Getting ready for opening day

Originally published February 17, 2011: OK.  One more quick one, and then I’m going to try to get 2 hours of sleep before I go back to the office to wait for the delivery guy.

From day one, I’ve aimed to underpromise and overdeliver.  Throughout this whole process, I’ve tried to set expectations low, so that I would be prepared to weather any storm that comes my way.  Despite this fact, I can’t help but wonder whether I had set my expectations low enough.  What if things take even longer to ramp up, if at all?

I’m quite certain that these thoughts go through everyone’s head as opening date nears.  Even though I know what I’m going through is normal for anyone with a life-changing event on the horizon, it doesn’t necessarily mean that I’m immune to the emotional effects of it.

It’s so funny.  I spent a whole year preparing for the BIG day, and I know for certain that the moment will be anticlimactic.  There won’t be any balloons, fireworks, or a roaring crowd.  It will just be me in my office playing minesweeper  as a wait for my first patient to call for an appointment. OK.  It’s probably not going to be that bleak, but you get the point.

All these worst case scenarios go through my mind more frequently these days, but in all likelihood, I’ll probably be fine.  One of my biggest strengths is that I know myself and I know people.  That’s what’s gotten me through life rather unscathed, and that’s why I’ve had such popularity amongst patients in residency.  Still, it’s hard not to think of these disaster scenarios.  It’s a lot like our residency match.  A good number of you guys knew that you were going to match into ophthalmology, but most of you probably didn’t sleep too well the night before the match because of that one person you heard about with 260 board scores and first author on NEJM that didn’t match.  That’s how I feel right now.

Several hours later: Ironically, after I had written my doom and gloom post, I received a call from someone wanting to have their eyes checked!  He caught me completely off guard.  He called me when the slit lamp was being installed, so I asked him to stop by in the afternoon.  I rushed back home to get my lenses and all other equipment, and by the time everything was in place for me to welcome him, he called me back to cancel the appointment because he was too busy at work.

So, I had my first patient call today, and I also had my first cancellation today.  =)

On a different topic, my office is 95% moved in, and everyone that’s visited so far has been saying awesome things about it.  I guess word of mouth will spread on my existence just through my interior decor as well, which is a pleasantly unexpected bonus. I also got my 46 inch plasma TV and ultra thin Blu-ray player mounted on the wall.  The entire cover of the Blu-ray player slides to the left to reveal the disc slot.  How cool is that.

Shoot…I don’t know if I turned my TV off on the way out.  So much for going straight to bed after this post.  I’m at 5+ hours of sleep in 60 hours.  So this is what general surgery residency feels like.

And the next day: I had all my equipment and software installed over the past 2 weeks.  I received initial training for all of them, but I will definitely need to read over the manuals and to practice more.  If you’re still in residency or in your current associate position, make sure you try to learn how to operate all the diagnostic equipment from the technicians before leaving.  All vendors will give you free training, but it’s probably a good idea to be familiar ahead of time.  None of the equipment or software is super complex, but there’s a lot of steps to learn. I plan to spend a good part of this weekend playing with everything.  Of course, if you hire someone with a technician backround, things will be easier.  The Cirrus OCT is definitely the most complex of all.  Too bad I won’t have anyone around to lend me their eyes to help me practice taking sample snapshots.

As for the software, I have a lot of training sessions ahead of me.  I have 5 half-day training sessions scheduled for the practice management software and 3 or 4 for my EMR.  Once again, much of the programs are self-explanatory, but will be rather time consuming to set up and to learn to use.  Having gone through EyeMD EMR training, I’m realizing that I made good choice.  It really is a neat program, and cheap too  (relatively speaking)!

Howie’s comments: now that we look back on it, there’s really no such thing as your “official” opening day. The first several months should be looked at as a “soft opening” where you make sure your equipment gets delivered and your office gets set up, you train on your equipment, EHR and practice management system, and you go out to meet referring doctors. All of these things take weeks if not months to finish. Think of any patients you see for the first two months in between doing these tasks as a bonus.

I got my keys to the office the day I came back from AAO annual meeting. All of my office furniture, my computers and IT, and my exam lane were all being installed the same morning. The place was total chaos and the whole time I was thinking, what the $*&#& have I gotten myself into! My OCT, IOL master, visual field and acuity screening chart would come via FedEx a few days later.

I had about ten days before thanksgiving to set everything up and start my training on my EHR and PM system. And unfortunately the front desk I hired bailed on me, so I had to interview some more candidates and hire another person (which took a extra week).

The Tuesday after thanksgiving, when I was in my office unpacking boxes, a patient stopped by to make an appointment! His optometrist told him he needed a Yag capsulotomy, so he found my office on his insurance company website and stopped by. I scheduled him for 3 PM on Friday so I would have the whole day to make sure I was ready to see him (at this point I hadn’t taken my dilating drops out of the boxes yet!)

Several years later, this patient is still very happy and seeing well post capsulotomy and I don’t see patients after 3 PM on Fridays. But the point I’m trying to make is to not be worried if only four patients show up opening week. Concentrate on getting your office in order, making fast plans for your EHR, learning your practice management system inside out, and going out to shake hands because once you get busier you won’t have the free time to focus on these details.

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