The physician assistant that I hired is back from a trip to Europe.

The local hospital refused to assist us and supervise her until I am well and cleared to work. The hospital CEO said that the physicians were willing to be collegial and help with medical questions, but the malpractice had advised them not to supervise her.

I responded dryly that having the physicians be collegial would certainly be a change. The refusal to help is a load of nastiness, since the hospital has bailed out five clinics in the past fourteen years. They just don't like me. Now I have a letter of documentation. How nice.

Another local independent doctor is going to help.

We are doing the paperwork to file the physician assistant supervision play with the state of Washington, get the malpractice all arranged. For 60 days she can be my "locum tenens", that is, fill in for me being out sick and we can use some special code to bill the insurances under my name and numbers. During that time we will work on CAQH, that is, getting her approved by medicare and all the insurances. CAQH is a data base for the insurance companies to check on medical providers.

It is massive amounts of arcane paperwork. I talked to MQAC yesterday and they explained what we did wrong with the first batch faxed in. We are hoping to get approval by Monday because we have an extremely disabled patient who can only move her face on the schedule and her advocate comes from two hours away. I don't like this sort of paperwork, but I can do it if forced.

While I am doing that, I am also ramping up continuing medical education. I have to do 150 hours every three years. I have only done 80 hours. I thought, why am I behind? Then I thought, oh, sister died, father died, legal crap, complicated estate and I've had strep sepsis twice, in 2012 and 2014. I could write a letter to the AAFP and ask for an extension, but barring new crises, I will just try to get it done. I did pass my medical boards in that time, due every 10 years, so that is out of the way. I have to do my yearly 20 hours on the ABFM website.

There are free classes through my malpractice insurance and classes through the WSMA. Some of the WSMA classes are free, some aren't. There is a class from the malpractice about motivational interviewing Thursday, Friday, Saturday in Seattle, but it's full. Rats. I need 25 live class credits. Telemedicine with UW counts and they have three weekly conferences: chronic pain, HIV and hepatitis C.

There was a free class Tuesday night, but it was two hours and in Seattle. Would have taken two hours to get there and two hours back. I was too tired. Good decision, because today I had a doctor appointment at 4 pm 40 minutes away. I went to sleep at 7 pm. Still tired.

My DEA number is up to date and my state license is up to date. Clia lab waiver, business license, workman's comp, taxes, check. All the little details to keep track of.....