Developments or Not

We’re beginning the transition into Texas summer and the lovely swelter of many months. We still have some relatively mild weather for the next few weeks, so I’ve been checking off my yard reboot task list. As of yesterday, I’ve completed manual aeration of both front and back yards, and I fertilized and seeded the front on Tuesday. Today I’ll finish that off for the back yard. The ratios and spreader settings are a bit sketchy, but I was trying to follow the recommendations from the soil sample testing I had done. As I may have mentioned, our yard was deficient in most nutrients, with only calcium and sulfur being overly abundant. I’m curious if that’s an issue of toxicity, or it just lays inert, so to speak, if the plant life isn’t using it. This is based on the assumption that my core sample mixture was representative.

Core aeration is not something I wish to perform manually for the entire yard again. It’s a tedious and cumulatively arduous task that would go exponentially faster with a machine. I ran into enough roadblocks trying to rent one or get the service performed that I got fed up and just decided to pay $36 and do it myself. I don’t regret the decision and the tool will come in handy in the future, because I’m sure there are nooks and crevices that the machine can’t reach. That said, my plan for the future is to hire a guy (as you do) to have this service performed in the fall and spring. This is assuming I can see some tangible improvements. Hopefully, the assortment of interventions (dethatching, scarifying, raking, aeration, raking, seeding, fertilizing, mowing, watering) will pay off with a thick, and dark green lawn. I have some iron supplement to provide more color if needed, but I’m holding off on that until the new seed is established.

The soil test lab recommended potash and phosphorus as well as “my choice of micronutrients” to get the soil into shape. I’m not sure I got the ratios right, but hopefully there’s enough of the potassium and phosphorus in particular to make up the deficit. I followed those two select ratios with your more standard fertilizer comprised of nitrogen and the typical cross section of micronutrients. Hopefully this won’t burn out the lawn. It’s a lot of supplements at once, hopefully in the future I’ll only need one standard fertilizer to complement the overseeding.

Despite waxing agricultural, I don’t want to dedicate any more time to this than is absolutely necessary. Our yard/soil had been neglected or at least hadn’t had focused supplementation since we moved in, so it was due for more TLC than would normally be necessary. We’ll see how things go. I’ll be watering twice daily for the next few weeks (not counting rainy days) so hopefully the new bermuda seed will germinate and take root. We have a few large bare patches in the back yard that are competing with trees and a reduced amount of sunlight exposure. I’ll see how overseeding goes there. We may eventually decide those areas should just be patios. One project at a time.

I got a second set of overhead storage shelves for the garage, but I’m going to delay installation until next week. We also got a paint sprayer so we can hit the garage door and fence, but that’s also going to wait until at least next week. I’m only going to engage in time-swallowing projects one day at a time. Today I’ll complete the back yard fertilization and overseeding since there’s a limited amount of effective time after aeration that it will make a difference. I think the aeration should have some long term benefits beyond just the seeding/fertilization, mainly in drainage and water/nutrient distribution, but the time for overseeding/fertilization is within 48 hours of aeration.

Continuing on this post a day later - I discovered my core aeration efforts in the front yard are giving me some extra work and additional practice at sprinkler system repair. To my chagrin, I learned the drip tubing on the streetside strip is only buried about 3-4 inches deep, so the core aerator punctured the lines in several locations. I’m going to need to buy a roll of tubing and some connectors and perform several repairs. As I’ve stated before in many different contexts, failure can be a great teacher.

I had performed a few google searches about sprinkler pipe depth but I guess I was using the wrong nomenclature and I should have searched drip tubing. When I searched for underground sprinkler rubber tubing repair I eventually discovered it’s called drip tubing in the industry and now I know it’s buried at a shallower depth. Not a devastating error, just some more sweat equity and a serving or two of humble pie.

Although not my intention, each project seems to beget more projects. My hope is to get most of this lawn and short term DIY stuff knocked out so I can get back to my core (no pun intended) disciplines. I definitely plan on availing myself of the core aeration service in the fall.

I took the Pathfinder in for an estimate of repairs to fix the gas neck issue that’s plagued us for years. I had found a service bulletin which I assumed meant it was a recall type issue, but I’ve learned that even though a service bulletin might get published, it doesn’t equate to a recall. So, I paid $120 to have Don Davis Nissan tell me it will be an additional $405 just to get a look at what’s wrong in particular.

No idea of what additional costs I might have to pay to actually get it fixed. It’s a pain in the ass to fill it up, but not a $500 to possibly $1000 (or more depending on how gougy they feel on that particular day) of a pain in the ass. I’ll just suck it up with my slow fill ups every couple of weeks. I only use it two days a week and eventually I want to get an electric car, but I’m putting that off until well after we pay off the house if possible.

On the workfront, things have settle into a tolerably predictable flow with VES. I’m slowly learning the techniques to avoid QA addendums. It goes against my long established habits when working directly for the VA, but ultimately it’s a losing battle against their policies, so I’ve adjusted to their preferences. I’ve learned that you really only want to address exactly what’s on a claim unless it’s a gen med “all conditions found…” type of exam. They invariably will ask to remove any conditions not mentioned on the claim, whether they are valid or not.

The DBQs are so much more convoluted on the VES side, and just ripe with opportunities for errors of omission. That’s one of many things I preferred about the VA’s version. Auto-negative functions like greying out irrelevant follow-up question were pretty standard, but the QA on the actual forms themselves is significantly lacking at VES. I guess they prefer to pay people to do it rather than build it into the forms.

Also of note, I had gotten a text from a former co-worker stating that “they” were looking to bring me back on as fee-basis at FWOPC. Apparently the low productivity rate of the federales has caught up with them again. Amazing, considering how far their numbers have dropped since most exam requests have been diverted to outside contractors. From what this co-worker said, even the contractors can’t keep up. I’ve seen a few announcements on the VES website that corroborate this, they did request for providers to provide additional booking days if available since there was a backlog.

All that said, I haven’t heard a peep so far. The co-worker had said they only wanted to ask me to come back, which indicates it’s not an enormous backlog, but in my estimation it’s probably those big cases that all the federales avoid. One big issue is my credentials being expired. In typical VA timeframes, that means it would likely be another 2 months to get me back on board. I’m wondering if they’ll go with a second or third choice from any of the providers who still have active credentials. It wouldn’t surprise me if they’re going for a quick fix and not thinking long term. Letting my credentials expire proves how nearsighted they can be.

If they aren’t willing to make the effort to get my credentials renewed, I’m not confident it would be worth the trouble. I definitely prefer fee-basis as I’m sure I’ve said ad nauseam in the past. The pay is better, the schedule is preferable, and the frustration index is significantly lower. We’ll see. At least I’ve settled into a livable lifestyle with VES and we can maintain this indefinitely if needed.

Nut Kickin'

In retrospect, I imagine this post will come across as first world bellyaching, but this is one of my preferred venting venues, so there.

