We also use our computers to submit our billing, generate letters to patients, transcription, e-mail, scheduling, and of course communication between "Advance" and myself.

I have not experienced the benefits of electronic records at this point, however will explore this logical step in advancement in the near future. This can potentially save you hundreds of dollars if not thousands over the long haul. Considering that my staff makes up over 30 new charts per week, which costs incurred includes staffing time, paper, the folder itself, stickers, and patient time to fill out these forms, is simply not cost effective in today's world.

You pay for the lump sum of money on the front end of the investment for electronic records. It is absolutely worth it!

I am currently limited to time to do the research on the different software that is available, however will be making time in the near future.

We are currently implementing software that my staff and I can dictate into that allows my transcriptionist to transcribe from any location that has a computer with an Internet connection.

An answering service is utilized 24/7 in my practice, that allows patient access in emergency situations to contact me for advice. My answering service calls my cell or my home phone to relay the message. A cell phone is invaluable doing this work.

It is difficult to imagine that just a few years ago that our technology did not even support pagers, cell phones, computers, etc... You can live without these things, however they sure make your life simpler in many regards. Then again, having this constant connection to you can get very frustrating after a day of many calls coupled with a very busy day! Keeping up with the competition has always been an art in business, and I don't see this changing any time soon.

Many times in my day to day practice I run into patients who have financial instability. These patients have difficulty paying their daily bills, let alone medical ones.

Sometimes as a provider of care you need to be resourceful for your patients' sake. Remember that many pharmaceutical companies have programs that will give patients free samples for up to a year. You may suggest to your patient that they get online and print off the application and have it filled out, so as a provider you simply have to review and sign the document.

Also don't forget about the $4 dollar prescription plans that are becoming very popular at the larger pharmacies. Many antibiotics and anti-hypertensives etc., that are generic are really cheap right now.

It is interesting how expensive medicine has become. The first thing I look at when I pick up the chart is if they do or do not have medical insurance. This tailors the care received to some point.

I always give the patient the option of the alternative medication prior to writing the prescription. Many times it is a convenience of less frequency or a shorter length of course, however the end result is the same.

Also insurance dictates where they may or may not go. Some facilities such as PT only accept certain insurances. These are sad facts of daily practice but must be considered in order to give the patient the best possible care within their financial ability.

After practicing for several years I have gained a rapport with other modalities and kind of squeeze them in for a discounted price, or even for free. Once you explain the current situation to the prospective provider of care, sometimes they will even do it for free. I have done this many times myself.

Practicing with love and compassion toward your fellow man goes a long, long way. I have received many referrals from such patients, who have sent new patients that do have insurance, simply because of the compassion that you have shown. So it will all work itself out in the long run.

I try to practice with Peace, Love, and Laughter.

Our clinic has a three-pronged mission: providing high quality health care services, serving as a resource to our community and promoting our profession. As one of two NP clinics in the area, we feel it is our duty to provide learning opportunities for health care professionals of the future.

Many of my colleagues are feeling the strain of financial pressures in their various practice settings. Instead of receiving straight salaries for work product, the trend is to compensate based on performance, which usually translates to sheer number of patients per day. Given the intense pressure to care for increasing numbers of patients, clinics and other health care systems are reducing or eliminating student opportunities. The argument is that students "take time" that could otherwise be spent seeing patients. Consequently there are fewer clinical sites available and far fewer students completing their training, especially in primary care.

Having control of my schedule and the general clinic schedule allows me the freedom to work students into the day without compromising patient care. Communication with the support staff as well as providers is essential. When the appointment time is flexible for the patient, we try to schedule visits to coincide with specific student requirements. Our patients are well aware of our educational advocacy and often express their excitement in "helping out" a budding health care professional.

What's in it for you?

Students challenge your process. They ask questions and want sound explanations for everything you do. Students force you to stay current with the latest research, evidence-based guidelines, practice trends and all the other aspects of practice one never has time to pursue. In a small practice, students are very valuable for filling the gaps with answering telephones or returning patient calls as the need arises. Students can also become future employees.

In some areas, clinics who train students are eligible for stipends through health care education funding.

I want to encourage you to design your practice to foster NP growth. Include student placement in your business model. Remember that you were once a student, too. Every single day I have a student, I learn something new or appreciate something special about my practice, my patients or myself. Today was another of those days.

