Up

Things are looking up. I don't have a lot of news, but I mostly just want to get that rant off my homepage. Ha. Felt good to do it, but now I am uncomfortable with it being the first thing seen. I had an interview, and it went really well (in my opinion). It's an innovative practice with a psychiatrist that really emphasizes therapy. Already has one NP and seeks another, so I won't have to break any new ground. Lots of experience to learn from. Excellently run, with an office manager that's been there 7 years. The office is simply gorgeous - in a lovely park-like setting, the building is quiet. Obviously been professionally decorated with no expense spared. I would have an office with a window. The only downside is the commute, but it's bearable. And he was amenable to working flexible hours. They asked the magic question near the end: How soon can you start? Anyway, I'm providing them with all my license numbers, diplomas, etc. It's definitely going on to the next step. We haven't talked money yet, but I've already heard that he's reasonable. I must confess, the idea of seeing a wider range of patients with a variety of issues does interest me. This practice only sees adults now, but perhaps I could broaden that - I'm so comfortable with adolescents at this point, as they've been the majority of my patients.

It's a snow day in Austin. A rare event. My gym opened about 45 minutes late, but I got over there and my wonderful spin instructor did two extra songs for the three of us there. Love her. And no work today! Of course, no pay today either! This part-time thing....not gonna work. I'm really trying to put on my big girl panties and smile and have a positive attitude there. There is only one person at work I've bitched to, and I'm going to keep it at that. But the signs continue to be quite negative. I was told that I need to start meeting in person (instead of calling) with parents of adolescents on admission day - which is great, I think it's a good idea, but I'm not there every day. Nobody thought of that. Another example: I had 4 insurance reviews to do today, which won't get done because of the snow. And I'm not there on Monday. Someone else will have to do them that day, or patients could get denied for coverage and we have to eat the cost. Hope that gets done (said in a bitchy voice). I asked how situations like that would be handled when we were discussing this part-time schedule, was told "we have a lot of things to work out" and that was it. Just like the contract I was supposed to sign on Tuesday. Never saw it.

Um, this is turning into a rant again. Damn.

So what else is going on? Running is going really well. My rule is that I run one song, walk one. I'm up to 40 minutes doing that, wearing a knee brace. No more pain than before I started this, so = success. My gym is strangely deserted for a January, and it's because the new location opened in Westlake. A lot of people are going to that one, it's brand new and has a pool. I'm going swimming today, for sure. And yoga, and oh my...it'll be a fantabulous workout day. It's nice not to have a jammed resolutioners crowd, but I'm also worried that they may cut some of the spin classes for poor attendance. And I must, I mean must, mainline my spin every morning or I go into withdrawal. Nothing else quite does it for me, I think it's the intervals. Working so hard you can't catch your breath, drenched in sweat, cranking it up to the nth degree, screaming inside when will this stop?! And then slow down, breathe, recover, and do it again! For 45 minutes! Yeah baby. This may completely be TMI, but it is a lot like sex. You're in a dark room, building up to the climax, breathing hard, focused, straining.... especially when we reach the top, folks sit down on the bike and everyone sighs and squeals. Sometimes I just have to laugh. Yes, it's a spin orgy.

My ham planet cat has learned how to open doors. We have hook door knobs, and he stands on his hind legs, reaches up and opens it. He really likes to do this to the bathroom and then destroy the toilet paper. His girth facilitates this - ha.

I just finished The Goldfinch by Donna Tartt. It's a novel about love, art theft, tragedy and PTSD, and the losses that all of us face in life; the unfinished nature of how things turn out, the missed connections and the way that love actually doesn't conquer all. But still... there remains beauty and meaning, if we are brave and face things. It takes place in New York, Las Vegas, and Amsterdam. It's hard to put in to words why it's so good. It's well written, it surprises, it is deep. And it's absolutely not trite. I guess that's what I value most in a novel. If you want to read more about it, here's a link. I can't recommend it enough. http://books.google.com/books/about/The_Goldfinch.html?id=T2CA83gbtM8C

OK, yoga in an hour.

I'm not crabby, I'm just really bitchy.

This is going to be a bitchy rant. If that's not your thing, walk on by.

As I've often mentioned, I love my job. I work at a small specialized treatment center that I feel really makes a difference in people's lives, especially those of girls and young women. Most of the clinicians there are so capable and there's this wonderful collaboration. It's a stimulating environment to work in, and when I look back on the 5 months I've been there, it's quite stunning how much I've learned.

