Not long after Randy introduced Tricia to the last of those present, Ryan Clark spoke up. “Bonnie,” he said rather loudly, “I know you’ve got to go over and get those photos at the volleyball game, so we might as well let you get out of here.”

“I’d appreciate that,” the girl said. “It’s been a long day and I’m going to be glad to get home. How do you want to do this?”

“How about if Dr. York and I shake hands over by the fireplace, with the rest of the board members in the background?”

“Mike isn’t real crazy about grip and grins, and neither am I,” she replied. “But I don’t know what else to do in this case. Dr. York, later this week, no later than the first of the week, I want to get together with you and do a little longer story for the Record-Herald.”

“I’m sure something can be arranged,” Tricia replied. “Why don’t you call me at Dr. Luce’s office and we can work out a time.”

“I can do that,” she said as the people present except for Nicole and Bonnie gathered in front of the fireplace. Bonnie shuffled them around a little, turned on the camera and raised it. Tricia took Ryan’s hand; it seemed warm and firm, if not overwhelming. The flash on the camera went off several times in quick succession, and Bonnie glanced at the display. “That ought to do it,” she said. “I guess I’ll be off to the volleyball game. Catch you later, Dr. York.”

“Looking forward to it,” she smiled.

“And while she’s going,” Nicole said, “I think I’d better run over to Jim and Rachel’s to check on the kids. If anyone needs anything, you know where to find it.”

“Fine, see you later, Nicole,” Randy told her as people broke away from the photo lineup. “I can do anything that needs to be done.”

“I’m sure you can,” she replied. “Don’t get into any mischief, now.” In a minute, both Bonnie and Nicole were gone into the warm fall evening.

“Well, we might as well get down to business,” Ryan said. “Dr. York, I’m sure you must have figured out this gathering is a little more than a normal meet and greet, but we have things to talk to you about.”

“I was starting to suspect it,” she said, wondering if her former life was going to be one of the things discussed. After all, Danny knew, and he was part of this group . . .

“It’s nothing really secret,” Ryan explained. “There are things we need to discuss that it would probably be best if they stayed among this group. There are probably going to be some things that would be particularly embarrassing to Dr. Luce, and there’s no point in getting him upset with us if we don’t have to. So grab a seat, maybe a glass of wine, and let’s get started.”

She found a seat in the grouping near the fire – it had obviously been left open for her. Randy handed her a glass of wine – she hadn’t had the opportunity before. This time it was in a real wine glass, not a plastic cup.

“First off, Dr. York,” Ryan said, “I’m glad to be able to welcome you to Spearfish Lake. You have been sorely needed here, and the need has only increased as the years have passed. Your coming is the culmination of several years’ work for this group.”

“I’ve heard that before,” she replied. “And I’m glad I’ve been so warmly welcomed.”

“Well, there are some things you ought to know,” Ryan continued. “Some are of immediate interest, and some are just points of information. The people present tonight, except for you, of course, have mostly been the heart of our effort to recruit a new doctor for the community. While we’ve never had a formal name or organization for this group, or for the project, as far as that goes, this is the steering committee.”

“I pretty much guessed that, too.”

“It’s not hard to figure out,” Ryan said. “To be honest, we’d originally planned to have this discussion with you earlier, before you came to town, and probably not with this whole group present. But you followed up so quickly on your notification of board certification that you rather ran between our feet, so we decided to use this meet and greet as an excuse for a more formal meeting. Things have changed a little since you signed your contract with us, so there are a few things you need to be brought up to date on.

“I’m afraid when we signed that contract with you, we had a rather simplistic view of how this was going to work out,” Ryan continued. “The intent at the time was to bring you up here and get you established in Dr. Luce’s practice with a gradual changeover and buyout. Since then, we’ve realized that approach wasn’t going to work as well as we’d hoped it would. I understand you’ve spent the last two or three days at Dr. Luce’s practice, am I correct?”

“Not a full day every day,” she replied. “I’ve had other things to do too.”

“What’s your impression of the practice?”

“Honestly?”

“As honest as you can be, Dr. York. Your opinion will go no farther than those present.”