Today one of our PNP students was evaluating two brothers for strep throat. English is not the family's first language. The eldest is 5 "and a half" years old, and the younger one is 4 years old. When they arrived I asked them why they came to visit me and the older brother said, "I have something in my throat that hurts but it's not strep throat." Throughout the visit the older brother continued his chatter; he couldn't wait to be 6 (years old) because then he would be King; he'd been to the dentist recently and described his experience by saying he didn't like "adult" dentists because they were mean and that "next time" he was going to see a "kid" dentist; he loved his brother and his brother copied him all the time but that he didn't want to copy his brother all the time; and he ended with: "my brother....we are a lot alike and like the same things but he is different because he is two shades lighter than me." The student was trying hard to stay focused and concentrate on the task at hand but couldn't help but laugh at this child's soliloquy...  In the end, both the boys had strep throat!

Do you have a contingency plan outlining how your patients will be handled if you are unable to care for them temporarily? Is there adequate internal staff to help, or do you need to find some to step in? What about administrative tasks?

In the short term, patients are usually able to accommodate your absence by rescheduling preventive care, working with a substitute provider or going to urgent care. If absences happen too often or for long periods of time, the business will suffer. Those extended times are when you need to be creative and provide some services to your patients in anticipation of your return.  

Here are a few of the ways I have managed changes in provider time:

• shortened office hours and kept an assistant to staff the telephones
• used picture phones for assessment and assistance by other specialists
• met patients in locations outside of the office
• had students work with certified NPs to manage a clinic day
• enlisted "volunteer providers" to cover key shifts
• diverted patients to other providers in the area and called ahead to alert the providers
• kept in contact as much as possible by calling patients at home to check in or asking the office staff to update key patients during provider absences

Clinical services aside, I was not prepared for the management of administrative activities that occur on a daily, weekly or monthly basis. In the recent case of our family emergencies, there wasn't time to gather all the information, write a list of what is pending, assign responsibilities or come up with any plan for other pre-emptive activities to help those who were running clinic. In the end we missed a few scheduled payments and scrambled to get payroll done. Rent went out late. I spent quite a bit of time on the telephone explaining the situation and asking for considerations. Not a good feeling.

I recommend having an administrative operations manual with information that would be useful if you are unavailable for more than 7 to 10days. Here are a few of the items I would include:

• E-mail: someone assigned to check administrative e-mail from patients, vendors, regulatory bodies, etc.
• Snail Mail: assign someone to open and distribute bills, payments, notices, medical records, junk mail
• Patient flow: patient flow is managed daily to decrease the likelihood of potential blocks, inappropriate scheduling, poor planning, time management
• Payroll: timecards, how to run payroll and who will be signing checks
• Accounts Payable: payment schedules, checks. paying the "float"
• Accounts Receivable: including insurance payments, patient payments, billing questions
• Pending: audits, taxes, insurance reviews, contracts, malpractice payments, credentialing processes
• Students: who will be mentoring the students, or do you need to contact the schools and work to reassign the student
• Physical maintenance: telephone, internet, IT, and building management contacts, plumber, electrician, pest control

I am glad the past few weeks are behind us, but I am still dealing with some of the issues that arose from patients and business relationships during our untimely absences. We have started an administrative manual that we hope to complete soon. I am proud of my staff and partner for "keeping it together" as well as they did, and I have learned a valuable lesson in emergency preparation!

"Word-of-mouth" advertising, even though very successful, can be very slow. That can be a problem for the new practice owner who needs patients quickly to cover their new expenses. I have found a way to help speed up this type of advertising: I call my patients a few days to a week after they have come in to the clinic. I ask how they are doing and if whatever their presenting diagnosis is getting better. We then talk about what was prescribed, if anything, and what else can be done to help their condition if needed.

I try to personalize the call whenever I can to show the patient or their family that I care. If, for example, the son came in with a baseball injury, after finding out how he is doing, I might ask if he had a game since he was in the clinic, how he did, and if his team won. If you had a mother come in with a sinus infection, you might call back and when checking on her, show empathy about how tough it is to care for kids and keep the house tidy when sick.

The patients and their families are always appreciative that you actually care. They all seem to love the follow-up calls. One of my patients that I see on a fairly frequent basis actually asked during one visit why I hadn't called and checked up on her after the previous visit.

The follow-up calls show I care, but they also remind the patient about their good experience with the clinic, which will prompt them to talk about the clinic to their family, friends and neighbors.

