Tablets and Pinball and The HealthSystem.

[RustedFox]

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Amigos.


I just spent a whole two hours playing pinball on my tablet.
The gin helps, especially after an awful nightshift.

When I say "awful", I don't mean that I told a mom that "she has cancer", or told a husband that "his wife was not coming back"

That's like, Tuesday.

This nightshift was 2 patients a hour of "my baby just came back from her daddy place, and she look sick"

... or ...

"Grandma woke up earlier than normal to take a pee."

All night long, it was *bull$hitasaurus* items that could have waited until morning, to be seen by their PMD or whatever.


But a funny thing happened...


When I wasn't playing "OH, I CARE SO MUCH ABOUT YOUR NONSENSE! HERE IS A PRESCRIPTION FOR MAGIC BEANS NOW GO HOME LOLZ."

I was playing pinball on my tablet.

If there are any other pinball fans reading this (we are a small community), I was playing "High Speed II" on my Samsung Galaxy 5 tab. "Medieval Madness" is a close second in terms of "favorites".


Here's the twist:

I paused my pinball game in the middle of a multiball.
I went to go see a patient and write a Rx for macrobid.
I cameback, pushed "resume", and three pinballs all remembered where they were, where they were going to be, and where they should be should [x,y,z,aa] happens.

THE YEAR IS 2019. THERE IS ABSOLUTELY NO EXCUSE WHY "MEDITECH" EXISTS.

When your pinball game that makes NO money is clearly more elegant and sophisticated than MEDITECH (and does it, without a fart) , then.... there's a problem.



Stay tuned.

 

[TooMuchResearch]

Lol

 

[thegenius]

LOL

 

[Perrin]

It seems many of the EMRs are like apps. They advertise with all the high end graphic cut scenes and deliver a 12-bit centipede game.

 

[Birdstrike]

Lol

 

[Birdstrike]

Haven't played pinball lately. Too busy trying to outdo my kids on Aquapark.io
Wait?
You mean you haven't raced a baby down a waterslide?
Weird.

 

[RustedFox]

For the life of me, I can't figure out why more of our patient care and throughput isn't tablet-and-app based.
They're so small, so lightweight, so high-powered, so elegant.
I see absolutely no reason why we can't streamline ER processes and make it tablet-based.
Walk in the room. Pick up the tablet. Punch the button for "chest pain workup". Go do your charting. One-touch.
Hell, restaurants are all over this. Why are we not ?

 

[Birdstrike]

For the life of me, I can't figure out why more of our patient care and throughput isn't tablet-and-app based.
They're so small, so lightweight, so high-powered, so elegant.
I see absolutely no reason why we can't streamline ER processes and make it tablet-based.
Walk in the room. Pick up the tablet. Punch the button for "chest pain workup". Go do your charting. One-touch.
Hell, restaurants are all over this. Why are we not ?

Because we’re regulated by a behemoth of government imposed bureaucracy now. “Great idea Dr Fox. We’ve looked into switching to iPads. It does appear it would make everything better for everyone. However, we’ve found it would create a glitch in our ability to comply with meaningless use, MIPPS, MACRA, TICCS, DICCS/DACRA/BlipsBla#!#@!!$!!! and mess up o u r . . . .

‘ N U M B E R S .’ ”


“So, sorry. We can’t do it.”

 

[Birdstrike]

What’s it going to take to turn this bulls**t around, or are we lost forever in a sea of meaningless box checking and following ridiculous protocols that make no medical sense?

What can we do to fix this BS?

There’s got to be a way. I don’t know what it is, but there’s got to be a way to have Medicine guided by people with at least a remote sense of what makes sense medically as opposed to running it like a post-office in a communist 3rd world country. There’s got to be a way to right the ship, at least partially.

 

[killerleaf]

My thought is that the programmers who are the uber-talented and could program for mobile apps for healthcare....are off programming apps for companies that actually make goood money.

 

[RustedFox]

What’s it going to take to turn this bulls**t around, or are we lost forever in a sea of meaningless box checking and following ridiculous protocols that make no medical sense?

What can we do to fix this BS?

There’s got to be a way. I don’t know what it is, but there’s got to be a way to have Medicine guided by people with at least a remote sense of what makes sense medically as opposed to running it like a post-office in a communist 3rd world country. There’s got to be a way to right the ship, at least partially.

Sure. Put the power back in the hands of the physicians and not the suits.