Can you hear the "yes, but..." coming? Our break-even census number is 11 patients, and since about late summer, we have not consistently been at that number. I've still had plenty of work, at first it was because I was learning so much, but I've taken on other tasks. I am the liaison to all the insurance companies, so I have to interface with them for each patient about every 4 days and get authorizations for continued stay. It takes time to collect the data from everyone on our team and build the story of what that patient needs. I also do three therapy groups each week and work with two different interns on separate days. I revised all of our medication management policies, which basically was non-existent. I was busy in spite of the low census, and I definitely worked more than 40 hours a week. I went in every Sunday afternoon, and frequently I had to meet with patients who were struggling over the weekend since none of the therapists were there. Sometimes I left early because of that, but not lately. In spite of all that, I knew that the organization was worried about the low census. In the past month, they laid off our HR person and our PR person. And guess who was next? Well, I'm their third-highest dollar employee, right behind the COO and the clinical director. But here's the deal, they really can't lay me off. Nobody else can do what I do - they aren't licensed to diagnose, treat, and prescribe. Only the doctor can, and he works only 8 hours a week, and half of those are meetings. I was thinking that they might consider dropping me to work only 4 days a week, or expanding my role to take on more of the therapist tasks. But they had something else in mind. And it didn't go down well.

So the delightful day before my birthday, the director tells me that they are dropping me from a salaried employee to only 25 hours a week, and keeping all my duties intact. I would work 3 days a week, and they propose that I see patients in a private practice using my office on the other days, and use a 60/40 split for the money I make on those days. The only problem with this is they were "too busy" to get me credentialed with the insurance panels all this time, so I've been billing under the doctor's name. I can't take any insurance patients on my own. And that's a ridiculous split - I would never agree to it. The going split around town is between 20 and 30, and that's with providing billing and insurance processing. They want 40% of my money just for me to use an office that's empty anyway? They also asked me to propose an hourly rate. So  I went away and started thinking about this.

The next morning, I see the COO in the coffee room and say, oh by the way, I forgot to ask when you guys want to implement this. He says, next week. My mouth falls open. I can't stop myself. I say "you are kidding". He says, oh I'm under a lot of pressure from Dr. M (our "headquarters" organization is a treatment center in another city; the doctor there owns both facilities). That's just peachy. You expect 2 weeks notice from me, yet you give me 5 days. That's just great. Later, in the weekly leadership meeting (and that they nicely inform me, I'll no longer be attending) our administrative head tells us that she worked all weekend on a proposal to fix financial problems that have recently been uncovered at HQ. Seems that their census has been low for months too, and they had been very sloppy about billing and record keeping when times were flush. Now they're not, and discovering that they have huge problems. Hmmmm. Could there be a connection to their sudden decision to cut my job to the bone?

Anyway, I calculate a rate that basically turns my salary into an hourly rate, I don't add on anything for the lost benefits. I am generous. I tell them the next day what I want, and that I want a 70/30 split and want to be credentialed. I offer to help with that process, filling out forms, making calls, whatever. Reasonable, no? I do this without being pissy, either, in spite of how I feel. And then I wait. And wait. So it's Friday, and all of this is supposed to start on Monday and fucking finally, he meets with me and counters my hourly rate with one dollar below that and they won't compromise on the 60/40 split. I say nicely through clenched teeth, I decline your offer. I can stay for the 3 part-time days but at my original rate and I'll find something else to do on those 2 days off. And incredibly, he says Well I have to run that by the owner. Great. Let me know by the end of the day. I'm not showing up to work without us coming to terms.

And at 2:00, they come back and agree to that.

I'm incredibly sad about all this. I really was doing work that fed my soul. But I can't stay at a place that feels they need to humiliate me. One dollar less? What is wrong with you people? I've had uncomfortable, strong signals for a while that our COO isn't very competent, and this just confirms it. Throughout all this, he kept saying this was not his choice, it was all coming from HQ, it was out of his hands. You fucking ballless wonder. So what exactly do you do here then? And the serious financial mismanagement is not trivial. I don't believe these people are good businessmen and women. I see reaction, I don't see strategic thinking.

I have a job interview Thursday, at an office with a psychiatrist that I've heard wonderful things about. The only downside is the drive. He's up 360 on Spicewood Springs, but that's reverse traffic so I don't think it will be bad. And it avoids Mopac, which is about to become a disaster area for years when they start building the toll road. My plan is to start working there on the 2 days I'm off, he can start getting me credentialed, and then I'll quit and go over there once my practice on those 2 days fills up. Actually, a pretty good deal because many times the first 6 months of a private practice are pretty lean as you build your clientele.

And I'm closing with a picture from the hot sauce fest this past summer. It allows me to do what I wanted to do all week. I look pretty happy.

More Naps

I'm at work. Seems like I could just say that at any moment and it's correct. Not too big a whine, but seems like lots of parents thought that they could "cure" their teenage daughter of her eating disorder in the two week break for the holidays. Ridiculous, sad, so misinformed. And then they are angry at us when we don't pull that rabbit out of the hat. My doc has worked only a total of 4 hours over the last 2 weeks, and numerous people have been on vacation. What I'm trying to remember is that I can only do what I can do, and that all of this is a choice. And people covered for me when I took a week off (of course, they have a PRN NP that has to come in for me. Nobody but the doc can actually do what I do; unfortunately that's not true for me. I can step in and do the therapist work and I have been.) But honestly, I've had some fantasies about finding another job. That bothers me. My boss returns Tuesday and we will be having a chat. I've decided that I need to set some limits on the time I leave the office. The actual patient work is quite rewarding, it's worth it to make a big effort to fix the problems.

