It’s the beard, isn’t it?

“Thank you, Jesus. Praise God. Thank you, Jesus.” On and on and on like that.

What I said: nothing.

What I wanted to say: “Ma’am, I’m cleaning your ears. I’m not washing your soul free of sin.”

Happy Fat Tuesday! If you’re living in a Super Tuesday State, don’t forget to vote.

D.

Hmm. Would anyone get the joke if I made my employees use bumper stickers reading, “My boss is a Jewish doctor”?

Slammed

Didn’t I take a vow, or an oath, or a New Year’s Resolution, to whine less?

No. I promised to whine more. Okay, we’re good.

In the office today, I saw thirty patients. Thirty. In the old days at County, back when I was paid little more than minimum wage, I doubt I saw this many. The other residents and I used to tell each other, “When we’re in private practice, no way are we going to do anything so ludicrous. If we allow ourselves to be this rushed, we’ll never practice quality medicine. We’ll make mistakes. We’ll burn out.”

But as I got older I got faster. I got better at the job. I don’t think I’m short-changing my patients with a schedule like this, but neither am I shmoozing them the way I would like to, nor do I have time to check the news during the day, nor can I keep abreast of my chart basket. I push more of the phone calls (to share results) onto my office staff, I get grumpy, I forget to feed the frogs.

As young docs looking forward, we saw this as a simple calculation. We would see the greatest number of patients possible while providing the high quality care we were trained to value. None of us were so greedy as to want to see more than that number. Even the docs-in-training whom I held in low esteem wouldn’t have cranked through the patients just to make more money. I’d like to think we were better than that, even the worst of us; at the very least, fear of malpractice would make a doctor shun such behavior.

I failed to anticipate the needs of my patient population, though. I’m the only ENT in town; the nearest other ENT is about 70 miles away (90+ minute drive, partly on curvy mountain roads). I’m sure he’s slammed, too, as are the ENTs in Grants Pass, Medford, and Coos Bay, who are even farther away.

I can pack ’em in like this and I’ll still have patients waiting to see me. Some of them really do need to see me yesterday or a week ago, but without seeing the patients, it’s nearly impossible to separate the true “urgencies” from the false alarms. (“Urgencies,” not emergencies. In my business, the emergencies are usually gushing blood from their noses or pus from their ears or slowly choking to death before my eyes. Pretty obvious, in other words. Yes, the emergencies do get priority over the “urgencies.”) So I have to fill the day’s schedule as best I can, and I can only see so many.

Why not bring on a partner? Because I know the numbers. This community needs 1.5 ENTs, not 2.0. Since I’m not ready yet to work part time, I would have to find someone else who is. Or we would have to cross our fingers and hope the numbers are wrong and the market could bear two of us.

So it comes down to a simple calculation, albeit a different calculation than the one I had in mind back in residency. I can see fewer patients, but then people who really need to see me will have to wait longer for their appointments. Or I can see more patients, cut out the shmooze, get the job done, take care of people, fix their problems, and they’ll still have to wait longer than I would like them to wait, but not quite as long.

There’s a doc shortage, have you heard? I think this is only going to get worse.

D.

Hosed frog.

Frog on Hose by Brenda Anderson

I’m not a greedy person. If I were greedy, I would jump at those headhunter offers from the deep South, offering guaranteed incomes over $500K; or I would have become a facial cosmetic surgeon, something I very well could have done, except I didn’t care much for the patient population. Because some things are important, you know? Like living in one of the most beautiful areas of the country, living in a place where my family is happy, even if the majority of my patients are Medicare or Medicaid.

But this is depressing:

Potential Medicare reimbursement cuts worry doctors

By LIZ FREEMAN

December has rolled around and doctors nationwide are in limbo, as they have been this time of year for the past six years.

They are left to speculate whether Congress will act in time, before the year’s end, to halt Medicare reimbursement cuts slated to take effect Jan. 1. For the most part, Congress has done last-minute reprieves and frozen cuts in prior years.

Doctors face the prospects of a 10.1 percent reimbursement loss next year on average depending on specialty, with no regard to increasing practice expenses. If the cut goes through, more physicians are expected to follow in the shoes of others fed up with the reimbursement system and say enough is enough.

It’s depressing because I’ve cut damn near all of the fat out of my practice already, and I have ratcheted up my patient load to the point that I’m already rushing through the day and feeling like road kill by the end of it. But what else can I do? My overhead costs get higher every year, insurance reimbursements get lower every year, so my only defense is to see more patients, work harder and smarter and cut what little fat is left to cut.

That article goes on to discuss the AMA’s bright idea — legislation that would allow us docs to bill over the Medicare rate and recoup money from our patients. Yeah, that’s right, the fixed income folks. Sure, some of them can afford it, but some can’t. Guess that would give me more opportunities to play Mr. Nice Guy, eh?

But the really depressing part is the primary care angle. We’re already strapped in this region; many of my patients can’t find a primary care provider. If this thing goes through as planned, it will be even harder for patients (the elderly and the disabled, that is) to find primary care.

And, yes, it’s depressing that I might have to squeeze more patients in, which in turn would mean cutting back on time spent per patient, or cutting back on services (like cleaning ear wax, which can be time consuming and reimburses poorly).

On my ENT mailing list, a lot of the older docs are saying this will push them into retirement. One guy said he already works gratis — everything he makes goes into his overhead. This, I suspect, is a fellow who hasn’t cut his overhead as well as I have. The older generation of doc, they’re used to having a nurse, an audiologist, maybe a few other ancillary staff. I have a staff of two. No audiologist, no nurse. Ours is a tidy ship, but of course that means I have already restricted services.

Bear in mind that Medicare reimbursements have already fallen 20% since 2001, and that when Medicare cuts their payments, private insurers soon follow.

It feels like I’m treading water, and I’ve never been very good with that.

D.

Let’s get one thing straight

It’s larynx, not larnyx. LAIR-INKS. Not LAIR-KNICKS.

Listen.

Similarly, it’s pharynx, not pharnyx. FAIR-INKS. Not FAIR-KNICKS.

Many patients have tried to impress me with their amazing intellect by saying, not voice box, but lair-knicks, not throat, but fair-knicks (or, worse, lar-knicks/far-knicks). Doesn’t work, folks. I’m far too arrogant to be impressed by your feeble mispronunciations!

***

I think I’m doing better today; I cleaned the kitchen, did the laundry, vacuumed upstairs, and went grocery shopping. I’ve even prepared a decent dinner (another farsumauro, which I blogged on Nov. 11). But it’s after 6, my head is starting to pound, and it’s beyond me to come up with a better post than this.

Earlier, I tried futzing around on Second Life, or whatever that thing is called. Any of y’all doing Second Life? I picked out a name for my lesbian alter ego (Scylla Bedrosian) and made it about halfway through my avatar-tweaking when I ran out of steam. She’s short, plump, kind of Asian-Hispanic-looking, and gravity affects her ample boobage by about 70%. If I had my act together a bit better tonight, I would have had a screen shot ready for your viewing pleasure. But I don’t and I don’t. Maybe tomorrow.

By the way, if that video up there struck you as mildly pornographic, you may be wrong, but you’re not alone. When I play back larynx viddies for my patients, it’s not uncommon to hear, “Is that . . . ? NO! How could it be? But . . .”

Another pet peeve: it’s vocal CORDS, not vocal CHORDS. Jeez.

Here. I saved the best larynx viddy for last, although this one is fun, too.

Live blogging tonight, probably around 7:45 PST. See ya soon.

D.