I've said this before, but it bears repeating: EVERY administrator needs to write a proposal that justifies their own employment and salary, in terms of "what I actually do for this hospital/system". Fail to do so, and/or fail to deliver on your proposal, and you're fired.

The suits apply this "lean" model to physician staffing. I say we apply it to them.

 

[VA Hopeful Dr]

Because we’re regulated by a behemoth of government imposed bureaucracy now. “Great idea Dr Fox. We’ve looked into switching to iPads. It does appear it would make everything better for everyone. However, we’ve found it would create a glitch in our ability to comply with meaningless use, MIPPS, MACRA, TICCS, DICCS/DACRA/BlipsBla#!#@!!$!!! and mess up o u r . . . .

‘ N U M B E R S .’ ”


“So, sorry. We can’t do it.”

Yep. You should have seen the EMR I used when I had my DPC clinic. Web-based. Worked great on my phone. $300/month per doctor.

 

[RustedFox]

I'm sorry; what is DPC?

 

[InternistDO]

I'm sorry; what is DPC?

Direct primary care, basically where patients pay a yearly/monthly fee for primary care. Doctors using this don't bill insurance (that would be concierge medicine), so they aren't constrained by CMS metrics for billing/EMR/etc. The idea is you can maintain a smaller patient panel and be more available to patients since you don't have to spend half your time charting anymore.

 

[RustedFox]

What a brilliant idea.
Primary care here is a wasteland, minus one or two "big groups" that can actually do the right thing.
The rest of the offices are "refill clinics" and "chelation centers of excellence" that prey on snowbirds.

 

[GonnaBeADoc2222]

Direct primary care, basically where patients pay a yearly/monthly fee for primary care. Doctors using this don't bill insurance (that would be concierge medicine), so they aren't constrained by CMS metrics for billing/EMR/etc. The idea is you can maintain a smaller patient panel and be more available to patients since you don't have to spend half your time charting anymore.

This sounds amazing

 

[TooMuchResearch]

Yep. You should have seen the EMR I used when I had my DPC clinic. Web-based. Worked great on my phone. $300/month per doctor.

That sounds amazing.
I have Epic Haiku, but I find it mostly useless, much as I find most of Epic.

 

[VA Hopeful Dr]

What a brilliant idea.
Primary care here is a wasteland, minus one or two "big groups" that can actually do the right thing.
The rest of the offices are "refill clinics" and "chelation centers of excellence" that prey on snowbirds.

This sounds amazing

Yes and no.

The smaller patient panel and longer appointments were nice - I literally knew and could remember all of my patients' medical issues easily. Charting was great, 2-3 lines for acute visits was my standard. I loved not having to care about 99% of government rules (taxes, licenses, and waste disposal were about the only stuff that still applied to me). My busiest 8 hour day was 14 patients.

The being on call 24/7 was less fun. Granted I didn't get called/texted every day, but just knowing I could be at any time can wear on you.

I also hate having to run a business. Rent, payroll, budgeting, I learned to hate all of that.

The money is also not as good. Most DPC solo docs can pull 200k, maybe a shade more with the standard prices/panel size. I fully expect to be pushing 300k within 15-18 months at my new job. Sure I'll be working harder (20-25 patients/day rather than 8-10), but I'd rather work hard at work and then go home. I know you EM folks can appreciate that.

 

[RustedFox]

Yes and no.

The smaller patient panel and longer appointments were nice - I literally knew and could remember all of my patients' medical issues easily. Charting was great, 2-3 lines for acute visits was my standard. I loved not having to care about 99% of government rules (taxes, licenses, and waste disposal were about the only stuff that still applied to me). My busiest 8 hour day was 14 patients.

The being on call 24/7 was less fun. Granted I didn't get called/texted every day, but just knowing I could be at any time can wear on you.

I also hate having to run a business. Rent, payroll, budgeting, I learned to hate all of that.

The money is also not as good. Most DPC solo docs can pull 200k, maybe a shade more with the standard prices/panel size. I fully expect to be pushing 300k within 15-18 months at my new job. Sure I'll be working harder (20-25 patients/day rather than 8-10), but I'd rather work hard at work and then go home. I know you EM folks can appreciate that.

Yeah, we can appreciate that.

The rub comes where we have to deal with PMD-style complaints at 2-3 AM that could have waited until the morning to do anything, and could have waited another several days to see their doctor... yet because this is America, the Medicare/Medicaid population comes to the ER because they want an answer, now.

