Defining Moments: My Sixth Decade

My sixth decade is a collage of my entire life  Work and my workaholic tendencies, exercise and athletics and my determination to get to the Kona Ironman, dedication to my children, my continual mission to seek out purpose, an particularly find purpose in helping older adults.  My sixth decade touched all the bases, though ironically was bracketed by my workaholism and drive for purpose.

Just prior to my 50th birthday, I had a PR at the Eagleman Half Ironman.  My training was going great in preparation for the Long Course World Championships in Perth, Australia  I felt like I was in the best shape of my life  At the same time, work was as busy as ever, which  meant I was going a mile a minute every day.  We'd had some inquiries from a hospitalist company about our practice, but I ignored them.  Still, there were actually a lot of stresses at work, as my business partner and I seemed to have more and more conflict on a regular basis.  And, then, in the summer of 2009, was Little Blossom  The previous winter, my daughters had written a couple of scripts for a television pilot and myth wife and I thought it's be "fun" to let them actually produce it.  I'd had a recent business success with a company called Common Sense Medical Management, and thought we could put the money to good use  In many ways, this endeavor had far reaching tentacles that would go on for the next decade.  My wife and daughters did all of the work preparing for the week of filming that was planned in August  I had decided to take a week's "vacation" to help out, but also "rest up" for the Boulder Half Ironman that was literally at the end our week of filming.  to this day, that week was one of the most stressful and hectic weeks of my life  Not a good way to taper for a race.  In fact, I got zero training, minimal sleep and tons of stress.  But, like everything in life, I learned a lot of lessons, and hopefully, so did my daughters.  My wife, on the other hand, pretty much hated the whole experience  But she did it for our kids, and she did brilliantly at that!  The most notable parts of the week were the extreme pride I had in my daughters and what they'd accomplished, and the point at which I'd pushed myself to a mental breakdown the day before my race.  The race itself became anticlimactic, but I was super proud of how I did considering that I persevered despite the incredible odds.

Senior Care of Colorado, the private practice I had co-founded in 2001, was growing  We were getting bigger and more complex.  We were negotiating for more business.  My business partner and I would disagree over how much time we should spend running the business rather than working in it.  My stress was building.  In October of 2009, my family left for a three week vacation to Australia and New Zealand.  The first part of the vacation had me splitting up to race at the Long Course World Championship in Perth, while my wife, two daughters, and 85 year old father in law vacationed on the other side of Australia for a few days.  I was excited.  I was in the best shape of my life and wanted to see how I might compete against the best in the world in my age group.  My swim was uneventful.  But, just a half of a mile into the bike ride, I got too close to the left curb and crashed, sliding along the side of the road for about 30 feet.  My bike was ok, and with crowds yelling "go USA," I got back on my bike to complete the 48 mile bike ride.  My flying dismount caused me to land on my left foot and the searing pain in my left hip sent me to the medical tent, where I was told that, at the very least, I had a separated shoulder.  They couldn't figure out what was wrong with my hip.  3 1/2 miles later, I shuffled back to the medical tent and nearly passed out.  A trip to the hospital led to a diagnosis of a fractured clavicle and an "irregularity" in my left hip.  Three weeks later, a CT scan showed a fracture of my left hip socket and pelvis.  Ironman St. George was still six months away, and I was determined to do my first ironman.

I took the accident as a signal that it was time for me to slow down.  I actually tried to do that in regards to work, which only increased the stress that I had with my business partner.  In the spring, IPC reached out and asked us what it would take to acquire our practice.  My CFO and I sat down and came up with a number.  As I was getting on a plane, coming back from the 2010 annual meeting of the American Geriatrics Society, we got the response.  They were going to give us what we wanted!  Over the next six months, I experienced what it was like to sell a business to a publicly traded company.  Only a few of us could know, which made many of my actions and decisions appear to be nonsensical.  In December of 2010, I sold my business and spent the next year and a half working part-time.  In many ways, it was one of the best times of my life.  I got to focus on my Ironman training and my family.  "Unfortunately," one of my ways of focusing on my family led me to invest in an entertainment internet business, GeekNation.  In the end, it wasn't a good business investment, and it turned our lives upside down, leading us to move back to California in 2012, which coincided with my retirement from clinical practice.  I was going to focus on my wife and training, but instead got neck deep in a new business.  There were many lessons from that business, but the most important was that I had no business in the entertainment business.

