Take Two

I mentioned a couple of weeks ago that my partners and I had a dinner with a new nurse we were hoping to hire.  To bring you up to speed, we negotiated a salary and equity package but on interesting thing was that her financial adviser asked her to negotiate a severance agreement.  A parachute if you will.  For me, this was a deal breaker for reasons I will get to.  We came to an agreement and she turned in her resignation to her current employer who was shocked that she was leaving and is now in full-court press mode to retain her.  She’s a good nurse and I don’t blame them.  The COO is having lunch with her on Thursday and I am guessing she can pretty much write her own ticket at this point.  I talked with my boss about this yesterday and when she asked my thoughts I said we should let her go.  We were are not about to get into a bidding war with a multi-billion dollar health system.  We can’t compete on that level.

Here’s the thing about working for a start-up company: your heart has to be completely in it.  Like Cortez, you have to burn your ships and not have a plan B to make it work.  My advice to this prospective nurse was this, if you have any doubt at all that this is the right step for you do not join us.  That was my reservation with the severance agreement.  There are no safety nets here.  You work very, very hard for a very large payday somewhere in the future because you know that failure absolutely is an option.  We have done well this year and hope to do even better next year but there are no guarantees.  This is why we are highly motivated and pour ourselves into the business to make the company a success.  Add to this the fact that a significant chunk of my net worth and retirement income is tied up in privately held stock and you can the motivation to do well.  I like that feeling of self-determination but it’s not for everyone.

Our assistant pastor this week announced to the church that he is starting a daughter work and largely putting his past/present/future income up as collateral to build a building.  I’m impressed with his level of dedication and I think he’ll do well but would I do what he’s doing.  In a word, no.  I don’t have enough faith in my ability to get something like that off the ground to stake everything on it.  This is probably why I have re-focused my efforts on business.  Am I a better nurse/consultant/case manager/life care planner than I was a pastor?  Definitely.  That’s why I pursue this as doggedly as I do.  His level of committment is a rare gem and that’s why he’ll succeed.  He is highly motivated not to fail and knows (at least I hope he knows;I sure think so) that he has the skill set and tools to take a church from zero to self-supporting.

So back to the nurse I though we were going to hire.  I think her current employer will offer her a significant bump in salary that we can’t (and won’t) match and let her choose her next assignment from any of their portfolio of facilities in Columbus (there are three hospitals and probably a dozen other facilities).  And if we were able to facilitate some career advancement and increase salary for her I am happy for her.  Because start-ups aren’t for everyone.

This was not my original planned first post however; it is too good not to share.  Howard Lindzon (who is both a brilliant investor and very funny guy) posted this on his website this morning.  For those who may not be familiar with Jim Rogers, he worked with George Soros in the 70s to build an incredible amount of wealth through the Quantum Fund which is legendary.  As a side note, this video comes from the Financial Times which is a great read and is free online so bully for them.  Jim’s advise is simple- let the bad companies fail.  We have, in his reasoning, spent the last fifteen years under Alan Greenspan and now Ben Bernanke bailing out poorly managed yet well connected companies.  He sites the bailout of Long Term Capital Management as the genesis for this culture of bailout.

I read first thing this morning that there is now talk to bailing out the credit card industry.  In the words of the Apostle Paul, these things ought not be.  I think the credit card industry is the only one in this mess more despised than the auto industry.  I have previously shared my thoughts regarding a bailout of the auto industry.

So what are we to do?  Capitalism is tough business (no pun intended).  My thinking is that we have regulated ourselves out of any form of capitalism where only large companies can survive in the public markets.  Thanks to Sarbanes-Oxley, it has become much more expensive for a small company to meet the regulatory and disclosure requirements of being public.  But the jobs are going to come from the small companies.  Our firm hired a new nurse last month (not a low paying unskilled job in any sense of the word) and will probably hire another in the second quarter of 2009.  As we are a service business, our capital costs are quite low but if you are making something or in a capital intense business, the access to public markets isn’t going to happen and venture capital is also unlikely (or comes at a very disadvantageous valuation to the entrepreneur) because there are so few exit strategies available.  It will take people far smarter than me to figure out how to fix this.