I worked 9pm-6am two days ago. The 2:30 am ' 69 year old constipation' visit, and the '28 year old sore throat' visit need to be obviated by improved accessibility to PMDs.

Sadly, these r/***** will then be calling you at 2:30 AM with total nonsense.

America needs to be educated about "what should go to the ER", and "what should wait until 2pm the next day".

Hmm...


...


This post is more me thinking out loud than anything else. Apologies to VA doc and the rest.

 

[VA Hopeful Dr]

Yeah, we can appreciate that.

The rub comes where we have to deal with PMD-style complaints at 2-3 AM that could have waited until the morning to do anything, and could have waited another several days to see their doctor... yet because this is America, the Medicare/Medicaid population comes to the ER because they want an answer, now.

I worked 9pm-6am two days ago. The 2:30 am ' 69 year old constipation' visit, and the '28 year old sore throat' visit need to be obviated by improved accessibility to PMDs.

Sadly, these r/***** will then be calling you at 2:30 AM with total nonsense.

America needs to be educated about "what should go to the ER", and "what should wait until 2pm the next day".

Hmm...


...


This post is more me thinking out loud than anything else. Apologies to VA doc and the rest.

Oddly enough, most of my late night stuff was appropriate - chest pain, stroke symptoms, wheezy baby, that sort of thing. Between 5pm and 8pm I would get more of the minor stuff as people got home from work, but if it doesn't wake me up I'm less bothered by it.

 

[RustedFox]

Oddly enough, most of my late night stuff was appropriate - chest pain, stroke symptoms, wheezy baby, that sort of thing. Between 5pm and 8pm I would get more of the minor stuff as people got home from work, but if it doesn't wake me up I'm less bothered by it.

So what did you do for these complaints?

 

[VA Hopeful Dr]

So what did you do for these complaints?

The chest pain/stroke-like symptoms/wheezy baby at 2am?

I think we both know the answer to that.

The minor stuff I could usually manage over the phone. "No you don't need antibiotics for your cold, send me a picture of the rash, drink some water for the dizziness if no better see me tomorrow, yes I really want you to take your cholesterol medication, here's some zofran for nausea see me tomorrow if still vomiting", you get the idea.

 

[Birdstrike]

The rest of the offices are "refill clinics" and "chelation centers of excellence" that prey on snowbirds.

That’s the fault of the federal government that sets industry fees with Medicare. Once the fees are set, private insurers copy them. Then once PCPs only get paid a pittance to see patients in 12-15 minutes, with 3/4 of that time eaten up by asking mandated (irrelevant) questions and checking mandated (irrelevant) boxes, there’s no time left for anything but a “refill clinic.” They can’t address 18 and a half complex problems in the time allotted and meet their overhead, pay back the cost of their education and make an acceptable salary relative to the time invested in training.

If the only thing the Feds (and insurance) will pay them to be is a refill clinic, then all you’re going to have is refill clinics. The same goes for psychiatry. None of the payers will pay for therapy for people to actually sit down, talk with someone and solve their problems. If they’ll only pay for an SSRI/SNRI refill clinic then all you’ll get is refill clinics.

Government f**ks (almost) everything up.

 

[RustedFox]

That’s the fault of the federal government that sets industry fees with Medicare. Once the fees are set, private insurers copy them. Then once PCPs only get paid a pittance to see patients in 12-15 minutes, with 3/4 of that time eaten up by asking mandated (irrelevant) questions and checking mandated (irrelevant) boxes, there’s no time left for anything but a “refill clinic.” They can’t address 18 and a half complex problems in the time allotted and meet their overhead, pay back the cost of their education and make an acceptable salary relative to the time invested in training.

Oh, I get it.
I just read an article (should have posted it) detailing why America has such a poor value/spending ratio in the world of medicine when compared to other health systems.

#1 was "America is a Primary Care Desert".

NO (before anyone asks), NPs are NOT the solution to this.

 

[thegenius]

Direct primary care, basically where patients pay a yearly/monthly fee for primary care. Doctors using this don't bill insurance (that would be concierge medicine), so they aren't constrained by CMS metrics for billing/EMR/etc. The idea is you can maintain a smaller patient panel and be more available to patients since you don't have to spend half your time charting anymore.

How much would be a standard monthly / yearly fee? I presume patients have to pay more for labs, UA, EKG, CT, XR?