A second way to speed up "word-of-mouth" advertising is to always show the patient you care about them. Be patient when they take an extra five minutes telling you about their brother's-sister's-son-in-law's strange mole. When they call your on-call number on a Saturday morning and apologize for doing so, tell them "it's OK, I have the number to call because I care about my patients." Furthermore, when appropriate, shake their hand, put your arm around their shoulders, give the kid's high five, etc.

Follow-up calls and befriending your patients can take extra time. However, if you are a new clinic owner, you will probably have more time than money until you get your patients established. Use your time wisely. Show patients that you care about them, and they will take care of you.

Well, I have listened to their cries and have decided to hire a hypnotherapist/Reiki Master. This individual has 12 years experience in hypnotherapy and at least 5 years in Reiki healing. I personally have become certified as a hypnotherapist and have gone through the Reiki training, levels I, II, and III.

Although I am limited in the time I can spend with alternative therapies due to my own busy case load, I am now educated in these alternative practices. My hypnotherapist is becoming very busy, especially with smoking cessation, stress reduction and weight management.

I truly believe that a combination of traditional medicine and alternative medicine is the wave of the future. This also gives your patients another option of care. Who better to evaluate the effectiveness of other modalities than a primary care practitioner?

Other helpful modalities may include massage therapy, herbal treatments and reflexology, to name a few. I don't believe that one modality is right for everyone but should simply be visited as a holistic approach towards caring for one's patients.

Does anyone else use alternative approaches in primary care?   

I started this last month and was called away to care for my father.  These are a few of the thoughts that fill my head when I look to the future of my practice and my profession.

On the heels of an historic election, we continue to fight the good fight. Politics is as important to your practice as education and equipment. Whether we need to be "politically correct" in approaching a problem with our peers, are involved in the latest catastrophe on the job or observe what is happening with health care reform around the nation. It is time for all of us to take notice of what is going on in the political arena and make our voices heard.

I recently read the "resolutions" approved by a state medical group. The current group of resolutions includes one that hits close to home. This group is seeking legislative support requiring all insured persons to identify a "medical home." This primary care provider would be the "gate keeper" for referrals and preventive care as well as case management services and education for chronic health conditions. (Sound familiar?)

While I applaud this idea (once again), I am very angry and a bit nervous about their insistence that, while nurses, nurse practitioners, physician assistants, physical and occupational therapists and mental health providers may be involved in the care of a patient, the physician must be designated as the "team leader" and in charge of the Medical Home. If you own your primary care practice, you may want to keep your eyes on this.

A newsletter from one of the larger medical insurance companies crossed my desk this past week. They are rolling out a new program that will provide their members disease management services. The company will assign a disease management coordinator to the patient when they have received a diagnosis. The patient can call this person and ask questions about their condition and ask for recommendations for treatments that would help the patient in managing their condition including information about prescribed medications, outside interventions, diagnostic tests or procedures and expected course of the disease or condition. Patients would be given pricing information so they could choose where and how they would like their condition to be managed.

I am encouraged by this company's effort to help their members manage their conditions. I am fortunate to be able to provide this information while I care for the patient in my office. Nurse practitioners have recently received a 15% reduction in reimbursement by this company due to economic woes.

Individual states are working on health care reform. One of the proposals that captured the attention of the legislators involves identifying "baskets of care" for certain diseases and conditions and encouraging health clinics and systems to set pricing based on the elements included in these baskets of care. Consumers would have another piece of information when choosing their health care providers -- pricing. It is similar to "capitation" processes of yesteryear. The state awarded a grant to three organizations to help define the criteria for each basket of care. None of the organizations represents advanced practice nurses.

I am excited about the general direction that health care reform seems to be headed -- greater patient control and responsibility, access, medical homes, programs for underinsured and uninsured, abolition of health insurance, single-payer systems, focus on wellness and optimum health achievement, health education, and all the elements of NP practice. Changes in leadership of our country have brought bipartisan hope toward a better future. We cannot be silent in the coming days. We cannot be left out of the decision making. Keep your eyes and ears open, listen for opportunities to make your voice heard. Do big things in small ways.

As a business owner, I am worried about the economy and its impact on my business. As a health care provider I am encouraged by the potential for real reform. As a nurse practitioner, I cannot be silent and see what may pass my way. As the CEO I am the visionary. I encourage people to be what they can be.  Make your own destiny.

