Well, I finally shared the address with a couple friends, so now someone has read these words. I am feeling pretty high about my plan for now. I’m caught up on notes and my in-basket looks good. I have many tasks for tomorrow, but I’ll get through them. I have moved on from the 12 months off idea. Right now I am thinking of opening my clinic right away. I think I have learned enough about this city that I kind of will know how to promote myself. And it is a kind of trail run. I could be leaving for the road in the future, but it makes sense to test things out before I go. And so my idea is to give myself that first 12 months to try things out before I settle into a “job” job.

The point of my clinic is just one on one conversation. I don’t think I need hardly any equipment. I guess they can be house calls, why not? But I wouldn’t mind having my own space. Because I have such little needs, I think I could find something for free or very cheap. If I could have a piano there, that would be excellent. But what I’m doing in my clinic is listening to my patients. It’s not “primary care” as defined by insurance companies and the AAFP. It’s more like medical therapy. It’s like paying to spend time with a massage therapist or with an astrologist. I bring my background and training, and we sit and I listen to the patient’s stories. They pay me for this. I can help create a treatment plan. I can write prescriptions. But that’s not really the main point. I am mostly being paid to listen. And to offer my opinion.

And I guess one of the therapies that I really believe in is the whole foods, plant based diet. So we can talk about that, and how that can reduce the need for blood pressure medicine, or diabetes medicine, or anti-cholesterol medicine. We can talk about exercise. I can show you some exercises and we can write an exercise prescription plan together. We can talk about meditation or other stress relief techniques. I want to use and promote mind-body skills. People can find other places to learn this, but some will get a real kick out of hearing it from an MD. Who am I to complain?

And so I have the idea to charge for my time. My first idea was 170 for an hour and 100 for 30 min. But then I was thinking of the cost of living of this city, and am willing to bump it to 230 and 150. I believe the service I offer is valuable, and will be appreciated. I think people investing in our relationship helps them to invest in the changes that we talk about. And also, importantly, is I don’t have a huge capacity to do this work. To spend an hour with a person, really getting to know them and giving them my best energy, this is not something I can repeat all day long. I can do it maybe 2-4 times a day. I think I can do it 3 days a week. ~ish. At first I will be excited and maybe want to do more. Okay. But I think in the long term, setting a limit so that I am seeing 4 patients, 3 days a week. This is from a whole other world than traditional family medicine. It almost doesn’t seem to make sense. But then it does. If I see these 12 patients a week, my goal is that that will sustain me. That that will provide a comfortable enough salary that I will be able to meet my needs, AND pay down on my student loans effectively. If I am earning “enough”, then all the extra space in my life is mine.

The point isn’t to rush through those 12 hours of work. It’s 12 hours of performance. It’s actually a lot of work. To be really engaged with it. But also, to be really engaged with my whole life. Taking good care of myself is a full time job. I will be cooking. I will be exercising. I will be involved in the community. I hope to be writing and giving talks (?) IDK. I have hobbies! I want to have a band.

So I have this sweet life. I mean, I’m not trying to brag, but what I’m describing sounds awesome. And then I can travel. I can just not schedule patients for a week or 2 and go do what I want. The idea is this skill I’m learning allows me to make money easily, anywhere. I’m not a traveling musician, I’m a traveling doctor. My skill set is in my head. (My heart?) And so I can pop-up in my hometown for a couple months and see folks. I can work 5 days a week for a bit if that’s what I want. I can work intensively for stretches, and I can work lighter for stretches.

Part of this is that my intervention happens in the room. I am not a surgeon, but I am performing an operation. People are engaged and in the moment with me. We talk about reducing their meds. I’m trying to wean them from healthcare. So we have our appointment or appointments, and then we each move on. You’re welcome! It’s not this chronic disease management thing. Go to your “doctor” for that. I’m here to talk about it. I can help you to understand your medical problems. I want to empower you to eliminate them. And if we are successful, then you’re done, you graduated. Congratulations. Money well spent I hope. And if it’s not working, then maybe this model wasn’t for you. Thanks for trying. Thanks for giving it a go.

And so, on I go. And then what’s the next step? And the next step? Those will come with time. Who knows? I can’t see them yet, because I am still months away from these first steps.

But having this cool plan feels so empowering to be getting through residency. My peers/faculty have no idea what I’m really up to. I’ve tried telling them about it, but it’s just like there’s no starting with them. I can’t get past “Solo clinic” and they have a thousand questions to shut me down. So on with it. Just do the thing. And who knows, they may have some sense that I was up to some alternative thing, but they probably won’t get it even when I’m doing it. So anyways, just do it. Do the thing.