Re: Don't jump. Take the right steps at the right time for you.

[Guest guest]

I would like a peek into those ideas as well, because I agree with the your last " Spending a lot of time on something that is not important does not make it important "

Sangeetha

 

I actually do have some ideas-but they are unconventional and require an open mind-

I've noticed that some newly minted physicians, especially those right from residency combined with electronic health records that are not real friendly combined with a fairly high work load = tremendous issues. (The question is what exactly is the work load-20 patients a day, 25 patient a day, 30 patients a day etc.)-the bottom line and somewhat unconventional wisdom is that you may be doing too good a job--no.... I'm not joking around... doing a perfect job requires unlimited time and unlimited resources.

There are many other issues as well.

Crystal-if you want to take somewhat unconventional advice I would be glad to talk with you further.

regards,

Lou Spikol

" Spending a lot of time on something that is not important does not make it important "

> > >

> > >

> > > From: impnewbie <crystalsdyer@>

> > > Subject: Wanting to leap but scared to jump...

> > > To: <http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups.com>

> > > Date: Monday, January 30, 2012, 3:02 PM

> > >

> > >

> > >

> > > Â

> > >

> > >

> > >

> > > I've been in communication with A. but new to the group...6 months

> > into my first " real " job out of training now (Family Medicine/Sports

> > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in an

> > employed position with a hospital organization with a religious (and very

> > admirable) mission and with actually very likable people but it is so

> > dysfunctional and so poorly run that I think that surely I can do it better

> > myself... They can't even tell me what insurances I'm contracted with

> > ( " well we accept them all " ) or what the contract rates are ( " it's about

> > 50% " ) or what my panel size is...The EMR that has been chosen for me (and

> > that I pay nearly $800/mo in licensing fees for) probably has potential if

> > all templates/customization didn't have to go before a committee somewhere

> > in FL (I'm in TN)--don't even get me started on that. My overhead for the

> > month of December as part of a 9 provider group was over $20k! It takes me

> > longer to do my

> > > notes on EMR than it ever did on paper and I am a self-confessed techie.

> > I have been working 14 hr days and my poor toddler slams my laptop shut

> > when I'm trying to work at home and says " Mommy put it away " which makes me

> > feel about 2 inches tall. My home life is non-existent. There's got to be

> > something better. I wholeheartedly believe in IMPs and have read all of

> > Gordon's articles, have joined the official IMP site and have read the

> > whole wiki but after reading some of the posts in this group about folks

> > who are struggling, I'm worried about making the leap--I've got a lot of

> > bills to pay and can't afford to go under. It's not just a dream , right???

> > If all were to go well, I would be looking at opening in about 6-12

> > months...

> > >

> > > Looking for reassurance!

> > >

> > > Crystal in TN

> > >****

> >

> > ****

> >

> >

> >

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

[Guest guest]

Hi Lou,Ditto, what Sangeetha said.Is that tag line your's or did you hear it somewhere?Would your ideas hold for an MD 20 years out from residency?May be you need to hold a teleconference for those with open minds who would like to hear some unconventional advice? Seriously.Straz

I would like a peek into those ideas as well, because I agree with the your last :)"Spending a lot of time on something that is not important does not make it important"

Sangeetha

I actually do have some ideas-but they are unconventional and require an open mind-

I've noticed that some newly minted physicians, especially those right from residency combined with electronic health records that are not real friendly combined with a fairly high work load = tremendous issues. (The question is what exactly is the work load-20 patients a day, 25 patient a day, 30 patients a day etc.)-the bottom line and somewhat unconventional wisdom is that you may be doing too good a job--no.... I'm not joking around... doing a perfect job requires unlimited time and unlimited resources

[Guest guest]

Lou,I' m with Straz and Sangeetha. Please share. Could this be substrate for a IMP phone meet-up, at least for some on the list? I think so. Here in Massachusetts, the entire state is a dead zone. All physicians are tiered by the controlling 3rd parties who really only negotiate with the hospital aggregates who will be beneficiaries of the bundled payment system taking effect. I have a patchwork life of teaching, clinic work and volunteering to stay in the game. Not financially sustainable. I rarely post because I have nothing much to add to a discussion, except a view of a rather depressing future for docs and most nurses in this state. We're it not for my students and clinic patients, I'm sure I'd be seriously bummed. Off line is fine. I don't want my grumpiness to spread.KathleenSent from my iPad

Hi Lou,Ditto, what Sangeetha said.Is that tag line your's or did you hear it somewhere?Would your ideas hold for an MD 20 years out from residency?May be you need to hold a teleconference for those with open minds who would like to hear some unconventional advice? Seriously.Straz

I would like a peek into those ideas as well, because I agree with the your last :)"Spending a lot of time on something that is not important does not make it important"

Sangeetha

I actually do have some ideas-but they are unconventional and require an open mind-

I've noticed that some newly minted physicians, especially those right from residency combined with electronic health records that are not real friendly combined with a fairly high work load = tremendous issues. (The question is what exactly is the work load-20 patients a day, 25 patient a day, 30 patients a day etc.)-the bottom line and somewhat unconventional wisdom is that you may be doing too good a job--no.... I'm not joking around... doing a perfect job requires unlimited time and unlimited resources

[Guest guest]

I think I am in need of your ideas as well. I am sure that I am spending too much time on my tasks but having difficulty identifying shortcuts/time savers etc.DannielleTo: Sent: Tue, January 31, 2012 8:08:28 AMSubject: Re: Re: Don't jump. Take the right steps at the right time for you.

I would like a peek into those ideas as well, because I agree with the your last :)"Spending a lot of time on something that is not important does not make it important"

Sangeetha

I actually do have some ideas-but they are unconventional and require an open mind-

I've noticed that some newly minted physicians, especially those right from residency combined with electronic health records that are not real friendly combined with a fairly high work load = tremendous issues. (The question is what exactly is the work load-20 patients a day, 25 patient a day, 30 patients a day etc.)-the bottom line and somewhat unconventional wisdom is that you may be doing too good a job--no.... I'm not joking around... doing a perfect job requires unlimited time and unlimited resources

[Guest guest]

Interestingly a recent title on LIFEHACKER

Learn to Practice “Intentional Neglect” to Ditch Unimportant Tasks and Recover from Workload Overload

Sangeetha

 

I think I am in need of your ideas as well. I am sure that I am spending too much time on my tasks but having difficulty identifying shortcuts/time savers etc.

Dannielle

To:

Sent: Tue, January 31, 2012 8:08:28 AMSubject: Re: Re: Don't jump. Take the right steps at the right time for you.

 

I would like a peek into those ideas as well, because I agree with the your last " Spending a lot of time on something that is not important does not make it important "

Sangeetha

 

I actually do have some ideas-but they are unconventional and require an open mind-

I've noticed that some newly minted physicians, especially those right from residency combined with electronic health records that are not real friendly combined with a fairly high work load = tremendous issues. (The question is what exactly is the work load-20 patients a day, 25 patient a day, 30 patients a day etc.)-the bottom line and somewhat unconventional wisdom is that you may be doing too good a job--no.... I'm not joking around... doing a perfect job requires unlimited time and unlimited resources.

There are many other issues as well.

Crystal-if you want to take somewhat unconventional advice I would be glad to talk with you further.

regards,

Lou Spikol

" Spending a lot of time on something that is not important does not make it important "

> > >

> > >

> > > From: impnewbie <crystalsdyer@>

> > > Subject: Wanting to leap but scared to jump...