Rah! Rah! Rah!

If you plan on opening an independent practice, one of the most important things on your "to-do list" if you plan on billing insurance is to get credentialed. This is a long and arduous process taking from around 60 days to several months depending on the insurance company.

The sooner you can get started, the better off you will be. I'll walk you through what you'll need to become credentialed and how to get started.

What you need:

1. A business address: As soon as you have one, start the credentialing process, even if you will not be starting your practice right away.

2. Tax ID #: These are easily obtained from your local government web site.

3. NPI #: apply online at https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart

4. State license, DEA number, business license

5. CLIA waived certificate: If you plan on drawing labs or doing in-office tests. For information go to: www.cms.hhs.gov/CLIA/downloads/HowObtainCertificateofWaiver.pdf

6. Professional liability insurance: Generally $1 million / $3 million is required.

7. Education history, transcripts, and professional memberships and certifications.

8. Three or four good professional reference.

9. Go online to http://www.caqh.com/ to register to be credentialed with several different companies.

10. Call the credentialing departments of the rest of the insurance companies you wish to bill and get started. You can find the numbers on each of the insurance companies web sites.

Be patient, remember the processes takes weeks to months. As soon as a company sends you an application or contract, quickly fill it out and send it back. If you don't hear from insurance companies for awhile, call the credentialing office or provider relations number and follow up.

Good Luck!

Well, I have been at my new office now for over a month, and yesterday's schedule had 38 people on! Yes, it is really taking off.  I have advertised again, and I'm thankful for the responses. I will be interviewing three new prospects at the end of the week.

It really is difficult to see patients and manage a a busy practice at the same time. I plan on hiring some individuals to take up some of the slack. I still intend to practice on occasion; however, I am unable to continue this pace!

I have also just hired two ultrasound techs. One's specialty is in cardiovascular medicine, and the other is in general medicine. I will be hiring a women's health NP to care for my female population.

This venture has just exploded with opened doors and opportunities. If you believe in the premise that "Thought becomes reality" then, the sky is the limit. I feel strongly that medicine needs to transition into having several specialties under one roof.  People enjoy convenience, and practitioners should welcome the continuity of care. I have also hired a hypnotherapist as well who also is a Reiki master. She is doing wonderful things for smoking cessation and stress management. Patients are always asking of "natural" ways of healing, therefore I offer these alternative services as well.

I will continue with the updates each time I blog for those who are interested.

The "reindeer party" is a big event. As soon as school resumes in the fall I get calls and questions about the party and the reindeer. We have had real reindeer with sleigh rides every year. (The reindeer are in training and are unable to fly so this seems to be OK with the little ones.)

I call the local high schools and ask if they have anyone who would like to be Santa and his elves. I try to get the music departments involved but run into conflicts with school programs. We contact the county Early Childhood Special Education team to provide crafts and information about their programs during the party. We have had guest authors, illustrators, musicians, storytellers and a book fair. The proceeds of the book fair are donated to the ECSE programs.

Our community fire truck and firemen pay a visit and present a quick fire safety program for the kids. The county health department is involved, and this year they brought a vehicle crash game to illustrate the importance of proper car restraints. We invite a variety of local businesses to promote their products or services and have hosted massage therapists, Mary Kay cosmetics, family fitness centers, book vendors and chiropractic services.

Kids are encouraged to write a letter to Santa, and our staff looks forward to responding to the letters. This year, one of our 8-year-old patients thought there should be a coloring contest so she brought 5 designs and markers for the party participants. Her mom told us that the girl came up with the idea on her own and insisted on bringing her own markers!

Each year we have numerous volunteers offer to help with face painting, refreshments and traffic control.  The event is scheduled for two and a half hours on a Thursday evening, when we would typically be open for business.

Promotion for this event is tricky as we usually do not have extra money for advertisement in the budget, so we include fliers with our November statements, a note to the "community happenings" section of the newspaper, a message on the Web site and distribute cards or fliers to businesses nearby. Families take fliers to distribute to friends and bring around the neighborhood.

We spend a lot of energy and time thinking of ways to promote what we do when a "simple" community party can have the same result. I did not keep an accurate count, but I estimate there were over 200 guests at the party. In the past we have had as many as 500+guests. In a small office like ours the benefit of gaining one new family to our patient panel because of the reindeer makes it all worthwhile.