They opened a new Gold's gym less than a mile from my office. It's pretty sweet, all brand-new equipment and .... a POOL. I've swum laps there twice now and I have all the excitement for the beginning of a long term relationship. They have a nice sauna too. I suspect that will become attractive for me, stop there a few times a week after work. Swimming has always been such a meditation activity for me, it would be perfect after a long day to "process" as we say. Their spin room is big too, I'll have to try that out. Brand new bikes. I've started running again. My knee really felt better after that week in Holland with just walking for exercise. Took away all the weights, yoga, spinning and rowing. So I've started VERY slowly. I run one song, walk one. And I stop after a cycle of 3. After two weeks, I'll let myself increase. This is so NOT what I did last time. I think in less than a week, I was running 30 minutes straight. Through the knee pain. Don't do that.

Ken and Dani are in Taos. They skied yesterday, I'm waiting to hear a snow report. And it's supposed to be a super-chilly day here. I should have some great snowy pics for my next post. They ate at Tecalote Cafe in Santa Fe, one of our favorite places. Blue corn pancakes.

Ken and I are going to Carnaval Brasileiro www.sambaparty.com this year. I figured no Mardi Gras, this'll stand in. And I bought the VIP tickets, so we'll have a nice little area to chill when we get out of breath from dancing. And baby, I sure plan to do that. I'm working on my costume, so far I've settled on freaky stockings and boots. Maybe a Lululemon top, I need some extra support for all my jumping up and down. Ha. Can't wait. From what I read online, this is a real feast for the eyes as well as the legs.

The holidays are over and I'm so ready. Not my favorite time of year, and I think with the work issues it was particularly bad this year. It's funny, I spend much of my days being somewhat of a cheerleader to my patients -- "What skills could you have applied in that situation? What things work for you to improve your mood? What's standing in your way of making those choices?" and I catch myself thinking, maybe (just maybe) I should apply them to myself. Certainly it's easier to tell others than to do it yourself when you're blue. Or stuck in the black and white of it all, technicolor gone missing.

Over the holiday revelry, here's something interesting that came up in the dining table conversation this year. We were all sharing the most interesting thing from our year's work. My brother owns a vintage furniture store in Austin called Modern Salvage www.royt.com and as part of his inventory acquisition process, he buys foreclosed storage units. One of the units he bought was owned by a great-grandson of Jack and Rose from the Titanic story. Yes, the movie. Those were actually real people, although they weren't that young, and they had children that were not with them on the boat and survived. So yes, most of the movie's plot line was fiction. Anyway, this guy that owned the storage unit has had a difficult life. Lots of money handed to him (the family was wealthy) but he was a sucker for con men with schemes. Lots of detritus in that unit from failed deals that he was involved  in, and also lots of expensive, little-used things he bought (great for my brother). One of the items was this beautiful Movado pocket watch that you slide apart to see the lovely little clockface - pic below. And here's the real kicker - there were Krugerrands in the unit too. Why would you put such a thing in storage and then stop paying the rent? Isn't that an interesting question.

I've been reading some of my friends' New Year's resolutions on Facebook, and so far my favorite one is "take more naps". I kind of hate the whole idea of setting goals, usually not realistic, at some arbitrary point. Maybe it stems from my distaste with my ridiculous overcrowded gym for the month of January. Yesterday I had to place my yoga mat right smack at the front mirror so that people who only stayed for 3 songs could have the primo spots. I'm serious, Erika even remarked "where did everybody go?" ARRRGGG. Lots of people with no sense of gym etiquette - muddy shoes, doing their sets right in front of the rack, using F'ing cell phone on the machines..... But on the other hand with resolutions, few of us take the time to stop and take a breath and evaluate our lives. So yes, I've taken a few moments to do that, need to do it some more. I heard a great thing on NPR this week about this by Two Guys on Your Head. I love them. It's locally produced by KUT and exactly the kind of stuff I think about constantly anyway. Here's a link. http://kut.org/post/how-make-effective-changes-new-year-0 So what are your resolutions? I am toying with the idea of taking a drawing class but wrestling with the reality of having to drive through traffic at the worst time of day to make that happen. I think I would love it but the truth is that my time is limited and precious. If only I could find something close - I'd be all over that. (Austin friends  -- any art classes in the Westlake/Lakeway area?) The other thing is meditate more and get in at least 2 yoga classes a week. Odds just went up on that one with that delightful Westlake gym.