 

[GeneralVeers]

The problem is that the payers, insurance and government plays games in order to reduce reimbursement. They keep moving the goalpost and adding quality measures, MIPS, protocols, and patient satisfaction in order to not pay the bill that is due. This results in EMRs becoming more complex, and the charting ever more onerous in order that we hit all the bullet points to get paid.

I can't see this ever changing, and in fact will only get worse under "Medicare for all". Government is going to do everything they can to reduce payments to hospitals and doctors, so will implement more and more measures. We are in a charting arms race with no end in sight!

 

[InternistDO]

How much would be a standard monthly / yearly fee? I presume patients have to pay more for labs, UA, EKG, CT, XR?

I'm but a humble med student so I don't have first hand knowledge but you can putz around on this website which links to a bunch of different practices and see for yourself: Mapper — Direct Primary Care Frontier

There are some explanations on how the whole thing works too, apparently its gets complicated with Medicare/Medicaid patients. My understanding is that for labs and out of office imaging you'd negotiate rates with the local imaging centers/labs and they tend to be receptive to agreeing to low cash prices, but again, this is all second hand.

 

[VA Hopeful Dr]

How much would be a standard monthly / yearly fee? I presume patients have to pay more for labs, UA, EKG, CT, XR?

Yearly fee was tiered by age. $50 to a max of $80 per month.

UA and ECG were included at my practice. Basically anything I could do in office was included - lacs, biopsy, IM meds, IV fluids, UPT, strep

Labs were extra but I had negotiated prices with Quest. Some examples:

CBC $4
TSH $7
PSA $12
CMP $5
Lipids $7
Testosterone $20

There was a free standing imaging place in the same building that I had negotiated rates with as well.

XR $30
RUQ US $90
Full abd US $150
CT Chest w/o $200
W/ 250
Abd/pelvis $450 w/ or +50 w/o
MRI of anything w/o $550
W/ add $100

 

[RustedFox]

Yearly fee was tiered by age. $50 to a max of $80 per month.

UA and ECG were included at my practice. Basically anything I could do in office was included - lacs, biopsy, IM meds, IV fluids, UPT, strep

Labs were extra but I had negotiated prices with Quest. Some examples:

CBC $4
TSH $7
PSA $12
CMP $5
Lipids $7
Testosterone $20

There was a free standing imaging place in the same building that I had negotiated rates with as well.

XR $30
RUQ US $90
Full abd US $150
CT Chest w/o $200
W/ 250
Abd/pelvis $450 w/ or +50 w/o
MRI of anything w/o $550
W/ add $100

Where are you? Will you be my PCP?

 

[thegenius]

The chest pain/stroke-like symptoms/wheezy baby at 2am?

I think we both know the answer to that.

The minor stuff I could usually manage over the phone. "No you don't need antibiotics for your cold, send me a picture of the rash, drink some water for the dizziness if no better see me tomorrow, yes I really want you to take your cholesterol medication, here's some zofran for nausea see me tomorrow if still vomiting", you get the idea.

Dude I ain't got no problem with any of this. I think it's totally fine to send your 50+ year old people with acute chest and abdominal pain to the ED. I'm almost never upset about this, unless I hear they have been having chest or abdominal pain for 3 months.

 

[thegenius]

Yearly fee was tiered by age. $50 to a max of $80 per month.

UA and ECG were included at my practice. Basically anything I could do in office was included - lacs, biopsy, IM meds, IV fluids, UPT, strep

Labs were extra but I had negotiated prices with Quest. Some examples:

CBC $4
TSH $7
PSA $12
CMP $5
Lipids $7
Testosterone $20

There was a free standing imaging place in the same building that I had negotiated rates with as well.

XR $30
RUQ US $90
Full abd US $150
CT Chest w/o $200
W/ 250
Abd/pelvis $450 w/ or +50 w/o
MRI of anything w/o $550
W/ add $100

This is unbelievably awesome. I too want to be your patient.

How do you deal with medications? Do patients have insurance for meds? Or are you just careful about what you prescribe and try to Rx the $4 ones as much as possible? I can see it being hard for the controller inhaled corticosteroids for COPD...I dunno about elsewhere but basically all these like qvar, advair, pulmicort, etc, they are all very expensive like $250-$300/month.