Happy Holidays and Best Wishes for the New Year!

Looking in an area that is close to my current location has left me empty handed. I had closed my mind to other possibilities, such as a separate practice, in a new location. As you may know, I had two practices at one time and after difficulties with colleagues, I had to close the less busy practice.

However, I have since hired three NPs instead of doctors and have just been presented an opportunity to take over another practice, in another town. At first I thought it would be prudent to purchase another building that would accommodate my current practice, as I have significantly outgrown the building. Once I opened my mind to the possibility of another location, I then had to come to terms with such things as staffing, computers, signs, advertising, etc...

Well it just so happens that it was an all in one deal!!! So I had no alternative but to jump on this opportunity. The lessons learned with my earlier adventure of two practices have become invaluable. I will focus on my primary practice expansion later.

Business can be a gamble at times, but when you have a strong model and stick to what works, things just explode!

I currently employ a Psych NP, an Adult NP, and a Family NP that will be picking up the slack at my Altoona office while I am off with this new adventure. I also intend to hire a Woman's Health NP in the near future.

I must tell you that I am there Tues. and Thurs. starting two weeks ago, and my schedule is booked. Once I follow my model and get things up to speed, I will be hiring more providers to "Answer the call."

The freedom of independent practice is indescribable. As I am writing this blog, I got a fax with the number of patients on the schedule for tomorrow = 27. We do take walk-ins so I will be taking my roller blades along.(LOL)

Since this will only be my third week, I will keep you posted in the next few blogs for successes and pitfalls as things progress.

A new research report confirms what NP practice owners have been telling ADVANCE for years: Word of mouth trumps advertising. By a lot.

The Washington, D.C.-based Center for Studying Health System Change found that, of the 17 million consumers choosing a new primary care provider in 2007, most based their choice on the recommendations of family members and friends. More than half (50.3%) of survey respondents said they used this source of information to find a new provider, and 26.9% said this was the only source they used.

Health plan and other health care provider recommendations were the next most used sources of information (34.7% and 38.1%, respectively). Only 2.2% of shoppers said they considered TV or radio ads. Books, magazines or newspapers were consulted by 6.8%. The Internet contributed to the decisions of 10.8%.

For more details, see the report here.

Admit it, we all like to receive mail. Being able to open the mailbox and having a letter with our name on it is fun — well, unless it's a bill.

This especially applies to the holiday season. Having a greetings card arrive in the mail, even from a health care provider is nice and helps the person think about that provider, even if for just a minute. These thoughts are associated with the joy of the season so that the person associates the good feelings with the sender of the card.

If used properly, sending holiday cards to our patients is an excellent way to advertise and increase the patient load of a clinic. Large clinics with many patients generally have the time and resources to send a quick generic card to each of its patients. However, if you are the owner of a newly opened NP practice with a small patient base, these cards can be personalized for much greater efficacy.

The more you personalize the card to the patient, the more likely they are to return to your practice and to tell their friends about you. Even feel free in the card to ask for referrals or to tell the patient you would love to help them, their family or friends. Just think of how it would be to get a handwritten card from your provider that asks you how work is going at your new clinic, or at the office, or how your new baby is?

If time or money is tight, just pick a certain group of patients. For example, for the next 3 weeks before Christmas, make it a point to talk a bit more with your patients and find out about them.

Then take that information and quickly include it in a card just after they leave the clinic or at the end of the day. Not only will the patient appreciate the opportunity to talk to you on a more personal basis, but you will then have a personal card you can send them at Christmastime. It will serve as a great reminder of how much they enjoyed their visit.

Finally, if holiday cards are just out of your budget, you'll have to learn to be creative. My dentist collects the cell phone numbers of his patients. On my birthday, I received a text message from him telling me Happy Birthday!!! I thought it was kind of cool and told my friends about it.

Furthermore, if you have the right cell phone plan, it costs nothing extra. E-mails are also free. Collect the e-mail address of your patients, and put them into a database. With the touch of a button you can wish them all a Merry Christmas or Happy New Year, and it didn't cost you a cent.

Remember, take time to do something for your patients this holiday season. They will appreciate the thought, and you will enjoy the business.

