OB-Gyn in trouble

I love being an Ob-Gyn. It was the only rotation in med school that I really truly could see myself doing as a job. Having said that, as time passes, I see more and more the dark underbelly...how things are going to get bad before they get better (sorta like residency, if you think about it).

Solo Ob-Gyns are a dying breed. It's not the call - it's the overhead! Even my practice (3 docs, a CNM, and 2 PAs), the numbers are now starting not to work. We've been looking at the numbers, and there's little to pare. I practice in a "red alert" state, so our malpractice insurance is a large expense. We docs actually pay ourselves less than the mean and median, so cutting there (although possible) is not a viable option for long. We have a great staff, but they're running close to maximum output. We're considering eliminating the match on the 401K, but that won't help a lot. I do make a profit, albeit barely.

I could add more hours. I value time with my kids and husband. I could squeeze in more patients. But I like my schedule as is - 30 minutes with a new patient is not a luxury with EMR, it's a necessity (especially those who come in with a long list of meds). (EMR is a whole 'nother rant)

So I'm at an impasse. I'm technically not a partner in the practice, I'm employed. My contract will be up in the summer. They would like to keep me but the writing is on the wall. Do I go to the hospital and become employed? Do I move back to where I trained, as they are looking (I've seen the ads in the Green Journal)? I talked to one of my former attendings, he said they would love to have me back on faculty. I haven't burned any bridges anywhere. I've talked to the Chief of Staff here, they would be interested.

Lots to think about. And I need to get moving, so I have a contract in place and a plan.

Question

Am I a horrible person for hoping that a certain pain-in-the-ass patient no-shows for her appointment?

We could have TOLD you that

http://news.yahoo.com/s/ap/20080212/ap_on_he_me/fewer_docs;_ylt=Alhcj1ZB3HddrZw5krgbE8qs0NUE


Fewer American grads going into primary care. DUH!!!! Why on earth would you - low reimbursement, long hours, lots more hassles than a specialist?

Don't get me wrong - a good PC doctor is worth his/her weight in gold, maybe even platinum. But many American medical school grads agree and they are voting with their feet by going into specialties. (and BTW, my specialty is having similar issues with getting people to train as one - more on the rant later)

Heck, pretty soon, all American grads will be either path, derm, rads, ortho, or anesthesia. ;)

Heal Thyself

I'm an Ob-Gyn. Many women (rightly or wrongly) come to me for their only care. I am a specialist, but we'll let that one point slide for now.

I'm like my patients. Getting older, a pound or two heavier each year. I can chart it. It's depressing.

So what do I tell my patients : Exercise. Eat right. Do the preventative stuff.

I decided to start walking the walk (so to speak, it's more like biking the bike, but you get the picture). I've even started lifting weights.

And I'm down a few pounds. My arms look a little bit better, more toned.

Hope it helps.