Nothing Has Changed, Everything Has Changed

It was both monumental and banal at the same time.

I sat at the restaurant with the check stowed safely in my right pant pocket.  The flimsy piece of paper burned through the cloth and singed the hair on my thigh.  It was screaming for attention,  trying to distract from the conversation and deliver me back to the worried thoughts that filled my mind over the last few weeks.  Will they come, will they come?

After breakfast, the whole family got back into the car and drove towards the bank.  They waited in the parking lot as I leaped towards the front door.  I had already filled out the deposit slip.  The line for the teller was short.  I handed the check and the slip forward and waited for something to happen.  Would thunder crash through the sky and lightning blaze down past the roof and strike me on the spot?  With little fanfare, she handed me a receipt, and I was returning to the car.

Nothing has changed, everything has changed.

With the deposit of my first check, I have started the true transition into my new practice.  Some may call it concierge, others membership based.  But what the lawyers tell me is that I am now charging for uncovered services.  There is much uncertainty.  Only after hearing my colleagues reactions have I started to question myself.  They hem and haw as they tell me that I am bold.  They envy my willingness to take such a risk.

For me, however, the risk is in staying the same.  The risk is abandoning one's beliefs to join the great healthcare race to assimilation.  Physicians will change their ways.  The art of medicine will become a borg like delivery of cookbook solutions spoken in hushed tones and explained in reams of computer printouts. 

Did you get the after visit summary, what about the patient education materials?

Will they come or not?  I have no idea. 

I am scared.  I have placed a value on my abilities, and now must wait to see if my patients are in agreement. 

What I don't question is the certainty of the stand I am taking.  Today, I stepped out of the system.  I abandoned the structure that has been placed on me since the day I accepted the position in my medical school class.

This has not been easy and comes with a great deal of risk . 

I will do it anyway.

I have done it already.