I’ve been working for VES for over a month now, and as time passes I question how sustainable it will be. They show all the marks of a bureaucracy like the VA, but without most of the incentives. Working as fee basis for the VA, we had a very fair payment structure, a decent clinic and network infrastructure, and a mostly autonomous working environment including how we got paid. VES has built up an administrative behemoth for reasons not fully understood, and every exam is often beset by multiple follow up questions that can add as much time as it took to complete the exam in the first place. This might be tenable if the pay structure was adequate, but it’s averaging around half that of fee basis at best. The frustrating thing about the incessant follow ups (QA addendums) is that they’re mostly irrelevant questions that VBA has never cared about in my personal course of completing nearly 15,000 exams. Regardless, VES will insist that these are due to “VA policies” and “VA preferences”, when I’m pretty sure this is entirely made up or at least based on some subjective request from VBA that isn’t based in any sort of regulation or guidance.

An example from just yesterday - I had a case that involved a Veteran with a long history of knee surgeries that ultimately culminated in a knee replacement last year. When I entered in the diagnoses, I still included the past history, some of which he was already specifically connected for. I get a QA addendum because they wanted me to only put the knee replacement as his diagnosis, and remove all the other diagnoses. This isn’t how we document in medicine. A knee replacement doesn’t wipe the slate clean and eliminate the previous history. Not to mention that some of his issues were extra-articular and weren’t involved in the knee replacement. What this admin person didn’t understand is that “knee replacement” doesn’t mean you get a brand new knee and start over. It’s an artificial knee that will wear out and in some cases, the surgical outcome is no better and maybe even worse than before.

This is the typical run-around I get on probably at least half of my exams. Another point of frustration is that they hold us to a 48 hour window to complete exams, but I still have unprocessed work from two months ago, and they have failed to process several exams in time for our payday, so they get held over until the next pay period. Do as we say, not as we do.

Contiguous with this I have been having my recurring OS overhaul, triggered by random untraceable events. This seems to happen with me and OSX every year or two, where the only way I can get things functioning is to wipe the slate clean and start anew. Another major point of frustration is that Backblaze, who I’ve been using for several years, sent me a recovery drive for my OS disk, but the copy speeds are so slow, it’s going to take 3-4 weeks to copy around 1.5 terabytes. I’m at the point of just scrapping the restore process and falling back on time machine.

I’m also recently made a major switch in my studio setup, by swapping places between the video and craft rooms. The big drafting/craft desk moved into the closet and the bed from the craft room is now in what amounts to a basic guest room with TV. Ultimately, this will be a superior setup, but there are a lot of growing pains in the process. I’m trying to back into video recording with a plan to jump headfirst into a YouTube channel with the hope I can build enough quality content that I would earn a subscriber base leading to some passive income, even if a modest amount. We don’t need a great deal of additional money to keep us comfortable, and one major lesson of COVID is that I don’t want to depend on any corporate or bureaucratic structure for my livelihood.

All these events sort of running concurrently has felt like a kick in the nuts, figuratively speaking. I’m spending more time keeping things from burning down and it distracts me from working on my disciplines. I have renewed my efforts to study and improve my video editing and post processing, but right now I’m just trying to get things running normally, so it’s a bit frustrating. …and the microwave died. And a few other things that aren’t coming to mind right at the moment. Wahh Wahh.

Still, we have a home, the utilities are paid, we have food to eat, the dogs, Aeyoung and I are relatively healthy and not really wanting for anything critical. Like I said, first world problems…

2020 was a year

So much of the focus of this past year has been on the negative, overwhelmingly centered on the Coronavirus Pandemic and all of its effects. For me, the most unfortunate aspect was just how inadequate and irresponsible were the reactions of individuals, leaders, and governments. There was no escaping the impact that such a new and deadly virus was going to have on society, but the devastation could have been mitigated to a greater degree, and the loss of life, jobs, and social safety nets could have been greatly minimized.

An analysis of this fallout must include the myriad of consequences. I was, like many others, personally affected when I lost my primary means of income shortly after the pandemic made its full effect known in the US. Arguably the single most devastating acute change I’ve experienced in my adult life, at least from an economic standpoint. Thankfully, my choice to make the Army a career and the pension resulting from that became our primary safety net and kept us in good stead for the lean times to come. Even with this, it wasn’t permanently sustainable.

A result of the layoff (and ultimate termination) was a blank canvas upon which to fill each day. As I’ve discussed before, although I never succumbed to depression or an emotional breakdown, there was definitely a mild funk that persisted for several months. It ultimately was a lack of direction stemming from all the uncertainty. I long ago realized that I must have a target for which I’m aiming, whether it’s creative, financial, professional, etc. The loss of income put so many goals in doubt that it became difficult to focus my efforts.

I didn’t let it keep me from my core disciplines and I continued to practice guitar and drums. I can’t specifically recall what my typical days were like back then, although I started to spend more time playing video games and other sorts of passive activities as I’ve previously discussed. Prior to the pandemic I had renewed my efforts to learn writing, drawing, and studying the Korean language. These fell by the wayside for several months as I had problems finding the motivation to keep all these disciplines going.

Eventually, I think near late summer or early fall, the slow re-opening of medical care and society in general started to hint at better days to come. This slowly helped renew my desire to restart these pursuits and I’ve settled back into a routine encompassing all my disciplines - guitar, drums, keys, bass, vocals, writing, drawing, and studying Korean. I’m still trying to sort out the optimal battle rhythm since I only recently returned to work and that’s been a big shift from the previous eight months.

All this rambling to say that despite the negative consequences of last year, it hasn’t been all doom and gloom. The challenge of the virus was met with an unprecedented effort to develop a vaccine and in an achievement that I would compare to the Apollo Space Program for its audacity and technical wizardry, several companies developed not only viable, but highly effective versions of a vaccine, several of which were using mRna, a complete paradigm shift in vaccinations. Sadly, our current administration is screwing up the rollout, but I’m not sure anyone expected anything else.

The good news is that here in the US we elected a new president/vp and in a few weeks, we’ll usher in a new era and a return to normalcy, at least in the executive branch. Another positive change has been the demonstration that remote work and learning is not only viable, it’s likely a superior alternative to many traditional processes in business and education. Why should we make people drive day in and day out to an office or classroom when they could achieve the same goals and processes from their homes? There will always be industries and jobs that can’t be done remotely, but we’ve definitely shifted the focus more in the last year than we might have in ten years pre-pandemic.

The most important lesson I’ve learned is that we’re not really that far removed from being able to sustain our lifestyle without me working at all. I don’t plan on fully retiring anytime soon (if ever), but I know now that within a few years and having achieved a few economic milestones, we can sustain a fully retired lifestyle indefinitely. I’ll likely always want to work a little bit for discretionary income purposes, but now we have a better idea of how life would look with no additional income.

