We will be approaching our anniversary date in a a few weeks and I wanted to do a series, maybe just two, posts about where we’ve been and where we are. A quick update:  The demand for our services has never been stronger.  Two of the five headache practices in the state are shutting down, so the demand should continue to grow. I’m quite confident that I could hire and support a new NP or PA in headache. The trouble would be the transition months. They would want a guaranteed salary. We would not have the funds to support them until their revenues started coming in . . . which would take about three months.  I’m still trying to get my head around that idea.  The bank has refused to help us. The revenues are steady. We are not getting rich as I have a large debt load. Much of load came from the perfect storm were we had to greatly under perform for about six weeks. It was the combination of the holidays, my office manager being out ill, snow storms and my SP being out of the country for two weeks forcing us to close our doors.  But I’m paying off the Feb debt $5,000 at a time. At this rate it will take two more months. I think we have helped a lot of people. It is so rewarding having patients come from 100 miles away on a whim (having been followed by several other clinics) and then to find relief. As a couple of patients told me last week that this is the best they’ve done in 30 and 40 years respectively.  That’s why we come to work everyday. I hate this idea of having to focus on money and worry about it. But if we don’t have the money to keep the doors open, then we can’t help the patients. In this posting I want to speak of one big lesson I’ve learned over this first year. I  may share more later. A wise PA, who had started his own practice a few years ago, told me, “Mike, figure your budget the best you can. Then double your expenses and halve your income . . . then you will have an accurate number.” That didn’t seem right to me. I honestly felt like I could do things better. Be more efficient. Hire good people, yadda, yadda, yadda. But, he was right.  I wanted to talk about why he was right. The Principle of Vendors: All companies need vendors to survive. These are the suppliers of materials and services that  you need to run a business. The way that vendor companies usually work, is that they have a sales force that pulls you in.  You have to keep in mind that the salesmen work on commission.  By selling you products and services, they are able to pay their mortgage, buy their cars, put food in their babies’ bellies and buy their little princesses the latest Justin Bieber CD.  So, they are highly motivated to make the sale. Once you have purchased their product, they disappear.  Products and services are always over sold. They never perform to the level you were told and they ALWAYS cost more than you are told. What is worse than that, is that you then decide that you will not take the disappointment sitting down. So then you go to war with your vendors to get what you had paid for. You can only fight so many wars for so long and you become completely exhausted. So when a phone company says their system can do A-Z and cost $x, what they really mean is that their phone system can do A – E and cost $x+30%. If you later want F-Z, it will cost you $x+300%.  That’s just one example of hidden cost. I will give another example. I pay $500/month for billing software. My biller doesn’t like the software. I started a dialog with several companies. It was like entering shark infested water coated in blood.  The phones rang off the hook. We finally “test drove” a system that promised to cost us $300/month.  After wasting hours on it, in the end (through bait and switch) we found out it could not do nearly what we wanted then, through hidden fees, realized it would cost us over $600/ month.  But that was a lot of wasted energy and time. Positive Note: One of the things that was keeping me awake a year ago was my fear that there would not be enough patients to support practice. By hard work (connecting with our referral base) and giving our patients a good service, we have had plenty of demand.  Patients don’t seem to care who owns the practice or who sees them, if that provider is knowledgeable and compassionate. I will be back as I have patients coming in the door and I must go. That is another issue, giving up virtually all your free time in order to keep the ship afloat.

Most of you are too young to know the TV series Twilight Zone. I had a love-hate relationship with the show. I was about six years old.  I felt drawn to it and begged my parents to let me stay up to watch it.  They would cave in. I would watch it. It would scare the hell out of me and I would end up sleeping between mom and dad for the night. Dad would always put his foot down that would be the last time I could watch it.  But then . . . a week later I would beg. I do clearly remember one episode when a man got a Genie in a Bottle.  He got the proverbial three wishes.

I  think it was the late Ronald Reagan who defined an optimist as a kid who steps in a pile of horse shit . . . smiles big and says, “Hey, there must be a pony around here somewhere!” I’m in the middle of a pile of manure right now with the clinic and my wife is perplexed while I seem to feel so positive about things. After all, I’ve struggled for months in frustration. Here’s the horse shit.  

T he photo is a thousand words for what kind of day its been. One of the most difficult in my thirty-year career. I hate to always come here and post when I’m frustrated or exhausted, but maybe that is my therapy. But I will try to end in some rightful praise. My mental marathon began a couple of days ago.  It is too complicated to explain here but, once again, has to do with our billing problems. I will just summarize and say that I was disappointed in our billing performance.  As an owner, such disappointments always creates an inward tension.  How am I to act to be a good boss?  

August 31st, marked the end of the first quarter.  It was a landmark for several reasons. For one, it was time to make my first report to the Quality Medical Assurance Committee.  I’ve submitted it. Haven’t heard back. I hope that is a good sign. It was also time to look at the numbers.  I hate even talking about the “numbers” because I started this path to deliver better care to suffering patients. However, the raw truth is, if the numbers don’t add up, I’m toast and there will be no care.