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.
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