Reflecting on this, I’m grateful. I’m grateful for the life we’ve been able to carve out after many decades of hard work. We didn’t suffer or feel deprived in the least, and I know there are millions if not billions of people who had a much harder time of this last year, and in many cases have always had a harder time of it. The biggest burden on us was mild anxiety about our economic future and whether we’d be able to endure additional economic hardships beyond the loss of work. Thankfully, that was the worst of it as we managed to make it through without any big disasters.

I should also take the time to mention that we lost some of my all time most important musical influences this year, ironically not due to the pandemic but to other health issues, I think cancer in all three cases. Early this year in January we lost Neil Peart, arguably as big of an influence on me as any other musician, especially considering his lyrics and prose. Not long after, we lost the brilliant musician and composer, Lyle Mays, the longtime musical partner of Pat Metheny and an amazing artist in his own right. He brought so much joy and wonder to so many people over the years. Finally, in October the world of rock and guitar specifically lost a man who arguably had a bigger influence than any other in history, Eddie Van Halen. It’s impossible to calculate just how important and far reaching Eddie’s influence has been on rock guitar. Often cited for his revolutionary approach to tapping and soloing, it’s his rhythm, riffs, and songwriting that are probably the most important elements of his style. Losing these three greats was just another kick in the gut to add to the misery of this year.

Thankfully, the year ended on a high note as I finally was able to return to work, albeit for a different employer. The eventual dismissal from the VA, my employer for the last nine years, was handled pretty callously and lacking in respect from the leadership in my former clinic, but I suppose I was a bit naive in assuming the best about certain people. It’s in the past now. As part of that scenario, the work seems to have mostly shifted to the contractors, so that’s where I followed it and now find myself working for one of them. I never predicted anything as universally devastating as a pandemic, but my belief that there would always be work for disability examiners has been proven true thus far.

My goals for this year are largely consistent with what they’ve always been. I want to continue improving my craft at the various disciplines, ultimately in the service of storytelling in various mediums. I am hoping in the near term to finally record and submit that audition for the guitar program at Berklee and hopefully begin a dual major track starting with the spring semester in a few months. I’ll have to adapt my battle rhythm yet again, but I suppose that’s always going to be a more fluid aspect of my daily efforts.

I hope this year has helped distill what’s most important in everyone’s lives, I think it has in mine.

Ten Years Gone

As of today, I have been officially retired from the Army for ten years. It’s been a fairly busy period of time and given a fair accounting, overwhelmingly positive on a personal level, if not in the national and international scope of things. I spent the first six and a half years or so continuing to work full time, and then switched to fee basis/part-time work about three and a half years ago. Despite the pandemic and forced layoff, I still think that decision was the right one to make. The three years of earning double for half the time made significant progress towards paying off our home and reaching our long term financial goals.

We haven’t neared the finish line as closely as planned for this point in time, but we still hold out hope that this temporary setback will eventually just be a historical footnote. I can say that there have been positive discoveries made in the context of the layoff. It’s not a big change to our philosophy, but we’ve learned to further appreciate the value of financial stability. Also, dialing back the continuous consumption has had little negative affect and it’s made me realize just how much fulfillment is available in what we already have. In a peripherally related issue, getting away from essentially all social media (FB, twitter, instagram) has had little downside in my estimation. Those mediums could offer occasional (and very temporary) entertainment, but they never offered anything of lasting value. And here lately, the constant daily onslaught of misery and controversy (especially twitter) just began to wear me down. I don’t miss it a bit.

We’ve learned how adequate (or not) our pure retirement income is against the cost of living. At present it’s a bit short, although as said before, some real belt-tightening might allow us to correct the course. The additional money from paying off the mortgage will make staying in the black a bit easier. Even at present, just a couple full days of clinic would be enough to keep that monthly ledger positive, so hopefully, in the not too distant future, I might get a little trickle of work to set the ship level.

On the creative side of things, in some areas, it’s felt like very incremental progress, but progress nonetheless. I should mention the considerable time I’ve spent at Berklee which has been a great boon to my artistic development, although I’m on an extended break at present. I still plan to return, but I want to shift my focus to guitar and I’m still slowly working towards what I consider a satisfactory audition. I have until 2025 to use my GI Bill benefits, and since I’ve already used around 75% of them, I should still be on track.

I’m not sure I’m where I would have wished to be on guitar and piano especially, but I can say that I didn’t necessarily expect I would have started on drums, bass, vocals, and songwriting as well. I also wouldn’t have thought my pursuits would turn towards writing and drawing, much less resuming my long procrastinated study of Korean. Things continue to inch forward a day at a time, but that they inch forward is the point. I’m happy with where I’m going (and maybe not totally unhappy with where I’m at creatively, either) and I still wake up every day looking forward to the work ahead.

The family is doing okay, as well as could be expected I suppose. We’re not any younger, but we’re holding in there I think. Ironically, our lifestyle was already suited to the pandemic since we’re homebodies with no social circles to speak of. The only inconvenience for us was delaying some routine medical care, concerts, and being more judicious about trips to the store. Otherwise, it’s situation normal here in the Hightower holdfast. We said goodbye to our sweet girls Lucy and Bridget, and still miss them all the time. We already had Arya by the time I retired and not long after we said goodbye to Bridget five years ago we added Skittles to our pack. A chihuahua mix, she’s the princess in the house and gets the lion’s share of the attention, although we don’t fail to shower our other two girls with affection.

My hopes for the future are largely unchanged. I want to continue working on my creative pursuits every day. I still hope that at some point I’ll spend more time in a purely creative headspace instead of practicing and developing my technique, but I expect that will always be part of the daily rituals. I hope to at least reach a level of competency (on the drums especially) where I can perform and record the sort of music I hear in my head. I’m closer to that on guitar, but there’s still a ways to go. Eventually, my goal is to combine the various disciplines of music, words, and art into cohesive works that tell compelling stories. I’ll get there, even if it takes a long time. I feel like this period of my life is when I can really create the works I have always needed to make. I don’t regret any part of my life, but it would be untrue to characterize my military service or medicine as my calling. These have been challenging and at times rewarding endeavors, but my creative efforts are where my true self lives.

As long as it’s available and I’m able, I’ll probably continue to earn an income to keep us afloat first and foremost, but also to have a comfortable discretionary budget for the quality of life expenses. As probably stated before, I hope we can get back on track and build our cash reserves back up and then pay the rest of the mortgage off. At that point, one decent shift a week would keep us pretty comfortable, methinks.

Looking ahead, it’s hard to surmise where we might be in ten years. I’ll be sixty-three, just having become eligible for my VA retirement (paltry as that may be) and about four years away from social security (if that hasn’t been stolen by then). I assume we’ll have the house fully paid off, and I’d say the odds are we’ll still be right here although might change as well. My main goal with writing is to continue to improve and just create some compelling stories. It would be the proverbial icing on the cake if that would ever reach a level of quality that someone would be willing to publish it. It would be a second cake with sprinkles on the icing to ever derive any sort of income from it. Still, I have to acknowledge that it is actually a goal. Musically, maybe I’ll actually be able to play those milestone songs (you know who you are) by then. A man can dream…

Back to the Infrequent...

