We are all torn between retrospect and anticipation at year’s end.  We want to remember what has passed and examine what those experiences have taught us while looking forward to the coming year and what it will bring.  Heather and I are no exception.  In the final days of 2023, we decided to revisit the year’s highlights.  We will each answer seven questions regarding the past year from our individual perspectives.  This is my version.  Heather’s will follow.  At the beginning of the new year, we will post our goals for 2024.  Thanks for reading, and Happy Holidays.  

What was your personal highlight in 2023?

     My family’s summer was the highlight for me.  During the school year, spending as much time with my children as I would like is difficult.  They are in school all day and then have after-school activities.  Before you realize it, it’s bedtime, and then you wake up and do it all again.  Weekends are great, but it is often three different kids doing three different activities in three different locations.  Couple this with me still working part-time out of town, and I’m always looking forward to the summer.  

Hawaii Highlight

During the summer of 2023, we spent two months in Hawaii and nine days in Montana.  I had to fly back and work for about two weeks, and my kids did a couple of weeks of summer camp, but we still spent a tremendous amount of time together as a family.  Whether it was playing at the beach, hiking, swimming in the pool, or reading at night before bed – it was a magical summer.  

What was your professional highlight of the year?

     In December of 2022, my urgent care company opened a new location, the culmination of several years of work and planning.  We had been looking at this site since 2019.  The unsigned lease was on my desk when COVID hit and the world shut down.  Fast forward two years to March 2022, and I had just completed the purchase of the shopping center where we were previously going to lease space.  We opened later than expected as the buildout and opening were delayed for various reasons, which cost us valuable time during the busy winter season.  

     The first year in a new location is usually a struggle.  It takes time to develop a presence in a new town and to earn patient trust and loyalty.  It is also quite expensive to fund the buildout and the operational costs as you build patient volume.  I believe that the second winter will tell you whether you will succeed.   We are now deep into December, and the patient volume is finally doing well.  I have a lot riding on the success of this clinic.  Not only has the urgent care company spent a lot of money to get to this point, but I personally spent a lot of money and assumed a lot of risk by buying the shopping center.  It has been a long year, but the hard work of our whole team seems to be paying off, which is the professional highlight of my year.    

Professional Highlight

    

What was your biggest personal challenge?

     This question is the most difficult of the seven for me to answer.  My life is wonderful, which doesn’t mean it’s perfect or that I don’t have any problems.  But there are so many good things in my life that any inconveniences seem small by comparison.  Additionally, having been an emergency room physician for over 20 years, I regularly see people suffer and grieve.  These secondhand emotions have always helped me keep my own problems in perspective.  

       With that in mind, my biggest personal challenge this year has been time management.  Although I am financially independent, I still choose to work.  My problem is not the shifts in the ER but the work I do at home on my companies.  Time management has not typically been a struggle for me because I have worked all the time for most of my adult life.  I consider business my hobby, so working at home is usually fun.  Unfortunately, my wife and kids don’t necessarily view things the same way.  I’ve been trying to find the right balance for several years.  My wife has convinced me to work less in the ER, but I have filled that time with new businesses and projects.  I plan to write more about my struggles with time management in a future article, which I will link to here when it is published.  

What was your biggest business challenge?

     On January 1st, 2023, the Centers for Medicare & Medicaid Services, also known as the federal government, changed the E/M coding for hospital-based practice.  This fundamentally changed how we document patient visits in the emergency department.  All our providers had used the old system for their entire careers, so this was a significant and unwelcome change.  This was a hair-on-fire problem for our ER group as documentation directly affects coding levels and, thus, reimbursement.  Oh, and January also happens to be when we see our highest patient volume.  If we got it wrong, we would lose a lot of money very quickly.  If you’ve ever had to get a group of doctors and APPs to change anything, you’ll understand how challenging this was.  

     It took until late March before everyone seemed comfortable with the new system, and fortunately, we navigated the transition without losing money.  However, I then had to turn around and do it all over again in the urgent care.  The E/M coding had already changed for outpatient practice in 2021, but most of the new rules had been masked by the COVID-19 pandemic and Public Health Emergency declaration.  When that ended in May, the new rules started to have an effect.  I had to lead the (re)education of all our urgent care providers now that it wasn’t all COVID all the time.  This took several more months of education, implementation, and chart reviews.  

     I literally just had a meeting this morning with one of our family practice providers who hasn’t properly implemented the changes into her practice, so I’m still occasionally dealing with this issue.  But for the most part, we have moved past it and are back to regular old documentation issues.  The funny thing is, no matter how much everyone complained about the change, if you tried to go back to the old way now, everyone would start complaining about it.  As always, no one likes change.    

What was your most significant financial win?

     My biggest financial win of 2023 was doing nothing.  The US stock market lost 19.53% in 2022, while bonds had their worst year in history, losing 13.16%.  I did not panic.  I did not sell.  Instead, I stuck with the basics of investing, like dollar cost averaging, by maintaining my automatic investing throughout 2022 and 2023.  Additionally, I have performed a type of portfolio rebalancing by allocating more of my contributions in the second half of this year to bonds.  In 2023, the US stock market is up 23.99% YTD as of 12/21/2023, while the bond market is up 5.37%.

Financial Win

What was your most significant financial loss?

       In business, you sometimes take a short-term loss to achieve long-term gains.  When you open a new medical clinic, you sign a lease, pay for the buildout, and pay salaries, whether you ever see enough patients to make a profit or not.  The hope is that you lose money for a year or less in exchange for a business that is then consistently profitable for a decade or more.  When it works, it is great.  When it doesn’t, well, then it becomes the answer to this type of question.       

     I mentioned our new urgent care location’s financial journey as a positive in question 2, yet we have taken a significant short-term loss this year.  I hope we have turned the corner and will be profitable in 2024 and for many years to come.  The money we have spent thus far has been an investment, not a loss, as we don’t know the end of the story.  However, a line item on our company’s P&L statement this year shows that we paid the final $67,808 in rent for a location that we closed in 2020.  That location now has a total loss of over a million dollars.  Ouch.  So, while it wasn’t all lost in 2023, the story is now officially over.  I’ll write about that journey another time and link it back here.       

Does anything else stand out from the past year?

     Starting Business is the Best Medicine stands out.  I have been teaching personal finance and business for several years and have been thinking and reading about it for decades.  This blog allows me to reach a larger audience and share my experience and passion on these topics.  This is a new adventure for me, one in which I am a complete novice.  It is fun, scary, and exciting.  Thank you for taking this journey with us.