“It’s pretty sad,” she said, not quite believing that she was being asked this, but realizing she had to answer as best she could. “Medically, he’s far out of date. I don’t see him putting the energy or interest into his patients that I would think appropriate, so it’s obvious he’s missing things and probably a lot of them. There are several simple things that could be done to improve matters, but he hasn’t done them. I can’t speak with any knowledge as to the business side, because I don’t know much about insurance procedures or remuneration, but I doubt he or his bookkeeper are taking very good advantage of them. To continue being honest, I’ve been very worried about how I am going to make a go of the practice, especially in a business sense. I get the impression his patient load is way down from what it once was, too. Don’t get me wrong, I’m willing to wade into it and give it my best shot, but things are going to have to change and I’m not sure how to change them.”

“Well, that was candid, to say the least,” Ryan smiled. “Gene, do you have comments?”

“As far as I can see,” Dr. Metarie said, “she hit everything between the eyes, except that she didn’t go far enough.”

“In general, to the limits of our knowledge, I don’t think anyone in this room would disagree,” Ryan said.

“Dr. York, don’t get me wrong,” Dr Metarie went on. “I’m not trying to show disrespect for Dr. Luce. In fact, I have a great deal of respect for him. He was a tremendous asset to the community for a good many years, and there are any number of people in this town who owe their lives to him. He’s been a good man in a situation that sometimes has not been easy. With the possible exception of Dr. Hartwell-Harris, who is relatively new to the community, everyone in this room has seen what I just said with their own eyes.”

“In fact,” Ryan broke in, “when Dr. Luce arrived in Spearfish Lake in 1955 with his late wife Penny, it was at the beginning of the worst polio outbreak the town ever saw, and they were indispensable. The two of them hardly even slept for a week after their arrival. It was totally above and beyond the call of duty for both of them and at considerable personal risk. We would have been literally up the creek, and it seems likely that many people would have died without them. There are people walking around town today who would have been in wheelchairs or worse for the last half century if it hadn’t been for them. They earned a tremendous amount of respect from that and a lot of it still sticks with him.

“But, all that said, for the good of the community it’s time for him to go. In fact, it has been time for much too long, which is why we started this effort some years ago when it became clear that normal methods of doctor recruitment weren’t going to work. I’m just sorry things have taken so long, but these things take time, and I hope we didn’t start too late. Dr. Luce has hung on much longer than he wanted to or planned to, mostly because he saw the need for a second physician in the community as well as the rest of us. Gene, we’ve talked about this many times, and I think you can address the need for a second physician better than the rest of us.”

“Very simply, Dr. York,” Dr. Metarie began, “There are too many people around here and not enough physicians. We service not only the town, but a wide area surrounding the town, as far as Warsaw to the east and Albany River to the south, along with smaller communities, and we have people coming in from even farther away. For many years, Dr. Luce and I have been the only physicians servicing this area. The doctor-patient ratio here is three or four times what would be expected in a more urban community and, with Dr. Luce fading, I’ve had no choice but to try to pick up the slack. I’ve had nurse practitioners and physician’s assistants to help me from time to time, but they’re almost as hard to recruit as doctors. Worse, I have trouble keeping them. A small town in a rural area seems idyllic to many of them, but soon they realize they’re more drawn to the bright lights and bigger paychecks, along with easier living they find in more urban areas. I have to credit Dr. Luce for hanging on as long as he has in order to try to ease the load as much as he can. But, I agree with Ryan, it’s been time for him to go for a long time.”

“And that, Dr. York, in a nutshell is why you’re here,” Ryan continued. “Back when we contracted with you, it was our intention that you just take over Dr. Luce’s existing practice, and we figured everything would be fine. We’ve realized since then that it wasn’t enough. To be very straightforward about it, we’ve succeeded in bringing you here. But at the same time, we’ve come to realize that we have to work very hard to keep you here for longer than the five years of your contract, or we might as well get started with looking for someone else right now.”

“I like what I’ve seen so far very much,” Tricia replied, “but I can’t predict how I’ll feel in five years anymore than you can.”