> > > To: <http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups.com>

> > > Date: Monday, January 30, 2012, 3:02 PM

> > >

> > >

> > >

> > > Â

> > >

> > >

> > >

> > > I've been in communication with A. but new to the group...6 months

> > into my first " real " job out of training now (Family Medicine/Sports

> > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in an

> > employed position with a hospital organization with a religious (and very

> > admirable) mission and with actually very likable people but it is so

> > dysfunctional and so poorly run that I think that surely I can do it better

> > myself... They can't even tell me what insurances I'm contracted with

> > ( " well we accept them all " ) or what the contract rates are ( " it's about

> > 50% " ) or what my panel size is...The EMR that has been chosen for me (and

> > that I pay nearly $800/mo in licensing fees for) probably has potential if

> > all templates/customization didn't have to go before a committee somewhere

> > in FL (I'm in TN)--don't even get me started on that. My overhead for the

> > month of December as part of a 9 provider group was over $20k! It takes me

> > longer to do my

> > > notes on EMR than it ever did on paper and I am a self-confessed techie.

> > I have been working 14 hr days and my poor toddler slams my laptop shut

> > when I'm trying to work at home and says " Mommy put it away " which makes me

> > feel about 2 inches tall. My home life is non-existent. There's got to be

> > something better. I wholeheartedly believe in IMPs and have read all of

> > Gordon's articles, have joined the official IMP site and have read the

> > whole wiki but after reading some of the posts in this group about folks

> > who are struggling, I'm worried about making the leap--I've got a lot of

> > bills to pay and can't afford to go under. It's not just a dream , right???

> > If all were to go well, I would be looking at opening in about 6-12

> > months...

> > >

> > > Looking for reassurance!

> > >

> > > Crystal in TN

> > >****

> >

> > ****

> >

> >

> >

>

>

>

> --

>

>

>

> MD

>

>

> ph fax

>

>

[Guest guest]

I need this advice, too, Lou! One of my attendings called it " giftwrapping the

garbage, " and I know I am doing it, but have trouble making myself stop. I also

think it got a lot worse when I started using an EHR in 2004. Something about

seeing my work in print, I think... Between all the junk the insurers and

malpractice lawyers tell us we need to be doing and my compulsion to do it

perfectly, I don't have enough time left over for patient visits or my personal

life! And it's not getting any better with experience, as I always thought it

would. Help us, Lou!---Sharlene

> > > >

> > > >

> > > > From: impnewbie <crystalsdyer@>

> > > > Subject: Wanting to leap but scared to jump...

> > > > To:

<http://us.mc1645.mail.yahoo.com/mc/compose?\

to=%40yahoogroups.com>

> > > > Date: Monday, January 30, 2012, 3:02 PM

> > > >

> > > >

> > > >

> > > > Â

> > > >

> > > >

> > > >

> > > > I've been in communication with A. but new to the group...6 months

> > > into my first " real " job out of training now (Family Medicine/Sports

> > > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in

an

> > > employed position with a hospital organization with a religious (and very

> > > admirable) mission and with actually very likable people but it is so

> > > dysfunctional and so poorly run that I think that surely I can do it

better

> > > myself... They can't even tell me what insurances I'm contracted with

> > > ( " well we accept them all " ) or what the contract rates are ( " it's about

> > > 50% " ) or what my panel size is...The EMR that has been chosen for me (and

> > > that I pay nearly $800/mo in licensing fees for) probably has potential if

> > > all templates/customization didn't have to go before a committee somewhere

> > > in FL (I'm in TN)--don't even get me started on that. My overhead for the

> > > month of December as part of a 9 provider group was over $20k! It takes me

> > > longer to do my

> > > > notes on EMR than it ever did on paper and I am a self-confessed techie.

> > > I have been working 14 hr days and my poor toddler slams my laptop shut

> > > when I'm trying to work at home and says " Mommy put it away " which makes

me

> > > feel about 2 inches tall. My home life is non-existent. There's got to be

> > > something better. I wholeheartedly believe in IMPs and have read all of

> > > Gordon's articles, have joined the official IMP site and have read the

> > > whole wiki but after reading some of the posts in this group about folks

> > > who are struggling, I'm worried about making the leap--I've got a lot of

> > > bills to pay and can't afford to go under. It's not just a dream ,

right???

> > > If all were to go well, I would be looking at opening in about 6-12

> > > months...

> > > >

> > > > Looking for reassurance!

> > > >

> > > > Crystal in TN

> > > >****

> > >

> > > ****

> > >

> > >

> > >

> >

> >

> >

> > --

> >

> >

> >

> > MD

> >

> >

> > ph fax

> >

> >

>

[Guest guest]

Hi Crystal,

Sorry to hear your'e feeling burnt out already- sigh.. welcome to

big-health-system USA.

I have to ask- says this bunch has paid off your loans already, and you

said you still have student loans? What on earth did they pay off if not those?

Maybe you meant your hubby still has student loans.

Either way, it can be tough if you're unwilling to move or travel, though I've

heard TN was a nice place for Docs. Maybe that was wrong?

.

> > > > >

> > > > >

> > > > > From: impnewbie <crystalsdyer@>

> > > > > Subject: Wanting to leap but scared to jump...

> > > > > To:

<http://us.mc1645.mail.yahoo.com/mc/compose?\

to=%40yahoogroups.com>

> > > > > Date: Monday, January 30, 2012, 3:02 PM

> > > > >

> > > > >

> > > > >

> > > > > Â

> > > > >

> > > > >

> > > > >

> > > > > I've been in communication with A. but new to the group...6

months

> > > > into my first " real " job out of training now (Family Medicine/Sports

> > > > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in

an

> > > > employed position with a hospital organization with a religious (and

very

> > > > admirable) mission and with actually very likable people but it is so

> > > > dysfunctional and so poorly run that I think that surely I can do it

better

> > > > myself... They can't even tell me what insurances I'm contracted with

> > > > ( " well we accept them all " ) or what the contract rates are ( " it's about

> > > > 50% " ) or what my panel size is...The EMR that has been chosen for me

(and

> > > > that I pay nearly $800/mo in licensing fees for) probably has potential

if

> > > > all templates/customization didn't have to go before a committee

somewhere

> > > > in FL (I'm in TN)--don't even get me started on that. My overhead for

the

> > > > month of December as part of a 9 provider group was over $20k! It takes

me

> > > > longer to do my

> > > > > notes on EMR than it ever did on paper and I am a self-confessed

techie.

> > > > I have been working 14 hr days and my poor toddler slams my laptop shut

> > > > when I'm trying to work at home and says " Mommy put it away " which makes

me

> > > > feel about 2 inches tall. My home life is non-existent. There's got to

be

> > > > something better. I wholeheartedly believe in IMPs and have read all of

> > > > Gordon's articles, have joined the official IMP site and have read the

> > > > whole wiki but after reading some of the posts in this group about folks

> > > > who are struggling, I'm worried about making the leap--I've got a lot of

> > > > bills to pay and can't afford to go under. It's not just a dream ,

right???

> > > > If all were to go well, I would be looking at opening in about 6-12

> > > > months...

> > > > >

> > > > > Looking for reassurance!

> > > > >

> > > > > Crystal in TN

> > > > >****

> > > >

> > > > ****

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > >

> > >

> > > MD

> > >

> > >

> > > ph fax

> > >

> > >

> >

>

[Guest guest]

They have paid 90% towards my student loans which is then re written as a logan

from then to me and then forgiven at a % for each year I remain on staff. So I

can get out of it, just have to repay And the hubby has his own set of loans.

He is an educator and can have a small portion of those forgiven.

> > > > > >

> > > > > >

> > > > > > From: impnewbie <crystalsdyer@>

> > > > > > Subject: Wanting to leap but scared to

jump...

