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Writing prompt: Taking into account all cost for the practice per year (salaries, rent, supplies, etc); number of patients seen per year;

calculate the cost per patient just to keep the Practice even..

How to Start Your Own Medical Practice, One Doctor Tells Her Story
During medical school T.C., M.D.(name abbreviated to protect privacy), never imagined herself in her own practice, “they don’t teach the

business side of things in medical school, I never wanted to be involved with that aspect of medicine,” she says.
Now several years later and after negative experiences as an employee in other people’s practices, she is enjoying life as a solo practice

family physician in Tampa, Florida.

After she completed residency she took a job at a multi-specialty group, it turned out to be a less than desirable situation. Others were

making decisions about her day, “it was all about numbers and as a physician I was disregarded as a person”, says Dr. C.
After taking another job with a flat salary and inflexible hours she decided to turn in her resignation. With four months notice to work

she had time to get funding and figure out how to start her own practice. Dr. C bought a publication from the AAFP on how to start a

practice, this was invaluable and told her everything she needed to know.
Finding Financing and a Location
“The hardest part was finding the location, that was not a quick process” she says. Once a suitable office was found next was securing

set-up financing. Young, with no assets and medical students loans, Dr. C first tried her local banks, then a commercial bank, but she was

declined. Finally, after seeing an ad in a medical journal she called a lending company. In 48 hours she had been given approval for her

loan. Within a week she was given a check to cover her starting costs, and later funds to cover tangibles, such as computers, exam tables,

office supplies and so on. In addition, Dr. C was able to negotiate terms similar to a bank. Lawyers helped her get incorporated and

obtain a business lease.
Finding Computers, Software, Supplies and Equipment
With a loan in place and suitable office found, she needed to find a computer system for her practice. “The computers were another

challenge”, Dr. C says, “just getting them set-up so everything worked took longer than we expected”. Using the Internet and copies of the

“Physicians and Computers” journal she researched different software vendors and selected a system that allows her to run a totally

paperless office. With a computer in every room, including exam rooms, the system works extremely well. Her medical assistant types in the

notes, vitals and reason for the patient visit, and then in the exam room she pulls up the file and is able to add Dr. C’s notes. The

software also allows her to run searches or reports on patients taking a particular drug, or find out when they are due for their next

mammogram. The EKG connects directly with the computer, reads it for her and allows her to edit the reading, and then print or fax it. Dr.

C says that running a paperless office allows her to spend more time with her patients. Using an article describing the things you need

for each room she equipped her practice and added her own personal touches fairly easily. Luckily, the previous tenant left some key

equipment such as examining tables, and the rest she ordered from medical supply companies.
Getting Patients and Insurance
Although she did not have a non-compete clause in her contract with her previous employer she did have a non-solicitation clause, so she

was not able to ask her patients to move with her. But once word was out many loyal patients gladly followed her to her new practice. Even

though she moved practices she kept her credentials with several major insurance companies. Normally the credentialing process with the

health insurance companies can take up to two months. “The hardest part with the insurance companies was getting a fee schedule”, she said

“we called in June, called again and again, then called everyday and finally in September they arrived”. Using the resources of her

regional Family Practice association she was also able to find malpractice insurance at reasonable rates.
Hiring Staff
Hiring staff was also easier than Dr. C first thought, her medical assistant and front desk receptionist from a former employer decided to

join her. Another key person she hired was a good accountant to help with many of the financial issues. Working well as a team she is able

to set the tone of how the office is run and she has much less stress on the job than her previous practice positions. She also made an

arrangement with a colleague for emergency and out-of-town coverage.
Balancing Family and Practice
Dr. C had her son during residency and returning to work after maternity leave she saw her son for only 20 minutes a day. Pregnant with

her second child she looks forward to balancing her family and thriving practice under her terms. Even though she says setting up her own

practice was more work and stress than she imagined she is very happy about it. Dr. C opened her practice doors in September 2000.

Survey: Medical practice managers struggling with operating costs
June 30, 2010 | Chelsey Ledue, Contributing Editor
ENGLEWOOD, CO – Medical practice managers cite “dealing with rising operating costs” as their biggest daily challenge in 2010, according

to a new Medical Group Management Association survey.
For a third year, medical practice professionals sounded off about their biggest daily challenges, as well as their struggles to safeguard

their practices’ financial solvency despite a failing economy, in the MGMA’s 2010 “Medical Practice Today: What Members Have to Say”

survey.
According to the research, the top three challenges of running a group practice are:
1. Dealing with rising operating costs;
2. Managing finances with the uncertainty of Medicare reimbursement rates; and
3. Selecting and implementing a new electronic health record system
“It is not surprising that ‘maintaining finances with the uncertainty of Medicare reimbursement rates’ jumped to the No. 2 spot this year

due to the continued Congressional irresponsibility in not permanently addressing the flawed sustainable growth rate (SGR) formula,” said

William F. Jessee, MD, president and CEO of the MGMA.
Medicare reimbursement rate uncertainty had ranked fifth in both 2008 and 2009.
An organizational governance issue MGMA introduced to the list this year, “managing teamwork and group dynamics among physicians,” debuted

at No. 8. “Implementing a patient-centered medical home model of care” made the biggest leap from last year’s list (from No. 22 to No.