“We realize that,” Ryan said. “And in five years, we all may have discovered that you’re not going to work out here, and if that happens we’re prepared to start over if we have to. But we’d really rather not. So, after considerable discussion, we’ve evolved a plan that should provide you with a considerable financial incentive to stay here once your contract is up, but one that will give us an incentive to bring in another physician if we have to. In case you’re wondering, we have discussed this plan with Dr. Luce, and he agrees to it in general although he’s not exactly totally happy about it, which is why we’re holding this meeting quietly. It would probably be best if you didn’t talk about it too much, at least till after Dr. Luce is gone. As I said earlier, there’s no point in upsetting him if we don’t need to. However, we need your agreement to the plan too.”

“May I ask what this plan is?”

“You certainly may,” Ryan smiled. “It’s what we’re getting to. As I said a couple minutes ago, initially our plan was to set you up in Dr. Luce’s practice, perhaps providing a little financing for modernization as a grant, but pretty much to let you sink or swim. However, the way his practice has deteriorated over the past few years, that wouldn’t be very fair to you, and certainly would not provide you motivation to stay here. So, simply put, if you agree to the plan, you won’t have to purchase the practice. The Donna Clark Foundation, with the assistance of the Jennifer Walworth Foundation and others will be the purchasers. That will give Dr. Luce a lump-sum check rather than a payment schedule that could outlast his lifetime. We are prepared, with some stipulations, to provide a guaranteed income level out of it. In other words, if your income from the practice falls below a certain level, we are prepared to make up the difference for a limited period of time, until you can get things going properly.”

“Mr. Clark,” she said in pure surprise. “I never expected that.”

“Well, up till recently, we didn’t either. Credit Gene for pointing out the problem to us. In fact, this idea is so new that we don’t have all the pieces in place yet to be legal. This kind of thing is a little out of the ordinary for the Donna Clark Foundation and way out of the ordinary for the Jennifer Walworth Foundation, as well as some of the other donors. Again with your agreement, we’re going to set up a separate non-profit foundation to administer this project, and transfer the necessary assets to it from the Donna Clark Foundation when everything is in place. The non-profit board will most likely consist of some of the people sitting in this room. Depending on what the lawyers involved say, you may be an employee of that as yet unnamed non-profit, or you may just get grants from it to cover the difference. That’s still up in the air. However, until the new corporation is in place, the arrangement will be administered by the Donna Clark Foundation. How does that sound to you?”

“For the moment, since I don’t know the details, it sounds pretty interesting. Like I said, it’s not what I was expecting.”

“We want you to examine the idea thoroughly and bring in your own lawyer if necessary. Dr. York, in the rush, I may have missed pointing out that the non-profit, whatever we call it, would retain ownership of the practice, so that if you leave we have a ready incentive for another physician. That would obviously mean that you would not personally gain financial reward by the sale of the practice should you leave. However, we’ll set it up so that you see the results of your labors, not the non-profit. As I said, Dr. York, we want to keep you here, and that’s just the first piece in the puzzle.”

“Well, if this goes through, it’s going to be a huge relief,” Tricia said. Unless there was some very sneaky fine print, this was a hell of a deal! “It’ll give me a little breathing room to tackle some of the other issues in the practice. There are some huge problems on the business side that I have no idea how or where to even begin.”

“Dr. York,” Dr. Metarie smiled, “did you ever see one of those bad TV commercials for some idiot gadget where the pitchman says, ‘But wait! There’s more!’”

“I’m sure I haven’t,” she smiled, wondering what was coming now. “I don’t own a TV. The last several years I wouldn’t have had time to watch one if I did.”

“Gene, this is your ball now,” Ryan said. “I think I’m going to go over and top off my wine glass.”

“Look, Dr. York,” Dr. Metarie smiled. “Maybe I should call you Tricia.”

“Please do.”

“Tricia, I’ll be the first person to admit I don’t know all I should know about medical billing, especially Medicare, Medicaid, and insurance issues. I just don’t have the time to learn them and there are more important things I have to do. I hire people to do that for me.”

