovery was slowed by the ever-worsening Parkinson’s.  Two years ago, I was forced to retire.  I hate retirement.  I also became a full-time patient.  I hate that role as well.  I had given up and was waiting to die when I got Covid.  Covid kicked my butt.  It also woke me up.  Jeremy came from Atlanta; and Lisa, sick with Covid as well, called twice a day checking on us.  It warmed my heart.

I called on my friends, Will Power and Milo, and they showed up immediately. Covid cleared, Jeremy left, Lisa got well.  Will and Milo hung out.  Their job, to get me back on the right track.

There are plenty of stories to tell.  It will become obvious that my style of treating people was unique and not for everybody.  I was the kid who owned a pool company at the age of 15.  I was the young man who tended bar and short order cooked.  I was the boy who went to Mexico and came back a man with a goatee.  I was a little of each of them and of other characters.  Most of all, I was the 13 year old who told Dr Perlman I was going to be his partner.  Years later, I called him and told him I loved being a family doc.

One big difference between me and my cronies was you wouldn’t catch me with a tie on. Not at home nor in the hospital or office.  I wore polo shirts and sometimes jeans.  It took 20 years for my fellow doctors to learn that ties spread germs.  It took another 10 for dress codes to relax. 

Did you ever wonder why a man would put on a tie? I’m sure some brilliant woman decided that if she put a pretty noose around her husband’s neck and tightened it enough to slightly compromise the blood supply to his brain, she could better control her man.  The word spread and women around the world started dragging their men around by the tie.  “Honey, put on that blue tie and choke yourself almost to death.  We’re going out with the Segals and were going to have fun!

Oh yeah, the rest of this book will review the lessons I’ve learned since becoming chronically ill and how they would have influenced my practice of family medicine had I learned them earlier in life.  I would become a mentor and offer my knowledge to a young MD but you may have noted that too many of my mentors died.  Giving up the knowledge you have must kill you.

Here’s your joke for the day.  Actually, it’s not a joke.  I’m so fat that the post office offered me my own zip code.

I think its time to get my act together.

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