12).
“Practices are clearly balancing the very serious issue of keeping their practices afloat amid unprecedented financial uncertainty with

the more delicate practice management issues such as managing group dynamics and overseeing their organizations’ strategic direction,”

Jessee said. “It’s a testament to the profession of medical practice management that they must find a way to survive and move forward

despite the dynamic and challenging environment in which they practice.”
The MGMA found that when compared with independent medical practices, hospitals and health system respondents were more likely to find

“challenging” these issues:
• Modifying physician compensation methodology;
• Recruiting physicians
• Dealing with rising operating costs; and
• Implementing a patient-centered medical home model of care
However, hospitals and health system respondents were less likely than independent medical practices to be challenged by “maintaining

physician compensation levels” and “negotiating contracts with payers.”
For a second year, the MGMA also asked study participants how the recession is affecting their medical groups and how they are responding.

Respondents indicated that improved billing collections and/or denial management process was at the top of the list.

• 1
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This model is based on a 30 patient daily average with a practicing Physician and Physician Assistant in one office that has already been

established.
Continuing cost of Practice:
1. Office rent and utilities/supplies/equipment on a yearly basis: $2,400 internet
+ $1,200 phone
+ $2,400 electric
+ $ 49,500 rent
Total $55,500
2.Insurance on a yearly basis: $ 60,000 Malpractice (Physician Assistant, Physician)
$ 6,000 Health
$9,000 Disablity
$15,000 property
Total $90,000
3. Pay-roll $200,000 Physician pay
$100,000 Physician Assistant
$30,000 Medical Assistant
$ 24,000 Billing/coding
$18,000 front desk
$ 8,000 property tax
Total $380,000
yearly total $545,500
So to break even we would have to charge an average of $30 per patient to break even on a conservative budget.

Instructions

Though colonialism may have officially ended, the effects of colonialism are still very much present today. This is true in modern-day

Africa.

Review the following resources for additional information on the slave trade in Africa:
•Origins of African Slaves: Slave Trade Routes
•Lasting Effects of Slavery on Africa
•African Countries and Independence Dates

Select 1 of the following countries from which the most slaves originated:
•Democratic Republic of the Congo
•Ghana
•Ivory Coast

Use this template to complete your paper:
•For your selected country, identify the former colonial ruling country.
•Identify your selected country’s date of independence from the colonial ruling country, and discuss the length of time the slave trade

operated there.
•Discuss how the depopulation and fractured familial relationships inherent in the slave trade have affected your chosen country. Be sure

to support your discussion with relevant examples. ◦Are these effects still felt today? If so, how? Provide examples.

•Based on your review of this information, what conclusions can you draw about the slave trade and its effects on your selected country?
•Based on your key findings and conclusions, what recommendations do you have to help improve the conditions in the country now? Make sure

your recommendations: ◦include specific interventions or strategies to address the issues and constraints identified
◦are feasible (politically and operationally)
◦are realistic (short- and long-term)

•Utilize at least 2 credible sources to support the arguments presented in the paper. Make sure you cite them appropriately within your

paper, and list them in APA format on your Reference page.
•Your paper should be 4–5 pages in length, not counting the Title page and Reference page. In accordance with APA formatting requirements,

your paper should include a Title and Reference page, should be double-spaced, and include a running head and page numbers.

 

Introduction:

The development of the United States in the twentieth century was shaped by several challenges: an economic collapse, global war, and social and political

upheaval at home. The economic collapse that preceded the Great Depression brought high unemployment, increased prices for goods, and displaced populations

across the United States. President Franklin Roosevelt promised a “New Deal” for Americans, and during his administration the federal government intervened

in the American economy with regulations and stimulus, changing the relationship between the states and the federal government. The aftermath of the Second

World War brought the United States to greater international prominence, but the following geopolitical and ideological struggle with the Soviet Union

divided the planet and threatened international destruction through the use of thermonuclear weapons. At the same time as the United States was expanding

its role as an international power, many domestic protest movements challenged institutional discrimination and unequal systems of power in federal and

state governments. Their victories resulted in legislation and legal precedents that changed the complexion of American society.