All the while, my sixth decade was my Ironman decade.  Over the course of ten years, I completed 14 Ironman races, and nine half ironman races.  I thus qualified for Kona through the Legacy program.  My first ironman was at St George in 2010, and I've written race reports for every one of the following races:

2010 St. George  13:18:26  (40/122 AG)

2011 St. George  12:45:54 (29/105 AG)

2012 St. George   13:52:21 (24/110 AG)

2013 Lake Tahoe  14:27:28 (72/161 AG)

2014 New Zealand 12:17:00 (22/92 AG)

2014 Boulder 12:34:19 (15/92 AG)

2014 Chattanooga 11:31:59 (11/103 AG) (PR)

2015 Boulder 13:07:15 (22/77 AG)

2016 Boulder 12:19:58 (6th/53 AG)

2016 Chattanooga 12:32:59 (10th/112 AG)

2017 Boulder 12:58:57 (10/63 AG)

2017 Santa Rosa 12:26:51 (23/105 AG)

2018 Santa Rosa 14:52 (52/92 AG)

2019 Boulder 12:46 (7/30 AG)

In 2014, I achieved Gold status as one of the top people in my age group in the world.  I was 34th in the world and 9th in the U.S.  My first Ironman in my new 60-64 age group in Boulder in 2019 garnered me my second highest placement in an Ironman, missing the podium by two spots.

"Retirement" lasted a few years, before a chance meeting got me to take a job running the nursing home arm of California's quality improvement organization.  I actually had a lot of fun for about a year and a half, working with a great group of people, until it wasn't fun.  As soon as the fun ended, I left.  Shortly thereafter, I was asked to become the Chief Medical Officer of the largest nursing home chain in California.  I didn't think that CMOs had any authority or clout, and said so, but I took the part-time job anyway.  It was fun again.  Eight months into the position, in August of 2017, I received a phone call asking if I'd be interested in becoming the CEO.  My life was about to change yet again.  The next fourteen months were the business and hardest of my life.  In a story that has started to be told in the media over the past year, I lasted 14 months before resigning.  Like every decision in life, I learned a lot from this experience.

Shortly after resigning, I completed my first ultra marathon, the Snowdrop 100, with my good friend Robert Key, and upon recovering from that began my preparation for Kona.  Part of that preparation was the decision to compete in the 2019 Ironman Boulder, which ironically turned out to be one of my best Ironman races ever from a placement perspective.  It was also just a week before my 60th birthday, and the beginning of my 7th decade. 

Defining Moments: My Fifth Decade

My father used to quote a saying that my grandfather, Morris Wasserman, was fond of.  It had to do with sacrificing one's health in order to gain wealth, and then using that wealth to try to regain one's health.  In my fifth decade, I put that saying to the test, with the addition of trying to achieve purpose all wrapped up in the middle of it!

My fifth decade began in the summer of 1999, as I continued to "commute" between Denver and Central Florida every week.  I'd leave the house on Sunday afternoon, get on an airplane and fly to Orlando, arriving past midnight and heading to the Hilton in Altamonte Springs.  On Thursday afternoon, I'd fly back to Denver.  On Friday, I saw patients in the clinic.  My daughters were 12 and 8, and it's a wonder that they knew who I was.  I was the President and Chief Medical Officer for GeriMed of America and I was trying to prove a point about primary care geriatrics and make a difference in the world.  In many ways the world wasn't ready.  Nevertheless, our business in Central Florida had expanded from Orlando to include Daytona and Tampa, and we were profitable.  We had "full-risk" contracts with Humana and Cigna. I was constantly battling these HMOs, as well as the hospital systems and other market forces.  Primary care geriatrics was a profitable business model.