…updates I suppose. Nothing monumental has happened in the past month. There has been slow progress on the work front. I’m not sure if it was within the last month that the director sent an email stating that VANTHCS would return to full operations with incremental steps for routine face to face encounters with a planned 100% restoration of services by October 6th. I’m not tracking the play by play, but it seems they’re on schedule at this point.

All that said, that doesn’t mean fee-basis will be needed in C&P in that same timeframe. Our department chief and program analyst had sent emails to the FTEs notifying them that face to face examinations would resume so they would be back in the clinic full time in the upcoming weeks. I responded to this email saying I knew that didn’t mean fee basis would be needed for quite a long time and they essentially confirmed this and expressed appreciation for my patience.

The unknown factors here are whether they will be able to stick to the plan and how quickly there will be a resumption of the normal flow of exam requests from VBA. Until they start getting a normal flow that exceeds the FTEs capability, it’s not likely we’ll see any request for fee-basis exams. My feeling for a long time (and probably expressed here previously) was the end of the year at best, and Dr. Potu (Chief of Ambulatory Care) had already expressed this timeframe as well. If anything, I could see them asking us to help out during the holidays as there’s always a shortage of providers since everyone wants to go on vacation, although it’s hard to say how that will be affected by COVID. If travel remains sketchy, those leave requests may drop off quite a bit.

I still think it will be well into next year before we can expect a resumption of full activities and fee basis numbers reaching anything near where they were at their peak. I hope I’m wrong, and I don’t necessarily need the desired workload to make a difference in our budget. One good day a month would be enough to put our monthly ledger in the black, and two days would make things comfortable. This wouldn’t facilitate the faster mortgage payoff schedule, but at least it would allow us to slowly accrue some cash reserves and give us some breathing room. My hope is we can get back at least to my normal salary limit, which would allow faster mortgage payoff, although it might take 2-3 years instead of the planned 12 months we were previously on track to achieve.

In other developments, I’ve started studying Korean and drawing again in the past week. I decided to go back to the beginning in Korean, and I’m still trying to figure out my battle rhythm with drawing. I had been bouncing around several different instruction programs and I’m starting to think I need to pick one and just stick with it through completion before moving on to the next thing. I have multiple training programs I plan to complete as I go along. Notice I didn’t mention writing. I still plan to start writing again, I’m just looking for the right window and motivation.

Although it’s incremental and often hard to quantify, I feel there has been progress in my musicianship, mainly drums, guitar, and keys. The downpicking drill based on Tommy Emmanuel’s fast run from Endless Road is definitely paying off, albeit slowly. Drumming has felt slower, but my added focus on kick pedal is slowly reaping rewards. I started alternating drill days with song days where I just play songs so I can apply some of these techniques, and I think that’s helping. Many of the drills I practice are isolated and don’t prepare you for the application within a song where all the other limbs are involved.

I need to start practicing bass again and my vocal drills have been functional but not really stretching my capabilities and I need to start singing some actual songs again. I’m not necessarily happy there was a drop off in some disciplines in light of the mild COVID funk, but I can understand it, and at least I kept applying my most primary disciplines. Not to mention, that game backlog has continued to shrink, so there’s that.

I just finished Divinity Original Sin 2 yesterday, and I’ll probably finish off Horizon Zero Dawn next and then I’ve got to decide what to tackle after that. I’m thinking Demon Souls although I realized today I might not be able to play that or Fallout 3 on my PS4, at least using the disc-based versions I own. I think there are versions if you have a subscription to Playstation Now, so I might look into that option.

Life is pretty good, all things considered. I’m not happy losing a significant chunk of earning potential, but we’ve managed to stay afloat for several months and with a few more adjustments to the discretionary expenses we could probably do it indefinitely. I’ve gotten into more cooking with the time off but the downside is that my waistline has grown with my cooking skills. It doesn’t help that I’m having a flare-up with my right knee again and I’m unable to run.

To add insult to injury, I had been trying to reintroduce push-ups and situps to my regimen so I could recover some muscle mass and stave off another ravage of aging. As luck would have it, I strained something in my lower abdomen and I’m hoping it’s just a delicate atrophied muscle and not a hernia waiting to happen. Location wise it could totally be an inguinal hernia. I’m not sure but I think it’s the same side in which I had hernia surgery as an infant and I doubt they used mesh back then. I’m hoping it’s just a muscle strain and I can resume activity in the coming weeks. One of the greatest frustrations of aging (besides becoming progressively more gray and squishy) is that your body starts to betray you and things that you are mentally and psychologically ready to do become difficult to impossible due to injury and declining function. Still, it could be a lot worse.

Speaking of, I’m essentially done with social media. After shutting down FB completely (two times now, most recently in June) I went ahead and pulled the trigger on twitter and Instagram as well. This was another decision based on the sum total effect of interaction and they both are responsible for bringing a lot of negativity that I can’t control. My political leanings are progressive and liberal and I’ll continue to support those candidates and causes, but I just can’t tolerate the day to day social media drama any longer. Every day is a new deplorable act, quite often by the nominal leader of the country and it’s easy to despair. I’m not sure the US as a country can recover from the damage it has sustained (and not just in the past four years), and although I make my best efforts to contribute, there seems to be no shortage of people who are willfully ignorant, obtuse, and have no regard or empathy for their fellow human beings. I hope we can overcome the hatred, greed, and racism running rife at present, but I have my doubts. I don’t endorse much that the catholic church says, but they got the seven deadly sins right.

The Retirement Mindset

This will be a brief discussion as I’m not sure what that means, and I’m not currently planning on shifting to the retirement mindset anytime soon. My long term plan has always been to pay off the mortgage and remain debt-free before we think about a self-sustaining income/lifestyle. Due to the COVID-19 layoff, we’ve been granted the opportunity to explore those realities sooner than planned.

Thus far, it seems that if we decided to really buckle down and eliminate most if not all discretionary spending, then we’re already capable of living on my pensions alone. Notice the plural. The pension I draw due to my service-connected disabilities has been a key source of income now that I’m not earning any sort of a normal salary. We, fortunately, had a bit of an emergency fund, just because our checking balance had built up to a decent level by the time of the layoff. That balance has been slowly dropping, but there’s also been a great deal of arguably discretionary spending as mentioned in the last post.

We’re going to try and cut way down on that for the next few months and see if we can get that balance crawling back upwards. At our present payoff level (essentially the minimum), our mortgage should be paid off in about five and a half years. We had been paying it off at about three and a half times the required amount for the three years since I switched to fee basis, so we made quite a dent in the principal. We’ve been paying the mortgage off since late 2013, so we’ve managed about twenty-five year’s worth of payments in under seven years so far. Once the mortgage is paid off, that should free up about 1.5K in monthly expenses. We’ll still have the rather high property taxes and insurance that are just part of living where we do. I sometimes wish they had a state income tax and would pass on some relief to property tax rates, but I doubt that will happen anytime soon. Our property taxes and insurance are the equivalent of many people’s rent.