In this assessment you will examine several major events that shaped modern American society. You will consider how the New Deal policies were designed to

ameliorate the effects of the Great Depression, how the Cold War was waged both internationally and domestically, and how the civil rights movement

challenged the perceived assumptions of American society.

Requirements:
A. Explain (suggested length of 1–2 pages) the major causes of the Great Depression (e.g., economic policies, trade concerns, banking practices,

international commerce).

B. Describe three ways (e.g., major legislation, organizations, relief and recovery efforts) that the New Deal sought to address the problems of the Great

Depression (suggested length of 1–2 pages).

C. Explain how the end of World War II contributed to the rise of Cold War tensions (suggested length of 1–2 pages) by doing the following:
1. Discuss the effect of the arms race on the rise of Cold War tensions.
2. Describe how differing ideologies led to increased Cold War tensions.
3. Explain the effect of Cold War tensions on American culture and domestic policies (e.g., security concerns, organizations, discrimination).

D. Explain two changes (e.g., legislation, cultural shifts, economic shifts) that came about as a result of one of the following historical events

(suggested length of 1–2 pages):
• civil rights movement
• feminist movement
• gay rights movement
• rise of the religious right

E. Provide acknowledgement of source information, using in-text citations and references, for quoted, paraphrased, or summarized content.
1. Include the following information when providing source references:
• author
• date
• title
• location of information (e.g., publisher, journal, or website URL)

 

What are additional questions that most interest you and might help discover the answers to your research question. What theory or hypothesis about your topic are you testing. What if any prior beliefs, assumptions preconceptions, ideas or prejudice do you bring to this project. What personal experience May have shaped the way you feel? Before you begin developing working knowledge on topic what were you thinking about It? What are you thinking about now?

 

Reading response
This reading response paper should address the questions “What should we know about the history of the real Africa that we don’t know (or aren’t

taught)? What does that say about the purposes (intended or unintended) of school curricula and about our alleged entrance into a postracial world?”

Your essay should cover the readings for Week 2 (Ehret, Van Sertima, Thornton).

 

strengths and weaknesses of history
What are the most significant strengths and weaknesses of history as an analytical discipline? Please explain why and support your responses with clear

references to the required readings and the provision of detailed practical examples.

There are inextricable connections of political, economic, and cultural influences to individual wellbeing. It is essential for community workers to

understand that those larger systems are made up of people and as such take on an identity of their own – hence, community as the client. The

Community Tool Box states: “By community, we mean a group of people who share a common place, experience, or interest. We often use this term for

people who live in the same area: the same neighborhood, the same city or town, and even the same state or country. People may also consider

themselves part of a community with others who have had similar experiences.” (Chapter 1, Section 3).

When an entire group of people are identified as a community, it is possible to interface with that community in a way that takes into consideration

the composition of that community, its social dynamics and history, etc. This comprehensive understanding of community supports the work in

developing programs to support the community’s constituents and the development of interventions and advocacy strategies aimed at creating larger

social change.

For this discussion, you will demonstrate your understanding of the concepts of the community, collective self-determination and how this can either

create social problems or improve the quality of life for all people, especially those perceived as vulnerable or disenfranchised.

For your initial post provide answers and discussion to the questions below :
1.Briefly describe a “community” you are a member of, or one that you have an interest in working with. a.What are the critical attributes of this

community, e.g., social interaction, common interests, goals, common experiences characteristics, locale, etc., in other words, its “personality”?

Why do you believe this to be so?
b.What are the particular attributes of this community that may limit its access to resources and opportunities that others may have?

2.Thinking about the resources that this community is not able to access: a.What steps would you take to ensure access to resources that would

benefit the whole community?
b.How do these steps differ from the steps taken when working with individuals? How are they the same?
c.What are the interpersonal skills needed to be successful in supporting the community? How do they differ from the steps taken when working with

individuals? How are they the same?

After writing your initial post, respond to at least two (2) of your classmates’ posts, using the following as your guide
a.How is your understanding similar/different from your classmates’ in regard to community as client? Please explain and give specific examples.
b.Are the steps your classmates described logical and complete and do they ensure the benefit of the whole community? Explain and give specific

examples. Are there any other steps you feel would be necessary to include? Why or why not?

 

Assignment Details
Assignment Description
Read sources, look at the slides for Chapter 13 and others related to ethics and privacy, and write a short paper on ethics in the IT arena.
Assignment Objectives
Read sources, look at the slides for Chapter 13 and others related to ethics and privacy, and write a short paper on ethics in the IT arena.
Other Information
There is no additional information to display at this time.