I remember once considering getting an MBA, only to realize that I'd gotten an MBA in the real world of health care business.  I had some of the best mentors.  Jim Riopelle, my boss, was one of the early pioneers in managed care and accepting risk.  Ray Delisle was our Chief Operating Officer.  In his previous role as VP of Human Resources for Samsonite, Ray knew more about HR than anyone I've ever met.  He'd also had extensive experience negotiating with unions.  And he was my friend.  Very few days pass where I don't think of one of Ray's colloquialisms.  And Jim, well, you had to really know him to love him. I miss both Jim and Ray as I write this, but they'll both always be looking over my shoulders and helping me along.  

Unfortunately, while we had been successful in Florida, our Denver operations were losing money.  In many ways, it wasn't surprising.  Our Denver clinics took care of the most frail patients and there was no such thing as "risk adjustment."  We actually were profitable when it came to specialist costs, but we had still lost nearly a million dollars due to excessive hospital costs.  As President of the company, I had no choice but to shut down our Denver operations.  In the winter of 2000, I was driving home from the office and my colleague, Don Murphy, called me.  He had decided to take over his clinic and turn it into a fee-for-service private practice.  Was I interested?  I was still President of GeriMed and all of my business was about to be in Florida.  Did I really want to continue commuting to Florida every week?  I was intrigued.  And, like every major decision in my life, I immediately knew the answer.  By the time I got home I told my wife that I was going to resign and go into private practice with Don.  On January 1st, 2001, Senior Care of Colorado was born.

I need to back up to some personal stuff first.  I had herniated my L5-S1 in 1998 and had really gotten off track from my marathon running and triathlon training.  In fact, I'd gained almost 20 lbs.  My dad underwent a Bypass and aneurysm repair in May and August of 2000, an I remember thinking, I need to focus on my health.  It was time to get back in shape and reset my ironman goal that I had postponed.  My new goal for to do an ironman when I turned 50.  First, I had to build up and get back in shape.  It took me a couple of years, but I did my first half marathon and first triathlon of the new millennium in 2003.  

My fifth decade was consumed by work and training.  Owning a business is a 24/7 commitment.  In 2016 Springer published my book, "The Business of Geriatrics," which tells a lot about my fifth decade.  There's so much.  Starting a business with a partner, taking on a second partner, divorcing the second partner, going $1.5 million in debt, figuring it out, hiring a CEO, firing a CEO, hiring my old CFO from GeriMed despite the fact that we had never gotten along, and now he's a lifelong friend, fighting with my business partner, battling the marketplace, being investigated by the OIG for most of the decade, it just doesn't end.  Missing my kids growing up.

I hired a coach in 2005 (and after 16 years he's still my coach!).  My half marathon times tell the story:

2003 (Denver) 2:00:37

2004 (Denver) 1:50:10

2005 (Denver) 1:39:33

2006 (Surf City) 1:37:14

2006 (Denver) 1:43:15

2007 (Surf City) 1:32:25 (PR)

2007 (Denver) 1:43:38

2009 (Surf City) 1:33:54

So do my half ironman times:

2004 (CA) 6:08:04

2005 (CA) 5:49:56

2005 (CO) 5:29:05

2006 (CO) 5:18:39

2006 (CO)-Harvest Moon 5:24:34

2007 (CA) 5:13:07

2007 (CO)-Harvest Moon 5:34:22

2007 (CO) 5430 5:07:24

2008 Halfmax Nationals 5:43

2009 (CA) 5:19:36

2009 (Eagleman) 5:02:44 (PR)

Of note, the 2008 Halfmax Nationals qualified me for the Long Course Triathlon World Championships in Perth, Australia in 2009, but that's my next decade, so it will have to wait.  I also ran my fastest 5K ever, and my only 5K under 20 minutes on my 49th birthday in 2008.  As I got close to turning fifty, my ironman dream was in the making, but my life was also careening in terms of work:life balance.  That would ultimately define my sixth decade.