> > > > > > To:

<http://us.mc1645.mail.yahoo.com/mc/compose?\

to=%40yahoogroups.com>

> > > > > > Date: Monday, January 30, 2012, 3:02 PM

> > > > > >

> > > > > >

> > > > > >

> > > > > > Â

> > > > > >

> > > > > >

> > > > > >

> > > > > > I've been in communication with A. but new to the group...6

months

> > > > > into my first " real " job out of training now (Family Medicine/Sports

> > > > > Medicine) and ready to slit my wrist, throat, any major vessel... I'm

in an

> > > > > employed position with a hospital organization with a religious (and

very

> > > > > admirable) mission and with actually very likable people but it is so

> > > > > dysfunctional and so poorly run that I think that surely I can do it

better

> > > > > myself... They can't even tell me what insurances I'm contracted with

> > > > > ( " well we accept them all " ) or what the contract rates are ( " it's

about

> > > > > 50% " ) or what my panel size is...The EMR that has been chosen for me

(and

> > > > > that I pay nearly $800/mo in licensing fees for) probably has

potential if

> > > > > all templates/customization didn't have to go before a committee

somewhere

> > > > > in FL (I'm in TN)--don't even get me started on that. My overhead for

the

> > > > > month of December as part of a 9 provider group was over $20k! It

takes me

> > > > > longer to do my

> > > > > > notes on EMR than it ever did on paper and I am a self-confessed

techie.

> > > > > I have been working 14 hr days and my poor toddler slams my laptop

shut

> > > > > when I'm trying to work at home and says " Mommy put it away " which

makes me

> > > > > feel about 2 inches tall. My home life is non-existent. There's got to

be

> > > > > something better. I wholeheartedly believe in IMPs and have read all

of

> > > > > Gordon's articles, have joined the official IMP site and have read the

> > > > > whole wiki but after reading some of the posts in this group about

folks

> > > > > who are struggling, I'm worried about making the leap--I've got a lot

of

> > > > > bills to pay and can't afford to go under. It's not just a dream ,

right???

> > > > > If all were to go well, I would be looking at opening in about 6-12

> > > > > months...

> > > > > >

> > > > > > Looking for reassurance!

> > > > > >

> > > > > > Crystal in TN

> > > > > >****

> > > > >

> > > > > ****

> > > > >

> > > > >

> > > > >

> > > >

> > > >

> > > >

> > > > --

> > > >

> > > >

> > > >

> > > > MD

> > > >

> > > >

> > > > ph fax

> > > >

> > > >

> > >

> >

>

[Guest guest]

Dear Crystal.I was and still am in your shoes.I realized that that only way that I could continue practicing medicine with a smile is the IMP solo way. I was like a tennis ball bouncing from job to job. I really did not appreciated the corporate america way of treating you. I was told but one employer that everything was fine that I was gonna need to cut myself in half to work more. I was financially happy working 3-4 12 hours shifts per week. I was working with a bunch of ER Rn's with a lot of experience . I was doing Urgent Care.My employer was not the hospital or owner of the urgent care.I was working for Physician staffing company called Phoenix physicians.Despite that I asked many times about the status of my job situation and they lied all those times.I got a call from the CEO of the company at 9pm to tell me how great I was and they told me that t"the hospital was getting rid of all the MDs to replace us with Nurse practitioners".You know all the gimmick of I did all I could to save you lalalalalalalalala.I decided to open up my Tinglado ( Nicaraguan slang way to call small street vendor shop).I met by change with Brady from the list in Boston while he was doing a lecture about how to start solo. He got my interest and did some readings and it all make sense, the smaller the better. when I came out of residency I had the idea of a big office with many rooms etc, bla, bla, bla. I asked about his business plan and he kindly told me to use it from his website.I consulted with SCORE people in my area and showed them my buss plan. They did not have a clue what I was talking about, they did not have any experience in open up a clinic. they had experience in selling shoes.I wasted many hours in fixing the grammar ( the wording) and cosmetic of the of buss plan. they recommended to adjust so the bank would give me the loan.I realized that they had great intentions but we were in a different frequency. they were trashing my buss because I did not have a office manager, front desk person,back person, and extra person for the front desk person when she get sick.I can assure you that hardly anybody get the IMP way. I talked to people and they mentioned all the time to growth into a huge office in the future with many people working for me. What I want is small office with a front desk person when I can afford it and 2 providers in the back ( my wife pediatric NP and I ). Thats it.I do not want the supervisor of the supervisor and Hippa compliance officer and the board of directors and so on. I do not want to have an office so big that I can playa soccer game with everybody. I tried to avoid opening my shop and got so comfortable with the Urgent care job but I think God was watching me so close and close that door for me and made me realize that I needed to open my Tinglado. sorry guys I am not trying to imitate here. I went to the Bank and they did not read my Business plan they did not care how the parragraphs were ordered. they went to the numbers and also to my surprise did not have a clue how opening a practice works ( they were from Bank of America they have a special elite division on their website).Why I said they did not have a clue about the numbers in the business plan? they trash the fact that I said that I was gonna be slow when I open. I used the numbers that I took for 's plan. Unless you have a establish patient population in the area I mean you are full and you move you will be full from day one. They did not like the fact that I said that I was gonna be slow at the beginning and that my patient population would growth slowly but surely. they wanted me to see 40 patients a day since day one , despite that fact that I was opening only Monday,Wednesday and Friday because I do not have enough patients to sustain my practice financially. they did not wanna hear it.Guess what I did ?I told them that they did not know what they were talking about it. I believe the only way that you will be full from day one is if you had a full practice or if you in a place that the doctor left or died or there are a lot patients with no PCP. I check other banks locally Suntrust declined me because my house is in red numbers . I told them to check the news and see a lot of americans that have their houses in red numbers. SBA bank did not want to give me the time of the day, I have no collaterals or money. I will stop here to avoid boring everybody.If you want to contact me to give you more ideas about my journey to find the place.you can find me in youtube as : OrangeDoc and look for a tour of the clinic and see how my wife decorated it.

I would like a peek into those ideas as well, because I agree with the your last :)"Spending a lot of time on something that is not important does not make it important"

Sangeetha

I actually do have some ideas-but they are unconventional and require an open mind-

I've noticed that some newly minted physicians, especially those right from residency combined with electronic health records that are not real friendly combined with a fairly high work load = tremendous issues. (The question is what exactly is the work load-20 patients a day, 25 patient a day, 30 patients a day etc.)-the bottom line and somewhat unconventional wisdom is that you may be doing too good a job--no.... I'm not joking around... doing a perfect job requires unlimited time and unlimited resources

[Guest guest]

So I hope I can say a few things that will help-it looks like I started a

conversation going here. I had a funny thought that if I did not post anything

else it would be like starting a bar fight and walking out the back door.

I will post a few more things tonight, but first it's almost dinner and I need

to get a beer.

[Guest guest]

I agree I have to go back home, I am off today and I was reviewing some patient info from previous pCPs.I am hungry too. Wifi is coming home from work so I have to figure out what is for Din-Din? ( dinner) . adolfo To: Sent: Tuesday, January 31, 2012 6:35 PM Subject: Re: Don't jump. Take the right steps at the right time for you.

So I hope I can say a few things that will help-it looks like I started a conversation going here. I had a funny thought that if I did not post anything else it would be like starting a bar fight and walking out the back door.

I will post a few more things tonight, but first it's almost dinner and I need to get a beer.

[Guest guest]

Don't forget forgiven loans are taxable.

How many years?