“Mrs. Warren in Dr. Luce’s office is supposed to do that,” Tricia shook her head. “Except from what I’ve seen she doesn’t do a very good job of it.”

“Well, I meant competent people,” he nodded. “People who understand the system and keep up with it. It’s not simple, it’s not easy, and you literally have to be something of a professional to keep up with all the ins and outs and changes, which happen continuously. Once upon a time, even back when Dr. Luce was young, a local physician’s medical practice was mostly a cash business, but that was a long time ago and things aren’t that way anymore. I know very little about what Betty does about Dr. Luce’s medical billing, except I know she doesn’t do a very good job of it. That’s mostly from anecdotal evidence from a few of Dr. Luce’s former patients, by the way.”

“Dr. Luce is not the only one with problems with insurance billing,” Randy pointed out, the first time he’d said anything since things got serious. “We have a similar problem with the ambulance department. Due to all the paperwork and complications, we’re just not getting back what we should from the insurance companies.”

“Right,” Dr. Metarie agreed. “I’ve had two dentists and a chiropractor here in town bitch about it to me from time to time, too. So I have a possible solution. Like Ryan’s proposal, not all the pieces are in place yet but they could be set up fairly quickly. Basically, what I’m proposing is that we start with my core staff that handles billing, set them up in a separate office somewhere under a wholly independent corporation to do nothing but medical billing, for a percentage of the take large enough to cover their expenses and salaries. The ambulance department has agreed to the idea in principal, as has one of the dentists, and I think others will be glad to hop on the bandwagon. We’ll have to expand the staff, but we’ll get more done with fewer people than it would take for each of us to do it independently. All our office staffs would have to do is to supply the basic records and information, and let the billing company take care of the details.”

The advantage was obvious to Tricia; it would immediately remove the biggest headache she had about the prospects of taking over Dr. Luce’s practice. “I can see how it might have some merit,” she smiled, barely able to restrain herself from running over and planting a big kiss on Dr. Metarie’s bearded cheek.

“More than some merit, from your viewpoint,” Dr. Metarie grinned. “I would suggest that about the first thing we’d do after we get the computers plugged in to the new office would be to have Laura Hutchison go through Betty’s old work and resubmit outstanding claims or ones with problems. As slow as insurance companies are it’d take a while to show a return, but if things are as bad as I suspect they are there ought to be some big checks or electronic transfers coming in within sixty to ninety days.”

“My god, yes,” she sighed. “Like I said, it was clear things were bad but I had no idea of where to start. I figured I was going to have to come to you for help on that anyway, and I could see myself sitting up nights trying to make sense of things.”

“Dr. York,” Dr. Metarie said pointedly, “I’ll tell you right now, that’s one thing you do not want to do. You have much more important things to do with your skills and training. The bottom line is that you and I are going to be responsible for providing medical service to this community. That’s a big enough job as it is without taking on another one.”

“Oh, I’m in, I’m in,” she said. “How long would this take to set up?”

“We’re going to have to go back to Ryan on that one,” Dr. Metarie frowned. “I see no reason we can’t have you in the program the day you take over operating the practice, but Ryan is the one who has to handle the details on that part of it.”

“Theoretically, we could start Monday,” Ryan said. “The paperwork is all signed and sealed, all it has to be is executed. But Gene, I suspect you could stand a week to get your ducks lined up. And, Dr. York, you probably could stand a week to review our agreement and figure out what you have to do. I don’t want to wait much longer than that if I can help it.”

“We could do it Monday, but it would have to be done out of my office in the short term, so I’d just as soon have an extra week,” Dr. Metarie replied thoughtfully. “We’d have to find office space, get things set up, things like that.”

“If you’re interested,” Danny said, “the old appliance store is sitting empty since I lost the last renter. I just use it for a warehouse but there’s not much there. I could get it cleaned out in a hurry. I don’t think it would do for the long term but it sure would work in the short term.”

“Sounds like it would work for me, for a little while that is. Long term is a different story. I have some ideas on that, but things are nowhere ready yet. I think that’s something Tricia and I are going to have to talk about between ourselves. Can you provide office furniture?”

