Dear Amazing Charts Colleagues,
Perhaps some of you remember me. My partner and I were AC users and owners of a private practice until about a year and a half ago when we made a rather sudden decision to take a job in the Northern Mariana Islands. I?d like to tell you about the job I?m doing now as part of a recruiting effort to get other experienced physicians here. I have been in Saipan since August 2014-don?t worry, I had to look up where and what Saipan was as well. It is a commonwealth of the United States in the Pacific down near Guam and near the Philippines. We are a tropical island 12 miles long x 5 miles wide. Our average temperature is between 80 and 85?. My house looks out on the Pacific ocean, I have coconuts, dragon fruit, pineapples , lots of citrus etc. growing in my yard, and access to the best SCUBA diving in the world. The island has Pacific Islanders including local Chamorro and Carolinians, neighboring Chukese, Yaps, Pohnepeians, Palauans, etc. There is also a large population of Filipinos and other Asians. The island is poor although we have a large population of tourists from Japan, China, Korea . We recently were hit by typhoon (some say supertyphoon) Soudelor and are still rebuilding. English is the local language. We use the dollar. We have US passports, zip codes, telephone numbers and legal system. It is, largely, a part of the United States, but with ample difference to make it fascinating
For nearly 43 years we practiced in Alaska. For the most part it was wonderful, with great patients and great reimbursement, and few of the nightmares we saw reported here. However, in recent years that started to change in subtle ways. Like many of you, I grew tired of all the rules, being an employer, billing, coding, but more than that, I got tired of finding myself limited to care of the worried-well. I was one more physician tweaking wellness issues and sometimes feeling like the life was being sucked out of me by neurotic patients, while ?real? medicine was fragmented into the system and out of my care.
Because of this series of what now I see as somewhat miraculous circumstances, within 3 months of hearing about the opportunity here, my wife/partner and I closed our out practice and started practice at the Commonwealth Health Care Corporation Hospital, the pubicly funded (and only) hospital in the Northern Mariana Islands. We are salaried, more or less government employees, with no production bonuses. We work hard because there is a lot of need, and the spark of idealism that US medicine almost managed to kill has flared back to life. It is a rare physician who?s been here for more than 20 years. There is a handful of those who?ve been here 5-10. There is a moderate population of people just out of training getting their national health services score loan repayment benefits. To be honest, there is also a group that is here because, perhaps like us, they have been gone from the ?real? America too long to be able to reassimilate into what mainstream US medicine has become. There are many who worked here, left, and realized this is a pretty good deal.
The job is not without its frustrations. The hospital is poor and resources are limited. Our electronic health system is kludgy, often slow, sometimes broken, always limited. You sometimes have to go down the hall and around the corner to find a printer that is filled with toner. Staffing issues are a common problem. The formulary is limited. There are frequent shortages, stressors, new challenging circumstances to deal with. We don?t have specialists other than a part-time gastroenterologist and frequent practice outside of our comfort zone is a fact of life.
We don?t have a dedicated air ambulance service, If a patient needs urgent referral, such as if we have placed a temporary pacemaker (yes, we do that ourselves) needing implantation of a permanent unit with minimal delay, medical evacuation is done on a stretcher in the back of a commercial airliner with one of us as an escort. If someone breaks her hip she often has to wait for several weeks to she can get shipped off island for repair. I have the patient in the hospital now with hemophilia and we are out of factor replacement and have only 3 more units of FFP. We fortunately do have some more blood products
But limited to the bottom line-the patients are lovely. There is a lot of noncompliance but there is also a lot of appreciation, respect, gratitude. Circumstances may set the bar low, but not a day goes by that we are not made to feel like a hero.
We do get paid reasonably well for this job (and a 90% US Federal Income taxes rebate on island-earned income helps a lot) and for me at least, it?s a job I?ve been looking for my whole life. As I frequently remark, if you are wanting to make a real difference, this place is ripe with opportunity. The job is not an easy one but it feels like being a real doctor. I put in many other volunteer hours trying to improve the health care system. This recruiting is part of that.
I don?t know where you are in your lives. I hope you have felt productive and appreciated and it had a good balance with your personal life. You may not be wanting to make a transition like this, but perhaps you know someone who does. The young people are great, but physicians with experience are priceless. Perhaps you are interested or know someone who was a little bit restless and willing to take a chance to find challenge and adventure. This would be that.
Sincerely,
David S. Grauman MD FACP
dgrauman137 (at) gmail dot com