The biggest concern with the reduced income is if we get hit by a large financial requirement like home/car repairs, major dental/medical expenses, etc. If we had a few of those in succession, we could quickly drain the remaining cash balance we have at present. If I’m able to return to work in the next year or so (hope), then the goal is to build the cash reserves up a bit more and then work on paying off the mortgage. If I’m able to sustain the work level I had previously, this should be manageable in about two years. Having the mortgage paid off will give us quite a bit more breathing room. At that point, any work that I did would be mostly for discretionary income purposes. I can see working one day a week indefinitely at that point.

So, I don’t know if I’ve adopted the retirement mindset just yet because I’m hoping to be able to return to work and if I’m being honest, I don’t want to completely cut out the ability to earn discretionary funds by virtue of the odd shift here and there.

A Few Milestones

Today marks nine years since my retirement from the Army, and it’s been overwhelmingly positive in retrospect. I got a good job, moved back home, and have spent a significant amount of time furthering my development as a musician, songwriter, and producer. There have been ebbs and flows over these years, some times of drama, but mostly a nice steady arc to the days. We got a great house six years ago, and I’ve been enrolled at Berklee Online for the past several years. Aeyong has turned our yard and house into a natural conservatory of sorts, and we’ve got a beautiful green space that envelops our house and will only shelter us further with time. We lost Bridget to the inevitable march of time, but have since welcomed Skittles, our Chihuahua mix and resident spoiled princess of the brood.

I spent about five and half years working the regular grind as a federal employee, but about two and a half years ago I switched to “Fee Basis” which is somewhat equivalent to a contractor, but without the contract. I get paid directly for the work and there’s no ongoing agreement or contract that binds either the VA or myself. That being said, our clinic has had Fee Basis examiners the entire time I’ve been there and long before as far as I know. That switch is probably the single biggest improvement in quality of life I’ve ever experienced, even compared to my retirement from the Army. I went from working full time to working nine days a month and earning twice as much. This is largely predicated by my ability to perform a large number of exams and handle complex cases that the regular federales don’t like to bother with. It’s really been a perfect storm of an employment situation for me.

I’ve had significantly more time to work on my various passions, and I’ve added filmmaking, video editing, video effects, drawing, and writing to the multitude of musical disciplines that provide great fulfillment and purpose to my life. As part of the added boon of income, we’ve been paying our mortgage off at more than triple the required amount, and so we’re hopefully going to see it paid off in the next two years, about twenty two years ahead of schedule. There’s one big milestone that we need to pass, and that’s another salary waiver approval for Fee Basis employees. The VA has been allowing Fee Basis to earn double their normal authorized annual salaries due to shortages of personnel and it’s been a policy that’s required renewal every two years. This year marks the end of a two year period, so we just need one more approval. By all signs it should happen because the VA has been one of the departments that’s seen expansion under the last several administrations.

Once the house is paid off, I intend to keep working at about the same rate I do now, but being completely debt free will put us in a position where we could probably survive without me working at all. I like the extra security of financial surplus, not to mention discretionary income, so I imagine I’ll keep working indefinitely, albeit on the reduced schedule which will eventually decrease even further. A lot more has happened over the last nine years - we’ve both passed fifty and it’s receding below the horizon, we’ve attended a lot of great concerts, and taken a few small trips. We plan to travel more once the house is paid off, although we’re limited by our dogs and some health issues. It can also be argued we’re both home bodies who really enjoy living in our own little world.

File under short term milestone, I’ve quit practicing any musical instruments for the past month, trying to get this chronic elbow tendonitis to fade away. It’s been in the left elbow for almost two years, and the right elbow started acting up a few months ago. It’s just the cumulative effect of playing so many different instruments - guitar, bass, drums, keyboards. It got worse when I bought acoustic drums and had been working on my double stroke by repetitively practicing the stick bounce off the drum head. That shock is transferred directly to my lateral elbow and it really has taken its toll. The problem with the elbows is that we’re constantly using them, and even something as trivial as picking up a coffee cup or tearing a piece of paper can tweak the injury. I have seen some improvement in the symptoms, so I’m hoping to start gradually re-introducing some practice to my schedule starting next month.

One benefit of the extra time is that I rekindled my interest in drawing and writing (which have been gathering dust for years) and I’ve made some progress, although I have a long way to go. I look forward to combining all my various disciplines into great storytelling in the future.

Drama on television or record is great, elsewhere not so much...

It's been a tumultuous couple of weeks at work and somewhat at school. At work we're hopefully near the end of a cycle that saw one of our doctors going off the rails. She was named an acting chief while they were looking to a hire a new permanent chief after the illness related departure of our former permanent chief.  To distill it down to a few sentences, let's just say she had a bit of a power trip and was butting heads and attacking several people in the clinic. 

We had been friends and supportive co-workers for many years but had a falling out a few months ago when we disagreed about implementation of the Gulf War illness policy. She's relatively new to government service and thought it was within her authority to implement the policy as she saw fit. It isn't, and she can't. But, in most cases we're willing to let individual providers rationalize their own opinions on cases as long as they understand they'll have to defend it if it's appealed or a complaint is filed. But in this case, and as part of her newly acquired (if temporary) authority, she decided the policy needed to change for the whole clinic and had directed our schedulers to change they way they scheduled these exams. 

This is where our big disagreement arose. She has this idea that if a claimed condition doesn't fit within a medical diagnostic criteria, then it's not valid. Something I've tried to explain to her for years is that our specific corner of government service is not strictly concerned with medical criteria. We work in disability claims and it's equal parts legal and even political. The entire philosophy of our claims is based on uncertainty. Our opinions typically include the statement "at least as likely as not", which basically says that if our determination of a claim is that it's fifty/fifty parts for and against the claim, then we grant the claim. 

Compared to what's happened between her and other people in the clinic, this has been pretty tame. Until she decided to go around me and accuse myself and our program analyst of inflating exams unnecessarily.  I have been a fee basis provider for over a year. This means that I am compensated by the exam. In the case of Gulf War exams, they tend to generate not only exams for conditions but also opinions for each condition. So, if a veteran claims four conditions, it results in eight total worksheets and I'm paid for each. The typical claim can generate from ten to twenty exams. Occasionally, that number can go significantly higher. 

I had an exam a month or so ago that was for around twenty claimed conditions but it also generated an equal number of direct opinions as well as fourteen or so Gulf War opinions. It ended up totaling fifty three worksheets. This is the highest number I've ever completed, and it's not typical by any stretch. A typical day for me is around twenty exams. I'm not sure if this is the exam which she questioned, but if not it was a similar one. I've had a few in the forties and many in the thirties. It should be noted that the FTE often don't reach these numbers in the course of a week, much less a day. 

