Whoa, I’m feeling good. There’s a lot to put down here, and I’m going to start at the end. I’ll try to unwind some of the thoughts I had on the walk, but I wish I could have captured them in the moment. Anyways. Part of the end is being on the road and showing up in a town and giving a talk, playing a show, and then seeing patients. Stay around for a week or so. Hang out in a coffee shop. Meet people and explore. Try things out. But start with a connection to a doctor friend if possible. I could post on FB: “So I don’t have merch, but uh, I’m a primary care doctor and I’m seeing patients tomorrow. If you’re having trouble with your blood pressure, feel depressed, or dealing with low back pain hmu.” And charging like $25 for 15 min appts. Just line ‘em up and knock ‘em down. 8am til noon and 1pm til 5pm. If it’s busy, make 800 bucks. They can wait to see the doc. If I see 8, I make 200 and that’s cool. A good day’s work. It’s super affordable for people. It’s accessible. People will connect. It will be rad. And then I just hop to the next town. Boulder, Fort Collins, Durango, Eugene, Klamath Falls, Vancouver, Olympia, Port Townsend, and on and on. Go, go go.

So I have been feeling upbeat lately. I have a vacation coming up and I am looking forward to being done with residency. I know this is all in flux, but what I see right now is probably doing some locums. I have a hunch that I won’t really like locums. But I will be a board certified family medicine doc and I will be qualified. I will make some money. I will have some flexibility. It can give a framework to my travels. Or it can fit into the framework of my travels. I will practice my skills, gain skills. I will learn and earn money. And, ultimately, maybe I will have tried it out enough to feel okay giving it up. That can be part of the process. I don’t have a STRONG need to do locums at all, but I do think it will be part of it.

The other part is the dream clinic part. I struggle to describe the dream, but writing about it is part of the practice. I want patients to value my time. I want to spend time with them in a meaningful way, and I want them to pay me for it. I think there is a kind of breakthrough that happens when I have convinced myself that my time is valuable, that I bring something valuable to my patients when I am present for them, and that they are willing to pay for it. It empowers me to leave the system behind. It allows me to travel more easily and set up shop again. I can work with the flexibility of letting myself and the patients define the practice.

And I can tinker with it. If I want to see more patients, charge less. At the beginning, I can charge rock-bottom rates and not even make money and just get practice. Just learn how to do the thing. And be grateful for my patients, and offer them exceptional value, and then, after having some experience and some success, THEN scaling up. Like shifting from 25 dollar appointments to 150 dollar appointments. That can happen. It will be almost a different phase. And eventually, in maybe 5 years or 10 years, if things go extremely well, then I’ll have new problems, but the sky will be the limit. If people really adore what I do, and they can’t find it anywhere else, and people are lined up for months, the sky is really the limit. They want what I got, and I only got such a little amount of it. I can charge 400 dollars, or a 1000 dollars and I can be full. I don’t see any reason to really charge 1000 dollars, but I do believe it is true that I could be in such demand that people would pay it and I couldn’t see them all.

That is somewhat pie in the sky dreaming. That is if things really, really, really take off and the kinks are ironed out, and I have a book and I am somewhat known for my work etc. etc. etc. And I might not want to go there. I might not want to be there. But it could happen, and at that point, if I like seeing patients one on one, I can just find the right price, and the right volume and enjoy my life. Do my hobbies. Take my time off and support myself with a career I enjoy. But, maybe if I don’t like it quite so much, or it doesn’t feel just right, or if my interest leads me this way, I might get into training community health workers to replicate my work, to expand my work. I might work with other doctors to do similar work. I might do coaching or I might do consulting. I could make bigger money doing this… but again, what for? I really don’t think I’ll need the money, so just do what is interesting.

So anyways, again, the first step might be doing locums and traveling, or the first step might be opening my clinic right here. I could stick my name on it for just a few months, and then hit the road. Get out of town for the winter. In those first months, just try to see patients. Keep it cheap. Work somewhat hard. But have a deadline and then move on. Have a 1^st and a 2^nd locums contract lined up. Do a lot of stuff early and then take a break. Make the transition first and then relax. It’s somewhat opposite from my earlier thinking, which was that the in-between is the right interval to take a break. And I thought so because for most people, you get into the cycle of work and you never get out again. But for me, because I’m doing things so differently, I aim to always keep that element of break, of rest. And I just don’t want to be in that usual position of procrastinating at the easy time. Then it gets hard to get restarted. Because the thing that comes next, you don’t even know how to do. Break the ice, THEN take a break. It’s better.  July, Aug, Sept, Oct… 4 months of a clinic. Many would say it’s hard to make anything happen in such a short time. But I’m aiming for a pop-up. I want to see SOME patients. I can set goals. I don’t expect, or need to make much money. But try this thing. Get some experience before you leave town. Then maybe spend November, Dec, Jan, Feb either on the road, traveling, or at some point starting a locums contract somewhere. Maybe even the rest of the year (Until July again). And then you can re-sort. Reset. You can decide from there to reopen the clinic. You can keep doing locums. You can open a clinic back home. Or you can move on to doing the pop-up clinics in Colorado, Washington, and Oregon like you said.

These things all sound so sexy. Play music. Make art. Give talks on health. Exercise and take care of yourself. Protect some free time. Eat well and meditate. Date and build relationships. Support parents and friends.

Some day, how about a retreat center with your partner? Maybe. I could do that. It might make sense for the children phase. A farm commune somewhere. Maybe still be on the road to make money. And people can visit you if they want.

I think I am still open to the long legs of love. I’m not done yet.