Still Breathing…

Word of my demise, widespread and nefarious as it has been, is most assuredly premature. I must put these scurrilous rumors to rest…

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.

Happy New Year!

Hi folks — been pretty quiet on the blog for the past few weeks, taking a needed breather to recharge my batteries and ponder some challenges in my personal, spiritual, and professional life. I hope to be back writing soon in the New Year.

In the meantime, here’s wishing you all a blessed, safe, and prosperous New Year.

God bless!

I’m a Three-Year-Old

It is with little ado that I note the passing of my third blogging birthday (several weeks ago, actually), having somehow managed to accumulate a rather substantial collection of essays and lesser posts, leveraging millions of letters into thousands of words, scanned by hundreds and read by tens. The worth of such efforts is, by any standard, hard to measure; the metrics of web readership, hits and referrals, visits and comments, providing but poor report of what words may do, or phrases may evoke. That, I trust, must be judged by others, and by Another. Ours is a journey through life often lived for self, but intended in its highest and purest form and design to be for others. Our knowledge of such impact, of whether our purpose has been met or missed, whether our mission has succeeded beyond our wildest dreams or failed in ways unimaginably disastrous, is known, in life’s great paradox, least well by us. For life is measured not by income or position, nor by fame or power, but by lives touched and hearts changed — a metric at once impossible to measure yet enormously gratifying when glimpsed even in some small way.

I am most grateful for those who spend some time here reading, and hope your life is touched in some way, by laughter or love or glimpse of grace.

Sunday Suggestions

One of the features I enjoy on some of my favorite blogs is a periodic summary of interesting things they are reading. After all, if you enjoy reading a blog, and value their thoughts and insights, it makes sense that you might well be interested in the things they find interesting. And so, I will begin an irregular weekly feature regularly on a sporadic basis every seven days or so, or whenever.

It’s my hope that both my regular readers will find this enlightening, educational and entertaining.

Cool tools I have stumbled across will also be on the docket, as will useful or interesting new sites.

And being a narcissist, I will also include some of my own previous posts which are lying in the digital dustbin, blowing off the cobwebs of some prior bloviations for old times’ sake.

So here goes:

♦ hitchens is not Great: As some of you may know, Christopher Hitchens has written a book entitled god is not Great. Now, I have a great deal of respect for Hitch, who like a lonely prophet cries out in the in the vast intellectual desert of the Left, seemingly alone understanding the stakes at hand in our struggle against the evil of Islamic fascism. Hitch is a very smart dude — and also an outspoken atheist, which indicates he’s not nearly as smart as he thinks he is.

So you owe it to yourself to check out Mark D. Roberts’ slapdown of ol’ Hitch in his series of posts on the book. See what Hitchens’ knowledge of church history and biblical scholarship looks like after being processed through a Cuisinart. Top with whipped cream, a cherry, and serve cold.

Apologetics at its very best (HT: Hewitt).

♦ Disputed Sovereignty: Richard John Neuhaus, the editor-in-chief over at First Things, has a transcription of a recent sermon to the military chaplains at the National Cathedral. Excellent discourse on the moral challenges of being a Christian minister at war. Key quote:

We are servants of a disputed sovereignty. In the responsorial psalm we declared, “God mounts his throne to shouts of joy.” Christ has ascended his throne, but his rule is challenged by rival thrones. For us who believe, St. Paul says in today’s second lesson, it is the fact that Christ rules “far above every principality, authority, power, and dominion.” But the principalities and powers of the present age still rage against his rule. We are the servants of a disputed sovereignty.

Check it out.

♦ In the Cool Tools Department: One major problem I have in life is time — not enough of it, that is. Being a physician is more than a full-time job, which seriously cuts into the gadzillion other things I enjoy doing, or which are important, and just need to get done. I’m beginning to utilize the GTD (Getting Things Done) approach (popularized by David Allen), although I’m not quite compulsive enough to really master it (actually, I spend so much time looking at GTD sites and tips that I have trouble, well, getting things done…)

This week I stumbled across a remarkable tool in my search for organizational Nirvana, called Backpack. Backpack is a web-based tool for creating To Do lists, project pages, idea buckets, and a host of other extraordinarily useful capabilities. It’s a breeze to master, intuitive, lean & mean interface — the first such web-based tool which you will want to use for getting your life under control. I could spend an hour describing its features and uses, but won’t — if you need to get your life together (organizationally, at least), try it out and be amazed.

♦ From the Dustbin: And closing with a blast from the past, here’s a lengthy, but hopefully worthwhile, meditation /essay of mine, on sitting down for a cuppa’ Joe with God, called The Prayer of Java.

Take care, God bless, and have a great Sunday.