“What I don’t have in stock I could have by the first of the week, even if I have to drive the delivery truck down to Camden and pick it up myself. Computers, you’re on your own, but you won’t have to go any farther than Marlin Computer to deal with it.”

“We’d probably just start out with the ones from my office to begin with, but we’d need more as we expand the staff, which we’d have to do pretty quickly. But those are just details. I have the key people we’ll need on my staff now, and frankly, I can use the space.”

“You mentioned a long-term solution,” Tricia pointed out. “Is that something we need to talk about now?”

“Might as well,” Dr. Metarie shrugged. “But like I said, at this point it’s mostly an idea for down the road a piece. Have you ever seen the old Spearfish Lake Hospital?”

“No,” she said. “Back when I was interviewed, Mr. Clark said there had been one here, but that it had to close. That’s the limit of my knowledge.”

“The building is sitting there, and largely empty,” Dr. Metarie said. “The senior citizens center uses a part of it, and there’s a physical therapist who rents a part of it. The rest of it, including the front office, just sits there. It was a fairly new building when it closed, and to the best of my knowledge it’s in fairly good shape.”

“Only fairly good,” Randy pointed out. “It needs some work, especially the roof. The county had me send Rod over there a while back just to put together a list of what had to be done. I don’t remember all that was on it but I know where the file is. But, Gene, I know there are special building codes for hospitals, and I’d be willing to bet it doesn’t meet them anymore.”

“Well, I’m not thinking about trying to re-open it,” Dr. Metarie said. “It proved uneconomical as a hospital due to its small size when it closed. I was here for the last part of it, and from what I understand things have only gotten worse for small hospitals since. But I don’t think there’s any reason Dr. York and I couldn’t set up there as a medical clinic, which isn’t the same as a hospital. We can use it as a joint medical office and share staffs and other expenses. There would be much more space to go around. There are probably some other tweaks that could be done, like bringing in specialists for half days or full days on a regular schedule, and providing office space for them. Like I said, at this point, it’s an idea, not a plan.”

“The county still owns it,” Ryan Clark said. “I don’t doubt they’d be happy to have someone take it off their hands and make use of it. There might even be some grant money that could get involved, and I’m not necessarily talking about the foundations.”

“We’ll have to look into it, and by that I mean Tricia and I as much as anyone else,” Dr. Metarie said. “But we all have enough on our plates for right now. Let’s get this ball rolling, first. That can wait a bit.” He turned to Tricia and added, “Is there anything else we can help you with right now?”

“Well, yes,” she replied. “Dr. Luce is getting along without an office nurse, and I don’t know how or why. In any case, I want to bring one in as soon as I can, but I don’t know where to start looking or how to go about it, at least till he leaves.”

“I can help on that,” he said. “I have a young RN on my staff. She’s brilliant, personable, and very dedicated. I don’t want to say I can’t get along without her, but I do have other staff. She’d be very capable of doing what you need her to do, and realistically you need her worse than I do. I’ll have to talk her into it, but I think I can do that. If she doesn’t work out for you, for whatever reason, I’d like her back and we can find someone else for you.”

“I’d like to talk to her if I could,” Tricia replied. “Especially since I’m going to have to work closely with her.”

“That can be arranged. I have little doubt you’ll like her.”

Tricia shook her head. “I suppose she has a story to tell. I seem to think everyone else in town does.”

“Oh, she does,” Gene smiled. “I’ll let her tell it, though. It’ll just make clear to you how dedicated she is. Look, Tricia. There was more than one reason Dr. Luce and I haven’t worked as closely together as we should have, especially the past few years. Some of those reasons are good, and some are not. There’s any number of things you and I can do more easily if we work together on them, from sharing staff, covering each other, to such things as sharing coroner duties. I want you to feel free to come to me if you have questions. I also want to feel free to come to you and have you comfortable with that. Your training is more recent than mine, and in some ways you’re probably more competent and up to date than I am, so don’t be surprised if I come to you with a problem from time to time, too.”

This work is licensed under a
Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.