All is Well in Robsville

Yep…I\’m still here.

For those who have worried that I am sick, that I was attacked by mutant slugs, that I moved to Peru and became a llama wrangler, that I ate one too many fluorescent tacos, that I am going through a midlife crisis…well, on that last one you might be right.  But overall I\’m fine; it\’s just been a complicated and busy year and my writing has fallen off.  Things have now changed enough that I think (hope) that I can once again start writing regularly.


In truth, once you stop writing for enough time (like a month or two), it\’s hard to get back on the horse (or llama).  The energy it takes to get the old proverbial (virtual) pen going is pretty great.  There\’s a certain flow to the brain that happens when you write, and that flow is easy to get going when you write often.  Right now it\’s like the sap in trees in the early spring that is still thick and sluggish but will soon be flowing again.

Yeah…I know. Comparing myself to sap is an invitation to all sorts of snarky remarks.

But before I get going on different topics, let me update you on what\’s going on in my practice.  We are getting very close to our four year anniversary/birthday/Kwanza.  We opened in February of 2013 and are doing remarkably well despite having a dopey doctor at the helm of the business.  I think that\’s testimony to the business model, actually, in that I was so afraid of the intricacies of business that I dumbed it down enough for it to be \”so easy, even a doctor could do it.\”  And I am still doing it!  We are up to about 670 patients and are still steadily growing.  For those who think this number should be higher, I was previously estimating our numbers based on my homemade EMR software, which, it turns out, was a braggart.  Now the numbers are more accurate, based on the actual billing subscriptions each month.  But still, that\’s a healthy number, and we continue to grow significantly year over year.


Jamie and Jenn are still working with me, and we are trying to improve the overall quality of the care we are giving.  Lately we\’ve been concerned that we are getting a little complacent about things – that we know we are good and don\’t feel the urgent need to prove it – so we are now trying to find ways to tighten the ship, improve our quality, fix areas where we are inefficient, and make the experience better for our patients.  There still are very few complaints, and the busiest day we\’ve ever had in the office is 13 patients (although there were many patients we took care of outside of the office), but we don\’t want to wait for complaints before working on improvement.

I reluctantly abandoned my homemade EMR product and now am using Elation EMR.  I switched mainly because I didn\’t see myself being able to keep up with where I felt the practice needed to go in the future (mainly in the area of direct engagement with patients through their records).  My EMR worked just fine, but I was basically having to do two jobs at once, which was overall too much to do in the long run.  We are 6 months into using Elation and are happy with it.

My interactions with the rest of the healthcare system increasingly show me the madness that I left is only increasing.  Specialists have less time and inclination to communicate with me, as do hospitals.  Primary care docs I speak to are all sad and/or tired.  Anyone who is trying to get insurance through anything besides a large employer finds the process difficult and incredibly expensive.  While the ACA never struck me as a solution to our problems (not addressing the man issue: the high cost of care), the tearing down of this program offers no better prospects for our future.  Few people have good insurance, and many have none.  It\’s a sorry system we have, and the prospects of improvement are not good.

But in our practice we live on this little island of sanity in a world where that is scarce.  We work in an place where \”you\’re welcome\” is said far more than \”I\’m sorry.\”  Patient wait times only go up when people have the nerve to show up early — otherwise, we still have an average of around 30 seconds.  I still spend an hour with new patients, for them to get to know me and me to get to know them; and they still generally walk away with an amazed expression on their face, having never experienced a good experience at a doctor\’s office.  We still have a steady stream of new patients without doing much at all in the way of marketing.  So all\’s well in Robsville. 

And the movement of direct primary care is booming.  There are many more physicians across the country either converting to DPC or starting out of residency in this model.  Just yesterday I spoke to a doctor in Augusta who plans on converting his practice \”by May.\”  I told him I\’d do whatever I can to help him.  He sounded like a man who is about to get out of jail.  So maybe there is some hope.  We will see.

Let me close by proposing a toast.


Here\’s to 2017.  May it be full of blog posts, devoid of mutant slugs, may it surprise us and somehow give us hope for the future of our healthcare system, may our facts always be factual, may our news sources always be reliable, may any squirrels we encounter not be angry enough to bite us, and may we smile far more than we scowl…even with what\’s-his-name in the White House.

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