That’s a lot to chew on for Monday morning.  I hope your brains are still intact.

Related articles by Zemanta

• China a buy for top investor Jim Rogers

It is a rare occurrence where I actually get to show someone what I do versus telling them what I do.  Today, I was visiting a friend of mine who broke his hip about a month ago.  This past week, he was rushed to the hospital which it was discovered that he had developed small blood clots in his leg and lungs.  The leg ones are potentially bad and painful.  The lung ones are bad and potentially fatal. He was, appropriately freaked out by this development and made his way one of the Columbus medical centers to receive appropriate treatment for his condition.  Fast forward four days, his clotting times are steadily improving and he is in no apparent danger so his physician wants to discharge him to home with Lovenox which is a low molecular weight heparin.  This is a very common treatment course.

It should be noted that Lovenox is very expensive so the social services person want to see if the pharmacy has the drug and what the co-pay will be for it.  Here’s where we learn how case management can help you.  The policy, as written, will require a $600 co-pay for my friend to purchase the Lovenox at home.  This is not chump change.  However, if he remains inpatient the insurer will cover the drug in full.  This does not make sense.

What the insurer is saying is we would rather pay for room and board, physician visits, daily blood draws and tests AND the drug rather than paying for the drug.  And you wonder why health care is so expensive and messed up in the country.  A good case manager would have said why don’t we enter an exception for this member’s plan, pay for the Lovenox, and the plan no longer has to pay for further hospital days and the related costs.  Additionally, the member is resting far more comfortably in his own bed and he is no longer at risk for nosocomial infections.  That’s what a good case manager would do.

Apparently my friends plan does not have any good case managers.

The New York Times reports this morning that there has been an arrest in the Long Island Railroad disability scheme.  As you know, I have been a bit obsessed with this story as it is the intersection of two of the larger areas of my work life, NYC and occupational disability.

Based on my initial reading of the story, the gentleman arrested is, to quote Lee Harvey Oswald, a patsy.  I would opine that AG Cuomo is using this maneuver to show the world that he is serious about this probe.  There will be far larger fish than this to be fried.

I would love to see this type of scrutiny come to other forms of disability retirement, specifically Social Security Disability Retirement.  If you are awake, you’re aware that the Social Security Trust Fund is in precarious territory.  There are now two workers for every one person receiving Social Security.  This clearly cannot continue.  I look at the FICA payments we make (both me as an individual and as a partner in our firm) and am disgusted with the knowledge that most of our folks will either never see the money or will see greatly reduced benefits. If this was a commercial enterprise (see, Enron and WorldCom), people would be on their way to jail for this type of mismanagement.  But because it’s a “government trust” (an oxymoron if ever I heard one) we let it ride.

On the bright side, maybe this is the start of a new period of examination for these benefits.  Wouldn’t that be great.

Related articles by Zemanta

• Railroad Retiree Board Vows Oversight
• Second Disability Exam Advised for LIRR Workers
• Agents Raid Office in L.I.R.R. Disability Inquiry
• L.I.R.R. Official Said to Have Sold Disability Help
• New Questions at Long Island Rail Road About Disability Claims
• More on the LIRR
• A Disability Epidemic Among a Railroad’s Retirees
• LIRR Follow-Up

I haved worked in the field of occupational medicine and workers’ compensation for the last 15 years.  Over that time, I have seen a variety of injuries and ailments.  The number one injury I see is low back strains (and their sequelae).  The number two injury I see is repetitive motion injuries and overuse syndromes.  These can range from carpal tunnel syndrome to lateral and medial epicondylitis to any number of other upper extremity disorder.  I am now firmly experiencing condition number two.