Defining Moments: My Fourth Decade

Looking back I realize how much happened during my fourth decade of life.  I started my first full-time job as a physician in July of 1989 at Kaiser-Permanente in Woodland Hills.  I would work at Kaiser for the next five years, before moving my family to Colorado to open up a hospital based senior clinic for GeriMed of America.  By the time my fourth decade came to a close in June of 1999, I was the President and Chief Medical Officer for GeriMed of America and was literally commuting between Denver and Central Florida every week. 

The most important thing that I did prior to starting my job with Kaiser was preparing to start the job.  A friend had warned me that if I didn't prepare in advance the system would suck me in and I'd never get rolling.  So, I planned ahead, and on my first day, Kaiser Permanente's first outpatient geriatric consultation clinic saw its first patient.  Over the next five years, I would accomplish a lot, which meant of course, that my workaholic life was starting.  My wife often reminds me of how it seemed that I was never not working during my time at Kaiser.  She was correct.  Not only did our clinic quickly get busy, but I started getting involved in just about anything and everything associated with the organization.  Thirty years later I spoke to a colleague who had a similar experience, and found that we were both doing the work of a few people.  This led to accolades and a one week trip to Hawaii, where I consulted with the Hawaii Kaiser-Permanente in regards to their geriatrics programs and care of older adults.

In the summer of 1994, six months after the Northridge earthquake, I was named co-chief of Kaiser's second Department of Continuing Care.  Two weeks later, I gave notice.  It turned out that at that year's annual meeting of the American Geriatrics Society, I had met Dr. Steve Phillips, who introduced me to Jim Riopelle.  Jim was an emergency room physician who had bought a company called GeriMed of America and was looking for geriatricians to come work for him.  At the time, despite having my own department at Kaiser, I knew that I was still just one geriatrician in an organization that had its own bureaucracy.  Jim was an entrepreneur, and something just clicked.  He would become my boss, my mentor, and a friend.  He died this past winter, and while he was a self-described asshole, he was still my friend.  

GeriMed of America was a new phase in my life, and the decision to move my family to Denver was certainly a big one!  In fact, we were living with my in-laws at the time due to construction on our house from the earthquake.  For the next couple of years, I was basically a practicing geriatrician, seeing my patients in the clinic, the hospital and the nursing home.  GeriMed was growing, and needed a President, and I wanted to be that person.  Ironically, the annual meeting of the American Geriatrics Society in 1997 was going to prove to be instrumental in yet another major change in my life.  A colleague, David Polakoff, told me about some clinics in Florida that his nursing home company was looking to sell.  They were in a full-risk contract with Humana and they were losing a lot of money.  Before I knew it, I had initiated GeriMed's first major acquisition and shortly thereafter began my weekly commute to Florida.  

Every Sunday night I'd get on an airplane to Florida, and every Thursday night I'd fly home to Denver.  On Friday, I was in the clinic seeing patients.  I racked up a lot of frequent flyer miles over the next three years.  I also had started running in 1991 and did my first marathon shortly after the Northridge earthquake in 1994.  I did my first triathlon in 1992 and dreamt of building up to the ironman distance by the time I turned forty.  However, by that time, I was commuting to Florida and running a healthcare company. Ironman would have to wait.  That didn't keep me from running, which became my major form of exercise, and I managed to do several marathons, my fastest being in 1997 in Philadelphia.  I managed to time that race with a geriatrics meeting, and will always remember two of my best geriatrician friends, Cheryl Phillips and Jim Lett cheering me on at the halfway point of the race. 

As my fourth decade came to a close, I didn't realize that I was about to embark on another journey in a year and a half.  In fact, I thought that I had reached a pinnacle, as president and chief medical officer of a geriatrics medical management company.  In retrospect, I learned a lot from acquiring a business and building it over three years.  We acquired four clinics from Mariner Health in Orlando, Florida.  Within a couple of years, we had ten clinics from Daytona down to Tampa.  I was running the company from Florida, which meant that I wasn't home very often.  That was going to change within the next couple of years.