Monday, February 9, 2015

A Tale of Two Offices

In previous blogs, I’ve made passing references to my rural home office. Such an office might seem anachronistic today, especially when large group facilities are becoming the norm. So how did I end up with such an arrangement, clearly bucking the trend?

About 25 years ago in my role as a professional, I felt the need to develop closer ties to my community. This was hard to do in the dense suburb outside the Washington Beltway where I rented a suite in a modern medical facility, a facility which sat along a six-lane parking lot/thoroughfare that was generously designated the main commuter artery into Bethesda, Md.

I had recently purchased a home quite a distance away in the last rural corner of my county. It took several years to adjust to the house payments and the expense of running a new office. I also had incorporated comprehensive orthodontics, which had its own startup expenses. Once I felt financially secure, I decided to attach a satellite office to my home, but I found the county regulations daunting—the medical facility in which I practiced had already satisfied the myriad of codes for a health care facility, but not my home. However, I persevered through the bureaucratic jungle.

And though the trend was toward multi-dentist, multidiscipline offices with a slew of hygienists and expanded duty auxiliaries, I felt drawn to a practice in my community. After jumping through all of the government hoops, I finally opened a home office with one operatory. Yes, I planned to do my own hygiene—at least for a while. (I now have three operatories and a full staff.)

I soon discovered an unforeseen advantage concerning emergency calls. Although living far from the suburban sprawl, I didn’t mind traveling the distance to Bethesda after hours if a patient had a truly pressing problem. But it always irked me to have this in-person conversation late on a Saturday night:

“Well, how long has this been keeping you up?” I’d ask, only to be answered by a flippant, “It started last Monday, but I didn’t want to take off work. And it’s not really that bad.”


“It’s actually never kept me from sleeping,” the patient would say, which wasn’t what I was told over the phone. Of course, these types of situations should be handled during regular office hours.

Once the home office was opened, I would begin to recite directions to it. Those folks who were really hurting had no problem with the drive, although many thought they might be lost when they passed the dairy farm. But those people who just wanted a convenient time quickly realized how far out the practice was and made an appointment “during the week.” I don’t mind seeing emergencies off hours—it’s part of the job—I just don’t want to be taken advantage of. This was a great way of screening people.

Initially, we were open just one day a week. And, at first, some patients would pay me in kind; like with eggs or venison. I know it sounds quaint, but accepting what the farmers offered helped them to “afford” basic treatment. However, I never traded goat cheese for high-end veneers.

My first local patient called on a Tuesday with a toothache, the day before my home office opened. My Bethesda receptionist gave Bud an appointment first thing on Wednesday morning. He was happy to be seen so soon. We were equally happy. Bud volunteered that he lived across the railroad tracks, “just opposite the country store.”

I went to sleep anticipating my new career move. About 2 a.m., my wife shot out of bed in response to what sounded like a loud explosion. She looked out the window and saw flames in the distance. Rolling over to go back to sleep, I muttered, “Let me know if the fire gets any closer.”

That morning, we awoke to a traffic jam along our country road, which was highly unusual. Commuters occasionally bypassed the congestion on I-270 using our road, but this was something else. Having plenty of time before the office opened, we walked the half mile to the center of “town” to see what was up. A train carrying new Cadillacs had derailed; railroad cars and Caddies were strewn about like Matchbox cars.

A neighbor told us that the home of Mr. and Mrs. Gwyn had been torn off its foundation by a flying railroad car. Their house, now a pile of rubble, was the only one across the tracks, behind the store. As it slowly dawned on me, I inquired if Mr. Gwyn’s first name was Bud.

“Yes,” their neighbor said. They had been taken to the hospital but were basically OK, just a few scrapes and bruises. It was truly a miracle.

That’s when I realized that my first patient would also be my first no-show. But Bud had a pretty good excuse. A week later, I extracted his tooth. He told me that the second scariest thing that ever happened to him was that train wreck. The first was a visit to a dentist years ago. But, in contrast, this procedure was pain-free; he left smiling. After this inauspicious beginning, my new practice grew exponentially.

I soon discovered that this rural area was populated by more than just farmers. Through the Lions Club, the local country club, and our church, I met many professional people who had moved to get away from the congestion: attorneys, university professors, journalists, politicians, and a couple of CIA analysts who can’t really tell you what they do. This allowed me to perform state-of-the-art treatment while helping the generational folks to obtain basic care on a regular basis—without my participating in charitable clinics far from where they lived.

Years later, I was so busy that I couldn’t keep up the pace of maintaining two offices. Although I had a part-time associate in Bethesda, I was basically a solo practitioner working two locations. And our county wouldn’t permit an associate in a home office. I even had to argue for a hygienist, which a bean counter thought might count as a dentist. In the end, my hygienist was allowed to stay and has been with me for more than 15 years.

For sanity’s sake, I had to close one of the offices. That was a hard decision. I’d known the people in my suburban office for years, and I had watched their kids grow up, marry, and have kids of their own. And I’d also made many friends in my rural practice. So which one to close? As I sat in stop-and-go traffic on Route 270, I realized it was a no-brainer. My commute through the kitchen was easier, as my main delay was whether or not to get another cup of coffee.

After I closed my down-county office, I happily discovered that most of my patients followed me to the country. Once in the car, it wasn’t that much further for most people; many found that they lived between the two offices and it was actually easier to drive in the opposite direction of rush hour. And they liked the ambience of our farm animals. Horses, dogs, rabbits, and peacocks are very soothing to patients anticipating dental treatment. I expanded my home office and never looked back. An oral surgeon recently took a cue from me and built a modern facility just across the street. We do a lot of implants together.

Yes, practicing in the country is an anachronism, but it’s one that I wouldn’t trade for anything.

Jim Rhea, DMD

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