For the last five (almost six) years I have worked at home and during that time I have pretty much exclusively used a laptop computer.  This is because my job(s) have required a fair amount of travel.  As any frequent laptop user can tell you, the keyboard of a laptop is compact (appropriately) so that it is portable.  This is all groovy except that, from an ergonomic standpoint, it is lousy.  I have noticed over the last several weeks that I have had increasing neck and right shoulder pain.  It is also noted that I spend 10+ hours a day in front of my computer.  This is a function of having a job a love and lots of work to do (Holla!).  Side note- the holla was an inside joke to Becky.  As this has progressed, I found myself being only able to work at the computer for an hour or two at a time.  This is contrary to my work requirements.  So, being the good nurse that I am I decided to take definitive action.

I have a keyboard tray on my computer desk which I (read:Charity) almost didn’t put on because I have a laptop.  Fortunately, I (read:Charity) had the foresight to go ahead and put it on.  I recently bought an ergonomic keyboard and moved my mouse down to the keyboard tray as well.  The difference was immediately felt.  It has been much easier to type with little to no pain in my neck or shoulder.  I am planning on taking some time off over Thanksgiving so hopefully that will allow my body to rest and heal up a bit.

I will note this lesson.  I am certainly more empathetic toward the people I work with with repetitive motion injuries.  Hopefully, this will make me a little more wise and compassionate in my practice.

Related articles by Zemanta

• Why carpal tunnel cases are down
• What happened to carpal tunnel syndrome?

Image via Wikipedia

I’ve been thinking a lot about the choices I’ve made in my life over the last several years.  I’ve mentioned before that, since turning 40, I seem to be more reflective.  Don’t know why that is but I think it’s a good thing.

I had dinner the other night with my colleagues and another nurse who is considering an offer to join our team.  She’s being very deliberate about her decision.  She’s a manager with one of the hospital systems here and, by all accounts, has a rewarding, well paying and secure job (such as they are).  What she is being offered is a position with a start-up company that has done well but has only been in existance for 10 months.  It would also be a change in the substance of her work (managing vs. consulting) which I think also weighs on her mind.  She’s taking a while to make a decision and I’m fine with that.  I want her to be sure.

While I was thinking about that, I did a rewind to my own decision to join NCA back in February.  With nothing other that a business plan on a napkin at Chili’s and my once and future boss’s assurance that this was going to be great, I quit my job and jumped in with both feet.  To understate, I was not deliberate at all.  It’s worked out great thus far but I have allowed myself to consider what would have happened if the venture would have (or still does) crater.  Not good times.

I mentioned in an earlier post that I was considering a pastoral position.  As some of you know, I was not nearly deliberate enough when I took that leap last time.  Again, not good times.  I have since cooled to the idea as it would be a major time commitment and time is something my schedule is sorely lacking.  I’d rather say no up front than get into the process and fail.  Is this playing it safe?  Of course it is.

I wrote when I turned 40 that it was time to bring things into perspective.  To add by subtraction and focus on those things that I could do well, commit to, and were fulfilling.  Lots of deliberation in that.  I make fewer snap decisions these days but will admit that, when opportunity presents itself, I want to be able to act.

Is deliberation a function of age and wisdom?  Do young people take risks because they don’t know better or because they have the time to fail?  Is it better to fail quickly and learn (I say yes to this one) or keep an idea/positions/whatever on life support in the hopes that one day things will turn around?  What is the process for deciding which method is best?

So many questions.  So few answers.

Related articles by Zemanta

• Failing is Easy, That’s Why It’s so Common

I have not posted for the last couple of days because I am buried.  My boss is in California and I am fielding her questions in addition to my own work which is nearly at capacity as well.  This certainly isn’t a bad problem but I’m spending perhaps too much time at my desk.  I saw this video on Fred Wilson’s non-blog site.  Very Timely indeed.  Enjoy.

HT: FredWilson.vc

There is a very good column from Joe Brancatelli on Portfolio.com today.  As a side note, I think every column by Joe is good.  He has a great feel for the business travel environment and what’s going on out there.

In the nutshell, he says that the airlines and hotel industry have taken advantage of (yea, punished) the business traveler for so long that, like a battered spouse who’s had enough, they’ve just walked away.  For me, here’s the money quote:

Consider this: Since Labor Day, the nation’s six network airlines and their commuter affiliates have grounded about 500 aircraft. That means a carrier the size of Northwest Airlines, the nation’s fifth largest, has essentially disappeared from the skies. Yet even with that estimated 10 percent cut in nationwide seat capacity, airlines haven’t been able to register increases in “load factors,” the percentage of available seats sold. In fact, passenger demand has fallen so precipitously that some carriers reported their load factors dropped in September or October.