Around 30 minutes before I was leaving today, I e-mailed my husband to let him know I would bring home my extra lunch for dinner. (I overbooked and had two lunches.) Things didn't workout the way I had planned. I called him at home, two and a half hours later, to see if he had eaten. His reply, amid chewing was - “yes.” I arrived home 20 minutes later and was greeted by my oldest son. We shared the leftover lunch and started talking about what I could write for this article. He wondered if I had addressed the topic of work-life balance ... not a bad idea.

Finding the balance between work and life can be extremely difficult. When you open your own health care business, it can be nearly impossible. I opened a primary care clinic. One of the biggest needs in health care today is access to primary services. Lack of PCP services results in overuse of the emergency rooms or urgent care centers, fragmented care from constant retail clinic use and poor case management or monitoring of chronic conditions. Poor utilization of health care services contributes to the high cost of health care today. How do you balance being there for your patients and taking care of yourself (and family)? How do you do it when you are the primary clinician and owner? The quick answer would be to hire more staff, but how do you pay for them? 

When I decided to try opening my clinic, I had a great job. I worked three days a week (Tues, Wed,and Thurs), had call only when someone was out of town or sick, had my own patient panel and was paid very well. Many of my colleagues wondered why I left my position. (My reasons were discussed in an earlier article). In the beginning I used my two days off during the week to plan and prepare for the opening of the clinic. I was able to be home when my family was home, continue to participate in my community activities and still feel like I was moving forward on the clinic opening.

Once the clinic opened, all my time was spent at work. Our model as a full-service primary care pediatric and family clinic meant that we needed to be available extended hours and on weekends. My original partner had a young child and felt she could not spend as much time in the clinic as was necessary. Someone needed to be there when patients needed to be seen. At the time my oldest son was in college and the younger two were in high school, so I told myself it was fine, the kids didn't need me to be around “as much.” My husband filled the gaps with the boys and kept quiet about my obsession. (Bless his heart!)

Last year (2007) was the first year I took an actual vacation from the clinic. There were times when I would be “out of the office” but never without contact. I have a picture that I keep on my wall of me talking on my cell while cruising around asthma camp on a golf cart. You can bet I was talking to someone at the office. Leaving the area and going to a place where there was no phone or cell service was very difficult for me. I admit I like to know what is going on at all times, but I have worked hard to keep from becoming a control freak. I am making progress...

That vacation was the first time my husband and I ever went to the BWCA alone. I love the BWCA (BoundaryWaters Canoe Area Wilderness in Minnesota). I introduced my family to its majesty when the boys were in elementary and middle schools. My husband has gone every year since, but I am always too busy with work. 

There were a number of factors that motivated me to take that vacation. I had finally found a potential partner who had the same passion and drive as me, I had another clinician who wanted to see the clinic succeed and was comfortable making decisions when I was gone, and I had excellent support staff to keep things running smoothly. Short of a natural disaster, I felt the place could hold its own for a week or so. It was risky taking vacation during summer break –typically a busy time in pediatrics - but we picked a week that was historically slow in patient visits.

I was a nervous wreck, but I learned one very important lesson: The world continued to revolve while I was gone. The people I chose and the systems we created, kept things going when Iwas gone. I also learned that I was missed by my family the past 5 years. My husband kindly told me that I was obsessed and that I was beginning to show the stress.  He didn't say how I showed the stress, but I felt the gray hair and wrinkles might have been a clue.

It wasn't until this year that I have felt I did not need to be involved in the business every waking minute. I have even started to take one day off during the middle of the week to get a few things done before the holidays. It took my partner to point out that I was going to burn out and be of no value to the business or myself.

Slowly I have moved some of the administrative and clinical responsibilities to other members of my staff. It is hard to keep myself from watching over their shoulders – this is my baby. Well, babies need to grow up. It has taken over 6 years for me to feel this comfortable. The clinic is still running in the red more than the black, we still have many battles to fight with insurance, legislation, competition and the like, but I have come to a place where I know I am better at my job if Ihave a break from it. My husband has remarked how much more relaxed I seem, and my kids are asking if the business is going well because they see me more often.

Keeping life and work apart is very, very difficult. As my partner says, your work is your life when you are the owner. Take heart in the knowledge that you have set up good systems and have surrounded yourself with good people who can keep things going when you need a break. Your emotional health is projected onto your staff and your patients.  It is very easy to get caught up in the business of doing business and forget that you are in this to care for others – don’t forget to include yourself.

Now, if I could take my own advice!