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So what IS going on with my business?

For one thing, I am scared of my autoclave.

That sounds ludicrous but it is true. It's not entirely unreasonable, because the guy at Seattle Surgical said, "Oh, it's an old one but in great shape. Don't change the setting while the timer is on or you'll melt the switch. And if you forget to raise the switch in the back when you start the timer, the water will leak out and everything inside will burn up. As long as you remember those two things, you'll be fine. Make sure only one person is in charge of autoclaving. That's what usually messes people up."

I have avoided the autoclave and tried not to make eye contact with it ever since. I was avoiding it BEFORE he gave me instructions. Eventually I will practice using it, but not yet.

I spent six months talking to local doctors, reading, being a Mad as Hell Doctor and writing a business plan. I got the loan, signed a lease and the beau went to town fixing the space up. "Do you really need sinks in both exam rooms?" he said. "Think about it," I said. "Oh. Uh, yes you do," he said. I loved the interview part because everyone happily gave me advice and no one agreed with anyone else. And after working for the hospital for 9.5 years, I thought, well, I might make a hash of the business, but it would be hard to do a worse job.

There was a moment when I thought, oh, dear, I need to write a job description and hire a receptionist. B called me. She is a retired doctor. She told me about a mutual friend's situation, which had suddenly become difficult. "She's looking for a job. Hire her." Oooooh. I did. There, receptionist found.

I have an electronic medical record (EMR) that I LIKE. I am a tactile kinetic learner, which makes reading instructions pretty unhelpful. I need to use something to understand it. We opened before my medicare billing came through. All the people that knew this said it was the wrong thing to do. I am sure they are right, except that cash only for the first three weeks has let the schedule be light enough for me to continue to set things up as I use them. I didn't know why I felt fine with starting without the medicare, except that I did. And I think we've already gotten to the first month's goals. Of course, my startup cost numbers were too low and just wrong, so time to rework the budget.

I worked very hard on the medicare application and it is arcane and made no sense to me. Meanwhile, I was exploring the EMR. It had links to three billing companies. I contacted them. I started asking questions about the medicare paperwork and the head of one company eventually said, "You are entirely clueless, but you make me laugh." I pointed out that the cluelessness was why I hired him. So the medicare paper is done, 80+ pages. I have to have two NPI numbers, National Provider Index or Natural Penis Implant or something, one for me as a doctor and one for the business. That was seriously tripping me up, especially when I confused it with my EIN. I had to email yesterday about the last form to ask whether the business or the doctor was filling it out. He said, "You do that one TWICE, fill it out for BOTH." Oh. I read the whole thing and it made no sense, so I'm glad I asked. I still need a letter from the bank. I took them the application and they photocopied the relevant part. The banker said, "We have doctors who have their loans with us and their merchant services with us but no one has asked for this letter before: but you're right, the medicare application requires it." Ha, ha, the other doctors don't understand it either. It may require the bank to rewrite the loan papers or me to switch my merchant services to a different bank. Yee-ha.

I have a great and joyous sense of relief each time I DO see a patient, a sense of "Hooray! Something that I actually understand and do well!" One woman came to me out of frustration with another clinic this week. "You took care of me in 2000 when I had horrible pneumonia and was hospitalized for 8 days!" I remembered her name but no details. There is sadness too, because I will be taking medicare but no other insurance, so some of my medicaid folks and state insurance folks can't afford even my low prices. It's the trade off for not working for the hospital corporation: I no longer have to attempt to follow their rules, but the advantage was that I could take care of anyone. Now I have to make the business float. Hard choices. We will see what happens with the new law.

Addendum: I got a call from the frustrated woman yesterday. "You fixed me. I feel lots better. Thank you." And last evening I was at the Unitarian Church at a meeting for parents and teens. We played one of those "get to know you" games. My teen hates them but she stayed home to do homework. This was "say your name and something you like doing." Most parents chose gardening. I said, "I am enjoying my work." After that, of course, everyone avoided me like I had the plague.

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