That is not inconsequential.  I have noticed in my travels 1) much better prices and 2) much emptier planes.  To wit- I went to New York this summer (I go to New York a lot)  and paid north of $500 for the ticket and couldn’t Priceline.com a three star room for under $300.  Fast forward to this month- same ticket is under $300 (with lots of availability on the seating chart) and four star rooms to be had on Priceline.com for $180.  Full circle indeed.

Remember how Skybus famously crated here in Columbus. Their business model was all wrong.  It was focused around leisure only travelers who you can’t make any money off of.  The vast majority of my travel is business.  That means, if I have to go somewhere I’ll pay the high priced ticket and hotel room because I don’t have a choice.  I won’t like it but I’ll do it.  Now, with the economy in full retreat, it seems more and more business travelers are saying “no mas”.  Leisure travelers nearly always take cost into account.  It’s their number one consideration.  No business traveler plus no leisure travelers equals a lot of airline employees flying on buddy passes (six on a recent flight I was on).  You won’t pay the fuel bill with that.

One bright spot is all that is noted:

Travel will be easier for those of us who’ll still be on the road in the coming months. Airports will be less crowded, security checkpoints will be less frenetic and, miracle of miracles, more and more flights are running on time. Last year I was writing that nationwide on-time performance had slid to schedule-destroying levels. But last month 84 percent of the nation’s flights arrived on time, according to FlightStats.com. It’s the fifth consecutive month airlines have improved on-time performance.

This desperately needs to happen.  At one point over the summer, only 27 percent of flights into and out of the New York City airports (LaGuardia, Kennedy, and Newark) were on time.  That is a sad statistic.  Now, with a significant reduction of planes that number is improving.  And bully for that.

I’ll be interested to see if any lessons get learned or if, like so many things, this is just cyclical.

Related articles by Zemanta

• Most-delayed airports: NYC leads list
• Summer of airline nightmares

Now that the election and afterglow thereof is over, I am back to doing all the things I love- work, church, family stuff.  I traveled with LJ to Dayton yesterday to meet our District Board and present plans and budget for 2009 to them.  I received a lot of compliments and constructive feedback. I will add this- I have heard some of the mess that my colleagues across our fellowship go through with their boards.  This is so not the case in Ohio.  We have an excellent board and it is a joy to work with them.  I am heading back to Dayton tonight for a keynote from our superintendent and a business meeting tomorrow.

I am also neck deep in work stuff which kind of hit the back burner as I was tracking the last couple of days of the election.  I will again note that we are blessed to be so busy and have so much work in the pipeline for the coming months.  I am trying to figure out how to do all of this plus get caught up on school (I’m a good two weeks behind).  I haven’t found a good answer yet but I’m sure there’s one out there somewhere.  Balance- still trying to achieve this.  On a different note, I did get to describe what I do to my district board yesterday.  They seemed genuinely interested and asked a lot of questions.  It goes without saying that my background is different from the majority of folks they meet with.  I think that’s a plus.

Okay, enough blogging.  Must finish some work and then head to Dayton.

Image via Wikipedia

I had a dinner meeting Friday night in advance of a seminar our Sunday School Department was sponsoring on Saturday (this was, of course, after trick or treating).  Seminar Saturday morning, small group study Saturday night, spoke in Columbus Sunday morning and night.  After service, we had food at the Cheesecake Factory at Polaris and then drove to Toledo where I had a 7:30 AM meeting today.  I got home about an hour ago.  Truly epic business meeting including some serious Ambit Energy planning also yesterday. We will be offering natural gas service in Ohio in January which is a later post.

I have to get ready to meet the district board on Wednesday and get a ton of projects out before the week is up.  Thankfully, I think the weekend is free.  I will weigh in on some final election thoughts tomorrow.

Have a great week.