What is the symbolic significance of the lighthouse? Discuss it in relation to the novels trajectory as well as individual characters

relationship to it.

Novel To the Lighthouse by Virginia Woolf
interesting and informative title needed
MLA format

no outside sources to be used or cited just need to be about the novel.

6.1 Critique and apply knowledge to understand person and environment – TANF

1. Explore “the ways social systems [i.e., organizational macro systems] promote or deter people in maintaining or achieving health and well-being.”
2. Identify some of the pros and cons of TANF.
3. Appraise the potential effects of TANF on poor, single mothers and their families

Read the following case example and address the subsequent questions at the end of the Case.
***Re-type each question and respond using critical thinking and solid analysis in a
minimum of one paragraph responses. You “must” provide at least one reference from
the Kirst-Ashman text or Menakam that supports your answer.

CASE EXAMPLE: Kaitlyn, 24, is a single mother with three children Sean, 2, Shane, 4, and Shannon, 5. She has an eleventh -grade education, as she dropped out of high school to live with Irving, the children’s father. Irving, 35, had lived with the family for six years until one year ago when he abruptly left without warning. Kaitlyn thought she had been smelling a woman’s perfume on his clothing for several months prior to his leaving. Although Kaitlyn loved Irving, he had refused to marry her, maintaining that marriage only ruins the spontaneity in a relationship. One Sunday Kaitlyn came home from visiting her mother and abruptly discovered that Irving had left with all his things—along with the TV, the DVR, the MP3 player, the blender, her crock pot, and some jewelry she had inherited from an aunt. At that point she wished she would have gone through with cutting every third stitch out of the seams holding his trousers together, a plan she had earlier considered after suspecting his infidelity.
Kaitlyn thought she and Irving had been happy. Now Irving is nowhere to be found. His work history involved a series of briefly held, part-time unskilled jobs. He has no immediate relatives. She feels he would be virtually impossible to track down.For the past year since Irving disappeared, Kaitlyn was forced to apply for public assistance and compelled to undergo some job training aimed at placement in a food service setting. She had recently gotten a minimum wage job for 35 hours a week as a cook at Boogie’s Burger Heaven. The job would be subsidized by state TANF funds for the next year. (The intent of such subsidy is to encourage businesses to hire TANF recipients, as what actually came out of the business’ pockets to pay employees is considerably less than minimum wage.) Boogie’s does not provide health insurance for its employees.
Kaitlyn enjoys her work and her fellow employees. She feels proud of getting back on her feet again and becoming independent. However, there are a few issues about which she has nagging concerns:
First, she has to work a lot of nights. Her children attend a publicly funded daycare center, but it closes at 8:00 p.m. Sometimes, she’s scheduled to work two nights a week until midnight. She then must impose on her neighbors or her mother to baby-sit. Her mother has arthritis and chronic bronchial problems so finds it difficult to help out.
A second issue is that Shannon finds daycare really boring and is beginning to manifest some behavioral problems when she’s there. Daycare staff have started to threaten Kaitlyn that if Shannon doesn’t “shape up,” they’ll expel her.
A third concern is that Shane has been diagnosed with Tourette’s syndrome, “a neurological disorder beginning in childhood … in which stereotyped motor movements (tics) are accompanied by multiple vocal outbursts that may include grunting or barking noises or socially inappropriate words or statements” (Hallahan & Kauffman, 2006, p. 256). Although daycare staff and baby-sitting neighbors tend to like Shane and tolerate his increasingly inappropriate and uncontrollable behavior, Kaitlyn thinks they’re beginning to tire of it. Meanwhile, Kaitlyn is working with medical specialists to administer, monitor, and adapt medications to help control Shane’s tics and outbursts. She has been told this will be a lifelong process.
A fourth issue is that Sean is not yet toilet trained. Kaitlyn finds it impossible to maintain consistency when she is at work so often and he is in the care of so many different people.
Finally, although Kaitlyn likes her job, she aspires to something that would provide her with a better future. She would like to get her GED (general education development, general education diploma, or high school equivalency). Ideally, she would prefer to work in a professional office, perhaps as an optometrist’s assistant or doing something with computers.

1. In what ways is TANF helping Kaitlyn and her family survive?
2. In what ways is TANF limiting Kaitlyn’s ability to attain her and her family’s optimal health and well-being?
3. What do you see as Kaitlyn’s future problems in view of TANF’s restrictions?
4. In what ways might public assistance help Kaitlyn become more independent and improve her and her family’s health, well-being, and quality of life?