My previous post history tells the story of the relative level of productivity among regular federal employees. Let's just say that they typically underachieve, at least compared to my levels. To make a long story short, she basically accused me and the program analyst of stealing money. Because she questioned the validity of the claims (going back to our fundamental disagreement of Gulf War), then she surmised that meant that any Gulf War related claims/opinions were invalid and shouldn't be billed. Like I said before, she doesn't have this authority. No one at our level has this authority. This is national policy and you're not allowed to take away from a regulation to suit your own needs. For what it's worth, my performance of these exams and opinions was directed before I was ever fee basis and had specific approval by the former chief (on more than one occasion), not to mention that the whole policy was directed by VBA personnel outside our clinic. It's a well established and approved policy that has been in place for a long time before she got here. 

All of this scenario is rather tame to what else she has been doing. To keep it short, let's just say she's accused others of outright fraud, abuse, and even having sex in the clinic. It's all bullshit and an attempt by her to discredit and destroy anyone who's crossed her path. I avoid psychoanalyzing in general, and also because I'm not qualified, but I think her specific pathology has something to do with growing up in an authoritarian regime which tends to encourage similar behaviors in those victimized or oppressed once they possess any power. She's demonstrated a feeling of superiority over others, including her own MD/DO peers. She has never understood that her authority as a doctor is strictly clinical. In the federal system, and in our country for that matter, we don't recognize social castes. Although we do have great inequalities in our country, we don't recognize our defer to people because they are part of a ruling class or aristocracy. She seems to think differently. Although some actions are still pending, it seems apparent they are going to remove her from the temporary position and her application for the permanent position would likely be dead in the water. Honestly, I hope she has enough personal shame to resign from the department if not the government as well. 

Although I know myself and our program analyst didn't do anything untoward or dishonest, it's still stressful to have those sorts of accusations hanging over you, because if they were true they would likely result in termination as well as a permanent black mark on our records. Mostly the stress derived from uncertainty to how far the accusation would go, and that the people passing judgement would be strangers who might be given incomplete and biased information. It appears that nothing will come of this for now, but it's still very troubling to face a sudden unexpected threat to your livelihood. As I have discussed with our program analyst, this was the ultimate betrayal and bridge burning offense from which a person will never come back. 

A year of freedom

This week marks one year as a contractor (fee basis) in my previous job. Fewer workdays, better compensation, and I'm almost exempt from the typical workplace drama (almost). Job security is lower in context, but otherwise there's really no downside. Our mid-range plan is to pay off the house and then we'll reassess. We may stay where we are, we may still pursue that house in the country.

This last year has seen the completion of several original tunes and videos. It's been a great year of development in most creative aspects. I'm not over the moon about anything I've done so far, but I would at least call all my projects successful in achieving what I had in mind in the beginning, and even moreso as learning processes. I expect my highly d̶r̶e̶a̶d̶e̶d̶/̶i̶g̶n̶o̶r̶e̶d̶ coveted creative efforts will likely only increase.  Not that I need more interests, but I've taken up drawing as part of my overall pursuit of visual arts. I hope to combine music, video and illustration in various ways. 

High Productivity is Celebrated...until it isn't.

In an ironic twist to my elevated productivity as a fee basis examiner, I had his supreme indolency take the trouble to drop by my office and let me know that my increased numbers (which had necessitated a salary waiver as I had hit my max after five months) had raised a few eyebrows. Although he was attributing it to "someone pretty high in Dallas" (high, he he), I'm sure most of it was coming from him. 

I reacted immediately (as I usually do, sometimes to my detriment) by telling him that I would welcome anyone who wants to take a close look at any of my work/exams and let me know what's lacking or inappropriate. I know my exams are complete by VA standards and I also know that I don't perform exams unless they're requested or justified in the case of a recently discharged veteran who requests to add a few more claims. 

As I explained to dicktug, I'm preferentially getting these bulk Gulf War exams which typically include 10+ actual claims and then an equal number of medical opinions for each claim. This can very quickly run my daily numbers to 20+. He made some sort of brief comment about his ability to generate those numbers which I just ignored because this jackhole was one of the examiners that weren't breaking 40 exams in a month. I've done more than that in one day. 

I also explained to him that I often take on other examiner's work because they call in sick or because they can't be bothered to complete opinions or equivalent. Our admin staff preferentially asks me to do these types of exams because I don't argue with them or make them feel bad for asking. Many of the regular Federal employees are downright adversarial to the people who are just trying to do their jobs and help veterans. 

When I was a regular Federal employee I had the second highest (out of 20ish examiners) productivity in the clinic. Now as a fee basis, I think it's possible I'm the highest, but I haven't been looking at the clinic numbers anymore. I'm definitely generating higher per day numbers as it's not uncommon that I get 25 or more exams in a day. I assume part of his problem is that my elevated productivity makes the glacial examiners look even worse by comparison. 

I'm not sure if the current scenario can be sustained, but I'm hoping things will move slowly as they do in the Federal government. I'm also hoping that we'll continue to have our minimal producers occupying full time slots which will in turn keep the demand up for fee basis examiners like myself.

I think he is offended by the situation in which a lowly PA like myself (in his eyes) can earn an equal income to his while working significantly fewer days and not having to deal with a lot of the regular federal pain (actually my total is probably greater considering my other incomes). I've met several doctors like him in the past that seem to think they have earned a perpetual income just based on their diplomas and not based on any work they're doing now. The good doctors (most of them) judge other providers on their own merits and don't make assumptions based on degrees held. We've never heard them express concern that we have doctors earning huge salaries while doing little to no work. The VA has a prevalence of these types, I think it's one of the primary attractions to the job. 

A busy two weeks

It's the Saturday after I completed my first two weeks as a fee basis (contractor) examiner for the VA in essentially the same job I was performing previously. I worked a total of seven days over two weeks and completed a record (for me) of 161 exams. This will result in a take home pay of about four times what I typically make. I don't necessarily think this workload will be typical, and I don't plan on working any more than three days a week going into the future as I was on the verge of burning myself out after four straight days of full speed ahead. I think it is feasible I could maintain an average of 60 a week with one week off a month for a monthly average of 180ish. Doing the math, this would put me right at the max salary for a year. I could earn more, but I'm pretty sure they wouldn't authorize any more.

At this rate, I think it's completely feasible to pay off the house in five years and move forward with our plan to have a home on 1-2 acres on the outskirts as well as getting my dedicated music studio built. This will largely depend on a continued steady supply of exams from work. The proposed presidential budget, as corrupt, lopsided, and tunnel visioned as it is, does allow for an increase in funding for the VA, so at least for the near future work should be plentiful. I'm hoping I may look back at this post some day in 5-10 years to confirm my projections were close. It's possible the timeline could be even shorter if they keep supplying me with exams. In the present environment, I'm not having any problems getting extra exams. I was even turning down a few every day last week because I was already swamped with 20+ exams each day. The lazy and ambivalent federalistas in my department are now a source of extra income for me, so as long as they stay around I should have no problem keeping my dance card full. 