Subject: Re: Don't jump. Take the right steps at the right time for you.To: Date: Tuesday, January 31, 2012, 4:24 PM

They have paid 90% towards my student loans which is then re written as a logan from then to me and then forgiven at a % for each year I remain on staff. So I can get out of it, just have to repay And the hubby has his own set of loans. He is an educator and can have a small portion of those forgiven.> > > > > >> > > > > >> > > > > > From: impnewbie <crystalsdyer@>> > > > > > Subject: Wanting to leap but scared to jump...> > > > > > To: <http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups.com>> > > > > > Date: Monday, January 30, 2012, 3:02 PM> > > > > >> > > > > >> > > > > >> > > > > > Â> > > > > >> > > > > >> > > > > >> > > > > > I've been in communication with A. but new to the group...6 months> > > > > into my first "real" job out of training now (Family Medicine/Sports> > > >

> Medicine) and ready to slit my wrist, throat, any major vessel... I'm in an> > > > > employed position with a hospital organization with a religious (and very> > > > > admirable) mission and with actually very likable people but it is so> > > > > dysfunctional and so poorly run that I think that surely I can do it better> > > > > myself... They can't even tell me what insurances I'm contracted with> > > > > ("well we accept them all") or what the contract rates are ("it's about> > > > > 50%") or what my panel size is...The EMR that has been chosen for me (and> > > > > that I pay nearly $800/mo in licensing fees for) probably has potential if> > > > > all templates/customization didn't have to go before a committee somewhere> > > > > in FL (I'm in TN)--don't even get me started on

that. My overhead for the> > > > > month of December as part of a 9 provider group was over $20k! It takes me> > > > > longer to do my> > > > > > notes on EMR than it ever did on paper and I am a self-confessed techie.> > > > > I have been working 14 hr days and my poor toddler slams my laptop shut> > > > > when I'm trying to work at home and says "Mommy put it away" which makes me> > > > > feel about 2 inches tall. My home life is non-existent. There's got to be> > > > > something better. I wholeheartedly believe in IMPs and have read all of> > > > > Gordon's articles, have joined the official IMP site and have read the> > > > > whole wiki but after reading some of the posts in this group about folks> > > > > who are struggling, I'm worried about making the

leap--I've got a lot of> > > > > bills to pay and can't afford to go under. It's not just a dream , right???> > > > > If all were to go well, I would be looking at opening in about 6-12> > > > > months...> > > > > >> > > > > > Looking for reassurance!> > > > > >> > > > > > Crystal in TN> > > > > >****> > > > >> > > > > ****> > > > >> > > > > > > > > >> > > > > > > > > > > > > > > > -- > > > > > > > > > > > > > > > > MD> > > > > > > > > > > > ph fax 207 778

3544> > > > > > > >> > >> >>

[Guest guest]

That is something that I will never forget - in 2009, we were subject to Alternative Minimum Tax because of the " boost " in income that the forgiven loans added.  We are still paying it....

 

Don't forget forgiven loans are taxable.

 

How many years?

 

Subject: Re: Don't jump. Take the right steps at the right time for you.

To: Date: Tuesday, January 31, 2012, 4:24 PM

 

They have paid 90% towards my student loans which is then re written as a logan from then to me and then forgiven at a % for each year I remain on staff. So I can get out of it, just have to repay And the hubby has his own set of loans. He is an educator and can have a small portion of those forgiven.

> > > > > >

> > > > > >> > > > > > From: impnewbie <crystalsdyer@>> > > > > > Subject: Wanting to leap but scared to jump...> > > > > > To: <http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups.com>

> > > > > > Date: Monday, January 30, 2012, 3:02 PM> > > > > >> > > > > >> > > > > >> > > > > > Â> > > > > >

> > > > > >> > > > > >> > > > > > I've been in communication with A. but new to the group...6 months> > > > > into my first " real " job out of training now (Family Medicine/Sports

> > > > > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in an> > > > > employed position with a hospital organization with a religious (and very> > > > > admirable) mission and with actually very likable people but it is so

> > > > > dysfunctional and so poorly run that I think that surely I can do it better> > > > > myself... They can't even tell me what insurances I'm contracted with> > > > > ( " well we accept them all " ) or what the contract rates are ( " it's about

> > > > > 50% " ) or what my panel size is...The EMR that has been chosen for me (and> > > > > that I pay nearly $800/mo in licensing fees for) probably has potential if> > > > > all templates/customization didn't have to go before a committee somewhere

> > > > > in FL (I'm in TN)--don't even get me started on that. My overhead for the> > > > > month of December as part of a 9 provider group was over $20k! It takes me> > > > > longer to do my

> > > > > > notes on EMR than it ever did on paper and I am a self-confessed techie.> > > > > I have been working 14 hr days and my poor toddler slams my laptop shut> > > > > when I'm trying to work at home and says " Mommy put it away " which makes me

> > > > > feel about 2 inches tall. My home life is non-existent. There's got to be> > > > > something better. I wholeheartedly believe in IMPs and have read all of> > > > > Gordon's articles, have joined the official IMP site and have read the

> > > > > whole wiki but after reading some of the posts in this group about folks> > > > > who are struggling, I'm worried about making the leap--I've got a lot of> > > > > bills to pay and can't afford to go under. It's not just a dream , right???

> > > > > If all were to go well, I would be looking at opening in about 6-12> > > > > months...> > > > > >> > > > > > Looking for reassurance!

> > > > > >> > > > > > Crystal in TN> > > > > >****> > > > >> > > > > ****> > > > >> > > > >

> > > > >> > > > > > > > > > > > > > > > -- > > > > > > > > > > > > > > > > MD

> > > > > > > > > > > > ph fax > > > >

> > > >> > >> >>

-- Pratt

[Guest guest]

Quoth Dr. Spikol, "... like starting a bar fight and walking out the back door." So. Two IMPs walk into a bar.... (complete this sentence) I agree I have to go back home, I am off today and I was reviewing some patient info from previous pCPs.I am hungry too. Wifi is coming home from work so I have to figure out what is for Din-Din? ( dinner) . adolfo To: Sent: Tuesday, January 31, 2012 6:35 PM Subject: Re: Don't jump. Take the right steps at the right time for you. So I hope I can say a few things that will help-it looks like I started a conversation going here. I had a funny thought that if I did not post anything else it would be like starting a bar fight and walking out the back door. I will post a few more things tonight, but first it's almost dinner and I need to get a beer.

[Guest guest]

I can't wait, Lou. Can we call the new thread, " Stop giftwrapping the garbage? "

Sharlene

>

> So I hope I can say a few things that will help-it looks like I started a

conversation going here. I had a funny thought that if I did not post anything

else it would be like starting a bar fight and walking out the back door.

>

> I will post a few more things tonight, but first it's almost dinner and I need

to get a beer.

>

[Guest guest]

--6 years. Yeah, not too smart in hindsight but damage done, lesson

learned.

, luckily, it's being added to each paycheck a little each time so it's

taxed along the way and not all at once.

> > > > > > > >

> > > > > > > >

> > > > > > > > From: impnewbie <crystalsdyer@>

> > > > > > > > Subject: Wanting to leap but scared to

> > jump...

> > > > > > > > To:

<http://us.mc1645.mail.yahoo.com/mc/compose?\

to=%40yahoogroups.com>

> > <

> >

http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups\

..com

> > >

> > > > > > > > Date: Monday, January 30, 2012, 3:02 PM

> > > > > > > >

> > > > > > > >

> > > > > > > >

> > > > > > > > Â

> > > > > > > >

> > > > > > > >

> > > > > > > >

> > > > > > > > I've been in communication with A. but new to the

> > group...6 months

> > > > > > > into my first " real " job out of training now (Family

> > Medicine/Sports

> > > > > > > Medicine) and ready to slit my wrist, throat, any major

> > vessel... I'm in an

> > > > > > > employed position with a hospital organization with a religious

> > (and very

> > > > > > > admirable) mission and with actually very likable people but it

> > is so

> > > > > > > dysfunctional and so poorly run that I think that surely I can

> > do it better

> > > > > > > myself... They can't even tell me what insurances I'm contracted

> > with

> > > > > > > ( " well we accept them all " ) or what the contract rates are

> > ( " it's about

> > > > > > > 50% " ) or what my panel size is...The EMR that has been chosen

> > for me (and

> > > > > > > that I pay nearly $800/mo in licensing fees for) probably has

> > potential if

> > > > > > > all templates/customization didn't have to go before a committee

> > somewhere

> > > > > > > in FL (I'm in TN)--don't even get me started on that. My

> > overhead for the

> > > > > > > month of December as part of a 9 provider group was over $20k!

> > It takes me

> > > > > > > longer to do my

> > > > > > > > notes on EMR than it ever did on paper and I am a

> > self-confessed techie.

