Meet Bluebonnet_909!

A signed employment contract sits on my lap. I'm riding to the hospital to drop it in the mailbox. It's an 8 1/2 X 11" envelope, courtesy of my training program, sporting five American flag stamps. So now it's final. When I finish up at the end of June, I will be working in a large, physician-owned multispecialty group. I'm pretty excited about it. Here's how it happened.

While in medical school, my husband and I decided in what state we wanted to live. We want to build a self-sustaining, solar powered home, and that meant a home site in a rural location. We factored in extended family concerns and by then we were down to a 150 mile radius in our chosen state.

We looked at the number of towns and their popularions. What were the options in this radius? Opportunities for private practive abounded. Two years ago I talked to a psychiatrist from the place I thought I wanted to settle at that time, a lakeside resort community. We met during my fourth year of medical school, when he was teaching a class at the program where I was doing an elective rotation. He said that to sustain a private practice in his area, at least in the beginning, I would have to "piece it together." That means visitng patients in jails, doing Social Security Disability evaluations, and also traveling to one or more "satellite" office spaces in the surrounding counties. I would be doing all of my own billing. I would be on call 24 hours a day, including weekends and holidays, unless I could find someone to share with.

Another location for private practice would be the town in which I am training. This option was appealing because it offered a choice about hospital work. I had six months experience in that hospital, so I knew all about it, but the subspecialostI'd be working with there, who had been there forever, wasn't a good match for me. Even so, I could have worked there without setting foot in a hospital, but I would have been all call all the time, or at best, half the time. I began to look at the largest city in our "target zone," mailnly for two reasons: call sharing and not needing to own and manage the business aspects of the practice.

More than a year ago, many members of our department attended a state-wide subspecialty meeting which happened to be in our target city. I studied the nametags and the programs carefully. I met doctors practicing in different ways from all over. In particular I enjoyed meeting a lady from one of the two largest cities in the state. She had decided never to refer a patient to another therapist. She did her patients' therapy all herself. Heatlh insurance company policies make this practice impossible in all but a few settings. The insurance company saves money by paying licensed social workers to do the therapy, refusing to pay doctors any more to do it, despite the obvios clinical advantage to the patient of continuity of care. This doctor made it work by treating wealthy patients who could afford to pay our of pocket, without health insurance. She was able to make this work by living in such a large city.

I met lots of doctors working in the conference city. One of my training faculty introduced me to a friend from her training days. He was with a group practice and they were interested in hiring more psychiatrists. I remembered his name.

My friend who was scheduled to finish training just before me was going to work for a large, single-specialty group in town. Fortunately, I got to interview at both of these places. The group with only mental health offered many psychotherapy groups for patients and a stunning office space. The multispecialty group had an electronic medical record and great physician communication. It was not an easy decision. I honestly enjoyed meeting doctors at both places, especially the older ones, because they knew so much about how psychiatry had gone over time in this area. Ultimately, my choice was from both head and heart, which is usually a good indicator for me, and I went with the multispecialty group.

Now it has been three more months. I am attending meetings a couple times a month at my new job. My name is on the door! A couple of weeks ago I good to choose my office, a choice between a big, long skinny office off a hallway and a corner office with two walls full of windows overlooking a wooded creek. Guess which one I chose. Just last week I got my keys and started setting up my schedule. It's a pretty exciting time, and I'm happy.

Unfortunately, all of this has unfolded on a dark backdrop for me in terms of health. At Thanksgiving, I was diagnosed with multiple sclerosis. A little tingle in the fingers of my left hand which I thought might mean a disc or nerve root problem in my neck turned out to be a "sleeping giant" when taken along with a history of facial numbness some years ago and the results of lots of MRIs and painful tests. Needless to say, it took me a while to be able to adjust to this and I'm still getting adjusted.

Then, in February we had ice, which we don't usually have in these parts. I dutifully began my 60 mile commute that morning and the guy at the gas station said I should think twice because the Interstate was closed. I got to the Interstate and it wasn't closed, but there were a lot of cars and trucks pulled off on the side of the road. I slid into one of them (an 18-wheeler), bounced across two lanes of traffic, and crashed into the concrete dividing wall between me and oncoming traffic. Thank goodness it was there. I totalled the car, broke my left collarbone, and suffered a concussion. That really has slowed me down for the last couple of months.

I'm officially tired of the two-hour commute, but that's okay because I only have about two months left, and for one month of that I won't even be making the commute. I'm making a big trip to Chicago in May to take the second of a three part boarding process for my specialty, and I'm looking forward to seeing some great museums there. One of my fantastic mothers-in-law is keeping the kids for the week, so it will be just us two. We're taking a family vacation to Arkansas this summer too, and I've booked two weeks of vacation time between the two jobs at the end of June. I'm definitely on the "home stretch" now in terms of residency and fellowship training.

Thanks to all who have helped me to make it here. You know who you are. ;)

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