Work related updates

Another infrequent update. I've been staying busy at work and school. I can't recall if I ever mentioned it before, but in the wake of a lot of upheaval in the VA system, not to mention crossing over the five year mark last August, I decided to request a change from a full time permanent position to fee basis (contract). This would see me forfeiting any additional deposits to my 401K as well as earning any more rate increase on my federal pension. I'm also technically forfeiting the other federal benefits (healthcare, dental, vision, paid leave) but those losses are negligible. I'm already eligible (and using) my retiree benefits for these and the loss of paid leave becomes irrelevant under the fee basis paradigm.  

What I gain from fee basis is getting paid for the amount of work I do, dictating what schedule I want to work (meaning I can work 5 days, 3 days, take a month off, etc.), and the ability to leave work as soon as I'm finished on any given day. The rate at which they pay (and considering how fast I work), means that if I maintain my current production levels I can realistically take home more money while working fewer days. Although I'll be forfeiting additional increase in my federal pension, it was never going to be a significant portion of my retirement and I will still be able to draw some money when I reach 62.  The 401k (TSP) may be eligible for transfer to another similar IRA type account. I will look into this in the future. Regardless, the cons are minor and the pros are great for this change. 

The decision to change was made in the wake of perceived sweeping changes in the VA (including an increased use of contractors) and the concerns about a new administration coming into power. I made the request in December and received fast and positive feedback from my direct supervisor. In this process, he has actually been the only real support and has moved things along at every step. It's still pending because of sitting in the Dallas VA mailroom for a month (literally) and then sitting on someone's desk in HR until my supervisor personally visited and got them to do their jobs. The complete lack of inertia among many employees in the VA is what gives us a bad name. There are people content to draw a paycheck and all the benefits and perform as little actual work as they can get away with. They act like they're doing you a personal favor just to listen to your request. 

All that being said, hopefully things are in the home stretch now and I can adopt a condensed schedule. My plan is to work Tue-Thu, but I'm requesting that they give me a dense schedule every day in the hopes I can maintain similar numbers. I'm hopeful I can nearly double my current take home pay, but that will be predicated by how much they offer in compensation and how high demand remains. 

Bloggery bloggington

Time for another infrequent update. What's happened since last I committed electrons to this dark, forgotten corner of the internet?  Of most significance is that I have applied for the Berklee College of Music (Online) Bachelor of Music Production degree, with an anticipated start date of January 2015. I'm not sure why I didn't previously make the connection between this course and my still valid (but eventually expiring) GI Bill benefits. I had looked at individual courses within Berklee and some other online colleges, but for whatever reason I didn't realize that there was actually a Bachelor's program in a Music related field that I was actually interested in that would be eligible for the GI Bill.

I won't know if I'm accepted until next month, but I'm cautiously optimistic. Firstly, since I have a reliable means of paying for the degree, and secondly, my academic records while not perfect, (I made a couple of Bs in PA school) are pretty competitive (3.8 cumulative GPA with two master's degrees).  What I don't have is any significant professional or academic music experience, but I'm hoping that since there aren't any specific prerequisites in those areas, that I will make up for in my enthusiasm for music. In my personal statement I related my lifelong love of music, my rekindled musicianship of 10+ years, my multi-instrumentalism and love for all things music production related. 

The course curriculum reads like all of my online self learning activities for the past 10 years. Looking through the entire course requirements and syllabi, I was amazed at how every course was something I was either interested in learning, or something I actually had already studied on my own. My dream scenario would be to channel this knowledge into a musical occupation that could pay the bills, but that isn't the only end goal. I know that regardless of whether I continue to need to work full or part time in healthcare, that the knowledge and experience I gain from this course will make me a better musician and I can't put a price on how valuable that is for me. 

My realistic goal is to continue improving my home studio as much as possible (without making structural changes to our current home), and eventually buying a home on a one acre lot and building a music studio from the ground up. I hope that with time and experience I can begin to attract clients and gain work through word of mouth and advertising. This is a path that some full time (and highly regarded) professional studio owners have followed. The other nice thing about owning/running a studio is that age isn't the limiting factor that it may be for musical artists that are just starting out. I will continue to be a musician, and hope that this knowledge and experience with facilitate opening new doors for me in that area as well. I just never get tired or bored with music at large. I may briefly run out of steam when I've been practicing a certain instrument, but that's easily remedied by picking up a different one, or studying an aspect of production, etc. 

It's hard to express how exciting these possibilities are for me. It's also nice to at least consider that it may be possible to earn a living equivalent to our current standard of living. Success as a musical artist can be a much more fickle target. I know plenty of world class artists who have their dedicated fan base but are otherwise ignored by the public at large. Success in music is often not directly correlated to talent and hard work (a small caveat in that the really hard working musicians who understand that they must do more than just write/record songs, often find a way to succeed through touring, videos & other merchandising).  

The true "If I win the lottery" (in a music sense) would be to build up a successful studio/operation as well as create my own music that might actually garner enough interest to release albums and even tour, if only on a small, regional level. Neither one of these is necessary for me to be happy in music, because I'm already there and I'm not making a penny doing it (quite the contrary, I spend quite a few pennies doing it). The greatest satisfaction would be in having the freedom to only need to "work" in music, and to have my own business that I can dictate the schedule, etc. I am confident that if I'm accepted to Berklee that I will be able to eventually build a free standing professional (albeit, not in the league of the Power Station or equivalent) studio and with the knowledge and experience gained in school I'll be able to record my own as well as others music in the best possible format. Maybe it will only be on nights/weekends when I have the time away from my regular job or maybe it will grow to a full time operation. I'm on board for the long haul either way...

Why I love my job(ish)...

Love is probably a bit strong, but there are several things about my job that make me not hate it. To wit:  1.  Regular hours with no nights, weekends, or call (unless I want to work overtime on Saturday to make extra money. Which I don't.)  2.  I'm mostly in control of my day and destiny. In other words, I can work as fast or as slow (usually the former) as I want and I'm not affected by the productivity of others (or the lack thereof). 3.  I have my own office, which is my private sanctuary where I can listen to music, use my iPad, etc. without interference/noise from outside. I sound like I hate people which is not the case, but it's nice to have your own personal space when you have noisy/smelly/etc. co-workers. 4. Kind of related to number one - the work is predictable and manageable. Some days I'm busy all day, but most days there are cushion times built into the schedule so I never feel overwhelmed. 5. Pay, benefits - while federal salaries are normally 10-30% below their civilian equivalents in gross salary, when you consider the benefits (pension, paid leave, health insurance, 401K), then my job is very competitive. Never underestimate the value of a pension. Even if I had been a smart investor and had been saving/investing towards my future since a young age, I most likely would have lost a huge chunk of that in 2008-2009. Because I retired from the Army I will have a very sizable monthly check for the rest of my life, regardless if I work or not. While the federal employee pension isn't as sizable as the military pension, it's essentially the same benefit. Although I do have a 401K that I've been investing in, the federal pension I'll be eligible to receive when I retire will combine with my Army pension and VA disability to essentially ensure that I won't need to work past my mid 60's unless I really want to. Also, the benefit of paid leave is considerable in this job. I worked as a DA civilian and then contractor after I first retired and my annual leave was somewhere around 10 days total. I think I had 10 sick leave days as well. In this job I am authorized 26 days of regular leave and 13 days of sick leave for a combined total of 39 days paid leave per year. And  I've been accruing that amount since I was hired. Most jobs require you to build up tenure to accrue the higher amounts, but not this one. Authorized/paid leave is a huge deal for me. I grew accustomed to 30 days of paid leave per year in my 23 year Army career, and that first year as a civilian with only 10 days of paid leave was a stark contrast to what I was accustomed to. This total doesn't include federal holidays.