> > > > > > > I have been working 14 hr days and my poor toddler slams my

> > laptop shut

> > > > > > > when I'm trying to work at home and says " Mommy put it away "

> > which makes me

> > > > > > > feel about 2 inches tall. My home life is non-existent. There's

> > got to be

> > > > > > > something better. I wholeheartedly believe in IMPs and have read

> > all of

> > > > > > > Gordon's articles, have joined the official IMP site and have

> > read the

> > > > > > > whole wiki but after reading some of the posts in this group

> > about folks

> > > > > > > who are struggling, I'm worried about making the leap--I've got

> > a lot of

> > > > > > > bills to pay and can't afford to go under. It's not just a dream

> > , right???

> > > > > > > If all were to go well, I would be looking at opening in about

> > 6-12

> > > > > > > months...

> > > > > > > >

> > > > > > > > Looking for reassurance!

> > > > > > > >

> > > > > > > > Crystal in TN

> > > > > > > >****

> > > > > > >

> > > > > > > ****

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > > --

> > > > > >

> > > > > >

> > > > > >

> > > > > > MD

> > > > > >

> > > > > >

> > > > > > ph fax

> > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

> >

> >

>

>

>

> --

> * Pratt*

>

[Guest guest]

Looking forward to the enlightenment!

> >

> > So I hope I can say a few things that will help-it looks like I started a

conversation going here. I had a funny thought that if I did not post anything

else it would be like starting a bar fight and walking out the back door.

> >

> > I will post a few more things tonight, but first it's almost dinner and I

need to get a beer.

> >

>

[Guest guest]

Lou,Yea and nay...I absolutely agree that many of us newly minted physicians (myself most definitely included) are wasting a lot of time on documentation--we get trained that xxx is the right way to do things, and then we learn that no, documenting yyy and zzz are important if you want to get paid and not get sued, and then we see some 'old school' written paper chart documentation (if you can call it that) that pretty much consists of a chief complaint and a notation of what was prescribed and we're left to shake our heads in wonder that anybody could have ever gotten away with practicing that way. And yet, when you break it down to essentials, for a lot of common complaints maybe it really is the case that a cc and a simple plan are all it SHOULD take, even if the prevailing standards demand so much more. So I can certainly see your point about what a time-waste excessive documentation can be.More defensively, I also see that a lot (i.e. the vast majority) of 'real-world' practicing docs skimp on patient education, some a little, some a lot. Effective teaching takes time, and time is something that most doctors have in short supply. A quick-printed fact sheet might work for some patients and pass for communication in some situations, but as often as not, such things end up unread in the garbage or buried in a stack of papers that the patient will get around to checking out 'someday when they have more time'. So I run into people time and time again who have no basic comprehension of what their diseases are or what their medications do or what kinds of side-effects/problems to expect or look for or why they should follow up with a specialist or spend money on expensive medications or put up with undesirable side effects or treat a problem that the doctor cares about but doesn't cause them any unpleasant symptoms. And then we tsk-tsk them when we see them and roll our eyes in wonder at their ignorance and stupidity and later we bitch about their non-compliance to our colleagues. I don't want to build up this straw man overly much and shout "J'accuse!" at you because I don't even know if patient education is one of those "perfect job" sorts of things you were alluding to. I would submit that some doctors (possibly including you, possibly not) might consider it a relative waste of time to relentlessly educate, educate, educate. Regardless, some of us would vehemently disagree as we've seen the difference that kind of 'wasted time' makes in the long run.Ken

I actually do have some ideas-but they are unconventional and require an open mind-

I've noticed that some newly minted physicians, especially those right from residency combined with electronic health records that are not real friendly combined with a fairly high work load = tremendous issues. (The question is what exactly is the work load-20 patients a day, 25 patient a day, 30 patients a day etc.)-the bottom line and somewhat unconventional wisdom is that you may be doing too good a job--no.... I'm not joking around... doing a perfect job requires unlimited time and unlimited resources

[Guest guest]

That's why I ended up at the small business support center and they helped me write my business plan and then approved me for small business loan for start up. If I hadn't taken over another office it wouldn't have been enough of a loan as they are small compared to the banks. I took a 12 week once a week class "start your own business" for 20 dollars and it was good for me to learn that aspect and gave me contacts. Good luck Cyrstral. Feel free to call if want to yak. My non convential way was to get community support with town meetings. I'm only 4 years out but like Matt I would NEVER go back despite the financial challenge. I've just added a NCBF last week and again folk are responding to the need to keep this practice open.

To: Sent: Tuesday, January 31, 2012 6:17 PMSubject: Re: Re: Don't jump. Take the right steps at the right time for you.

Dear Crystal.

I was and still am in your shoes.

I realized that that only way that I could continue practicing medicine with a smile is the IMP solo way.

I was like a tennis ball bouncing from job to job. I really did not appreciated the corporate america way of treating you.

I was told but one employer that everything was fine that I was gonna need to cut myself in half to work more. I was financially happy working 3-4 12 hours shifts per week. I was working with a bunch of ER Rn's with a lot of experience . I was doing Urgent Care.

My employer was not the hospital or owner of the urgent care.

I was working for Physician staffing company called Phoenix physicians.

Despite that I asked many times about the status of my job situation and they lied all those times.

I got a call from the CEO of the company at 9pm to tell me how great I was and they told me that t"the hospital was getting rid of all the MDs to replace us with Nurse practitioners".

You know all the gimmick of I did all I could to save you lalalalalalalalala.

I decided to open up my Tinglado ( Nicaraguan slang way to call small street vendor shop).

I met by change with Brady from the list in Boston while he was doing a lecture about how to start solo. He got my interest and did some readings and it all make sense, the smaller the better. when I came out of residency I had the idea of a big office with many rooms etc, bla, bla, bla. I asked about his business plan and he kindly told me to use it from his website.

I consulted with SCORE people in my area and showed them my buss plan.

They did not have a clue what I was talking about, they did not have any experience in open up a clinic. they had experience in selling shoes.

I wasted many hours in fixing the grammar ( the wording) and cosmetic of the of buss plan. they recommended to adjust so the bank would give me the loan.

I realized that they had great intentions but we were in a different frequency. they were trashing my buss because I did not have a office manager, front desk person,

back person, and extra person for the front desk person when she get sick.

I can assure you that hardly anybody get the IMP way. I talked to people and they mentioned all the time to growth into a huge office in the future with many people working for me.

What I want is small office with a front desk person when I can afford it and 2 providers in the back ( my wife pediatric NP and I ). Thats it.

I do not want the supervisor of the supervisor and Hippa compliance officer and the board of directors and so on. I do not want to have an office so big that I can play

a soccer game with everybody.

I tried to avoid opening my shop and got so comfortable with the Urgent care job but I think God was watching me so close and close that door for me and made me realize that I needed to open my Tinglado.

sorry guys I am not trying to imitate here.

I went to the Bank and they did not read my Business plan they did not care how the parragraphs were ordered. they went to the numbers and also to my surprise did not have a clue how opening a practice works ( they were from Bank of America they have a special elite division on their website).

Why I said they did not have a clue about the numbers in the business plan? they trash the fact that I said that I was gonna be slow when I open. I used the numbers that I took for 's plan. Unless you have a establish patient population in the area I mean you are full and you move you will be full from day one.

They did not like the fact that I said that I was gonna be slow at the beginning and that my patient population would growth slowly but surely.

they wanted me to see 40 patients a day since day one , despite that fact that I was opening only Monday,Wednesday and Friday because I do not have enough patients to sustain my practice financially. they did not wanna hear it.

Guess what I did ?I told them that they did not know what they were talking about it. I believe the only way that you will be full from day one is if you had a full practice or if you in a place that the doctor left or died or there are a lot patients with no PCP.

I check other banks locally Suntrust declined me because my house is in red numbers . I told them to check the news and see a lot of americans that have their houses in red numbers. SBA bank did not want to give me the time of the day, I have no collaterals or money.

I will stop here to avoid boring everybody.