What do you think an average 55 yo person with HTN, IDDM would pay per year to be a patient of yours? Maybe they see you 5 times a year. 3 visits are routine checkups and the other 2 are for acute symptoms. He takes lisinopril, metformin, and glipizide. (this ain't me!!! LOL).

Man....this year I'm spending $1700 / month on premiums to insure my family through Kaiser. We probably spend another $100/month on office visits, medicines, kids breaking s**t on their bodies, etc.

And you're making about 200K/year doing this? Seeing about 14 pts/day? (I can't remember if you already wrote about this...)

 

[thegenius]

Yearly fee was tiered by age. $50 to a max of $80 per month.

UA and ECG were included at my practice. Basically anything I could do in office was included - lacs, biopsy, IM meds, IV fluids, UPT, strep

Labs were extra but I had negotiated prices with Quest. Some examples:

CBC $4
TSH $7
PSA $12
CMP $5
Lipids $7
Testosterone $20

There was a free standing imaging place in the same building that I had negotiated rates with as well.

XR $30
RUQ US $90
Full abd US $150
CT Chest w/o $200
W/ 250
Abd/pelvis $450 w/ or +50 w/o
MRI of anything w/o $550
W/ add $100

See...this is an example on why I think it's critically important that people PAY FOR STUFF THEY USE. If the government just gave every single person an "Health Savings Account" and funded it with $10K / year and did away with insurance. Now people have to pay for their doctors. They would see you VA Hopeful Dr and spend maybe $2K/year until they start to get older and they spend more because they get more ailments. But each year this money accrues. And they can also buy catastrophic health insurance for hospitalizations...which is the way insurance is supposed to work. You insure against rare things like being hospitalized.

Prices would come down, people theoretically would take better care of themselves. We can have ER's and we charge you upfront, no quibbling. We only don't charge upfront (but definitely later) you if you are unable to talk, or are unconscious, or have a real damn emergency.

There are obvious problems with this model. The unfortunate dude at age 32 who gets ESRD from FSGS and either has to go on dialysis or gets a kidney transplant. He would probably eat away at that govt issued HSA fund pretty quickly and run out. Then...well...I guess he dies.

 

[VA Hopeful Dr]

This is unbelievably awesome. I too want to be your patient.

How do you deal with medications? Do patients have insurance for meds? Or are you just careful about what you prescribe and try to Rx the $4 ones as much as possible? I can see it being hard for the controller inhaled corticosteroids for COPD...I dunno about elsewhere but basically all these like qvar, advair, pulmicort, etc, they are all very expensive like $250-$300/month.

What do you think an average 55 yo person with HTN, IDDM would pay per year to be a patient of yours? Maybe they see you 5 times a year. 3 visits are routine checkups and the other 2 are for acute symptoms. He takes lisinopril, metformin, and glipizide. (this ain't me!!! LOL).

Man....this year I'm spending $1700 / month on premiums to insure my family through Kaiser. We probably spend another $100/month on office visits, medicines, kids breaking s**t on their bodies, etc.

And you're making about 200K/year doing this? Seeing about 14 pts/day? (I can't remember if you already wrote about this...)

So medications are even better. In 48 states as of 2 years ago, physicians can dispense medications out of their offices (**** you NJ).

I would buy common meds wholesale, mark them up 10% to cover pill bottles and labels, and sell at that price.

30 days of things like prozac, lisinopril, and mobic were under a dollar.

Lexapro, metformin, flomax and zoloft were between $1-2 for 30 days.

DIflucan is about $1.30 per pill.

Crestor runs about $5 per month.

Glipizide was weirdly expensive but glimeperide ran about $4 a month.

That all said, I sold my practice 2 years ago - our family moved and I couldn't take it with me. But I think even my limited experience proves that this is absolutely something that can make a huge impact on health care. It really shows just how much money is wasted on insurance/government admin. Take a look at this place, cash only surgery center: Procedures Archive - Surgery Center of Oklahoma

As for income, its really easy to calculate.

For DPC, overhead works out to be about 33%.

600 patients (full capacity for most FPs doing this) x $50/month is 30k/month. Take out 30% and you're left with 20k/month. For the year that's actually 240k. Now there's always something that comes up - rush of patients quitting one month, having to buy new equipment, whathave you so the number that most use is 200k. But once things are running smoothly, you don't work nearly as hard for that 200k as you do in FFS. Generally speaking.

