I think I was seven years old the first time I visited Rock City, in Chattanooga, Tennessee. One of the most famous of their trails takes you though a narrow place, they named “Fat Man’s Squeeze.” Tomorrow is my “Fat Man’s Squeeze.”  I alluded to on my last post that a perfect storm of factors had created another financial crisis . . . out of a brief financial surplus. The good news is that just on the other side there is a lot of daylight.  The demand of our services is going through the roof right now. We stopped scheduling new patients (from requests coming in from referring providers) because I embarrassed to tell people that our next opening wasn’t for two months. We have a lot going for in other ways as well. We have a better payor mix.  We’ve worked out many bugs in our billing and etc. So this is how it stands. I have $5100 in the bank.  On Monday, I must make payroll. To make Payroll, I need $7400. Tomorrow is when we get our largest checks in. I don’t know what to expect. It could be like last Thursday . . . $50.  Or it could be like our normal Thursdays, $2500. Our doors have been back open for three weeks now so the drought should be drawing to a close. But will the checks start to come tomorrow?  Or will it be a week from now?  If I don’t have the money by Monday, what will I do?  I have no clue. I will get back on the other side. 

You know the image, the guy (or gal) keeping 20 or more plates spinning at the same time. That’s what owning a business is like. So Monday started my long-anticipated vacation.  On that day, I spent 6 hours in the office catching up and working on problems. Then Tuesday, I spent 5. Then yesterday I spent 4 hours in the office. Today I will spend 3 (or so I hope). Still, my office voice mail box had 10 at last count. I’m going to ignore them starting tomorrow. I’m leaving for Florida to visit my family. Sure, I will have hell to pay when I get back. But sometimes you have to put up some space for rest. I’ve been working seven days a week for almost a year now. Demi Moore was admitted for exhaustion? It seems like a lot of stars are admitted for exhaustion. Is there such a hospital? If so, what do they do for you there? I had a neurologist very willing to be my alternate supervision physician.  Unfortunately, his malpractice insurer is horrified by the thought. After all, PAs do hurt a lot of patients don’t they?  Hmm, they don’t?  They studies say no?  I’ve seen over 100,000 patients in my career and have never made a major error or mis-diagnoses.  There is a PA-paranoia out there, unfounded by the facts, but creates so much more complicating factors for a PA-owned practice. So, here is a toast to a few days of bliss, where I will try and pretend I don’t own a medical practice.

So, I’m sitting in Mesa, Az waiting for my flight back home. We were just told that it will be another hour wait so  have time to chat. I was here for the Scottsdale Headache Symposium.  We finished early this morning (10 AM) so my wife and I hiked from the hotel to the top of Camelback Mountain (pictured). It was a 5 mile round trip hike.  The climb up the mountain is 2.5 miles of that. It is steep. Very Steep in places and 50% of the “hike” is bouldering. They have these strange metal rails up the steepest parts, which do help. So, I’m a bit tired. But this is also a respite from clinic climbing. My mind has been able to get away from the grind for time to reflect.  On Thursday night I did a presentation to a group of NPs and PAs about my process.  I was almost moved to tears when so many came up and said dumb things like “you’re my hero.”  I was moved to tears because I feel like for the past year I’ve been one of those adventurers who is skiing, solo, across Antarctica. It is nice to be with PAs and NPs who understand what I am talking about when I struggled with banks who would not loan to a PA who is trying to start a clinic, or malpractice insurers who couldn’t get their heads around the idea. I had some quality visits with my SP, whom I brought to the conference. I got to rub shoulders with many old colleagues.  It has been a good time. I’m going back feeling refreshed, and with a new zeal.  I see things I need to fix in the way we do business. I have some new dreams of expanding into different cities and into SE Alaska. It has been good indeed.