If you want to contact me to give you more ideas about my journey to find the place.

you can find me in youtube as : OrangeDoc and look for a tour of the clinic and see how my wife decorated it.

I would like a peek into those ideas as well, because I agree with the your last :)"Spending a lot of time on something that is not important does not make it important"Sangeetha

I actually do have some ideas-but they are unconventional and require an open mind-I've noticed that some newly minted physicians, especially those right from residency combined with electronic health records that are not real friendly combined with a fairly high work load = tremendous issues. (The question is what exactly is the work load-20 patients a day, 25 patient a day, 30 patients a day etc.)-the bottom line and somewhat unconventional wisdom is that you may be doing too good a job--no.... I'm not joking around... doing a perfect job requires unlimited time and unlimited resources.There are many other issues as well.Crystal-if you want to take somewhat unconventional advice I would be glad to talk with you further.regards,Lou Spikol"Spending a lot of time on something that is not important does not make it important"

> > >> > >> > > From: impnewbie <crystalsdyer@>

> > > Subject: Wanting to leap but scared to jump...> > > To: <http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups.com>

> > > Date: Monday, January 30, 2012, 3:02 PM> > >> > >> > >> > > Â> > >> > >> > >> > > I've been in communication with A. but new to the group...6 months> > into my first "real" job out of training now (Family Medicine/Sports> > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in an> > employed position with a hospital organization with a religious (and very> > admirable) mission and with actually very likable people but it is so> > dysfunctional and so poorly run that I think that surely I can do it better> > myself... They can't even tell me what insurances I'm contracted with> > ("well we accept them all") or what the contract rates are ("it's about> > 50%") or what my panel size is...The EMR that has been

chosen for me (and> > that I pay nearly $800/mo in licensing fees for) probably has potential if> > all templates/customization didn't have to go before a committee somewhere> > in FL (I'm in TN)--don't even get me started on that. My overhead for the> > month of December as part of a 9 provider group was over $20k! It takes me> > longer to do my> > > notes on EMR than it ever did on paper and I am a self-confessed techie.> > I have been working 14 hr days and my poor toddler slams my laptop shut> > when I'm trying to work at home and says "Mommy put it away" which makes me> > feel about 2 inches tall. My home life is non-existent. There's got to be> > something better. I wholeheartedly believe in IMPs and have read all of> > Gordon's articles, have joined the official IMP site and have read the> > whole wiki but after reading some

of the posts in this group about folks> > who are struggling, I'm worried about making the leap--I've got a lot of> > bills to pay and can't afford to go under. It's not just a dream , right???> > If all were to go well, I would be looking at opening in about 6-12> > months...> > >> > > Looking for reassurance!> > >> > > Crystal in TN> > >****> >> > ****

> >> > > >> > > > -- > > > > MD> > > ph fax > >

[Guest guest]

" I tried to avoid opening my shop and got so comfortable with the Urgent care

job but I think God was watching me so close and close that door for me and made

me realize that I needed to open my Tinglado. " Adolfo, this is exactly what

happened to me! I loved your long post and enjoyed watching your video and

seeing your nice office and beautiful wife. You both look so proud!

Congratulations on how far you have come! So, where did you end up getting the

money?---Sharlene

> > > > >

> > > > >

> > > > > From: impnewbie <crystalsdyer@>

> >

> > > > > Subject: Wanting to leap but scared to jump...

> > > > > To:

<http://us.mc1645.mail.yahoo.com/mc/compose?\

to=%40yahoogroups.com>

> >

> > > > > Date: Monday, January 30, 2012, 3:02 PM

> > > > >

> > > > >

> > > > >

> > > > > Â

> > > > >

> > > > >

> > > > >

> > > > > I've been in communication with A. but new to the group...6

months

> > > > into my first " real " job out of training now (Family Medicine/Sports

> > > > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in

an

> > > > employed position with a hospital organization with a religious (and

very

> > > > admirable) mission and with actually very likable people but it is so

> > > > dysfunctional and so poorly run that I think that surely I can do it

better

> > > > myself... They can't even tell me what insurances I'm contracted with

> > > > ( " well we accept them all " ) or what the contract rates are ( " it's about

> > > > 50% " ) or what my panel size is...The EMR that has been chosen for me

(and

> > > > that I pay nearly $800/mo in licensing fees for) probably has potential

if

> > > > all templates/customization didn't have to go before a committee

somewhere

> > > > in FL (I'm in TN)--don't even get me started on that. My overhead for

the

> > > > month of December as part of a 9 provider group was over $20k! It takes

me

> > > > longer to do my

> > > > > notes on EMR than it ever did on paper and I am a self-confessed

techie.

> > > > I have been working 14 hr days and my poor toddler slams my laptop shut

> > > > when I'm trying to work at home and says " Mommy put it away " which makes

me

> > > > feel about 2 inches tall. My home life is non-existent. There's got to

be

> > > > something better. I wholeheartedly believe in IMPs and have read all of

> > > > Gordon's articles, have joined the official IMP site and have read the

> > > > whole wiki but after reading some of the posts in this group about folks

> > > > who are struggling, I'm worried about making the leap--I've got a lot of

> > > > bills to pay and can't afford to go under. It's not just a dream ,

right???

> > > > If all were to go well, I would be looking at opening in about 6-12

> > > > months...

> > > > >

> > > > > Looking for reassurance!

> > > > >

> > > > > Crystal in TN

> > > > >****

> > > >

> > > > ****

> >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > > --

> > >

> > >

> > >

> > > MD

> > >

> > >

> > > ph fax

> > >

> > >

> >

> >

> >

> >

> >

>

[Guest guest]

So, a few observations

1. By any means, seeing 25 to 30 patient's a day is a daunting task especially

if your panel is near or over 2000 patients. Other than enlisting help, trying

to reduce the number of patients that you see, I don't have any amazing insights

into this. I did this for a number of years and I must say I never thought I

was doing a great job seeing that many patients. However, you should be making

upwards of $170,000 a year at least if your doing this on a consistent basis and

at least this will help reduce debt.

2. I think primary care physician should take advantage of the advantages of

being primary care. This basically means you have a good relationship with the

patient, fairly consistent follow-up and over time a good understanding of both

the patient's physical and psychological needs. All things being equal the

should enable you to be more efficient and effective taking care of your

patients without over-documentation. What reduces liability in my opinion is

the relationship, follow-up and knowledge of the patient, not the documentation.

Closely related to the above issue is the idea of uncertainty. Family

physicians, internal medicine physicians another primary care physician's need

to get a grip on uncertainty. I believe after 20 or 25 years I'm able to group

my patients when they come in into categories as to whether there are severe

issues going on that need addressing or not. It really is amazing the job most

of us to with minimal studies, instruments, stuff in the office.

3. Sometimes a cigar is just a cigar-certainly there are some visits where the

patient is coming in with a specific request, specific problem and really, if

it's okay just to address that problem and not veer off into other issues is ok.

next topic-dealing with emr

[Guest guest]

I got it from Band of america. I changed the numbers the way they wanted and I got the money from them.

SBA loans did not want to give me money ( I am too risky because I live in a house that I am paying to the bank. I am 50,000 dollars in negative).

I really done understand Mr. Obama, he wants to insure 40 million people out there.The SBA( his federal goverment) dont want to lend money to the doctors who

wants to open their doors. The federal govemerment may think that doctors offices opens via Harry Potter.

I also notice when you open your doors you will have countless people trying to sell you the golden gate.

Ardiana my wife one deay got a call from a suposed official that I did not buy an OSHA manual from them I would be breaking the law.

jejejejejejejejeej

I also get so many marketing venues that I never heard off.

I think you have to have an idea what works in your community. I think is a trial and erro thing.

You have to use the IMP way otherwise I will go broke spending my money in marketing that does not work.

I developed a nose for people that falsely believes that I coughing benjamins. They have the crazy idea that somebody gives you money from the sky.

