Sunday, August 20, 2006

A Long Year

I absolutely cannot believe that more than a year has passed since I wrote one word in this little blog! Guess because so much has happened to change the pattern of my days, it's really no wonder.

What happened?

Well, I started working outside my house, that's what happened. Not too far outside, but outside it is. It all started when my husband told his partners he was planning to retire in two years...
Not an unexpected event, really. He thought that when he turned 62, it would be a good idea to take up other interests. Put more time into his golf game. Work out more often. Travel to Denver to see the grandchildren. You know. Just ordinary stuff.

However, it turns out that his first partner didn't agree, suddenly, on the terms of the contract that had been in place for over 20 years.

Man oh man, what a mess! Lawyers, letters, disputes, and a lot of really childish behavior(his). This man figured since he was going to be left with the practice, he could arbitraily decide what he wanted to do with it. And, if my husband, who started the whole thing in 1979, was leaving, then he could keep all the money. (And not share any with my husband, ever)

Amazing what a lack of morals allows people to do. It didn't help that we had a contract that was "loosely translatable" either.

So, what to do? It took a year, but in the end, we decided to start our own practice - again. I had helped him set the first one up back in 1979. I am an R. N. and a Pediatric Nurse Practitioner, so I was his nurse, his receptionist, his bookkeeper as well as wife and mom of our two young sons. Very young.

I really didn't want to work at that time. My kids needed me and I wanted to be with them. I had never planned on having them and then handing them over to someone else to raise. Yeah, yeah, yeah, I know that's really old fashioned and probably not even politically correct anymore, but even in the face of the pressure put on by the women's movement, I still felt my place was home, home, home with my kids.

After a couple of years of frantic working schedules, I did finally quit when the practice was able to support a nurse, a receptionist and us too.

Being a home suited me. Suited us. Everybody knew I was there for them. For my husband, I was his center. For my children, I was their touchstone. And, I was there to carpool, cook, shop, get the laundry done, organize family parties and take care of our pets, the garden, cheap chic decorating the house and do volunteer work at the synagogue.

As the kids grew up, I had lots of time to do other things too. I started a small business and made beautiful prayer shawls for women. A chance to develop my sewing, machine embroidery, dyeing, fabric painting, silk ribbon embroidery and beading skills. So much fun to do! Soon, I made shawls for men and boys too. I got so busy I had to hire help. It was great. Then it got so busy it got to be unfun. I was running ragged around the edges and slowly pulled back.

I was kind of in a coasting mode and soon the grandchildren began to appear. New fun! New things to do! A different phase of life. Wonderful, wonderful, wonderful.

And then this. Now I am back to work full time. I have set up a new office for my husband.
And, let me tell you, it ain't like it used to be.

Everything is computerized and electronic. The charts, the billing, and really fancy phones!

And, everything is dependent on the medical insurance industry. They have complete control over every aspect of running a medical practice. If they decide to take you on as a provider of medical services, you have to run everything according to their rules. They tell you what has to be hung on your walls and what has to be in the charts. And they tell you what they will pay for and what they will not. And, how much.

It's a problem just getting them to give us enough money to cover the cost of the vaccines we have to give to our little patients. And some drugs they don't even cover! If my husband feels that a child needs a certain vaccine and that patient's insurance company doesn't cover it, we have to pay for it. And, according to some of these contracts, we are NOT ALLOWED TO BILL FOR IT. We take a hit because we want to do the right thing.

If you want patients to see you, you have to have insurance plans that they use. A pediatrician is considered a "primary care physician". A gate keeper. Ugghh! That means for most insurance that most people can afford, they have to have PERMISSION from their primary doctor to see any specialist they may wish to consult.

I am beginning to hate the word: Referral.

As office manager, I have to write all the referrals. It wouldn't be so bad if all they needed was a signed prescription, but it aint' so easy as that. Sometimes it takes as long as 45 minutes or two days to get permission from the insurance company for the patient to see a specialist.

It's really sickening.

Anyway, as this post is getting too long, I'm gonna have to stop. But, since I feel as if my head is just bobbing to the surface of a routine these days, I will make an effort to show some of what I am doing again. I am painting the walls and doors of the office, making it colorful and fun for the kids who have to face big scary needles and other unexpected insults to their beautiful young selves.

Note to self (and to anybody out their who has a business of their own) :



Andrew McAllister said...

Many people struggle to find the right balance between home and out of home. And that is good advice about equal partnerships.
To Love, Honor and Dismay

Cindra said...

I'm glad to see you posting again. I hope your husband does well with this move and that the former partner is shown the error in his greed. It really is a shame both on the partnership and the shape of medicine/insurance.