Growing Pains

It is a dilemma that we now face. With our schedule packed well into the future, I had a call today from the director of the largest headache clinic in the state. She called to tell me that she was leaving the region . . . and behind her, 15,000 headache patients. Those north of Seattle, she is sending my way.  The second busiest headache clinic closed two months ago (director retired). The third key is that I re-applied to Group Health insurance today. They had boycotted our clinic and they make up 30% of the insured in our area. If we got that contract . . . holy cow, what are we going to do?

I feel the thundering of the ground . . . the caribou are coming, not that patients are caribou, but I’m speaking of the crowds.

Here is the real dilemma.  I’m confident I could use another full time headache provider.  A neurologist would be nice (and make life a heck of a lot easier as we would no longer be a square peg in a round hole). However, it would take funds of $250-$275k/year to support one.

I would love to hire another headache PA. There the problem is physician supervision. In my present situation, we are on the fringe of what the state allows. It would really be complicated to have another PA and find the time with the supervising physician to keep it within the state boundaries for practice.

I could hire a NP. That would get us past the supervising physician rule. However, it would have to be a unique person. She/he must have a lot of headache experience. They must also be self-starters. But the biggest problem is that they must be a risk taker.  I don’t have the funds to support for much more than a month.  I could pay them strictly on productivity, and if they play their cards right (promoting their practice, treating their patients well) I’m confident that they could be earning $150,000/ year within two years.  But the problem is getting from point A to B.

In the meantime, I’m working as hard as I can work. I’m exhausted. I’m still paying myself at the bottom of the ladder, less than what a new graduate would earn (and I’ve been doing this for thirty years). The sound of hoofs are echoing over the hill.  I just have to figure out away to make this work.