Profile For Rudy B.

While I appreciate your comments on the "process," your illustration does little to help understand the problems doctors are facing. As a long time company driver, I have never been treated anything but generously and kindly. I certainly have never been asked to work beyond HOS regulations. Those stories about the poor company drivers being mistreated and taken advantage of are myths that O/Os like to believe because it helps them justify their reasons for what they do.

I am very glad to hear that you are being treated well. I know there are companies that treat their drivers well, but in general I just have not heard good things from others who are rookies like myself.

If you wish to know the problems physicians are facing, it started decades ago as small independent practices merged into bigger groups. Bigger groups sold out to even bigger groups, which then sold out to private equity. Private equity has done what private equity does, and leveraged the groups to within pennies of financial ruin while squeezing the physicians to 1) see patients faster, 2) see more patients per day (in an office almost every 15 minute block will be double-booked, some triple-booked), 3) don't allow for physicians to have the time to complete the mandatory paperwork for all of those visits while on duty, and 4) cut back on pay. Repeat the process again and again, until the company is about to implode, and then sell for the maximum possible profit. Physicians are as expendable as any other employee, and my friends truly feel this to their core. Physicians are often required to "supervise" or "collaborate with" others (PAs or NPs) and take full legal responsibility for what those others do, without being able to actually direct or control the treatment of those patients in any meaningful way. Imaging being told that you are the "trainer" for a new CDL driver who is driving in a different truck. The company can and will hold you accountable for whatever that driver does incorrectly. However, you can't convoy with the driver. They have their own loads separate from your loads. You only get paid for your loads. You get their ELD logs that you have to co-sign every day, but you can't change anything. You can't help them real-time with backing into a tight dock, you can only give some guidance afterwards and at times that might be after they have bent some metal. This is the situation of physicians now.

Over the last 18 months, I have personally seen up to a 50% decrease in the amount corporations have been willing to pay me for what I was doing. To give some numbers, they would pay me $85 to see a particular patient and then bill that patient $850 under my name and my NPI (sort of like a social security number for healthcare professionals). The amount billed under my name has not decreased, but what I receive severely decreased.

My reasons for going the O/O route may be somewhat misguided. You may be correct. Time will tell. However, I do understand that I am sitting in a six figure investment that requires constant attention and feeding. I have spent more money on starting my trucking business than I had spent to go to medical school, thanks to the fact that I got a huge scholarship for medical school. But I need to be my own boss. I need to be able to spend time with my wife on a schedule that I can control. If there is an emergency I need to be able to get home in a matter of days, not a matter of weeks. I have not had a real holiday with family in decades - my former life mandated that if I did not work the holiday itself I was almost certainly on the night before the holiday. If I take a week off now I know I still have insurance ticking away. I still have rent for the office. I still have my fees for the ELD and managed services (compliance, D&A consortium, etc.) that I have contracted out. However, I do not have someone telling me that at one minute past my 34 I need to be back in the truck. If I want to set that expectation for myself that is my choice, and some times I will. But if I need more rest, I will take more rest.

What year is the truck? Manual or auto?

Any suggestions for a 2017 Peterbilt 579?

I'm debating a gas-powered generator on the catwalk with an Arduino controller as a backup to keep my batteries charged.

It seems like drivers are at the mercy of whoever they get for the process. What experiences have you had with MD's or PA's who do these exams?

You are often at the mercy of the process. That is the whole problem with healthcare right now, the process.

As a board-certified emergency physician who has retired from practicing medicine and is now an owner-operator full-time, let me just say that your mileage may vary. Most physicians who own their practice and do our exams understand that DOT physicals are 1) a cash stream of revenue and 2) much less liability if done right than the run-of-the-mill primary care cases. In short, you would have to be remarkably stupid as a businessperson and a physician should you not prioritize fed med exams. Most physicians are, basically, company drivers now.

The majority of physicians are now employees of large corporations or hospitals (this was just reported within the last few months in major medical societies), and many of them are burned out. Think about company drivers being treated horribly and asked to work beyond HOS regulations, then think about what it would be like if HOS regulations didn't exist. That is your doctor right now.

At the moment I'm far more interested in shifting the 13-speed in my new-to-me Pete than picking up my stethoscope again for hire.

My fed med exam was done by a chiropractor, not because I didn't want a physician to do the exam but because there were no physicians in my rural area who were available.

I am a physician, board-certified in emergency medicine but also residency-trained in internal medicine. I am also in CDL school at the moment, and although I will admit that I suck at backing a combination vehicle I am not that terrible at shifting since I have driven a manual transmission for 28 years. Yes, I will admit, I do have some bad habits with regards to transitioning from my 6-speed diesel pickup to a 10-speed semi. Double clutching is, shall we say, different. Regardless, let's just say that this virus currently spreading around the globe has completely trashed my business plan as a doctor and I rapidly need to think of a new business plan. Here it is:

I drive to truck stops with a trailer converted to a medical office and you can just pop in for a visit. For my comfort, the trailer/office is equipped to do the emergency procedures I am used to performing. If you try to die on me, I try to save your life while waiting for an ambulance to get you to a hospital. Yes, expect a bill. No, it will be nowhere near what a hospital would charge. However, I can't drive and do CPR at the same time, so you very likely will still need a hospital. For your comfort, I can go wherever you as a community need me (within reason - state licenses to practice medicine are very expensive). As I am licensed in multiple states already, but as federal law further complicates things, let's just say for example that I can do some very basic lab tests (electrolytes, hemoglobin, kidney tests) and maybe some other tests, if necessary.

Would you even want to see a doctor who knows at least a little about trucking, owns a truck and trailer, and drives OTR? I'm not talking about getting your fed med card from me. I don't do that. I'm talking about routine or urgent issues including things like stitching and splinting.

Would you be interested in seeing such a doctor by telemedicine (so long as you are actually in a state where I am licensed)?

The big question is how much would you think such a service would be worth to you?