 

[VA Hopeful Dr]

See...this is an example on why I think it's critically important that people PAY FOR STUFF THEY USE. If the government just gave every single person an "Health Savings Account" and funded it with $10K / year and did away with insurance. Now people have to pay for their doctors. They would see you VA Hopeful Dr and spend maybe $2K/year until they start to get older and they spend more because they get more ailments. But each year this money accrues. And they can also buy catastrophic health insurance for hospitalizations...which is the way insurance is supposed to work. You insure against rare things like being hospitalized.

Prices would come down, people theoretically would take better care of themselves. We can have ER's and we charge you upfront, no quibbling. We only don't charge upfront (but definitely later) you if you are unable to talk, or are unconscious, or have a real damn emergency.

There are obvious problems with this model. The unfortunate dude at age 32 who gets ESRD from FSGS and either has to go on dialysis or gets a kidney transplant. He would probably eat away at that govt issued HSA fund pretty quickly and run out. Then...well...I guess he dies.

 

[killerleaf]

I remember as a kid, going to the local doctor, who had been practicing for years. probably delivered half the kids I went to school with. He was just a GP...but that is who we saw (even when we thought I had broken a foot). I know that the prices were reasonable;; and he did offer a payment plan if someone was a little strapped. It seems as if that just does not exist anymore.

 

[scummie]

My mom works at a job where she doesn’t get health insurance, makes too much for subsidies and if she wanted health insurance, was about $800/monthly on the insurance marketplace. Lives in a state that did not expand Medicaid. Never been hospitalized except for childbirth. Takes just one blood pressure medication. Ridiculous. But anyways, she has this set up with her PCP and the prices are actually pretty good. Sadly, actually cheaper than paying for insurance. It’s a gamble because you hope nothing happens that warrants an inpatient stay.

 

[FamilymedMD]

So medications are even better. In 48 states as of 2 years ago, physicians can dispense medications out of their offices (**** you NJ).

I would buy common meds wholesale, mark them up 10% to cover pill bottles and labels, and sell at that price.

30 days of things like prozac, lisinopril, and mobic were under a dollar.

Lexapro, metformin, flomax and zoloft were between $1-2 for 30 days.

DIflucan is about $1.30 per pill.

Crestor runs about $5 per month.

Glipizide was weirdly expensive but glimeperide ran about $4 a month.

That all said, I sold my practice 2 years ago - our family moved and I couldn't take it with me. But I think even my limited experience proves that this is absolutely something that can make a huge impact on health care. It really shows just how much money is wasted on insurance/government admin. Take a look at this place, cash only surgery center: Procedures Archive - Surgery Center of Oklahoma

As for income, its really easy to calculate.

For DPC, overhead works out to be about 33%.

600 patients (full capacity for most FPs doing this) x $50/month is 30k/month. Take out 30% and you're left with 20k/month. For the year that's actually 240k. Now there's always something that comes up - rush of patients quitting one month, having to buy new equipment, whathave you so the number that most use is 200k. But once things are running smoothly, you don't work nearly as hard for that 200k as you do in FFS. Generally speaking.

Forgive me if you've posted this elsewhere but why did you quit DPC and go back to the system? I saw you hope to make $300K in your new job but I would think you could've done that quicker and more easily by simply increasing you DPC panel slowly above 600 since your workload was light.

 

[VA Hopeful Dr]

Forgive me if you've posted this elsewhere but why did you quit DPC and go back to the system? I saw you hope to make $300K in your new job but I would think you could've done that quicker and more easily by simply increasing you DPC panel slowly above 600 since your workload was light.

We moved.

And my workload was light by FFS standards, by the time I had hit 600 (I was at 450 when I sold), it would have been about average busy by DPC standards and I wouldn't want to increase by much since at 450 patients I was seeing 7-10 per day with probably 10-15 e-mails/texts per day as well. Another 150 patients would have likely pushed those up to 12-14 patients and 20-25 email/texts per day. Anything much more than that and you start losing same-day visits and quick responses to communication.

That aside, I was also getting disenchanted running the business part and likely would have burned out on that in another handful of years anyway.

 

[FamilymedMD]

Ah, that makes sense.

Everyone is different, my MA/manager and I are enjoying the business end.

We were also surprisingly busy at 450-550 but things have improved markedly now that we've slowed the new patient flow to a trickle. At 600 patients, 4-7 visit days are very common again.

Thanks for the info and good luck with your new gig.

BP