Home Forums Discussions General Discussion Free to a Good Home

For some time I have been following the tribulations of the primary care community in the lower 48... hassles, poor reimbursement, desperation even. They make the practice of medicine as most of you experience it sound truly dreadful. So, I have a for-real, honest offer.

My wife/medical partner and I are closing our primary care internal medicine practice in Fairbanks, and have taken positions on Saipan at a publicly funded hospital serving a low income community. We plan to be gone by December. What we are leaving is a practice that makes an almost embarrassing income for us, great patients, a good staff who want to keep working, optional hospital duties, no night calls, and (by our choice) no involvement with meaningful use, and no badly paying contracts. By doing so we are leaving a big hole in the IM outpatient care picture of our community. Our two PA's and we represent about 30% of the outpatient IM slots in the community that has been so kind to us.

And so we want to give it away. Free. All of it. Patients, staff, EHR, office equipment, computer hardware, software, pictures on the walls, pens in the drawers... All of it. Free. All you would need to do is agree to take good care of our patients and staff.

I actually will be surprised if anyone gives this serious thought. For all the complaining and dissatisfaction, our community recruiting experience is that very few people actually want to change their situation. I get that. It is scary. I am currently sitting in a hotel room in Saipan just having announced that I am tossing away the golden goose that has given me both fortune and pleasure for 40 years. But "To discover new lands you must first decide, for a very long time, to lose sight of the shore." If anyone out there is adventurous enough, crazy enough, or desperate enough to give this serious thought, contact me at dgrauman(at)avtox.com and respond to the challenge from my spam filter.

David,
Good luck in your new venture. My in laws would skin me alive, but it sounds very enticing. Saipan sounds great!!! I wish you and your wife the best.

OMG! Two years ago I would have jumped at the idea. Good luck to you and your wife, David.

David,

Best of luck in your new venture!

Good luck in Saipan.

I spent a 6 week elective working in the hospital during my residency in 1982. Interesting experience with a few MD's from the US, along with medical officers and other personnel from around the Pacific. Nursing was mostly from elsewhere in Micronesia.
Lab and radiology was hit and miss with technicians. Hopefully that has improved :^)

Great diving and weather however

Hafa adai
Greg

David,

What an interesting life you lead! First Alaska and now Saipan.

There goes our next user group meeting in Alaska.

You are certainly right, very few have the wherewithal to dramatically change our circumstances. I am interested in how you came to your decision.

Although you may no longer use AC, I hope that you remain in touch here on the Board. Your wise prose would be sorely missed. I certainly have benefited from your advice.

Thanks for the well wishes. The offer remains open.
This is what we sent our patients...

?Any path is only a path, and there is no affront, to oneself or to others, in dropping it if that is what your heart tells you . . . Look at every path closely and deliberately. Try it as many times as you think necessary. Then ask yourself alone, one question . . . Does this path have a heart? If it does, the path is good; if it doesn't it is of no use.?
--- Carlos Castaneda

Dear Patient,
We began our medical education and practices over 30 years ago. Since that time, practicing medicine has been a path with a heart for us, providing a great deal of satisfaction. Following this path, have learned a lot from our patients, and have come to believe in the goodness of people. You have become our friends.
Medical practice is changing and the milieu is confusing and somewhat frustrating. We believe in the basic intelligence, priorities, and ingenuity of the American people and believe that this will sort itself out, although we believe this will take many years. We have found a new path for us that we strongly believe also has a heart. We have accepted jobs on the island of Saipan in the Northern Mariana Islands with the Commonwealth Health Care Corporation, a publicly funded hospital and clinic. We are excited about this adventure and working in an underserved area.
We expect to be gone for many months. Therefore, although Fairbanks remains our home, we will be closing our medical practice in December of this year.
We would encourage you to establish yourself with another provider as soon as possible. Fairbanks is somewhat shy on Internists and the family medicine physicians in town are also very capable and up to date. We strongly suggest that you do establish with a primary care provider rather than risk fragmented care from specialists alone.
We have had long and close relationship with many of you, and it will be hard on both of us to bring this to a close. If you have ongoing medical issues, we are hopeful that we can bring them to some logical conclusion or stable condition before we leave. To those of you who are new to our practice and came to us hoping to establish long term care, we apologize-we were not anticipating this change until very, very recently.

Dear Dave,

Wish I could bilocate! Alaska would be great fun. But alas my roots are strong and deep here where I've been planted. I do hope and pray that someone takes you up on your generous offer. Love the letter you wrote your patients and the quote from Castaneda (haven't read anything from him in about 40 years)!

Have fun in the sun down in Saipan.

John

To answer Donna's question, we were not looking to relocate. I was looking for a volunteer position in the south pacific, hoping for a month or two, and getting no takers. It was odd; I wanted to give it away, and then Saipan came back basically saying "we don't need you for a month, but how about a job?"
Something in this clicked, and over the course of maybe 72 hours we decided to change our lives. It was, and is, a very strange experience. Maybe it was that what we were doing was too comfortable. Maybe it was the hope that we could get two lives for the price of one. I'm not sure. I do know that to live free and happy you must first sacrifice boredom. It is not always an easy sacrifice.

I'm still waiting for that golden e-mail.

I am very intrigued David. I am also very sad to hear you are leaving. I have a mind for business and have been trying to grow my practice here. I have compatriots from residency: perhaps I can toss out a lure to them.

Email me a phone number. Let me call you please, I'm still too jet lagged to know my sleep schedule.