I also noticed that you become a target for Narcotic seeking patients. you know are you the new kid in the block so there you go. Well enough of complaing or venting. I can tell you that my schedule is getting busier and slowly but surely. I notice one problems that for the health insurances acreditations take forever so sometimes you see the patient and you do not get paid because you are fully acredited with them. Adolfo

To: Sent: Wednesday, February 1, 2012 11:40 AMSubject: Re: Don't jump. Take the right steps at the right time for you.

"I tried to avoid opening my shop and got so comfortable with the Urgent care job but I think God was watching me so close and close that door for me and made me realize that I needed to open my Tinglado." Adolfo, this is exactly what happened to me! I loved your long post and enjoyed watching your video and seeing your nice office and beautiful wife. You both look so proud! Congratulations on how far you have come! So, where did you end up getting the money?---Sharlene > > > > >> > > > >> > > > > From: impnewbie <crystalsdyer@>> > > > > >

> Subject: Wanting to leap but scared to jump...> > > > > To: <http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups.com>> > > > > > > Date: Monday, January 30, 2012, 3:02 PM> > > > >> > > > >> > > > >> > > > > Â> > > > >> > > > >> > > > >> > > > > I've been in communication with A. but new to the group...6 months> > > > into my first "real" job out of training now (Family

Medicine/Sports> > > > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in an> > > > employed position with a hospital organization with a religious (and very> > > > admirable) mission and with actually very likable people but it is so> > > > dysfunctional and so poorly run that I think that surely I can do it better> > > > myself... They can't even tell me what insurances I'm contracted with> > > > ("well we accept them all") or what the contract rates are ("it's about> > > > 50%") or what my panel size is...The EMR that has been chosen for me (and> > > > that I pay nearly $800/mo in licensing fees for) probably has potential if> > > > all templates/customization didn't have to go before a committee somewhere> > > > in FL (I'm in TN)--don't even get me started on that. My

overhead for the> > > > month of December as part of a 9 provider group was over $20k! It takes me> > > > longer to do my> > > > > notes on EMR than it ever did on paper and I am a self-confessed techie.> > > > I have been working 14 hr days and my poor toddler slams my laptop shut> > > > when I'm trying to work at home and says "Mommy put it away" which makes me> > > > feel about 2 inches tall. My home life is non-existent. There's got to be> > > > something better. I wholeheartedly believe in IMPs and have read all of> > > > Gordon's articles, have joined the official IMP site and have read the> > > > whole wiki but after reading some of the posts in this group about folks> > > > who are struggling, I'm worried about making the leap--I've got a lot of> > > > bills to pay and

can't afford to go under. It's not just a dream , right???> > > > If all were to go well, I would be looking at opening in about 6-12> > > > months...> > > > >> > > > > Looking for reassurance!> > > > >> > > > > Crystal in TN> > > > >****> > > >> > > > ****> > > > > >> > > > > > > >> > > > > > > > > > > > -- > > > > > > > > > > > > MD> > > > > > > > > ph fax > > > > > >> > > > > > > > >

>>

[Guest guest]

Adolfo You are cracking me up herejejeje yourslef! Gracias que es   coughing benjamins???Jean

 

I got it from Band of america. I changed the numbers the way they wanted and I got the money from them.

SBA loans did not want to give me money ( I am too risky because I live in a house that I am paying to the bank. I am 50,000 dollars in negative).

I really done understand Mr. Obama, he wants to insure 40 million people out there.The SBA( his federal goverment) dont want to lend money to the doctors who

wants to open their doors. The federal govemerment may think that  doctors offices opens via Harry Potter.

I also notice when you open your doors you will have countless people trying to sell you the golden gate.

Ardiana my wife one deay got a call from a suposed official that I did not buy an OSHA manual from them I would be breaking the law.

jejejejejejejejeej

I also get so many marketing venues that I never heard off.

I think you have to have an idea what works in your community. I think is a trial and erro thing.

You have to use the IMP way otherwise I will go broke spending my money in marketing that does not work.

I developed a nose for people that falsely believes that I coughing benjamins. They have the crazy idea that somebody gives you money from the sky.

I also noticed that you become a target for Narcotic seeking patients. you know are you the new kid in the block so there you go.  Well enough of complaing or venting. I can tell you that my schedule is getting busier and slowly but surely. I notice one problems that for the health insurances acreditations take forever so sometimes you see the patient and you do not get paid because you are fully acredited with them.  Adolfo

 

 

To: Sent: Wednesday, February 1, 2012 11:40 AM

Subject: Re: Don't jump. Take the right steps at the right time for you.

 

" I tried to avoid opening my shop and got so comfortable with the Urgent care job but I think God was watching me so close and close that door for me and made me realize that I needed to open my Tinglado. " Adolfo, this is exactly what happened to me! I loved your long post and enjoyed watching your video and seeing your nice office and beautiful wife. You both look so proud! Congratulations on how far you have come! So, where did you end up getting the money?---Sharlene

> > > > >> > > > >

> > > > > From: impnewbie <crystalsdyer@>> > > > > >

> Subject: Wanting to leap but scared to jump...> > > > > To: <http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups.com>

> > > > > > > Date: Monday, January 30, 2012, 3:02 PM> > > > >> > > > >> > > > >> > > > > Â> > > > >

> > > > >> > > > >> > > > > I've been in communication with A. but new to the group...6 months> > > > into my first " real " job out of training now (Family

Medicine/Sports> > > > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in an> > > > employed position with a hospital organization with a religious (and very

> > > > admirable) mission and with actually very likable people but it is so> > > > dysfunctional and so poorly run that I think that surely I can do it better> > > > myself... They can't even tell me what insurances I'm contracted with

> > > > ( " well we accept them all " ) or what the contract rates are ( " it's about> > > > 50% " ) or what my panel size is...The EMR that has been chosen for me (and> > > > that I pay nearly $800/mo in licensing fees for) probably has potential if

> > > > all templates/customization didn't have to go before a committee somewhere> > > > in FL (I'm in TN)--don't even get me started on that. My

overhead for the> > > > month of December as part of a 9 provider group was over $20k! It takes me> > > > longer to do my> > > > > notes on EMR than it ever did on paper and I am a self-confessed techie.

> > > > I have been working 14 hr days and my poor toddler slams my laptop shut> > > > when I'm trying to work at home and says " Mommy put it away " which makes me> > > > feel about 2 inches tall. My home life is non-existent. There's got to be

> > > > something better. I wholeheartedly believe in IMPs and have read all of> > > > Gordon's articles, have joined the official IMP site and have read the> > > > whole wiki but after reading some of the posts in this group about folks

> > > > who are struggling, I'm worried about making the leap--I've got a lot of> > > > bills to pay and

can't afford to go under. It's not just a dream , right???> > > > If all were to go well, I would be looking at opening in about 6-12> > > > months...> > > > >

> > > > > Looking for reassurance!> > > > >> > > > > Crystal in TN> > > > >****> > > >> > > > ****> > > > > >

> > > > > > > >> > > > > > > > > > > > -- > > > > > > > > > > > > MD> > >

> > > > > > ph fax

> > > > > >> > > > > > > > >

>>

--      MD          ph    fax

[Guest guest]

coughing money. adolfo

To: Sent: Thursday, February 2, 2012 3:05 PMSubject: Re: Re: Don't jump. Take the right steps at the right time for you.

Adolfo You are cracking me up herejejeje yourslef! Gracias que es coughing benjamins???Jean

I got it from Band of america. I changed the numbers the way they wanted and I got the money from them.

SBA loans did not want to give me money ( I am too risky because I live in a house that I am paying to the bank. I am 50,000 dollars in negative).

I really done understand Mr. Obama, he wants to insure 40 million people out there.The SBA( his federal goverment) dont want to lend money to the doctors who

wants to open their doors. The federal govemerment may think that doctors offices opens via Harry Potter.

I also notice when you open your doors you will have countless people trying to sell you the golden gate.

