direct care practice

“This could be big,” he said after I told him about the company who wants me to cover their 100+ employees.  I pay him to give me the stark reality of things, but his optimism made me uncomfortable.  ”You’ve got to go for this.  I know you don’t feel ready for it yet, but this could really be huge for your business, and I don’t think you should pass this up.”

I sighed.  Yes, this is a victory of sorts (still only theory, not reality), but what if I can’t deliver?  What if I fail?

“You know,” a colleague told me during another phone conversation, “you are the buzz of the medical community right now.  We talked about you for half an hour at lunch today…and it was all good!”  He went on to use phrases like “our only hope,” and “the way out,” to describe the potential for my practice model.

“No,” I thought, “I am not Obi-Wan.  I’m not your only hope.”  I sighed.  I don’t want that kind of pressure on me before I even see my first patient.  What if I fail?

Even worse: what if I succeed?

One of the main things that separates good clinicians from the rest is the ability to think through contingencies.  When I order a test or prescribe a treatment I have to consider the possible outcomes: if the test shows X, then we do Y; if it shows not-X, then we do Z.  Or, here’s the plan if you get better on the medication, and here’s the plan if you don’t.  The more contingencies I can anticipate and plan for, the more direct the path to the ultimate destination: resolution (or management) of the problem.  I find that my experience in thinking through contingencies serves me well in my current job of building a new and innovative practice.

Continue reading “What If Success Sucks?”

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I grew up in Rochester, NY. Statistically, this means that I probably had a family member who worked at Eastman Kodak, as the company employed over 62,000 people in Rochester at it’s peak. I did, in fact, have two: my father and my brother-in-law. My brother and I both worked there during two fun and profitable summers of our college years in the delightful “roll coating” division. It actually paid quite well, but was miserable work.

Kodak was, at one point, the consummate American success story, dominating its market like few others. In 1976, it had a 90% market share of film, as well as 80% of cameras sold in the US. Kodak Park, the property at the center of manufacturing once employed 29,000 employees, with its own fire company, rail system, water treatment plant, and continuously staffed medical facility.

Fast-forward to 2012, and the picture changes dramatically. In a single year, Kodak declared chapter 11 bankruptcy, received a warning from the New York Stock Exchange that its stock was below $1/share for long enough that it was at risk of being delisted, announced it is no longer making digital cameras so as to focus on its core business: printing, and then a few weeks ago announced it was no longer making inkjet printers. The job force in Rochester alone has gone down by nearly 90%, to an estimated 7200 employees. (All of this info came from Wikipedia, if you wondered).

Adding pain for former Kodak fans was the announcement in April of this year that Facebook was buying the photo sharing company Instagram (which employed 13 people at the time) for an estimated $1 Billion.

So how could a company so dominant be overcome by one with only 13 employees? Didn’t the resources of Kodak give them anything better to sell than this small start-up? And what spelled the doom of a well-proven system of photography that fueled one of the most successful companies of its time? Was it acts of congress? Was it passage of a photography reform bill, or Obamachrome? Was it formation of ACO’s (accountable camera organizations), the use of the photographic centered media home, or the willingness of the government to pay photographers over $40,000 if they prove they use digital cameras in a “meaningful” way?

Continue reading “Instadoc!”

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