Kicking Back, Looking Forward

I’ve been kickin’ back for the past week or so, taking a much needed vacation from work, and — as is commonly the case — I’ve been as busy at home as at work: yard work, catching up on chores around the house, making a dent in my reading list, and getting my new web site for vasectomy reversals up to speed.

The web site’s been a lot of work, but I’m enjoying it immensely. I’m building it in — WordPress!

Blogging software for a professional content-oriented web site? You betcha — the capabilities of WordPress in its latest renditions (now up to version 2.2) are truly amazing. It is now easy to have a static page as home page, and use page templates and post categories to display specific content on a specified page. So I can have, say, a page for frequently asked questions, and add new questions as blog posts with the category “FAQ.” WordPress page templates and template tags (pieces of PHP code which are used in the templates, and pull content from the database) are very flexible, well-documented in the WordPress Codex, with a short learning curve. This is sooo much easier than hacking together a static site using Dreamweaver or hard-coding html and css.

On the writing front, I’ve been giving some thought to my direction here, as I approach my third blogging birthday. As both my readers know, my typical format has been long essays or multi-part series (which are really very long essays, too long for a single post). These essays can prove to be rather gargantuan tasks at times, often taking 1-2 weeks to formulate, edit, and complete. The amount of time and effort thus entailed pose a significant initial hurdle: it takes quite a bit of energy to launch into one, and it is all too easy to procrastinate. The time limits of my profession don’t help as well. So I periodically get tired of the demands incurred, and have trouble gearing up again.

I have thought of branching out a bit — being a semi-professional techno-dweeb, I have a million little tools, utilities, and programs (Mac & Windows) which I find immensely useful, so I thought I might review the good, the bad, and the ugly I’ve run across and use regularly. I’ve also thought of having a Q&A format: any pressing issues you’d like me to pontificate upon, medically, faith-related, or other off-label topics? Let me know, and I’ll give it a shot.

My current readership (site visits per month) is about half what it was one year ago. The reasons for this are of course inscrutable — perhaps the content no longer appeals to as many people, or to other, more prominent bloggers who bring traffic by mentioning and linking to posts. Perhaps it has nothing at all to do with such factors, and is just part of a down cycle. I write from a passion of the soul — for my faith, for my profession, for a great culture in decline, for the joy of life, and family, and pets, and laughter. Hit counts mean little — but being human, they give rise to second-guessing when their decline is noted. Sending words blindly into the digital ether — especially when their generation requires substantial effort and time — can prove easily discouraging when few echoes return.

Well, enough of my navel-gazing — I will write as long as I am called to do so, and as long as there are those who read, and listen, and hopefully gain some insight and benefit from the effort. I genuinely appreciate those of you who visit regularly, and comment — you have blessed me far more than you know.

Have a happy and safe Memorial Day, and God bless. Back soon.

Link Whorage

OK, I admit it: I’m a link whore.

But a very nice link whore. And I won’t get you in trouble with your wife, I promise.

Seriously, while I’m in the process of changing the site, it’s time to revisit the blogroll–pruning this, adding that, making it leaner and meaner.

So if you’re interested in in exchanging links, leave a comment here or drop me an email.

New Blog Theme

Day LilyI’ve been working on a different look and feel for the blog, based on a new WordPress theme called CutLine. The designer (Chris Pearson) has created a very clean look with some excellent page layout features, especially image handling and pull quotes.

I’m still in the process of thinking through how best to handle archived posts. One of the big downsides of the blogging medium–especially for essay-oriented sites like this–is improving access to earlier materials which many newer readers may not have seen. I have handled this in the past with periodic reposts of older material, especially during light blogging times, as I have been doing lately. But it would be nice to have older material more accessible and categorized more clearly, perhaps with short excerpts rather than simply titles.

Any thoughts you might have on this–or tips on other sites which have addressed this dilemma in a creative and useful way–would be appreciated.

For a sneak peak at the new look, mosey over here and take a gander.

Thanks, and hope your Thanksgiving was a wonderful one.

Light Posting for a While

Virginia V Mosquito Fleet ferry
Virginia V – Mosquito Fleet ferry
I’ve been a bit out of pocket of late, in no small part due to an ongoing family crisis (which I alluded to here) which has consumed a lot of time and even more emotional energy. So I haven’t had the time or mental wherewithal to put many cogent thoughts together for posting. Hopefully this will change in the near future, but in the meantime I’ll repost a few of my earlier essays which some of you may not have read, or may do some shorter posts as time and energy permit. I may also post some photos I’ve got lying around: the above is the Mosquito Fleet ferry Virginia V, which made its maiden voyage in Puget Sound in March 1922, and is the last remaining steam-powered ferry of the Mosquito Fleet, seen above, restored, sailing in the Tacoma Tall Ships Festival in July 2005, where I took the above shot.