Shirah Vollmer MD

The Musings of Dr. Vollmer

Unknowable

Posted by Dr. Vollmer on November 20, 2012

Trina, fifty-six, a physical therapist in private practice for twenty-two years does not understand how her business works. She has great referral sources, but the flow of her practice changes “wildly,” she says. “Sometimes I have no time to myself, whereas other times I think I am going out of business,” she says, with palpable anxiety and uncertainty about her future. “I have many colleagues and they have the same experience, except for them, they make these false attributions, like blaming the economy.” Trina says, explaining that her perspective is that her business plods along at a rate which is not simply explained by market forces. “There is no way to get a handle on the supply and demand aspect of what I do,” she says, with a sound of frustration that she cannot control her world. “Well, let’s assume it is unknowable, what does this mean to you?” I ask, wondering how she manages this anxiety. “It means to me that I have to understand that my business is vulnerable in a way that I may never fully comprehend.” Trina says with resignation. “When you hear your colleagues talking about how the economy is hitting their practice and you don’t see it that way, how do you cope with that?” I ask, wondering about how she deals with not finding colleagues who share her point of view. “First, I think they are saying that to make themselves feel better. Maybe their practice is down because someone is guiding them to someone who they feel is doing a better job. That is always a possibility. It is hard to go down that road. It is hard not to take it personally and feel that a low practice is secondary to poor work, so it is comforting to know that the force is external instead of internal. No one ever says that their practice is down because they are not good at what they do, but I am sure many people feel that. We, in private practice, get so vulnerable because training programs that offer additional certification can seduce us into believing that if we just could use one more machine then our practice would flourish. Of course, that may be true, but it may also be a way for these training programs to make more money. It is so hard to know. Other people feel the key to building a practice is marketing, so they spend a lot of time and energy trying to package their practice, but it is not possible to know if that is helpful, or the tides are turning on their own. You cannot do a randomized control trial to see what the key ingredients to building a practice. I think this is why a lot of physical therapy students are looking at a place like Kaiser, where there are no business worries. I could not do that because then I would have a boss, and you know me enough to know, that as much as I hate thinking about how vulnerable I am, I also do not like the idea of working for someone else.” Trina explains to me why she copes with this uncertainty. “So, living with the unknowable in private practice seems better than living with the knowable of having a boss while being employed.” I say, articulating her dilemma. “That is exactly right. Life is unknowable. This is just one more thing,” Trina says poetically.

2 Responses to “Unknowable”

  1. Shelly said

    I can understand and sympathize with Trina’s worries. It must be very anxiety-provoking to watch the ebb and flow of her private practice while her colleagues don’t always feel the same effects as she does. On the other hand, after following your blog since its inception, I remember your writing about how freeing it is to work for oneself and to have to report to a boss, to make one’s own decisions about the direction of one’s business, etc… So I can relate to Trina’s feelings in this regard and often wish I could be on my own. As you say, there are pluses and minuses to working for someone else and for being in independent practice.

    • Shirah said

      Thanks, Shelly. Yes, particularly in this day and age, where very few people stay at one job throughout their career, it is not as certain as it used to be to be employed. At the same time, as health care is undergoing massive changes, places such as Kaiser do offer a substantial amount of job security. As with so many delicate subjects, it is very hard to talk honestly about the pros and cons as defenses mount very quickly. Thanks again.

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