Ahhh, professionalism...

I would have posted this to facebook, but this is probably a better venue (because no one will read it) for a short vent. When I arrived at work today, I discovered my computer had basically called it quits. It had done this a few times in the past, but it was usually revivable with a few hard reboots. This time, after 6 or 7 attempts it was still down for the count. I notified our administrator and the clinic chief and switched to an office across the hallway until they could fix the problem. We can't do our job in C&P without the computer (well, technically you could if you had the forethought to print out exam worksheets before the exam, but why would you do that, it would be wasting paper since they have to be submitted electronically anyway).

Long story short, the office I was borrowing had been reserved for another PA but he hadn't ever used it yet (he already has an office). I didn't think it would be a problem since I would most likely only need it for one or two days. I had notified the chief and administrator when I told them my computer was down that I was going to be using that office. Apparently he had received his keys last week, and today was going to be his big move-in day. He walked into the office after 8am and I was preparing to see my first patient and I quickly told him that I had to borrow his office until my computer was fixed.

Without going into all the gory details, he essentially threw a temper tantrum and said I had to get out of his office and he was going to call security. I explained to him that this was cleared through the chief of the clinic, and we could talk to him about it. This guy refused to talk to the chief and said he would get security if he had to.

He was blowing smoke, because this wasn't "his" office anymore than it belongs to anyone. It's the VA and everything is government property. He then later barged in while I was seeing a patient and acted like an ass in front of the patient as well.

I spoke to the chief of the clinic about his behavior and the chief said he would counsel him later. I made a point of documenting the encounter in detail and sending it to the chief. I haven't seen Mr professional since then, I'm hoping he's coming to realize what an unprofessional ass he was and is perhaps rethinking his conduct.

It was really random. I don't know this guy at all, we haven't previously interacted much at all. I almost wonder if he has borderline personality disorder or some other mental illness. That does stand out as the single most immature episode of behavior I have ever seen in a colleague since I became a PA nearly 14 years ago. I expect that sort of behavior from privates in basic training, but this was just plain weird. What an ass clown...

Employee Orientation

Is everything you would expect. I wonder if this is more of a test of your commitment to work here.

Back to work

It's been a busy two months, moving from Killeen to Crowley (south Fort Worth) and all that goes along with that. Our house has been on the market nearly two months with little to no interest expressed so far. We may need to adjust the price or adjust our realtor (again).  The credentialing process with the VA added a month to my start date, primarily because of inattention from one of the credentialing clerks if my suspicion is correct. Not that I'm complaining about having two months off of work. This first week back will be mostly new employee orientation in Dallas with the requisite one hour drive and musical parking spaces at the D/FW VA Hospital. I assume that on Friday I'll be reporting in at my permanent job location (a more convenient 20 minutes away).

I am being sorely tested...

by all involved parties. First we get smoked by our walkins today (3x the usual number) and then our staff is doing their best to give the exponentially enlarging snowball an extra kick before it gets to me. I love the fact that people who are not ultimately responsible to care for a patient are more than willing to sign them in when they don't have an appointment since it's my responsibility to take care of them. Soon I will be in a job that doesn't have walkins and I won't have subordinate personnel who can arbitrarily add to my workload.

Being a provider with a schedule of patients is an occupational experience that most people don't comprehend. When you have a schedule, you are locked into that schedule. Your day is dictated by the schedule and you must stick to it or suffer complaints and backlash from patients and staff alike. As a provider I accept this, because it's what I get paid to do. Where I get really frustrated is when other people through ambivalence, naivete or outright intention add to or otherwise complicate my schedule. I don't mind a busy, fully booked schedule. The busier I am at work, the faster the day goes by. I pride myself on staying ahead of my schedule, finishing my notes in a timely manner, and getting all the time sensitive issues handled as soon as safely possible. When it's up to me, this is very rarely a problem. The only time I typically fall behind is through the action or inaction of others.

Today we had 15 people signed in for sick call, and we only have 90 minutes to see them before appointments start. The frustrating thing is that most of these people don't truly have acute medical issues. Most of our sick call patients are here because they don't want to wait for an appointment, or they are trying to get out of work. Rarely do I see a patient on sick call that I think "It's good you came in when you did, because this was a serious issue". Most of the time I think "Why would anyone ever seek medical treatment for this issue?" This gets back to my fundamental problem with most clinic visits by soldiers which is that they get free healthcare and have the secondary gain of time away from work, duty modification, etc.

The NCOs responsible for triaging the acute patients are not very good at what they do. They have a tendency to not want to enforce sick call complaints to acute only, and if the patient argues with them or insists on being seen, they sign them in. Military patients essentially have no negative reinforcement system for spurious complaints. The worst thing that happens to them is being told they are normal or their issue doesn't require any more workup or treatment. Even in those cases, they were at least able to get out of pt and work for a few hours. Patients can no-show, malinger, drug seek, or engage in a multitude of fraudulent or exaggerative behaviors and they very rarely get held accountable. This is one of the reasons I have sought employment elsewhere. The secondary gain issue is fairly common with the normal active duty population, but it's the modus operandi of the meb patient. I don't know how any competent provider with military experience could tolerate long term employment with this population. "Never has so much been done for so few who are so less deserving" - this should be the clinic motto. I find myself less and less proud to be an American citizen and retired soldier the more of these types of patients I am exposed to. There is a significant portion of the young population who look at the world as a set of entitlements with no requirement to work or produce for those entitlements.

I'm rambling now. Rant over. I expect my relative attitude will improve here shortly.

3 clinic days left...

and then hopefully <1 day of clearing. Not that I'm counting. The realtor should be coming over later today to take pictures of our house and then hopefully get it listed here in the next few days. We're going to be taking it somewhat in the shorts since we've only lived here two years and the market is pretty flat (better than most other places, though). We've accepted the loss because of all the positive reasons for the move and job change. It's also taught us a bit about the home buying/selling process.

And yea, there was much wailing and gnashing of teeth...

Unsurprisingly, not everyone is greeting the news of my pending departure with words of encouragement and congratulations.