Ardiana my wife one deay got a call from a suposed official that I did not buy an OSHA manual from them I would be breaking the law.

jejejejejejejejeej

I also get so many marketing venues that I never heard off.

I think you have to have an idea what works in your community. I think is a trial and erro thing.

You have to use the IMP way otherwise I will go broke spending my money in marketing that does not work.

I developed a nose for people that falsely believes that I coughing benjamins. They have the crazy idea that somebody gives you money from the sky.

I also noticed that you become a target for Narcotic seeking patients. you know are you the new kid in the block so there you go. Well enough of complaing or venting. I can tell you that my schedule is getting busier and slowly but surely. I notice one problems that for the health insurances acreditations take forever so sometimes you see the patient and you do not get paid because you are fully acredited with them. Adolfo

To: Sent: Wednesday, February 1, 2012 11:40 AMSubject: Re: Don't jump. Take the right steps at the right time for you.

"I tried to avoid opening my shop and got so comfortable with the Urgent care job but I think God was watching me so close and close that door for me and made me realize that I needed to open my Tinglado." Adolfo, this is exactly what happened to me! I loved your long post and enjoyed watching your video and seeing your nice office and beautiful wife. You both look so proud! Congratulations on how far you have come! So, where did you end up getting the money?---Sharlene > > > > >> > > > >> > > > > From: impnewbie <crystalsdyer@>> > > > > >

> Subject: Wanting to leap but scared to jump...> > > > > To: <http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups.com>> > > > > > > Date: Monday, January 30, 2012, 3:02 PM> > > > >> > > > >> > > > >> > > > > Â> > > > >> > > > >> > > > >> > > > > I've been in communication with A. but new to the group...6 months> > > > into my first "real" job out of training now (Family

Medicine/Sports> > > > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in an> > > > employed position with a hospital organization with a religious (and very> > > > admirable) mission and with actually very likable people but it is so> > > > dysfunctional and so poorly run that I think that surely I can do it better> > > > myself... They can't even tell me what insurances I'm contracted with> > > > ("well we accept them all") or what the contract rates are ("it's about> > > > 50%") or what my panel size is...The EMR that has been chosen for me (and> > > > that I pay nearly $800/mo in licensing fees for) probably has potential if> > > > all templates/customization didn't have to go before a committee somewhere> > > > in FL (I'm in TN)--don't even get me started on that. My

overhead for the> > > > month of December as part of a 9 provider group was over $20k! It takes me> > > > longer to do my> > > > > notes on EMR than it ever did on paper and I am a self-confessed techie.> > > > I have been working 14 hr days and my poor toddler slams my laptop shut> > > > when I'm trying to work at home and says "Mommy put it away" which makes me> > > > feel about 2 inches tall. My home life is non-existent. There's got to be> > > > something better. I wholeheartedly believe in IMPs and have read all of> > > > Gordon's articles, have joined the official IMP site and have read the> > > > whole wiki but after reading some of the posts in this group about folks> > > > who are struggling, I'm worried about making the leap--I've got a lot of> > > > bills to pay and

can't afford to go under. It's not just a dream , right???> > > > If all were to go well, I would be looking at opening in about 6-12> > > > months...> > > > >> > > > > Looking for reassurance!> > > > >> > > > > Crystal in TN> > > > >****> > > >> > > > ****> > > > > >> > > > > > > >> > > > > > > > > > > > -- > > > > > > > > > > > > MD> > > > > > > > > ph fax > > > > >

>> > > > > > > > > >>

-- MD ph fax

[Guest guest]

ah:)

 

coughing money. adolfo

To: Sent: Thursday, February 2, 2012 3:05 PM

Subject: Re: Re: Don't jump. Take the right steps at the right time for you.

 

Adolfo You are cracking me up herejejeje yourslef! Gracias que es   coughing benjamins???Jean

 

I got it from Band of america. I changed the numbers the way they wanted and I got the money from them.

SBA loans did not want to give me money ( I am too risky because I live in a house that I am paying to the bank. I am 50,000 dollars in negative).

I really done understand Mr. Obama, he wants to insure 40 million people out there.The SBA( his federal goverment) dont want to lend money to the doctors who

wants to open their doors. The federal govemerment may think that  doctors offices opens via Harry Potter.

I also notice when you open your doors you will have countless people trying to sell you the golden gate.

Ardiana my wife one deay got a call from a suposed official that I did not buy an OSHA manual from them I would be breaking the law.

jejejejejejejejeej

I also get so many marketing venues that I never heard off.

I think you have to have an idea what works in your community. I think is a trial and erro thing.

You have to use the IMP way otherwise I will go broke spending my money in marketing that does not work.

I developed a nose for people that falsely believes that I coughing benjamins. They have the crazy idea that somebody gives you money from the sky.

I also noticed that you become a target for Narcotic seeking patients. you know are you the new kid in the block so there you go.  Well enough of complaing or venting. I can tell you that my schedule is getting busier and slowly but surely. I notice one problems that for the health insurances acreditations take forever so sometimes you see the patient and you do not get paid because you are fully acredited with them.  Adolfo

 

 

To:

Sent: Wednesday, February 1, 2012 11:40 AMSubject: Re: Don't jump. Take the right steps at the right time for you.

 

" I tried to avoid opening my shop and got so comfortable with the Urgent care job but I think God was watching me so close and close that door for me and made me realize that I needed to open my Tinglado. " Adolfo, this is exactly what happened to me! I loved your long post and enjoyed watching your video and seeing your nice office and beautiful wife. You both look so proud! Congratulations on how far you have come! So, where did you end up getting the money?---Sharlene

> > > > >> > > > >

> > > > > From: impnewbie <crystalsdyer@>> > > > > >

> Subject: Wanting to leap but scared to jump...> > > > > To: <http://us.mc1645.mail.yahoo.com/mc/compose?to=%40yahoogroups.com>

> > > > > > > Date: Monday, January 30, 2012, 3:02 PM> > > > >> > > > >> > > > >> > > > > Â> > > > >

> > > > >> > > > >> > > > > I've been in communication with A. but new to the group...6 months> > > > into my first " real " job out of training now (Family

Medicine/Sports> > > > Medicine) and ready to slit my wrist, throat, any major vessel... I'm in an> > > > employed position with a hospital organization with a religious (and very

> > > > admirable) mission and with actually very likable people but it is so> > > > dysfunctional and so poorly run that I think that surely I can do it better> > > > myself... They can't even tell me what insurances I'm contracted with

> > > > ( " well we accept them all " ) or what the contract rates are ( " it's about> > > > 50% " ) or what my panel size is...The EMR that has been chosen for me (and> > > > that I pay nearly $800/mo in licensing fees for) probably has potential if

> > > > all templates/customization didn't have to go before a committee somewhere> > > > in FL (I'm in TN)--don't even get me started on that. My

overhead for the> > > > month of December as part of a 9 provider group was over $20k! It takes me> > > > longer to do my> > > > > notes on EMR than it ever did on paper and I am a self-confessed techie.

> > > > I have been working 14 hr days and my poor toddler slams my laptop shut> > > > when I'm trying to work at home and says " Mommy put it away " which makes me> > > > feel about 2 inches tall. My home life is non-existent. There's got to be

> > > > something better. I wholeheartedly believe in IMPs and have read all of> > > > Gordon's articles, have joined the official IMP site and have read the> > > > whole wiki but after reading some of the posts in this group about folks

> > > > who are struggling, I'm worried about making the leap--I've got a lot of> > > > bills to pay and

can't afford to go under. It's not just a dream , right???> > > > If all were to go well, I would be looking at opening in about 6-12> > > > months...> > > > >

> > > > > Looking for reassurance!> > > > >> > > > > Crystal in TN> > > > >****> > > >> > > > ****> > > > > >

> > > > > > > >> > > > > > > > > > > > -- > > > > > > > > > > > > MD> > >

> > > > > > ph fax > > >

> >

>> > > > > > > > > >>

--      MD          ph    fax

--      MD          ph    fax