Tempest Milky Way from Randy Halverson on Vimeo.

And this, with the winter sky in time lapse photography:

Sub Zero – winter night timelapse from Randy Halverson on Vimeo.

But life has been, well, most interesting…

The past year or so has been one of the most challenging in many a season, on a number of fronts. Professionally, the passage of Obamacare has made it abundantly clear that the independent private practitioner is a dying breed, and likely will disappear — with the exception of cash-only, concierge-style arrangements — within the next few years. The administrative burden is crushing — unfunded mandates, such as pay-for-performance, compliance programs, HIPAA, mandated “government certified” EMRs (even though existing, non-certified ones are fully functional), and intrusive, abusive audits by the Feds and third party carriers. Such mandates and regulatory excesses place, or will soon place, such an overwhelming burden on the solo physician or small group as to make their continued existence unsustainable, even in the near term — and the full implementation of Obamacare will put roses on their grave. Reimbursements are dropping precipitously (my income dropped about 25% last year), as expenses spiral upward (employee health insurance rates are up 25%; malpractice rates up 15%, etc., etc.). The small business model of solo practice or small medical group is rapidly becoming extinct: its executioner, Big Government and Big Insurance.

The medical-legal environment remains as hostile and capricious as ever — I have endured two lawsuits in the past three years, both resolved with decidedly mixed outcomes while taking an enormous toll both in time wasted and emotional sobriety. I hope to share some insights thus gleaned on this horrendously dysfunctional system in the not-too-distant future.

Personally, although my health remains good, the exhaustion borne of these and other struggles had taken much of the joy and energy from life. The time for renewal was long overdue.

And so, big changes are in store: my practice will be sold in the next few months to a large medical group affiliated with a nearby hospital, and I will have as a primary responsibility inpatient hospital care, with a much diminished office practice focusing primarily on my specialty of male infertility and vasectomy reversal. I have decidedly mixed feelings about this change — I anticipated going to my deathbed as a private, solo practitioner, loving the independence and rich patient relationships which this brings.

But I am weary. After nearly 30 years in private practice, I am not sure which straw broke the camel’s back, but it is most surely broken. It is a weariness born of 14 hour days; of dictating charts and finishing paperwork until 8 or 9 pm each night, after starting the day at 7 am; of endless audits by the insurance industry and Medicare; of the constant threat of litigation; of the crushing burden of one more federal requirement mandated but never recompensed; of a host of ever-expanding administrative burdens having nothing to do with patient care, and everything to do with bureaucratic micromanagement of the profession. And this before we have even begun to see the nightmare which Obamacare will inflict. Camels weren’t designed to carry such a load.

But the change is nevertheless much anticipated in a host of other ways, with its reduced administrative and regulatory burdens, and substantial increase in free time. For me, the war is over: I have fought the good fight, and no longer see it as profitable to battle the inexorable forces which threaten to crush a beloved profession. My spirit is in many ways free now, as though a great burden has been lifted. God is good, and has been gracious and kind to me in so many ways.

I have needed an extended break from blogging to process these many life changes, but in its absence have heard the siren call of the muse quietly whispering to my soul.

So I am back — bitterly clinging to God, guns and guitars — and hope to speak of each in their turn, among others, as the spirit moves. For those who have checked back regularly, only find a petrifying post from the past, you have my great gratitude for your loyalty. I hope to reward that loyalty with something of worth in the coming days.

The WSJ has a book review of Son of Hamas which will definitely be on my reading list when it comes out:

Mosab Yousef is the son of Sheikh Hassan Yousef, a founder and leader of the Palestinian terrorist group Hamas. Throughout the last decade, from the second Intifada to the current stalemate, he worked alongside his father in the West Bank. During that time the younger Mr. Yousef also secretly embraced Christianity. And as he reveals in his book “Son of Hamas,” out this week, he became one of the top spies for Israel’s internal security arm, the Shin Bet.

Matt Kaminski describes the book as follows:

The book, a Le Carréesque thriller wrapped in a spiritual coming-of-age story, is an attempt to answer what he says “is impossible to imagine”—”how I ended up working for my enemies who hurt me, who hurt my dad, who hurt my people.”

“There is a logical explanation,” he continues in fairly fluent English. “Simply my enemies of yesterday became my friends. And the friends of yesterday became really my enemies.”

Just to whet your appetite — back soon.

Enjoy your family, the great food, and the time off.

And be mindful of its meaning:

Now in those days a decree went out from Caesar Augustus, that a census be taken of all the inhabited earth. This was the first census taken while Quirinius was governor of Syria. And everyone was on his way to register for the census, each to his own city. Joseph also went up from Galilee, from the city of Nazareth, to Judea, to the city of David which is called Bethlehem, because he was of the house and family of David, in order to register along with Mary, who was engaged to him, and was with child. While they were there, the days were completed for her to give birth. And she gave birth to her firstborn son; and she wrapped Him in cloths, and laid Him in a manger, because there was no room for them in the inn.

In the same region there were some shepherds staying out in the fields and keeping watch over their flock by night. And an angel of the Lord suddenly stood before them, and the glory of the Lord shone around them; and they were terribly frightened. But the angel said to them, “Do not be afraid; for behold, I bring you good news of great joy which will be for all the people; for today in the city of David there has been born for you a Savior, who is Christ the Lord. “This will be a sign for you: you will find a baby wrapped in cloths and lying in a manger.” And suddenly there appeared with the angel a multitude of the heavenly host praising God and saying, “Glory to God in the highest, And on earth peace among men with whom He is pleased.”

Check it out. (HT: OrthoCath Blog)